[Clinical and pharmacokinetic studies of gentamicin in intravenous drip infusion to children]

Eighteen children with urinary tract infection were treated with intravenous drip infusion of gentamicin (GM), and clinical efficacy and pharmacokinetics were studied. Ages of the patients ranged from 2 months to 12 years. Doses of GM ranged 1.0 to 2.5 mg/kg every 8 to 12 hours, and treatment continued for 4 to 10 days. Among 18 patients treated, clinical results were excellent in 12, and good in 6. Values of BUN and creatinine remained within normal range in all patients during and after the GM treatment. One child had an eosinophilia. There were no cases that showed signs and symptoms of oto- and nephrotoxicity. Twenty eight time-serum level curves were studied in 16 patients during and after intravenous infusion of GM over 30 minutes. Doses were 1.0 mg/kg in 4, 1.9-2.0 mg/kg in 14, and 2.2-2.5 mg/kg in 10. Peak serum levels at 30 minutes after the start of infusion were 2.66-7.38 micrograms/ml (average 5.45 micrograms/ml) in cases receiving 1.0 mg/kg, 4.67-10.8 micrograms/ml (7.26 micrograms/ml) in 1.9-2.0 mg/kg, and 6.16-16.5 micrograms/ml (8.86 micrograms/ml) in 2.2-2.5 mg/kg. Elimination half-lives were 1.75-2.48 hours (average 2.10 hours) in cases with ages less than 1 year, 1.58-2.58 hours (2.01 hours) with 1 to 6 years, and 1.20-3.07 hours (1.66 hours) with 7 to 12 years who were given doses of 1.9-2.5 mg/kg. There were no significant differences in pharmacokinetic parameters between first and last administration in these patients, suggesting that no accumulation occurred with above mentioned doses. Urinary recovery of GM ranged from 21.9 to 99.2 percent (average 62.48%) within 6.5 hours after the initiation of drip infusion.

Assay of ptaquiloside, the carcinogenic principle of bracken, Pteridium aquilinum, by mutagenicity testing in Salmonella typhimurium

The mutagenicity of ptaquiloside, the carcinogenic principle of Pteridium aquilinum, was tested in Salmonella typhimurium TA100 and TA98. Under weakly basic conditions (pH 8.5), ptaquiloside decomposed into a conjugated dienone (considered to be the ultimate form), which was mutagenic in both strains. A novel bioassay, using the pre-incubation method at pH 8.5 with S. typhimurium tester strains was developed for the assay of ptaquiloside extracted from plants. By this bioassay the ptaquiloside content of ferns collected at different localities during various seasons, and in various parts of the plant was determined. The ubiquitous presence of ptaquiloside in fresh plant materials was confirmed. Bracken processed in alkali was found not to contain the carcinogen.

Sequences responsible for erythroid and lymphoid leukemia in the long terminal repeats of Friend-mink cell focus-forming and Moloney murine leukemia viruses

Despite the high degree of homology (91%) between the nucleotide sequences of the Friend-mink cell focus-forming (MCF) and the Moloney murine leukemia virus (MuLV) genomic long terminal repeats (LTRs), the pathogenicities determined by the LTR sequences of the two viruses are quite different. Friend-MCF MuLV is an erythroid leukemia virus, and Moloney MuLV is a lymphoid leukemia virus. To map the LTR sequences responsible for the different disease specificities, we constructed nine viruses with LTRs recombinant between the Friend-MCF and Moloney MuLVs. Analysis of the leukemia induced with the recombinant viruses showed that a 195-base-pair nucleotide sequence, including a 75-base-pair nucleotide Moloney enhancer, is responsible for the tissue-specific leukemogenicity of Moloney MuLV. However, not only the enhancer but also its downstream sequences appear to be necessary. The Moloney virus enhancer and its downstream sequence exerted a dominant effect over that of the Friend-MCF virus, but the enhancer sequence alone did not. The results that three of the nine recombinant viruses induced both erythroid and lymphoid leukemias supported the hypothesis that multiple viral genetic determinants control both the ability to cause leukemia and the type of leukemia induced.

