[Fundamental and clinical studies on cefamandole in pediatric treatment (author's transl)]

Cefamandole (sodium salt) was administered to total 32 cases of bacterial infectious diseases of children, and in 3 cases, there were investigated of these absorption and excretion. The results are as follows; 1. Blood levels: Cefamandole was given intravenous dose of 25 mg/kg to 3 children. The blood level of 15 minutes after intravenous injection was 140.4 micrograms/ml in average, and 0.3 micrograms/ml in average at 4 hours after intravenous injection. T 1/2 was 13.9 minutes. 2. Urinary concentration: Within 6 hours after intravenous injection, 51.8% of the drug was recovered in average from the urine and the urinary concentration reached to 3,050 micrograms/ml in average (0 approximately 2 hours), 1,262 micrograms/ml in average (2 approximately 4 hours), 41 micrograms/ml in average (4 approximately 6 hours) after injection. 3.

CLINICAL RESULTS

The drug was given 109 mg/kg/day (t.i.d. or q.i.d.) by intravenous route. The duration of administration was 11 days in average. The overall efficacy rate was 97%. In bacteriological results, excellent in 2, failure in 1, out of 3 strains. As side effects vascular pain was observed in 3 cases at the intravenous injection, and eosinophilia in 2 cases.

Congenital deficiency of alpha 2-plasmin inhibitor associated with severe hemorrhagic tendency

alpha(2)-Plasmin inhibitor (alpha(2)PI) is a recently characterized, fast-reacting plasmin inhibitor in human plasma that appears to play an important role in regulation of in vivo fibrinolysis. We report here a case of complete deficiency of alpha(2)PI in man. The patient, a 25-yr-old Japanese man, had a life-long severe bleeding tendency (hemarthrosis and excessive bleeding after trauma). The following tests were within normal limits: platelet count, bleeding time, thrombin time, prothrombin time, partial thromboplastin time, titers of known clotting factors, platelet glass bead retention, Factor VIII-related antigen, platelet aggregation by ADP, collagen and ristocetin, and clot retraction. Routine liver function tests were also normal. The only abnormal finding was that whole blood clot lysis was extemely rapid and was complete in 4-8 h. The concentration of plasma protease inhibitors, including alpha(2)-macro-globulin, antithrombin III, alpha(1)-antitrypsin, and C1INH, were all normal. The concentration of alpha(2)-PI in the patient's plasma, assayed by immunological methods, was <0.1 mg/100 ml (normal concentration, 6.1+/-0.88 mg/100 ml [mean+/-SE]) and functional assays showed a complete deficiency of alpha(2)PI. Addition of purified alpha(2)PI to the patient's whole blood completely corrected the accelerated fibrinolysis. The patient's parents, four siblings, and four other members of this family were asymptomatic, but the titers of alpha(2)PI in their plasmas were congruent with50% of normal pooled plasma. There were three consanguineous marriages in this family, and the alpha(2)PI deficiency appears to have been inherited as an autosomal recessive trait. We speculate that alpha(2)PI deficiency in this patient has led to uninhibited in vivo fibrinolysis that probably causes the severe hemorrhagic tendency. Thus, this study indicates the important role of alpha(2)PI in hemostasis.

Comparison of thermosensitivity in the preoptic/anterior hypothalamic area and the midbrain of the rabbit

To characterize the role of the midbrain temperature-sensitive structure in thermoregulation, the relative importance of thermosensitivity in the hypothalamus and the midbrain was studied in terms of heat production and heat loss in the rabbit. It was found that altering the local temperature in the midbrain had no influence at all on heat loss from the ear surface and also on heat production, while cooling and warming of the preoptic/anterior hypothalamic area induced appropriate thermoregulatory responses.

Statistical analysis of the discharge patterns of medullary temperature-responsive neurones in rabbits

To characterize the medullary temperature-responsive neurones in rabbits, statistical analysis of interspike intervals was performed on 24 neurones recorded at various temperatures of the medulla. It was found that the medullary neurone fired at a relatively regular interval and 11 of 24 neurones displayed an invariable precision in thermoreception over a broad range of medullary temperatures; also, that the temporal distribution of interspike intervals of medullary neurones was markedly different from that of hypothalamic neurones.

