[Evaluation of cefotaxime for postoperative infection in surgery]

Cefotaxime (CTX) was microbiologically and clinically studied in surgery. CTX shows excellent antibacterial activity in vitro against Gram-negative bacilli including E. coli. Klebsiella spp., and Proteus spp. in comparison with cefmetazole (CMZ) and cefazolin (CEZ). Antibacterial activity of CTX is found to be superior to that of CEZ and equal to that of CMZ against Gram-positive bacteria (S. aureus and S. epidermidis). The antibacterial activity of CTX against anaerobic bacteria exceeds that of CEZ and almost equal to that of CMZ. It also showed minimum inhibitory concentration values which, clinically speaking, offer great expectation. CTX is also superior to CMZ and CEZ in its antibacterial activity against P. aeruginosa. Clinical studies were carried out in the group A for which CTX was administered a drug of first choice for postoperative infections in surgery, and in the group B for which CTX was administered as a drug of second choice since the antibiotic of first choice had been ineffective for these cases. As a result, high effective rates were obtained in both groups (80.3% for the group A, and 77.1% for the group B). With reference to the group B, an effectiveness rate of 100% was obtained for the cases in which CEZ had been ineffective and 55.6% was obtained for 10 cases in which mainly combination of CMZ had been ineffective. Side effects appeared in 3 cases (1 case each of tinnitus and malaise, vomiting and nausea, and fever) with an incidence rate of 1.46%. Abnormal clinical laboratory findings appeared in 4 cases (1 case each of leukopenia and increase in GOT and GPT; eosinophilia; increases in platelet and monocyte; and increases in GOT, GPT and A1-P) with an incidence rate of 1.95%.

[Indication of minimized regional operation for primary liver cancer]

In the cirrhotic patient with inadequate liver functional reserve, curative standard resection due to anatomic basis often lead to liver failure postoperatively. Therefore, prognosis and resectability remained unsatisfactory for these patients. Definition of minimized regional operation which is performed to the patient with decreased functional reserve of the liver is not clearly determined. In our department, definition of minimized regional operation is made as follows. 1. The liver is impaired to more than moderate degree. (Child B and C or decreased liver functional reserve) 2. Maximum tumor diameter is less than 5 cm. 3. The extent of resection is less than subsegmentectomy. Study of 23 patients undergoing this minimized regional operation was made and the result is as follows. In relation of extent of resection to tumor diameter, in patients with less than 3 cm tumor recurrence developed only in one (7.6%) of thirteen patients undergoing minimized regional operation and none of four undergoing conventional standard resection. While in patients with more than 3 cm tumor, recurrence was found in two (25%) of eight patients with minimized regional operation and three (60%) of five patients with resection of one segment. In relation of the extent of resection to tumor capsule, in patients with less than 3 cm tumor with capsule, minimized regional operation and three standard resections were performed and in none of which recurrence developed. In patients with less than 3 cm tumor without capsule, recurrence developed in one of four patients undergoing minimized regional operation. While in patients with more than 3 cm tumor, recurrence developed in two (25%) of eight patients with tumor possessing capsule and three (60%) of five patients without capsule. As a result, in patients with less than 3 cm tumor diameter, minimized regional operation is acceptable with little recurrence but in patients with more than 3 cm tumor with or without capsule, anatomic lobe resection is necessary and resection of more than two segments is mandatory if functional reserve of the liver allows. In our department, extent of resection is determined by the functional reserve of the liver which is graded into three degree. For subsegmentectomy, following laboratory date has to be met: ICG-Rmax greater than 0.4, sigma IRI/sigma BS greater than 0.2, Ch-E greater than 500 IU/1, Total Bil. less than 2.5 mg/dl, S-Alb greater than 3.0 g/dl, GPT less than 300 IU and HPT greater than 50%.(ABSTRACT TRUNCATED AT 400 WORDS)

Antihypertensive effect of MK-421 in rats. Role of the renal kallikrein-kinin system

