Cytology and arrangement of enterochromaffin (EC) cells in the human stomach

Serotonin containing enterochromaffin (EC) cells in the human gastric mucosa were observed using serial semithin sections immunostained by Sternberger's PAP method and reconstructed by computer-assisted methods. In oxyntic glands, EC cells displayed a marked pleomorphism which suggests their plasticity or active movement. They sometimes possessed multipolar cytoplasmic processes directly contacting the neighboring epithelial cells and/or gastric lumen. In the antropyloric glands, they are exclusively the "closed-type," which fails to contact the lumen, and are often arranged touching other EC cells (cluster formation), apparently exhibiting polynuclear enterochromaffin syncytia. This syncitium-like arrangement is interpreted as the morphological counterpart of a possibly synchronized function of these cells. The morphological differences of EC cells in their shape, luminal endings and arrangement between both regions may be indicative of regional differences in their functions. Furthermore, the present study provides the first three-dimensional visualization of EC cells in the human stomach.

A case of lung infection caused by an unusual strain of Nocardia farcinica

A case of lung infection caused by an unusual strain of Nocardia farcinica is reported. This is the third case of the N. farcinica infection in this country. The strain failed to utilize rhamnose as sole carbon source, but could be identified by a numerical identification method. The mycolic acids contained 1-3 double bonds and the numbers of the carbon atoms of the mycolic acids were 50 to 60, average 56.

[Results of the treatment of malignant lymphoma of the brain--a report of Japan Lymphoma Radiation Therapy Group (JLRTG)]

Retrospective analysis of patients with malignant lymphoma of the brain was carried out. All cases were mainly treated with radiation therapy. Overall survival was 44% and 37% at two and five year. Survival was statistically better for patients with diffuse medium-sized cell or diffuse mixed type compared with diffuse large cell type by the LSG classification, for the age group less than 50 years compared with greater than or equal to 50 years, and for the group with Karnofsky Index greater than or equal to 50% compared with less than or equal to 40%. In 11 of 15 patients the first recurrent site was the central nervous system.

[Recurrence of non-Hodgkin's lymphoma: local control failures and regional recurrences]

From 1972 to 1982, 563 patients with Stage I and II non-Hodgkin's lymphoma received radiation therapy in the department of radiology which belongs to the JLRTS group. Local control failures were seen in only 5 cases (0.9%). The regional recurrences were found in 30 cases (5%). 17 of recurrences occurred during the first 5 years. 17 cases had remissions again, and 5 cases had 5 year survivals.

[Recurrence of non-Hodgkin's lymphoma: late recurrences]

563 patients with Stage I and II non-Hodgkin's lymphoma were treated by radiotherapy. 34 recurrences that occurred after 3 years from initial treatment were seen in those patients. 15 (44%) of 34 recurrences occurred after 5 years. 20 patients (59%) had remission by re-treatment, and 13 (38%) survived more than 2 years. 20 (59%) of recurrences were seen on head and neck lesions and superficial lymph nodes.

Results of transtrochanteric rotational osteotomy for nontraumatic osteonecrosis of the femoral head

From 1976 to 1985, transtrochanteric rotational osteotomy was applied to 58 hips of nontraumatic necrosis of the femoral head. Of these, 52 hips were available for the present study. The follow-up periods ranged from one to ten years (average, 5.1 years). Satisfactory results were obtained in 69%, as there was no evidence of progressive collapse of the head. Hips that had had no collapse or slight collapse before osteotomy had a significantly better prognosis, compared with those that had marked collapse of the head. The extent of the lesion as depicted on the preoperative lateral roentgenogram also influenced the eventual function. Patient satisfaction was significantly greater when these lesions were less than 70% (31/37), compared with greater than 70% (5/15).

