Polysomnographic Sleep Disturbances Due to High-Dose Zolpidem Use: A Case Report

ABSTRACT

Zolpidem is widely prescribed for the treatment of insomnia and is used to both induce and maintain sleep. Previously, zolpidem was thought to have low abuse potential; however, several reports have documented dose escalation and abuse in the past two decades. Here, we report the case of a patient with high-dose zolpidem dependence who underwent polysomnography (PSG) and the Multiple Sleep Latency Test (MSLT). The patient, a 29-year-old man, was administered zolpidem at doses of 300 to 1,200 mg/day, but he abused zolpidem to feel energetic. Consequently, he had a car accident while on a high dose, which the PSG revealed caused activation instead of sedation. The MSLT showed excessive daytime sleepiness despite a lack of subjective sleepiness under this condition. Our findings suggest that disrupted sleep and daytime sleepiness caused by supratherapeutic zolpidem doses could place individuals at high risk for accidents, including those who are unaware of sleepiness.

A comparative study of single-incision versus conventional multiport laparoscopic ileocecal resection for Crohn's disease with strictures

INTRODUCTION

Single-incision laparoscopic surgery (SILS) offers excellent cosmetic results compared with conventional multiport laparoscopic surgery. Recently, this technique has been applied to colorectal disease. However, there have been few reports about its application to Crohn's disease (CD) in the literature. The aim of this study is to describe our early experience with SILS for 11 patients with CD and make comparisons with the conventional multiport laparoscopic surgery.

METHODS

We reviewed all patients with CD who underwent laparoscopic surgery for the presence of ileocolic strictures at our institution between January 2006 and March 2011. Data from consecutive patients undergoing SILS were analyzed and compared with those from conventional multiport laparoscopic surgeries.

RESULTS

During the study period, 11 patients underwent SILS. All surgeries were completed with SILS. Operative time, blood loss and conversions were not significantly different between the two groups. Postoperative complications and length of hospital stay also had no significant difference.

CONCLUSION

In conclusion, SILS for CD may be safe and feasible in selected patients, and have better cosmetic results than conventional multiport laparoscopic surgery. Further studies are needed to evaluate the outcome of SILS compared to that of conventional laparoscopic surgery.

The outcome of Japanese anorexia nervosa patients treated with an inpatient therapy in an internal medicine unit

OBJECTIVE

To investigate the outcome of Japanese anorexia nervosa (AN) patients who were treated with the standard Japanese inpatient therapy.

METHOD

Of the 88 female AN patients treated with our inpatient therapy between January 1997 and December 2002, 67 (76.1%) who agreed to cooperate in this study were assessed by the Global Clinical Score (GCS) at admission and follow-up, 6.3±1.8 years after discharge. Their clinical characteristics at admission and discharge were also examined.

RESULTS

Four (6.0%) patients had died before follow-up. BMI was significantly increased during inpatient therapy. At follow-up, excellent, much improved, symptomatic, and poor outcomes on GCS were 57.1%, 14.3%, 14.3% and 14.3%, respectively. Younger age at admission and larger BMI at discharge were significantly associated with a better outcome.

DISCUSSION

This study shows the potential for the use of this method for the treatment of AN patients in countries without specialized eating disorder units.

Predictors of menstrual resumption by patients with anorexia nervosa

OBJECTIVE

To investigate which factors predict the resumption of menstruation by patients with anorexia nervosa (AN).

METHODS

Participants were AN patients who, even after weight recovery by inpatient treatment, had prolonged amenorrhea (N=11), AN patients who resumed menstruation after weight recovery (N=9), and age-matched healthy controls (N=12). Anthropometric data and the serum levels of leptin, insulin-like growth factor I (IGF-1), cortisol, luteinizing hormone (LH), estradiol (E2), and other hormones were measured at the beginning of the inpatient treatment and after weight recovery.

