Gatifloxacin treatment for chronic prostatitis: a prospective multicenter clinical trial.

Antimicrobial treatment is usually used for chronic prostatitis. However, the efficacy of such treatment has not been fully evaluated. We conducted a study to evaluate the efficacy of gatifloxacin for patients with chronic prostatitis using the Japanese version of the National Institutes of Health Chronic Prostatitis Symptom Index (JPN-NIH CPSI). The study included 46 patients for final analysis. Patients who were younger than 65 years of age were treated with 200 mg gatifloxacin twice daily, and those who were 65 years and older were treated with 100 mg gatifloxacin twice daily, for 4-8 weeks. The study consisted of 10 patients in category II, 13 in category IIIA, 11 in category IIIB, and 12 who were unclassified. The gatifloxacin treatment resulted in significant reductions in the scores on the JPN-NIH CPSI. Of the total number of patients, 58.1% and 27.9% were 25% and 50% responders, respectively, 4 weeks after treatment, and these figures improved to 66.7% and 33.3%, respectively, 8 weeks after treatment. No significant difference was found in the changes in symptom scores between Category II and Category IIIA/IIIB groups. In conclusion, gatifloxacin treatment improved the symptoms in patients with chronic bacterial and nonbacterial prostatitis. This study is the first in this country to evaluate the efficacy of antimicrobial treatment for chronic prostatitis by using the NIH CPSI.

Acquired pure red cell aplasia in a hemodialyzed patient.

A 68-year-old male had end-stage renal disease secondary to hypertension. He was placed on chronic dialytic therapy and was given recombinant human erythropoietin (epoetin) for renal anemia. One month later, rapidly progressing anemia was noted. The anemia was unresponsive to maximal doses of epoetin and the patient soon became transfusion-dependent. Erythroid hypoplasia was demonstrated by bone marrow biopsy. A detailed search for the cause of the erythroblastopenia revealed nothing. A diagnosis of acquired pure red cell aplasia was made. The use of immunosuppressive agents improved the patient's symptoms and laboratory data. Antibodies for erythropoietin (EPO) were negative after the treatment. It is suggested that patients with EPO-resistant anemia with no obvious etiology should be examined for underlying hematologic disorders.

[Idiopathic retroperitoneal fibrosis with large vessel thrombosis].

A 53-year-old female was hospitalized for evaluation of swelling in the bilateral lower extremities. A computed tomography (CT) scan of the abdomen revealed bilateral hydronephrosis and features consistent with retroperitoneal fibrosis. Transfemoral venography and magnetic resonance angiography (MRA) showed thrombosis of both the left common iliac vein and inferior vena cava, and filling of numerous collateral veins in the retroperitoneal area. A diagnosis of idiopathic retroperitoneal fibrosis with central venous thrombosis was made. Ureteral stenting, medication with corticosteroids and subsequent warfarin were started, resulting in marked improvement of renal function and the lower extremities. Diagnosis and follow-up of deep venous thrombosis can be aided by MRA. Administration of steroids with anticoagulation was considered to be successful in the case presenting with deep venous thrombosis caused by retroperitoneal fibrosis.

Analysis of cross infection using genomic fingerprinting in nosocomial urinary tract infection caused by Enterococcus faecalis.

To evaluate cross infection and a possible outbreak of Enterococcus faecalis urinary tract infection (UTI) in our urology ward, we studied the DNA fingerprinting of E. faecalis strains isolated from nosocomial UTI patients, in the period 1982-1996, using arbitrarily primed polymerase chain reaction (AP-PCR) analysis. The serovar and amplified products of DNA extracted from clinically isolated urinary E. faecalis strains by the AP-PCR method were analyzed, and the respective isolation periods of E. faecalis-positive UTI patients were investigated. There were nine patients with E. faecalis UTI between March and May 1994 and all strains isolated from their urine specimens were serovar type 7. AP-PCR revealed that five of the nine isolates had the same pattern. It appeared that these strains had caused the outbreak of E. faecalis UTI. Cross-infection between patients with E. faecalis UTI was demonstrated by genomic fingerprinting, suggesting that cross infection had occurred via urinary catheters or by hand contact in our ward. We may, therefore, reasonably conclude that we should beware of the transmission of urinary E. faecalis and take countermeasures against its dissemination.