[A study on the penetration of imipenem/cilastatin sodium into the female genital tissues]

A new carbapenem antibiotic, imipenem/cilastatin sodium (MK-0787/MK-0791), was administered by intravenous drip infusion at a dose level of 500 mg/500 mg to 30 patients who underwent total abdominal hysterectomy for uterine myomas with or without benign ovarian tumors. The uterine arteries were clamped bilaterally at 0.25, 0.5, 1, 2, 3, 4, 6 and 8 hours after administration, and plasma samples and uterine tissues were taken for measurements of MK-0787 by bioassay and MK-0791 by HPLC. The measured values were analyzed using a two-compartment open model. Maximum concentrations of MK-0787 at 0.5 hour after the start of intravenous drip infusion were 98.5 micrograms/ml in the antecubital vein, 100.1 micrograms/ml in the uterine artery, 26.5 micrograms/g in the oviduct, 21.2 micrograms/g in the ovary, 19.1 micrograms/g in the endometrium, 19.0 micrograms/g in the myometrium, 22.1 micrograms/g in the cervix uteri and 16.4 micrograms/g in the portio vaginalis. These results suggest that the penetration of MK-0787/MK-0791 into female genital tissues is good, and sufficient concentrations are obtained enough to inhibit organisms which are frequently isolated from patients with pelvic inflammatory disease.

[Study on transfer of aztreonam into female genital organs]

Aztreonam (AZT) is a newly developed beta-lactam antibiotic for use of intravenous injection. It is the first drug in the world of monobactam series with the structural characteristic of monocyclic beta-lactam. The antimicrobial spectrum of AZT is unique, having little or no susceptibility against Gram-positive organisms and anaerobes, but showing high susceptibility against aerobic Gram-negative rods including Pseudomonas. One gram of AZT was given intravenously to 32 patients prior to abdominal total hysterectomy for uterine myoma. Bilateral uterine arteries were clamped at 0.25, 0.5, 1, 2, 4, 8 or 12 hours after administration, and serum samples and uterine tissues were taken for the measurement of AZT concentration by bioassay method. Little difference was found in the serum concentration between cubital venous and uterine arterial serum, the half-lives of both being 2.11 hours. The initial concentrations were estimated to be 68.0 micrograms/ml and 63.9 micrograms/ml, respectively. While the peak concentrations of the portio vaginalis, cervix uteri, myometrium and oviduct were obtained at about 10 minutes, those of the endometrium and ovary were at 18.2 minutes and 31.3 minutes, respectively. They were as follows; the portio vaginalis 50.0 micrograms/g, the cervix uteri 43.6 micrograms/g, the myometrium 29.8 micrograms/g, the oviduct 44.7 micrograms/g, the endometrium 27.3 micrograms/g, the ovary 29.0 micrograms/g. After showing peak, tissue levels were kept fairly high up to 3 hours, then decreased gradually as time passed up to approximately 8 hours. Judging from its favorable transfer into the uterine tissues and MICs against main clinical isolates in the field of obstetrics and gynecology, AZT is evaluated to be clinically useful in the treatment of obstetrical and gynecological infections.

[Breast metastases from extramammary malignancies in men]

Metastases to the breast from extramammary carcinomas are rare. Carcinoma of the male breast is generally regarded as primary in origin and uncommon, accounting for less than 0.42% of all malignancies in men. Tow men who presented with breast malignancies in the course of their prostatic carcinoma are described. One was metastasis to the breast from prostatic cancer, the other from pancreatic cancer. The prostatic origin of these carcinomas, was confirmed by histological findings and immunocytochemical demonstration of prostatic acid phosphatase with the avidin-biotin-complex method.

[An evaluation of multi-disciplinary treatment combined with intra-arterial chemotherapy of head and neck cancer]

Seventy-five cases of head and neck cancer except of maxillary sinus, 27 cases of mesopharyngeal cancer, 6 cases of oral cancer, 9 cases of thyroid cancer and 9 cases of the other cancer, were treated with this multi-disciplinary treatment and the results were evaluated in this series. An intraarterial infusion drug, 5-FU, was used mainly through the superficial temporal artery. The five year survival rate was 46.1% in mesopharyngeal cancer, 34.4% in oral cancer and 33.3% in thyroid cancer. The results were relatively satisfactory despite the advanced stage of the cancer. Intraarterial chemotherapy has been a common treatment for maxillary cancer but the indication of this treatment should be developed in advanced head and neck cancer with radiotherapy or surgical treatment as a part of multi-disciplinary treatment.

