[Clinical study of recombinant human granulocyte-colony stimulating factor (KW-2228) in pediatric field. 2. Effectiveness on neutropenia associated with administration of anticancer agent and safety]

The effect of KW-2228, a derivative of recombinant human granulocyte colony stimulating factor, on neutropenia associated with chemotherapy was studied in pediatric patients with malignant tumor. To patients repeatedly treated with the same chemotherapy, KW-2228 was administered subcutaneously at 1 microgram/kg or intravenously at 2 micrograms/kg once a day in the 2nd course of the chemotherapy. During the administration term of KW-2228, the nadir of neutrophils went up, and the duration of neutrophil count under 500/microliters as well as the interval for recovery of the count to 500/microliters were remarkably shortened, compared with those during the observation term. Further, the duration of fever in patients and the administration days of antibacterial agent were also reduced. The effective rate judged by attending doctors was as high as 78.9%, consisting of 83.3% in 42 cases of subcutaneous administration and 73.5% in 34 cases of intravenous administration. Side effects such as slight skeletal pain and slight fever in one case each (2.3% in total) were improved without treatment. It is concluded that KW-2228 may be a useful drug for treatment of neutropenia associated with chemotherapy in pediatric patients with malignant tumor.

The in vivo and in vitro postantibiotic effect of aminoglycosides using a clinically isolated micro-organism

We reported a case of abscess in which Serratia marcescens was isolated as the causative organism. We measured the postantibiotic effect (PAE) of dibekacin (DKB) and gentamicin (GM) against S. marcescens and studied the relationship between the clinical effect and the PAE. The minimal inhibitory concentration (MIC) of DKB against S. marcescens was 6.25 micrograms/mL and the serum concentration 30 min after infusion of 100 mg DKB was 5.99 micrograms/mL. The abscess was cured by the administration of DKB every 12 h. The PAE in vivo was 2.5, 2.9 and 3.3 h when DKB was administered at 50 mg/kg, 100 mg/kg and 200 mg/kg, respectively. This PAE is one of the reasons that infection can be effectively treated with intermittent administration, even if the serum concentration is below the MIC.

[Clinical study of recombinant human granulocyte-colony stimulating factor (KW-2228) in pediatric field. 1. Effectiveness on neutropenia by various causes and safety]

The effect of KW-2228, a derivative of recombinant human granulocyte colony stimulating factor, on neutropenia in children was studied in 23 cases of aplastic anemia, 13 cases of chronic benign neutropenia, 6 cases of congenital neutropenia (Kostmann type), 2 cases of cyclic neutropenia, 2 cases associated with glycogenosis type Ib and 1 cases associated with immune deficiency. KW-2228 was administered at 1-8 micrograms/kg subcutaneously and at 2-16 micrograms/kg intravenously. As a principle, the administration was started at low doses and continued for 7-28 days increasing the doses in the cases who didn't respond to the treatment well. The response rate of all the cases by the physicians in charge was 81. 8% (36/44). The mean absolute neutrophil count was increased from 304 to 1,300/microliters in aplastic anemia, from 204 to 3,027/microliters in chronic benign type, from 125 to 2,193/microliters in Kostmann type, and from 360 to 2,007 microliters in others. KW-2228 did not induce any noteworthy serious side effects. These results indicated that KW-2228 is a useful drug to treat neutropenia in children.

[Investigation of meropenem levels in the human bone marrow blood, bone, joint fluid and joint tissues]

A solution of 0.5 g of meropenem (MEPM) in 100 ml of saline was administered to adult patients before the orthopaedic surgery via intravenous drip infusion for 30 minutes. Eleven samples of bone marrow blood, 13 bone, 8 joint fluid and 8 joint tissues obtained from 15 clinical cases were analyzed for MEPM levels. At the same time, blood samples were taken from peripheral veins and serum served as control was analyzed. The concentration of MEPM in the marrow blood at 30 minutes after administration of MEPM reached 15.4 micrograms/ml, which was above 50% of the maximum concentration in serum. Ratios of concentration in bone marrow to that in serum were between 93% and 105% at that time. MEPM levels were 5.74-0.40 micrograms/g in bones, 20.3-4.55 micrograms/ml in joint fluid and 18.2-4.05 micrograms/g in joint tissues at 30 to 75 minutes after administration. In joint fluid and joint tissues, the concentration above 50% of maximum level in serum were maintained for more than an hour. MEPM is thought to be useful for the treatment of bone and joint infections and also prophylaxis of infections in cases of major surgery of skeletal tissue in the field of orthopaedic surgery.