[Pharmacokinetics of amikacin in infants and children]

Twenty-one children, from 41 hours to 12 years of age, were given amikacin (AMK) for suspected bacterial infections. In the 41 hours old newborn infant, the half-life of AMK was 6.9 hours. As infants' ages increase, half-lives of AMK became shorter. The trend toward a shorter half-life in an older child was the most marked during neonatal period. At an age of 7 days, the half-life was shorter than 3 hours. In infants exceeding 6 months of age, ages did not make differences in the length of half-lives. The apparent volume of distribution in newborn was, as average, 350.6 ml/kg body weight. The average for children 5 years and older was smaller, 280.7 ml/kg. The peak level-dose ratio was 2.8 (micrograms X ml-1 X mg-1 X kg) in newborns. There was a tendency that this ratio increased with age. The average ratio for children over 5 years was 4.5 (micrograms X ml-1 X mg-1 X kg). In summary, the 2 remarkable observations obtained from the present study were; 1) The trend that the half-life of AMK shortens as the child grows older was clearest in neonatal period. 2) Peak serum level produced by the same dose per kilogram body weight had a tendency to increase with ages of children.

Inductions of ornithine decarboxylase and DNA synthesis in rat stomach mucosa by 1-nitrosoindole-3-acetonitrile

Administration of 1-nitrosoindole-3-acetonitrile (NIAN) at doses of 40 to 300 mg/kg body weight by gastric intubation to male F344 rats induced up to 100-fold increase in ornithine decarboxylase activity with a maximum after 24 hr and up to 10-fold increase in DNA synthesis with a maximum after 16 hr in the pyloric mucosa of the stomach. These results suggest that NIAN has potential tumor-promoting activity in carcinogenesis in the glandular stomach.

Enhanced immunogenicity of the cultured rat fibrosarcoma KMT-17 by cultivation in a low concentration of fetal calf serum

We examined in different culture conditions alterations in the tumorigenicity and immunogenicity of an A3 clone that had been derived from a rat fibrosarcoma KMT-17. When a fetal calf serum concentration in a culture medium was lowered from 10 to 1%, the tumorigenicity was diminished while the immunogenicity was enhanced in a reversible manner; this was accompanied by a reversible prolongation of the in vitro doubling time. These phenomena were not due to an increase in the quantities of the original tumor-associated antigen and/or of the rat major histocompatibility complex (RT1) but seemed to be due to the appearance of a unique antigen(s) that was detected by an antibody taken from rats immunized with A3 tumor cells cultured in the low fetal calf serum concentration; this antigen(s) may consist of glycoprotein and exist as a crypt antigen(s). These phenomena were measured by an absorption test and flow cytometric analysis. Our observations suggest that the in vitro culture condition of tumor cells, in particular their culturing in the low fetal calf serum concentration medium, modifies the surface of tumor cells and causes a diminishment in their tumorigenicity and an enhancement of their immunogenicity.

Demonstration of herpes simplex 1 virus antigen mouse brain after fixation

The effects of several fixatives and fixation periods on recovery of viral antigen by indirect immunofluorescence (IF) and indirect immunoperoxidase (IP) were examined in mouse brains infected with type-1 herpes simplex virus. In 10% formalin, the sensitivity of antigen detection by IF decreased after one month fixation and viral antigen was barely detectable after fixation for three months. But in 10% buffered formalin antigenicity was not lost after six months. Similar effects were obtained by IP; however, specimens fixed in 10% formalin for three and six months showed positive reactions. Viral antigen was detectable without enzyme digestion in paraffin materials fixed in Bouin's, Carnoy's and Dubosq-Brazil solutions, but when treated with proteolytic enzyme for three hours, antigen could not be detected by either IF or IP. Ten per cent buffered formalin, Bouin's or Dubosq-Brazil solutions are recommended as fixatives for retrospective immunohistochemical and histopathological studies of viral infection in autopsy and biopsy materials.

