[Studies on S-1108 in pediatric infection]

Pharmacokinetic and clinical studies on S-1108, a new oral cephem antibiotic, were performed in pediatric infections and the following results were obtained. 1. Pharmacokinetics studies Pharmacokinetics of S-1108 was studied in 4 children (3 y 7 m-11 y 1 m) using doses of 2 mg/kg (n = 2) and 4 mg/kg (n = 2). The average peak plasma level was 0.88 microgram/ml at 2 hours after administration of 2 mg/kg and 2.00 micrograms/ml at 3 hours after administration of 4 mg/kg, and plasma half-lives were 1.45 and 0.96 hours, respectively. Average cumulative urinary recovery rates at 0-6 hours were 30.0 and 34.8%, respectively. 2. Clinical studies S-1108 was administered to 32 patients with various infectious diseases (6 with acute tonsillitis, 2 each with pertussis and acute bronchitis, 3 with pneumonia, 4 with scarlet fever, 5 with impetigo contagiosa, 6 with acute urinary infection and 1 each with subcutaneous abscess, impetigo, vulvitis and urethritis) at daily doses between 6-12 mg/kg/day, t.i.d., for 5-12 days. Clinical responses were excellent in 17 patients, good in 13, and poor in 2, and the efficacy rate was 93.8%. Bacteria were identified and 33 strains of 12 species were found. The eradication rate was 93.9%. No side effects were observed in 43 patients. Abnormal laboratory test values were observed in 2 patients, 1 with elevation of eosin. and the other with elevations of GOT and GPT. The results suggest that S-1108 may be a very useful and safe drug for the treatment of pediatric infections.

Transadventitial localisation of atheromatous plaques by fluorescence emission spectrum analysis of mono-L-aspartyl chlorin e6

OBJECTIVE

The aim was to demonstrate specific detection of the fluorescence spectra of mono-L-aspartyl chlorin e6 (NPe6) emitted from atherosclerotic arterial lesions using an extravascular approach.

METHODS

Cholesterol fed atherosclerotic rabbits were injected intravenously with 0.5 mg.kg-1 of NPe6. A fluorescence spectrum analysis system with a dual real time imaging system and a flexible endoscopic catheter was used. The pulsed excimer dye laser excited the photosensitiser. The fluorescence spectra were measured by a fluorescence spectrophotometer.

RESULTS

Analysis of fluorescence spectra detected from outside the adventitia showed that a fluorescence spectrum peak at 675 nm was obtained only in parts of the artery with an atheromatous plaque; however, no fluorescence could be shown in aortic segments free of atheroma. It was also noted that the intensity of the specific peak of the spectrum detected from outside a vessel was closely related to the depth of atheromatous lesions, as determined by histological analysis. An in vivo study revealed good correlation between the peak intensity (which could vary with the amount of NPe6 accumulated in the tissue) measured laparoscopically from outside the abdominal aorta and the peak intensity measured angioscopically from inside the abdominal aorta.

CONCLUSIONS

It is possible to detect atheroma from outside a vessel by fluorescence spectrum analysis employing NPe6 as the probe.

Significance of glomerular deposition of plasmin-alpha 2-plasmin inhibitor complexes in various glomerulopathies

To elucidate the relationship between glomerular deposition of plasmin-alpha 2-plasmin inhibitor complexes (PIC) and renal lesions or dysfunction, 25 patients with various glomerulopathies and various degrees of renal injuries were examined. Glomerular PIC deposition was found in eight patients (group A), and other 17 patients showed no deposition (group B). PIC was found mainly in the mesangium and along the capillary loops. Group A showed significantly more severe hematuria (p < 0.05) than group B. Group A showed a significant decrease in glomerular filtration rate (GFR; p < 0.05): the mean values being 60.8 +/- 39 in group A and 94.5 +/- 32 ml/min in group B. Group A showed a significant decrease in the phenolsulfonphthalein excretion test (p < 0.05). There was no significant difference in the mean values of plasma PIC, D-dimer, and thrombin-antithrombin III complexes (TAT) between two groups. Histologically, group A showed a significantly high incidence of adhesion (p < 0.05), crescentic formation (p < 0.05), endothelial swelling and/or detachment (p < 0.01), tubulointerstitial changes (p < 0.01), and glomerular deposition of platelet factor 4 (p < 0.01). The present study demonstrates that glomerular PIC deposition reflects the existence of activation of coagulation and fibrinolysis within the glomeruli and suggests that glomerular PIC deposition plays a part in the progression of renal injuries in various glomerulopathies.