Maclura pomifera agglutinin-binding glycoconjugates on converted apatite from synthetic octacalcium phosphate implanted into subperiosteal region of mouse calvaria

We have previously shown that the mineral in granules of synthetic octacalcium phosphate (OCP) implanted subperiosteally in mouse calvariae was converted to apatitic crystals and that the OCP implantation stimulated bone formation. The matrix components accumulated on the converted apatite were very similar to those of bone nodules (starting locus of calcification) in intramembranous osteogenesis. In the present study, the nature of the matrices accumulated on OCP implants in calvariae was compared with that of the matrices accumulated in abdominal subcutaneous implants. The comparison was facilitated by the use of Maclura pomifera agglutinin (MPA) lectin which is known to have a high affinity for the primary intramembranous bone matrix. Micro-beam x-ray diffraction indicated conversion of the implanted OCP to apatitic crystals in situ, both in subperiosteal and subcutaneous sites, after 10 days. Additional bone formation was detected on the converted apatite after 13 days in subperiosteal implantation, whereas bone was not formed in the subcutaneous implantation. MPA reaction was strongly manifested after 10 days in matrices accumulated on the converted apatite in both subperiosteal and subcutaneous implantations. Biochemical data showed that intensely and weakly MPA-blotted molecules (53.0 and 152.6 kDa, respectively) were in all the mouse sera, in the guanidine HCl-EDTA extracts of mouse calvarial bone and in the extracts of the implanted OCP in both subperiosteal and subcutaneous sites. These findings indicated that the glycoconjugates accumulated on the converted apatite from OCP were similar to the glycoconjugates in the serum in terms of reactivity with MPA and molecular weights. Furthermore, the results suggest that MPA-binding glycoconjugates which had accumulated on the converted apatite may be a requisite for the differentiation of mesenchymal cells into osteoblasts in periosteum but not in subcutaneous sites.

Enhanced incorporation of 1-beta-D-arabinofuranosylcytosine by pretreatment with etoposide

We examined the effects of timing of administration of etoposide on cytosine arabinoside (ara-C) incorporation into DNA in L1210 ascites tumor. At 1 hr after injection of ara-C, 3-hr and 6-hr pretreatments with 15 mg/kg of etoposide increased ara-C incorporation to more than 200% as compared to that of ara-C given alone. Simultaneous administration of etoposide, however, decreased ara-C incorporation to 33% of that of ara-C alone. These results might explain the previously reported sequence dependency of the antitumor effect of etoposide and ara-C.

Leiomyosarcoma of the bladder eighteen years after cyclophosphamide therapy for retinoblastoma

We report a case of leiomyosarcoma in the bladder which occurred in an 18-year-old boy who had been treated with cyclophosphamide over a period of 6 years for retinoblastoma diagnosed 50 days postpartum. Total cystectomy and formation of an ileal conduit were performed. Three years after the operation, he was tumor-free.

Successful treatment of chronic disseminated candidiasis with high-dose fluconazole in a child with acute myelo-monocytic leukemia

A 6-year-old boy with acute myelo-monocytic leukemia [French-American-British classification, M4 (Bennett et al., Br J Haematol 1976; 33: 451-458)] developed chronic disseminated candidiasis (CDC) in a phase of remission induction chemotherapy. The diagnosis was made based on the histological examination of the biopsy specimen of the liver that showed invasion of Candida. High-dose fluconazole (FCZ) therapy (up to 23.5 mg/kg/day) was given effectively and without significant side effect over a period of 15 months. Pharmacokinetic analysis revealed that FCZ showed one or two compartment model. Administration of 12 mg/kg/day of the drug showed that t (1 2 ) were 11.5 and 16.1 h, respectively. We would suggest that if lesser doses are ineffective in eradicating invasive fungal infection, dose escalation of FCZ was possible up to a single administration of 20 mg/kg daily in children.

Ten-year survey of the intellectual deficits in children with acute lymphoblastic leukemia receiving chemoimmunotherapy

Effects of chemoimmunotherapy, including cranial irradiation for central nervous system (CNS)-directed therapy, on children with acute lymphoblastic leukemia (ALL) were investigated. Fifty-five children with ALL in continuous complete remission (> 5 yr) and without evidence of current or past CNS diseases were evaluated in this retrospective study. Using standard measures of intelligence (IQ), we repeatedly (1-4 times/person; mean 2.1 times) evaluated IQ in the cohort of patients for the mean follow-up time of 9.7 yr, ranging from 5.4 to 15.8 yr. Fifty-five patients received the total number of 118 IQ testings and 40 patients received them more than twice. Patients were examined periodically at intervals of 1.4 to 10.0 yr (mean 4.8 yr) following diagnosis. Most of the published studies dealt with single IQ testing, and long-term follow-ups were not enough to assess the consequent IQ change. This report confirms and extends the previous findings: decreased IQ was related to age at diagnosis and irradiation (< 5 yr of age at diagnosis), irradiation-examination interval, and female sex. Further long-term follow-up study will be needed in these groups, since their IQs are still on the decline even after 10 yr of diagnosis.