Various kinds of lipoamino acids including a novel serine-containing lipid in an opportunistic pathogen Flavobacterium. Their structures and biological activities on erythrocytes

Lipoamino acids were found to represent 60% of the total extractable cellular lipids in Flavobacterium meningosepticum and F. indologenes which are known to be opportunistic pathogens. The structures of the lipoamino acids were resolved by chemical and physicochemical methods. Three kinds of lipoamino acids were included in the lipid of Flavobacterium: 3-hydroxyisoheptadecanoic acid amide-linked to serine and esterified to isopentadecanoic acid, and 3-hydroxyisoheptadecanoic acid amide-linked to ornithine and esterified to isopentadecanoic acid or 2-hydroxyisopentadecanoic acid. This type of serine-containing lipid is a novel, rare substance and exhibited high hemagglutinating activity (minimum hemagglutinating concentration was 0.25-0.5 micrograms/ml) with very good, stable dispersion of its liposomes. We called the serine-containing lipid 'flavolipin', based on the genus name of the bacteria. Of the two types of the ornithine-containing lipids, the one that had a nonpolar terminal fatty acid showed higher hemagglutinating activity than the one that had a polar terminal fatty acid. The reconstituted liposomes whose lipid composition was similar to that of the original bacterial cell membrane exhibited definite hemagglutinating activity. As soon as a terminal fatty acid of the lipoamino acids was lost, their biological activity on erythrocytes changed from hemagglutinating to hemolytic, being accompanied by the disappearance of animal species specificity. The mechanism of both the hemagglutination and the hemolysis was discussed.

Mesenteric lymphadenitis of swine caused by Rhodococcus sputi

Rhodococcus sputi caused tuberculosislike lymphadenitis of mesenteric lymph nodes in swine. This is the first study reporting that R. sputi can be a pathogen in swine.

Neutralizing monoclonal antibodies against recombinant human interleukin-2

A series of hybridoma cell lines which produce monoclonal antibodies (MAbs) against recombinant human interleukin-2 (rIL-2) have been established by fusion of murine myeloma cell line P3-NS1-1-AG4-1 and spleen cells of BALB/c mice which had been immunized with rIL-2. 48 hybridoma strains were selected by a solid-phase screening method which produced MAbs reacting with IL-2: four MAbs, L-15, L-20, L-34, and L-61, exhibited strong inhibition of the proliferating effect of rIL-2 on IL-2-dependent cell lines, NK7 and CTLL-2. L-61, the most potent MAb among them, also neutralized natural human IL-2, while the other three MAbs were unreactive. All the four MAbs were specific to human IL-2: they did not cross-react with mouse or rat IL-2. These MAbs are expected to be useful tools in the investigation of IL-2 function.

Isolation of mycolic acid-containing glycolipids in Nocardia rubra and their granuloma forming activity in mice

Three classes of glycolipids (TMM (trehalose monomycolate), TDM (trehalose dimycolate) and GM (glucose mycolate] containing mycolic acids as hydrophobic components were isolated from a strain of Nocardia rubra (Rhodococcus rubrum) and their structures have been partially characterized using infrared spectrometry, gas-liquid chromatography and gas chromatography-mass spectrometry. Acid or alkaline hydrolysis of isolated glycolipids revealed that trehalose was the sole water soluble component in TMM and TDM, while glucose was the hydrophilic component in GM. On the other hand, saturated, monoenoic and dienoic mycolic acids with carbon atoms ranging from C36 to C50 contained constituents of fatty acid moiety at C44. From the analytical results, TMM, TDM and GM were tentatively identified as trehalose monomycolate, trehalose dimycolate and glucose monomycolate, respectively. The mycolic acid composition differed significantly by the glycolipid classes: the highest amount of saturated mycolic acids were detected in TMM and GM, while a significant amount of dienoic mycolic acids have been found in TDM and the cell wall bound lipid fraction (BL). All these three classes of glycolipids containing mycolic acids showed strong granuloma forming activity in lungs and spleen of ICR mice 1 week after intravenous injection of 100 to 500 micrograms glycolipid in W/O/W micelles containing Freund's incomplete adjuvant. These results indicated that glycolipids containing shorter carbon chain mycolic acids ranging C40-50, corresponding to less acyl numbers or monosaccharides such as glucose, can also produce foreign body-type granuloma in mice without protein antigens.

