[Antimicrobial activities of clavulanic acid/ticarcillin against clinical isolates]

In order to investigate antimicrobial activities of clavulanic acid/ticarcillin (CVA/TIPC) against Escherichia coli, Enterobacter spp. and Pseudomonas aeruginosa in 1992 and 1994, beta-lactamase activities were analyzed and minimum inhibitory concentrations (MICs) were determined including those of the control drugs. The results are as follows; 1. Compared to a report in 1980, the MIC distributions of CVA/TIPC against E. coli and P. aeruginosa did not show large differences. We found, however, that CVA/TIPC-resistant strains increased among Enterobacter spp. 2. Almost all of CVA/TIPC-resistant strains of Enterobacter spp. were also resistant to cephems and new quinolones, thus they were multiple drug resistant. 3. CVA/TIPC showed strong antimicrobial activities against penicillinase producing E. coli.

[Antimicrobial activities of clavulanic acid/amoxicillin against freshly isolated clinical strains from outpatients]

In order to investigate antimicrobial activities of clavulanic acid/amoxicillin (CVA/AMPC) against freshly isolated clinical strains obtained in 1995, beta-lactamase activities and minimum inhibitory concentration (MICs) were determined including those of the control drugs. The results are summarized as follows; 1. Detection frequencies of beta-lactamase producing strains were as follows: methicillin-susceptible Staphylococcus aureus subsp. aureus (MSSA, 90.0%), Haemophilus influenzae (22.0%), Moraxella subgenus Branhamella catarrhalis (100.0%), Escherichia coli (100.0%), Klebsiella pneumoniae subsp. pneumoniae (100.0%) and Neisseria gonorrhoeae (14.0%). It appeared that beta-lactamases produced by these strains were mostly penicillinase or enzyme of similar that. 2. Antimicrobial activities of CVA/AMPC against beta-lactamase producing strains were stronger than those of AMPC, and MIC90 of CVA/AMPC against benzylpenicillin (PCG)-insensitive or resistant Streptococcus pneumoniae was lower than those of sultamicillin, cefaclor and cefpodoxime. 3. CVA showed strong beta-lactamase inhibitory effect against M.(B.) catarrhalis of direct and indirect pathogenicity. We can expect CVA/AMPC to negate or decrease the influence of indirect pathogenicity.

[Antimicrobial activities of cefepime against clinically isolated strains]

In order to evaluate antimicrobial activity of cefepime (CFPM), minimum inhibitory concentrations (MICs) of CFPM and other drugs were determined against clinical isolates that were obtained in 1994. 1. CFPM showed a wide antibacterial spectrum against Staphylococcus spp. and glucose non-fermentative Gram-negative rods ((G)NF-GNR). Antimicrobial activities of CFPM against Staphylococcus spp. were stronger than those of ceftazidime (CAZ) and somewhat stronger than those of cefotaxime (CTX), and antimicrobial activity of CFPM against Pseudomonas aeruginosa was same as that of CAZ. 2. Antimicrobial activities of CFPM against almost all of Enterobacteriaceae were stronger than those of CAZ and CTX. And CFPM showed strong antimicrobial activities against CAZ-resistant Escherichia coli, Citrobacter freundii and Enterobacter spp. 3. Antimicrobial activities of CFPM were weaker than those of CAZ against some of strains of Klebsiella oxytoca, beta-lactamase high producing strains of Moraxella subgenus Branhamella catarrhalis and than those of CTX against beta-lactamase high producing strains of Prevotella spp. 4. The feature of new cephems was demonstrated in that CFPM had wider antibacterial spectrum than cephems of previous genenations against Staphylococcus spp. and (G)NF-GNR and CFPM showed strong antimicrobial activities against almost all of oxacephem-resistant Enterobacteriaceae.

Anti-Ro/SSA-associated annular erythema in childhood

We report four children with anti-Ro/SSA positive who presented with an annular erythema as a manifestation of Sjögren's syndrome. One patient had an aseptic meningoencephalitis as well as cutaneous lesions. Children with annular erythema should be carefully followed for features of Sjögren's syndrome, which is believed to be a rare condition in children.

[Frequency of clinical isolation of glucose non-fermentative gram-negative rods and their susceptibilities to antibacterial agents]

A comparison was made for frequencies of isolation o glucose non-fermentative Gram-negative rods ((G)NF-GNR) from clinical specimens during a period from July, 1986 to June, 1987 (the first period) and that from January, 1994 to December, 1994 (the second period). Also, minimum inhibitory concentrations of principal drugs were determined against these isolates. The obtained results are summarized as follows: 1. Thirty four (34) species of (G)NF-GNR were found from 35,200 clinical specimens in the two periods. Numbers of strains of (G)NF-GNR obtained were 4,575 during the first period and 4,704 during the second period, thus no significant difference existed in numbers of strains isolated in the two periods. 2. Among the 34 species to which the 4,704 strains were classified into, Pseudomonas aeruginosa comprised 68.4%, Stenotrophomonas maltophilia 6.9%, Acinetobacter baumannii 5.6%, Burkholderia cepacia 3.1%, Acinetobacter Iwoffii 2.6%, Alcaligenes xylosoxidans subsp. xylosoxidans 2.4%, Flavobacterium indologenes 1.7%, Pseudomonas putida 1.1%, Acinetobacter junii 1.1% and Moraxella subgenus Moraxella lacunata 0.9%. When these frequencies of isolation were compared with those in the first period, it was found that B. cepacia decreased significantly (P < 0.01) and that S. maltophilia increased significantly (P < 0.001). 3. MIC determinations revealed multiple drug resistance strains in many different species of bacteria. Minocycline, however, were active against many such strains, and ofloxacin was found to have strong antibacterial activity against some strains.

[A case of malignant fibrous histiocytoma treated with intraarterial chemotherapy under complete venous isolation and charcoal hemoperfusion]

Herein reported is a case with malignant fibrous histiocytoma (MFH) at the left elbow treated successfully with intraarterial chemotherapy under complete brachial venous isolation and charcoal hemoperfusion (BVI-CHP). A 56-year-old man was admitted to our institution because of local recurrence at the left elbow 6 months after extended local resection combined with systemic chemotherapy. We treated the patient with a 15-min intraarterial infusion of adriamycin (100 mg/body) and cisplatin (30 mg/body) under a concomitant 30-min BVI-CHP. Two weeks after the first treatment, he received a repeated intraarterial infusion of adriamycin (80 mg/body) and cisplatin (50 mg/body) under BVI-CHP. The tumor became necrotic one week after the first treatment, resulting in 60% reduction in tumor diameter. In addition, angiography demonstrated a remarkable shrinkage of the tumor stain. Despite repeated intraarterial high-dose infusions of chemotherapeutic agents, systemic toxicities, such as leukopenia, nausea/vomiting and alopecia, were not observed. These results indicate that this approach offers a novel therapeutic option for malignant tumors in the extremities.