[Clinical and pharmacokinetic evaluation of cefotiam in neonates and young infants]

Seven neonates and young infants were treated with cefotiam (CTM) in doses ranging from 8-25.6 mg/kg every 6 to 24 hours for 1 to 14 days, and the clinical efficacy and side effects were evaluated. Among 5 infants with bacterial infections including bacteremia, perianal abscess, pneumonia, urinary tract infection and probable sepsis and meningitis, clinical responses were excellent in 1 and good in 4 patients. In the 7 patients, no side effect attributable to CTM was observed. Serum concentrations of CTM were measured in 5 patients administered with 10 to 20 mg/kg of CTM by bolus intravenous injection. Peak serum concentrations of 21.9 to 38.0 micrograms/ml were noted in samples taken at 15 minutes after injection. Serum half-lives of the drug were 2.35 hours in 2 day-old neonate, 0.72 to 0.85 hours in 3 infants of 25 to 37 days, and 8.46 hours in an 18 day-old neonate with renal insufficiency.

Synergistic effects of the myc and ras oncogenes on ganglioside synthesis by BALB/c 3T3 fibroblasts

The effects of oncogene activation on glycosphingolipid (GSL) synthesis by a mouse fibroblast clonal cell line were studied. A transfectant that expressed the activated ras gene showed a definite change in the composition of acidic GSLs, probably an increase in polysialoganglioside, while one that expressed the myc gene showed only a slight change. Neither transfectant grew in soft agar. However, another transfectant, which expressed both the myc and ras genes, and grew in soft agar, showed a more dramatic increase in the acidic GSL component. Thus, activations of the myc and ras oncogenes have a synergistic effect on GSL synthesis during transformation.

Recognition by a natural cytotoxic antibody of lactoneotetraglycosyl ceramide as an antigenic molecule in a syngeneic rat fibrosarcoma

Conventionally bred rats possess in their sera an NA which has a cytotoxic effect on a tumor cell line (KMT-17) derived from a fibrosarcoma induced by 3-methylcholanthrene and which can be absorbed by normal rat tissues. We have succeeded in purifying a glycosphingolipid as an antigen reactive to NA. GSLs isolated from the tumor cells were separated into neutral and acidic fractions. The former fraction was judged to be antigenic as detected by its capacity to absorb NA. The antigenic fraction was further separated into 7 fractions (Frs. A to G) by silicic acid chromatography. The antigenic activity was detected in only Frs.D and E, although Fr.D was a more potent antigen than Fr.E. Chemical and immunochemical analyses showed that both fractions are composed of lactoneotetraglycosyl ceramide (paragloboside), Gal(beta 1-4)GlcNAc(beta 1-3)Gal(beta 1-4)Glc(beta 1-1)ceramide, and that the more active GSL, Fr.D, contains larger amounts of long fatty-acid chains. Inhibition studies using disaccharides and monosaccharides indicated that a N-acetyllactosamine moiety, Gal(beta 1-4)GlcNAc, of the GSL is a specific site of NA. These results suggest that paragloboside is an NA antigen and that a sugar chain portion of this GSL is required for defining specificity while the ceramide portion plays a role in potentiating the antigenicity of this GSL antigen for NA.

[Study on a tumor associated antigen on a rat fibrosarcoma cell line--chemical structure of an antigen reactive to a rat natural antibody]

Conventionally bred rats possess a natural antibody (NA) in their sera, which is cytotoxic in its effect on a KMT-17 tumor cell line derived from a fibrosarcoma induced by 3-methylcholanthrene and can be absorbed by normal rat tissues. We have succeeded in isolating and purifying an antigen reactive to NA from the tumor cells as a glycosphingolipid (GSL). GSLs from the tumor cells were separated into neutral and acidic fractions. The former fraction was judged to be antigenic as detected by its capacity to absorb NA. The antigenic fraction was further separated into 7 fractions, Fr.A to Fr.G, by silicic acid chromatography. The antigenic activity was detected in only Frs.D and E, although Fr.D was a more potent antigen than Fr.E. Chemical and immunochemical analyses showed that both the fractions are lactoneotetraosylceramide (paragloboside), Gal (beta 1-4) GlcNAc (beta 1-3) Gal (beta 1-4) Glc (beta 1-1) ceramide, and that the more active GSL, Fr.D, contains larger amounts of long fatty acid chains. Inhibition studies using disaccharides and monosaccharides indicated that a N-acetyllactosamine moiety, Gal (beta 1-4) GlcNAc, is a specific site of the GSL antigen to NA. These results suggest that a sugar chain portion of this GSL is required for defining specificity and that the ceramide portion plays a role in potentiating the antigenicity of this GSL antigen.

