Comparison of amikacin and gentamicin in the treatment of urinary tract infections

The use of standard doses of gentamicin and small doses of amikacin was compared in the treatment of urinary tract infections in 30 adults. Patients were prospectively randomized to treatment with 3 to 4 mg/kg/day of gentamicin (group 1) or 9 mg/kg/day of amikacin (group 2). The age and sex of the patient, and the duration of the treatment were similar in the two groups. Eleven of the 15 patients in each group were diagnosed clinically as having pyelonephritis. The majority of patients in both groups either required a permanent Foley catheter or had associated diseases predisposing to urinary tract infections. In nine of 15 patients in each group, the bacterial etiology was Pseudomonas aeruginosa. Bacteriologic cures were achieved in nine of 15 patients treated with gentamicin (group 1) and in 10 of 15 patients treated with amikacin (group 2). The mean peak concentration of gentamicin was 5.4 μg/ml (range: 2 to 13 μg/ml), and the mean peak concentration of amikacin was 11.2 μg/ml (range: 8.2 to 19.6 μg/ml). In the patients treated with gentamicin, there was no correlation between the peak serum concentration of gentamicin, the in vitro minimum inhibitory concentration and the bacteriologic response to treatment. No direct evidence of antibiotic-induced toxicity was detected. These results suggest that a reduced amikacin dosage schedule gave results essentially equivalent to standard doses of gentamicin in adults with urinary tract infections.     

Control of late postoperative ventricular arrhythmias with phenytoin in young patients

Ventricular arrhythmias probably initiate the events leading to sudden death in patients who have recovered uneventfully from surgery for congenital heart disease. It is therefore recommended that antiarrhythmic therapy be given to all patients who have had surgery for congenital heart defects and who have ventricular arrhythmias found in a routine electrocardiogram taken after the immediate postoperative period. The response of ventricular arrhythmias to treatment was studied in six ambulatory patients aged 7 to 27 years (mean 16.5) who had had surgery a mean of 10.7 years before the arrhythmia was recognized. Four patients had unsatisfactory repair of the congenital defect; the two other patients had only a palliative operation. Each patient's electrocardiogram was monitored continually by tape recording. Each received phenytoin, 3.75 mg/kg body weight, every 6 hours for four doses, then 1.9 mg/kg every 6 hours until the serum concentration of phenytoin was 15 to 20 μg/ml. This serum concentration was maintained with the daily administration of 2.5 to 3 mg/kg every 12 hours. In the 24 hours before treatment, two patients had ventricular tachycardia, two had paired premature ventricular complexes and two had 10 or more single premature ventricular complexes/hour. After treatment, all patients had “effective control” (one or less premature ventricular complex/hour for 12 consecutive hours). This control was achieved with phenytoin in five patients, but one patient required the addition of disopyramide (2 mg/kg every 6 hours). All five patients undergoing a treadmill test before treatment had premature ventricular complexes during or after exercise; after treatment, only one had premature ventricular complexes after exercise. The patient who required two drugs was unable to perform a treadmill test. The mean effective serum phenytoin concentration, 15.7 μg/ml (range 8.5 to 20.0), was reached at a mean time of 61.2 hours (range 42 to 80) after the start of phenytoin therapy. Ataxia occurred in two patients with serum phenytoin concentrations of 16 and 20 μg, but not in the other four, three of whom had serum concentrations greater than 20 μg/ml. Echocardiographic, hematopoletic, hepatic and renal function indexes remained constant with treatment.It is concluded that (1) phenytoin suppressed ventricular arrhythmias in six children and young adults after surgery for congenital heart disease; (2) the effective serum concentration of phenytoin was approximately 15 μg/ml, but varied widely; and (3) this concentration was achieved within 48 to 72 hours when an oral loading dose was administered.     

