Cold agglutininemia with acrocyanosis in multicentric Castleman's disease: a case report

We report the first case of multicentric Castleman's disease with acrocyanosis due to cold agglutinins. A 75-year-old female patient presented with fever, weight loss, general malaise and multiple lymphadenopathy for 2 months. During admission, supportive treatment was given and several episodes of acrocyanosis were relieved by oxygen inhalation. Cold agglutination was demonstrated when screen cells and the patient's own RBC were incubated with her serum initially at room temperature with weak positively, at 4 degrees C with 4+ reaction strength, and later dissolved at 37 degrees C. Histopathological examination of the cervical lymph node showed a dense interfollicular plasmacytosis around hyperplastic follicles with inconspicuous capillary proliferation. The plasma cells were mature-appearing with polyclonal immunoglobulin production as shown by immunostaining. These findings were consistent with a plasma cell variant of Castleman's disease. She died of cardiac arrhythmia and subsequent decompensation on the day of the lymphadenectomy, four months after the presentation of apparent symptoms.

Pharmacokinetics of intravenously administered isepamicin in men

The pharmacokinetics of isepamicin, a broad-spectrum aminoglycoside antibiotic, were studied in men after intravenous administration. Three groups of six volunteers received isepamicin for 10 consecutive days by 0.5-h intravenous infusions at respective dosages of 7.5 mg/kg of body weight once daily, 7.5 mg/kg twice daily, and 15 mg/kg once daily. Levels of isepamicin in plasma and urine were determined by a specific high-performance liquid chromatography method. For all three groups, steady-state concentrations of the drug in plasma were attained with the first dose. The area under the concentration-time curve for plasma and urinary drug excretion were dose proportional. A half-life ranging from 2.0 to 2.5 h was independent of the dosage regimen. Isepamicin excreted in urine over 24 h accounted for about 100% of the dose. The results show that the pharmacokinetics of isepamicin are linear with these dosage regimens. The drug does not accumulate upon multiple dosing, undergoes no detectable biotransformation, and is cleared solely by urinary excretion.

Human gamma X satellite DNA: an X chromosome specific centromeric DNA sequence

The cosmid clone, CX16-2D12, was previously localized to the centromeric region of the human X chromosome and shown to lack human X-specific alpha satellite DNA. A 1.2 kb EcoRI fragment was subcloned from the CX16-2D12 cosmid and was named 2D12/E2. DNA sequencing revealed that this 1,205 bp fragment consisted of approximately five tandemly repeated DNA monomers of 220 bp. DNA sequence homology between the monomers of 2D12/E2 ranged from 72.8% to 78.6%. Interestingly, DNA sequence analysis of the 2D12/E2 clone displayed a change in monomer unit orientation between nucleotide positions 585-586 from a "tail-to-head" arrangement to a "head-to-tail" configuration. This may reflect the existence of at least one inversion within this repetitive DNA array in the centromeric region of the human X chromosome. The DNA consensus sequence derived from a compilation of these 220 bp monomers had approximately 62% DNA sequence similarity to the previously determined gamma 8 satellite DNA consensus sequence. Comparison of the 2D12/E2 and gamma 8 consensus sequences revealed a 20 bp DNA sequence that was well conserved in both DNA consensus sequences. Slot-blot analysis revealed that this repetitive DNA sequence comprises approximately 0.015% of the human genome, similar to that found with gamma 8 satellite DNA. These observations suggest that this satellite DNA clone is derived from a subfamily of gamma satellite DNA and is thus designated gamma X satellite DNA. When genomic DNA from six unrelated males and two unrelated females was cut with SstI or HpaI and separated by pulsed-field gel electrophoresis, no restriction fragment length polymorphisms were observed for either gamma X (2D12/E2) or gamma 8 (50E4) probes. Fluorescence in situ hybridization localized the 2D12/E2 clone to the lateral sides of the primary constriction specifically on the human X chromosome.