To study the hypotensive mechanism of the new oral converting-enzyme inhibitor, MK-421, we evaluated the antihypertensive effect of MK-421 in rats with hypertension induced by chronic administration of norepinephrine (NE) or vasopressin and measured urinary kallikrein and kinin excretions as indices of the renal kallikrein-kinin system. When 6 mg/kg/day of MK-421 was administered simultaneously with 1.8 mg/kg/day of NE, the systolic blood pressure of conscious rats rose on Day 1 to only 122.6 +/- 3.4 mm Hg compared with the rise to 146.3 +/- 1.6 mm Hg when NE alone was infused (p less than 0.001). Similarly, when the same dose of MK-421 was administered simultaneously with 7.2 U/kg/day of vasopressin, the systolic blood pressure of conscious rats rose on Day 1 to only 117.4 +/- 3.8 mm Hg compared with the rise to 141.6 +/- 3.4 mm Hg when vasopressin alone was infused (p less than 0.01). The antihypertensive effect of MK-421 was sustained for 6 days in rats infused with NE or vasopressin. Infusion of NE alone resulted in a small but significant increase in urinary kallikrein excretion and no change in urinary kinin excretion. The combined administration of NE with MK-421 induced additional increases in urinary kallikrein and kinin excretions. Vasopressin alone resulted in marked decreases in urinary kallikrein and kinin excretions. The combined administration of vasopressin with MK-421 induced no additional changes in urinary kallikrein and kinin excretion. These results indicate that the hypotensive effect of MK-421 may depend on a reduced sensitivity of the peripheral arteries to vasoconstrictor substances.(ABSTRACT TRUNCATED AT 250 WORDS)

Antihypertensive effect of MK-421 in rats. Role of the renal kallikrein-kinin system

To study the hypotensive mechanism of the new oral converting-enzyme inhibitor, MK-421, we evaluated the antihypertensive effect of MK-421 in rats with hypertension induced by chronic administration of norepinephrine (NE) or vasopressin and measured urinary kallikrein and kinin excretions as indices of the renal kallikrein-kinin system. When 6 mg/kg/day of MK-421 was administered simultaneously with 1.8 mg/kg/day of NE, the systolic blood pressure of conscious rats rose on Day 1 to only 122.6 +/- 3.4 mm Hg compared with the rise to 146.3 +/- 1.6 mm Hg when NE alone was infused (p less than 0.001). Similarly, when the same dose of MK-421 was administered simultaneously with 7.2 U/kg/day of vasopressin, the systolic blood pressure of conscious rats rose on Day 1 to only 117.4 +/- 3.8 mm Hg compared with the rise to 141.6 +/- 3.4 mm Hg when vasopressin alone was infused (p less than 0.01). The antihypertensive effect of MK-421 was sustained for 6 days in rats infused with NE or vasopressin. Infusion of NE alone resulted in a small but significant increase in urinary kallikrein excretion and no change in urinary kinin excretion. The combined administration of NE with MK-421 induced additional increases in urinary kallikrein and kinin excretions. Vasopressin alone resulted in marked decreases in urinary kallikrein and kinin excretions. The combined administration of vasopressin with MK-421 induced no additional changes in urinary kallikrein and kinin excretion. These results indicate that the hypotensive effect of MK-421 may depend on a reduced sensitivity of the peripheral arteries to vasoconstrictor substances.(ABSTRACT TRUNCATED AT 250 WORDS)

Renal kallikrein-kinin system and the depressor effect of angiotensin converting enzyme inhibitors MK 421, SA 446, and captopril in rats

Responses in urinary kallikrein and kinin excretion and systolic blood pressure to MK 421, SA 446 or captopril were studied in normotensive rats fed on a regular or a low sodium diet to assess the role of renal kallikrein-kinin system in their hypotensive effect. MK 421, SA 446 or captopril were infused at a rate of 6 mg/kg/day by osmotic minipump implanted intraperitoneally for up to 6 days. The magnitude of fall in systolic blood pressure was greater on a low sodium diet when compared to on a regular diet, whereas the pattern of the fall was similar on both diets. The magnitude of falls in plasma angiotensin II and aldosterone concentration induced by MK 421, SA 446 and captopril was not significantly different between both regular and low sodium diets. Urinary kallikrein and kinin excretion and sodium excretion were increased during infusion of MK 421, SA 446 or captopril on a low sodium diet, however any significant changes were not found in each of them on a regular diet. The present results suggest that on a low sodium diet the augmented hypotensive response to angiotensin converting enzyme inhibitors in the rats might be due to the enhanced renal kallikrein-kinin system in addition to suppressed renin-angiotensin system.

[Clinical evaluation of the method to determine antibiotic concentrations in small amounts of samples]

Concentrations of cefotiam (CTM) in the exudate after abdominal operation were studied. The exudates were collected by 6 mm paper discs and the antibiotic concentrations were determined by the paper disc method using Proteus rettgeri ATCC 9250 as test organism. Comparison between agar well and paper disc assay for CTM in ascites specimens showed good correlation. Two grams of CTM was intravenously given to the patients after abdominal operations. The concentration of CTM in the exudate for 6 hours after injection was 0.4--14.2 micrograms/ml and this value exceeded the antibacterial level of CTM. It is, therefore, concluded that CTM will be effective for the postoperative prophylaxis.