[Effectiveness of cefotaxime in pediatric infectious diseases]

Cefotaxime (CTX) was administered to 117 pediatric patients. Although 26 of these patients were excluded from the clinical evaluation of the study because other antimicrobial agents were given concomitantly with CTX or because no infectious diseases were proved, these cases were evaluated for adverse effects of the drug. The remaining 91 cases were evaluated for clinical effect; pneumonia in 56 cases, septicemia in 5, suspected septicemia in 5, meningitis (aseptic cases included) in 3, urinary tract infection in 5 and other diseases in 17. No pathogenic organisms were identified in any of the pneumonia cases, even either by bacterial culture or other laboratory test methods. Pathogens of septicemia were E. coli in 3 cases, K. pneumoniae in 1 and E. agglomerans in 1. Those of urinary tract infections were E. coli in 3 cases, a mixed infection of S. aureus and an unidentified species of Gram-negative rods in 1, and unknown in 1. Clinical effectiveness rates of CTX were 78.6% in pneumonia and 100% in septicemia, suspected septicemia and urinary tract infections. One patient with purulent meningitis caused by H. influenzae was also treated with CTX successfully. Adverse reactions and abnormal laboratory findings were observed in 12 cases (12/117 = 10.3%); rash in 2 cases, vomiting in 1, abdominal pain in 1, diarrhea in 5, granulocytopenia and thrombocytopenia in 1, eosinophilia in 3 and elevation of liver enzymes (GOT and LDH) in 1.

[Adjuvant BCG immunotherapy for breast cancer (T1N0M0, T2N0M0)]

The present study was performed to evaluate the effect of BCG immunotherapy for breast cancer (T1n0M0, T2n0M0) in nonrandomized series. During a 5-year follow-up study, patients in the BCG-treated group suffered neither recurrence nor death, while the historical control group had 6 cases of recurrence and 5 cases of disease death. As seen in our series, we concluded that breast cancer patients should be advised to accept adjuvant BCG immunotherapy after mastectomy.

[Pharmacokinetic and clinical studies of latamoxef (moxalactam) in neonates and premature infants]

Studies were carried out on the in vivo kinetics and clinical efficacy of latamoxef (LMOX) in neonates and premature infants. The results are summarized below. Serum concentration and T1/2 following intravenous injection of LMOX to neonates LMOX was intravenously administered to neonates as one shot doses of 10 mg/kg and 20 mg/kg. The serum concentration of LMOX showed a dose-response to the 10 and 20 mg/kg doses in each of the 0--3 day-old group, 4--7 day-old group and 8--28 day-old group. The T 1/2 values were as follows; for the 10 mg/kg dose, 5.17 hours in the 0--3 day-old group, 3.28 hours in the 4--7 day-old group and 2.79 hours in the 8--28 day-old group; for the 20 mg/kg dose, 5.58 hours in the 0--3 day-old group, 3.46 hours in the 4--7 day-old group and 3.14 hours in the 8--28 day-old group. Thus, it is seen that the half-life of both dosages decreased as the infants became older. Serum concentration and T 1/2 following intravenous injection of LMOX to premature infants Similar to the case of neonates described above, the concentration of LMOX in the serum of the premature infants showed a dose-response to the 10 mg/kg and 20 mg/kg dosages. The T 1/2 values for the 0--3, 4--7 day-old and 8--28 day-old groups were 7.54, 3.93 hours and 6.25 hours, respectively, for the 10 mg/kg dose, and 10.8, 4.05 hours and 3.23 hours, respectively, for the 20 mg/kg dose. Again, it is seen that the half-life of both dosages decreased as the age of the prematurely-born infants increased. Serum concentration and T1/2 following 1-hour intravenous drip infusion of LMOX to neonates LMOX was administered to neonates in doses of 10 mg/kg and 20 mg/kg, by i.v. drip infusion over a 1-hour period. With both dosages, the peak serum concentration of LMOX occurred at the time of completion of the infusion. The T1/2 values for the 0--3, 4--7 day-old and 8--28 day-old groups were 5.41, 3.68 hours and 1.92 hours, respectively, for the 10 mg/kg dose, and 5.31, 2.67 hours and 4.86 hours, respectively, for the 20 mg/kg dose. Urinary excretion of LMOX in neonates and premature infants. The percentage of the administered LMOX dose contained in the urine excreted during the 6-hour period following intravenous administration of LMOX to neonates and premature infants was determined.(ABSTRACT TRUNCATED AT 400 WORDS)

