The Japanese surveillance committee conducted the first nationwide surveillance of antimicrobial susceptibility patterns of uropathogens responsible for female acute uncomplicated cystitis at 43 hospitals throughout Japan from April 2009 to November 2010. In this study, the causative bacteria (Escherichia coli and Staphylococcus saprophyticus) and their susceptibility to various antimicrobial agents were investigated by isolation and culturing of bacteria from urine samples. In total, 387 strains were isolated from 461 patients, including E. coli (n = 301, 77.8 %), S. saprophyticus (n = 20, 5.2 %), Klebsiella pneumoniae (n = 13, 3.4 %), and Enterococcus faecalis (n = 11, 2.8 %). S. saprophyticus was significantly more common in premenopausal women (P = 0.00095). The minimum inhibitory concentrations of 19 antibacterial agents used for these strains were determined according to the Clinical and Laboratory Standards Institute manual. At least 87 % of E. coli isolates showed susceptibility to fluoroquinolones and cephalosporins, and 100 % of S. saprophyticus isolates showed susceptibility to fluoroquinolones and aminoglycosides. The proportions of fluoroquinolone-resistant E. coli strains and extended-spectrum β-lactamase (ESBL)-producing E. coli strains were 13.3 % and 4.7 %, respectively. It is important to confirm the susceptibility of causative bacteria for optimal antimicrobial therapy, and empiric antimicrobial agents should be selected by considering patient characteristics and other factors. However, the number of isolates of fluoroquinolone-resistant or ESBL-producing strains in gram-negative bacilli may be increasing in patients with urinary tract infections (UTIs) in Japan. Therefore, these data present important information for the proper treatment of UTIs and will serve as a useful reference for future surveillance studies.

No abstract

An extremely rare case of esophageal metastasis from prostate cancer is reported. A 65-year-old man presented with anorexia and back pain. Upper gastrointestinal X-ray fluoroscopy and endoscopy revealed a shallow longitudinal ulcer, with converging mucosal folds, approximately 5 cm above the esophagogastric junction. The histological diagnosis of the biopsied specimen was adenocarcinoma. Blood biochemistry revealed elevated serum prostate-specific antigen (PSA) and gamma-seminoprotein levels. Ultrasonography of the prostate disclosed a hypoechoic lesion in the left lobe, and needle biopsy led to the diagnosis of prostatic adenocarcinoma. Since there was no finding suggestive of a primary lesion, apart from that in the prostate, we conducted reverse transcriptase-polymerase chain reaction (RT-PCR) for PSA. PSA-positive mRNA was demonstrated in the tissue of the esophageal tumor. There are three reports on metastasis to the esophagus from prostate cancer, but this is the first case of esophageal metastasis from prostate cancer without any evidence of metastasis to other organs. The importance of RT-PCR for the diagnosis of primary lesions of metastatic cancer is discussed.

Serum prostate-specific antigen (PA), a new tumor marker of prostate cancer, was evaluated with an enzyme immunoassay (EIA) in various urologic cancer patients and benign prostatic diseases in Japanese. Sera of prostate cancer patients before treatment (n = 27) revealed a range of PA concentrations from 0.12-23 ng/ml with a mean ( * SD) of 5.78 + 6.85 ng/ml, while that of patients with benign prostatic hypertrophy (BPH) (n = 27) showed from less than 0.10 to 2.6 ng/ml with 0.84 f 0.81 ng/ ml (mean f SD). The mean serum PA levels in nonprostatic cancers were calculated as follows: bladder cancer (n = 21), 0.77 i 0.55 ng/ml; renal pelvis or ureteral cancer (n = 6), 0.46 0.47 ng/ml; renal adenocarcinoma (n = 6), 1.07 k 0.77 ng/ml; other urologic cancers (n = 6), 0.55 L-0.52 ng/ml. Serum PA ranged from less than 0.10 to 1.1 ng/ml in patients with prostatitis (n = 5). A significant statistical difference in serum PA levels between prostate cancer and other groups was rccognized. These results suggested that an elevation of serum PA value was highly specific to prostate cancer in urological malignancies. The evaluation of serum PA may be of great value in the detection of prostate cancer.

Summary Lactate dehydrogenase (LDH) isoenzyme distribution was examined in 106 urine samples being tested cytologically for evidence of bladder cancer; the samples were selected to have <20 leucocytes and erythrocytes per high power field and the LDH pattern determined by electrophoresis. The Papanicolaou stained-smears showed 68 negative, 17 suspicious and 21 positive. The LDH M-fraction of the urinary supernatant in cytologically positive cases was significantly greater than in negative cases, although the latter included a few false negative samples. Some of the false negatives gave positive results for the LDH M-fraction; these results suggest that the determination of LDH isoenzymes in the urine is useful in diagnosing urinary tract cancers, including early stage, and for follow-up of patients with bladder cancers after surgical resection.Because of such advantages as the ease of sample collection, the ability to test frequently and the absence of risk to patients, urine cytology has been regarded as one of the most useful diagnostic procedures for the screening of urinary tract neoplasms as well as for their post-operative follow-up (Fujii et al., 1982 (Fujii et al., 1982).The presence of lactate dehydrogenase (LDH) activity in urine was initially reported by Rosalki and Wilkinson (1959). Although Wacker and Dorfman (1962) noted elevated levels of LDH activity in the urine of patients with carcinoma of the urinary tract, the elevation of total urinary LDH activity is not now assumed to be cancer specific (Posey & Morgan, 1977). Increased urinary LDH may reflect contamination of urine with cells such as polymorphonuclear leucocytes, or proteinuria rather than the presence of neoplasia (Mirabile et al., 1966;Malik et al., 1983). It has also been suggested that urinary LDH isoenzyme patterns vary according to the site of inflammation in the urinary tract (Devaskar & Montogomery, 1978). However, unless urine is heavily contaminated with inflammatory cells, the M-fraction of urinary LDH may increase with the rising stage and the grade of the bladder tumour (Mortomiya et al., 1975(Mortomiya et al., , 1979. Therefore, it has been emphasised that the combination of urinary cytology and the determination of urinary LDH isoenzymes may be of value in the diagnosis of bladder tumours (Motomiya et al., 1975(Motomiya et al., , 1979. In the present study, urinary LDH isoenzymes were evaluated in urinary specimens examined by routine cytology. Materials and methodsUrinary specimens collected from routine cytology were centrifuged at 1,500 r.p.m. for 10 min. The method. Simultaneously, air-dried smears were also prepared for Giemsa stain to determine the number of contaminating leucocytes and erythrocytes per high powered field (x 400). Cytological findings were interpreted as negative, suspicious or positive for malignant cells in the Papanicolaou-smears.Thus, a total of 106 specimens which contained less tjhan 20 leucocytes and less than 20 erythrocytes per high power field and were cytologically diagnosed as negative...