Acute effects of MK421, a new angiotensin converting enzyme inhibitor, in man

Acute effects of MK421 were examined in 11 male normal volunteers. Oral administration of 5 mg of MK421 did not induce any changes in blood pressure or pulse rate. Plasma renin activity increased significantly from 7.3 +/- 2.9 ng/ml to 22.2 +/- 7.1 (p less than 0.05), whereas plasma aldosterone concentration did not change. Blood kinin, or urinary excretion of kallikrein and of prostaglandin E did not change. However, urinary excretion of sodium increased significantly from 44.0 +/- 6.8 mEq/4 hr to 56.5 +/- 6.5 (p less than 0.02) following the administration of MK421. The present results show that an increased renin release induced by MK421 is independent of change in blood pressure, and also suggest that MK421 may have a direct action on the renal tubules.

[Clinical evaluation of diagnostic methods of nodular goiter]

In 47 patients who had undergone roentgenography, ultrasonography, 201 Tl-scintigraphy, and aspiration cytology and on whom a pathological diagnosis had been made, the diagnostic value of the above-mentioned 4 examinations was evaluated. The correct diagnosis rate for aspiration cytology and 201 Tl-scintigraphy was 76.6%; for ultrasonography and roentgenography it was 70.2%. The false-negative rate of cancer for aspiration cytology was 14.9%; for the other examinations it was 10.6%. The false-negative rate upon combining 3 examinations, except roentgenography (soft tissue technique), proved to be 0% and 24 patients with thyroid cancer were preoperatively correctly diagnosed as "malignant" by means of the combination method.

[UFT concentration in various tissues from cancer patients]

UFT, an antitumor drug combined of Tegafur 1 and Uracil 4, was administered preoperatively to 23 cancer patients including 11 cases of breast, 8 of gastric, 2 of colon and 2 of other cancers. Tissue specimens of different sites and serum samples were collected during the operation: cancer tissues, normal breast, normal gastric, colon or rectal wall, lymph nodes and subcutaneous fatty tissues, etc., and concentrations of tegafur (FT), 5-fluorouracil (5-FU) and uracil were studied using HCLP or GC-MF methods. In most cases, 5-FU and uracil concentrations detected in cancer tissues from the patients were higher than those found in non cancer sites. FT and 5-FU fractions in cancer tissues were found to be higher than those of the patients receiving only 800 mg of Tegafur fine granules as previously reported. Patients with benign tumor having mastopathy or were reported to show very low 5-FU concentration in tissue which was almost undetectable. From the above results, it has been suggested that UFT is a useful drug in cancer chemotherapy.

[Long-term results of curative operation of breast cancer]

Follow-up studies on 172 patients who had undergone curative surgery for breast cancer, were done. 1) There was no significant difference in the 5-year-survival rate between stage I and stage II, however, this survival rate was lower in stage III. 2) The survival rate of patients with metastasis to fewer than 3 lymph node tended to be higher than in patients with metastatic involvement of 4 or more lymph nodes. 3) Patients with papillo-tubular type cancer had the best prognosis followed by medullo-tubular type and scirrhous type. 4) The operative procedures used made no significant difference on the long-term results, although extended operation for stage II cancer showed better result than typical operation in terms of 10-year-survival. 5) The chemotherapy group showed better results than the radiation-treated group in terms of 5-year-survival.

[Surgical case of simultaneous triple cancers of the esophagus, stomach and colon]

We report a patient with synchronous triple cancers arising in the digestive tract. It was a combination of esophageal, gastric and colonic cancers; total excision was performed in one operation. Histological study confirmed that each cancer had developed independently. The esophageal cancer was of ulcerated type; histologically it was poorly differentiated squamous cell carcinoma. The gastric and colonic cancers were both of Borrmann II type and well differentiated adenocarcinoma.

[Clinical effect of intramuscular injection of cefpiramide in infections associated with surgery]

The authors treated a total of 23 patients (15 were outpatients, 8 were hospitalized), employing an injectable preparation of cefpiramide (CPM) a new antibiotic of the cephems. Included in this total were 10 cases of acute infectious diseases of skin and soft tissues, 5 cases of acute localized peritonitis, 5 cases of acute urinary tract infection and 3 cases of acute and subacute cholecystitis. To 15 cases of outpatients, CPM in a dose of 500 mg were given by intramuscular injection once a day, and to 8 cases of hospitalized patients were given 500 mg of CPM by intramuscular injection twice a day. The duration were 3 to 15 days. The clinical efficacy obtained was excellent in 4 cases, good in 17 cases, and fair in 2 cases. In no case was CPM found to be completely ineffective. Clinical adverse effect was not recognized. Therefore, CPM will be a useful drug when used for chemotherapy of acute or subacute infectious diseases on surgical field following intramuscular administration.