Effects of felbamate on the pharmacokinetics of a low-dose combination oral contraceptive

The effects of felbamate on the pharmacokinetics of a low-dose combination oral contraceptive containing 30 micrograms ethinyl estradiol and 75 micrograms gestodene were assessed in a randomized, double-blind, placebo-controlled parallel-group study in healthy premenopausal female volunteers established in a regimen of oral contraceptive use. They received either placebo or 2400 mg/day felbamate from midcycle (day 15) to midcycle (day 14) of two consecutive oral contraceptive cycles (months 1 and 2). Pharmacokinetic assessments of ethinyl estradiol and gestodene were performed on day 14 of both cycles. To determine whether ovulation occurred, plasma progesterone and urinary luteinizing hormone levels were measured, and diaries recording vaginal bleeding were kept. Felbamate treatment resulted in a significant 42% decrease in gestodene area under the plasma concentration-time curve (0 to 24 hours) (p = 0.018) compared with baseline, whereas a minor but not clinically relevant effect was observed on the pharmacokinetic parameters of ethinyl estradiol. There were no changes in the pharmacokinetics of ethinyl estradiol or gestodene after placebo treatment. No volunteer showed hormonal evidence of ovulation; however, one volunteer reported the onset of intermenstrual bleeding during felbamate treatment. Because of the effect of felbamate on the pharmacokinetics of gestodene and the report of intermenstrual bleeding, it is possible that the contraceptive efficacy of low-dose combination oral contraceptives may be adversely affected during felbamate treatment.

Selective oxidative modification and affinity cleavage of pigeon liver malic enzyme by the Cu(2+)-ascorbate system

Pigeon liver malic enzyme was rapidly inactivated by micromolar concentration of Fe2+ in the presence of ascorbate at neutral pH. The inactivated enzyme was subsequently cleaved by the Fe(2+)-ascorbate system at the chemical bond between Asp258 and Ile259 (Wei, C.H., Chou, W.Y., Huang, S.M., Lin, C.C., and Chang, G.G. (1994) Biochemistry, 33, 7931-7936), which was confirmed by site-specific mutagenesis (Wei, C.H., Chou, W.Y., and Chang, G.G. (1995) Biochemistry 34, 7949-7954). In the present study, at neutral pH, Cu2+ was found to be more reactive in the oxidative modification of malic enzyme and the enzyme was cleaved in a similar manner as Fe2+ did. At acidic pH, however, Fe2+ was found to be ineffective in oxidative modification of the enzyme. Nevertheless, Cu2+ still caused enzyme inactivation and cleaved the enzyme at Asp141-Gly142, Asp194-Pro195, or Asp464-Asp465. Mn2+ and L-malate synergistically protect the enzyme from Cu2+ inactivation at acidic pH. Cu2+ is also a competitive inhibitor versus Mn2+ in the malic enzyme-catalyzed reaction with Ki value 70.3 +/- 5.8 microM. The above results indicated that, in addition to the previously determined Asp258 at neutral pH, Asp141, Asp194, and Asp464 are also the coordination sites for the metal binding of malic enzyme. We suggest that the mechanism of affinity modification and cleavage of malic enzyme by the Cu(2+)-ascorbate system proceed in the following sequence. First, Cu2+ binds with the enzyme at the Mn2+ binding site and reduces to Cu+ by ascorbate. Next, the local oxygen molecules are reduced by Cu+, thereby generating superoxide or other reactive free radicals. These radicals interact with the susceptible essential amino acid residues at the metal-binding site, ultimately causing enzyme inactivation. Finally, the modified enzyme is cleaved into several peptide fragments, allowing the identification of metal site of the enzyme. The pH-dependent different specificities of metal-catalyzed oxidation system may be generally applicable for other enzymes or proteins.

Effects of felbamate on the pharmacokinetics of the monohydroxy and dihydroxy metabolites of oxcarbazepine

