A Case of Miscarriage Caused by a Small Uterus following Childhood Chemotherapy

A majority of miscarriages have been thought to be caused by fertile ovum abnormalities; however, our findings suggest that a small uterus can also potentially cause miscarriage. There are no reports on the association between a small uterus and miscarriage. A woman in her late 20s, whose medical history revealed childhood acute lymphocytic leukemia, which progressed to remission after chemotherapy, radiotherapy, and bone marrow transplantation. Ultrasound revealed no ovarian follicles in either of the ovaries and small uterus (length, 32 mm) In cycle 15, after ovum collection, frozen embryos with Veeck's classification of G3b9 were obtained. Embryo transplantation was performed during the hormone replacement cycle, resulting in pregnancy. On day 5 of gestational week 18, the patient experienced mild lower abdominal pain, and she underwent a spontaneous delivery.

[Transvaginal ultrasound-guided core needle biopsy for residual potentially malignant ovarian tumors in cases with severe peritoneal adhesion and frozen pelvis requiring polysurgery]

A multiparous woman in her 40s had advanced peritoneal adhesions and frozen pelvis from 3 previous surgeries. Endometrial ovarian cysts also remained. After the last surgery, imaging showed cysts with a septum and enhanced moieties in the Douglas pouch. Highly invasive surgery was anticipated, and the patient underwent a transvaginal ultrasound-guided core needle biopsy(TVCNB, 16-gauge needle)with full awareness of the risks involved. The histopathological diagnosis was adenocarcinoma. We inserted a ureteral stent and performed an S-shaped colon resection and standard ovarian cancer surgery after preoperative chemotherapy. TVCNB in this case was less invasive and easier to perform than other exploratory procedures, and has a low risk of iatrogenic intraperitoneal dissemination even if the tumor is malignant. Chemotherapy can be administered before surgery if malignancy is detected. In summary, TVCNB is a useful alternative method for conducting exploratory operations.

In vitro antibacterial properties of T-5575 and T-5578 novel parenteral 2-carboxypenams

T-5575 and T-5578, novel 2-carboxypenams in which a carboxyl group has been introduced into the C-2 beta position of the nucleus, were evaluated for their in vitro antibacterial properties. The spectrum of activity of T-5575 was similar to that of aztreonam. However, it showed stronger activities than those of aztreonam against most gram-negative bacteria. T-5575 also showed potent activities against isolates of Enterobacter cloacae, Citrobacter freundii, and Pseudomonas aeruginosa resistant to ceftazidime, with MICs at which 90% of the isolates were inhibited of 0.39, 0.39, and 3.13 microgram/ml, respectively. T-5578 showed moderate levels of activity against gram-negative bacteria, compared with those of T-5575. Its activity against P. aeruginosa, however, was superior to those of T-5575 and the reference drugs tested. The most characteristic feature of T-5578 was its potent activities against ceftazidime-, imipenem-, and gentamicin-resistant P. aeruginosa isolates, with MICs at which 90% of the isolates were inhibited at 0.39, 3.13, and 3.13 microgram/ml, respectively. These two compounds were unfortunately poorly active against gram-positive bacteria, such as Staphylococcus aureus and streptococci. Both compounds were found to be stable for hydrolysis by various kinds of beta-lactamases and to have low affinities for these enzymes, with Ki values of > 100 microM. These novel penams bound most tightly to penicillin-binding protein 3 of Escherichia coli and P. aeruginosa. These results indicate that T-5575 and T-5578 can be regarded as promising 2-carboxypenams specially targeted against gram-negative pathogens.

[Serum protein binding of T-3761]

We investigated the extent of the binding of T-3761 to serum protein and obtained the following results. 1. The binding rates of T-3761 to serum protein from various animals and human were 16.9-27.7%, and a little higher than those of ciprofloxacin and ofloxacin. 2. The binding rates of T-3761 to human serum protein were 19.1-23.8% at concentrations of 0.25-20 micrograms/ml. 3. The binding rates of T-3761 lowered as the decrease of protein concentration. 4. The binding rates of T-3761 (2 micrograms/ml) to human serum protein were 12.4, 21.3 and 32.1% at pH 7.0, 7.4 and 8.0, respectively, showing the effect of the pH. 5. The binding of T-3761 to human serum protein was reversible. 6. In vivo binding rates of T-3761 in rabbits after a single oral administration of 20 mg/kg were 26.1-33.2%, which were similar to those obtained in vitro.