RESULTS

Of the baseline anthropometric and hormonal factors, logistic regression analysis extracted a high serum cortisol level as a predictor of the inhibition of the resumption of menstruation. After weight recovery, the E2 and leptin levels were significantly higher for eumenorrheic patients than for amenorrheic patients.

CONCLUSION

The baseline serum cortisol level was a predictor of the prolonged inhibition of menstrual recovery.

Somatic and psychological factors related to the body mass index of patients with anorexia nervosa

OBJECTIVE

The aim of this study was to examine somatic and psychological factors related to the body mass index (BMI) of anorexia nervosa (AN) patients.

METHOD

The analysis was of 24 hospitalized AN patients from the day after admission to the 4th day. The somatic factors analyzed were duration of AN, daily food intake, eating regulatory substances in blood (acylated ghrelin, desacyl ghrelin, leptin), serum cortisol, insulin and estimated creatinine clearance (CCr). The psychological factors analyzed were depression, anxiety, Eating Disorder Inventory (EDI), and hunger/fullness feeling. Measurement of BMI and collection of blood samples were done on the morning after hospitalization. Statistical analysis was by multiple linear regression analysis.

RESULTS

BMI showed a reverse correlation with desacyl ghrelin (beta=-0.486, p=0.015) and maturity fears (beta=-0.375, p=0.046), but was not associated with any other factor by multiple regression analysis.

CONCLUSION

The results suggest that desacyl ghrelin and maturity fears play important roles in the prolonged malnutrition state seen in AN patients.

Factors related to renal dysfunction in patients with anorexia nervosa

OBJECTIVE

Anorexia nervosa (AN) patients were surveyed to determine which disease factors were related to AN influenced renal dysfunction.

METHODS

Data were from forty-five AN patients hospitalized in our department between 1995 and 2002. The patients were classified into three groups based on the type of anorexia: restricting (n=18), self-induced vomiting (n=13), and laxative abuse (n=14). Twenty-four hour-creatinine clearance (Ccr) was calculated within two weeks of hospitalization for comparison among the three groups.

RESULTS

The Ccr level of the laxative abuse group was significantly lower than that of the restricting group (65.8+/-31.4 ml/min vs restricting type: 104+/-23.3 ml/min, p=0.002). The laxative abuse group had a significantly longer duration of illness than the restricting group (p<0.0001). Multiple regression analysis revealed the duration of illness to be a risk factor for renal function deterioration in AN patients (r=0.580, p<0.001).

DISCUSSION

Renal function should be carefully followed during the treatment of AN patients with a long duration of illness, especially those with long-term laxative abuse.

Psychopathological features of patients with prolonged anorexia nervosa as assessed by the Minnesota Multiphasic Personality Inventory

OBJECTIVE

The duration of illness is quite long in some anorexia nervosa (AN) patients. In the present study, we investigated the psychopathological features of patients with prolonged AN as assessed by the Minnesota Multiphasic Personality Inventory-1 (MMPI-1).

METHODS

Fifty-five AN patients completed the MMPI-1 on admission to Kyushu University Hospital from 1999 to 2002. The patients were divided into three groups on the basis of their illness duration: a short-term group, less than 5 years of illness duration (n=31); a middle-term group, from 5 to 10 years (n=14); and a prolonged group, 10 years or more (n=10).

RESULTS

The prolonged group scored significantly higher on the MPPI-1 scales of hysteria (Hy), low back pain (Lb) and family conflict than the short-term group.

DISCUSSION

AN patients whose illness duration was prolonged characteristically had more hysteria with family conflict. This should be considered in their treatment.

