[Effect of biapenem (L-627) on fecal flora in gnotobiotic mice and children]

Biapenem (L-627), a novel injectable carbapenem antibiotic, was studied with regard to its effect on mice inoculated with four types of bacteria and on the intestinal flora of pediatric patients. L-627 was given i.m., 40 mg/kg once daily for 5 consecutive days, to mice inoculated enterically with four types of bacteria (Escherichia coli, Enterococcus faecalis, Bacteroides fragilis, and Bifidobacterium breve). Except for a mild decrease in E. coli, there were no major fluctuations in viable bacterial counts in the feces during the treatment. Five children with bacterial infections (3 boys and 2 girls; ages: 1 month to 7 years and 7 months; body weights 4.62-21.8 kg) were given L-627 at 6.0 to 11.7 mg/kg 3 times daily for 7 to 11 days. Among aerobes, although Enterobacteriaceae such as E. coli tended to decrease remarkably in all patients, there was no major change in Enterococcus. Consequently, total aerobe counts did not change significantly in any patient. Among anaerobes, Bifidobacterium, Bacteroides, and Eubacterium, which are the predominant organisms in infants, decreased remarkably in some patients. One of the patients showed a marked decrease in total anaerobe count associated with a change in fecal characteristics (diarrhea). Glucose nonfermenting Gram-negative bacilli or fungi did not become predominant organisms in any patient. Recovery from these changes in the intestinal flora was noted promptly after terminating L-627 treatment. L-627 was detected in the feces of 4 patients during treatment. The fecal concentration ranged from 0.24 to 2.22 micrograms/g. Clostridium difficile was not detected in any patient. Although C. difficile D-1 antigen was observed in 2 patients, it bore no relationship to fecal properties. The results indicated that L-627 had relatively few effects on the intestinal flora compared to other new beta-lactam antibiotics.

[Pharmacokinetic and clinical studies on cefozopran in pediatrics]

Cefozopran (CZOP, SCE-2787), a new parenteral cephalosporin antibiotic, was studied for its pharmacokinetics, bacteriological and clinical effects in the field of pediatrics. The serum and cerebrospinal fluid concentrations 1 hour after a bolus intravenous injection of 50 mg/kg were, respectively, 92.1, 10.5 micrograms/ml, and penetration rate to cerebrospinal fluid of CZOP in patients with purulent meningitis was 11.4%. 25 patients, including those with purulent meningitis, pneumonia, urinary tract infections, staphylococcal scalded skin syndrome (SSSS) etc., were treated with CZOP at dose levels of 16.0 to 50.0 mg/kg 3-4 times daily, via intravenous injection and intravenous drip infusion. CZOP gave "excellent" or "good" responses in all the 25 patients. In bacteriological examinations, 25 strains were identified and were eradicated except 1 strain of Staphylococcus aureus and 2 strains of Salmonella sp. As a side effect, diarrhea was observed in 1 patient among the 27 patients treated with the drug. As for abnormal laboratory findings, eosinophilia was observed in 1 patient, increases of thrombocytes in 3 and GPT in 2. Influences on blood coagulation parameters were studied. No changes in PIVKA II, HPT or APTT were observed during the treatment. Based on the above results, it has been concluded that CZOP is a safe and effective drug to use in the treatment of pediatric infections. The normal recommended dosage and administration should be 20 to 50 mg/kg of CZOP at a time, using intravenous injection or intravenous drip infusion 3 to 4 times a day.

Endoscopic mucosal resection for colorectal neoplastic lesions

PURPOSE

Endoscopic mucosal resection, which is a new option for endoscopic polypectomy of colorectal polyps without stalks, was evaluated on its usefulness in polypectomy.

METHODS

Three hundred thirty-seven lesions, which were removed by endoscopic mucosal resection between January 1990 and January 1993, were studied. The endoscopic configuration of neoplastic lesions were classified into four types: flat, sessile, large sessile with distinct lobulations, and semipedunculated.

