Retrospective analysis of the efficacy of cefotaxime sodium dosed twice daily. The Swedish experience

In a Swedish multicenter, comparative, retrospective study, patients with different types of infections--bacteremia-septicemia, genitourinary, intra-abdominal, central nervous system, and lower respiratory tract infections--were randomly selected from the hospital records. Patients treated with cefotaxime twice or three times a day as monotherapy (excluding metronidazole) for at least 1 day (240 cases) were analyzed in terms of clinical and bacteriologic outcome, these results were correlated with the dosing regimen. Similarly high success rates (cure and improvement) at hospital discharge were observed in both group initially treated with cefotaxime 1 g twice daily and 2 g twice daily (97 and 96%, respectively). A total of 73% of patients were initially treated with cefotaxime for only 3 days at most before changing to a lower dose regimen, an alternate intravenous treatment, or oral drug follow-up. Clinical evaluation at hospital discharge revealed a clinical success rate between 87 and 100%, depending on the type of infection.

Biosynthesis of heparin. Different molecular forms of O-sulfotransferases

O-Sulfotransferases involved in heparin biosynthesis were purified > or = 10,000-fold from detergent extracts of mouse mastocytoma tissue by sequential chromatographies on DEAE-Sephacel, heparin-agarose, blue Sepharose, and 3',5'-ADP-Sepharose. The resultant preparation catalyzed the transfer of 35S from 3'-phosphoadenosyl-5'-phospho-[35S]sulfate into N,O-desulfated, re-N-sulfated heparin. Anion-exchange high performance liquid chromatography of disaccharides obtained by deaminative cleavage of the 35S-labeled polysaccharide product revealed O-35S-sulfation at C-2 of L-iduronic acid and at C-6 of D-glucosamine units. SDS-polyacrylamide gel electrophoresis of semipurified enzyme followed by extraction of gel segments and renaturation of proteins consistently showed two distinct fractions of O-sulfotransferase activity, corresponding to proteins of approximately 20 and approximately 60 kDa. The approximately 60-kDa enzyme(s) catalyzed both the 2-O- and 6-O-sulfotransferase reactions, whereas the approximately 20-kDa fraction promoted iduronosyl 2-O-sulfation only. These results are discussed in relation to previous findings, indicating that some of the enzymes involved in heparin biosynthesis catalyze more than one reaction.

Lipid lowering through work stress reduction

Swedish civil servants, who reported considerable stress while working in larger government authorities, were randomized into either a work stress reduction intervention or a control group. Four work units constituted the intervention group (n = 94). and one unit formed the control group (n = 35). Participants in the two groups were of similar age and two thirds were women. Psychosocial, lifestyle, and physiological assessments were made before, during, and after the 8-month intervention period. A significant decrease in apolipoprotein B/apolipoprotein A I ratio (p < 0.05) occurred in the intervention group but not in the control group. No changes were seen in either group in smoking, eating. exercise, relative weight, or other lifestyle factors. which could explain the lipid profile changes. Stimulation from and autonomy over work increased in the intervention group (p < 0.01) hut remained the same in the control group. Results have implications for the efficacy of work stress interventions in decreasing coronary risk.

cDNA cloning and sequencing of mouse mastocytoma glucosaminyl N-deacetylase/N-sulfotransferase, an enzyme involved in the biosynthesis of heparin

A 110-kDa protein involved in heparin biosynthesis in mouse mastocytoma cells was previously shown to express both glucosaminyl N-deacetylase and N-sulfotransferase activity. In this study, the complete nucleotide sequence corresponding to this protein is reported. The mRNA, estimated to contain 3.9 kilobases encodes a protein with an M(r) of 101,092. The predicted domain structure of the protein resembles those of previously characterized Golgi proteins with an N-terminal cytoplasmic tail, a single membrane-spanning domain, and a large catalytic domain linked to the transmembrane domain through a "stem region." Comparison of the deduced amino acid sequence of the mouse mastocytoma protein and a previously cloned similar enzyme from rat liver demonstrated that while large portions of the proteins, corresponding essentially to the putative catalytic domains, were closely related, other portions, in particular in the N-terminal parts, were markedly different. The divergence was not due to species differences since two separate mouse transcripts could be identified that hybridized with probes specific for the two proteins. Also, functional differences were noted since the mastocytoma enzyme, contrary to the liver enzyme, requires a polycation cofactor for expression of N-deacetylase activity. The results are discussed in relation to the structural properties of heparin and heparan sulfate.

