[The potential of anastomosis of the gastroepiploic artery to the left anterior descending artery in coronary artery bypass grafting]

It would be a great contribution in coronary artery bypass grafting (CAGB) using arterial graft (AG) if right gastroepiploic artery (GEA) could be grafted onto left anterior descending artery (LAD) in situ. In this study, we discussed 22 cases where anastomosis of GEA to LAD was made in situ. The subjects were limited to high stenotic cases of > 90% stenosis or more > 75% stenoses recognized in the proximal segment of coronary artery from the anastomosed site. The sex ratio of 18 (male): 4 (female) and the age varied from 40 to 78 years (the mean age: 58 years). The details were 2 cases of single CABG, 6 cases of double CABG, 11 cases of triple CABG and 3 cases of quadruple CABG and 22 GEA's were anastomosed onto 32 vessels. There was no operative death. Postoperative angiography performed on the 21 cases showed the patency of 95.2% (20/21). These finding indicate that the use of GEA is effective for multivessel CABGs in LAD.

Overexpression of the PRAD1 oncogene in a patient with prolymphocytic leukemia with t(11;14)(q13;q32)

Prolymphocytic leukemia (PLL) was diagnosed by morphologic and immunophenotypical studies in a 72-year-old Japanese man. Massive splenomegaly was present but lymphadenopathy was minimal in this case. Chromosomal analysis of peripheral mononuclear cells showed t(11;14)(q13;q32) in all metaphases examined, except for one normal karyotype. Northern blot analysis of RNA prepared from leukemic cells obtained from the patient revealed overexpression of the PRAD1/cyclin D1 proto-oncogene, which has not been described previously in patients with PLL.

Overexpression of the PRAD1 oncogene in a patient with multiple myeloma and t(11;14)(q13;q32)

The t(11;14)(q13;q32) chromosomal translocation is associated with several B-cell lymphoproliferative disorders and is thought to result in upregulation of expression of PRAD1/cyclin D1 proto-oncogene. A patient with multiple myeloma of IgG kappa-type with t(11;14)(q13;q32) is now shown to overexpress PRAD1. The clinical stage of the disease was advanced (IIIA), with a myeloma cell count of 94.6% in the bone marrow. Chromosomal analysis of bone marrow cells showed t(11;14)(q13;q32) in five of 20 metaphases as well as other karyotypic features. Northern blot analysis of RNA prepared from myeloma cells revealed overexpression of PRAD1. Multiple myeloma with t(11;14)(q13;q32) has been associated with an aggressive clinical course. Although neither myeloma cells in the peripheral blood nor extramedullary lesions were apparent in the present patient, the myeloma was refractory to several chemotherapeutic regimens from the beginning. Detection of PRAD1 expression may offer an easier alternative to cytogenetic analysis in myeloma and is a potentially useful indicator of a poor prognosis.

[Coronary artery bypass with free arterial grafts]

Between October 1988 and October 1993, we experienced 15 cases of free arterial grafting for coronary artery bypass (11 men, 4 women: age range from 42 to 75 years). The bypass grafts were used 11 right internal thoracic artery (RITA), 4 right gastroepiploic artery (RGEA), and 1 left internal thoracic artery (LITA). There were no surgical complications by using free arterial graft. The patency rate at one month after operation was good (86.7%, 13/15 anastomoses). Sites of proximal anastomosis were ascending aorta in all patient. These results indicated that free arterial graft is usefull for multiple coronary artery bypass by arterial graft.

[Sequential coronary artery bypass using right gastroepiploic artery]

Between January 1989 and March 1993, sequential coronary artery bypass grafting using the right gastroepiploic artery (RGEA) were performed in seventeen patients. Seven patients were anastomosed from left anterior descending artery to diagonal artery. Six patients were anastomosed from right coronary artery to left circumflex artery. Two patients were anastomosed from right coronary artery to left anterior descending artery. Two patients were anastomosed to two branches of left circumflex artery and one patient was anastomosed from right coronary artery to two branches of left circumflex artery. Postoperative angiograms were performed sixteen patients and patency rate was 93.9% (31/33 anastomoses). There were no early death, and all patients were free from angina. In situ anastomoses with the most of the coronary arteries could be performed, by using sequential RGEA grafting. These results indicated that sequential RGEA grafting is useful for multiple coronary artery bypass grafting by arterial graft.