Small amounts of exogenous IL-4 increase the severity of encephalitis induced in mice by the intranasal infection of herpes simplex virus type 1

The effect of murine rIL-4 on the development of herpesvirus encephalitis (HSE) in mice infected intranasally with herpes simplex virus type 1 (HSV-1) was investigated. The mortality rates of mice infected with a 0.5 LD50 dose of HSV-1 were greatly increased after the administration of rIL-4 at doses ranging from 0.01 to 1.0 U/mouse 2 h before and 2, 4 and 6 days after the infection. In contrast, survival rates of mice exposed to a 5 LD50 dose of HSV-1 were clearly increased when these mice were treated with anti-IL-4 mAb. Cervical lymph node (CLN) cells and cerebrospinal fluid (CSF) cells from mice with HSE (HSE mice) produced IL-4 in their culture fluids when they were stimulated in vitro with HSV-1 Ag. Increased amounts of HSV-1 infection in mice resulted in the increased production of IL-4 in the culture fluids of local lymphocytes. However, significant amounts of IL-4 were not produced in serum specimens or in culture fluids of spleen cells from HSE mice. IL-4 production in culture fluids of CLN and CSF cells from HSE mice was clearly reduced after treatment of HSE mice with anti-IL-4 mAb. Furthermore, IL-4 production by CLN and CSF cells was greatly enhanced when the cells were prepared from HSE mice previously treated with rIL-4. The IL-4 was mainly produced from CD4+ T cells. These results demonstrate that small amounts of exogenous IL-4 increase the severity of HSE in HSV-1-infected mice through the increased production of IL-4 from local CD4+ T cells.

[Study of clinically isolated new quinolones-resistant Haemophilus influenzae. Part 1]

A study was done to determine susceptibilities of Haemophilus influenzae that were obtained in our laboratory in 1994 to new quinolones (NQ) and other drugs. The results were as follows; 1. Among the 300 isolates, the detection frequency of NQ-resistant strains was 8.7% (26 strains), including isolates from chronic lower respiratory tract infections (22 strains) and those from middle meatus of nose (2 strains), etc. NQ-resistant strains were not isolated from children. 2. The cross resistance was studied for different NQs against NQ-resistant strains. Clavulanic acid/amoxicillin, cefteram, cefpodoxime, cefditoren, cefodizime (CDZM) and cefpirome showed strong antimicrobial activities against NQ-resistant strains. MIC90 of CEPs against all isolated strains including NQ-resistant strains and beta-lactamase producers was low. And the MIC90 of CDZM was < or = 0.025 microgram/ml, which was the lowest among all the antibiotics tested. 3. We found 47 strains (15.7%) of beta-lactamase producers among the 300 isolates, the frequency of beta-lactamase producing strains was high among strains obtained from children.

[Antimicrobial activities of norfloxacin against clinical isolates from ocular infections]

In order to evaluate antimicrobial activity of norfloxacin (NFLX), minimum inhibitory concentration (MICs) of NFLX and control drugs were determined against clinical isolates from ocular infections that were obtained in our laboratory from July, 1993 to December, 1994. The results are summarized as follows; 1. Compared to MIC distributions of NFLX against clinical isolates from ocular infections studied in 1986 and 1987, the MIC80 of NFLX against Corynebacterium spp., Enterobacter spp., Serratia spp., Burkholderia cepacia, Flavobacterium spp., Alcaligenes spp. increased 8 times. Almost all of NFLX-resistant strains among them were ofloxacin (OFLX)-resistant, new quinolones resistant strains, and a part of them were aminoglycosides, beta-lactams-resistant as well, thus all of these strains were multiple drug resistant. 2. MIC of NFLX against Pseudomonas aeruginosa were lower than that of OFLX. 3. NFLX showed strong antimicrobial activities against so-called "particular bacteria" including Staphylococcus aureus subsp. aureus, Moraxella spp., Haemophilus spp., and P. aeruginosa from ocular infections. And MIC80 of NFLX against these bacteria was 0.05-1.56 microgram/ml. We observed that NFLX eye drops was administered so that concentrations above the MIC against these clinical isolates were maintained.

Immunohistochemical localization and biological significance of the phylogenically conserved thymus-brain antigen (UB-13 antigen) in skate, rat and human

A monoclonal antibody (UB-13) originally raised against the brain of the skate (Raja kenojei, a cartilaginous-fish) was found to react with lymphoid and brain tissues from many species when examined immunohistochemically. In rat and human thymus, UB-13 antigen was observed to be closely associated with reticular tissue in the medulla and cortex. Interestingly, a few or several thymocytes were encircled by the UB-13-reactive reticular tissue. At 14 days gestation, rat thymus consisted mainly of reticular epithelial tissue, after which strong thymocyte production started. At this stage, some of the reticular tissue was heavily stained with UB-13. In the thymus tissues of the irradiated and recovering rats, where reduction and massive reproduction of thymocytes were observed, extensive UB-13 antigen expression localized on the reticular epithelial tissue, an observation which may support the thymocyte re-population. These findings suggest that the antigen recognized by UB-13 may be important for thymocyte proliferation and maturation. UB-13 antigen was found in the fibrous structure of the molecular and granular layer of the human cerebellum. Some glial cells were also stained strongly with UB-13 in the human cerebellar or cerebral grey and white matter. In rat, glial cells, especially astroglias, and the endothelial structure of blood vessels were stained strongly with UB-13. These findings suggest that UB-13 may be a useful monoclonal antibody for analysis of brain-lymphoid antigen in many species.

Small amounts of exogenous IL-4 increase the severity of encephalitis induced in mice by the intranasal infection of herpes simplex virus type 1

The effect of murine rIL-4 on the development of herpesvirus encephalitis (HSE) in mice infected intranasally with herpes simplex virus type 1 (HSV-1) was investigated. The mortality rates of mice infected with a 0.5 LD50 dose of HSV-1 were greatly increased after the administration of rIL-4 at doses ranging from 0.01 to 1.0 U/mouse 2 h before and 2, 4 and 6 days after the infection. In contrast, survival rates of mice exposed to a 5 LD50 dose of HSV-1 were clearly increased when these mice were treated with anti-IL-4 mAb. Cervical lymph node (CLN) cells and cerebrospinal fluid (CSF) cells from mice with HSE (HSE mice) produced IL-4 in their culture fluids when they were stimulated in vitro with HSV-1 Ag. Increased amounts of HSV-1 infection in mice resulted in the increased production of IL-4 in the culture fluids of local lymphocytes. However, significant amounts of IL-4 were not produced in serum specimens or in culture fluids of spleen cells from HSE mice. IL-4 production in culture fluids of CLN and CSF cells from HSE mice was clearly reduced after treatment of HSE mice with anti-IL-4 mAb. Furthermore, IL-4 production by CLN and CSF cells was greatly enhanced when the cells were prepared from HSE mice previously treated with rIL-4. The IL-4 was mainly produced from CD4+ T cells. These results demonstrate that small amounts of exogenous IL-4 increase the severity of HSE in HSV-1-infected mice through the increased production of IL-4 from local CD4+ T cells.