Granuloma formation and hemopoiesis induced by C36-48-mycolic acid-containing glycolipids from Nocardia rubra

As previously reported (I. Yano, I. Tomiyasu, S. Kitabatake, and K. Kaneda, Acta Leprologica 2:341-349, 1984), Nocardia rubra, one of the nonpathogenic actinomycetes, possesses three classes of mycolic acid-containing glycolipid, i.e., glucose mycolate, trehalose dimycolate, and trehalose monomycolate. The carbon chain length of their mycolic acids is shorter (C36-48) than that in mycobacteria (longer than C70), and the glycolipid consists of only alpha-mycolic acid. One intravenous administration of 500 micrograms of each purified glycolipid to ICR mice in the form of water-in-oil-in-water emulsion without any protein antigens caused prominent granuloma formation in the lungs, spleen, and liver. The lung index in the treated mice was about 3.5 times larger than that in the control mice (given water-in-oil-in-water emulsion only) at 1 week after the injection and then rapidly declined, while spleen and liver indices peaked at 2 weeks after the injection and persisted longer. The granuloma consisted of macrophages, some of which phagocytized glycolipid micelles, lymphocytes, monocytes, and neutrophils. In addition, many small hemopoietic islands were observed in the liver sinusoids, where various immature blood cells were trapped by the prominent cytoplasmic projections of Kupffer cells. The granuloma formation and hemopoiesis observed here are considered to be the most characteristic morphological expression of macrophage activation in these organs. This is the first report to show that such histological changes can be induced by chemically defined and homogeneous mycolic acid-containing glycolipids other than those of mycobacteria.

Determination of molecular species composition of C80 or longer-chain alpha-mycolic acids in Mycobacterium spp. by gas chromatography-mass spectrometry and mass chromatography

The molecular species composition of alpha-mycolic acids ranging from C68 to C86 in 13 rapidly growing and 12 slowly growing mycobacterial species was determined by gas chromatography, gas chromatography-mass spectrometry, and mass chromatography. In gas chromatographic analysis, the molecular species of alpha-mycolic acids were well separated as trimethylsilyl ether derivatives of the methyl esters, according to their total carbon numbers. The total carbon and double-bond numbers of mycolic acids at each peak on gas chromatograms were determined from the [M]+, [M - 15]+, and [M - 90]+ ions on the mass spectrum, and straight and branched chain structures were identified by the mass fragment ions [A]+, due to C2--C3 cleavage [R-CH-O-Si(CH3)3]+, and [B]+, due to C3--C4 cleavage [(CH3)3-Si-O-CH-CH(R')-COOCH3]+. The concentration of odd- and even-carbon-numbered mycolic acids, which often overlap each other on gas chromatograms, and the composition of three homologous mycolic acids with different alpha units (C22:0, C24:0, and C26:0) were clearly determined by mass chromatography monitoring [M - 15]+ ions and [B - 29]+ ions, respectively. The molecular species composition of alpha-mycolic acids and their average carbon numbers (av. cn.) as a simple expression of the composition were calculated from the mass chromatograms. Each mycobacterial species examined was demonstrated to possess a characteristic profile of alpha-mycolic acid composition, and based on this the species were classified approximately into eight groups: C68 to C76 (av. cn. 72), dienoic, possessing a C20 alkyl branch at the 2 position (C22 alpha-unit) for Mycobacterium diernhoferi and Mycobacterium sp. strain 3707, a chromogenic rapid grower; C72 to C78 (av. cn. 75), dienoic with both C22 and C24 alpha units, containing a small or a large amount of odd-carbon-numbered molecules, for M. vaccae, M. rhodesiae, and M. phlei (chromogenic rapid growers); C72 to C80 (av. cn. 75 to 77), dienoic with C24 alpha-unit, containing a moderate or a large amount of odd-carbon-numbered molecules, for M. smegmatis, M. chitae, M. chelonae (M. chelonei), and M. fortuitum (nonchromogenic rapid growers); C78 to C82 (av. cn. 80), even-carbon-numbered dienoic with C24 alpha unit for M. agri and M. thermoresistible (rapid growers); C75 to C81 (av. cn. 77 to 79), odd-carbon-numbered dienoic with C24 alpha unit for M. nonchromogenicum complex (M. nonchromogenicum, M. terrae, and "M. novum") (slow growers); (vi) C76 to C84 (av. cn. 79 to 81), even-carbon-numbered dienoic with C24 alpha unit for MAIS complex including M. scrofulaceum, M. avium, and M. intracellulare (slow growers); (vii) C72 to C80 (av. cn. 77 to 79), even-carbon-numbered dienoic with C24 alpha unit for M. szulgai, M. gordonae, and M. kansasii (chromogenic slow growers); and (viii) C76 to C86 (av. cn. 79 to 81), even-carbon-numbered dienoic with C26 alpha unit M. bovis Ravenol and BCG and M. tuberculosis H37Rv. This study demonstrated that gas chromatography-mass spectrometric analysis of the molecular species composition of alpha-mycolic acid can give rapid, important, and very precise information for the identification of pathogenic and nonpathogenic mycobacterial species.