[Study on the transfer of cefminox into female genital organs]

One gram of cefminox (CMNX, MT-141) was injected intravenously to a total of 29 patients prior to abdominal total hysterectomy and drug levels in the uterine and adnexal tissues were bioassayed. Serum samples and uterine tissues were taken at 0.25, 0.5, 1, 2, 4 or 6 hours after the administration, when bilateral uterine arteries were clamped. As to serum levels no difference has seen between cubital venous serum and uterine arterial serum, the half-lives being 2.32 hours and 2.22 hours, respectively. The peak level was 66.7 micrograms/ml for both. The drug level in tissues reached its peak at 15 minutes in the myometrium and cervix uteri, at 30 minutes in the endometrium, portio vaginalis and oviduct and at 1 hour in the ovary. The mean peak level was the highest for the oviduct (55.3 micrograms/g), followed by the portio vaginalis (47.7 micrograms/g), the cervix uteri (46.2 micrograms/g), the myometrium (42.8 micrograms/g), the ovary (37.3 micrograms/g) and the endometrium (34.2 micrograms/g) in this order. After reached the highest levels, the tissue levels decreased gradually in the same manner as the serum levels. From these results it was shown that CMNX is well transferred into various female genital tissues to achieve concentrations higher than MICs for organisms isolated clinically with high incidences in the field of gynecology and obstetrics. It was assumed from these results that CMNX is clinically useful enough in the treatment of genital organ infections.

An evaluation of neck dissection in carcinoma of the tongue

Forty-six neck dissection cases were performed out of 117 cases of tongue cancer occurring from 1973-1981 at the Gunma Cancer Center. Among the 47 cases, 27 were initially treated surgically. In 14 cases radium therapy was used for the primary lesion and was followed by neck dissection. In another 13 cases hemiglossectomy and neck dissection were performed together. In addition, in 19 cases neck dissection was performed as secondary treatment for metastatic nodes or for recurrence of the primary lesion following radium therapy. In the cases of neck dissection performed as initial treatment along with hemiglossectomy, 84.6% had a two-year survival rate. Neck dissection performed as a secondary treatment resulted in a 46.7% survival rate over 3 years. It is evident from these figures that neck dissection performed as initial treatment results in better prognosis for the patients. In cases where metastatic nodes are present or suspected, neck dissection and hemiglossectomy should be undertaken.

[Study on transfer of ceftriaxone into female genital organs]

One gram of ceftriaxone (Ro 13-9904, CTRX), a new cephalosporin antibiotic, was given intravenously to a total of 25 patients prior to abdominal total hysterectomy for uterine myoma with or without small benign ovarian tumor. Bilateral uterine arteries were clamped at 0.5, 1, 2, 6, 12 and 24 hours after administration, and serum samples and uterine tissues were taken for the measurement of CTRX concentration by bioassay method. A little difference was found in the serum concentration between cubital venous and uterine arterial serum, the half-lives being 8.0 and 7.9 hours, respectively. The initial concentrations were estimated to be 153 micrograms/ml and 160 micrograms/ml, respectively. The tissue peak concentrations were obtained at 30 minutes in the myometrium, portio vaginalis, oviduct and ovary, and at 1 hour in the endometrium and cervix uteri. These were 41, 51, 51, 39, 42 and 47 micrograms/g, respectively. The tissue concentrations after peak decreased in the same manner as the serum concentrations. Judging from its favorable transfer into the uterine tissues, CTRX was evaluated to be clinically useful in the treatment of obstetrical and gynecological infections.