The effects of felbamate on the multiple dose pharmacokinetics of the monohydroxy and dihydroxy metabolites of oxcarbazepine were assessed in a placebo-controlled, randomized, double-blind crossover study in 18 healthy male volunteers. Oxcarbazepine, 1200 mg/day, was administered on an open basis in combination with double-blind placebo or 2400 mg/day felbamate for two 10-day treatment periods separated by a 14-day washout period. Pharmacokinetic parameters of monohydroxyoxcarbazepine and dihydroxyoxcarbazepine were determined from plasma and urine samples obtained on the tenth day of each treatment period. Felbamate had no effect on monohydroxyoxcarbazepine plasma or urine pharmacokinetics compared with placebo, but it significantly increased values for dihydroxyoxcarbazepine maximum concentration and area under the curve from 0 to 12 hours, as well as urinary excretion of free and total dihydroxyoxcarbazepine. The mechanism that may account for the observations is the induction of oxidative metabolism of monohydroxyoxcarbazepine. Despite these changes, the relative amount of dihydroxyoxcarbazepine is small in comparison to monohydroxyoxcarbazepine, and antiepileptic activity is associated with monohydroxyoxcarbazepine rather than dihydroxyoxcarbazepine. Therefore we conclude that felbamate has no clinically relevant effects on the pharmacokinetics of oxcarbazepine in humans.

Antihistamine activity, central nervous system and cardiovascular profiles of histamine H1 antagonists: comparative studies with loratadine, terfenadine and sedating antihistamines in guinea-pigs

BACKGROUND

Sedation limits the clinical utility of classical H1 antihistamines, while newer antihistamines such as loratadine and terfenadine are non-sedating. However, clinical use of the terfenadine has been associated with rare but severe cardiac arrhythmias, in particular torsades de pointes.

OBJECTIVE

To establish a quantitative experimental model for assessing the sedating and cardiotoxicity potential of non-sedating and sedating antihistamines.

METHODS

Drugs were administered intravenously and the integrated amplitude of the cortical electroencephalogram (EEG) signal was recorded. The threshold dose that depressed EEG activity was compared with the dose required to inhibit by 50% the peripheral bronchospasm elicited by 10 micrograms/kg i.v., of histamine. In separate studies, the electrocardiogram (ECG) and cardiovascular effects of loratadine (30 and 100 mg/kg, i.v.), terfenadine (10 mg/kg, i.v.), promethazine (5 mg/kg, i.v.) and diphenhydramine (20 mg/kg, i.v.) were evaluated.

RESULTS

The sedating antihistamines, diphenhydramine and promethazine, depressed the integrated EEG at doses between 0.6 and 2.0 times their peripheral antihistamine doses. Loratadine had no EEG depressant activity at 100 mg/kg, i.v., a dose more than 170 times its ED50 (0.58 mg/kg, i.v.) against histamine bronchospasm. We were unable to evaluate the EEG effects of terfenadine, because it produced cardiovascular collapse at 10 mg/kg, i.v. Loratadine and promethazine did not produce adverse cardiovascular effects, nor did they alter normal ECG activity. Diphenhydramine produced bradycardia followed by a transient hypertensive phase without affecting the QTc interval. In contrast, terfenadine elicited hypotension, bradycardia and significant arrhythmogenic activity, causing a prolongation of the QTc interval and a torsades de pointes--like ventricular arrhythmia. Pharmacokinetic studies after i.v. administration of loratadine (30 and 100 mg/kg) demonstrated plasma levels of loratadine and its major metabolite descarboethoxyloratadine to be several orders of magnitude greater than levels found in humans at the clinical dose of 10 mg.

CONCLUSION

The CNS depressant effects of H1 antihistamines are promethazine approximately diphenhydramine >> loratadine = placebo. Of the non-sedating antihistamines, loratadine was devoid of adverse cardiovascular effects whereas terfenadine caused a pronounced disruption of the normal ECG, characterized by a torsades de pointes-like effect.

Loratadine administered concomitantly with erythromycin: pharmacokinetic and electrocardiographic evaluations

OBJECTIVE

To evaluate the effects of coadministration of loratadine and erythromycin on the pharmacokinetics and electrocardiographic repolarization (QTc) pharmacodynamics of loratadine and its metabolite descarboethoxyloratadine in healthy volunteers.

METHODS

Twenty-four healthy volunteers were studied in a prospective, double-blind crossover design while confined in a Clinical Research Center. The primary pharmacodynamic end point of the study was the difference between baseline and day 10 mean QTc intervals obtained from surface electrocardiograms. Plasma concentrations of loratadine, descarboethoxyloratadine, and erythromycin were measured on treatment day 10 for pharmacokinetic analysis. Subjects received in random sequence the following three treatments for 10 consecutive days during three separate study periods: 10 mg loratadine every morning plus 500 mg erythromycin stearate every 8 hours, or 10 mg loratadine every morning plus placebo every 8 hours, or placebo every morning plus 500 mg erythromycin stearate.