[Clinical study on imipenem/cilastatin sodium in the field of pediatrics]

Imipenem/cilastatin sodium (MK-0787/MK-0791) was administered to pediatric patients with infections, and the following results were obtained. Pharmacokinetic study Two children, 11 years of age (38 kg body weight) and 3 years of age (15.5 kg body weight), were administered by 30 minutes intravenous drip infusion a single dose of 500 mg/500 mg (13.2 mg/13.2 mg per kg) and 250 mg/250 mg (16.1 mg/16.1 mg per kg) of MK-0787/MK-0791, respectively. Serum concentrations of MK-0787 reached their peaks at the end of drip infusion at a value of 56.33 micrograms/ml and 55.98 micrograms/ml, respectively. Concentrations of the drug decreased as the time after the administration increased, and they reached 0.14 microgram/ml and 0.12 microgram/ml, respectively in the older and the younger children at 6 hours after the administration. Half-lives (T 1/2) of the drug in serum were calculated to be 1.21 hours and 1.04 hours, respectively. The concentration of the drug in cerebrospinal fluid for the 11 years old was 0.52 microgram/ml 2 hours after the drip infusion and the serum concentration at the time was 4.02 micrograms/ml. Peak serum concentrations of MK-0791 in the 2 children were 53.73 micrograms/ml and 22.99 micrograms/ml, respectively, at the end of drip infusion. After 1 hour, the serum concentration of the drug decreased to 10.54 micrograms/ml in 1 case and not detectable in the other case. Urinary recovery rates of MK-0787 in 6 hours after the drip infusion was 82.9% and 63.6% in the 2 children and those of MK-0791 were 57.9% and 74.6%. Clinical study Clinical studies on MK-0787/MK-0791 were carried out in 6 pediatric patients; 1 each with femoral cellulitis, sepsis suspected, salmonellosis, acute tonsillitis, bronchopneumonia and streptococcosis. Lengths of treatment were 2 2/3-4 days for 5 cases and 6 days for 1 case. The patients were treated by 30-60 minutes intravenous drip infusions twice a day for 1 case, and 3 times a day for 5 cases at daily doses of 54.5-66.7 mg/kg. The treatment was effective in all cases, with 3 cases judged excellent and 3 cases good. The safety of the drug was studied in 7 patients. No side effects nor clinically abnormal values were observed in any cases.

Results with Zielke instrumentation for idiopathic thoracolumbar and lumbar scoliosis

Thirty-one patients (23 adolescent, eight adult) underwent spinal fusions with Zielke instrumentation for idiopathic thoracolumbar and lumbar scoliosis. Their curves averaged 55.2 degrees. In most patients the length of fusion did not extend beyond the major curve. Correction of scoliosis was 82% in adolescents and 59% in the adults. The kyphotic component of the curves was corrected from an average of 21 degrees to 8 degrees. Correction of the spinal vertebra rotation was 46% in the adolescent patients. The tilt angle of the vertebra at the lower end of the curve was reduced significantly. The fusion rate was 93.5%. Two of the adult patients developed pseudarthrosis. Major complications were not encountered. The Zielke instrumentation system in the management of idiopathic thoracolumbar and lumbar scoliosis offers the advantages of a relatively good correction and minimal segment fusion.