Effects of 5-fluorouracil and a combination of tegafur and uracil (UFT) on nucleotide metabolism in L1210 ascites tumor

Changes in the deoxyribonucleotide pools following a single oral administration of 13 mg/kg of 5-fluorouracil (5-FU) or of 64.8 mg/kg of UFT (a mixed compound of tegafur and uracil) were investigated. We compared their pharmacodynamics and effects on nucleotide metabolism in L1210 ascites tumor on day 3 after intraperitoneal tumor inoculation. The intracellular dTTP pool decreased to half the control level 1-6 hr after the administration of 5-FU. The dTTP pools rapidly recovered after 6 hr. In contrast, UFT kept the intracellular dTTP level to 1/3 to 1/2 of the control level for 24 hr. Either drug elevated the intracellular dATP pools, but decreased dCTP pools. UFT influenced the intracellular dATP and dCTP levels longer than 5-FU. Orally administered UFT seemed to exert a longer and more potent inhibitory effect on thymidylate synthetase than equimolar 5-FU. In view of these results, we suggest that UFT could be a more potent chemotherapeutic drug than 5-FU in oral administration.

[Multilocular cystic renal cell carcinoma: a report of two cases]

Two cases of multilocular cystic renal cell carcinomas in a 48-year-old man and in a 41-year-old woman are reported. Radical nephrectomy was performed in both cases. Both histologic diagnoses were multilocular cystic renal cell carcinoma, clear cell subtype, grade 1. We had some difficulty in diagnosing the latter case with multilocular cystic mass which had smooth, glistening lining and contained clear-yellow fluid. Microscopical examination of the permanent sections revealed that the cysts were lined by a cuboidal or flattened epithelium, but no tumor cells. However, laminar growth of renal cell carcinoma of the clear cell type was present in several areas in the septa, and a few residual tumor cells were found in the hyalinized septa. When renal cell carcinoma is present in only a part of the multilocular cystic renal mass, it should be diagnosed as multilocular cystic renal cell carcinoma. The literature was surveyed.

[Home oxygen therapy using liquid oxygen system]

Home oxygen therapy (HOT) for patients with chronic respiratory failure has been believed to increase the quality of life and to improve the prognosis of such patients. In Japan, HOT for chronic respiratory failure has been supported by health insurance since March 1985. Since then, patients with HOT have increased progressively, and it has been reported that there are now over 20,000 patients with HOT. The oxygen concentrator which extracts oxygen from atmospheric air has been commonly used as the oxygen delivery system. Recently the liquid oxygen system has provided an attractive, convenient source of oxygen. Since April 1990, HOT using liquid oxygen system has been supported by health insurance, and its use will become widespread in Japan. A major characteristic of this system is that oxygen condensed into a liquid form allows storage of a larger supply. This system consists of two parts: stationary type which stores the liquid oxygen, and a portable type which can easily be refilled with oxygen a larger source. In the present study, we examined the efficacy of portable liquid oxygen in 50 patients with chronic pulmonary diseases including patients with chronic respiratory failure who had PaO2 < 55 mmHg during air breathing. We measured changes of ten minutes walking distance (10 MD) and blood gas analysis with and without portable liquid oxygen. We also performed on estimation of efficacy of liquid oxygen by questionnaires in patients receiving liquid oxygen for HOT. We did not find a significant improvement of 10 MD with portable liquid oxygen, but found a significant improvement of arterial oxygen tension at the end of walking.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term treatment with 1 alpha-hydroxyvitamin D3 with calcium supplement in spinal osteoporotic patients

The long-term effect of 1 alpha-hydroxyvitamin D3 and calcium lactate in osteoporotic patients was evaluated by the bone mineral density (BMD) measured at the distal one third and one sixth of the radius and by the vertebral fracture rate. Forty-five osteoporotic patients medicated for 1 to 13 years (treated group) and 11 osteoporotic patients with no medication for 1 to 3 years (control group) were compared. The BMD of the treated group remained unchanged for the first 4 (one-third site) and 6 years (one-sixth site), followed by significant decreases, whereas that of the control group decreased significantly at the second and third year. The effect on BMD was more prominent in the patients with lower initial BMD. The vertebral fracture rate of the treated group was significantly less than that in the control group at the third year. No serious side effects were recognized. Overall, we believe 1 alpha-hydroxyvitamin D3 with calcium supplement can be considered a safe and effective agent for long-term use in osteoporotic patients.