Fibrinolytic States in a Patient with Congenital Deficiency of Alpha 2-Plasmin Inhibitor

A patient with congenital deficiency of α2-plasmin inhibitor (α2PI) was studied for his fibrinolytic system. The patient’s whole blood clot formed in vitro was lysed rapidly in several hours on incubation. This accelerated in vitro fibrinolysis was blocked by an addition of purified α2PI. In spite of the accelerated in vitro fibrinolysis, the increases of fibrinogen/fibrin degradation products and Fragment A were not detected when the blood was mixed with tranexamic acid-aprotinine mixture immediately after drawing blood, suggesting no increased in vivo fibrinogenolysis. When the patient’s citrated plasma was incubated in vitro, no or little progressive degradation of fibrinogen was observed in spite of the accelerated conversion of native Glu-plasminogen to modified Lys-plasminogen in the patient’s plasma. When the patient’s plasma was clotted by recalcification, fibrin formed was rapidly lysed. These results may suggest that α2PI is effective in inhibiting fibrinolysis but other protease inhibitors in plasma such as α2-macroglobulin are ineffective in inhibiting fibrinolysis although they are effective in inhibiting plasmin in plasma milieu thereby prevent fibrinogenolysis. Deficiency of α2PI in this patient may have led to uninhibited in vivo fibrinolysis resulting in friable hemostatic plugs causing severe hemorrhagic tendency.

Effects of pyrogen on the medullary temperature-responsive neurone of rabbits

Effects of intravenously injected endogenous pyrogen on the unit activity of temperature-responsive neurones (TR neurones) of medulla oblongata were investigated in urethanized rabbits with an intact or lesioned preoptic/anterior hypothalamic area (PO/AH). TR neurones of the medulla responded to pyrogen in the same manner as did those of the PO/AH; the firing rate in the warm-responsive neurones were depressed and the cold-responsive neurones augmented. However, one-fourth of the medullary TR neurones did not respond to pyrogen in the PO/AH intact group (the control group). Following lesion of the PO/AH, the relative frequencies of TR neurones affected by pyrogen decreased as compared with those in control, and such was suggested to be more apparent in TR neurones discharging at rates of 10 imp./sec or more. Effects of the PO/AH-lesion were also seen in that the magnitude of the facilitatory or inhibitory effect of pyrogen was reduced in the PO/AH-lesioned group as compared with the control group. In some TR neurones an antipyretic agent (Sulpyrine, 48--151 mg/kg) was found to abolish responses to pyrogen.

[Clinical studies of PC-904 in pediatrics (author's transl)]

PC-904 was administered to 24 patients: urinary tract infections (7 cases), bronchitis (2 cases), pneumonia (3 cases), brain abscess (1 case), septicemia and the suspected cases (10 cases), and buttock abscess (1 case). The daily dosage varied from 60 to 223.4 mg/kg and averaged 86.9 mg/kg. The drug was administered three times a day by 1-hour drip infusion, and the duration of the treatment averaged 11 days. Clinical results were obtained as excellent responses in 5 cases, good in 13, poor in 4, and unknown in 2, giving 75% of the clinical effectiveness. Bacteriological responses were excellent in 7, good in 2, poor in 2, and unknown in 13, and the overall effectiveness was evaluated as excellent in 2, good in 17, and unknown in 5. Antibacterial activities against clinically isolated bacteria were examined. MIC values of PC-904 were over 100 mg/ml 1 strain of E. coli and 2 strains of Klebsiella, however excellent sensitivities were observed in 3 strains of Ps. aeruginosa and MIC values varied 1.56 to 3.12 microgram/ml at 10(8) of inoculum size and 0.78 to 1.56 microgram/ml at 10(8). As to side effects, diarrhea was observed in 1 case, rash in 2, lowering ob blood pressure in 2, elevation of GOT in 1, and elevation of LDH in 2. Abnormal elevations of GOT (10 cases), GPT (5 cases), A1-P (1 case), LDH (7 cases), and BUN (1 case) were noticed in other patients, but it was considered to be due to underlying diseases.

Abnormal plasminogen. A hereditary molecular abnormality found in a patient with recurrent thrombosis

A patient who suffered a recurring thrombosis over the last 15 yr has been investigated. The only abnormality found in this patient was a significantly depressed level of plasminogen activity in plasma. In spite of the depressed plasminogen activity, the patient was found to have a normal level of plasminogen antigen concentration. It was calculated that the activity per milligram of plasminogen of the patient was approximately one-half the values of normal subjects. The same discrepancy between biological activity and antigen concentration was found in the other members of the kindred. A niece was found to have practically no plasminogen activity but possessed a normal concentration of plasminogen antigen. Both her parents were found to have approximately half the normal plasminogen activity and normal antigen levels. These studies suggested that the molecular abnormality was inherited as an autosomal characteristic, and the family members who had half the normal levels of activity with normal plasminogen antigen were heterozygotes whereas the one with practically no plasminogen activity was homozygote. Subsequent studies showed that the pattern of gel electrofocusing of purified plasminogen of the heterozygotes consisted of 10 normal bands and 10 additional abnormal bands, each of which had a slightly higher isoelectric point than each corresponding normal component. This indicates that plasminogen of the heterozygote is a mixture of normal and abnormal molecules in an approximately equal amount, which was substantiated by active site titration of purified plasminogen preparations obtained from the propositus and a normal individual. The gel electrofocusing pattern of the homozygote consisted of abnormal bands only. The defect is a hereditary abnormality of plasminogen.