RESULTS

The 337 lesions included 243 adenomas, 30 mucosal cancers, 13 submucosal cancers, 3 carcinoids, 43 hyperplastic polyps, and 5 inflammatory polyps. Of the 286 neoplastic lesions, excluding 3 carcinoids, 137 were flat, 81 were sessile, 18 were large sessile, and 50 were semipedunculated. The 137 flat lesions consisted of 125 adenomas, 10 mucosal cancers, and 2 submucosal cancers. The rate of complete removal was related to their size and configuration and was 87 percent in flat neoplastic lesions. Lesion diameters of greater than 20 mm and the large sessile-type configurations were factors that were associated with incomplete removal. Two (0.7 percent) cases were complicated by perforations, and one (0.4 percent) case was complicated by bleeding.

CONCLUSION

Endoscopic mucosal resection is an useful option for complete removal of colorectal nonpolypoid adenomas and cancers.

Interaction between human polymorphonuclear leucocytes and bacteria released from in-vitro bacterial biofilm models

The interactions between phagocytic cells (polymorphonuclear leucocytes) and Escherichia coli cells released from a biofilm model formed in vitro on the surface of cotton threads in an artificial medium were compared with those of phagocytes and bacteria released from a newly developed in-vitro biofilm model. This new model of bacterial biofilm on the surface of cotton threads was developed by soaking cotton threads in rat carboxymethylcellulose pouch exudate and culturing E. coli in the exudate. The structure of the biofilm model and the surface structure of the bacteria in the biofilm resembled those observed in vivo in infected pouches, and they were quite different from those observed with the biofilm model in artificial medium. Both bacteria released from biofilm models in an artificial medium and those from biofilms in rat carboxymethylcellulose pouch exudate, in vitro, were almost equally resistant to killing by phagocytes. The sensitivity of these bacteria to phagocytosis was no different from that of normal bacteria grown in artificial medium. Bacteria from both models were also less sensitive to the killing activity of H2O2. Electronmicroscopy showed that bacteria from both models had some products that interacted with ruthenium red on their surfaces, but the respective quantities of these products differed.

[A case of malignant fibrous histiocytoma in the mediastinum]

A 81-year-old man was admitted to the hospital because he complained of hoarseness. Chest radiography showed a mass in the right upper mediastinum. An operation was done to remove the mass and make a conclusive diagnosis. Histologically, the tumor tissue consisted of spindle-shaped fibroblast-like cells and round histiocyte-like cells with bizarre giant cells. Part of the tissue had a storiform pattern. These findings led a diagnosis of malignant fibrous histiocytoma (MFH) of the "usual type". MFH is known to occur frequently in the soft tissues of extremities, trunk, and retroperitoneum, but it is seldom detected in the mediastinum. We report here a rare case of primary MFH in the mediastinum.

[The monitoring of cytomegalovirus antigenemia and arterial oxygen saturation for the early detection of cytomegalovirus pneumonia]

Eighteen patients underwent allogeneic bone marrow transplantation (allo. BMT) during the period May, 1991 to December, 1992 in the Center for Adult Diseases, Osaka. They were monitored for cytomegalovirus (CMV) antigenemia and arterial oxygen saturation (SaO2). More than 10 antigen-positive cells per 50,000 polymorphonuclear leukocytes were detected in five of 18 patients. Three of these 5 patients developed CMV pneumonia several weeks after the first detection of more than 10 positive cells. Six of 18 patients developed interstitial pneumonia (IP) (3 CMV pneumonia and 3 idiopathic IP). SaO2 decreased less than 95% several days before the development of IP in 3 of these 6 patients (2 of CMV pneumonia and 1 of idiopathic IP). CMV antigenemia assay and SaO2 assay were thus both considered to be useful for the early detection or prediction of development of CMV pneumonia.

[Clinical studies on clarithromycin dry syrup in the pediatric field. Pediatric Study Group of TE-031 Dry Syrup]