The natural history of radiographic instability of the lumbar spine

The natural history of radiographic instability of the lumbar spine was determined by reexamination of 50 patients who had been diagnosed with this condition at least 10 years previously and correlation of these findings with changes in the clinical condition. The initial diagnosis and follow-up examination was performed by dynamic radiography, and the following observations were made: 1) radiographic instability resolved spontaneously in 20% of cases; 2) radiographic instability due to isolated posterior opening (asymmetric anterior collapse of the intervertebral disc in flexion) usually was self-limited; and 3) combined posterior opening and forward translation in flexion was associated with chronic instability and debilitating symptoms. The functional prognosis, whether or not symptoms are improved, in patients with radiographic lumbar instability depends primarily on developmental narrowing of the spinal canal, rather than on the existence or type of radiographic instability.

Phototaxic behavior and the retinotectal transport of horseradish peroxidase (HRP) in surgically created cyclopean salamander larvae (Ambystoma)

Negative phototaxis (NP) was used to evaluate the recovery of vision in albino axolotl larvae with one eye discarded and the other transplanted either to the orbit (orthoclops) or to the top of the head (cyclops). NP was assessed at approximately 1, 2 and 3 months postoperatively, using an automated, infrared monitor. Some 88% of the orthoclopes and 64% of the cyclopes recovered NP. However, among the cyclopes that did recover, the quantitative aspects of NP were virtually the same as those of the orthoclopes. That the cyclopean eye can regenerate retinotectal pathways was established by anterograde tracing of horseradish peroxidase (HRP). But where previously uninjured animals transported HRP to the contralateral tectum, both the cyclopes and the orthoclopes distributed the enzyme to the left and right tectal halves. Heavy deposits of HRP were found in the tecta of some animals that lacked NP. To find out if an optic tectum is actually required for NP, a series of ablation experiments were performed, using Ambystoma punctatum larvae. Tectectomy had the same effect on NP as bilaterally extirpating the eyes or intracranially severing both optic nerves, i.e. removing the tectum abolished NP.

THE RESULTS

(1) confirm the efficacy of the ectopic eye in the cyclops preparation; (2) show that the ectopic eye can regenerate retinotectal pathways; (3) indicate that retinotectal contact is a necessary but insufficient condition for NP.

Depressive states in workers using computers

There have been few reports investigating the depressive states in workers using computers. We describe the depressive states observed in workers using computers and discuss the sources of their occupational stresses. The first subject is a 34-year-old male manager of a manufacturing company who had customarily worked until 9 PM. In 1985, it become necessary for him to work until midnight; symptoms of depression began to appear during this period, exacerbated after trouble with a computer. In 1986, he visited a psychiatrist and his condition was diagnosed as Major Depression according to DSM-III. The second subject is a 26-year-old male VDT (visual display terminal) operator in a general hospital. Before the onset, he had had to work until 8 PM and, at the end of each month, until midnight. Two months later, he became depressed and his condition was diagnosed as Major Depression according to DSM-III. The third subject is a 32-year-old male chief in the computer programming section of a bank. He had had to work until 8 PM, became depressed, and visited a psychiatrist who diagnosed his condition as Major Depression according to DSM-III. The authors discuss these cases from the standpoint of occupational stresses, as they are associated with work overload, and the important role these stresses played in the onset of the workers' depressive states.