Epidemiological studies on patients with a persistent vegetative state

Persistent vegetative state after severe brain damage was studied epidemiologically in 110 cases from 1973 to 1976. The causes of brain damage were varied. More than one-third of the cases were due to trauma, and about one-fifth were the result of vascular accidents. Three year observation revealed that 65% of the patients died during this period. Mean survival time for dead patients was 38 months. Reactivity, clinical signs, EEG findings, methods of management, and results of various trials of treatment were investigated in connection with the patient's prognosis.

IgE-type antibodies to Ascaris antigens in man

IgE antibodies to Ascaris antigens were detected by radioallergosorbent test (RAST) in the serum obtained from a person experimentally sensitized with Ascaris suum antigens prepared from the body fluid of worms. This serum passively sensitized human skin in vitro and histamine release from the sensitized skin was observed by challenge with antigens. The allergenicity of A. suum antigens was present over a very broad spectrum of molecular size. The present results suggest that specific IgE antibodies to Ascaris antigens might be in Ascaris-infected patients and allergic symptoms which belong to type 1 reaction might be mediated by IgE in these patients.

Effects of noradrenaline injected into the brainstem on reflex vasodilatation in the pinna of rabbits

Reflex vasodilation in one ear of a rabbit following radiant heating of the opposite ear was observed by measuring the heat loss by a change in the heat flux when either noradrenaline or porcaine hydrochloride was administered locally into various diencephalic or mesencephalic loci in the brain. Hypothalamic cooling resulted in less reflex vasodilatation, while no vasodilatatory effect was observed immediately after an intravenous administration of atropin sulphate (0.5 mg). Five mug of noradrenaline injected intrahypothalamically either eliminated or reduced the development of reflex vasodilatation to the same extent as did an injection of procaine hydrochloride (0.5 mg). On the other hand, the magnitude of the reflex vasodilatation increased markedly with an injection of either procaine hydrochloride (1.5 mg) or noradrenaline (10 mug) into the reticular formation of the midbrain. Increased reflex vasodilatation was also obtained with a localized administration of procaine hydrochloride into the medial forebrain bundle of the hypothalamus. The results suggest that the noradrenaline in the preoptic/anterior hypothalamic (PO/AH) area and the midbrain reticular formation exerted an inhibitory effect on the action of the neural structure in connection with the heat dissipation system.

A new colimetric assay for monoamine oxidase in serum and its clinical application

A new colimetric assay for serum monoamine oxidase and clinical findings based on this method are described. This rapid, precise procedure employs 1-[(4-aminomethylphenyl)azol]-2-naphthol as a substrate. The enzymatically generated 1-[(4-formyl phenyl)azo]-2-naphthol is extracted into cyclohexane to form a colored solution whose absorbance is determined at 500 nm. The method proved to be extremely simple, and the results obtained correlated well with those given by the standard method of McEwen.

Effects of antipyretics on normothermic rabbits

The effects of antipyretics on the ear skin and rectal temperature (Te and Tre) were investigated in non-febrile rabbits placed in a cold environment or when they were cooled locally in the hypothalamus. Intravenous injections of sulpyrin (25-500 mg/kg) or sodium salicylate (25-100 mg/kg) produced the dose-related increase in Te and slight fall in Tre. Decrease in Te induced by hypothalamic cooling was also reversed by the intravenous injection of antipyretics. Intraventricular injections of sulpyrin and salicylate (0.5-5.0 mg/kg) also caused the vasodilatation of the pinna skin and the fall in Tre. Bilateral microinjections of sulpyrin were made into various areas of the brain stem in order to locate the site of action. The injection sites where the vasodilatatory effect was elicited were the anterior hypothalamus, ventromedial nucleus of hypothalamus and the midbrain reticular formation. The responses elicited from the ventromedial nucleus were usually accompanied by restless and violent struggling. Injection of antipyretics into the mammillary body had no effect on Te. Intrahypothalamic injection of procaine depressed the sulpyrin-induced vasodilatation. These findings suggest that action of antipyretics on the normal body temperature is mediated through anterior hypothalamus and midbrain reticular formation.