5-HT2A promoter polymorphism is not associated with anorexia nervosa in Japanese patients

Genetic factors have been implicated in playing a significant role in susceptibility to anorexia nervosa (AN). Among many candidate genes for AN, an association with the A allele of the -1438G/A polymorphism in the promoter region of the 5-HT2A receptor has been reported. However, these findings are controversial and all patients studied to date have been Caucasian. This study was designed to determine whether this association is reproducible in Japanese subjects. This case-control study of a cohort of 75 female Japanese AN sufferers and 127 normal female control subjects revealed no significant association between the 5-HT2A promoter polymorphism and AN. Thus, at least for Japanese subjects, the A-allele of the -1438G/A polymorphism in the promoter region of the 5-HT2A receptor gene does not contribute to a predisposition to AN.

Analysis of tumor necrosis factor-alpha gene promoter polymorphisms in anorexia nervosa

Elevated plasma tumor necrosis factor-alpha (TNFalpha) levels and enhanced spontaneous TNFalpha release from peripheral blood mononuclear cells in patients with anorexia nervosa (AN) have been reported. TNFalpha activates the hypothalamic-pituitary-adrenal axis and reduces food intake, which is characteristic of eating disorders. Recently, three novel polymorphisms in the 5'-flanking region of the TNFalpha gene were reported at positions -1031 (T --> C substitution), -863 (C --> A) and -857 (C --> T). Differences in these alleles are reportedly related to altered TNFalpha-transcriptional promoter activity. Therefore, we performed a case-control association analysis to determine whether any of those three polymorphisms in the TNFalpha promoter region were involved in a predisposition to AN. The results of our analysis of a cohort of 79 female Japanese AN sufferers and 127 normal female control subjects provide no support for the hypothesis that -1031T/C, -863 C/A and -857C/T polymorphisms in the TNFalpha gene promoter region influence the susceptibility to AN.

Orexin-A and leptin change inversely in fasting non-obese subjects

OBJECTIVE

Leptin, neuropeptide-Y (NPY) and orexin are peptides regulating energy metabolism and appetite control. NPY and orexin are mainly found in the central nervous system and they have also recently been found in the peripheral nervous system. We investigated how fasting affects changes in circulating concentrations of these peptides and their association with nutritional and metabolic parameters in humans.

DESIGN AND METHODS

Ten non-obese female patients with psychosomatic disorders fasted for 7 or 10 days. Blood samples were collected at 0800 h before fasting, on the 3rd and 7th days during the fast (with an additional sample taken on the 10th day when the fasting continued for 10 days) and on the 3rd and 7th days of refeeding. We measured blood concentrations of orexin-A, NPY, leptin, adrenocorticotropin, cortisol, insulin, C-peptide, glucose, and beta-hydroxybutyrate.

RESULTS

Body mass index and plasma leptin concentrations concomitantly and significantly decreased during fasting, whereas serum orexin-A concentrations significantly increased and were negatively correlated with plasma leptin concentrations. Plasma NPY concentrations decreased slightly but were not significantly different from the prefasting values, and no significant relationship with leptin or orexin-A was found. Orexin-A and leptin concentrations showed a significant inverse correlation with serum glucose, insulin, C-peptide, and beta-hydroxybutyrate concentrations. Only changes in plasma leptin concentrations showed a significant negative correlation with serum cortisol concentrations. All the measured indices which changed during fasting returned to the prefasting concentrations by the 7th day of refeeding.

CONCLUSION

Peripheral orexin-A and leptin concentrations inversely change during fasting, which is significantly correlated with energy metabolism in humans.

A case of splenic abscess due to Chlamydia pneumoniae

In this report, a case of chlamydial disease with splenic abscess associated with Chlamydia pneumoniae antigen and antibody was described. On spleen biopsy of the patient, an antigen specific to C.pneumoniae was detected by immunofluorescence staining with a monoclonal antibody. Serologic studies revealed a high antibody titer to C.pneumoniae in sera collected from the patient and her husband. Treatment with the antibiotic minocycline improved her condition.