[Anatomic correction without extracardiac conduit for Taussig-Bing malformation (REV procedure)]

A 2-year-old boy with Taussig-Bing malformation with mild pulmonary stenosis underwent anatomical repair without extracardiac conduit (REV procedure). He had pulmonary arterial banding at 4 months of age, and REV procedure was performed at 2 years and 4 months of age. Under cardiopulmonary bypass, enlargement of ventricular septal defect were performed with an internal conduit. Pulmonary arterial trunk was divided and the proximal end was closed. Direct anastomosis of the posterior wall of the distal pulmonary arterial trunk to the right ventriculotomy was carried out without transection of aorta or translocation of pulmonary artery. Right ventricular outflow tract (RVOT) was reconstructed with a patch bearing a monocusp. The postoperative course was very smooth and postoperative cardiac catheterization revealed no stenosis in both left and right ventricular outlfow tract and good cardiac performance.

[Subacute subdural hematoma--reexamination of mechanism by CT and MRI findings]

We have already reported about the importance of establishing the concept of subacute subdural hematoma. But the mechanism by which this disease develops has not as yet been elucidated fully. In one case of subacute subdural hematoma, we were able to perform CT and MRI over time and obtained findings which were of use in studying the mechanism of development. The case was a 56-year-old male. He developed with seizure. CT on admission revealed acute subdural hematoma and subarachnoid hemorrhage. But neurological deficits were absent. So he was treated conservatively. On the 16th hospital day there appeared seizure, anisocoria and an increase in the mass sign due to subdural hematoma was noted on CT, so a diagnosis of subacute subdural hematoma was made. Cerebrospinal fluid was considered accountable for the increase in the mass sign judging from the findings of CT and MRI each performed over time. It was surmised that subdural effusion developed concurrently in the subacute stage. Three conditions, namely, presence of (1) arachnoid tear, (2) clots, (3) no intracranial hypertension are considered important as the mechanism by which subacute subdural hematoma develops.

Cloning and characterization of a 23-kDa stress-induced mouse peritoneal macrophage protein

Exposure of mouse peritoneal macrophages to oxidative and sulfhydryl-reactive agents in vitro enhances synthesis of a few cellular proteins that may be important in a self-defense system. A cDNA encoding a novel stress-inducible protein, designated MSP23 (macrophage 23-kDa stress protein), was cloned from a cDNA library of the macrophages by differential screening. A 1.0-kilobase mRNA transcript hybridized with the MSP23 cDNA gradually increased in macrophages upon culture in vitro. Treatment with diethylmaleate or glucose/glucose oxidase, which generates H2O2, markedly enhanced the induction of the transcript after several hours. Cadmium chloride and sodium arsenite also induced the transcript. An antiserum raised against recombinant MSP23 reacted with the 23-kDa stress-inducible protein of the macrophages. The amounts of 23-kDa protein in the cells rapidly increased during culture with diethylmaleate. The mRNA was detected in various tissues, and it was especially high in content in the liver. A search of databases revealed that six proteins of various species from bacteria to the mouse have a sequence homology to MSP23. One of the proteins is the C22 component of alkyl hydroperoxide reductase, which is induced by hydrogen peroxide in Salmonella typhimurium.

Incidence of acetylcholine-induced spasm of coronary arteries subjected to balloon angioplasty

To examine the vasospastic activity of coronary arteries which have been subjected to previous balloon angioplasty, we conducted an acetylcholine provocative test at diagnostic catheterization in 147 consecutive patients. All patients underwent successful elective angioplasty and had follow-up angiography 1 to 6 months after the procedure. Sixty-two patients had a history of prior myocardial infarction and 43 patients had multivessel coronary artery disease. Angioplasty was performed on 176 vessels. Incremental doses of acetylcholine (25 micrograms, 50 micrograms, 100 micrograms) were injected into the right and left coronary arteries over a period of 1 min. The incidence of coronary spasm of arteries which had been subjected to angioplasty was 44%. Angiographic restenosis was observed in 59 patients (40%). There was no correlation between the occurrence of coronary spasm and the presence of restenosis. The maximal dose of injected acetylcholine was smaller in patients with positive evidence of spasm than in patients with negative evidence of spasm (55 +/- 27 micrograms vs 82 +/- 28 micrograms, p < 0.01). In patients with single vessel coronary artery disease, the incidence of spasm of the contralateral artery, i.e. the artery without angioplasty, was lower than that of the artery subjected to angioplasty (22% vs 46%, p < 0.01). Thus, the data suggest that coronary arteries which have been previously subjected to angioplasty have enhanced vasospastic activity in response to acetylcholine.