Intertribal somatic hybrids between Brassica napus and Barbarea vulgaris - production of in vitro plantlets

Intertribal somatic hybrids were produced between Brassica napus and Barbarea vulgaris. The two species belong to the tribes Arabidae and Brassiceae, respectively, B. vulgaris is known to be cold tolerant and of interest to use as a gene donor to rapeseed. Of the plants produced in five fusion experiments six plants were verified to be hybrids by RFLP analysis utilizing one B. vulgaris-specific repetitive DNA sequence and two nuclear probes (rDNA and cruciferin) as markers. When analysing nuclear DNA content in four of these six hybrids, all had a higher DNA content than B. napus. However, mature plants could not be established outside in vitro conditions, indicating problems with compatibility between the species.

Intertribal somatic hybrids between Brassica napus and Thlaspi perfoliatum with high content of the T. perfoliatum-specific nervonic acid

Protoplast fusions were performed between hypocotyl protoplasts of Brassica napus and mesophyll protoplasts of Thlaspi perfoliatum. The two species are members of the Lepidieae and Brassiceae tribes, respectively, in the family of Brassicaceae. Seeds of T. perfoliatum are rich in the fatty acid C24∶1 (nervonic acid), an oil valuable for technical purposes. In the search for renewable oils to replace the mineral oils, plant breeders have been trying to develop oil crops with a high content of long-chain fatty acids. After fusion of B. napus protoplasts with non-irradiated as well as irradiated protoplasts of T. perfoliatum selection was carried out by flow cytometry and cell sorting. Of the shoots regenerated from different calli 27 were verified as hybrids or partial hybrids using the isoenzyme phosphoglucose isomerase (PGI) as a marker. Another 6 plants were identified as partial hybrids using a T. perfoliatum-specific repetitive DNA sequence. Slot blot experiments were performed to estimate the copy number of the repetitive DNA sequence in the parental species and in the hybrids. In T. perfoliatum there were approximately 10(5) copies per haploid genome, and the range in the hybrids was 1-37% of the value in T. perfoliatum. When the nuclear DNA content of the regenerated shoots was analysed we found partial as well as symmetric hybrids. Even though the rooting and establishment of hybrid shoots in the greenhouse were difficult, resulting in the death of many plants, 19 plants were cultured to full maturity. Seeds obtained from 15 plants were analysed to determine whether they contained nervonic acid, and 5 of the hybrids were found to contain significantly greater amounts of nervonic acid than B. napus.

Urethral reconstruction with a new synthetic absorbable device. An experimental study

Four centimeters of the canine urethra was replaced by a graft consisting of a polyglactin fiber mesh tube, coated with polyhydroxybutyric acid. Microscopic examination 8-12 months later showed almost complete regeneration of the urethral epithelium and the adjacent connective tissue. The neo-urethra was patent and there were no anastomotic strictures, nor was there any inflammatory reaction around the urethra. The validity of this concept in humans remains to be proved.

Muscle ATP and lactate and the release of myoglobin and carbanhydrase III in acute lower-limb ischaemia

Serum-myoglobin and carbanhydrase III (S-CAIII), a specific muscle enzyme, were measured on admission, during surgery and in the postoperative period in 23 patients with acute lower-limb ischaemia and in 21 patients with chronic limb ischaemia in order to evaluate these molecules as possible markers of the degree of clinical ischaemia. The muscle contents of ATP and lactate were determined in muscle biopsies from patients with acute ischaemia on admission. Unlike S-myoglobin and S-CAIII they discriminated between cases which required subsequent amputation from those which did not. Clinical signs of ischaemia were, however, of no value in this respect and there were no correlations between clinical signs or the duration of ischaemia and S-myoglobin or S-CAIII or the contents of ATP or lactate in muscle tissue. The levels of S-myoglobin and S-CAIII correlated well (r = 0.95, p less than 0.0001). In patients who subsequently required an amputation S-myoglobin increased ten-fold (i.e., from 24-48 h postoperatively in acute arterial ischaemia and from 3 h postoperatively in patients with chronic limb ischaemia). In patients with a successful revascularisation S-myoglobin returned to normal levels. It is concluded that in this investigation S-myoglobin had no prognostic value on admission and that S-myoglobin analyses in the postoperative course may be useful for making clinical decisions concerning impending recirculation failures.