[Microbiological assay method for T-3761 concentration in body fluids]

A microbiological assay method for measurement of T-3761 and its stability in body fluids were investigated. The paper disc method proved suitable for this assay using Escherichia coli Kp as a test organism and commercially available heart infusion agar as a test medium. When using the paper disc method, lower detection limit of T-3761 was approximately 0.05 microgram/ml and 0.1 microgram/ml for 1/15M phosphate buffer (pH 7.0) and human serum, respectively. T-3761 in human serum and urine was stable under freezing -20 degrees C for at least 28 days.

Protective effect of piperacillin against the nephrotoxicity of cisplatin in rats

The protective effect of piperacillin against the nephrotoxicity of cisplatin was compared with that of fosfomycin in Fischer 344 rats. Blood urea nitrogen, serum creatinine, and morphological changes were evaluated as the renal toxicological parameters. Rats receiving 2 mg of cisplatin per kg of body weight for 5 days showed significant (P less than 0.01 by multiple-comparison test) elevation of blood urea nitrogen and serum creatinine concentrations compared with rats receiving saline alone and also exhibited development of cell lesions in the pars recta of the tubules in the outer stripe of the outer medulla. However, piperacillin (250 and 1,000 mg/kg) significantly (P less than 0.01 by multiple-comparison test) reduced these toxicological parameters in comparison with results for cisplatin alone. The protective effect of piperacillin was superior to that of fosfomycin, although platinum levels in the kidney were higher with the combination of cisplatin and piperacillin than with cisplatin plus fosfomycin. Although the nephrotoxicity of cisplatin was also reduced when cisplatin was administered concomitantly with sodium chloride in mole-equivalents to 250 and 1,000 mg of piperacillin per kg, its protective effect was less than that of the corresponding piperacillin dose. These results suggest that piperacillin may have a role as a protective agent against the nephrotoxicity of cisplatin.

Protective effect of piperacillin against nephrotoxicity of cephaloridine and gentamicin in animals

The protective effect of piperacillin against the nephrotoxicity of cephaloridine and gentamicin was examined in experimental animals. In rabbits, piperacillin was infused at a dose of 1 mg/kg (body weight) per min over 225 min and cephaloridine (300 mg/kg) was intravenously administered as a bolus 45 min after the start of a drip infusion. Blood urea nitrogen, serum creatinine, and N-acetyl-beta-D-glucosaminidase (NAG) in urine were measured as the renal toxicological parameters before and 24 h after cephaloridine dosing. Although the single administration of cephaloridine significantly elevated these parameters, the elevation was prevented by the concomitant administration of piperacillin. The protective effect of piperacillin was superior to those of cephalothin and fosfomycin. In rats, piperacillin (1,000 mg/kg) was intravenously administered and immediately followed by the intramuscular administration of gentamicin (100 mg/kg) every 24 h for 5 days. When piperacillin was concomitantly administered with gentamicin, the elevations of blood urea nitrogen, serum creatinine, and urinary NAG were significantly lower than when gentamicin was given alone. The concomitant administration of piperacillin resulted in a significant protective effect against the nephrotoxicity of cephaloridine in rabbits and of gentamicin in rats. Histopathological observation also supported the protective effect of piperacillin. The protective mechanism of piperacillin might be the inhibition of transport from the peritubular side to tubular cells for cephaloridine and from both the peritubular and luminal sides for gentamicin.

Pharmacokinetic studies on the concomitant administration of piperacillin and cefazolin, and piperacillin and cefoperazone in rabbits