[Clinical and pharmacokinetic evaluation of ceftazidime in children]

Forty-two pediatric patients were treated with ceftazidime ( CAZ ) in the doses ranging from 45.6 to 120 mg/kg/day for 2 to 10 days, and the clinical efficacy and side effects were evaluated. Among the 37 children with bacterial infections including pneumonia, bronchitis, tonsillitis, croup, cervical lymphadenitis, abdominal abscess and urinary tract infections, the results were excellent in 22, good in 12, fair in 2, and poor in 1 patient with pneumonia. Out of the 42 patients, 5 cases showed eosinophilia, but no clinical sign such as rash, fever or diarrhea, attributable to CAZ was observed during the study. The serum concentrations of CAZ in 4 patients ranged from 60.8 to 71.0 micrograms/ml (mean 66.1 micrograms/ml) at 30 minutes and from 0.5 to 1.2 micrograms/ml (mean 0.8 micrograms/ml) at 8 hours after 20 mg/kg intravenous bolus injection of the antibiotic. The mean serum half-life was 1.42 hours (85 minutes). Patients with impairment of renal function were excluded from this study.

Crystal structure of 3-(adenin-9-yl)propionhistamide hydrochloride monohydrate and the role of protonation in protein-nucleic acid interactions

The three-dimensional structure of 3-(adenin-9-yl)propionhistamide hydrochloride, as a model of interactions between the protonated imidazolyl group and adenine moiety, has been determined by X-ray crystallography. The crystal data are a = 10.314 (1), b = 7.854 (1), c = 20.780 (1) A, beta = 92.765 (4), Z = 4, Dm = 1.32 g X cm-3, space group P2(1)/n. The imidazolium group interacts with adenine moiety by stacking. A comparison with the related neutral derivatives leads to a hypothesis that adenine stacks with the protonated, but not with the neutral, imidazolyl group. Such a characteristic behaviour of the imidazolyl group depending on protonation was shown by ultraviolet and NMR spectroscopy, and by polarographic experiments in solution. We note that a role of the essential histidine in RNAase reaction is a switch between capture and ejection of the substrate, which depends upon proton uptake and its release, respectively.

[Clinical effect of latamoxef on newborn and premature infants]

Eleven infants ranging 2 days to 3 months of age were studied for clinical evaluation. Ten of them were diagnosed as sepsis or suspected to be septic. Another one contracted umbilical infection. In 7 of 10 cases, causative bacteria were detected by blood culture, that is S. epidermidis in 3 cases, E. cloacae in 2 cases, K. pneumoniae in 1 case and A. calcoaceticus in another. Those infants were treated by parenteral LMOX. Dosage was 30 to 75 mg/kg per day. Clinical results were excellent in 6 cases (3 cases of S. epidermidis, 2 of E. cloacae and 1 of K. pneumoniae) and good in another case (A. calcoaceticus). The other 3 infants clinically diagnosed as sepsis but not proven by blood culture were also treated successfully. The result of the umbilical infection in 1 case was good. Another group of 5 infants ranging 4 to 22 days of age were also treated by LMOX because of suspected bacterial infections. With these infants pharmacokinetic study was done. Peak serum levels after 1 hour drip infusion of 20 mg/kg ranged from 43 to 53 micrograms/ml. Average of half-lives was 2.7 hours. Estimation of distribution volume resulted in 350 to 523 ml/kg body weight.