CD8+ type-2 T cells enhance the severity of acute herpes virus infection in mice

The role of CD8+ suppressor T cells in acute herpes simplex virus type 1 (HSV) infection was investigated in mice. CD8+ CD11b+ TCR-gamma/delta + suppressor T cells (HSV-STC) were demonstrated in spleens of mice infected intraperitoneally (i.p.) with HSV. When HSV-STC from mice infected with a 10 LD50 of HSV (donors) were adoptively transferred to mice 3 days after being infected with a 1 LD50 dose of HSV (recipients), the morbidity and mortality of recipients were greatly increased (mean survival time in days (MSD): 9.4 days; mortality, 100%) as compared with controls that received CD4+ T cells or a whole T-cell lysate from donors (MSD, > 19.6 days or > 19.1 days; mortality, 38% or 50%). The morbidity and mortality of mice exposed to a 1 LD50 of HSV were also increased when they were continuously treated with recombinant murine IL-4. However, the survival rate of mice exposed to a 10 LD50 of HSV increased after multiple treatments of these mice with anti-IL-4 monoclonal antibody. IL-4-producing cells were detected in a population of HSV-STC, and IL-4 was produced when these cells were cultured in the presence of UV-inactivated HSV in vitro. These results indicate that IL-4 plays an important role in the progression of acute HSV infection and, through the production of IL-4, HSV-STC may increase the severity of the acute-phase infection of HSV in mice.

Enhanced efficacy of bleomycin adsorbed on silica particles against lymph node metastasis in patients with esophageal cancer: a pilot study

BACKGROUND

Lymph node metastases occur very frequently and extensively in patients with esophageal cancer. The aim of this pilot study was to try the targeting chemotherapy for lymph node metastases by use of bleomycin adsorbed on silica particles (BLM-SI).

METHODS

BLM-SI or bleomycin solution (BLM-SOL) was injected into the submucosa of the esophageal wall by means of endoscopy 3 days before operation in 16 patients with middle thoracic esophageal cancer. The distribution of bleomycin in the regional lymph nodes and surrounding connective tissues was studied.

RESULTS

When BLM-SI was administered, bleomycin activity was found in both the regional lymph nodes and connective tissues, not only in the mediastinal region but also in the cervical and abdominal region. Bleomycin activity was significantly higher in all regions after BLM-SI administration than after BLM-SOL administration. Degenerative or necrotic changes were microscopically observed in 11 of 36 lymph nodes with metastatic foci. Bleomycin activity in the blood was significantly lower after BLM-SI was administered than after BLM-SOL. Serious systemic side effects except for fever were not observed in any patients.

CONCLUSIONS

These results indicate that BLM-SI could be a useful treatment modality for targeting lymph node metastasis of esophageal cancer without serious side effects.

Lymph node metastasis of early stage carcinoma of the esophagus and of the stomach

We undertook a comparative histologic study of early stage carcinoma of the esophagus and stomach, with tumor invasion limited to the submucosa. Here we analyze lymph node metastasis, lymphatic invasion, and vascular invasion. Our study is based on a retrospective review of 77 patients with early stage carcinoma of the esophagus and 192 patients with early stage carcinoma of the stomach treated during the period from 1973 through 1991. The incidence of lymph node metastasis and lymphatic invasion was significantly higher in intramucosal or submucosal esophageal cancer than in intramucosal or submucosal gastric cancer. However, there was no significant difference between intramucosal esophageal cancer and submucosal gastric cancer. The metastatic site of lymph nodes in esophageal cancer tended to be distant from the location of primary tumor compared with lymph nodes invaded by gastric cancer. Lymphatic invasion and vessel invasion between submucosal esophageal cancer and submucosal gastric cancer was statistically significant. From these results, we conclude that intraepithelial or intramucosal esophageal cancer is comparable to early stage carcinoma of the stomach, whereas submucosal esophageal cancer is actually an advanced lesion.

Evidence that portal vein decompression improves survival of canine quarter orthotopic liver transplantation

The minimum graft volume still remains unclear in reduced-size liver transplantation (RLT). This study reports the improved survival of canine RLT using a quarter graft with the aid of a portahepatic vein shunt (PHVS). In beagles, the donor liver was reduced to the right lateral and caudate lobes (quarter graft) with or without provision of PHVS, and transplanted orthotopically in the recipient. The PHVS was established by an end-to-end anastomosis of the portal vein branch and the hepatic vein in the resected left lateral lobe. Liver chemistries including arterial blood ketone body ratio (AKBR) were serially measured during and after surgery. All seven animals with PHVS survived more than 3 days (mean +/- SD; 5.3 +/- 1.7 days), whereas all six without PHVS died within 3 days (1.8 +/- 0.8 days, P < 0.01). Portal vein pressures immediately after recirculation in animals with and without PHVS were 8.5 +/- 1.2 mmHg and 16.9 +/- 3.1 mmHg, respectively (P < 0.01). Regardless of the presence or absence of PHVS, AKBR dropped to a level lower than 0.7 during the anhepatic period and returned promptly to above 1.0 as early as 30 min after recirculation. Thereafter, the AKBR values in animals with PHVS remained higher than 1.0, whereas those in animals without PHVS showed a progressive decrease, showing a statistically significant difference between the two groups after 12 hr (P < 0.05). Graft function, as assessed by AKBR, was well correlated with survival and other liver chemistries. These results indicate that, in an extreme RLT, portal hypertension is a risk factor predisposing to graft failure, most likely by increasing microvascular injury after recirculation.

[Antibacterial activities of cefmenoxime against recent fresh clinical isolates from patients in sinusitis]

In order to evaluate antimicrobial activity of cefmenoxime (CMX), minimum inhibitory concentrations (MICs) of CMX and control drugs were determined against clinical isolates from patients of sinusitis that were obtained in our laboratory from October of 1993 to March of 1994. The results are summarized as follows; 1. CMX showed strong antimicrobial activities against Streptococcus pneumoniae, Haemophilus influenzae and Moraxella subgenus Branhamella catarrhalis that were 3 major aerobic bacteria from sinusitis. Antimicrobial activities of CMX against benzylpenicillin (PCG)-insensitive S. pneumoniae (PISP) and PCG-resistant S. pneumoniae (PRSP) were stronger than those of ampicillin (ABPC), and these strong activities suggested that CMX might have strong antimicrobial activities against beta-lactamase producing H. influenzae and M. (B.) catarrhalis. 2. Antimicrobial activities of CMX against microaerophiles, Streptococcus constellatus, Streptococcus intermedius and Gemella morbillorum and against Peptostreptococcus spp., from chronic sinusitis and odontogenic maxillary sinusitis, were stronger than those of most of the control drugs. 3. The MIC90's of CMX against isolates from patients of sinusitis were < or = 0.025-0.39 micrograms/ml. These values were lower than transitional concentrations in mucous membrane of maxillary sinus obtained when "1% CMX nasal solution" was used with nebulizer. It appears likely that sufficient concentrations exceeding MICs against main organisms would be obtained by nebulizer treatment using CMX nasal solution.

Clinical pilot study on high-dose intraarterial chemotherapy with direct hemoperfusion under hepatic venous isolation in patients with advanced hepatocellular carcinoma

BACKGROUND

We recently developed a novel system of direct hemoperfusion under hepatic venous isolation in an attempt to achieve high-dose intraarterial chemotherapy for patients with malignant liver tumors. We report here the results of treatment of these patients with advanced hepatocellular carcinoma.