[Carcinoma of the esophagus with hepatic metastasis]

Six patients with esophageal cancer with liver metastasis are reported and the clinicopathological features are discussed based on collected autopsy cases. 1) The incidence of liver metastasis was higher when the primary site was in the lower part of the esophagus. 2) There were many cases without abdominal lymphnode metastasis. 3) Metastasis was noted primarily as small nodules in the left lobe of the liver. 4) The prognosis was poor; liver metastasis was rarely the cause of death. In esophageal cancer, liver metastasis seems to occur via the portal route and combined liver resection is indicated when possible.

[Clinical effect of cefmenoxime on cholecystitis; its clinical efficacy and tissue concentration]

A new antibiotic drug of cephalosporin, with marked resistance to beta-lactamase, cefmenoxime (CMX) for parenteral use was used in 14 patients with acute or subacute cholecystitis and cholangitis. CMX was given by intramuscular or intravenous drip infusion at a daily dose of 500 mg to 2 g. Clinical response was excellent in 3 cases, good in 10 cases, fair in 1 case and poor in none. Any clinical adverse effect was not recognized. CMX in a dose of 500 mg was given by intramuscular administration before the operation to 8 patients, and in 7 cases CMX in a dose of 1 g was given by intravenous administration before or during the operation. Tissue specimens of different sites were taken from the removed organs. The materials of A-bile and B-bile were subsequently taken at intervals. CMX concentrations in the A-bile increased after intramuscular injection and reached to peak 2 hours, then declined very slowly. CMX concentrations in the A-bile after intravenous administration reached to peak at 1 hour, then declined very slowly, too. CMX concentration in the B-bile reached to high level of the concentration comparative quickly after intramuscular and intravenous administration, and it was thought to be excreted through the gallbladder wall. CMX concentration in the gallbladder wall was directly proportional to the degree of pathological changes of the inflammation. On the CMX concentration in patients with cholecystitis and cholangitis, the concentration in A-bile, B-bile and gallbladder wall were observed higher than the MIC of CMX for pathogenic Gram-negative bacilli. CMX therefore will be a very useful drug when used for chemotherapy of the infectious diseases of the biliary tract.

[Clinical study of cefmenoxime in acute peritonitis: clinical effect and tissue concentration of cefmenoxime]

A new antibiotic drug of cephalosporin group, with marked resistance of beta-lactamase, cefmenoxime (CMX) for parenteral use was tested in 15 patients with acute peritonitis. CMX in a dose of 500 mg was given intramusculary before the operation, to 8 cases with appendicitis, and 2 cases with intestinal obstruction. In 3 cases with appendicitis and a case with intestinal perforation, CMX in a dose of 500-1,000 mg was given by intravenous injection before or during the operation. And in a case with appendicitis, CMX in a dose of 1 g was given by intravenous drip infusion before the operation. Tissue specimens of different sites or body fluids were taken during the operation and from the removed organs. The materials of purulent ascites were subsequently taken at intervals. Determination of CMX concentration was performed according to cup bioassay method with Proteus mirabilis ATCC 21100 strain. The peak of CMX concentration in purulent ascites of patient with panperitonitis for intestinal perforation was 39.5 microgram/ml at 41 minutes after 1 g intravenous administration. Concentration of CMX in pus in the appendix was 52.5 microgram/ml at 20 minutes after 1 g intravenous administration. In 15 patients with acute peritonitis, 11 patients were given CMX in a dose of 500 mg by intramuscular administration twice a day, and the serious 4 patients were given in a dose of 500 mg to 1 g by intravenous drip infusion twice a day. Clinical response was excellent in 10 cases, good in 5 cases, fair and poor were none.(ABSTRACT TRUNCATED AT 250 WORDS)

Primary yolk sac tumor of the liver. An autopsy case with ultrastructural and immunopathological studies

An autopsy case of yolk sac tumor of the liver in a 29-year-old female was reported. The tumor was found originally in the right anterior segment of the liver on the first operation. The autopsy disclosed that the liver was almost entirely replaced by multiple, round tumor nodules. The tumor masses continuously extended to the peritoneum and to the subcutaneous tissue. There were no tumors in other organs including the ovaries, gut, stomach, lung, uterus, and kidneys, indicating that the tumor originated in the liver. Microscopically, the tumor showed typical characteristics of the yolk sac tumor. An immunohistochemical study showed that AFP was distributed fine granularly in the cytoplasm of tumor cells. Electron microscopic observation disclosed large amounts of electron-dense material being closely related to basement membrane.