[Serum and pleural SCC-antigen levels in patients with pulmonary tuberculosis]

We measured the serum and pleural levels of squamous cell carcinoma related antigen (SCC-Ag) in patients with active pulmonary tuberculosis and studied the relationship between SCC-Ag and tuberculosis. Serum levels of SCC-Ag in 63 patients with newly diagnosed untreated tuberculosis were 1.76 +/- 2.16 ng/ml, significantly higher than in 118 healthy controls (0.67 +/- 0.52 ng/ml) or in 11 patients with old tuberculosis (0.92 +/- 0.38 ng/ml; p < 0.01). Pleural effusion levels of SCC-Ag in 41 patients with tuberculosis pleurisy were 4.5 +/- 3.4 ng/ml, significantly higher than in 54 patients with non-malignant, non-tuberculous, pleurisy (2.3 +/- 1.7 ng/ml: p < 0.05). In patients who responded well to anti-tuberculous chemotherapy, serum levels of SCC-Ag decreased to the normal range (1.6 ng/ml) with clinical improvement, while in nonresponders they did not decrease. Isoelectolic focusing electrophoresis showed serum SCC-Ag to be composed of a neutral fraction as a single peak, which was corresponded to that of squamous cell carcinoma of the lung. The tuberculous lesions were stained with anti-SCC-Ag antibody in one case and weak SCC-Ag positive findings were observed in the intercellular spaces of the epidermoid cells in the area without necrosis. These results raise the possibility that SCC-Ag is produced in or released from not only squamous cell carcinoma of the lung but also pulmonary tuberculous lesions.

Apotransferrin stimulation of thyroid hormone dependent rat pituitary tumor cell growth in serum-free chemically defined medium: role of FE(III) chelation

Triiodothyronine (T3) dependent growth of GH1 rat pituitary tumor cells in serum-free defined culture requires apotransferrin (apoTf) (Sirbasku et al.: Mol. Cell. Endocrinol., 77:C47-C55, 1991). Diferric transferrin (2Fe.Tf) also is necessary as an iron source (Eby et al.: Anal. Biochem., 203:317-325, 1992). Further, T3 dependence is prevented by soluble Fe(III) addition to the medium (Sato et al.: In Vitro Cell. Dev. Biol., 27A:599-602, 1991). While our data suggested that apoTf caused growth by chelation of Fe(III), direct evidence was required. We used urea polyacrylamide gel electrophoresis along with autoradiography and Western immunoblotting to measure the Fe(III) content of growing GH1 cell cultures and identify the apoTf, mono-metal transferrins and 2Fe.Tf present. We found that apoTf per se did not cause growth but instead chelated inhibitory levels of Fe(III). In fact, apoTf need not be present at all provided that Fe(III) is reduced to < or = 0.6 microM. In addition, other protein and non-protein Fe(III) chelators were shown to be as effective as apoTf. Here, we report that pituitary cells are completely inhibited by > or = 1.2 microM Fe(III), which are concentrations which might be expected in many culture media and usually are not thought to influence growth. The high sensitivity of pituitary cells to Fe(III) suggests further study to determine what cellular functions are affected and how they interfere with thyroid hormone dependence.

Coronary perforation to the left ventricular cavity by a guide wire during coronary angioplasty

We describe a case in which the guide wire penetrated through the left anterior descending artery into the left ventricular cavity during percutaneous transluminal coronary angioplasty. This complication of coronary angioplasty which had not been previously reported was suspected because of the characteristic motion of the guide wire on the X-ray image and was confirmed by echocardiography.