RESULTS

Concomitant administration of loratadine and erythromycin was associated with increased plasma concentrations of loratadine (40% increase in area under the plasma concentration-time curve [AUC]) and descarboethoxyloratadine (46% increase in AUC) compared with loratadine alone. Analysis of variance showed no difference between the treatment groups in effect on QTc intervals compared with baseline, and no significant change from baseline was observed. No clinically relevant changes in the safety profile of loratadine were observed, and there were no reports of sedation nor syncope.

CONCLUSION

Although concomitant administration of loratadine and erythromycin was associated with increased plasma concentrations of loratadine and descarboethoxyloratadine, no clinically relevant changes in the safety profile of loratadine were observed. In this study, 10 mg loratadine administered orally for 10 consecutive days was well tolerated when coadministered with therapeutic doses of erythromycin stearate.

Effects of felbamate on the pharmacokinetics of phenobarbital

The effects of felbamate on the pharmacokinetics of phenobarbital and one of its main metabolites, parahydroxyphenobarbital, were assessed in a parallel-group, placebo-controlled, double-blind study, in 24 healthy volunteers. Pharmacokinetic parameters of phenobarbital and parahydroxyphenobarbital were determined from plasma and urine samples obtained after 28 days of daily administration of 100 mg phenobarbital and after a further 9 days of phenobarbital plus 2400 mg/day felbamate or placebo. Felbamate increased phenobarbital values for area under the plasma concentration-time curve from 0 to 24 hours and maximum concentration by 22% and 24%, respectively, whereas placebo had no effect. This increase was caused by a reduction in parahydroxylation of phenobarbital and possibly through effects on other metabolic pathways. Because felbamate inhibits the S-mephenytoin hydroxylase (CYP2C19) isozyme in vitro, it appears that phenobarbital hydroxylation is mediated in part by this isozyme.

Glucose metabolism in 'Sphingomonas elodea': pathway engineering via construction of a glucose-6-phosphate dehydrogenase insertion mutant

'Sphingomonas (formerly Pseudomonas) elodea' produces the industrially important polysaccharide gellan when grown in media containing glucose. Glucose catabolic enzymes and enzymes of central carbon metabolism were assayed in crude extracts of glucose-grown cultures of this bacterium. Based on these analyses it was concluded that glucose is converted to either gluconate or glucose 6-phosphate and that both of these products are converted to 6-phosphogluconate, a precursor for the Entner-Doudoroff (ED) and pentose phosphate pathways. Phosphoglucoisomerase (Pgi) activity was detected, but the lack of phosphofructokinase activity indicated that the Embden-Meyerhof glycolytic pathway is non-functional for glucose degradation. Thus, this bacterium utilizes glucose mainly via the ED and pentose phosphate pathways. Enzyme analyses suggested the involvement of glucose-6-phosphate dehydrogenase (Zwf) in glucose utilization and CO2 production. The zwf gene was cloned from 'S. elodea' and partially sequenced, and a null zwf mutant was constructed. This mutant exhibited no Zwf activity in in vitro assays, grew normally on glucose minimal medium and accumulated biomass (cells plus gellan) and produced CO2 at the same rates as the parental strain. Potential explanations for this finding are provided. Clones carrying the pgi gene were isolated fortuitously.

Rebleeding rate of various stigmata of recent hemorrhage in peptic ulcer bleeding with different severity