[der(1;7) (q10;p10) in three patients with malignant hematologic disorders]

The chromosome der(1;7) (q10;p10) is a derivative chromosome consisting of the short arm of chromosome 7 and the long arm of chromosome 1. We observed this abnormality in three patients with acute myeloblastic leukemia (AML), myelodysplastic syndrome (MDS), or myeloproliferative disorder (MPD). Case 1 was a 76-yr-old male with a history of IgG myeloma treated with melphalan, cyclophosphamide, vincristine, and prednisolone (MEVP). AML-M1 developed one and half years after discontinuation of the MEVP therapy. Case 2 was a 39-yr-old male with MDS. Case 3 was a 56-yr-old male with refractory anemia with excess of blasts in transformation that evolved from primary myelofibrosis. Chromosome analyses revealed der(1;7) (q10;p10) in bone marrow cells of the three patients. All patients failed to respond to chemotherapy, and died within four months after the diagnosis. Thus, der (1;7) (q10;p10) may indicate a very poor prognostic outcome in patients with malignant hematologic disorders.

[Pharmacokinetic, bacteriological and clinical studies on cefprozil in pediatric patients]

Cefprozil (CFPZ, BMY-28100), a new oral cephem antibiotic, was studied for its antibacterial activities, absorption and excretion upon administration. Its clinical efficacies were also studied in pediatric patients with infections. A study on antibacterial activities of CFPZ against 11 clinical isolates including 6 species found that its activities against Staphylococcus aureus, alpha-hemolytic Streptococcus, Escherichia coli and Haemophilus influenzae were equal or superior to those of CCL. When CFPZ was given to patients orally at 15 mg/kg, maximum serum concentration was obtained between 1 to 2 hours after administration and urinary excretion rate in the first 6 hours was 33.8 +/- 17.6%. Clinical evaluation was done in a total of 25 patients with various infections. Responses were excellent in 15 cases and good in 10 cases, hence the efficacy rate was 100%. As side effect, soft stool was found in 1 case, and eosinophilia in 2 cases and elevation of GOT and GPT in 1 case were found as abnormal laboratory test results, but none of them was serious. It appears that CFPZ is an effective and safe antibiotic in the field of pediatrics.

Lidocaine unmasks silent demyelinative lesions in multiple sclerosis

Blockage of a small number of sodium channels may prevent impulse conduction in some demyelinated segments of nerve fibers with low safety factors, thereby unmasking subclinical demyelinative lesions. On the basis of this hypothesis, lidocaine, a sodium channel blocker, was administered intravenously to 28 MS patients and to 19 normal subjects and seven patients with nondemyelinating diseases. As predicted, lidocaine (mean plasma level, 2.7 micrograms/ml) elicited reversible subclinical symptoms in 23 of the MS patients, but it had not effect on the control subjects. We made a quantitative study of the visual functions (visual acuity, color vision, visual evoked potential [VEP]) that were impaired in 15 MS patients. Of the 23 affected eyes, nine showed normal VEPs, indicative of the test's sensitivity to focal lesions. This test should be useful in the diagnosis of MS and in the evaluation of the subclinical activity of MS as well.

[The effect of etoposide on influx and efflux of cytosine arabinoside in P388 murine leukemic cells]

We studied the effects of etoposide on the influx, intracellular accumulation and efflux of ara-C in P388 leukemic cells. Etoposide inhibited the active influx of ara-C in a dose dependent manner, and the inhibition was reversible. Etoposide also affected the intracellular accumulation of ara-C, though its inhibitory effect for the intracellular accumulation was weaker than that for the influx of ara-C. It was also shown that etoposide inhibited the active efflux of ara-C. Furthermore, etoposide inhibited the active transport of ara-C bidirectionally but the insensitive route of etoposide existed especially at high concentration of ara-C. The effect of inhibition of the transport of ara-C on the accumulation of ara-C was more significant at lower concentration of ara-C. Judging from the drug concentrations used in this study, an interaction between etoposide and ara-C could occur in the clinical treatment.