METHODS

Adriamycin (100 to 150 mg/m2) was administered into the hepatic artery of 15 patients, under conditions of extracorporeal drug elimination by direct hemoperfusion under hepatic venous isolation. Hepatic venous isolation was accomplished mainly by the double-balloon technique with an occlusion catheter and a balloon catheter. The isolated hepatic venous blood was filtered by direct hemoperfusion and pumped to the left axillary vein.

RESULTS

During 5 minutes of adriamycin infusion, the mean drug extraction ratios of the direct hemoperfusion filters were 91% +/- 9% (mean +/- SD). The amount of drug removed by the system was 26.4% +/- 16.0% of the amount of drug administered. Two patients died, one of necrotizing pancreatitis and the other of hepatic arterial thrombosis. Both deaths were related directly to the hepatic arterial catheter. Other side effects included hemolysis related to the system of hemoperfusion (87%), chemical hepatitis (80%), leukopenia less than 3000/mm3 (67%), alopecia (33%), and nausea and vomiting (20%). Nine (64%) of 14 evaluable patients had objective tumor responses, with a median duration of response of 6.2 months.

CONCLUSIONS

This approach offers an effective therapeutic option for patients with advanced hepatocellular carcinoma.

[Antimicrobial activities of piperacillin against fresh clinically isolated strains]

In order to evaluate the antimicrobial activity of piperacillin (PIPC), along with control agents, minimum inhibitory concentrations (MIC's) were determined against fresh clinically isolated strains from January to June, 1994. 1. The MIC70's of PIPC against major strains were approximately equal to those reported in the mid 1980s. 2. Strains for the study were supplied in approximately equal numbers from community-acquired hospitals and general hospitals. The ratios of bacteria resistant to beta-lactams including PIPC were low in the former group and high in the latter. 3. "New types of beta-lactam-resistant strains" which did not exist in mid 1980s but found at this time included benzylpenicillin (PCG)-insensitive Streptococcus pneumoniae, PCG-resistant S. pneumoniae, cephems-resistant Escherichia coli and beta-lactamase producing Prevotella spp. These bacteria were also found among strains obtained from community-acquired hospitals.

[Antimicrobial activities of sulbactam/ampicillin against clinically isolated microbial strains]

Antimicrobial activities were examined for sulbactam/ampicillin (SBT/ABPC) against clinically isolated microbial strains in 1987, 1990, 1994. Besides, the beta-lactamase productivity and MICs of these strains were measured, and the following conclusions were obtained. 1. The ratio of beta-lactamase producing strains were 90% of methicillin (DMPPC)-susceptible Staphylococcus aureus subsp. aureus (MSSA), about 80% of DMPPC-resistant S. aureus (MRSA), 100% of Escherichia coli, Klebsiella pneumoniae subsp. pneumoniae and Proteus mirabilis, 95% of Moraxella subgenus Branhamella catarrhalis and 15-20% of Haemophilus influenzae. Several kinds of beta-lactamase productivity were observed. 2. Antimicrobial activities of SBT/ABPC against beta-lactamase producing strains of MSSA, M. (B.) catarrhalis, H. influenzae, and almost all of Enterobacteriaceae were stronger than those of ampicillin (ABPC) and piperacillin (PIPC), but antimicrobial activities of SBT/ABPC were weak against MRSA and cephems (CEPs)-resistant strains detected in some of Enterobacteriaceae. 3. It appeared that benzylpenicillin (PCG)-insensitive Streptococcus pneumoniae (PISP) or PCG-resistant S. pneumoniae (PRSP) and CEPs-resistant Escherichia coli increased year by year. 4. Antimicrobial activities of SBT/ABPC were strong against Streptococcus pyogenes, S. pneumoniae, M. (B.) catarrhalis and H. influenzae including beta-lactamase producing strains. Additionally, beta-lactamase inhibiting effect of SBT was observed against beta-lactamase produced by S. aureus and K. pneumoniae which demonstrate indirect pathogenicity. Thus, SBT/ABPC is an injectable antibiotic that is expected to demonstrate clinical usefulness, especially as the first line drug for the respiratory tract infections that are community-acquired.

Expression of desmoglein-I cell-adhesion molecule in primary tumors and metastatic lymph-nodes of esophageal cancer

The expression of desmoglein I (DGI) in both primary turners and metastatic lymph node of esophageal carcinoma was studied immunohistochemically in 102 patients using an anti-DGI monoclonal antibody. Normal squamous epithelial cells strongly expressed DGI at their cell-cell boundaries. DGI expression in the tumors was divided into DGI (++), DGI (+), DGI (-) according to the staining intensity. DGI (+) or DG (-) tumors had lymph node metastases more frequently than DGI (++) tumors (p<0.01). DGI expression was the same or of less intensity, than in the primary tumor in 128 (85%) out of 151 metastatic lymph nodes. These results indicate that reduction or loss of DGI expression may promote lymph node metastases.

Cerebral mass lesions associated with adult T-cell leukemia/lymphoma

Three patients with adult T-cell leukemia/lymphoma (ATLL) accompanied by cerebral mass lesions in their courses are reported. The findings of cerebrospinal fluid and their history suggested that those three cerebral involvements were the mass lesions derived from ATLL. Two of the three patients had acute type and the other one had chronic type ATLL. During the same period in which these three patients were observed, we experienced 17 other patients with ATLL. Although this group included 12 lymphoma type and five acute type ATLL, involvement of the central nervous system (CNS) was not observed in these 17 patients. The incidence of CNS involvement was 3/20 (15%). The prognoses of the three patients after the occurrence of CNS involvement was 1, 4, and 8 months, respectively. In these three patients, cerebral lesions became the cause of death for two patients although they continued to be in complete remission hematologically. Cerebral lesions, once occurring, are very hard to cure and spoil the quality of life for sufferers. From these points, prophylactic therapy against central nervous system involvement seems necessary not only for acute leukemias, but also for ATLL patients.

Lymph node metastasis and the recurrence of esophageal carcinoma with emphasis on lymphadenectomy in the neck and superior mediastinum

A series of 335 patients with squamous cell carcinoma of the thoracic esophagus undergoing resection and reconstruction via a right thoracotomy and laparotomy with cervical anastomosis between 1973 and 1990, were reviewed. Prior to 1982, the removal of lymph nodes was limited to the nodes in the mediastinum below the tracheal bifurcation and upper abdomen (142 patients). Nodal metastases were found in 89 of these patients at operation. The upper abdominal nodes were the most frequent sites of metastasis (47.2%). None of the 38 patients with positive nodes sampled from the neck and superior mediastinum survived for more than 45 months. In the 50 patients with recurrences, 30 were in the neck and/or superior mediastinum. During or after 1983, the superior mediastinal nodes, particularly the bilateral recurrent nerve nodal chains, were routinely removed (193 patients). Nodal metastasis was proven in 131 of the 193 patients, in whom 87 (45.1%) had metastasis in the neck and superior mediastinum. Eleven of these 87 patients survived for 45 months or more. In the 61 patients with recurrences, 20 were in the neck and/or superior mediastinum. These data suggest that recurrent nerve nodal chains should be removed to improve survival in patients with esophageal carcinoma.