Clarithromycin dry syrup, a new drug preparation, was clinically evaluated in the pediatric field and the following results were obtained: 1. Absorption and excretion In infants administered with single oral dose of 5 mg (potency)/kg and 10 mg/kg, the Cmax was 2.26 +/- 0.42 and 3.23 micrograms/ml; Tmax, 1.6 +/- 0.1 and 2.0 hours; T 1/2, 3.89 +/- 0.52 and 2.06 hours; AUC (0-infinity), 13.48 +/- 1.93 and 13.84 micrograms.hr/ml, respectively. Urinary concentrations peaked in 2-4 hours after administration at 5 mg/kg and 0-2 hours at 10 mg/kg. Urinary recovery rates in the first 6 hours were 25.8 +/- 3.9% at 5 mg/kg and 20.7% at 10 mg/kg. 2. Clinical results The clinical efficacy of the drug was evaluated in 150 patients with various infections. Clarithromycin dry syrup was administered to all the patients at daily doses of 10-15 mg/kg divided into 2-3 equal doses. The overall clinical efficacy rate was 98.0%, and this drug was effective in 98.9% of 90 patients for whom the causative pathogens were identified and in 96.7% of the other 60 patients for whom the causative pathogens were unknown. The bacteriological eradication rate was 88.5%. The efficacy and eradication rates for 19 patients who had not responded to previous chemotherapy that lasted for more than three days were 94.7% (18/19) and 75.0%, respectively. Side effects occurred in 4 (2.4%) of 169 patients subjected to safety analyses, but none was serious. As to abnormal laboratory test results, moderate increases of eosinophils and elevations of transaminases were observed in 5.9% of the cases. No particular and serious problems were associated with administration of this drug. Based on the above results, clarithromycin dry syrup is considered to be very useful and have a good compliance at a daily dose of 10-15 mg/kg divided into 2-3 doses.

[Acute relapsing ataxic polyradiculoneuritis following respiratory tract infections]

We report a patient with a relapsing form of acute ataxic polyradiculoneuritis. The patient developed marked sensory ataxia with mild limb weakness following a respiratory tract infection. Five similar relapses occurred over 18 years. The symptoms reached their maximum in 2 weeks, followed by subsequent gradual improvement over 1-2 months. Sural nerve biopsy showed mild loss of large myelinated fibers.

Dysautonomia with acute sensory motor neuropathy. A new classification of acute autonomic neuropathy

OBJECTIVES

To characterize the dysautonomia associated with acute sensory motor neuropathy and to discuss the classification of acute autonomic neuropathy.

DESIGN

Case series.

METHODS

Sympathetic skin response. Local sweat response to acetylcholine. Norepinephrine infusion test and acetylcholinesterase histochemistry of sural nerve biopsy specimens in addition to making conventional analyses of myelinated and unmyelinated fibers.

RESULTS

In 12 patients with chronic neuropathy, acetylcholinesterase-positive fiber density and plantar sympathetic skin response size were well correlated, but in the two patients with acute autonomic sensory and motor neuropathy, there were discrepancies, acetylcholinesterase-positive fiber density being well preserved and sympathetic skin responses being absent. Histologic and electrophysiologic results indicated primary demyelination of the myelinated fibers. In contrast, previous studies of acute autonomic sensory and motor neuropathy reported dysfunction of the sympathetic postganglionic fibers and axonopathic change in myelinated fibers, poor recovery from dysautonomia.

CONCLUSIONS

Dysautonomia with acute idiopathic neuropathy can be divided into two categories--postganglionic axonopathic and preganglionic demyelinating types of the sympathetic efferent pathways. The recovery from dysautonomia produced by the former lesion is poor, but recovery is better for that produced by the latter lesion.

Potential mechanism of cadmium-induced cytotoxicity in rat hepatocytes: inhibitory action of cadmium on mitochondrial respiratory activity

The present study was designed to clarify the mechanism of cadmium (Cd)-induced toxicity in rat hepatocytes. Cd and Mg-ATP induced cellular acidification at concentrations lower than 25 microM. In Mg-ATP-treated cells, maximal acidification occurred within 2.5 min, with a subsequent return to control levels. In Cd-treated cells, maximal acidification (pH 6.76) occurred 10 min after exposure to the metal, then the cytoplasmic pH began to rise but did not return to normal. Cd eliminated the membrane potential of isolated mitochondria in media at both pH 6.5 and 7.4. This effect of Cd on membrane potential was approximately equivalent in both media when the metal concentration was 5 microM, but was more intense in the medium at pH 6.5 than in the medium at pH 7.4 at the metal concentration > 5 microM. Acidic medium alone had no effect on membrane potential. Mitochondrial uptake of Cd increased in a dose-dependent manner in media at both pH 7.4 and 6.5. The uptake of 5 microM Cd was significantly increased by acidic medium, however at Cd concentrations > 5 microM, there were no pH-dependent differences in Cd uptake. The incubation of hepatocytes in the medium at pH 6.0 and 6.5 resulted in 5 and 7.5% inhibition of mitochondrial respiration in intact cells, respectively. The presence of 10 microM Cd in the medium at pH 6.0 enhanced this inhibition. Mitochondrial respiration was inhibited to 60% of the control mitochondria at pH 7.4 when exposed to the medium at pH 6.5 without Cd and this inhibition was extended to 70% by the presence of 5 microM Cd. Cd in the medium at pH 7.4 had no deleterious effect on mitochondrial respiration at all concentrations examined. The results indicate that the respiratory activity of mitochondria is sensitive to the low pH rather than to Cd although the metal strongly inhibits the activity when in the medium at low pH. Therefore, it appears Cd-induced acidification plays an important role in the initiation of deteriorative processes in mitochondria.