Pharmacokinetic analysis of amikacin twice and single daily dosage in immunocompromised pediatric patients

Summary Ten children received amikacin twice daily and 13 were treated using the single daily protocol. All had fever and neutropenia on admission, and received a total daily dose of 20 mg/kg when included in the study. Individual pharmacokinetic parameters were calculated using a one-compartment model for two blood amikacin samples. The mean (±SD) of elimination half-life (h), amikacin clearance (l/h/kg), volume of distribution (l/kg), peak concentration (μg/ml) and trough concentration (μg/ml) were: 2.51 (0.74) and 2.85 (0.32) h; 0.26 (0.16) and 0.115 (0.02) l/h/kg; 0.74 (0.44) and 0.47 (0.11) l/kg; 19.1 (12.3) and 42.6 (12.6) μg/ml; 0.85 (0.74) and 0.18 (0.24) μg/ml with twice and single daily dosage schedules, respectively. A single daily dose of amikacin had a significantly longer elimination half-life, lower clearance, higher peak concentration and lower trough concentration in comparison to the twice-daily schedule. The use of amikacin 20 mg/kg daily delivered in a single daily dose is recommended for immunocompromised pediatric patients with fever and neutropenia, in spite of the measured pharmacokinetic differences. Part of this work was presented in a poster session at the 8th International Congress on Anti-Cancer Treatment, Paris, France, February 1998.     

胞内分枝杆菌临床分离株亚种组成及体外耐药性分析

目的 分析深圳地区胞内分枝杆菌临床分离株的亚种组成及其耐药谱,为治疗胞内分枝杆菌肺病提供科学依据。方法 选取中国疾病预防控制中心国家结核病参比实验室保存且初步鉴定为胞内分枝杆菌的临床分离株,共计97株。菌株均分离自深圳市第三人民医院2018年收集的疑似肺结核和非结核分枝杆菌(NTM)肺病患者的呼吸道标本。采用PCR及基因测序鉴定胞内分枝杆菌临床分离株亚种,使用Sensititre^? SLOWMYCO药敏板测定菌株对13种药品(克拉霉素、阿米卡星、莫西沙星、利奈唑胺、利福平、利福布汀、乙胺丁醇、链霉素、多西环素、环丙沙星、异烟肼、乙硫异烟胺及复方磺胺甲噁唑)的药物敏感性情况。结果 97株胞内分枝杆菌临床分离株以亚种胞内分枝杆菌最多[63.92%(62/97)],其次为奇美拉分枝杆菌[18.56%(18/97)]和副胞内分枝杆菌[17.53%(17/97)]。药物敏感性试验显示,胞内分枝杆菌的MIC₅₀和MIC₉₀值最低的是利福布汀(0.5和8μg/ml),最高的是链霉素(32和64μg/ml);亚种胞内分枝杆菌和副胞内分枝杆菌的MIC₉₀均为2μg/ml,而奇美拉分枝杆菌则高达64μg/ml。胞内分枝杆菌临床分离株对克拉霉素、乙胺丁醇、利福平、利福布汀、链霉素、阿米卡星、利奈唑胺和莫西沙星总的耐药率分别为9.28%(9/97)、44.33%(43/97)、42.27%(41/97)、15.46%(15/97)、36.08%(35/97)、11.34%(11/97)、38.14%(37/97)和46.39%(45/97);奇美拉分枝杆菌对克拉霉素的耐药率[27.78%(5/18)]明显高于亚种胞内分枝杆菌[4.84%(3/62)],差异有统计学意义(χ²=8.156, P=0.012)。结论 深圳地区胞内分枝杆菌以亚种胞内分枝杆菌为主,对各药品的敏感性有差异,且各亚种对同一药品的敏感性也不同,建议临床治疗前应鉴定至亚种并行药物敏感性试验,以实现个性化治疗。     