Maternal autoimmune response to recombinant Ro/SSA and La/SSB proteins in Japanese neonatal lupus erythem atosus

BACKGROUND

Neonatal lupus erythematosus (NLE) is a syndrome characterized by dermatitis and congenital heart block (CHB). The disease is mostly associated with transplacental passage of maternal anti-Ro/SSA and/or La/SSB antibodies.

OBJECTIVE

To examine maternal autoimmune response to recombinant Ro/SSA and La/SSB proteins in NLE with a single ethnic background.

METHODS

This study examined 12 NLE infants and their mothers. Serum samples were tested by enzyme-linked immunosorbent assay for reactivity with full-length recombinant human 60-kd Ro/SSA, 52-kd Ro/SSA, and 48-kd La/SSB proteins.

RESULTS

All 10 infants with skin lesions and/or CHB had maternal antibodies reactive to both the 60- and 52-kd Ro/SSA polypeptide components of the Ro/SSA particle. Anti-60-kd Ro/SSA without anti-52-kd Ro/SSA, or vice versa, was found in mothers of infants who had only hepatic manifestation of NLE. Nine of 12 NLE infants had anti-48-kd La/SSB.

CONCLUSION

In the majority of Japanese infants with NLE, maternal anti-Ro/SSA autoimmune response was directed against both of 60-kd and 52-kd recombinant Ro/SSA proteins. There was no profile of anti-Ro/SSA and La/SSB response unique to mothers of children with CHB or cutaneous manifestations of NLE.

[Antibacterial activities of cefetamet against clinically isolated strains from community acquired respiratory tract infections (II)]

Antibacterial activities of cefetamet (CEMT) against clinically isolated strains from patients with community acquired respiratory tract infections were compared to those of other oral beta-lactam antibiotics in the period from January to March 1994. The following results were obtained. 1. CEMT showed strong antibacterial activities against three major pathogens causing community acquired respiratory tract infections, Streptococcus pyogenes, Streptococcus pneumoniae, and Haemophilus influenzae. However, antibacterial activities of CEMT against benzylpenicillin (PCG)-insensitive S. pneumoniae (PISP) and PCG-resistant S. pneumoniae (PRSP) were slightly weaker than of those of some the reference antibiotics. 2. No MIC value changes of CEMT were observed from year to year against Moraxella subgenus Branhamella catarrhalis and Klebsiella pneumoniae.

Effects of irradiation, glucocorticoid and FK506 on cell-surface antigen expression by rat thymocytes: a three-colour flow cytofluorometric analysis

The expression of T-cell antigen receptor (TCR) alpha beta was investigated in rat CD4- CD8- thymocytes during thymic reconstitution after the exposure of animals to irradiation or glucocorticoid. The effect of the immunosuppressant FK506 on the expression of TCR alpha beta in rat CD4- CD8- thymocytes was also examined. The percentage of CD4- CD8- thymocytes constituted 2.6% of total thymocytes and that of CD4- CD8- TCR alpha beta high cells constituted 12.6% of CD4- CD8- thymocytes in normal adult Lewis rats. The percentage of CD4- CD8- TCR alpha beta high cells increased during thymic reconstitution after irradiation, and maximally constituted 28.6% of CD4- CD8- thymocytes on day 7. Similar results were obtained during thymic reconstitution after glucocorticoid treatment. In contrast, continuous treatment with FK506 for 7 days markedly decreased not only the percentages of CD4+ CD8- TCR alpha beta high and CD4- CD8+ TCR alpha beta high thymocytes, but also that of CD4- CD8- TCR alpha beta high thymocytes. These results indicate that rat CD4- CD8- thymocytes contain a subpopulation of mature (TCR alpha beta high) cells. The possible implications of the existence of this subpopulation with regard to thymocyte differentiation and maturation are discussed.

Direct hemoperfusion under infrahepatic inferior vena caval isolation for the intraarterial chemotherapy of pelvic tumors

A new simple technique consisting of direct hemoperfusion under infrahepatic inferior vena caval isolation for intraarterial chemotherapy of pelvic tumors is herein described. The inferior vena cava is occluded at the infrahepatic level by means of balloon inflation using a balloon-tipped catheter (16F), which is placed through the right greater saphenous vein. The isolated infrahepatic vena caval blood is withdrawn by a centrifugal pump through a catheter (16F) in the contralateral greater saphenous vein and is filtered by direct hemoperfusion during intraarterial infusion of anticancer drugs. Venous reentry is provided by the central lumen of the balloon-tipped catheter. This procedure was used sequentially on two different occasions to treat a patient with an extensive pelvic tumor. Good hemodynamic stability and a reduction of the systemic drug toxicities were confirmed in both trials. Therefore, we believe that this technique is technically feasible and highly effective in reducing systemic toxicities during high-dose intraarterial chemotherapy for pelvic tumors.

[Antibacterial activities of new quinolones against fresh clinical isolates]

In order to investigate antibacterial activities of new quinolones (NQs) against a number of clinical isolates obtained in our laboratory during a period from February, 1993 to January, 1994, minimum inhibitory concentrations (MICs) were determined using most of the NQs available in the market as of December, 1993. The obtained results are summarized as follows: 1. Noticeable differences were observed among the antibacterial activities of 8 different NQs tested against Gram-positive bacteria, i.e., there were large differences in their MIC distributions. Some differences were also observed among different NQs in ratios of NQ-resistant strains among Staphylococcus spp. From these results, it seems necessary to further study tolerance mechanisms of these Gram-positive bacteria toward different NQs and also to examine possible differences in antibacterial activities among different NQs against Gram-positive bacteria in clinical settings. 2. MIC distributions against Gram-negative bacteria were also different among the 8 NQs tested. Though elevated MICs were observed against NQ-resistant Gram-negative bacteria in many cases, and somewhat higher, though not exceedingly high, MIC values than those against NQ-sensitive bacteria were found in other cases, patterns of MIC values against different NQ-resistant Gram-negative bacteria were similar for all of the 8 NQs tested. This may explain the fact that most of NQ-resistant Gram-negative bacteria showed similar resistant patterns to the 8 NQs tested. 3. Among the NQ-resistant bacteria, were found Haemophilus influenzae and Neisseria gonorrhoeae strains. Ratios of resistant strains were approximately 10% or lower for the former and approximately 20% for the latter. 4. With MICs of ampicillin and cefaclor used as control, it appears that benzylpenicillin (PCG)-insensitive or PCG-resistant Streptococcus pneumoniae (PISP or PRSP) and CEPs-resistant Escherichia coli are increasing.

Expression of desmoglein I in squamous cell carcinoma of the esophagus

Desmoglein I (DGI) is major component of the desmosomal membrane core that plays an important role in epithelial cell adhesion. The aim of this study was to explore the correlation between the expression of DGI and the clinicopathological findings of esophageal cancer. DGI expression was immunohistochemically examined using an anti-DGI monoclonal antibody in 139 patients with squamous cell carcinoma of the esophagus. Normal squamous epithelial cells strongly expressed DGI at their cell-cell boundaries. According to the intensity and pattern of DGI expression, the cancerous tissues were divided into three groups: DGI (++), DGI (+), and DGI (-). Of the 139 tumors, 35 (25%) were DGI (++), 65 (47%) were DGI (+), and 39 (28%) were DGI (-). A good inverse correlation between DGI expression and tumor invasion, lymph node metastasis, lymphatic invasion, and vessel invasion was observed. These results indicate that DGI expression may be a significant factor for invasion, metastasis, and prognosis of human esophageal cancer.