Dissolution of pancreatic stones by oral trimethadione in patients with chronic calcific pancreatitis

The effect of oral dissolution therapy for pancreatic stones was evaluated in patients with chronic calcific pancreatitis. The anti-epileptic agent trimethadione was given orally to 30 outpatients at a dose of 0.9-1.5 g daily. On plain X-ray films and CT scans of the abdomen, pancreatic stones began to be dissolved around 8 months of treatment, and diminished in size and number or disappeared in 21 patients (70%) during the mean follow-up period of 32 months. The effect of trimethadione treatment on dissolution of stones was not closely related to the aetiology of the disease, distribution and size of stones, previous history of surgical interventions, or the degree of pancreatic dysfunctions. In three patients who stopped this medication of their own accord, pancreatic stones re-increased or reappeared about 6 months later. During trimethadione treatment, impaired exocrine pancreatic function returned to normal in four of nine patients examined, and diabetes mellitus was well controlled by either diet therapy alone or oral hypoglycaemic agents in eight of 10 patients who did not need insulin before trimethadione treatment. Complete relief of pain was noted in 73% of patients during the treatment. Overall gains and no change in bodyweight were observed in 83% of patients. Mild photophobia was the most common side effect, but could be easily overcome by wearing sunglasses. No severe side effects were observed in the liver, kidney, blood or the eyeground. Pancreatic stones in 30 patients not treated with trimethadione neither disappeared nor diminished spontaneously. Trimethadione treatment may be a useful tool for chemical dissolution of pancreatic stones.

Signals and nuclear factors that regulate the expression of interleukin-4 and interleukin-5 genes in helper T cells

Mouse thymoma line EL-4 cells produce cytokines such as interleukin (IL)-2, IL-3, IL-4, IL-10, and granulocyte-macrophage colony-stimulating factor in response to phorbol 12-myristate 13-acetate (PMA). EL-4 cells also produce low levels of IL-5 when stimulated by PMA alone; however, cAMP greatly augments PMA-dependent IL-5 production. A transient transfection assay revealed that two signals, PMA and cAMP, are required for optimal activation of the IL-5 promoter. In contrast, cAMP almost completely inhibited the PMA-dependent activation of the endogenous IL-2 gene, as well as the transfected IL-2 promoter. These results indicate that the IL-5 gene is positively regulated by cAMP in a manner opposite to that for the IL-2 gene. One of the nuclear factors (NFs) that regulates the response of the IL-5 promoter to cAMP and PMA has properties similar to NF for activated t cell. The P sequence of the IL-4 gene, defined as a responsive element for PMA and calcium ionophore (A23187), shares sequence similarity with the NF kappa B and the NF-activated T cell binding sites. We attempted to determine whether NF(P), a nuclear factor specific for the P sequence, is related to NF-kappa B and nuclear factor for activated T cell (NF-AT). In electromobility shift assays both NF-kappa B (P65 or P65/P50 heterodimer) and NF-AT bound to the P sequence. However, sequence specificity of NF-AT was more similar to that of NF(P), and only a small amount of P65 was detected in NF(P). These results indicate that a component or components of NF-AT have the potential to reconstitute NF(P), whereas NF-kappa B alone does not account for NF(P) in Jurkat crude extract. Taken together, these results suggest that NF-AT-like factors are involved in the regulation of IL-4 and IL-5 genes.