Human corticosteroid-binding capacities in normal, high-risk or pregnancies with an abnormal outcome

To determine whether or not the serum corticosteroid binding capacity (CBC) level is related to the outcome of pregnancy or fetal well-being, a total of 124 determinations of CBC were performed in 96 pregnant individuals, using hydrophobic resin adsorption methods. The serum CBC values were elevated with progression of gestation. On the other hand, high-risk pregnancies or those with an abnormal outcome were among the low CBC group, below the mean value (p less than 0.001), whereas normal pregnancies were more often in the high CBC group, over the mean value, in comparison with the low CBC group below the mean value (p less than 0.001), after 28 weeks of gestation. In addition, the ratios of birth weight/placental weight and maternal weight/placental weight were slightly but not statistically high in the low CBC group, in comparison with the high CBC group. Thus, various events related to placental growth might be important factors regulating the serum CBC level. While there are many determinants of corticosteroid binding globulin production and excretion, assessment of CBC levels seems to be a reliable indicator of the outcome of pregnancy, including high-risk pregnancy, in the 3rd trimester.

Follow-up study of medial facetectomies and posterolateral fusion with instrumentation in unstable degenerative spondylolisthesis

From 1978 to 1983, 54 consecutive patients with unstable degenerative spondylolisthesis were treated by medial facetectomies and posterolateral fusion with combined distraction and compression rod instrumentation. The average period of follow-up observation was 30 months. Twenty-five patients had a combination of disc herniation or instability, excluding olisthesis. Single-level fusion was performed in 29 patients, two-level in 23, and three-level in two. Preoperative low-back pain in 87.0% and sciatica in 66.7% were reduced to 7.5% and 5.6%, respectively, at follow-up treatment. Preoperative neurogenic intermittent claudication in 63.0% and neurogenic bladder in 11.1% disappeared completely in all patients at follow-up examination. The solid fusion rate was 96.3%. Difference between the values of %-slip and slip-angle before surgery and those at follow-up examination was not statistically significant. Rod breakage occurred in two patients with pseudarthrosis. The overall clinical results were satisfactory relief of clinical symptoms and regression of physical signs, with a high rate of solid fusion.

[Treatment result of radiation therapy alone in carcinoma of the breast--analysis of 116 cases from 19 hospitals]

In order to analyze the radiation effect for the breast cancer 116 patients without distant metastasis were collected from 19 large hospitals in Japan. The cumulative five and ten year survival rates were 85%, 80% in stage I (20 cases), 75%, 61% in stage II (41 cases) and 21%, 9% in stage III (55 cases), respectively. In stage I-II, the five year actuarial survival rate of the papillotubular type is better than that of the scirrhous type. In stage III, more than 70 Gy for the primary breast tumor and more than 50 Gy for the regional lymph node regions must be given, to obtain the good result. On the other hand, no correlation was observed between the given dose and the survival rate in stage I-II, due to the influence of the distant metastasis.

Cubitus varus deformity following supracondylar fracture of the humerus. A method for measuring rotational deformity

Cubitus varus following supracondylar fracture of the humerus in children consists of varus, hyperextension, and internal rotation deformities of the distal bone fragment of the humerus. There has been no simple clinical method of measuring internal rotation deformity. The authors report here on a method of accurately measuring the internal rotation of the shoulder in a position with the elbow at 90 degrees flexion on the back and the shoulder held at the maximum extension. When a patient with developing cubitus varus attempts to rotate his shoulder internally, there is an apparent increase in the degree of internal rotation at the shoulder of the fractured side. The mean value of the angle formed between the horizontal plane of the back and the mid-line of the forearm was approximately 0 degrees in 217 normal children, whereas an increase of 35 degrees was seen in seven children with cubitus varus. When this angle was corrected successfully, the angle after surgical correction became approximately 0 degrees. In the treatment of cubitus varus deformity, it is necessary to simultaneously correct three-dimensional deformities.