Pathogenesis of late airway changes in long-term surviving lung allografts

Late airway changes are frequently observed in long-term surviving rat lung allografts. In this present study, we investigate this problem using the mixed lymphocyte reaction, graft-versus-host assay (popliteal lymph node assay), skin grafting from the donor strain to the lung allograft recipient, and histology to evaluate this problem. The results show that spleen cells from recipient rats with long-term surviving lung allografts possessed alloreactivity in mixed lymphocyte reaction against both donor and third-party ACI antigens. Suppressor cell activity was not detected in spleen cells from these recipient rats. The popliteal lymph node assay showed that the response to recipient spleen cells was detectable but weaker than that of naive spleen cells from the same strain. Mean survival time of skin grafts from the donor strain to long-term allograft survivors was significantly longer than that between donor and recipient strains. Chest roentgenograms revealed opacification of long-term surviving lung allografts at 2 to 3 wk after skin transplantation that was coincident with the rejection of the skin grafts, and histologic examination of the lung allografts revealed changes compatible with acute rejection. We conclude that alloreactivity can be demonstrated in rats with long-term surviving lung allografts and suggest that late airway changes in these lungs are immunologically mediated.

Analysis of cell surface antigens using anti-rat hepatocyte monoclonal antibodies, particularly HAM 1

The expression of antigens on rat hepatocytes was examined by immunoelectron microscopy using monoclonal antibody HAM 1. The antigen recognized by HAM 1 was expressed mainly on both sinusoidal and bile-canalicular faces and only sparsely on the contiguous face. All rat hepatoma cell lines examined were intensely labeled with HAM 1, but poorly labeled with HAM 3, HAM 4, and HAM 5, as revealed by flow cytofluorometry and radioimmunoassay. Expression levels of HAM 1 antigen on the AH 44 hepatoma cell line similar to the degree seen in normal liver were demonstrated by radioimmunoassay. HAM 1 antigen was also expressed weakly on lymphocytes, thymocytes, and some bone marrow cells, but not on red blood cells, and differed from the MHC class I antigen recognized by HAM 2 and OX 18. Significant amounts of cell surface antigens recognized by all the monoclonal antibodies (HAM 1-HAM 5) were confirmed by radioimmunoassay on the cell surface of primary cultured hepatocytes. These results suggest that the rat hepatoma cell lines employed are different from normal hepatocytes, that primary cultured hepatocytes are more similar to normal hepatocytes in the degree of expression of their cell surface antigens, and that HAM 1 antigen appears to be a significant antigen on both normal and transformed hepatocytes.

[Antimicrobial activities of fosfomycin against Streptococcus pneumoniae and Haemophilus influenzae recently observed in sinusitis patient]

In order to examine antimicrobial activities of fosfomycin (FOM), the minimum inhibitory concentrations (MICs) of FOM and those of control drugs were determined against Streptococcus pneumoniae and Haemophilus influenzae isolated from sinusitis patients from September to November, 1993, and the following results were obtained. 1. Among 50 S. pneumoniae strains tested, there were 10 strains (20.0%) of benzylpenicillin (PCG)-insensitive S. pneumoniae (PISP) and 2 strains (4.0%) of PCG-resistant S. pneumoniae (PRSP); but the MIC distributions of FOM among the PISPs and the PRSPs were almost identical to those among the PCG-susceptible S. pneumoniae (PSSP). 2. There were 12 strains (24.0%) of beta-lactamase producing strains among 50 strains of H. influenzae tested, but the FOM's MIC distribution among these strains was almost identical to that among beta-lactamase non-producing strains. 3. The results obtained on the MIC90s of FOM against S. pneumoniae and H. influenzae suggest that the nebulization treatment with FOM nasal preparation satisfies the condition "above the MIC".

[Antimicrobial activities of ciprofloxacin against recently obtained clinical isolates]

In order to evaluate antimicrobial activity of ciprofloxacin (CPFX), minimum inhibitory concentrations (MICs) of CPFX and other drugs were determined against clinical isolates that were obtained in our laboratory from January to December of 1991, and of 1993. The results are summarized as follows: 1. CPFX-resistant strains were on the increase in various strains, compared to those in the early 1980s. However, many of CPFX-resistant strains were multi-drug resistant including beta-lactams. In addition, they showed cross resistance to other fluoroquinolone agents. 2. MIC distribution of other drugs suggested that there were increased frequencies of benzylpenicillin (PCG)-insensitive Streptococcus pneumoniae (PISP) and CEPs-resistant Escherichia coli. However, MIC distribution of CPFX to these resistant strains were in a relatively low range. 3. When isolates of 1991 were compared to those of 1993, we confirmed that CPFX-resistant strains decreased among certain bacteria such as Staphylococcus aureus. Also we confirmed that fewer CPFX-resistant strains were found among bacteria that may be highly related to infections encountered in daily medical care.

[A case of hepatic atrophy by irradiation]

A 44-year-old woman was treated with 60Co irradiation (total dose, 6000 rads) focused on the right side porta hepatis under the diagnosis of cholangiocarcinoma in 1975. Seventeen years after the treatment, she was admitted to our institution because of dull pain at right hypochondriac region. Abdominal CT demonstrated an extreme hepatic atrophy and tumor mass in the right lobe of the liver. In November, 1991 right tri-segmentectomy was performed under the diagnosis of hepatocellular carcinoma. Laparotomy revealed the extreme atrophy of the right lobe and associated hypertrophy of the left lobe of the liver. In this case radiation hepatitis occurred after irradiation to the liver and it was followed by the extreme hepatic atrophy as a long term effect of high dose irradiation on the liver.

Bullous eruption of systemic lupus erythematosus

A bullous eruption is now recognized as a specific complication of systemic lupus erythematosus (SLE). We described a 22-year-old woman with SLE whose vesiculobullous eruptions exacerbated with a flare of visceral manifestations of the disease and resolved when the systemic disease was controlled by oral prednisolone.

The effects of FK506 and dexamethasone on rat thymocyte differentiation

We investigated the effects of FK506 and glucocorticoids (GC) on rat thymocytes using flow cytofluorometry. Rats were treated with GC (0.1 mg/body, by single injection), with FK506 (1 mg/kg/day, for 7 days), or with FK506 and GC. GC alone significantly decreased the percentage of CD4+8+ thymocytes and increased the percentages of CD4-8-, CD4+8- and CD4-8+ thymocytes on day 7. FK decreased the percentage of CD4+8- and CD4-8+ thymocytes and increased the percentage of CD4+8+ thymocytes on days 5 to 14. FK and GC induced a significant decrease in the number of CD4+8+ thymocytes greater than that seen with GC alone on day 7. The absolute number of TCR alpha beta high MHC class Ihigh thymocytes after FK and GC was significantly lower than that of the control group, and was slightly lower than that after FK alone on day 14. These results suggest that combined treatment with FK506 and GC acts complexly to decrease rat CD4+8+ thymocytes and prevents thymocyte differentiation and maturation.

