In a randomised trial based on a parallel design to determine the prophylactic effect of thiazide on stone formation, 210 calcium urolithiasis patients with idiopathic hypercalciuria were allocated either to treatment with trichlormethiazide (4 mg/day) or no treatment with only close follow-up; 35 patients were excluded for various reasons, including voluntary withdrawal. The background of the remaining 175 patients (82 in the thiazide group and 93 in the control group), including age and sex, was similar for both groups. In patients treated with thiazide there was a statistically significant fall in urinary calcium output. Statistical analyses also demonstrated that the stone formation rate in the thiazide group was significantly less than that in the control group. Adverse clinical reactions probably due to the drug were observed in 9 patients. These findings indicate that trichlormethiazide has a prophylactic effect on calcium urolithiasis in patients with idiopathic hypercalciuria.

Minocycline hydrochloride as a sclerosant for the treatment of simple renal cysts was evaluated. Cyst puncture was performed, and minocycline hydrochloride solution for intravenous administration was injected after aspiration. Of 154 cysts evaluated by ultrasound after 3 months or more, 69 were no longer demonstrable, 49 showed 50% or greater reduction in the maximum cyst diameter, and only 8 were unchanged or slightly increased in size. In contrast, only 1 of 20 cysts aspirated without minocycline hydrochloride injection (controls) showed 50% or greater reduction after 3 months. There was a significant difference in the reduction rates between the minocycline-treated group and control group (p < 0.01). These results suggest that minocycline hydrochloride is an effective sclerosant to treat simple renal cysts.

Bacterial and crystal adherence to the surfaces of indwelling urethral catheters was investigated by scanning electron microscopy and immunofluorescence method in relation to microbiological examination. Gram-negative bacteria were isolated more frequently than gram-positive bacteria in urine and catheter cultures. Microorganisms and crystals frequently were associated with fibrillar material, some of which was considered to be fibrin. On the surfaces of catheters indwelling for more than 1 week bacteria often were embedded in an amorphous matrix. It was believed that the thick coherent matrix adherent to the catheter served as a protected reservoir of microorganisms that persisted despite antimicrobial chemotherapy. Additionally, urease-producing bacteria attached to the catheter could have an important role in the development of calculous incrustation.

The pharmacokinetics of cefimetazole, a new cephamycin antibiotic, were examined after a 1-h intravenous drip infusion of 1 g to 5 healthy volunteers with normal renal function and 16 Group 1 was composed of five healthy volunteers with creatinine clearances of 95.6 to 155.6 ml/min. Group 2 was composed of four patients with creatinine clearances of 65.5 to 86.8 ml/min. In group 3 were four patients with creatinine clearances of 35.2 to 52.7 ml/ min. Group 4 had four patients with creatinine clearances of 10.2 to 24.8 ml/min. Group 5 was composed of four patients with creatinine clearances of 0 to 9.7 ml/min. Two patients in this group were being treated by hemodialysis twice weekly over 6 to 8 h.All of the subjects were given 1 g of cefmetazole dissolved in 200 ml of 5% dextrose-water. The drug was administered intravenously by drip infusion over a 1-h period. Blood samples were obtained just before infusion and 1, 2, 4, and 6 h after beginning the infusion. Urine specimens were collected from 0 to 2, 2 to 4, and 4 to 6 h. Because only two patients in group 5 were treated by periodic hemodialysis, they were studied between two dialysis sessions.Serum and urine samples were stored at -20°C until assayed. The concentrations of cefinetazole in serum and urine were determined by the thin cupplate method, with Micrococcus luteus ATCC 9341 as the test organism and heart infusion agar as the medium. For the measurement of serum concentrations, a standard solution series was prepared in pooled normal human serum. The assay range was from 200 to 7.8 itg/ml. For the measurement of urinary concentrations, the standard solution series of 20 to 1.25 ,ug/ ml was prepared with 1% phosphate buffer (pH 6.0). Urine was diluted with 1% phosphate buffer (pH 6.0) to give approximately a 5-,ug/ml sample solution. Table 1. The results demonstrated significant negative correlation between the serum concentration and the creatinine clearance (P < 0.05 at 1 h and P < 0.001 at 2, 4, and 6 h). As renal function declined, peak serum concentrations increased, i.e., the mean peak concentration in group 5 (severely impaired renal function) was 1.5 times that of normal subjects.

A case of a rare renal tumor showing characteristic histologic features is presented. The patient was a 54 year old female, whose renal tumor was incidentally detected on abdominal ultrasound (US) examination. Ultrasound, computed tomography and angiography findings were consistent with a diagnosis of renal cell carcinoma of the hypovascular type. Left nephrectomy was performed. The tumor, which measured 2.6 x 2.6 x 2.5 cm, was located in the left renal cortex, and had a uniformly whitish-yellow cut surface and well-defined margin. Histologically, the tumor was characterized by its monomorphous growth pattern and was composed of uniformly small cells arranged in a tubular or rosette-like pattern. The tumor cells had scant cytoplasm and the nuclei were small, round and regular. These histologic features resembled the epithelial elements of a metanephric hamartoma in the nephroblastomatosis complex in infants. However, there was no mitosis and cellular atypia was minimal, suggesting benignity. According to these histologic features, the diagnosis of metanephric adenoma was made. Its clinicopathologic features are discussed.