A sensitive assay system screening antiviral compounds against herpes simplex virus type 1 and type 2

A highly sensitive and accurate assay system was developed for in vitro evaluation of anti-herpes simplex virus (anti-HSV) agents using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and human embryonic lung fibroblast (MRC-5) cells. This assay system was found to be highly sensitive for both HSV-1 and -2. Confluent MRC-5 cells were infected with either HSV-1 KOS strain or HSV-2 G strain of 25 TCID50 in the presence of various concentrations of test compounds. The optical density of formazan was used to determine cell viability. The EC50 values of acyclovir and several other anti-HSV agents were found to be similar to those obtained by the plaque reduction method. These results indicate that this MTT assay is useful for screening anti-HSV-1 and -2 agents.

Activation of early response genes and cell proliferation by human interleukin-3, granulocyte-macrophage colony-stimulating factor, and interleukin-5 receptors: comparison with human interleukin-4 receptor signaling

Interleukin (IL)-3, granulocyte-macrophage colony-stimulating factor, and IL-5 receptors (IL-3R, GMR, and IL-5R) are composed of the alpha chain specific to each and the common beta chain, and both the alpha and beta subunits are members of the cytokine receptor superfamily. We previously showed that the high-affinity human GMR reconstituted by cotransfecting the alpha and beta chain cDNA clones transduces signals in response to hGM-CSF to activate transcription of c-fos, c-jun, and c-myc proto-oncogenes in mouse proB cell line BA/F3 or in mouse fibroblast NIH3T3 cells. These results indicated that molecules, such as tyrosine kinase, unique to hematopoietic cells are not essential to transduce signals. In this study, the function of the alpha subunit of GMR was compared with those of IL-3R and IL-5R by cotransfecting human cDNAs encoding the alpha subunit of IL-3R or IL-5R and the common beta subunit into BA/F3 or NIH3T3 cells. We found that the reconstituted human IL-3R, in response to hIL-3, transduced signals to activate transcription of c-fos promoter and induced DNA synthesis in both types of cells in a manner similar to hGMR. Likewise, hIL-5 activates c-fos promoter in transfected NIH3T3 cells expressing hIL-5R. These results indicated that the alpha subunits of IL-3R and IL-5R have properties similar to those of the GMR alpha subunit. In contrast, transfected human IL-4 receptor (hIL-4R) cDNA, which weakly activated c-fos promoter and induced DNA synthesis in BA/F3 cells, failed to elicit these activities in NIH3T3 cells in response to hIL-4.(ABSTRACT TRUNCATED AT 250 WORDS)

[Evaluation of local treatment for unresectable primary liver tumor]

To ascertain the effect of local treatment for unresectable primary liver tumor, 59 patients were investigated retrospectively. Patients were classified into four groups; transcatheter arterial embolization (TAE) group, intermittent intra-arterial infusion chemotherapy group, combined therapy group (TAE+intermittent intra-arterial infusion chemotherapy) and a group without adjuvant therapy. The results revealed that TAE and intermittent intra-arterial infusion chemotherapy both prolonged the survival period. We found that the survival rate depends largely on the therapeutic method. No correlations were confirmed with the liver function nor stage grouping of the tumor. Therefore, we concluded that intermittent intra-arterial infusion chemotherapy is a beneficial treatment, considering its minimal adverse effect, broad indication and the fact that it does not require hospitalization.

Dopamine-induced protection of striatal neurons against kainate receptor-mediated glutamate cytotoxicity in vitro

The effects of dopamine on glutamate-induced cytotoxicity were examined using the primary cultures of rat striatal neurons. Cell viability was significantly reduced by exposure of cultures to glutamate or kainate for 24 h. In contrast, similar application of N-methyl-D-aspartate (NMDA) or alpha-amino-3-hydroxy-5-methyl-4-isoxazole-propionate (AMPA) did not induce cytotoxicity. Kainate-induced cytotoxicity was significantly inhibited by kynurenate but not by MK-801. Dopamine at concentrations of 1-100 microM dose-dependently reduced kainate-induced cytotoxicity. Forskolin also significantly reduced kainate cytotoxicity. The neuroprotective effect of dopamine was antagonized by SCH 23390, a D1 receptor antagonist, but not by domperidone, a D2 receptor antagonist. Moreover, kainate-induced cytotoxicity was prevented by SKF 38393, a D1 receptor agonist, or forskolin but not by quinpirole, a D2 receptor agonist. The patch clamp study revealed that the same striatal neurons responded to both kainate and NMDA. During voltage clamp recording, neither kainate-induced currents nor NMDA-induced currents were affected by dopamine. Moreover, dopamine did not affect glutamate- or kainate-induced Ca2+ influx measured with fura-2. These findings indicate that dopamine prevents kainate receptor-mediated cytotoxicity without affecting the kainate receptor activities and intracellular Ca2+ movement. Dopamine-induced neuroprotection may be mediated by an increased intracellular cAMP formed following activation of D1 receptors.