Elevated Serum Ferritin in Children with Malignancies

Serum ferritin (SF) is elevated in adults with malignancies, chronic inflammatory disease, liver disease and iron overload. The purpose of this study was to determine whether the concentration of SF in children with a variety of malignancies correlated with the activity of their disease. Patients with acute lymphoblastic leukaemia (ALL) at initial diagnosis (n = 11) and relapse (n = 15) had a mean SF of 238 and 338 ng/ ml, respectively, compared to the normal mean of 31 ng/ml and range of 7 to 140 ng/ml in children. In 30 patients with ALL in remission the mean SF was 109 ng/ml, less than the values in patients with active disease and greater than the normal mean (P < 0.001). The concentration of SF was also increased in a group of 77 patients with a variety of solid tumors. The 28 cases with active disease had a mean SF of 242 ng/ml, significantly higher (P < 0.001) than the value of 84 ng/ml in 49 patients with no evidence of residual tumor. The differences in SF concentration did reflect the activity of disease in the groups as a whole but it remains uncertain whether the assay will prove useful in following the response to treatment of patients with certain types of tumor.     

Elevated serum ferritin in children with malignancies.

Serum ferritin (SF) is elevated in adults with malignancies, chronic inflammatory disease, liver disease and iron overload. The purpose of this study was to determine whether the concentration of SF in children with a variety of malignancies correlated with the activity of their disease. Patients with acute lymphoblastic leukaemia (ALL) at initial diagnosis (n = 11) and relapse (n = 15) had a mean SF of 238 and 338 ng/ml, respectively, compared to the normal mean of 31 ng/ml and range of 7 to 140 ng/ml in children. In 30 patients with ALL in remission the mean SF was 109 ng/ml, less than the values in patients with active disease and greater than the normal mean (P less than 0.001). The concentration of SF was also increased in a group of 77 patients with a variety of solid tumors. The 28 cases with active disease had a mean SF of 242 ng/ml, significantly higher (P less than 0.001) that the value of 84 ng/ml in 49 patients with no evidence of residual tumor. The differences in SF concentration did reflect the activity of disease in the groups as a whole but it remains uncertain whether the assay will prove useful in following the response to treatment of patients with certain types of tumor.     

Serum lysozyme,serum proteins,and immunoglobulin determinations in nonspecific inflammatory bowel disease

The serum levels of lysozyme, serum electrophoresis, and serum immunoglobulins were determined prospectively in 101 patients with ulcerative colitis, ulcerative proctitis, Crohn's disease, or nonclassifiable nonspecific inflammatory bowel disease. Although the mean serum lysozyme concentration of patients with Crohn's disease (10.5±6.8 μg/ml) and ulcerative colitis (9.6±4.1 μg/ml) performed by a standardized lysoplate method was significantly greater than normal controls (6.0±1.5 μg/ml), the results did not correlate with the diagnosis nor with the degree of disease activity. Individually separated protein fractions and serum immunoglobulins also did not correlate with the serum lysozyme levels. This study indicates that measurement of the level of serum lysozyme in individual patients is not helpful in determining the cause or degree of activity of non-specific inflammatory bowel disease.     

Echocardiographically guided pericardiocentesis for treatment of clinically significant pericardial effusion in rheumatoid arthritis

OBJECTIVE: To assess the safety and efficacy of echocardiographically guided pericardiocentesis for patients with rheumatoid arthritis (RA) and hemodynamically significant pericardial effusion. METHODS: We identified 16 patients with RA who underwent 18 echocardiographically guided pericardiocentesis procedures at our institution over a 20-year period. Clinical and laboratory characteristics of the patients, response to treatment, complications, and need for future pericardial surgery were abstracted from the echocardiography database. RESULTS: Ten patients were men and 6 were women (mean age, 62 yrs; range, 36-75 yrs). On average, patients were diagnosed with RA 11 years before pericardial disease developed. Twelve of 15 patients were seropositive for rheumatoid factor, 10 patients had radiographic evidence of erosions, and 7 patients had rheumatoid nodules. Cardiac tamponade was present in 11 of the 18 cases. Mean volume drained on the first pericardiocentesis was 504 +/- 264 ml (range 120-1000 ml). The fluid was an exudate with a mean protein concentration of 5 g/dl (range 3.3-51.1 g/dl). All cultures and cytologic findings were negative for bacteria and neoplastic cells. No serious complications resulted from echocardiographically guided pericardiocentesis. For 11 patients, a catheter was placed for intermittent drainage over an average of 3 days. Seven patients ultimately required a more definitive surgical procedure. CONCLUSION: Echocardiographically guided pericardiocentesis is a safe and effective treatment for this uncommon but serious complication of RA.     