The stigmata of recent hemorrhage (SRH) have been used as a factor for predicting peptic ulcer rebleeding. In previous studies, the rebleeding rate of the visible vessel varied. A hypothesis had been proposed stating that the evolution of the color of the stigmata depends on the point in the healing process of the blood clot on the bleeding ulcer. This retrospective study evaluates the rebleeding rates associated with various colors of stigmata of recent hemorrhage. Of a total of 623 cases of peptic ulcer bleeding (474 male and 149 female, with a mean age of 59 years old), there were 232 gastric ulcers, 369 duodenal ulcers, and 22 stomal ulcers. Stigmata of recent hemorrhage were found in 387 cases (62%). The overall rebleeding rate for those with gastric ulcers was higher than for those with duodenal ulcers (24.2% versus 16.3%, p<0.05), especially for oozing and sentinel clots, the rebleeding rates for active bleeding, blood clots, sentinel clots, and others were 35%, 24.8%, 17%, and 11.3% respectively. The red clot of stigmata of recent hemorrhage had a slightly higher rebleeding rate than the black clot, but the difference was not statistically important. Furthermore, the 5 duodenal ulcers with white sentinel clots experienced no rebleeding. When comparing the rebleeding rates between groups with massive and minor bleeding, a significantly higher rebleeding rate was found in the massive bleeding group (50.5% versus 6.6%, p < 0.001). It can thus be seen that the different types of stigmata of recent hemorrhage represent different stages in the healing process of a bleeding ulcer. A white sentinel clot had a change of not rebleeding.(ABSTRACT TRUNCATED AT 250 WORDS)

Zygomycotic lung abscess: a case report

Zygomycosis is an uncommon, but frequently fatal, fungal infection caused by members of the class Zygomycetes. The risk factors include diabetes mellitus, uremia, leukemia and use of deferoxamine as an iron-chelating agent; healthy persons also are occasionally infected. Those fungi, spread by their ubiquitous spores, most frequently involve the respiratory system. Rhinocerebral zygomycosis occurs predominantly in patients with uncontrolled diabetic ketoacidosis. Pulmonary zygomycosis most frequently is observed in granulocytopenic and corticosteroid-treated patients. Other clinical manifestations are gastrointestinal, cutaneous, disseminated and miscellaneous. This report concerns a previously robust farmer who suffered from left upper lung abscess caused by Rhizopus spp.-one member of the order Mucorales. Initially, it was intended to administer amphotericin B to a total dose of 2,000 mg; however, the patient could not tolerate such side effects as nausea, vomiting and refused further management when the cumulative dose was 948 mg. However, he did recover without further fever and cough. Chest X-ray, followed every three months, disclosed satisfactory improvement.

[Assessing the effect of health belief, knowledge, and social support on compliance behaviors in chronic hemodialysis patients]

The purposes of this study were to investigate the effects of hemodialysis patients' health belief, knowledge on uremia, and social support upon their compliance behavior. The convenience sample of 330 hemodialysis (HD) patients was obtained at HD centers in southern Taiwan. With the use of a questionnaire developed by the researcher, all subjects were interviewed during hemodialysis. Data analyses were processed by a personal computer with SPSS/PC. Pearson correlation, ANOVA, chi-square, multiple regression and factor analysis were selected as the analysis methods for this study. The results indicated: (1) The average overall rate of compliance was 72.1% by patient self report for fluid limit, diet restriction and taking PBM. (2) Two factors of subject's health belief were identified by factor analysis. (3) Those who had more positive motivation for compliance with therapeutic regiments, more knowledge on uremia and stronger social support were positively correlated with compliance behaviors. (4) The best predictive variables of compliance behaviors of HD patients included positive motivation, knowledge on uremia, educational level, current daily urine amount and age; these five variables explained 23% of variance in compliance behaviors. (5) The instruments with a satisfactory validity and reliability developed by the researcher could provide a valuable basis for relevant future research. Implications of these findings for nursing practice are also discussed.

Ectopic supernumerary teeth as a predisposing cause in localized periodontitis. Case report

Supernumerary teeth are relatively common in the maxillary incisor and molar areas. However, bilateral ectopic, fully erupted supernumerary mesiodentes are relatively rare. The present case documents a patient with localized periodontitis of the maxillary first and second molars associated with bilaterally erupted supernumerary teeth located in proximity to the buccal embrasure space between the molars. Combined clinical data suggested that these ectopic mesiodentes predisposed or contributed to the development of localized periodontitis.