[Eating disorders concurrent with type 1 diabetes: pathology and management]

Development of disordered eating is not unusual in young females with type 1 diabetes. Although the debate continues over whether or not young diabetic females are at increased risk for developing eating disorders, no one questions the devastating effect of eating disorders on the clinical course of diabetes, successful intervention is exceedingly difficult. This manuscript introduces the most current research on the epidemiology, pathology, possible mechanism of development, and management of eating disorders in type 1 diabetes. It also discusses ongoing study at Kyushu University related to the clinical characteristics of and therapy for females with type 1 diabetes and recurrent binge eating.

[Activities of antimicrobial agents against 5,180 clinical isolates obtained from 26 medical institutions during 1998 in Japan. Levofloxacin--Surveillance Group]

The surveillance study was conducted to determine the antimicrobial activity of fluoroquinolones (ofloxacin, levofloxacin, ciprofloxacin, tosufloxacin) and other 20 antimicrobial agents against 5,180 clinical isolates obtained from 26 medical institutions during 1998 in Japan. The resistance to fluoroquinolones was remarkable in Enterococci, methicillin-resistant staphylococci and Pseudomonas aeruginosa from UTI. However, many of the common pathogens such as Streptococcus pneumoniae including penicillin-resistant isolates, methicillin-susceptible Stahylococcus aureus, Moraxella catarrhalis, the family of Enterobacteriaceae, Haemophilus influenzae including ampicillin-resistant isolates have been kept to be susceptible to fluoroquinolones. About 90% of P. aeruginosa isolates from RTI were susceptible to fluoroquinolones. In conclusion, the results from this surveillance study suggest that fluoroquinolones are useful in the treatment of various bacterial infections including respiratory infections.

[Microbiological and clinical studies with Streptococcus pneumoniae isolated in 5 Kitakyushu municipal hospitals]

Epidemiological and microbiological studies were carried out using 200 strains of pneumococci isolated from clinical specimens in 5 Kitakyushu municipal hospitals, between October 1994 and July 1995. Eighty nine percent of pneumococci were detected in the specimens from the respiratory tract. Pneumococci were isolated mainly from infants under 3-years of age and adults over 50-years of age, and the rates of isolation were 40.5% and 39.5%, respectively. MICs of 8 antimicrobial agents, such as PCG, NFLX, CPFX, LFLX, FLRX, TFLX, SPFX, LVFX, were determined using broth microdilution methods. According to NCCLS standard (1997), recovery rates of PSSP, PISP and PRSP were 48.0%, 39.5% and 12.5%, respectively. Among 7 quinolones, TFLX, SPFX and LVFX were effective so far examined, except for a few resistant strains. Four cases in which quinolones resistant pneumococci were isolated were reviewed retrospectively. Among them 3 cases had been given quinolones before the strains were detected.

Differences between bulimia nervosa and binge-eating disorder in females with type 1 diabetes: the important role of insulin omission

This study explored the differences between bulimia nervosa ("BN," n=22) and binge-eating disorder ("BED," n=11) in type 1 diabetic females and the factors most predictive of poor glycemic control in patients suffering from these disorders. These two groups and a control group without eating disorders (n=32) were compared across a number of demographic, psychological, and medical variables. BN manifested significantly more severe disturbances related to eating disorders, depression, anxiety, a higher rate of co-occurring mental disorders, and poorer psychosocial functioning compared with BED. BN also showed poorer glycemic control. Multivariate analysis indicated that higher serum glycosylated hemoglobin (HbA1c) levels were most associated with the presence of severe insulin omission in type 1 diabetic females with binge eating. Clinicians may be able to determine the psychological/medical severity of illness in these patients by identifying the presence of compensatory behaviors to prevent weight gain such as severe insulin omission, as described in the DSM-IV.