[Clinical studies on cefprozil granules in pediatrics]

Cefprozil (CFPZ, BMY-28100) granules was administered to a group of pediatric patients. The new oral cephalosporin, CFPZ, was evaluated clinically in 42 pediatric patients, and a pharmacokinetic study was performed in 6 patients. Serum and urinary concentrations of CFPZ were determined in 6 patients who were given single dose of 7.5 or 15.0 mg/kg. Serum concentrations were determined at 1, 2, 3, 4 and 6 hours after dosing. Urinary concentrations were measured for periods of 0-6 hours after dosing. With oral administrations of 7.5 mg/kg and 15.0 mg/kg, peak serum concentrations were 2.13 micrograms/ml and 6.22 micrograms/ml, respectively, at 2 hours, and biological half-lives were 1.06 hours and 1.36 hours, respectively. Urinary recovery rates were 44.8% and 56.1%. The clinical evaluation was conducted in 41 patients including 16 patients with acute tonsillitis, 8 patients with lacunar tonsillitis, 4 patients with scarlet fever, 3 patients with acute bronchitis, 1 patient each with pertussis, furuncle, impetigo and lymphadenitis, and 6 patients with urinary tract infections. The ages of the patients were 10 month to 11 years 1 month, and they were treated with CFPZ at doses ranging 9.0-45.0 mg/kg daily for 3-14 days, the overall clinical efficacy rate was 92.7%. An eradication rate of 79.2% was achieved for 28 strains of 8 species identified in the patients. No side effects were observed. Abnormal laboratory test results obtained were eosinophilia in 2 patients.

[Removal of infected pacemaker leads using lead removal kit (Cook Pacemaker Corporation)]

A new technique for effective removal of chronic transvenous pacemaker lead was developed to address the need for explantation of eroded and infected lead (Lead Removal Kit, Cook Pacemaker Corporation). This Kit consists of a stylet for locking at the distal tip of the lead and a sheath for separating adhering fibrous tissue. Successful removal of 3 leads in 2 patients using this kit was reported.

[Studies of flomoxef in neonates]

Studies on pharmacokinetics and clinical effects of flomoxef (FMOX), a parenteral oxacephem antibiotic, were carried out in neonates. The results obtained are summarized as follows. 1. Mean peak serum concentrations of FMOX upon single administrations at doses of 20 mg/kg and 40 mg/kg were 33.3 +/- 7.33 micrograms/ml and 68.9 micrograms/ml, respectively. 2. Mean urinary recovery rates of FMOX in the first 6 hours after administration of the above doses were 35.2% and 48.3%, respectively. 3. FMOX was administered to 4 cases including 1 prophylactic case, 1 case each with aspiration pneumonia and sepsis, hypodermic abscess of the head, and itrauterine infection, at a dose of 20-30 mg/kg 2 or 3 times a day. Clinically, excellent results were obtained in 3 cases including an methicillin-resistant Staphylococcus aureus case. 4. No side effects nor abnormal laboratory test results were observed.

[Pharmacokinetic and clinical evaluation of cefpirome in the pediatric field]

Pharmacokinetic and clinical evaluations of cefpirome (CPR), a newly developed cephalosporin, were performed in the field of pediatrics. The results are summarized as follows. 1. Peak serum concentrations of CPR after a dose of 20 mg/kg via 30 minutes and that via 60 minutes intravenous drip infusion and a dose of 40 mg/kg via 60 minutes intravenous drip infusion were 80.8, 63.7 and 128.8 micrograms/ml, respectively, with half-lives being 1.41, 1.28 and 1.79 hours, respectively. Urinary excretion rates for CPR in the first 6 hours after administration ranged 66.7-77.1%. 2. The clinical efficacy rate in pediatric infections obtained at daily dose levels ranging 55.6-166.7 mg/kg was 95.7%. 3. The eradication rate for 22 strains identified in the study was 95.5%. 4. Side effects were found in 2 cases of diarrhea. The abnormal laboratory test results were observed in 5 cases with 7 test items (increased number of platelets; 2 cases, increased activity of GOT; 2 cases and increased activity of GPT; 1 case). According to these results, CPR was considered to be a useful antimicrobial agent in pediatric infections.