The early bactericidal activity of amikacin in pulmonary tuberculosis.

SETTING: Stellenbosch University, a tertiary care hospital in Cape Town, South Africa. OBJECTIVE: To determine the early bactericidal activity (EBA) of amikacin in dosages of 5 mg/kg, 10 mg/kg and 15 mg/kg body weight in comparison to that of isoniazid 6 mg/kg body weight or no drug. DESIGN: An open, randomised trial. PATIENTS: Patients with previously untreated, sputum smear-positive pulmonary tuberculosis. INTERVENTION: Patients received amikacin 5 mg/kg (12 patients), 10 mg/kg (13 patients) or 15 mg/kg (15 patients), isoniazid 6 mg/kg (9 patients) or no drug (10 patients). RESULTS: The rate of decrease in log viable colony forming units of Mycobacterium tuberculosis per ml of sputum per day during the first 2 days of treatment with amikacin 5 mg/kg, 10 mg/kg and 15 mg/kg was 0.041 (SD 0.100), 0.045 (SD 0.144) and 0.052 (SD 0.096), respectively, 0.515 (SD 0.173) in the patients receiving isoniazid 6 mg/kg, and 0.041 (SD 0.113) in those receiving no drug. The EBA found in patients receiving amikacin did not differ significantly from that of the no drug group. However, as the EBA in the no drug group was the highest ever encountered at Stellenbosch University, the mean in patients receiving drug was tested against 0 and found to differ significantly (P = 0.03), suggesting minimal activity. Mean amikacin serum concentrations 1 hour after intramuscular drug administration were 13.5 microg/ml, 26.7 microg/ml and 39.2 microg/ml in the patients receiving 5 mg, 10 mg and 15 mg per kg body weight, respectively. CONCLUSION: Despite serum concentrations well in excess of the minimal inhibitory concentration of 2-4 microg/ml, the EBA of amikacin in patients with smear-positive pulmonary tuberculosis was only just detectable.     

Effect of Treatment with Paromomycin on Endotoxemia in Patients with Alcoholic Liver Disease—A Double-Blind, Placebo-Controlled Trial

The results of experimental and clinical studies support the hypothesis that gut-derived endotoxins might be of relevance for the development and course of alcoholic liver disease. The aim of this study was to test the effect of a nonabsorbable, broad-spectrum antibiotic on endotoxemia in patients with alcoholic liver disease. Fifty patients with alcoholic liver disease (27 with cirrhosis, 23 without cirrhosis) were randomly assigned to receive either paromomycin sulfate (3 × 1 g/day) or placebo in a double-blind fashion for at least 3 weeks, and if possible 4 weeks. Endotoxin concentration, liver function tests, and other laboratory parameters were determined in weekly intervals. Endotoxin concentration was also determined in 15 healthy controls. Groups receiving paromomycin or placebo were similar for clinical and biological items collected initially. Mean initial endotoxin concentrations were significantly elevated in both groups (mean ± SEM; paromomycin, 16.7 ± 5.3 pg/ml; placebo, 17.5 ± 6.9 pg/ml; healthy controls, 2.3 ± 0.4 pg/ml). Although the mean endotoxin concentration was lower in the verum group after 1 week (paromomycin, 8.0 ± 1.9 pg/ml; placebo, 14.6 ± 3.5 pg/ml; p > 0.05), paromomycin treatment had no significant effect on endotoxin concentration or liver function tests during the 4-week period. The beneficial effect of paromomycin treatment on endotoxemia in cirrhotics reported in earlier studies could not be reproduced under the conditions of this trial in patients with alcoholic liver disease.     