[Correlation between respiratory or circulatory state and postoperative extravascular lung water volume in patients undergoing surgery for esophageal carcinoma of the thorax]

Postoperative extravascular lung water index (EVLWI, ml/kg) was analyzed in 30 patients who underwent esophagectomy through right thoracotomy for esophageal carcinoma from the day of operation to 5th postoperative day, in order to clear the correlation between respiro-circulatory state and EVLWI. The results are as follows. 1. EVLWI on 1st postoperative day correlated significantly not only with blood loss during operation (p < 0.01, r = 0.65) but also with systemic vascular resistance index on 1st postoperative day (p < 0.05, r = -0.43). 2. EVLWI correlated with the respiratory index (RI) on the 2nd and 4th postoperative day (p < 0.01), suggesting that EVLWI is an important indicator in judging the respiratory state following esophagectomy. 3. EVLWI on 4th postoperative day correlated with accumulative fluid balance up to 4th postoperative day (p < 0.05, r = 0.41), however neither correlated with other hydrostatic parameters nor the COP-PCP gradient. Furthermore, EVLWI on 4th postoperative day correlated more significantly with oxygen consumption index (p < 0.05, r = 0.58) than that with accumulative fluid balance up to 4th postoperative day. According to those results, the increased systemic vascular permeability immediately after the surgery attributes to the increase of EVLWI on the 1st postoperative day. Whereas, the increased EVLWI on 4th postoperative day depends on not only the hydrostatical factors but also the increased pulmonary vascular permeability caused by the surgical maneuver to the lung during esophageal surgery.

[Antimicrobial activities of cefuroxime against recent clinical isolates]

Antimicrobial activity of cefuroxime axetil (CXM-AX) was compared with those of other cephem antibiotics against clinically isolated strains obtained mainly from outpatients of our center in a period from January to September of 1990 and 1993. Minimum inhibitory concentrations were determined and the following results were obtained. 1. The results suggested that, compared with reports of studies conducted with clinical isolates in early 1980's, MIC80 of CXM were equal to or lower against Staphylococcus spp., Streptococcus pyogenes, Escherichia coli, Klebsiella spp., Proteus mirabilis, Haemophilus influenzae, Moraxella subgenus Branhamella catarrhalis, Neisseria gonorrhoeae, Peptostreptococcus spp., and Propionibacterium acnes, except for Streptococcus pneumoniae, MIC80 which was slightly higher. 2. MIC90 of comparator drugs reflected those of new resistant organisms recently appeared, such as benzylpenicillin (PCG)-insensitive S. pneumoniae (PISP), cephem-resistant E. coli and Klebsiella spp., new quinolone-resistant H. influenzae and N. gonorrhoeae. Methicillin-resistant Staphylococcus aureus (MRSA) was detected also from specimens of community acquired infections. From the nature of MRSA detected in those situations MRSA appeared to present a continuing problem. 3. MIC90 against strains obtained from patients with community acquired infections was a good index of increases of multidrug-resistant organisms in the past. Therefore, the determination of MIC90 is important in examining changes with time of sensitivities or resistances of clinically isolated strains to antimicrobial drugs. 4. Antimicrobial activities of CXM against recent clinical isolates showed the existence of problems as mentioned above. However, MIC of CXM as well as those of comparator drugs indicated that antimicrobial activities of CXM against Staphylococcus spp., Streptococcus spp., H. influenzae appeared to be relatively strong, and it is concluded that cefuroxime axetil still is one of the clinically useful oral antimicrobial drugs in the 1990's.

Correlation of ultrasound-measured common carotid artery stiffness with pathological findings

To quantitatively and noninvasively evaluate common carotid atherosclerosis in a series of patients, we measured the stiffness parameter beta, which represents the mechanical properties of the vessel. beta was calculated from the relationship between blood pressure and the diameter of the artery as measured by an ultrasonic, phase-locked, echotracking system. Increases in the severity grade of atherosclerosis as subsequently determined at autopsy were correlated with increased beta values in 60 common carotid arteries (r = .68). Patients with beta values greater than 13 had a pathological diagnosis of atherosclerosis in the common carotid artery. The sensitivity of this discrimination ratio was 80%, and the specificity was 80% as well. Thus, beta shows promise as a useful diagnostic indicator for detecting asymptomatic common carotid atherosclerosis.

Long-term results of subtotal esophagectomy with three-field lymphadenectomy for carcinoma of the thoracic esophagus

OBJECTIVE

This study evaluated the impact of aggressive surgery on survival in patients with carcinoma of the thoracic esophagus.

SUMMARY BACKGROUND DATA

Prognostic value of lymph-node status for patients with esophageal carcinoma was emphasized, although it is currently under debate whether extensive lymph node dissection improves survival.

METHODS

Two hundred ninety-five patients with thoracic esophageal carcinoma were admitted to Kagoshima University Hospital from December 1982 to December 1990. Esophagectomy was performed on 244 (82.7%) of these patients; 106 of whom underwent three-field lymphadenectomy (bilateral cervical, mediastinal, and abdominal regions) were analyzed regarding lymph-node status, tumor recurrence, and the effect of prognostic factors on survival using Cox's proportional hazards model.

RESULTS

Hospital mortality and morbidity were 10.4% (11/106) and 65.1%, respectively. Seventy-eight patients (73.6%) had nodal involvement, including 49 patients with abdominal lymph-node metastases and 46 patients with recurrent nerve-node metastases. Five-year survival rates were 54.5% for 16 patients with a solitary nodal metastasis, 30.3% for stage III, 17.4% for stage IV, and 7.2% for 28 patients with six or more metastatic nodes. The most frequent sites of recurrence were the upper mediastinal region and the lung--its incidence increased significantly as the number of positive nodes increased. The most unfavorable prognostic factors included regional or recurrent nerve-node metastasis and patient age of more than 71 years.

CONCLUSIONS

Three-field lymphadenectomy, including especially the removal of bilateral recurrent nerve nodes in the cervical region, is essential for improving the survival of patients with carcinoma of the upper two thirds of the thoracic esophagus.

Analysis of cell surface antigens on glucocorticoid-treated rat thymocytes with monoclonal antibodies

The effects of glucocorticoid (GC) on thymocytes have been utilized to investigate the maturation and differentiation of thymocytes, but these experiments have mainly been performed on mouse thymocytes. We investigated the cell surface antigens expressed by LEW rat thymocytes during thymic reconstitution after GC treatment. Three-color flow cytofluorometric analysis of CD4, CD8 and the T cell antigen receptor (TCR alpha beta) clearly demonstrated that normal rat thymocytes contain CD4-8+ TCR alpha beta- and CD4+8- TCR alpha beta- cells. After GC treatment, we observed significant increases in the percentages of CD4-8+ TCR alpha beta- and CD4+8- TCR alpha beta- cells. The extent of the increase in the percentage of CD4-8+ TCR alpha beta- cells was greater than that of CD4+8- TCR alpha beta- thymocytes. Two-color analysis of TCR alpha beta and major histocompatibility complex (MHC) class I antigen showed that GC treatment significantly increased the percentage of TCR alpha beta- MHC class Ihi cells. Three-color analysis of CD4, CD8 and MHC class I demonstrated that normal rat thymocytes contain CD4-8- MHC class Ihi cells, which increased in number after GC treatment. These results indicate that rat thymocytes contain no fewer CD4-8+ TCR alpha beta- and CD4+8- TCR alpha beta+ cells than do mouse thymocytes, and that CD4-8+ TCR alpha beta- cells predominate over CD4+8- TCR alpha beta- cells in LEW rat thymus. Rat CD4-8- cells seemed to be divided into two subsets of TCR alpha beta- MHC class Ihi and TCR alpha beta- MHC class I- cells.