[Bacteriological, pharmacokinetic and clinical evaluations of cefpirome sulfate in the pediatric field. Pediatric Study Group of Cefpirome]

A research group was organized with the purpose of making basic and clinical studies on cefpirome sulfate (HR810, CPR), a newly developed cephalosporin antibiotic, in the pediatric field. Through meetings a joint research was done involving 19 key institutions and their related facilities throughout Japan. The obtained results are summarized as follows. 1. Antibacterial Activities Minimum inhibitory concentrations (MICs) were determined against 71 Gram-positive and 110 Gram-negative bacteria in the present clinical trials. CPR showed antibacterial activities 2-16 times higher than those of ceftazidime (CAZ) against Staphylococcus aureus and other Gram-positive bacteria including MRSA. Against Gram-negative bacteria, CPR showed a somewhat broad range of distribution in MIC against Branhamella catarrhalis, while the antibiotic inhibited the growth of all the strains of Escherichia coli and Haemophilus influenzae at concentrations no more than 0.10 and 0.20 micrograms/ml, respectively. 2. Blood Concentrations and Urinary Excretion Rates The pharmacokinetics in pediatric patients was investigated with a dose of 20 mg/kg in most cases via one shot intravenous injection or 30- and 60-minute intravenous drip infusion. Mean blood concentrations of CPR at 15 minutes after one shot intravenous injection of 10, 20, and 40 mg/kg were 51.2, 70.5, and 123.5 micrograms/ml, with half-lives of 1.21, 1.39, and 1.53 hours, respectively. Urinary excretion rates in 6 hours were 63.6, 66.0 and 71.6%, respectively for the 3 dose levels. After 30- and 60-minute intravenous drip infusions at the same dose, the pharmacokinetic parameters observed were similar to those obtained with one shot injections. 3. Concentration in the Cerebrospinal Fluid CPR penetrated well into the cerebrospinal fluid in patients with purulent meningitis and levels of 1.85-24.2 micrograms/ml 45-60 minutes were achieved after intravenous injection at a dose of 40-80 mg/kg, the penetration rate of CPR was at an intermediate degree compared with other cephalosporin antibiotics. 4. Clinical Results Clinical efficacies of CPR on infectious diseases were analyzed in 454 plus 3 cases which were complicated with other infectious diseases, hence totaling 457 cases out of 499 cases originally chosen for clinical evaluation. The remaining 45 cases were excluded from the clinical evaluation. As for the clinical efficacy, CPR was found to be effective (good or excellent) in 430 (94.1%) of the 457 cases. CPR was found to be effective in 243 (95.3%) of 255 cases for which causative bacteria were identified. The efficacy rate was 92.6% (187 of 202) in those cases in which causative bacteria were not identified.(ABSTRACT TRUNCATED AT 400 WORDS)

[Clinical studies on cefdinir granules in pediatric field]

Cefdinir (CFDN, FK482) granules, a new oral antibiotic for children, were given to children with infections. The results obtained are summarized as follows. 1. The plasma level of CFDN peaked at 0.38-0.88 microgram/ml in 2-3 hours after administration of the drug at a dose of 3 mg/kg. Meanwhile, the plasma level peaked at 1.85 micrograms/ml in 3 hours after administration of 6 mg/kg. The plasma level was higher in the 6 mg/kg group than that in the 3 mg/kg group, thus a dose response was clearly observed. 2. The 8 hour urinary excretion accounted for 10.3-17.4% of administered amount of the drug in children with 3-6 mg/kg dosage. 3. CFDN granules were administered to a total of 42 children with upper or lower airway infections or with urinary tract infections at daily doses of 9.0-20.7 mg/kg in 3 divided portions. The clinical efficacy was "excellent" in 28 patients, "good" in 13, and "fair" in 1, hence an efficacy rate of 97.6% was obtained. 4. Bacteria identified from various diseases were 29 strains of 9 species, and the eradication rate was 82.8%. 5. No. side effects were noted in any of the children. Laboratory test results showed an abnormality in 1 case each with a rise of platelet count and eosinophilia.