Alterations in serum immunoglobulin G subclasses in patients with ulcerative colitis and Crohn's disease

We have examined the concentration of immunoglobulin G (IgG) subclass antibodies in the sera of 27 patients with ulcerative colitis and 21 patients with Crohn's disease as well as in 11 normal controls and 11 patients with systemic lupus erythematosus. In comparison with a control mean serum IgG1 concentration of 5173 micrograms/ml, patients with ulcerative colitis exhibited a significantly increased mean serum concentration of 7924 micrograms/ml (p less than 0.05), whereas patients with Crohn's disease had a near normal mean serum IgG1 level of 5898 micrograms/ml. In contrast, control sera had a mean IgG2 level of 2477 micrograms/ml and ulcerative colitis sera had a similar IgG2 level of 2269 micrograms/ml, whereas Crohn's disease sera had a significantly increased mean IgG2 level of 5111 micrograms/ml (p less than 0.05). Patients with systemic lupus erythematosus, like those with ulcerative colitis, had a markedly elevated serum IgG1 level of 15,594 micrograms/ml (p less than 0.001) without a significantly increased IgG2 serum level (3271 micrograms/ml). Neither ulcerative colitis nor Crohn's disease sera exhibited altered levels of IgG3 or IgG4. These data show that alterations in IgG subclass concentrations occur in the sera of patients with active, untreated inflammatory bowel disease, similar to the previously noted changes in the IgG subclasses secreted by lymphocytes from involved inflammatory bowel disease intestinal specimens.     

Modification of ventricular tachycardia by procainamide in patients with coronary artery disease

Fifteen consecutive patients with coronary artery disease had rapid (158 to 272 beats/min) and sustained ventricular tachycardia induced by the extrastimulus technique, and received procainamide infusion. Before the study, all but one patient had severe symptoms with tachycardia, and six had survived apparent sudden death. Procainamide consistently slowed ventricular tachycardia. However, in traditional doses (1 g infusion, plasma concentration greater than 4 μg/ml), it prevented induction of ventricular tachycardia in only 2 of the 15 patients. Induction of ventricular tachycardia was facilitated by procainamide in 10 patients. Larger doses of procainamide (plasma concentration 20.2 μg/ml ± 9.7 [mean ± standard deviation]) prevented induction of ventricular tachycardia in one of eight patients. Rapid ventricular rates (more than 210 beats/min) that were not slowed (by 50 percent or more) after a 1 g infusion of the drug predicted failure of procainamide to prevent ventricular tachycardia. Therefore, procainamide slowed but did not prevent induced ventricular tachycardia in most of these patients with coronary artery disease at risk of sudden death.     

Azlocillin und Mezlocillin: Zwei neue semisynthetische Acylureidopenicilline

The pharmacokinetic parameters of two new ureido-penicillins (azlocillin and mezlocillin) were determined in 12 healthy subjects after a half-hour continuous infusion of 5,000 mg. The agar diffusion test (test strain Bacillus subtilis ATCC 6633) was used for the microbiological assays. The mean azlocillin serum concentration after the half-hour infusion was 431.0 +/- 75.0 microgram/ml; after eight hours it had fallen to a mean value of 4.7 +/- 2.6 microngram/ml. The mean elimination half-life was 77.5 +/- 10.4 minutes, and the relative distribution volume was 19.4 +/- 1.9% of the bodyweight. At the end of the infusion, mezlocillin showed a mean serum concentration of 426.0 +/- 61.0 microgram/ml and after eight hours an average of 1.1 +/-0.9 microgram/ml; the half-life was shorter (56.9 +/- 9.9 minutes) and the distribution volume lower (14.8 +/- 3.1%) than that of azlocillin. The renal clearance values measured in three subjects during a four-hour continuous infusion were: azlocillin 111.6 ml/min/1.73 m2, mezlocillin 121.5 ml/min/1.73 m2. The kinetic behaviour of the two ureido-penicillins was essentially very similar to that of ampicillin and carbenicillin, 38 patients with bronchopneumonia, cholangitis or urinary tract infections, which in some instances were severe, were treated for an average of 10 days with an average daily dosage of 3X4.0 g azlocillin or 3X5.0 g mezlocillin. 30 patients showed clinical improvement, and in 17 of these the pathogen was eliminated. These therapeutic results appear more favourable than those obtained with the newer aminoglycoside antibiotics (amikacin, sisomicin); in particular the drug was well tolerated.     