Bypass grafting to the popliteal artery in limbs with occluded crural arteries

Intraoperative completion angiograms of 47 femoropopliteal bypasses in limbs with occluded crural arteries were reviewed to identify the angiographic determinants of early outcome. Of 28 limbs in which the foot vessels were available for analysis, only 2 (7%) had an intact pedal circulation, and 18 limbs demonstrated no crural arteries suitable for distal reconstruction. The overall cumulative patency rate was 51% with a 76% limb salvage rate at 12 months. All seven grafts performed onto a popliteal artery segment of less than 8 cm occluded in the early period. The status of crural and foot arteries and the number of collaterals did not correlate well with early patency. Limbs with no patent crural artery that were analyzed in the poor angiographic runoff group, according to our previously reported classification, demonstrated relatively higher patency rates than the other subgroups with poor runoff. In cases where angiography demonstrates a poor runoff for distal revascularization, popliteal bypass with occluded crural arteries might achieve acceptable patency rates.

Efficacy and safety of amikacin in systemic infections when given as a single daily dose or in two divided doses. Scandinavian Amikacin Once Daily Study Group

Two hundred and twenty patients with serious infections verified or suspected to be of Gram-negative aetiology were treated in an open randomized comparative multicentre trial with amikacin 15 mg/kg/day given either as a single dose or in two divided doses at 12-h intervals. Amikacin was administered as a short-term iv infusion. When additional therapy was considered necessary piperacillin or ampicillin was recommended. The trial continues and an interim report on data from the 12 participating Scandinavian hospitals is presented. One hundred and forty-four patients have been evaluated for efficacy and 213 patients for safety. There were no significant differences between the two dosage regimens regarding efficacy and safety. A satisfactory clinical response was recorded in 129 (90%) of the evaluable patients. One serious adverse reaction was seen in a patient in the once-daily group. This was ototoxicity which was superimposed on a long standing hearing defect possibly caused by previous streptomycin therapy.

A simple infusion method for measurement of intraoperative peripheral vascular runoff resistance

A simple infusion system to assess the status of distal runoff was investigated on both hindlimbs of five mongrel dogs. Infusion catheters were placed in the superficial femoral arteries and the origin of the lower leg arteries was exposed for anatomic manipulation of the distal runoff. Saline solution was infused through the superficial femoral arteries at 64, 129, and 193 cm levels to calculate volume flow and index of resistance to flow. The in vitro part of the study was undertaken to analyze the effect of different-size catheters on flow rates in a rigid undistensible model. In the hindlimb study the flow differed significantly between two- and one-vessel runoff status at 50 and 100 mm Hg infusion pressures. In the in vitro study, in contrast to the hindlimb study, index of resistance to flow values for different-size catheters remained almost unchanged as the infusion pressure increased, demonstrating the distensibility of the runoff bed in dogs. A preliminary clinical study in 13 patients undergoing infrainguinal bypass surgery demonstrated a good correlation between angiographic runoff evaluation and intraoperative flow values. Valuable information can be obtained about the status of the distal runoff by this simple infusion method, which might be used to improve the prediction of outcome of infrainguinal bypass surgery.

Natural history of patients with abdominal aortic aneurysm

Factors determining the outcome for patients with abdominal aortic aneurysm (AAA) were analysed in a retrospective population-based study of 187 consecutively diagnosed AAAs at one hospital during a 9-year period. All aneurysms were diagnosed by ultrasound, and those cases that were not primarily operated upon, were followed by repeat ultrasound examinations. An expansion rate of more than 0.4 cm/year was seen in 27% of the aneurysms and a tendency towards a higher rate of expansion could be seen with larger lesions. The overall cumulative rupture rate was 12% at 5 years. For patients with small (less than 5 cm) aneurysms it was 2.5% at 7 years, and no aneurysm could definitively be shown to be smaller than 5 cm at the time of rupture. The rupture risk was significantly higher (28% at 3 years) for larger aneurysms (greater than or equal to 5 cm). The only reliable predictor for rupture was aneurysm size. The overall cumulative survival was 51% at 5 years. Patients with large aneurysms did not have a significantly shorter survival although a tendency for this to be the case was found. There was a significant difference between the proportion of deaths caused by aneurysm rupture in patients with small aneurysms when compared to those with large aneurysms, 5.5 and 53%, respectively. The expansion rate for AAA was highly individual and aneurysm diameter was the only recognisable predictor of rupture. The rupture rate for AAAs smaller than 5 cm was lower than previously reported.