Myocardial protection during cardiac ischemia by coronary perfusion with cold lactated Ringer's solution plus mannitol

This experimental and clinical study evaluates the degree of myocardial protection afforded by coronary perfusion with cold lactated Ringer's solution plus mannitol. In the experimental study, diluted blood at 30 degrees C (Control G.), lactated Ringer's solution at 4 degrees C (G. A), 1,000 ml lactated Ringer's solution plus 200 ml of 20% mannitol at 4 degrees C (G. B), and 1,000 ml lactated Ringer's solution plus 500 ml of 20% mannitol at 4 degrees C (G. C) were used for coronary perfusion. The myocardial-protecting effect of each perfusate was evaluated by examining serum isoenzymes (CPK-MB, LDH1+2), left ventricular function (Vmax, LVEDP, CO), and the ultrastructure of myocardium. there were no significant differences in myocardial changes between the control group, G. A and G. B. Left ventricular enddiastolic pressure increased significantly in G. A and a significant increase in CPK-MB was seen in G. C. Mitochondrial scores for each group were 98 (Control G.), 86 (G. A), 93 (G. B), and 51 (G. C). Minimal myocardial change was seen in G. B. In the clinical study aortic root perfusion with cold lactated Ringer' s solution (400 m Osm) under aortic cross clamping (27-144 min) was employed in 25 patients. They all survived and CPK-MB returned to preoperative values within 49 hours after operation. In 6 cases, the ultrastructure of left ventricular papillary muscle was examined. It was confirmed that no significant mitochondrial changes developed during aortic cross-clamping.

Effects of hypertonic mannitol on renal function in open heart surgery

An extracorporeal bypass was performed in mongrel dogs for 2 hours with or without hypertonic mannitol infusions. In animals given mannitol, the plasma osmolality was elevated maximally to 344 +/- 7.1 mOsm/L and the urine volume was maintained well during bypass. A hypertonic mannitol solution was effective in maintaining the CPAH during and after bypass, but was not effective in minimizing the reduction in Ccr. When the mean arterial pressure during bypass was kept at 60 mmHg, the carbon filling rates in glomeruli showed the favorable effects of mannitol upon renal function, but no effects were observed at a mean arterial pressure of 80 mmHg. In 11 patients who had undergone a bypass lasting more than 2 hrs with mannitol infusions, the plasma osmolality reflected the serum mannitol level and reached 320 +/- 11.0 mOsm/L at 150 min of bypass. The mean urine volume was 5.0 +/- 3.3 ml/min/M2 during the bypass, which was about 7 times as great as before the bypass. The Ccr increased during the first 30 min of the bypass, but it fell to about one half of the initial value after 90 min of the bypass. It was concluded that a hypertonic mannitol solution is effective in maintaining the RPF and urine volume during and after the bypass and that it also preserved the glomerular perfusion even at a low arterial pressure.

[Clinical studies with cefmenoxime in the field of pediatrics]

The present study was performed to evaluate the clinical effectiveness and safety of cefmenoxime (CMX), a new cephalosporin antibiotic for injection in the field of pediatrics. Thirty-one cases, including 2 cases with sepsis, 18 cases with respiratory tract infections and 7 cases with urinary tract infections, were given CMX at daily doses of 30 mg/kg to 125 mg/kg divided into 3 or 4 for 3 days to 13 days. Clinical responses were excellent in 16 cases, good in 9 cases and poor in 6 cases, the satisfactory response being 80.6%. No side effects and no abnormal laboratory findings relating to the drug were observed.

[Clinical results and pharmacokinetics of cefotaxime in newborn infants]

One full-term newborn infant and 2 premature ones were treated with cefotaxime for the treatment of suspected sepsis and umbilical suppurative inflammation. Pathogenic organisms could not be identified in all cases. A good result was obtained with the case of suspected sepsis. But the other 2 cases were not evaluable because underlying diseases such as massive pulmonary atelectasis or respiratory distress syndrome masked the effects of this agent. Serum levels of cefotaxime in 3 of the 4 cases were determined with bioassay. Time courses of the serum levels in 2 of them resulted in peculiar biphasic disappearance curves. This fact implies the possibility that desacetylation of cefroxime proceeds also in newborns as in adults and that desacetyl metabolite accumulates in the body owing to the premature function of the neonatal kidney.