Serum Selenium Levels in Malignant Lymphoproliferative Diseases

Serum selenium levels were measured in 38 patients with malignant lymphoproliferative diseases (MLD) and in 34 non-hospitalized healthy individuals. Selenium was determined by proton induced x-ray emission. In Hodgkin's disease and non-Hodgkin malignant lymphoma the mean serum levels of selenium were not different from those of the control group. On the contrary lowered mean serum selenium concentrations were observed in the group with chronic lymphocytic leukaemia (5.2 + 0.7 μg/100 ml) as compared to normal individuals (7.9 + 0.3 μg/100 ml). The difference is highly significant (P < 0.005). A second selenium test was made in 11 out of the 38 patients within 8 weeks from the beginning of radiotherapy or chemotherapy; unchanged levels were found.     

脂多糖/脂多糖结合蛋白复合物的初步构建

目的采用温孵法构建脂多糖/脂多糖结合蛋白(LPS/LBP)复合物,研究LPS炎症信号通路。方法将LPS与LBP按15︰1、10︰1、5︰1的比例混匀。把LPS/LBP混合物、LBP(浓度分别为200μg/ml、100μg/ml和50μg/ml)、LPS(浓度分别为100μg/ml、50μg/ml)过夜孵育。将孵育后的LPS/LBP混合物、LBP、LPS行凝胶电泳,经考马斯亮蓝染色后将各染色条带切取,行蛋白回收,并测定内毒素。结果凝胶电泳后,LPS/LBP复合物、LBP泳道于相对分子质量52×10~3处可见考马斯亮兰染色的条带。样本中LBP浓度越高、条带染色越浓,LPS泳道对应于相对分子质量52×10~3处无染色条带出现。各浓度比例的LPS/LBP复合物电泳后凝胶条带回收物中均能检测出内毒素。10︰1 LPS/LBP复合物组、15︰1 LPS/LBP复合物组复合物内毒素浓度显著高于5︰1 LPS/LBP复合物组内毒素浓度(P0.05)。10︰1 LPS/LBP复合物组与15︰1 LPS/LBP复合物组内毒素浓度无统计学差异(P0.1)。各浓度LBP组均未检出内毒素,各LPS组内毒素检测也为阴性。结论 LPS︰LBP为10︰1是较为合理的构建LPS/LBP复合物的比例,通过温孵及凝胶电泳可获得纯度较高的LPS/LBP复合物。     