[Pharmacokinetic, bacteriological and clinical studies in the pediatric field on norfloxacin]

We have evaluated norfloxacin (NFLX), a fluoroquinolone agent, in tablet form for its efficacy and safety in the field of pediatrics. 1. Mean serum concentrations of NFLX following oral administration to 3 children at dose levels of 3.2 mg/kg, 3.7 mg/kg and 5.4 mg/kg were, respectively, 0.7 microgram/ml, 0.18 microgram/ml and 0.64 microgram/ml at 2-4 hours. Mean serum half-lives (T1/2) of NFLX were 2.5-2.9 hours and mean urinary recovery rates in the first 6 hours after administrations were 7.1-30.7%, depending on dose levels. 2. Antibacterial activities of NFLX against clinically isolated 30 organisms from children were determined. MIC of NFLX against Staphylococcus aureus was similar to that of ABPC, 0.39-25 micrograms/ml. MIC of NFLX against Escherichia coli was approximately less than or equal to 0.10 microgram/ml. This MIC value was lower than other antibiotics. MIC of NFLX against Vibrio parahaemolyticus was less than or equal to 0.10 microgram/ml. 3. NFLX was administered to 30 patients (7 patients with Salmonella enteritis, 7 patients with Campylobacter enteritis, 5 patients with other enteritis, 1 patient with bacillary dysentery, 8 patients with urinary tract infection, 2 patients with skin soft tissue infection). The clinical responses of these 30 patients were as follows; excellent: 24 patients, good: 4 patients. The efficacy rate was 93.3%. 4. The bacteriological efficacy rate of NFLX against clinically isolated 29 organisms from children was 75.9%, including 3 cases in which other antimicrobial agents had been ineffective. Especially against Salmonella spp. was superior to other agents tested. 5. Neither clinical adverse reaction nor abnormal laboratory data was found in any of these 33 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Studies of aztreonam in neonates]

Absorption and excretion of aztreonam (AZT) in neonates were studied and its clinical evaluation in 10 cases of neonates was performed using 1 hour intravenous drip infusion. 1. Serum concentrations of AZT in 7 neonates younger than 11 days of age were lower than those in infants. 2. Serum concentrations of AZT in 5 neonates given 20 mg/kg reached their peaks at the end of intravenous drip infusion with an average value of 45.8 +/- 10.41 micrograms/ml, and T 1/2 was 2.77 +/- 0.32 hours on the average. 3. Serum concentrations of AZT in 2 neonates given AZT 25 mg/kg reached their peaks at the end of intravenous drip infusion at 31.1 and 33.4 micrograms/ml with little difference from the 20 mg/kg group. Half-lives of serum AZT in the 2 cases were 1.87 hours and 3.23 hours, respectively. 4. Urinary excretion rates of AZT in 7 neonates younger than 11 days of age in the first 6 to 8 hours after the administration were 18.8 to 50.0%, or 31.7% on the average, which was lower than the average excretion rate found with infants. 5. All the cases given AZT showed clinical results rated better than "effective". Effect of AZT was excellent on 3 UTI cases caused by Escherichia coli and Klebsiella pneumoniae, but bacterial replacement (superinfection) of Enterococcus faecalis was observed when AZT was administered. 6. Transient elevations of GOT and GPT were seen in 2 cases when AZT administration was continued at length. Clinical side effect was not observed. 7. The most appropriate dosage and administration scheme of AZT against Gram-negative infections in neonates seems to be 40-60 mg/kg/day, b.i.d. or t.i.d.

[Evaluation of norfloxacin in the pediatric field. Pediatric Study Group for Norfloxacin]

