Studies on vitamin K-dependent factor deficiency during early childhood with special reference to prothrombin activity and antigen level

8 young infants aged 14 days to 5 months with vitamin K-dependent factor deficiency were studied with special reference to prothrombin activity and antigen level. Among them, 3 infants had congenital bile duct atresia and 5 were breast-fed babies with severe hemorrhagic tendency of unknown cause. In the patients with both congenital bile duct atresia and breast feeding the ratio of prothrombin activity to prothrombin antigen was lower than 0.1. Furthermore, the arc of prothrombin antigen in these patients demonstrated a faster anodal shift than did normal prothrombin antigen on crossed immunoelectrophoresis. This abnormal prothrombin antigen was not consumed after recalcification of patient plasma, and absorbed poorly on BaSO4. In addition, the abnormal prothrombin antigen disappeared from the patient plasma within a few days after parenteral administration of vitamin K. These results suggest that this abnormal prothrombin is PIVKA-II.

Urinary fibrinogen and fibrin fragments in children with renal disease

Fibrinogen fragments (X, Y, D and E) and fibrin fragments (D-dimer and E) were examined in the urine of 52 patients with various types of renal diseases. One or more of the fibrinogen fragments were detectable in all the urine specimens. D-Dimer together with fibrinogen fragments was found in 38 of the 52 patients. The clearance ratio of D-dimer to IgG, which indicates D-dimer generated in the kidney, was lower than 1 in all the patients with the minimal changes nephrotic syndrome, and was greater than 1 in the majority of patients with acute glomerulonephritis, rapidly progressive glomerulonephritis, mesangial proliferative glomerulonephritis and membranoproliferative glomerulonephritis. Our results suggest that urinary fibrin/fibrinogen degradation products (FDP) in renal diseases are derived primarily from increased filtration of FDP from the plasma through a damaged glomerular basement membrane, and that the mechanism of lysis of cross-linked fibrin deposited in the glomeruli occurs simultaneously in some types of glomerulonephritis. It seems that the determination of the clearance ratio of D-dimer to IgG may be useful in assessing the activation of the coagulation and fibrinolysis systems in the kidney in patients with renal diseases.

[Therapeutic effect of ticarcillin against severe infection in patients with hematologic malignancy (author's transl)]

Seventy patients with severe infection accompanying hematologic disorders including leukemia and lymphoma were treated with ticarcillin in combination with aminoglycosides and/or cephem derivatives. Of the 58 patients in whom the efficacy could be evaluated, 17 (29%) responded markedly and 22 (38%) moderately, the effective rate being 67%. Side effects attributable to the treatment were noted: rash in 2, fever and rash in 1, vascular pain in 2 (5 and 7 years of age). Renal and hepatic functions were abnormal in 4 each. However, these abnormal findings were not attributed to ticarcillin. These results indicate that ticarcillin is an effective and safe antibiotic for the treatment of severe infection accompanying hematologic malignancy when used in combination with aminoglycosides and/or cephem derivatives.

Effect of albumin on amylase assay using blue starch polymer

The nature of the stimulation by albumin of amylase activity determined by use of blue starch polymer was studied. The binding of albumin to the starch polymer was responsible for the stimulation of amylase activity, since the stimulation was observed with the albumin-bound blue starch polymer as substrate irrespective of the presence or absence of free albumin in the reaction mixture. When the albumin-bound blue starch polymer was hydrolysed by amylase, the blue oligosaccharide fragments were released with the albumin attached. These oligosaccharide fragments were about 1.3 times larger in average molecular size than the fragments released in the absence of albumin, suggesting that the apparent stimulation of amylase by albumin, (about 1.3 times) is due to the liberation of the larger oligosaccharide fragments.

IgE biosynthesis and IgE-bearing cells in atopic and normal peripheral blood

The authors investigated the number of IgE-bearing cells in atopic and normal peripheral blood as well as IgE produced in vitro by mononuclear cells. The significant correlation between IgE produced in vitro and IgE in plasma (r = 0.91, P less than 0.001) or the number of IgE-bearing cells (r = 0.44, P less than 0.03) was observed. The data suggest that increased plasma IgE level in atopic patients is due mainly to conditions favoring increased production of IgE. The catabolic rate of IgE did not seem to exert an important effect on plasma IgE level.

Transient remission of juvenile rheumatoid arthritis after measles

A 4-year-old Japanese girl with systemic juvenile rheumatoid arthritis had an attack of measles. On the day following the first signs of measles she became afebrile and free of joint pain even though aspirin therapy was discontinued. The remission lasted for 10 days. It appears that the measles virus infection may have been responsible for the brief remission in this patient. The observation of a remission of juvenile rheumatoid arthritis after measles is extremely rare.