[Antibiotic activities of cefpirome against fresh clinical isolates resistant to multiple drugs]

Using multiple drug-resistant clinical isolates isolated since September 1992, minimum inhibitory concentrations (MICs) of cefpirome (CPR) were determined. Several control drugs were also used, and these MIC-determinations were made to determine the antibiotic activity of CPR. The obtained results are summarized as follows: 1. Antibiotic activities of CPR against methicillin-resistant Staphylococcus spp., Enterococcus faecalis, and benzylpenicillin-insensitive or resistant Streptococcus pneumoniae showed that expanded antibacterial spectrum of CPR and its enhanced antibiotic action against Gram-positive bacteria. We suggest that among the existing fourth-generation cephem antibiotics, CPR is "characteristically strong against Gram-positive bacteria". 2. Strong antibiotic activities of CPR were recognized against bacteria of family Enterobacteriaceae that were resistant to the third-generation cephems. The strong antibiotic activities appeared to be due to CPR's stability and decreased affinity for beta-lactamase. 3. Antibacterial spectrum of CPR was expanded against non-glucose fermented Gram-negative bacilli including Pseudomonas aeruginosa. It appears that this expansion of antibacterial spectrum is due to CPR's affinities for a wide range of penicillin-binding proteins as well as its improved permeability into tissues.

[beta-lactamase activity in sputum of patients with community-acquired lower respiratory tract infections]

beta-Lactamase production and activities in sputa of patients with community-acquired lower respiratory tract infections (LRTI) were determined and following results were obtained: 1) Suspected causative organisms frequently isolated were H. influenzae and Streptococcus pneumoniae. Similar results were previously reported. 2) Various beta-lactamase producing indigenous bacteria were detected. In many cases these indigenous beta-lactamase producing strains were isolated even when suspected causative bacteria were not beta-lactamase producers. 3) beta-Lactamase activities were detected from 61.5% of the sputa tested. Remaining activities of antibiotics added to the sputa were highly correlated with detection of beta-lactamases produced by suspectedly causative and indigenous strains and with presence of beta-lactamase activities in the sputa. Sulbactam/cefoperazone was stable in sputa than other antibiotics tested. 4) We concluded that the beta-lactamase produced by indigenous strains can be one of the factors of indirect pathogenicity in the community-acquired LRTI.

Membrane antigen expression of syngeneically but heterotopically transplanted hepatocytes in rats

The expression of membrane antigens on rat hepatocytes transplanted syngeneically and heterotopically was analyzed immunohistochemically using monoclonal antibodies against rat hepatocytes. Isolated adult and fetal hepatocytes were able to survive in the spleen, salivary gland, thymus, or subcapsular region of the kidney for various periods after transplantation. Fairly clear expression of HAM2, 4, and 8 antigens was observed on hepatocytes transplanted into syngeneic spleen, suggesting that the cells might be functionally equivalent to hepatocytes in situ. HAM4 antigen was localized specifically on the newly formed bile-canalicular faces of hepatocytes. The expression of HAM2 (MHC class I) antigen on the transplanted hepatocytes appeared much stronger on the side facing lymphoid tissues, than on the other faces, suggesting that some immunological reactions may take place between hepatocytes and lymphoid tissue. HAM8 antigen, which is localized on gap junctions between neighboring hepatocytes in rat liver, was also recognized between transplanted hepatocytes. In salivary glands where hepatocytes were transplanted, bile-canaliculus-like structures were observed not only between neighboring hepatocytes but also between hepatocytes and salivary acinar cells, suggesting good interaction between the two different epithelial cell types. Hepatocytes transplanted into thymus appeared viable, but most showed fatty degeneration. Some healthy hepatocytes survived in the interlobular connective tissue and the thymic cortical tissue. When fetal hepatocytes were transplanted heterotopically, they formed a mass consisting of hepatocytes and bile duct-like structures 7 wk after transplantation. The inoculated hepatocytes possessed HAM4 antigen, which was not recognized on fetal hepatocytes at day 14 of gestation.(ABSTRACT TRUNCATED AT 250 WORDS)

Changes in the distribution and intensity of alkaline phosphatase activity in rat lymph node and spleen cells after antigen stimulation

We investigated the reaction of the popliteal lymph nodes (PLN) to the injection of two antigens, keyhole limpet hemocyanin (KLH) and lipopolysaccharide (LPS), into the footpads of rats, as well as the changes occurring in the PLN after allogeneic cell stimulation. Changes in alkaline phosphatase (ALP) activity of the lymph nodes were examined enzyme histochemically. Paralleling with PLN weight gain, increased ALP activity was observed in the medullary regions of the lymph nodes of stimulated rats. ALP reactivity in the stimulated lymph nodes was observed to be weak in the germinal centers and strong in the medullary regions. The spleens of rats subjected to systemic graft-vs.-host (GVH) reaction were examined in a similar fashion. The ALP-positive areas of the GVH spleens increased in size as compared with normal spleens. These positive areas of lymph node and spleen appear to correspond mainly to areas containing OX12-positive cells. These results suggest that enzyme-histochemical analysis of ALP activity together with immunohistochemical analysis of lymphocyte phenotypes may be a useful method for examining lymph node and spleen reactions to soluble and cellular antigens in rats.

[Antimicrobial activities of polymyxin B against clinically isolated microbial strains. Results of MIC determination including high concentrations]

Minimum inhibitory concentrations (MICs) were determined for polymyxin B (PL-B), gentamicin, ofloxacin and norfloxacin against clinically isolated microbial strains collected since November 1992, and the following conclusions were obtained: 1. Judging from the MIC distribution of PL-B against the studied strains including multi-drug resistant organisms of major strains of family Enterobacteriaceae, such as Escherichia coli, Klebsiella pneumoniae, Enterobacter spp., and Pseudomonas aeruginosa, it appeared that no PL-B resistant strains were detected among those Gram-negative organisms within the antimicrobial spectrum of PL-B. 2. MICs of PL-B against most strains including methicillin resistant Staphylococcus aureus and coagulase-negative staphylococci were distributed between 100 and 800 micrograms/ml. These results supported reports of other investigators that the eradication of Staphylococcus spp. including MRSA (methicillin-resistant S. aureus) was possible by the use of PL-B at 1 mg/ml. 3. MIC distribution of PL-B against organisms of the Bacteroides fragilis group was almost the same as the results described above.