Pharmacokinetics of ceftibuten in children

The bioavailability and pharmacokinetics of ceftibuten administered as an oral suspension were characterized by several studies in young healthy male adults (19 to 39 years old) and children ranging in age from 6 months to 17 years. Ceftibuten suspension was found to be bioequivalent and thus interchangeable with a standard 400-mg capsule. As with the capsule formulation, food slightly (< 20%) affected the rate and extent of absorption of the suspension. The recommended dose of 9.0 mg/kg was found to produce comparable plasma concentrations in children of all ages (6 months to 17 years). The range of mean values of maximum plasma concentrations (Cmax) was 12 to 16 micrograms/ml at the 9.0-mg/kg dose level. Doses of 4.5, 9.0 and 13.5 mg/kg produced Cmax and area under the plasma concentration-time curve values that were dose-proportional. The half-life (t1/2) was essentially independent of age and dose, ranging from 2 to 3 hours. The apparent clearance (Cl/F), uncorrected for the fraction of drug absorbed (F), is independent of dose but appears to increase with a decrease in age. This also occurs to a lesser degree with the volume of distribution (Vd/F), uncorrected for F. Current evidence suggests that this is more likely to be caused primarily by a decrease in F than an increase in Cl. Ceftibuten rapidly and extensively reaches the middle ear fluid in children with acute otitis media. Within 4 hours concentrations in middle ear fluid are similar to plasma concentrations and can be measured for 12 hours. The ratio of area under the concentration time curve for middle ear fluid relative to plasma was about 70%.(ABSTRACT TRUNCATED AT 250 WORDS)

Mechanical properties and histological evaluation of sintered beta-Ca2P2O7 with Na4P2O7.10H2O addition

The ultimate goal of implantation of biomaterials in the skeleton is to reach full integration of the non-living implant with the living bone. The biomaterial can be used much as a bone graft, resorbing or dissolving as bone growth occurs, and the end result is a new remoulded bone. Calcium pyrophosphate, Ca2P2O7, is one of the intermediate products of bone mineralization. beta-Dicalcium pyrophosphate (beta-DCP) doped with certain amounts of Na4P2O7.10H2O was prepared as the developed material. Na4P2O7.10H2O was used as a liquid-phase additive to improve the sintering process and promote physiological bioresorbability. Compressive strength and four-point bending strength were measured by the Bionix test system 858. The mechanical strength of the sintered beta-DCP increased with the addition of Na4P2O7.10H2O up to 5 wt%, but thereafter decreased. The microstructure and crystal structure were analysed by the techniques of SEM, EPMA, TEM and XRD. The relationship between the mechanical strength of the sintered bioceramics and the Na4P2O7.10H2O dopant was examined in terms of the presence of NaCa(PO3)3, grain growth and abnormal grain coalescence while the dopant increased. Preliminary in vivo evaluation was studied by rabbit femur condyle implantation. There was no inflammation or any toxic sign during the experimental period. The histological section of intraosseous implantation revealed that the new bone deposited directly on the surface of the material in the fourth week after operation. The implant gradually decreased in volume and was replaced by the surrounding regenerated bone in the rabbit condyle in vivo environment. The results led us to conclude that the developed material has great potential as a biodegradable bone substitute.

Radical scavenger and antihepatotoxic activity of Ganoderma formosanum, Ganoderma lucidum and Ganoderma neo-japonicum

The free radical scavenging and antihepatotoxic activity from Ganoderma lucidum, Ganoderma formosanum and Ganoderma neo-japonicum were studied. Treatment with the water extract of Ganoderma lucidum, Ganoderma formosanum and Ganoderma neo-japonicum caused a marked decrease in the CCl4-induced toxicity in rat liver, made evident by their effect on the levels of glutamic oxaloacetic transaminase (GOT) and lactic dehydrogenase (LDH) in the serum. The scavenging potency of the water extracts of the crude drugs was evaluated in terms of their ability to reduce the peaks of spin adducts using electron spin resonance (ESR) spin-trapping techniques. The results indicated that Ganoderma formosanum showed the greatest antihepatotoxic activity and the greatest free radical scavenging activity.

Scavenging effects of Mallotus repandus on active oxygen species

The active oxygen species scavenging potencies of Mallotus repandus (Willd.) Muell.-Arg. extracts were evaluated by the electron spin resonance (ESR) spin-trapping technique. Superoxide radical (O2.-) and hydroxyl radical (OH.) were supplied enzymatically from hypoxanthine-xanthine oxidase (HPX-XOD) reaction and hydrogen peroxide-ferrous sulfate (Fenton reaction), respectively, to the assay system. The ethyl acetate fraction of Mallotus repandus (stem) showed the greatest superoxide radical scavenger activity and the n-hexane fraction of Mallotus repandus (stem as well as root) the greatest hydroxyl radical scavenger activity.