Norfloxacin (NFLX, AM-715), a new quinolone antibiotic agent, was evaluated clinically and bacteriologically for its efficacy and safety in pediatrics by a study group organized with pediatricians from all over the country. A summary of the results of the evaluation is as follows. 1. Incidence of NFLX-resistant strains (MIC over 12.5 micrograms/ml) isolated from children with various infections was 1.6% (8/512). One resistant strain was observed among 45 isolates of Staphylococcus aureus, and none among 30 isolates of Pseudomonas aeruginosa. 2. After single oral administration of 1.5-2.9, 3.0-4.8 and 5.1-6.1 mg/kg NFLX in tablet form at fasting, mean peak values of serum concentration of 0.37, 0.56, 0.92 micrograms/ml, T1/2 of 2.5, 2.6, 2.6 hours and urinary recovery rates in 8 hours at 25.3, 25.3, 27.1% were observed, respectively. 3. Clinical effects were studied chiefly in intestinal and urinary tract infections. Among 317 patients from whom pathogens had been isolated, responses to the treatment were excellent in 187, good in 79, fair in 9, poor in 7, and unknown in 35 cases. The overall efficacy rate was 94.3% (266/282) and the efficacy rate for excellent responses was 70.3% (187/266). Among all the 406 patients treated, including those with undetermined pathogens, responses were excellent in 233, good in 106, fair in 11, poor in 11, and unknown in 45 cases. The overall efficacy rate was 93.9% (339/361). 4. Clinical effects of NFLX classified by diseases with identified pathogens were 81.8% (9/11) for acute pneumonia, 80.8% (21/26) for other respiratory infections, 95.8% (23/24) for bacillary dysentery, 98.6% (70/71) for Campylobacter enteritis, 100% (24/24) for Salmonella enteritis, 100% (6/6) for other acute enteritis and 98.1% (104/106) for urinary tract infections. Including other infections as high as 94.3% (266/282) of efficacy rate was obtained in total. There was no significant difference in NFLX efficacies between unidentified and identified pathogens. Thus, the total clinical efficacy rate was 93.9% (339/361). 5. The total eradication rate of 325 pathogens evaluable was 84.3%, with identical eradication rates for Gram-positive cocci (GPC) (43/51) and for Gram-negative rods (GNR) (231/274). 6. The optimal daily dose of NFLX seemed to be in a range between 6.0 and 12.0 mg/kg, and the optimal duration of treatment to be 7 days for children over 5 years old. 7. The clinical efficacy in treating P. aeruginosa infections in 12 patients was 100% (11/11) and the eradication rate was 83.3% (10/12).(ABSTRACT TRUNCATED AT 400 WORDS)

[Pharmacokinetic and clinical studies on cefmenoxime in newborn infants]

Pharmacokinetic and clinical studies on cefmenoxime (CMX) were performed in infants given by the drug intravenous drip infusion or one shot intravenous injection. The results obtained are summarized as follows. 1. Serum concentrations of CMX in infants given CMX at 10 mg/kg by intravenous drip infusion peaked at 12.0 to 26.5 micrograms/ml at the termination of the administration, and the levels were 8.62 to 26.3 micrograms/ml in 1 hour after dosing. Half-lives were 2.9 to 3.8 hours. 2. Serum concentrations of CMX in infants given the drug at 20 mg/kg by the same manner for 30 minutes to 1 hour peaked at 40.8 to 74.3 micrograms/ml at the termination of the administration, and drug levels decreased to 17.6 to 45.4 micrograms/ml in 1 hour after dosing. Half-lives were 0.8 to 2.7 hours. Those of CMX in infants given the same dose by one shot intravenous injection peaked at 61.7 to 90.6 micrograms/ml immediately after dosing, and decreased to 22.3 to 48.2 micrograms/ml at 1 hour. Half-lives were 1.2 to 2.7 hours. 3. As described above, dose-response was observed between the doses of 10 mg/kg and 20 mg/kg. 4. Urinary recovery rates were 2.6 to 47.7% during the first 6-8 hours in most of 1 to 2 day-old infants, and 17.6 to 72.4% in most of 5 day-old or older ones. 5. Twelve infants with various bacterial infections were given CMX by intravenous injection or drip infusion. Clinical efficacies of CMX were excellent or good in all the 9 infants with pneumonia, septicemia, amniotic fluid-aspiration syndrome or intra-placental infection etc., while 3 cases were excluded: 1 each with congenital syphilis (0 day old), acute bronchitis (56 days old) and whooping cough (54 days old). 6. Dosages of CMX used in the present study were 33 to 79 mg/kg/day, and durations of treatment ranged from 4 to 13 days. No abnormal laboratory test values were observed. Moreover, neither systemic nor local adverse effects attributable to CMX were encountered in any of the infants.

[Clinical studies on cefteram pivoxil granules in pediatrics]