The pharmacokinetics of each drug on the concomitant administration of piperacillin (PIPC) and cefazolin (CEZ) or cefoperazone (CPZ) were studied in rabbits. When rabbits received the consecutive drip infusion administration of CEZ (0.71 mg/kg/minute) and PIPC (1.38 mg/kg/minute) and likewise of CPZ (0.72 mg/kg/minute) and PIPC (1.54 mg/kg/minute) for 1 hour, respectively, the serum half-lives of CEZ and CPZ were respectively prolonged about 1.8 and 1.6 times during drip infusion of PIPC than administered alone. However, when the sequence of administration were reversed, the serum levels of PIPC were not affected by the consecutive drip infusion administration of CEZ and CPZ. To study these findings in detail, the single intravenous dose of 20 mg/kg of CEZ and CPZ were administered under drip infusion of PIPC (2.65-2.93 mg/kg/minute). The serum half-lives of CEZ and CPZ were also prolonged about 5.4 and 1.9 times, respectively, whereas urinary excretion of CEZ, and urinary and biliary excretion of CPZ were reduced by PIPC. Moreover, when the single intravenous dose of 20 mg/kg of PIPC were administered under drip infusion administration of CEZ (0.96-2.60 2.60 mg/kg/minute), the pharmacokinetics of PIPC was not affected by the presence of CEZ. However, under drip infusion administration of CPZ (2.60-2.70 mg/kg/minute), the PIPC serum half-life was prolonged about 1.4 times, and biliary excretion of PIPC was reduced but urinary excretion was not. From the results of renal clearance experiments, tubular secretion appeared to be the predominant mechanism of renal elimination for these three drugs. These results indicate that PIPC influences the pharmacokinetics of both drugs by the competitively inhibiting tubular secretion in CEZ, and tubular secretion and hepatic transport system in CPZ. Therefore, in this respect PIPC seems to have probenecid-like action.

Studies on protein binding of antibiotics. V. Effect of the binding of drug to 100,000 X g supernatant fluid of human liver homogenates on urinary excretion

To characterize the effect of the binding of antibiotics to tissue protein on urinary excretion, we examined the extent of the binding of 9 penicillins and 9 cephems to 100,000 X g supernatant fluid of human liver homogenates. The correlation analysis revealed a significant simple correlation between the binding to 100,000 X g supernatant fluid of liver homogenates and urinary excretion. Drugs with lesser binding were mainly excreted in the urine, conversely, urinary excretion of highly bound drugs exhibited lower values. The prediction with regard to urinary excretion of healthy subjects was done by multiple regression analysis using the binding to 100,000 X g supernatant fluid and other physicochemical factors. The values predicted for urinary excretion coincided well with the observed values.

Studies on protein binding of antibiotics. IV. Effect of the binding of drug to 100,000 X g supernatant fluid of rabbit liver homogenates on urinary excretion

The extent of the binding of beta-lactam antibiotics to 100,000 X g supernatant fluid of rabbit liver homogenates was investigated. Urinary excretion tended to decrease as the extent of the binding to 100,000 X g supernatant fluid increased. Predicting urinary excretion was achieved using the binding to 100,000 X g supernatant fluid and other physicochemical factors. A good coincidence resulted from multiple regression analysis. [14C]Benzylpenicillin binding proteins in rabbit liver were investigated and revealed that the affinity of cefoperazone was much stronger than that of cefazolin.

Studies on protein binding of antibiotics. II. Effect of apalcillin on protein binding and pharmacokinetics of cefoperazone and cefazolin

The drug-protein interactions between cefoperazone (CPZ) and apalcillin (APPC), and between cefazolin (CEZ) and APPC were investigated in in vitro and in vivo experiments. Through the binding rates of CPZ or CEZ to rabbit serum and human serum albumin subsided remarkably with increased drug concentrations, APPC was not greatly affected, even at high concentrations. It appeared that APPC had a higher binding capacity to protein than CPZ or CEZ. From the results of competitive study, it became clear that APPC partially shared the binding sites on protein with CPZ or CEZ. The CPZ or CEZ serum levels in rabbits administered together with APPC were not different from those for the single administration, but APPC levels for the simultaneous administration were slightly lower.

Studies on protein binding of antibiotics. III. Effect of novobiocin on protein binding and pharmacokinetics of cefoperazone and cefazolin

The drug-protein interactions between cefoperazone (CPZ) and novobiocin (NB), and between cefazolin (CEZ) and NB were investigated. Though there was a remarkable reduction of CPZ or CEZ binding to rabbit serum and human serum albumin with increases in drug concentrations above 3.0x10-4M (CPZ: 200 microgram/ml, CEZ: 140 microgram/ml), NB binding was not affected. In addition, when CPZ or CEZ was added to the NB solution, NB binding was not altered and remained above 90%. Therefore, it was evident that NB had a high capacity for binding to protein, compared with CPZ or CEZ. From the competitive study, the main binding site of NB to protein appeared to differ from that of CPZ or CEZ. The CPZ or CEZ serum levels in rabbits for the simultaneous adminstration of NB were significantly higher than those for the control experiments, however, the NB serum levels were not greatly affected by CPZ or CEZ.