[A case of pulmonary alveolar proteinosis with increased IgE and CEA]

We report here a case of pulmonary alveolar proteinosis with significantly increased IgE and CEA values, in both serum and bronchoalveolar lavage fluid. A 35-year-old man presented with exertional dyspnea, diffuse abnormal shadows on radiological examination of the chest and physiologic evidence of a restrictive lung disease. Bronchoalveolar lavage and transbronchial lung biopsy proved that the patient was suffering from pulmonary alveolar proteinosis. He had worked as a landscape gardener for the past 2 years, and had been exposed to insecticides. IgE and CEA levels were significantly elevated in both serum and bronchoalveolar lavage fluid. After whole lung lavage, general status improved remarkably and serum CEA fell to the normal range. The serum IgE level was, however, reduced by only half. Proliferating type II epithelial cells in pulmonary alveolar proteinosis have been suggested to produce CEA. However, the cause of the increased IgE level remains unknown. This case report suggests that some abnormal immunological events, leading to hyperproduction of IgE, could play a role in the onset of pulmonary alveolar proteinosis.

Hypotensive effects and influence on serum lipids of SQ29,852, a new angiotensin converting enzyme inhibitor, in patients with essential hypertension: a comparison with atenolol

The effects of SQ29,852 (n = 24), a new angiotensin converting enzyme inhibitor, and atenolol (n = 22), monotherapies were compared in 46 patients with mild to moderate essential hypertension. Both SQ29,852 (mean dose 15.0 +/- 5.1 mg/day) and atenolol (mean dose 37.5 +/- 18.5 mg/day) significantly decreased both systolic and diastolic blood pressures. There were no significant changes in serum lipids, apolipoproteins, lipoproteins or atherosclerotic indices after both SQ29,852 and atenolol. There were also no significant inter-group differences. There were no serious side effects or abnormal laboratory tests in both treatment groups. It is concluded that SQ29,852 is an effective antihypertensive drug without adverse effect on lipid metabolism.

Pancreatic B-cell functioning after intravenous glucagon administration in anorexia nervosa

Abnormal glucose tolerance is often found in patients with anorexia nervosa (AN). We attempted to evaluate pancreatic B-cell functioning after intravenous glucagon administration. Fourteen patients with the restricting type of AN (percentage of ideal body weight 71.5 +/- 1.6%, mean +/- SE) and 6 patients with the bulimic type of AN (77.0 +/- 3.0%) were studied. After an overnight fast, glucagon (0.02 mg/kg) was injected i.v. into all subjects and 6 normal controls. Blood samples were obtained at 0, 5, 30, 60, 90 and 120 min to measure blood glucose (BS), serum insulin (IRI) and C-peptide (CPR). The same tests were repeated in 8 patients with restricting AN after therapy and restoration of body weight (85.9 +/- 1.0% of ideal body weight). BS responses did not differ among the groups. Peak serum levels (5 min) of both IRI and CPR in restricting AN patients were significantly lower than those in bulimic AN patients and in normal controls. BS, IRI and CPR concentrations did not change significantly following restoration of body weight. Pancreatic B-cell dysfunction after glucagon administration was observed in restricting AN patients and the abnormality persisted after short-term weight restoration.

[A case of unstable diabetes mellitus after total pancreatectomy controlled by CSII]

Continuous subcutaneous insulin injection (CSII) is one of good methods to control unstable diabetes. In this paper, we reported a case of a patient with unstable diabetes after total pancreatectomy, to whom CSII was very effective. The case was 53 years of age, lean woman. In 1980, she had pancreatoduodenectomy for the treatment of cancer of duodenal papilla. In June, 1986, she was diagnosed as recurrence of the cancer, and undertaken total pancreatectomy. And then, insulin treatment was commended. But she readily developed hypoglycemic reactions by ordinary insulin injection once or twice a day, and glycemic control was very poor. On April 22, 1987, CSII was started. 8 units of regular insulin were given during 24 hours, and 2 units of regular insulin were added before every meal. Thereafter, the frequency of hypoglycemic reaction decreased dramatically, and HbA1c level decreased from 8.5% to 8.1% three months later. This report indicated usefulness of CSII to patients with unstable diabetes, who couldn't be controlled by ordinary insulin injection.