Analysis of results with Zielke instrumentation for thoracolumbar and lumbar curvature

Thirty-nine patients (idiopathic in 26, paralytic in 11 and congenital in 2) treated by Zielke instrumentation with fusion for thoracolumbar and lumbar curvature were reviewed. The average follow-up was 34 months. The corrections of scoliosis was 76% in the adolescent idiopathic group, 59% in the adult idiopathic group and 55% in the paralytic group; rotation corrected (38%). Kyphosis was reduced from 61 degrees to 20 degrees on the average by derotating the spine using the derotator followed by placing bone graft in the anterior disc spaces. The tilt angle of the lower end vertebra in the idiopathic group and the pelvic obliquity angle in the paralytic group were corrected remarkably. Fusion rate was 92.3%. Two of three pseudarthrosis were repaired by Harrington instrumentation and fusion. One was free from symptoms. Complications were frequent, though in most cases only minor.

Distraction rod instrumentation with posterolateral fusion in isthmic spondylolisthesis. 53 cases followed for 18-89 months

Fifty-three cases of isthmic spondylolisthesis were treated with distraction rod instrumentation and posterolateral fusion with or without nerve root decompression, and they were followed for an average of 39 months. Thirty-one cases without neurologic deficit were treated with instrumentation and fusion only. In 22 cases of predominant sciatic pain with neurologic deficit signs, nerve root decompression and instrumentation with fusion were conducted. The results showed a 90.6% solid union rate with satisfactory clinical improvement. Realignment of the vertebral displacement such as reduction of olisthesis and widening of the olisthetic disc spaces was obtained to some extent. No serious complications were encountered.

Pit cells in extrahepatic organs of the rat

Electron microscopic examination of the extrahepatic distribution of pit cells, a cell type found in the liver, revealed their existence in several other organs of the rat. They were relatively frequent in lungs, spleen (red pulp), small intestine, epididymis, trachea, and peripheral blood; much fewer in bone marrow and thymus (medulla); and nonexistent in lymph nodes, spleen (white pulp), and thymus (cortex). The pit cells in these organs, as well as in the liver, contained characteristic dense granules and rod-cored vesicles in the cytoplasm. Our observations suggest that pit cells circulating in the peripheral blood adhere to the endothelium of capillaries in the various organs and migrate into the tissue, where they have some special immunological function.

[A clinical study of radiotherapy with HCFU for advanced and recurrent breast cancers. Radiation and HCFU Study Group for breast cancer]

We have investigated the usefulness of combination therapy with radiation and HCFU for advanced and recurrent breast cancer according to a clinical controlled multicenter trial from 1982 to 1984. One hundred cases were registered and 82 of them were available. Treatment sites were the lymph nodes, skin, bone and lung, and the overall response rate was 58% in CR and 19% in PR, while the duration of remission was 18 weeks in CR. Side effects were found in 10% of the patients. Combination therapy with radiation and HCFU may be useful in multimodal treatment for advanced recurrent breast cancer.

[A case of giant hydronephrosis and a review of 324 cases in the literature]

A case of giant hydronephrosis due to ureteropelvic junction obstruction in an 18-year-old boy is reported. The patient had been told to undergo an operation for the left hydronephrosis at 2 years of age. However, he stayed away from hospital until he presented at our clinic with nausea caused by a large abdominal mass. Radiological evaluation revealed a left giant hydronephrosis with no function and slight compensatory hypertrophy in the right kidney. Left nephrectomy was performed and the pelvic capacity was approximately 7,700 ml. Histopathological examination showed muscular hyperplasia at the ureteropelvic junction. The term giant hydronephrosis may be defined as a hydronephrosis the contents of which are greater than 1,000 ml. Three hundred twenty four cases of giant hydronephrosis in the literature are reviewed and the age, sex, side involved, pelvic capacity, etiology, and relation to hypertension are discussed.