Induction of DNA fragmentation in chronic B-lymphocytic leukemia cells

Chronic lymphocytic leukemia of B cell type (B-CLL) is a neoplastic disorder characterized by the accumulation of small resting lymphocytes in the periphery. The phenotype of these cells suggests that they are "frozen" at an early stage of maturation. Glucocorticoid hormones are commonly used to treat patients with B-CLL, resulting in a reduction in the peripheral lymphocyte count by an undefined mechanism. Here we report that glucocorticoids stimulate DNA fragmentation characteristic of a suicide process known as apoptosis or programmed cell death (PCD) in suspensions of cells from patients with B-CLL. The effects can be mimicked by Ca2+ ionophore and involve a sustained increase in the cytosolic Ca2+ concentration. Specific antibodies binding to membrane-associated IgM on the leukemic cells can also induce PCD by a similar mechanism. Phorbol esters block DNA fragmentation and cell killing in response to all of the agents, suggesting that activation of protein kinase C desensitizes the cells to PCD. Targeting the B-CLL cells with antibodies that induce an unbalanced, sustained Ca2+ increase may therefore represent a rational strategy for the destruction of leukemic cells.

Abdominal aortic aneurysm with perianeurysmal fibrosis: experience from 11 Swedish vascular centers

Case records of 2026 patients operated on because of abdominal aortic aneurysms from 11 Swedish Vascular Centers were reviewed and revealed 98 cases (4.8%) of inflammatory abdominal aortic aneurysm. Also included in this case-control study was an analysis of a randomized group of 82 patients from the same centers who had noninflammatory abdominal aortic aneurysms. Four inflammatory aneurysms were ruptured, compared with 16 in the noninflammatory group (p less than 0.01). A higher proportion of patients with inflammatory abdominal aortic aneurysms had symptoms that led to radiographic investigations. The median erythrocyte sedimentation rate was 39 mm versus 19 mm (26% of patients with inflammatory abdominal aortic aneurysms had erythrocyte sedimentation rates greater than 50 mm; p less than 0.001), and the serum creatinine level was increased in 27 and 8 patients (p less than 0.01) in the inflammatory and noninflammatory groups, respectively. Preoperative investigations revealed ureteral obstruction in 19 patients with inflammatory abdominal aortic aneurysms, of whom 12 had preoperative nephrostomy or ureteral catheter placement. At operation, 20 additional patients exhibited fibrosis around one or both ureters. Although ureterolysis was performed in 19 patients, preoperative and postoperative creatinine levels did not differ between these patients and the conservatively treated ones. Duration of surgery (215 vs 218 minutes), intraoperative blood loss (2085 vs 2400 ml) and complications did not differ significantly between the groups. Overall operative (30-day) mortality was equal (11% vs 12%) but was increased for patients undergoing elective surgery for inflammatory abdominal aortic aneurysms (9% vs 0%; p = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

Expression of a new set of glycolytic isozymes in activated human peripheral lymphocytes

The combination of phorbol 12-myristate 13-acetate (PMA) and concanavalin A induces the expression of a new set of glycolytic isozymes in human peripheral lymphocytes. The induced isozyme for each enzyme tested (hexokinase, phosphofructokinase, enolase, pyruvate kinase and lactate dehydrogenase) is usually the muscle form, which is often associated with rapidly dividing tumor cells. Increases in a specific isozyme can account for the 2-5-fold increase in specific activities of the enzyme induced by Con A plus PMA. Increased specific activities and the appearance of the new isozyme forms both occur relatively late, and are probably associated with the G1 or S phase of the cell cycle.