[Clinical studies on the utility of ofloxacin for lower respiratory infections]

One hundred and thirteen patients who were treated at the Kyushu University Hospital and other related hospitals were randomly assigned to 2 groups to compare the effect of twice daily administration of 200 mg each and that of 300 mg each of ofloxacin (OFLX). The patients included 41 cases with pneumonia, 18 with acute bronchitis, 33 with chronic bronchitis, 15 with bronchiectasis with infection, 3 with diffused panbronchiolitis, and 3 with other secondary infectious diseases. Fifty-five cases were administered 400 mg OFLX a day and 58 cases received 600 mg. The number of severe cases in the 600 mg group was greater than that in the 400 mg group. The ratios of general amelioration of clinical symptoms were 92.6% in the 400 mg group and 82.1% in the 600 mg group. Thus, the ratio of the 400 mg group was better than that of the 600 mg group. However, the ratio of significant amelioration in the 600 mg group was 35.7% which was better than that in the 400 mg group, 27.8%. For bacteriological effects the rate of disappearance and decrease in number of bacteria was 92% in the 400 mg group and was significantly better than that of the 600 mg group, 70%. The incidence of side effects in the 600 mg group was 22.4% and this was high in contrast to that in the 400 mg group, 3.6%. Most of the side effects in the 600 mg group involved symptoms of the central nervous system such as sleeplessness. No significant differences were observed in incidences of abnormalities of laboratory tests at 1.8% and 1.7%, respectively. Safety in the 400 mg group were 96.4% which was significantly higher in number than those in the 600 mg group, 77.6%. Efficacy rates of twice daily administrations each with 200 mg and 300 mg OFLX for lower respiratory infections were 94.4 and 79.3%, respectively. In conclusion, the daily dose of 400 mg was the most effective.

Prolactin responses in dexamethasone suppression test in patients with anorexia nervosa

In anorexia nervosa (AN), abnormalities are present in the hypothalamic-pituitary-adrenal axis, but the prolactin (PRL) response to dexamethasone suppression test (DST) has not yet been studied. In order to study the interrelationships between the various endocrine abnormalities, we investigated the responses of PRL and cortisol to DST (1 mg of dexamethasone at 2300) in AN patients. The subjects were 12 female inpatients with AN and 8 age- and sex-matched healthy controls. The percentage suppression and absolute change in PRL levels before and after dexamethasone administration were significantly different in the 2 groups. In the control group PRL levels suppressed to 36.5 +/- 3.7% of basal, while AN levels declined to 79.4 +/- 8.9% of basal. When the percentage suppression of PRL was compared between patients with and without cortisol suppression, the mean PRL level was 68.9 +/- 7.8% of the basal level for the cortisol-suppressed patients and 100.4 +/- 19.1% for the nonsuppressed patients. Hence in both groups, the percentage PRL suppression was significantly reduced compared with the control group, and indeed nonexistent in cortisol-nonsuppressed patients. The finding that there was less PRL suppression in the cortisol-suppressed patients than in the controls suggests that, in AN, there may be an abnormality in PRL secretion not related to the hypothalamic-pituitary-adrenal axis. Further work is needed to distinguish between the PRL response to stress and potential hypothalamic abnormality.

Right atrial vegetation in left ventricular-right atrial communication

We report a case of right-sided endocarditis with left ventricular-right atrial communication in which right atrial vegetation was demonstrated by two-dimensional echocardiography. The present case demonstrates that the right atrial vegetation in ventricular septal defect is suggestive of left ventricular-right atrial communication.