[Evaluation of enzyme multiplied immunoassay technique for gentamicin assay. Comparison with bioassay]

To assess an enzyme multiplied immunoassay technique (EMIT) for determination of gentamicin, comparison was done with a microbiological bioassay. Twenty-nine samples from 5 patients and 1 volunteer were assayed by both EMIT and bioassay methods. Concentrations of gentamicin obtained with EMIT were compared with those with bioassay. Statistical calculation resulted in a regression line with a correlation coefficient of 0.9496, a slope of 0.735 and an ordinate intercept of 0.878. To test the specificity of EMIT, serum controls which contain a constant quantity of gentamicin and a variable quantity of ampicillin concomitantly were assayed for gentamicin concentrations by both EMIT and bioassay. This test demonstrated that EMIT is free from interference of ampicillin while bioassay is vulnerable to interference. To conclude, EMIT proved to be a practical alternative to current bioassays for determination of serum gentamicin concentrations.

[Clinical results of 9, 3"-diacetylmidecamycin dry syrup in the pediatric field (author's transl)]

9, 3"-Diacetylmidecamycin (MOM), a new macrolide antibiotic, was administered to 28 patients: 6 with pharyngitis caused by Group A beta-Streptococcus, 2 with lacunar tonsillitis, 8 with upper respiratory tract infection, 6 with acute bronchitis, 3 with Mycoplasma pneumonia, 1 with primary atypical pneumonia, 1 with pneumonia caused by H. influenzae and 1 with whooping cough. MOM in the form of fine granules was administered at a daily dose of about 20-30 mg/kg divided into 3 doses. Isolated group A beta-Streptococcus strains were eradicated in only 1 out of 6 strain S. One strain of H. influenzae was eradicated. The clinical results could be obtained with 21 cases and the response was excellent in 1 case, good in 7, fair in 3 and poor in 10. Although diarrhea was found in 3 cases during the administration of MOM, it was not clear whether these phenomena were caused by MOM, because of the prevalence of diarrhea among the children treated by us at that time.

[Protective effect of CoQ 10 administration on cardial toxicity in FAC therapy]

An unique combination treatment for cancer patients has been attempted in our department. The treatment consists of 500 rad irradiation of cobalt 60 on the first day and drip infusion of mixture of 50mg adriamycin, 500mg cyclophosphamide and 500mg 5-fluorouracil on the next day. This combination therapy was repeated every 3 weeks. The myocardial intoxication may be a great problem in this therapy. Investigation was performed in 40 cancer patients in order to clarify of Coenzyme Q10 (CoQ10) could show any protecting effect upon the possible myocardial intoxication. All patients were divided into 2 groups; one with CoQ10 of 20 patients, who received CoQ10 of 90mg/day orally and the other without CoQ10 of 20 patients. In the group without CoQ10, cardiothoracic ratio (CTR) and pulse rate increased significantly in all patients and on ECG low voltage of QRS complex was seen in 2 cases, changes of ST-segment, T-wave and appearance of arrhythmia were more than frequent in the group without CoQ10 than that with CoQ10. It is concluded that CoQ10 is effective for protecting the myocardium in this cancer therapy.

Pulsatile venous flow in extracorporeal circulation

Effects of pulsatile venous flow upon the microcirculation were investigated in conditions with different venous pressures by using regional perfusion in dog's hind legs. In animals with venous pressure of -18 cmH2O (Collapsed stage), venous pulsation brought about a significant increase in mean oxygen consumption ratio and suppressed a rise of mean resistance ratio significantly. In animals with venous pressure of +2 cmH2O (normal venous pressure stage), the venous pulsation was effective in a rise of mean oxygen consumption ratio but was not effective in suppression of mean resistance ratio. In animals with venous pressure of +10 cmH2O (congestive stage), no effect of venous pulsation was recognized. We suppose that the intermittent elevation of venous pressure by venous pulsation is effective for opening some capillaries in animals with venous pressure below +2 cmH2O.

[Clinical results of cefotiam in the field of pediatrics (author's transl)]

We have administered cefotiam intravenously to 23 pediatric patients. The daily dose was 13-210 mg/kg. The clinical responses were excellent and good in 20 cases. Excluding 1 case with infectious mononucleosis, the efficacy rate of 90.9% (20/22 cases) was achieved As for side effect, diarrhea and eosinophilia were observed one each in 2 cases. In 2 cases, half lives were 24 and 53 minutes, urinary recovery rates were 88.3 and 91% over 6 hours.