Attenuation of ecto-5'-nucleotidase activity and adenosine release in activated human polymorphonuclear leukocytes

To examine whether activation of polymorphonuclear leukocytes attenuates release of adenosine through attenuation of their own ecto-5'-nucleotidase activity, human polymorphonuclear leukocytes were incubated with and without exposure to either N-formyl-methionyl-leucyl-phenylalanine (FMLP) or complement C5a. Ecto-5'-nucleotidase activity of polymorphonuclear leukocytes was attenuated by both FMLP and complement C5a (22.7 +/- 3.6 vs 9.7 +/- 2.6 nmol/min per 10(7) cells at 10(-6) M FMLP, P < .05; 21.5 +/- 2.2 vs 10.2 +/- 1.2 nmol/min per 10(7) cells at 5 x 10(-7) g/mL complement C5a, P < .001), whereas cytosolic 5'-nucleotidase activity was not affected by either FMLP or complement C5a. These reductions of ecto-5'-nucleotidase activity that were caused by both FMLP and complement C5a were dose and time dependent and were inhibited by superoxide dismutase. Desferrioxamine did not inhibit the decreases in ecto-5'-nucleotidase. In accordance with the decreases in ecto-5'-nucleotidase activity, release of adenosine was attenuated in the FMLP-pretreated and complement C5a-pretreated polymorphonuclear leukocytes, which were restored by concomitant administration of superoxide dismutase. The viability of FMLP-pretreated and complement C5a-pretreated polymorphonuclear leukocytes was markedly decreased compared with the untreated group after 60 minutes of hypoxia followed by 60 minutes of reoxygenation. Thus, we conclude that: (1) activation of polymorphonuclear leukocytes attenuates their own ecto-5'-nucleotidase activity and thereby reduces adenosine release, (2) reduction of ecto-5'-nucleotidase activity is attributable to generated superoxide anion in polymorphonuclear leukocytes, and (3) viability of polymorphonuclear leukocytes after hypoxia and reoxygenation largely depends on the extents of decreases in ecto-5'-nucleotidase activity.

Superoxide dismutase enhances both adenosine release and coronary hyperemic flow through protection of 5'-nucleotidase against its degradation during reperfusion following ischemia in dogs

Oxygen-derived free radicals are thought to inactivate ectosolic enzymes that regulate myocardial cellular functions. One such enzyme is ecto-5'-nucleotidase, which is responsible for adenosine production during coronary hyperemic flow. In the present study, we measured both reactive and hyperemic flow and adenosine release during reperfusion with and without superoxide dismutase. In 10 open chest dogs, the left anterior descending coronary artery was perfused through an extracorporeal bypass tube from the carotid artery. In the control hearts, a five-minute occlusion of the coronary artery caused the hyperemic flow with increased release of adenosine. In the superoxide dismutase-treated hearts, although administration of superoxide dismutase altered neither adenosine release nor coronary blood flow in the baseline, it augmented both peak coronary blood flow and repayment, and adenosine release during reperfusion. Therefore, we hypothesized that superoxide dismutase reduces generation of oxygen-derived free radicals during ischemia and reperfusion and attenuates the degradation of ecto-5'-nucleotidase. The administration of superoxide dismutase enhanced the increase in ecto-5'-nucleotidase activity at 10 minutes after reperfusion over the untreated group. Thus, we conclude that superoxide dismutase enhances reactive hyperemic flow and adenosine release during reperfusion following ischemia, which may be attributable to the protection of ecto-5'-nucleotidase by superoxide dismutase during ischemia and reperfusion.