[Topical timolol and blood-aqueous barrier permeability to protein in human eyes]

The effect of topical 0.5% timolol on the permeability of the blood-aqueous barrier to plasma protein was studied in ten young normal volunteers. Before and after instillation of timolol in one eye, simultaneous measurements of aqueous flow rate, f(t), by fluorophotometry and protein concentration in the anterior chamber, Ca(t), with a laser flare-cell meter were made in both eyes at hourly intervals. The coefficient of protein entry into the anterior chamber was calculated using an equation formulating protein dynamics in the anterior chamber from the changes in f(t), Ca(t), and plasma protein concentration. The Ca(t) in the treated eye showed a maximum increase of 37 +/- 4% (mean +/- SEM) as compared with that in the fellow eye 5 hours after instillation, while the f(t) in the treated eye showed a maximum reduction of 30 +/- 4% 2 hours after instillation. The intraocular pressure in the treated eye showed a maximum reduction of 3.0 +/- 0.3 mmHg 2 hours after instillation. No significant changes were found in the coefficient of protein entry in the anterior chamber between before and after timolol instillation or between timolol-treated and fellow untreated eyes. These results indicated that topical 0.5% timolol does not affect the permeability of the blood-aqueous barrier to plasma protein significantly.

Thresholds for decrease in intracellular pH and increase in blood lactate during progressive exercise: 31P-MRS study

The purpose of this study was to compare the intramuscular and the intravascular events in relation to energy metabolism during progressive arm exercise. Twelve healthy untrained Japanese males participated in this study as subjects. They performed wrist flexion in a ramp incremental load of 0.14 W/min until exhaustion. 31P-MR spectra were obtained from wrist flexor muscle before and throughout the exercise. Venous blood was also sampled from antecubital vein with one minute interval during the exercise, and a change in plasma lactate concentration (La) was observed. Intracellular pH (pH) was calculated from a chemical shift between phosphocreatine (PCr) and inorganic phosphate (Pi) of the 31P-MR spectra. Change in pH showed a threshold behavior during exercise. Threshold points at decline in pH (pHT), increase in Pi/PCr (PT), and increase in La (LT) were determined by piecewise linear regression analysis of minutes-by-minutes data. Mean values of pHT, PT and LT were 43.0, 42.5, and 24.8% of maximal work rate, respectively. LT was significantly smaller than pHT and PT. This result suggests that lactic acidosis has already existed when pH is kept at resting level, and pHT reflects the capacity of remaining intracellular biochemical homeostasis, which might be one of the physiological indices of muscle fatigue.

Recombinant human granulocyte colony-stimulating factor enhanced cytotoxicity of Ara-C in Ara-C-resistant leukemic cells from a patient with biphenotypic leukemia in cell kinetic quiescence

In vitro preincubation with recombinant granulocyte colony-stimulating factor(rhG-CSF, 100 ng/ml) enhanced the cytotoxicity of 1-beta-D-arabinofuranosylcytosine(Ara-C) in leukemic cells resistant to Ara-C from a patient with biphenotypic leukemia. Treatment of the cells with rhG-CSF resulted in a 17-fold increase in DNA synthesis, 4.6-fold increase in percentage of S-phase, and a two-fold increase in Ara-CTP formation. Maximal effect was observed at 72 h of incubation. Combination chemotherapy with rhG-CSF and Ara-C to the patient showed remarkable cytoreduction. These results indicate that recruitment of resistant leukemic cells in cell kinetic quiescence is inducible by rhG-CSF and that it is possible enhancement of the cytotoxicity to cell cycle-specific drugs such as Ara-C.

[Clinical experience of a percutaneous ventricular support for profound heart failure following acute myocardial infarction--a case report]

Percutaneous biventricular support with centrifugal pump was applied to a 59-year-old man with profound heart failure following acute myocardial infarction. Direct coronary angioplasty was performed under percutaneous cardiopulmonary support (PCPS). After angioplasty, he could not be weaned from PCPS under IABP. We used percutaneous left ventricular support (PLVS) with transseptal left atrial cannulation. PLVS could not maintain effective assist flow and he developed a cardiogenic shock again. PCPS was added to PLVS, and percutaneous biventricular support was started. Assist flow ranged 1.7-3.0 L/min in PLVS, and 1.7-2.0 L/min in PCPS, and total assist flow was 3.4 L/min. Pulsatile pressure was obtained by adding IABP. The patient was successfully weaned from PCPS in 26 hours and PLVS in 118 hours. Patient is alive and well one year after PLVS. Combination of PLVS and PCPS is an effective ventricular support system, being less invasive than conventional method with thoracotomy, and may be useful for profound heart failure.