[Clinical results and pharmacokinetics of 6059-S in the field of pediatrics (author's transl)]

6059-S, a new injectable oxacephem antibiotic, has been investigated to give following results. 1. Clinical results Twenty patients were administrated intravenously 20 approximately 124 mg/kg/day of 6059-S for 2 approximately 14 days. Clinical effect was excellent in 5 cases, good in 7, fair in 3, poor in 1, unknown in 3 and except in 1, and efficacy rate was 75%. Side effect was observed only 1 case of discomfort and chill of hand and foot immediately after intravenous injection and no adverse value in laboratory findings was seen. 2. Pharmacokinetics Blood level and urinary excretion of 6059-S single administration were measured in 4 patients with normal renal function and a patient with renal failure. Half life was 1.27 approximately 1.76 hours in 4 patients with normal function and 4.33 hours in a patient with renal failure. Urinary excretion was 43.4 approximately 50.9% up to 4 hours in 2 patients with normal renal function, and it was delayed to 1.0% up to 12.5 hours in a patient with renal failure.

[Clinical results of cefadroxil in children and pharmacokinetics of the drug (author's transl)]

Cefadroxil was administered orally at a daily dose of 30-40 mg/kg to 8 cases of the infection of upper respiratory tract mainly due to beta-hemolytic Streptococcus, and efficacy was obtained in 7 cases, this rate being considered to be satisfactory, though the cases were too few to reach a conclusion. As to pathogens of bacterial infection of upper respiratory tract, beta-hemolytic Streptococcus and Staphylococcus aureus were encountered especially frequently, and in view of antibacterial activity against these 2 bacteria, our results could be approved. Further investigations should be performed carefully, however, to determine if cefadroxil may be a drug of first choice in the treatment of severe bacterial pneumonia and pyothorax. No side effects were observed throughout our treatment, though digestive tract disorders, especially diarrhea, are most frequent in literatures. As to pharmacokinetical characteristic of cefadroxil, almost the same results were obtained to other reports, though our data are insufficient as our experience was limited in only 1 case. Serum levels were determined after 35.7 mg/kg of cefadroxil were administered once orally, and a peak of about 38 mcg/ml appeared 2 hours later, and a high level of about 30 mcg/ml was maintained at 5 hours, though an oral dose was high. Efficacy for large area of bacterial infections may be expected from these serum levels. From urine collected simultaneously, about 74% of cefadroxil was recovered within more than 4 hours. This showed that cefadroxil was well absorbed from digestive tract, and a major part was excreted rapidly through kidney. From the results of our experiment, characteristics of cefadroxil may be summarized as follows. Cefadroxil is absorbed well after oral administration, antibacterial action is fully expected from serum level, a major part is excreted through kidney, and clearance is good. Cefadroxil will be recommended especially for bacterial infections of upper respiratory tract due to beta-hemolytic Streptococcus and Staphylococcus aureus.

Sensitivity of group A streptococci to antibiotics. Prevalence of resistance to erythromycin in Japan

More than 60% of all strains of group A streptococci isolated during the period from 1974 to 1975 from children with streptococcal infections in Hokkaido district, Japan, were highly resistant to erythromycin. These strains were found to be multiply resistant to lincomycin hydrochloride monohydrate, chloramphenicol, and tetracycline, and were exclusively type 12 by T-protein typing. The clinical symptoms produced by these organisms were rather mild, responded to penicillin well, and were rarely complicated with glomerulonephritis. The high prevalence of resistant group A streptococci was nationwide, which may have been related to recent excessive use of erythromycin and other macrolide antibiotics. Erythromycin can no longer be considered the drug of choice in the management of streptococcal infections in Japan. This suggests that a periodic surveillance of antibiotic sensitivity of streptococcal isolates may be necessary in other countries in which macrolide antibiotics are frequently prescribed.

Pharmacokinetics of tobramycin in the newborn

Following an intramuscular dose of 5.0 mg of tobramycin in eight full-term newborn infants, peak levels averaging 2.69 +/- 0.70 microgram/ml were attained after 30 to 60 minutes. The serum half-life thereafter correlated inversely to postnatal age during the first seven days after birth. Pharmacokinetic analysis revealed that in newborn infants the elimination rate was markedly declined, but the absorption rate was nearly the same as that in older children. Average urinary recovery within eight hours was as low as 26.8%, which suggested accumulation of this antibiotic in the renal tissue.