Pharmacokinetics of isepamicin in paediatric patients

The pharmacokinetics of isepamicin were evaluated in 50 paediatric patients ranging from newborn to 13 years old. Children with subdivided according to age: Group I (6-13 years); Group II (4 months to 6 years); Group III (16 days to 4 months); and Group IV (newborn to 16 days). All patients received isepamicin 7.5 mg/kg every 12 hours except those in Group IV who received 7.5 mg/kg once daily. Isepamicin was administered initially as an intravenous 30-minute infusion and then either intravenously or intramuscularly for between 4 and 12 days. Plasma samples were obtained after the first or second dose on day 1 at 0, 0.5, 1, 4, 6, 8 and 12 hours after the initiation of dosing and at 0.5 and 12 hours on other dosing days. Additional samples were collected in the Group IV patients at 18, 20 and 24 hours. Isepamicin showed a similar plasma concentration-time profile in Groups I, II and III (children from 16 days to 13 years), and in these groups the profile was generally similar to that observed in adults. Neonates up to the age of 16 days (Group IV) showed a distinctly different pharmacokinetic profile: a significantly larger AUC, longer half-life, lower Cmax and lower total body clearance. Isepamicin 7.5 mg/kg administered once daily to children less than 16 days old and twice daily to children aged 16 days to 13 years appears to be pharmacokinetically appropriate. The drug was very well tolerated by children of all age groups.

Anthropometry and lipoproteins-related characteristics of young adult males in Taiwan

OBJECTIVES

To investigate the prevalence of obesity and the lipoprotein-related characteristics among young male adults in the Taiwan area.

DESIGN AND SUBJECTS

After cluster sampling, a cross-sectional survey with a total of 936 males (mean age 20, 18-24) were enrolled.

MAIN OUTCOME MEASURES

The distribution of anthropometric and lipoprotein-related variables and their correlations in young male adults were measured. The prevalence of obesity by different criterion and the lipoprotein characteristics of obese and non-obese were analyzed separately.

RESULTS

The prevalence of obesity was 9.6% by the criterion of body weight greater than 20% of ideal body weight, or 12.6% by the criterion of body mass index (BMI) greater than 25. The obese subjects had significantly higher serum total cholesterol (CHOL), triglyceride (TG) and apo-lipoprotein B (apo B) and lower higher density lipoprotein-cholesterol (HDL-C) levels than the non-obese. The apo A1 levels were 141.3 and 141.9 mg/dl and the lipoprotein [a] (Lp[a]) were 17.4 and 17.1 mg/dl in obese and non-obese respectively, the difference being not statistically significant. Pearson correlation coefficients of body weight, body height, BMI, waist circumference, hip circumference and waist-hip ratio (WHR) to lipoprotein variables showed that both BMI and WHR are positively correlated with CHOL, TG and apo B, but negatively correlated with HDL-C. Furthermore the lipoprotein variables were better correlated with BMI than WHR in lean subjects (BMI < 25). However, this phenomenon was quite different in obese (BMI > 25) subjects, where the WHR was more highly correlated with lipoprotein variables than with BMI.

CONCLUSION

The prevalence of obesity is slightly higher than reported in previous studies in Taiwan. The obese subjects had various abnormal lipoprotein metabolic characteristics, such as higher CHOL, TG, and apo B and lower HDL-C levels than non-obese subjects. The BMI was more highly correlated with lipoprotein variables than was WHR in lean subjects, but the WHR was more highly correlated with lipoprotein variables than was BMI in obese subjects.