[Clinical and pathological studies of organizing pneumonia]

Clinical and pathological studies on organizing pneumonia (OP) were performed in 16 cases diagnosed by transbronchial lung biopsy (TBLB). All patients were elderly and poorly-nourished with underlying disease, and suffered from fever and various respiratory symptoms. Results of laboratory studies in these cases were positive for C-reactive protein, negative for tuberculin reaction and showed high complement levels. Pathological findings demonstrated that there were two kinds of organizing process classified according to whether fibrin exudation was detected in Masson bodies or not. Twelve of the 16 cases were treated with prednisolone, and two cases were observed without administration. In nine of the 16 cases, abnormal shadows in chest X-ray disappeared, although abnormal shadows remained in five. Regarding the relationship between pathological findings and shadows in chest X-ray, Masson bodies without fibrin were observed in nine cases in which abnormal shadows in chest X-ray disappeared, but Masson bodies containing fibrin were observed in five cases in which abnormal shadows remained. These results suggest that there are two kinds of organizing process in OP. Steroid therapy tends to be ineffective in OP demonstrating organization containing fibrin caused probably by infection. However, prednisolone is effective in the OP associated with a fibrosing process, similar to idiopathic BOOP, without or with unrelated fibrin exudation of unknown origin.

Electrophysiologic evaluation of intermittent sacral nerve dysfunction in lumbar spinal canal stenosis

Intermittent sacral nerve dysfunction, induced by walking in lumbar spinal canal stenosis, may cause symptoms including hyperesthesia and pain in perineum, urinary bladder incontinence, and penile erection. However, it is difficult to objectively document these symptoms. Evoked external urethral sphincter potentials by conus medullaris stimulation were measured both before walking and after walking in five patients who complained of sexual organ or urinary dysfunction during walking, and were compared with simultaneously induced sacral nerve symptoms. These potentials were also measured during surgery. Sacral nerve symptoms were reproduced by walking 80-350 meters (average 177.5 m). These potentials disappeared in one patient and were decreased in four patients at the time when the claudicant symptoms disabled the patient during walking. The amplitude subsequently recovered in keeping with relief of those symptoms during rest. Monitoring of these potentials during surgery showed an increase of amplitude shortly after the decompression procedure of the cauda equina. In conclusion, this measuring method was valuable as an objective evaluation of intermittent sacral nerve dysfunction in lumbar spinal canal stenosis.

Syntheses and biological activities of chemically stable prostacyclin mimics with cis-bicyclo[4.3.0]nonene ring system: the novel homoisocarbacyclin analogues

The synthetic studies concerning a series of homoisocarbacyclin analogues, which are homologous compounds of isocarbacyclin, with cis-bicyclo[4.3.0]non-2-ene or cis-bicyclo[4.3.0]non-3-ene as a nucleus have been carried out. The general synthetic methods of homoisocarbacyclin analogues have been accomplished starting with the versatile Corey lactone. Among the analogues synthesized in the present studies, a promising compound (TY-11223) exhibiting a good selectivity in biological actions was found to be studied further.

Plant regeneration from protoplasts of peppermint (Mentha piperita L.)

Enzymatically isolated leaf-derived protoplasts of peppermint (Mentha piperita L.) were cultured in modified B5 medium containing 1 mg/l NAA, 0.4 mg/l BA, 0.5% sucrose, 0.5 M mannitol and 0.1% Gelrite (first medium). After 30 d culture at 25°C in the dark, protoplasts formed colonies consisting of about 100 cells. Gelrite medium blocks were transferred into liquid medium to promote further growth. Colonies of 0.5 mm transferred to 0.2% Gelrite solidified medium (same components as first medium) formed green calli (1-2 mm) under incubation in the light. Green calli transferred to differentiation medium (B5, 0.1 mg/l NAA, 5 mg/l BA, 2% sucrose, 0.2 M mannitol, 0.2% Gelrite) developed shoot buds after 3-4 weeks. Whole plants were recovered following rooting of shoots in B5 medium without hormones.

Head and neck carcinomas in patients under the age of forty years

From 1973 to 1988, 1,104 patients with head and neck carcinomas (excluding thyroid carcinoma) were admitted to the Yokohama City University Hospital, and among them, 48 (4.3%) were under the age of 40 years. We made a retrospective survey of these young patients. There were 36 males and 12 females. An increasing ratio of male to female was seen with increasing age. The primary site was most frequently the nasopharynx (29 cases), followed by the maxillary sinus (9 cases), and the tongue (4 cases). Squamous cell carcinoma in these young patients characteristically showed a low grade of differentiation.