Vitamin D status in primary hyperparathyroidism in India

OBJECTIVES Primary hyperparathyroidism is a syndrome with variable clinical expression, presenting as asymptomatic hypercalcaemia in Western countries and with predominant bone disease in developing countries. Vitamin D deficiency has been implicated as the cause of bone disease. There is a paucity of information on the vitamin D (25-OHD₃) status of patients with primary hyperparathyroidism presenting with bone disease. The present study aims to evaluate the vitamin D status in patients with primary hyperparathyroidism and to correlate it with the bone disease. DESIGN Twenty consecutive patients with primary hyperparathyroidism admitted to the endocrinology and metabolism wards of the All India Institute of Medical Sciences were analysed to assess their clinical, radiological and biochemical features, as well as parathyroid hormone (mid-molecular, PTH-MM) and 25-OHD₃ levels. MEASUREMENTS PTH-MM levels and 25-OHD₃ levels were measured using RIA kits. RESULTS Bone disease (osteitis fibrosa cystica) was the mode of presentation in 90%. Radiologically, sub-periosteal resorption was present in 90% of the total group of patients, brown tumours in 60%, and pathological fractures in 40%. Renal stones and/or nephrocalcinosis was present in 50% of patients. Mean serum calcium, phosphate and alkaline phosphatase concentrations (mean of 3 days values) were 2.72 ± 0.24 mmol/l; 1.01 ± 0.28 mmol/l and 425 ± 249 IU/l respectively. The 24-hour (mean of 3 days values) urine calcium and phosphate excretions were 8.0 ± 4.2 mmol and 19.0 ± 13mmol. Only 50% of the patients had hypercalcaemia (> 2.7 mmol/l). However, 90% of the whole group of patients had hypercalciurla. The mean serum creatinine concentration of patients with hypercalcaemia was 108 ± 38 μmol/l and of those with normocalcaemia 89 ± 33 pmol/l. The mean serum PTH-MM was 438 ± 350 pmol/l (the detection limit for the kit was 34 pmol/l). Ultrasound examination detected adenomas in 72% of the cases and computerized tomography of the neck localized adenomas in 71 % of the cases. The median weight of the adenoma was 4.6 g (range 0.125–25 g). Two patients had coexistent hyperplasia of the other parathyroid glands and two had recurrent adenomas. 25-OHD₃ levels were assessed in all 20 patients under fasting conditions. The mean value of 25-OHD₃ observed (8.4 ± 51 μg/l) was comparable to the mean value measured in 14 healthy age and sex matched controls (83 ± 25 μg/l). CONCLUSION Patients with primary hyperparathyroidism in India presented with bone and renal diseases; half were normocalcaemic. All the patients had hypercalcuria despite the bone disease. The PTH-MM levels were increased and 25-OHD₃ levels were low. The predominant bone disease is probably due to prolonged primary hyperparathyroidism coexisting with low calcium intake and/or 25-OHD₃ deficiency. The mean weight of the adenoma was higher than that reported for patients in the Western literature.     

Treatment of proliferative lupus nephritis with methylprednisolone pulse therapy and oral azathioprine

Objective: To evaluate the treatment of proliferative lupus nephritis with methylprednisolone pulse therapy and oral azathioprine.Patients and methods: Eighteen patients with severe proliferative lupus nephritis (Class III, IV or Vd according to criteria of the World Health Organization) were treated with intravenous methylprednisolone (MP) pulse therapy in combination with a low oral maintenance dose of prednisone (20 mg) and azathioprine (2 mg/kg). Thirteen patients (Group I) had a recent onset of clinical manifestations of nephritis at referral (mean and median 4 months). Five patients (Group II) had clinical signs of nephritis for a long time (median 4 years, mean 5 years) and were referred because of progressive renal failure. The mean plasma creatinine in Group I was 109 μmol/l with a mean GFR of 58 ml/min, the mean plasma creatinine in Group II was 284 μmol/l with a mean GFR of 12 ml/min. Renal histology in Group II was characterized by severe chronic damage (chronicity index 8–10).Results: Short-term and long-term effects of treatment were excellent in Group I. The mean plasma creatinine was 68 μmol/l with a mean GFR of 102 ml/min at a mean follow-up of 7 years, median 4 years (range 1–15 years). All patients in Group II needed renal replacement therapy after a mean follow-up of 2.6 years, median 2 years (range 0–8 years). Major side-effects of treatment were only seen twice.Conclusion: Methylprednisolone pulse therapy in combination with low oral maintenance doses of prednisone and oral azathioprine is an effective and safe treatment for patients with severe active proliferative lupus nephritis. In patients with extensive irreversible lesions, this treatment has no or only a temporary effect.     