Molecular cloning of a novel human cDNA encoding a zinc finger protein that binds to the interleukin-3 promoter

The CT/GC-rich region (-76 to -47) is one transcriptional regulatory region of the interleukin-3 (IL-3) gene which confers basic transcriptional activity and responds to trans-activation by human T-cell leukemia virus type I-encoded Tax. We isolated three types of cDNAs encoding Cys2/His2-type zinc finger proteins that bind to this region. Two were identical to known transcription factors, EGR1 and EGR2, and the other clone, named DB1, encoded a novel protein of 516 amino acids with six zinc finger motifs. DB1 mRNA was present in human tissues, ubiquitously. Two constitutive transcripts of 4.0 and 4.8 kb in length were present in Jurkat cells. Electrophoretic mobility shift assay, with specific antibodies, showed that DB1 constitutively binds to this region whereas EGR1 binds in a T-cell activation-dependent manner. Overexpression of DB1 in Jurkat cells had no detectable effect on the transcription activity of the IL-3 promoter, in a transient-transfection assay. EGR1 and EGR2 increased IL-3 promoter activity when the transfected cells were stimulated with phorbol-12-myristate-13-acetate and A23187. When DB1 was cotransfected with a Tax expression vector, transcription activity of the IL-3 promoter induced by Tax was significantly increased, while EGR1 and EGR2 were without effect. These results suggest that EGR1 has a role in inducible transcription of the IL-3 gene, while DB1 sustains basal transcriptional activity and also cooperates with Tax to activate the IL-3 promoter.

A patient with primary hypoparathyroidism developing hypercalcemia associated with adult T-cell leukemia/lymphoma

A 38-year-old woman was admitted to our hospital with symptoms and signs of hypocalcemia in 1977 and a diagnosis of primary hypoparathyroidism was made with a positive Ellsworth Howard test. She was then lost to follow up until 1992 when she returned this time with symptoms and signs of hypercalcemia. An inguinal lymph node was biopsied showing non-Hodgkin's lymphoma, diffuse pleomorphic type and monoclonal integration of proviral human T-cell lymphotropic virus-1 DNA was detected in lymph node cells indicating ATLL. Serum parathyroid hormone-related peptide (PTHrP) was slightly elevated and the tumor cells were positively stained with anti-PTHrP serum. Combination chemotherapy with vincristine, adriamycin, cyclophosphamide and prednisolone was given to the patient with disappearance of the lymphadenopathy and subsequent normalization of PTHrP levels. Interestingly, the signs and symptoms of hypocalcemia reappeared after the treatment requiring replacement therapy with calcium and vitamin D.

[Increased unilateral central motor tract excitability in a patient with corticobasal degeneration]

In a 64-year-old woman with a clinical diagnosis of corticobasal degeneration, a hyperexcitability of central motor tract was demonstrated. She had akinesia, regidity, myoclonic movement, hyperreflexia, forced grasping and clumusiness on the right extremities. The asymmetry of these symptoms was striking. Dopa therapy was not effective. On single photon emission computed tomography (SPECT), blood perfusion was reduced especially on the left side in the frontoparietal area. She had large C-reflex after the median nerve stimulation only on the affected side. The intensity threshold of motor evoked potential by stimulation on the left motor cortex was lower than that on the right motor cortex. Conditioning stimulation of the median nerve on the affected side, greatly increased MEP size as compared to those of normal subjects, at conditioning-test (C-T) intervals of 40-80 ms; whereas, stimulation on the contralateral side did not. On the other hand, SEP did not have a marked increase or asymmetry in size and SEP recovery curve showed no hyperexcitability. These results indicate there is a hyperexcitability of the central motor tract on the affected side.