[Clinical evaluation of ceftriaxone in the pediatric field]

Ceftriaxone (Ro 13-9904, CTRX), developed by F. Hoffmann-La Roche Ltd. in Switzerland, was used for the pediatric infections and the following results were obtained. The mean blood level of CTRX in 2 children after a 60-minute intravenous drip infusion with 20 mg/kg was 58.6 micrograms/ml at 30 minutes, 75.0 micrograms/ml at 1 hour, 39.85 micrograms/ml at 2 hours, 27.74 micrograms/ml at 4 hours, 20.71 micrograms/ml at 6 hours, 11.72 micrograms/ml at 12 hours and 3.91 micrograms/ml at 24 hours while the half-life time was 5.9 hours in one child and 7.6 hours in the other. CTRX was used in 22 children with acute infections consisting of 3 with acute pharyngeal tonsillitis, 4 with acute bronchitis, 8 with bronchopneumonia, 6 with infections of skin soft tissue and 1 with salmonellosis. The results were excellent in 5 cases and good in 17, indicating an efficacy rate of 100%. Out of 10 cases where the causative strains were detected, 4 cases were followed about the activities of the respective bacteria, i.e., H. influenzae, Streptococcus group A, S. aureus and Salmonella group B, all of which were eradicated after the end of administration. The daily dose of CTRX ranged from 30 to 50 mg/kg and generally a larger dose was used for serious infections. CTRX was administered twice daily in 20 out of 22 cases, by an intravenous injection in 4 and an intravenous drip infusion in 18, for 2 to 4 days in 16 and 5 to 8 1/2 days in 6. No clinical adverse reactions were observed while the laboratory test found a slight elevation of GOT in one and that of GOT and GPT in another. From the above results, CTRX was judged to be a highly useful drug for treatment of pediatric infections.

Burst fractures with neurologic deficits of the thoracolumbar-lumbar spine. Results of anterior decompression and stabilization with anterior instrumentation

Twenty-seven burst fractures with neurologic deficits of the thoracolumbar-lumbar spine were treated with an one-stage anterior operation consisting of anterior decompression through vertebrectomy, realignment and stabilization with Zielke instrumentation (12 patients), and our new anterior instrumentation (15 patients). Only two disc spaces directly related to the injury were fused. No patient showed neurologic deterioration after surgery. All 26 patients with incomplete lesions improved postoperatively, with 19 of them entering the next Frankel subgroup. The newly designed anterior instrumentation afforded enough stability to enable early ambulation with alignment and solid fusion.

[Clinical study on sulbactam/cefoperazone in the field of pediatrics]

Sulbactam/cefoperazone (SBT/CPZ) was used in pediatric patients with acute infections, and the following results were obtained. SBT/CPZ was administered to 18 pediatric patients with acute infections. Out of them, 14 patients, i.e., 3 with acute tonsillitis, 1 with acute laryngitis, 1 with acute bronchitis, 4 with acute pneumonia, 4 with bronchopneumonia, 1 with pyothorax, were adopted for the evaluation, and the other 4 were excluded because they were judged inadequate for clinical efficacy evaluation. The clinical efficacy of SBT/CPZ was assessed as excellent in 4, good in 9 and fair in 1. The effective rate was 92.9%. In 6 cases causative organisms were detected, i.e., Haemophilus influenzae in 3, Klebsiella in 1 and Staphylococcus aureus in 2 cases. Eradication of these organisms was confirmed in all cases except for 1 patient with pyothorax caused by S. aureus. The doses used in 12 out of the evaluated 14 cases ranged from 58.4 to 80 mg/kg/day, 84.1 mg/kg/day was used in 1 case and 101.4 mg/kg/day was used in 1 case with pyothorax. Patients with severe infections were generally given large doses. The frequency of administration was 3 times per day except 1 case, and intravenous drip infusion was used in all cases. The duration of treatment was 2- less than 3 days for 7 cases, 3-5 days for 6 cases and 9 days for 1 case (pyothorax). No clinical side effects were observed in any case. In laboratory examinations, a slight elevation of GOT was observed in 1 case, but no abnormal findings in the other cases. From the above results, SBT/CPZ was considered to be a highly useful drug in the treatment of pediatric infections.