[Clinical studies on netilmicin]

Netilmicin (NTL), a new semisynthesized aminoglycoside, was evaluated in 11 episodes of infection in 10 patients, who had severe underlying diseases, such as acute myocardial infarction, cerebral infarction, malignancy and hepatic cirrhosis. The infection was bacteremia in 3 cases, urinary tract infections in 3 cases and respiratory tract infections in 5 cases. NTL was administered intramuscularly at a dose of 100 mg twice a day for 3 to 14 days. Overall clinical efficacy was only 40%, including excellent in 2 cases, good in 2 cases, fair in 3 cases and poor in 3 cases. Bacteriologically, 2 episodes of E. coli, 2 of S. marcescens and 1 of K. pneumoniae were eradicated, whereas, 2 of P. aeruginosa were decreased, and 1 of K. pneumoniae and 1 of P. rettgeri were persisted. Transient eosinophilia was observed in 1 case, and also nephrotoxicity was encountered in 1 case.

Benign and malignant fibrous histiocytomas of the soft tissues: functional characterization of the cultured cells

Cell cultures were carried out from fresh tumor tissues obtained from seven cases of histiocytic tumors of the soft tissues including four of malignant fibrous histiocytoma, two of benign fibrous histiocytoma, and one of giant cell tumor of tendon sheath. The cultured cells were studied by light and electron microscopy, rosette formation for surface receptors, immune phagocytosis, and enzyme cytochemistry. The culture of each tumor revealed a mixture of histiocyte-like cells, fibroblast-like cells, amd intermediate forms. Bizarre giant cells were numerous in the early cultures of malignant fibrous histiocytoma, but they were absent in the cultures of benign fibrous histiocytoma and giant cell tumor of tendon sheath. In all the seven cases the cultured cells exhibited several features characteristic of histiocytes: (1) surface receptors for the Fc-portion of immunoglobulin G; (2) surface receptors for the third component of complement; (3) immune phagocytosis of opsonized erythrocytes; and (4) lysosomal enzymes including alpha-naphthyl butyrate esterase, and acid phosphatase. These findings suggest that the histiocytic tumors of the soft tissues in discussion actually comprise the cells that have the functional property of histiocyte. The tumor cells in the surgical specimens presented essentially the same ultrastructural and enzyme histochemical characteristics as those of the cultured cells.

[Preclinical and clinical studies of clindamycin-2-phosphate (author's transl)]

Preclinical and clinical studies of clindamycin-2-phosphate developed as an infectable were conducted, and the following results were obtained: 1) Clindamycin-2-phosphate administered by the intravenous drip in a dose of 600 mg over one hour showed a peak blood clindamycin level of 10.5 mcg/ml at the end of administration. Though the blood level then decreased rapidly, it stayed at 0.7 mcg/ml at 8 hours later. 2) The blood level of clindamycin following intramuscular injection of 300 mg of clindamycin-2-phosphate reached a peak of 3.3 mcg/ml at one hour later. The blood level of 6 hours after injection was 1.0 mcg/ml. 3) Clindamycin-2-phosphate 300 mg was given intramuscularly 2 to 4 times daily for 5 approximately 14 days in 4 cases of pneumonia. The drug proved effective in two cases of pneumonia due to Mycoplasma; fairly effective in another case of mixed infection caused by pneumococci, Hemophilus and N. meningitidis; and ineffective in the fourth case of infection due to Hemophilus parainfluenzae. 4) No such adverse reactions as hepatic disorder, renal disorder and colitis were noted following administration of clindamycin-2-phosphate.

Differential response of cultured mammalian cells to cytochalasin B in multinucleation

Cytochalasin B (CB) was applied to 13 kinds of non-tumorigenic or tumorigenic cells in vitro to investigate whether the drug would be applicable as an indicator to identify the transformation of cells. Normal cell strains suffered from more deteriorative changes in morphology than cell lines, showing arborization of their cytoplasm at 5 mug/ml. CB at 2.5 mug/ml consistently prevented cytoplasmic cleavage without interfering with nuclear division. Multinucleation of the cells exposed to CB was not related to their generation time. The correlation between multinucleation and tumorigenicity of the cells was found with some exceptions. It appears, however, that multinucleation induced by CB would not be a reliable parameter for identifying malignant transformation of cells in vitro.