[Laboratory and clinical evaluation of cefoxitin in children (author's transl)]

Pharmacokinetics of cefoxitin, a new injectable semisynthetic-cephamycin, was studied in 12 healthy children and also was studied cerebrospinal fluid levels in 1 patient with bacterial meningitis received 44.5 mg/kg of cefoxitin and thoracic fluid levels in 2 patients were measured. Cefoxitin was administered intravenously to 50 patients with various types of infections an average dose of 130 mg/kg/day for an average of 9 days. The results were as follows: 1. Favorable plasma levels were obtained comparing with those off conventional injectable cephalosporins after 15 mg/kg and 25 mg/kg of cefoxitin for one shot intravenous injection. The half lives of cefoxitin in the plasma were about 15.9 minutes up to 1 hour and 25.5 minutes up to 2 hours after an intravenous administration of cefoxitin at a dose of 15 mg/kg, and while, those were 15.9 minutes and 27.5 minutes after an intravenous administration of cefoxitin at a dose of 25 mg/kg, respectively. 2. Cefoxitin was excreted with high concentration up to 2 hours after the administration and thereafter, urinary concentration of cefoxitin declined rapidly with the lapse of time. The time course urinary concentration reflected those of plasma levels. Approximately 94.7% and 90.6% of dosed cefoxitin were recovered in the urine for 6 hours after the administration at the dose of 15 mg/kg and 25 mg/kg, respectively. 3. The cerebrospinal fluid levels of cefoxitin were only determined in a patient of bacterial meningitis. Therefore, further study should be performed. 4. The thoracic fluid levels with 2 patients were higher than cerebrospinal fluid levels. 5. Among the 50 patients with various infections, cefoxitin was clinically effective in 84% and bacterial response in 87%. 6. As adverse reactions, in total 79 patients included exclusive 29 patients, diarrhea occurred in 1 patient, sweating and cough in 1 patient, rash with fever in 4 patients, vascular pain in 2 patients, and leukopenia was observed in 1 patient, eosinophilia in 1 patient, and increase of GOT and LDH were observed in each 2 patients. The other adverse reactions were not experienced.

The insulin secretion of a minced neonatal rat pancreas cultured in a pancreatic chamber, in response to various insulin secretagogues

The minced pancreas of the neonatal rat was cultured for 35 days in a pancreatic chamber which was constructed of a plastic tube and an ultrafiltration membrane. Insulin and amylase secreted from this pancreatic chamber into the culture medium were measured. During the experiment, the concentration of glucose in the culture medium was changed between 5.5 and 16.5 mM at 2-3 day intervals in order to determine the insulin secretory response of the pancreatic tissue. Insulin secretion was markedly increased in response to 16.5 mM glucose. The ratio of insulin secretion to amylase secretion in the culture medium increased with the advance of culture days although secretions of both insulin and amylase decreased individually. On the 7th culture day, short term incubations were performed to test with various insulin secretagogues; obvious insulin release into the incubation medium was observed. These results show that the pancreatic chamber also in vitro secretes insulin rapidly and significantly in response to various stimuli; that by longer culture of a neonatal rat pancreas in this device, insulin secretory cells without exocrine tissue would be obtained without using digestive enzymes; that application of a pancreatic chamber for a pancreatic transplantation may be feasible.

Plasma factor XIII levels in children with renal disease

Plasma levels of coagulation factor XIII determined quantitatively were found to have a tendency to be decreased in more severely affected cases of acute poststreptococcal glomerulonephritis and Henoch-Schönlein nephritis, and found to be decreased in patients with rapidly progressive glomerulonephritis and chronic renal failure in comparison with normal controls. It seems that the degree of decrease in factor XIII reflects the intensity of glomerular damage. In contrast, the patients with the nephrotic syndrome showed significant elevation of plasma factor XIII levels and it was closely correlated with the increase in serum triglycerides. The elevation of factor XIII levels in the nephrotic syndrome is suggested to be mainly attributed to enhanced protein synthesis in connection with urinary loss of proteins.

Selective elimination of motor nerve terminals in the rat soleus muscle during development

1. The pattern of innervation and either frequency of miniature end-plate potentials (m.e.p.p.s) or acetylcholine (ACh) sensitivity was examined in individual fibres of the soleus muscle in new-born rats to elucidate the mechanism of elimination of motor nerve terminals. 2. the number of motor nerve terminals innervating a muscle fibre was judged by the difference in latencies of end-plate potentials evoked by stimulation of the ventral roots L4 and L5. 3. At early developmental stages, about 50% of soleus muscle fibres were usually singly innervated by the L5 ventral root and this nerve to fibre relation did not change throughout the developmental days. In contrast to the L5 root, the L4 root innervated all the muscle fibres polyneuronally at day 6. In day 16 or older animals, the remaining half of the fibres were singly innervated by the L4 ventral nerves. Therefore, it is concluded that the elimination of motor nerve terminals in the soleus muscle occurs selectively only for the L4 ventral nerves. 4. The number of polyneuronally innervated fibres was increased, to some extent, within 2 days after transection of the spinal cord at day 12. It is suggested that the increased polyneuronal innervation following the inactivity produced by cordotomy may reflect the recovery of terminals which had lost function only a short time previously during elimination. 5. Though frequency of m.e.p.p.s increased from day 6 to adult age as previously reported, there was no significant difference in the frequencies between singly and polyneuronally innervated fibres at any age. Cord transection at day 12 caused no change in the frequency. 6. ACh sensitivity observed in singly innervated fibres was similar to that in polyneuronally innervated fibres. Furthermore, cordotomy on day 12 did not induce an increase in ACh sensitivity around the end-plate. It is concluded that the elimination of terminals is not causally related to changes in ACh sensitivity. 7. The possible mechanisms of selective elimination of terminals and the process of elimination are discussed.