Serum erythropoietin (ESF) titers in polycythemia

Serum ESF titers were measured in 42 polycythemic patients using the fetal mouse liver cell bioassay. ESF titers in patients with secondary polycythemia differed significantly from those in patients with polycythemia vera (p less than 0.0001). Among the 21 patients with secondary polycythemia, 1 patient had an ESF titer less than 10 mU/ml (the lower limit of sensitivity) and 20 had ESF titers that ranged between 11 and 112 mU/ml, with a mean titer of 56 mU/ml. Among the 21 patients with polycythemia vera, 13 patients had ESF titers less than 10 mU/ml and 8 had ESF titers ranging between 12 and 55 mU/ml, with a mean titer of 26 mU/ml. The mean hemoglobin concentration in the 8 patients with ESF titers greater than 10 mU/ml was significantly below that in the 13 polycythemia vera patients with ESF titers less than 10 mU/ml (p less than 0.03). If ESF titers less than 10 mU/ml had been indicative of polycythemia vera and ESF titers greater than 10 mU/ml had been indicative of secondary polycythemia in patients with hemoglobin concentrations greater than 17.7 g/dl, but not indicative of either condition in patients with hemoglobin concentrations less than 17.7 g/dl, 71.5% of the polycythemic patients in this study would have been diagnosed correctly, 9.5% incorrectly, and in the 19% the diagnosis would have remained uncertain. It was concluded that measurement of serum ESF titers using this in vitro bioassay can be of clinical importance in differentiating between polycythemia vera and secondary polycythemia.     

Resistance to gentamicin,tobramycin and amikacin among clinical isolates of bacteria

Susceptibility to the administration of gentamicin, tobramycin and amlkacin was determined for all isolates of aerobic and facultative gram-negative bacilli submitted for testing to the clinical bacteriology laboratory of the Massachusetts General Hospital between July 1, 1974, and June 30, 1976. In this 24-month period more than 46,000 isolates of bacteria were tested by the single-disc diffusion (Bauer-Kirby) method. Resistance to one or more of the aforementioned aminoglycosidic aminocyclitol antibiotics was found among 4, 114 stains. Correlation with quantitative susceptibility test methods revealed that disc-diffusion methods using 10 μg discs accurately predicted resistance to gentamicin and tobramycin, but overestimated the prevalence of resistance to amikacin by 20 to 50 per cent. Most of the gentamicin-reslstant Enterobacteriaceae in this study were also cross-resistant to tobramycin but were susceptible to amikacin. Many gentamicin-resistant strains of Ps. aeruginosa were susceptible to both tobramycin and amikacin. Resistance to amikacin tended to be of relatively low magnltude (most had minimal Inhibitory concentrations (MIC's) between 31 and 125 μg/ml), but organisms which were resistant to the administration of amikacin were usually resistant to the other two aminoglycosidic antibiotics as well.     

Serum Erythrocyte Folate Levels in Thalassaemic Patients in Thailand

The mean serum and adjusted red cell folate levels, as measured by microassay using Lactobacillus casei, respectively were 8.87 ± SD 3.28 μg/1 and 436 ± SD 107 μg/1 in 76 normal subjects, 4.22 ± SD 2.70 μg/1 and 182 ± SD 114 μg/1 in 55 patients with β-thalassaemia/Hb E disease and 6.36 + SD 2.95 μg/1 and 320 ± 158 μg/1 in 37 patients with Hb H disease. The mean serum and adjusted red cell folate values of the patients with β-thalassaemia/Hb E disease and the mean serum folate value of the patients with Hb H disease were significantly lower than those of the normal subjects (P < 0.001). 33 % of the β-thalassaemia/Hb E patients and 8 % of the Hb H patients showed low serum folate levels (< 3 μg/1) whereas 84 % of the former and 45 % of the latter showed low adjusted red cell folate levels (< 270 μg/1). The group of β-thalassaemia/Hb E disease with low serum folate levels had lower mean haemoglobin concentration and lower mean adjusted red cell folate level than the group with normal serum folate levels. Since the Thai diets have high folate content, the observed low serum and erythrocyte folate levels in thalassaemic patients most likely occur from massively increased erythropoiesis. Folate, 5 mg/d, is now routinely prescribed to such patients especially to those with severe anaemia.