A newly developed cephalosporin, cefteram pivoxil (CFTM-PI, T-2588), was evaluated clinically in 40 patients. A pharmacokinetic study was also performed with 8 patients. CFTM-PI was administered as granules. One patient was given CFTM-PI at a dose of 1.5 mg/kg, each of 3 patients was given the drug at a dose of 3 mg/kg and each of 4 patients at a dose of 6 mg/kg. In most cases, serum concentrations of CFTM were determined at 2, 3, 4, and 6 hours after dosing. Urinary concentrations of CFTM were measured for urinary samples collected during periods of 0-2, 2-4, 4-6 and 6-8 hours after dosing. CFTM was assayed using the disk or the cup method using Klebsiella pneumoniae ATCC 10031 as the test organism. The clinical evaluation was conducted in 40 children including 13 patients of acute tonsillitis, 10 of acute lacunar tonsillitis, 10 of scarlet fever, 2 of acute bronchitis, 2 of pneumonia, and 1 each of pneumonia with enteritis, phlegmon and urinary tract infection. The patients were from 4 months to 13 years old. Daily doses were from 8.7 to 12 mg/kg. After CFTM-PI administration in doses 1.5 mg/kg, 3 mg/kg and 6 mg/kg, peak serum concentrations of CFTM were 0.38 microgram/ml, 0.73-2.25 micrograms/ml and 1.2-2.9 micrograms/ml, respectively, and half-lives were 1.55, 0.95-2.30 and 0.80-2.72 hours, respectively. Urinary excretion rates up to 6 or 8 hours after dosing were 10.8-24.7%. Clinical efficacies of CFTM-PI in 40 patients were "excellent" in 27 children, "good" in 12 children and "fair" in 1 with an efficacy rate of 97.5%. Twenty seven strains of causative organisms, including 15 strains of Streptococcus pyogenes, 1 of Escherichia coli, 1 of Salmonella 04, 6 of Haemophilus influenzae, 1 of Haemophilus parainfluenzae and 3 of Branhamella catarrhalis, were isolated. After treatment all strains except 1 strain of B. catarrhalis (unchanged), Salmonella 04 (unknown) and 1 strain of H. parainfluenzae (unknown) were eradicated. Side effects observed clinically were only 1 case of diarrhea. Eosinophilia was observed in 1 case.

[Evaluation of cefpodoxime proxetil in the pediatric field]

Pharmacokinetic and clinical evaluation of cefpodoxime proxetil (CPDX-PR, CS-807) were performed in the field of pediatrics. The obtained results are summarized as follows. 1. Peak serum concentrations of CPDX upon single oral doses of 3.0 mg/kg and 4.4 mg/kg of CPDX-PR were 1.26-1.46 micrograms/ml and 1.45 micrograms/ml, respectively, achieved at 4 hours and 1 hour after administration. Urinary excretion rates for CPDX in the first 8 hours ranged between 28.1 and 30.2%. 2. Clinical efficacy rates for pediatric infections obtained at single dose levels ranging 3 to 6 mg/kg were 97.5%, and that at a single dose of 1 mg/kg were 90.9%. 3. Bacteriological effectiveness was determined in 45 strains identified in recent cases. Eradication rates for these bacteria at dose levels of 3 to 6 mg/kg and 1 mg/kg were 91.3% and 95.5%, respectively. 4. No side effect nor abnormal laboratory test data were found in any of the cases examined. From these results, CPDX-PR appeared to be a useful antibiotic agent in the field of pediatrics.

[Bypass operation adaptable to stature increase in child with atypical coarctation of the aorta]

A 9-year-old girl was admitted with hypertension and severe congestive heart failure. Upon physical examination, a discrepancy of blood pressure between arm and leg was noted. Aortography revealed narrowing about 5 cm in length at the midportion of the descending thoracic aorta. Bypass operation of the narrow segment was performed under mild hypothermia with the diagnosis of atypical coarctation of the aorta. It was supposed that the patient might outgrow the graft and the graft would become too small for grown-up patient in diameter and length, then the haemodynamics would become less satisfactory and too much tension on the suture line would occur. A woven Dacron graft, 10 mm in diameter, 15 cm in length, was anastomosed proximally and distally to the coarcted segment at a distance of about 6 cm. So, the graft was disposed in a C-shaped configuration. It was expected that the arch of the graft would open more widely with increase of her stature, even if the graft does not increase in length. She has been followed for twelve years. Hypertension of upper extremity and arm-to-leg gradients of the systolic blood pressure were recognized from two years after the operation, particularly with exercise. However, cardiomegaly and left ventricular hypertrophy in ECG were improved. She appears to have been developing normally with no cardiac symptoms. Estimating from angiography, the distance between proximal and distal anastomoses stretched about 2 cm during the period of rapid growth, though calcification of the graft had been seen from four years after the operation, perhaps due to increased calcium turnover in childhood.