Pharmacokinetics of isepamicin

Isepamicin is a new aminoglycoside that has activity against many bacteria resistant to other aminoglycosides. The pharmacokinetics of isepamicin have been characterized in neonatal, pediatric, adult, elderly and renally impaired human populations as well as in clinical trials using the techniques of population pharmacokinetics. The pharmacokinetics of isepamicin are uncomplicated and generally similar to those of other aminoglycosides, although there is some evidence that it may have less tissue accumulation. The drug is completely absorbed following intramuscular administration. The drug is not metabolized and unchanged isepamicin accounts for all of the drug substance in plasma and urine. It is completely eliminated via the renal route; consequently dosing in patients with renal insufficiency has to be adjusted according to the degree of renal impairment. The pharmacokinetics of isepamicin are generally linear. Thus peak plasma concentrations and area under the plasma concentration curve (AUC) values are proportional to the administered dose while clearance (1.1-1.3 mL/min/kg), volume of distribution at steady state (0.23-0.29 L/kg) and half-life (2-2.5 h) are independent of dose. There is no significant accumulation of drug in the plasma with once- or twice-daily dosing. The isepamicin plasma concentration curve following a 1 g intravenous dose to healthy volunteers can be best characterized by a tri-exponential curve corresponding to a t1/2 alpha of 0.17 h, a t1/2 beta of 2.1 h, and a gamma-phase of 34 h. The t1/2 beta represents the elimination phase and changes with age and renal functions, while the gamma-phase represents the return of drug to plasma from a deep compartment including binding in renal tissue. The gamma-phase represents less than 3% of the total AUC and does not change with age. Isepamicin readily distributes to extracellular fluid and pulmonary tissue. In conclusion, isepamicin demonstrates predictable linear kinetics and is similar pharmacokinetically to other aminoglycosides. Preliminary indications of decreased tissue accumulation implied from pharmacokinetic and pharmacodynamic characteristics of isepamicin favour once-daily dosing.

Success of endoscopic injection therapy in correlation with maximal one-day transfusion requirement

BACKGROUND AND STUDY AIMS

The rate of blood transfusion is related to blood flow and the diameter of the bleeding vessel. Therapeutic endoscopy is less effective in larger vessels. To determine the effect of therapeutic endoscopy with pure ethanol injection in massive peptic ulcer bleeding, we conducted a retrospective study using the maximal one-day blood requirement as an indicator of the required blood transfusion.

PATIENTS AND METHODS

The maximal one-day blood requirement was defined as the total amount of blood transfusion needed within a day to keep hemodynamics stable and hemoglobin above 8.0 g% before therapeutic endoscopy. From January 1986 to May 1993, 283 patients with high-risk signs of the stigmata of hemorrhage on endoscopy, who received pure ethanol injection therapy, were included in this study. There were 214 men and 69 women with a mean age of 58.4 years (ranging from 16 to 93 years). One hundred forty-three had gastric ulcers; 125 had duodenal ulcers; and 15 had stomal ulcers. Patients whose maximal one-day blood requirement was less than 1000 ml were assigned to Group I. Patients without, and patients with, major organ diseases whose maximal one-day blood requirement was more than 1000 ml were assigned to Group IIa and Group IIb, respectively.

RESULTS

In Group I, 87.1% attained permanent hemostasis; 51.3% in Group IIa; and 49.4% in Group IIb. Temporary hemostasis and failure rates were 8.9% and 4.8% in Group I; 14.5% and 33.8% in Group IIa; and 21.2% and 29.4% in Group IIb. The rate of permanent hemostasis was significantly lower in patients with massive bleeding (p < 0.001) but did not differ between patients with and without major organ diseases (p > 0.05).

CONCLUSION

The success rate for pure ethanol injection therapy was lower in patients with a large maximal one-day blood transfusion requirement.

Pulmonary carcinoid tumor--tumorlet type: a case report

A rare case of bronchiectasis with carcinoid tumor, tumorlet type, is reported. The patient was a 53-year-old female who underwent lobectomy of the right middle and lower lobes for severe hemorrhage secondary to bronchiectasis. No tumor was seen on chest X-ray or by gross examination of the lung. Microscopically, there were multiple tumorlets in the pulmonary parenchyma surrounding the bronchiole and small bronchus. The tumor cells stained positive for neuron-specific enolase, keratin and chromogranin stain. The morphology, and staining properties suggested that the pulmonary tumorlets were carcinoid tumor. No tumor cells were identified in the four peribronchial lymph nodes. The patient is disease-free after four years of follow-up.