Angiographic criteria for prediction of early graft failure of secondary infrainguinal bypass surgery

Complete intraoperative postreconstruction angiograms were obtained during 93 reoperations after failed femoropopliteal and femorodistal bypass grafts to evaluate the predictive value of a new method of angiographic runoff assessment. Good runoff was defined as patency of two or three lower leg arteries to the foot, or one patent vessel continuous with an intact anterior or posterior foot arch in femoropopliteal and proximal femorodistal bypasses, and integrity of both arches in low femorodistal bypasses. All other outflow patterns were considered poor. The cumulative 1-year patency rate was 61% with a 79% limb salvage rate after reoperations performed in limbs with good runoff. In reoperations with poor runoff, the patency rate was only 5% with a 22% limb salvage rate. In reoperations with good runoff, and 85% patency rate of vein grafts compared to 43% of prosthetic grafts clearly demonstrated the importance of graft material on early outcome. The improved prediction of early outcome with this new method of angiographic runoff evaluation might allow more rational management of patients with failed infrainguinal grafts.

A new method of angiographic runoff evaluation in femorodistal reconstructions. Significant correlation with early graft patency

In 62 patients undergoing femorodistal bypass surgery, the foot vessel runoff was analyzed with a new grading system based on intraoperative postreconstruction serial angiography. The patients were divided into two groups according to the level of the distal anastomosis (proximal or low). Good runoff was defined as integrity of the anterior and/or posterior foot arch in proximal femorodistal grafts and integrity of both arches in low bypasses. In the proximal group, runoff was classified as poor when the arches were deficient or occluded, and in the low group, when only one arch was intact. The patency rate after 6 months was 81% in the good runoff group, whereas all grafts in patients with poor runoff were occluded. The new method allowed better prediction of the early outcome than does the primary and secondary pedal arch integrity concept.

Prevention of myocardial infarction and stroke in patients with intermittent claudication; effects of ticlopidine. Results from STIMS, the Swedish Ticlopidine Multicentre Study

The Swedish Ticlopidine Multicentre Study (STIMS) was a double-blind placebo-controlled trial designed to determine whether ticlopidine, a platelet antiaggregatory agent, reduces the incidence of myocardial infarction, stroke and transitory ischaemic attacks in patients with intermittent claudication. A total of 687 patients was monitored for a minimum of 5 years or until an end-point was reached. The number of end points (99 vs. 89), analysed according to the intention-to-treat principle, was 11.4% lower in the ticlopidine group (P = 0.24). The mortality rate was 29.1% lower in the ticlopidine group (64 vs. 89, P = 0.015); this observation could be accounted for by a reduced mortality from ischaemic heart disease. On-treatment analysis showed there to be significantly fewer end points in the ticlopidine group (47 vs. 76, P = 0.017). Diarrhoea was the most common side-effect. Reversible leucopenia or thrombocytopenia was reported in seven patients on ticlopidine. It is concluded that the high morbidity and mortality from cardio- and cerebrovascular disease in patients with intermittent claudication can be reduced by long-term treatment with ticlopidine.

Phlebographic evaluation of nonthrombotic deep venous incompetence: new anatomic and functional aspects

The anatomy, valvular function, and reflux patterns in the deep veins of the lower extremities were studied by ascending and descending phlebography in 126 limbs with nonthrombotic deep venous incompetence. The most common patterns were isolated reflux in the superficial femoral vein (51%), and combined reflux in the superficial femoral and the deep femoral veins (44%). Isolated deep femoral vein reflux occurred in 5%. As the degree of reflux in this vein varied considerably, a grading system for classification of deep femoral vein reflux was proposed. Depending on variations in the deep femoral vein anatomy, four different patterns could be distinguished. This study demonstrated that contrast filling of the deep femoral vein during ascending phlebography may indicate the presence of reflux in this vein. Complete visualization of the deep femoral vein is a new diagnostic sign that strongly correlates (p less than 0.001) with reflux in the deep femoral vein. The mean number of valves in the superficial femoral vein was reduced with increasing degree of reflux compared with a reference group consisting of 41 extremities without reflux. The diameter of the popliteal vein was significantly increased in the presence of pathologic reflux, which may indicate that vein wall dilation is a major cause of primary nonthrombotic deep venous incompetence.