[Pharmacokinetic and clinical studies on cefodizime in the pediatric field. Pediatric Study Group of Cefodizime]

A multi-center open study was conducted to investigate cefodizime (CDZM), a newly developed cephem antibiotic, from pharmacokinetic, bacteriological and clinical aspects, in the pediatric field with the participation of 17 institutions and their related facilities. The results are summarized as follows: 1. Serum concentrations and urinary excretion: The pharmacokinetics in pediatric patients was investigated with a dose of 20 mg/kg, via a bolus intravenous injection or intravenous drip infusion over 30 or 60 minutes. The results were nearly the same as those in adult patients. Mean serum concentrations 5 minutes after a bolus intravenous injections were: 105.5, 264.0 and 461.7 micrograms/ml with 10, 20 and 40 mg/kg, respectively, and T 1/2 (beta)'s for the 3 dosages were 1.75, 1.92 and 1.88 hours, respectively. With 30-minute intravenous drip infusion, mean serum concentrations at the end of infusion were: 90.5 micrograms/ml with a dose level of 10 mg/kg, 178.3 micrograms/ml with 20 mg/kg, and 322.8 micrograms/ml with 40 mg/kg, and T 1/2 (beta)'s for these dosages were 1.90, 2.15 and 1.93 hours, respectively. With 60-minute intravenous drip infusion, mean serum concentrations at the end of infusion were: 66.3 micrograms/ml with a dose level of 10 mg/kg, 136.0 micrograms/ml with 20 mg/kg and 259.2 micrograms/ml with 40 mg/kg, and T 1/2 (beta)'s for these dosages were 1.43, 2.05 and 1.46 hours, respectively. In 8 hours after administration of CDZM, urinary excretion rates were 82.1, 77.7 and 76.5% for bolus intravenous injections of 10 mg/kg, 20 mg/kg and 40 mg/kg, respectively, and 83.3, 71.3 and 68.1% for 30-minute intravenous drip infusions of 10 mg/kg, 20 mg/kg and 40 mg/kg, and 84.4 and 84.3% for 60-minute intravenous drip infusions of 20 mg/kg and 40 mg/kg, respectively. 2. Concentrations in cerebrospinal fluid: Penetrations into cerebrospinal fluid in patients with purulent meningitis reached levels of 1.96-9.48 micrograms/ml with administration of CDZM at 50 mg/kg in acute cases within 6 days after onset. The penetration rates of CDZM were about a median range among injectable beta-lactam agents. 3.

CLINICAL RESULTS

Of 457 cases treated with CDZM, 53 cases were excluded from the clinical evaluation. Clinical efficacies were evaluated as "excellent" in 126 and "good" in 78 out of 221 case from which causative agents were isolated, with an efficacy rate of 92.3%. Efficacies were "excellent" in 97 and "good" in 69 out of 183 cases from which pathogens were not isolated giving an efficacy rate of 90.7%.(ABSTRACT TRUNCATED AT 400 WORDS)

[Clinical and pharmacokinetic studies on intravenous administration of sulbactam/ampicillin in pediatrics]

Intravenous administration of sulbactam/ampicillin (SBT/ABPC) was evaluated in pediatric patients. The serum half-lives of both ABPC and SBT were approximately 1 hour following the intravenous injection or intravenous drip infusion of 20-35 mg/kg, and 30-50% of ABPC and 30-70% of SBT were recovered in the urine 6 hours. Cerebrospinal fluid concentrations of ABPC and SBT were 0.76 and 0.68 micrograms/ml, respectively, at 1 hour after intravenous drip infusion of the 58 mg/kg, and concentration ratios of the drugs in cerebrospinal fluid/serum were 6.39 and 5.71%, respectively. Thirty-four pediatric patients were treated with intravenous drip infusion of SBT/ABPC in doses ranging from 54 to 150 mg/kg divided into 3 times a day. The rate of clinical efficacy was 93.5% and the bacterial elimination rate was 92.3%. The synergistic activity of sulbactam with ampicillin was demonstrated against beta-lactamase-producing Staphylococcus aureus and Haemophilus influenzae isolated from patients in the present study. The side effects of SBT/ABPC were observed in 6 patients (5 diarrheas; 1 diarrhea with vomiting) out of 34 patients administered. Eosinophilia (2 patients) and a slight elevation of GOT (1 patient), GPT and LDH (1 patient) were observed. The tolerance to the therapy, however, was good.