Systemic lupus erythematosus with vesiculobullous lesions. Immunoelectron microscopic studies

A 20-year-old man had systemic lupus erythematosus (SLE) and a skin eruption that consisted of pruritic, tense, clear, bullous, and vesicular lesions. Histopathological examination of the bullous lesions disclosed papillary microabscesses of neutrophils and subepidermal bulla formation. Direct immunofluorescence microscopy demonstrated linear bandlike depositions of IgA and IgG at the basement membrane zone in both peribullous and normal-appearing skin. By immunoelectron microscopy, the IgA and IgG deposits were found beneath the basal lamina, extending beyond the anchoring fibril zone into the deeper portion of the dermis. The immunoelectron microscopic features supported the conclusion that this patient had SLE with vesiculobullous lesions rather than SLE concurrent with dermatitis herpetiformis, linear IgA bullous dermatosis, or bullous pemphigoid. Oral dapsone therapy gave the patient dramatic relief from the cutaneous lesions, although he was unable to tolerate extended treatment with the drug.

Resistance of thermophilic ATPase (TF1) to specific F1-atpase inhibitors including local anesthetics

F1-ATPase obtained from mesophilic organisms is inhibited by specific inhibitors, such as aurovertin, efrapeptin, quercetin and several local anesthetics. This property has been explained by the common structure at the catalytic center of F1. However thermophilic F1 (TF1), which has the same primary structure at the center as other F1's, was shown to be resistant to these F1-specific inhibitors. Thus, the inhibitory mechanism may be explained not by the common structure at the catalytic site, but by some conformational changes of the flexible mesophilic F1 molecules or the absence of an inhibitor binding site in thermophilic F1.

[Study on transfer of T-1982 (cefbuperazone) into female genital organs]

One gram of T-1982 (cefbuperazone), a new cephamycin antibiotic, was given intravenously to a total of 28 patients prior to abdominal total hysterectomy for uterine myoma or benign ovarian tumor. Bilateral uterine arteries were clamped at 0.25, 0.5, 1, 2, 4 hours or 6 hours after administration, and serum samples and uterine tissues were taken for the measurement of T-1982 concentration by bioassay method. A little difference was found in the serum concentration between cubital venous and uterine arterial serum, the half lives being 1.88 hours and 1.74 hours, respectively. The initial concentrations were estimated to be 99.9 micrograms/ml and 103.2 micrograms/ml, respectively. The peak concentrations were obtained at 30 minutes in the endometrium, myometrium, oviduct and ovary, and at 1 hour in the cervix uteri and portio vaginalis. These were 45.2 micrograms/g, 22.4 micrograms/g, 36.1 micrograms/g, 19.9 micrograms/g, 27.6 micrograms/g and 23.4 micrograms/g, respectively. The tissue concentrations thereafter decreased in the same manner as the serum concentrations. Judging from its favorable transfer into the uterine tissues and MICs against clinical isolates often seen in the field of obstetrics and gynecology, T-1982 was evaluated to be clinically useful in the treatment of obstetrical and gynecological infections.

Synthesis and immunoadjuvant activities of the repeating, disaccharide-dipeptide unit of the bacterial, cell-wall peptidoglycan and of some carbohydrate analogs

The repeating disaccharide-dipeptide units of the bacterial, cell-wall peptidoglycan, one being O-(N-acetyl-beta-muramoyl-L-alanyl-D-isoglutamine)-(1 leads to 4)-2-acetamido-2-deoxy-D-glucose, and the other, O-(2-acetamido-2-deoxy-beta-D-glucosyl)-(1 leads to 4)-N-acetyl-muramoyl-L-alanyl-D-isoglutamine, have been synthesized. Some carbohydrate analogs, such as O-(N-acetyl-beta-muramoyl-L-alanyl-D-isoglutamine)-(1 leads to 4)-N-acetylmuramoyl-L-alanyl-D-isoglutamine, O-beta-D-glucosyl-(1 leads to 4)-N-acetylmuramoyl-L-alanyl-D-isoglutamine, and O-(6-acetamido-6-deoxy-beta-D-glucosyl)-(1 leads to 4)-N-acetylmuramoyl-L-alanyl-D-isoglutamine, were also synthesized. Their immunoadjuvant activities were examined in guinea-pigs.