Pit cell-hepatocyte contact in autoimmune hepatitis

This is the first report to document pit cells in the human liver. These cells were identified by characteristic electron-dense granules and rod-cored vesicles. The granules of human pit cells were smaller in number and size than those of the rat. In the present case of autoimmune hepatitis, pit cells and conventional agranular lymphocytes migrated into hepatic parenchyma and contacted degenerating and immature hepatocytes. Pit cells show natural killer activity (Kaneda et al., 1983), and may participate in development of lesions and cellular damage.

[Clinical study on ceftazidime in the field of pediatrics]

Ceftazidime (CAZ), developed by Glaxo U.K., was used in pediatric patients with acute infections, and the following results were obtained. The mean blood concentrations of CAZ in 2 children were 142, 70.3, 46.9, 35.7, 16.2, 5.82 and 2.36 micrograms/ml at 5, 15, 30 minutes, 1, 2, 4 and 6 hours, respectively, after start of 5 minutes' intravenous injection of 20 mg/kg, with the half-life of 1.25 hours. CAZ was administered to 19 pediatric patients with acute infections. Out of them, 15 patients, i.e., 3 with acute tonsillitis, 1 with acute bronchitis, 5 with bronchopneumonia, 2 with pertussis accompanying pneumonia, 2 with Salmonella enteritis, 1 with impetigo staphylogenes and 1 with subdural abscess, were adopted for the evaluation, and the other 4 were excluded from the evaluation because of inadequate indications. The efficacy rate in these 15 cases was 93.3%. The doses used in 14 out of the evaluated 15 cases ranged from 31 to 50 mg/kg/day, the frequency of dosing was twice daily in 8 cases and 3 times daily in 7 cases. One shot intravenous injection was used in 6 cases, intravenous drip infusion in 8, and combination of these, in 1 case. The duration of treatment was 2 days in 3 cases, 3 days in 3, 4 days in 4, and 5 days in 3 cases. Patients with severe infections were generally given large doses for long-term. No clinical adverse event was observed in any case. In laboratory examinations, slight elevation of S-GPT alone was observed in 1 case. From the above results, CAZ was considered to be a highly useful drug in the field of pediatrics.

Posterolateral fusion with instrumentation in the symptomatic failed back patients

Thirty-two symptomatic failed back patients after lumbar spine surgery performed for disc lesions underwent posterolateral fusion involving an adaptation of two distraction rod or combined distraction and compression rod instrumentation following decompression procedure when necessary. The main causative pathology of persistent pain was segmental instability with or without nerve root entrapment. The average follow-up period was 35 months. Twenty-eight patients responded that they were satisfied with the final operation. Fusion rate was 100% at the present study. The salvage instrumentation surgery to the failed back was thought to have brought about removal of instability, restoration of the disc height to some extent and decompression in some cases.

[Computed tomography in lumbar degenerative disease]

We reported the 18 patients which underwent surgical exploration and reviewed these CT findings. Method. All CT scans were obtained on Somatom II, high resolution CT scanner, with the patient in the supine position. A lateral localizer image (Topogram) was used to select the appropriate intervertebral disk space. The slice thickness was 4 mm. Results. CT findings in lumbar degenerative diseases include bony canal stenosis (central canal stenosis, narrowed lateral recess), soft tissue abnormalities (herniated nucleus pulposus, bulging annulus, hypertrophy and/or ossification of ligamentum flavum, no delineation of nerve root in lateral recess), and spinal instability (spondylolisthesis, vacuum phenomenon). The above three factors contribute to narrowing of spinal canal. No delineation of nerve root or soft tissue replacement of epidural fat in lateral recess suggests that the nerve root may be compressed by some factors. Herniated nucleus pulposus may cause nerve root compression with or without canal stenosis. Conclusion. This study revealed that the CT findings correlated closely with the surgical findings and the site of nerve root compression could be determined.