[Pharmacokinetic, bacteriological and clinical studies in the pediatric field on clarithromycin]

Pharmacokinetic, bacteriological and clinical studies were carried out on clarithromycin (TE-031, A-56268) in the pediatric field and following results were obtained. 1. Peak concentrations of TE-031 in the serum occurred at 1-2 hours after administration of 10 mg/kg in granular form and at 2 hours after administration of 20 mg/kg in granular form. Half-lives of the drug in serum were 2.5-3.3 hours in cases of 10 mg/kg dosage and 5.5 hour in case of 20 mg/kg dosage. TE-031 tablets were administered in a dosage between 1.7 and 5.0 mg/kg and peak concentrations in the serum occurred at 0.5-2 hours. Half-lives were 2.0-4.3 hours. 2. Urinary recovery rates obtained upon administration of TE-031 granule during the first 6 hours after administration were 20.3-62.9%, while they were 11.6-42.4% with TE-031 tablets. 3. Antibacterial activity of TE-031 against Campylobacter jejuni was equal to that of erythromycin and slightly superior to those of josamycin, midecamycin acetate and rokitamycin. 4. Bacteriological efficacy rate of TE-031 on 8 species of bacteria isolated from various samples was 88.4% and clinical efficacy rate on 66 cases (upper/lower respiratory tract infections, mycoplasmal pneumonia, Campylobacter enteritis, et al.) was 100%. 5. TE-031 was administered in dosages of 6.8-42.3 mg/kg/day (mostly 20-30 mg/kg/day) 3 times a day and lengths of administration ranged from 4 to 15 days. 6. Side effects due to TE-031 were observed in 1 case each of transient symptom and abnormal clinical laboratory test value. According to the above results, TE-031 was recognized as a useful antibiotic for the treatment of infections in the pediatric field.

[Clinical and pharmacokinetic studies on sultamicillin fine granules in pediatrics]

Sultamicillin (SBTPC) is a mutual prodrug of sulbactam (SBT) and ampicillin (ABPC). A study has been performed to evaluate pharmacokinetic properties and clinical usefulness of SBTPC fine granules in the treatment of pediatric infections. After an oral dose of 5-15 mg/kg of SBTPC fine granules, peak serum concentrations of ABPC and SBT were 1.18-3.26 micrograms/ml and 0.97-3.05 micrograms/ml, respectively at 1 hour. Serum half-lives for elimination (T 1/2 (beta] of ABPC and SBT were 0.83-1.83 hours and 0.94-1.71 hours, respectively. Serum concentrations of ABPC at 1-6 hours after an oral administration of SBTPC fine granules were similar to those of SBT. Serum concentrations of ABPC and SBT were proportional to dose levels of SBTPC fine granules. Following oral administrations of 5-15 mg/kg, 33.9-64.8% of ABPC and 38.1-76.6% of SBT were recovered in urine in 6 hours. SBTPC fine granules were administered in a daily dose of approximately 30 mg/kg divided into 3 doses to 14 pediatric patients with bacterial infections. All 14 were cured with 11 excellent and 3 good clinical response to this drug. Microbiological eradication was obtained in 85.7%. beta-Lactamase-producing ABPC-resistant strains were eradicated. Adverse effects including laboratory test values that may be attributed to the administration of SBTPC fine granules were not observed except a treatment episode of diarrhea in 1 patient.

[Pharmacokinetic and clinical studies with imipenem/cilastatin sodium in neonates]

Pharmacokinetic and clinical evaluations of imipenem/cilastatin sodium (IPM/CS) were carried out in neonates. The following results were obtained: 1. The plasma concentrations of IPM/CS were determined upon doses of 10 mg/10 mg/kg and 20 mg/20 mg/kg administered using 30- and 60-minute drip infusion, respectively. Peak concentrations of IPM/CS were 19.0-34.7 micrograms/ml/32.6-73.4 micrograms/ml, respectively, at the end of the drip infusion. Plasma half-lives of IPM and CS were 1.4-1.6 hours and 1.7-2.1 hours, respectively. 2. Over a period of 6-8.5 hours, urinary excretions of IPM and CS totaled 19.8-42.7% and 46.9-89.3% of the dose administered, respectively. 3. Clinical responses to IPM/CS were excellent in 4 patients, good in 8 patients and unknown in 1 patient. 4. No side effect was observed except for a platelet increase in 2 patients. From the above results, it has been concluded that IPM/CS is an effective and safe drug in the treatment of neonatal infections.