Inhibitory effect of cadmium on collagenous peptide synthesis of embryonic chick bone in tissue culture

The effect of cadmium (Cd) on bone collagen synthesis was assessed in organ cultures of embryonic femur by measuring the incorporation of [³H]-proline(Pro) into collagenous-digestible protein (CDP) using purified bacterial collagenase. Cd produced a decrease when [³H] Pro was incorporated in CDP. There was little alteration in the hydroxylation of [³H] Pro to [³H]hydroxyproline(Hyp) in CDP of Cd-treated bone. An accumulation of underhydroxylated collagen and a decrease in the activity of prolyl hydroxylase (EC 1.14.11.2) in Cd-treated bone was not observed. These results indicated that the inhibitory effect of Cd on collagen synthesis was largely due to inhibition of collagenous peptide synthesis without inhibition of its hydroxylation.     

Changes in uterine size after vaginal delivery and cesarean section determined by vaginal sonography in the puerperium

There have been few reports on postpartum changes in the uterus during the three months after delivery. The aim of this study was to evaluate uterine morphological changes in women after vaginal delivery (n=262–351) and in women after cesarean section (n=64–82) and to evaluate the relation between breast-feeding and parity, and uterine involution at 1 and 3 months postpartum measured by vaginal ultrasonography. There were no significant differences in parity between the vaginal delivery group and the cesarean section group. The length of the uterus at one month (7.93±1.16 cm, mean±SD) and, three months (7.03± 1.19 cm) and the width of the uterus at three months (3.83±0.94 cm) after delivery in the cesarean section group were greater than in the transvaginal group (7.64±1.03 cm, 6.65±0.99 cm, 3.57±0.62 cm, respectively). Increasing maternal parity was associated slightly with larger uterine size at one month post partum. The length of the uterus of women with a breast-feeding rate of 80% or more per day was 6.35±0.85 cm, and shorter than in women with a rate of 20% or less 7.03±1.04 cm, at three months after delivery. The width of the uterine body of women with a breast-feeding rate of 80% or more per day was 3.32±0.45 cm, and shorter than in women with a rate of 20% or less 3.87±0.66 cm, at 3 months after delivery. Stepwise regression and multiple regression analysis among parity, the history of cesarean section, the breast-feeding rate at one and three months after the delivery, and the restoration of the menses at three months after the delivery showed that the uterine size at one month after the delivery was related to the cesarean section and that the uterine size at three months after delivery was mostly related to the rate of breast-feeding. These results indicated that uterine involution was related to delivery mode at one and three months postpartum, feeding mode at three months postpartum, the menses restoration, and parity. The rate of breast-feeding was mostly related to the uterine size at three months postpartum. Received: April 1998 / Accepted: 26 March 1999     

The significance of methicillin-resistant Staphylococcus Aureus infection in general surgery: A multivariate analysis of risk factors and preventive approaches

To investigate the characteristics, risk factors, and prevention of methicillin-resistant Staphylococcus aureus (MRSA), a total of 3,627 patients were studied. Among these, 1,336 patients with various infections were used in a risk factor analysis of MRSA to determine the relationship between the use of antibiotics and the incidence of MRSA. Only 3.0% of infections were attributed to MRSA, the esophagus and colorectal region being highly involved, as anastomotic or pelvic abscesses, while the lung had a lower incidence. Almost half the patients with MRSA infections (47.6%) had concomitant infections. A univariate analysis revealed the following significant factors: The coexistence of gastrointestinal or metastatic malignancy, sepsis, tracheostomy, and the prior use of antibiotics such as the -lactam compounds or aminoglycosides. A multivariate analysis showed that gastrointestinal malignancy, sepsis, and the prior use of aminoglycosides, tetracycline, macrolides, and carbapenems were independently significant factors. To promote the education of doctors and nurses, regular in-service meetings on MRSA were held in the ward. Moreover, preventive approaches such as patient isolation, strategically placed hand washing equipment, and the use of disposable gloves and contaminated waste bags, have been initiated, and the incidence of MRSA has decreased significantly since then. Thus, to control MRSA, the following steps should be taken: (1) constant and careful surveillance, (2) regular risk factor analyses, (3) the optimal administration of antibiotics, and (4) the education of all hospital staff.     

Reevaluation of clinical efficacy of piperacillin against complicated urinary tract infections

Forty-six inpatients with complicated urinary tract infections (UTI) were treated with 2 g piperacillin (PIPC) twice a day through drip intravenous infusion. After 5 days, evaluation was made using the criteria proposed by the UTI Committee in Japan. The overall clinical efficacy was rated "excellent" in 4 (8.9%), "moderate" in 22 (47.8%), and "poor" in 20 (43.5%) cases with a total efficacy rate of 56.5% (26/46). We previously presented the clinical efficacy of PIPC in 74 cases with complicated UTI. Herein, a total of 120 cases were analyzed and these cases were divided into two groups. The overall clinical efficacy, bacteriological response, type of infection, background of patients and its safety were evaluated. Almost no change was seen for four years. Also this study revealed the usefulness against Enterococcus infections. In conclusion, PIPC is still a useful antimicrobial agent against complicated UTI even after the appearance of many new Cephems.     

Clinical studies of efficacy of piperacillin against complicated urinary tract infections

Clinical efficacy of piperacillin against 74 cases with complicated urinary tract infection was examined. Piperacillin was administered at the dose of 4 g (2 g twice daily) through intravenous drip infusion. The overall clinical value was rated in "excellent", in 9 cases, "moderate" in 34 cases and "poor" in 31 cases with a total efficacy of 58.1%. In the analysis of clinical values based on background, its efficacy was statistically significantly lower in the patients at a higher age, those with complication of diabetes mellitus, and those with indwelling catheter. In operated cases compared to non-operated cases, it was suggested to be more effective for improving the disturbances in urinary flow as a result of the removal of the underlying conditions by the operation. As to bacteriological efficacy, 64 out of 95 strains (67.4%) isolated were eradicated following its administration. Microbes which appeared after its dosing belonged to 9 classes of 18 strains, of which 5 strains (27.8%) of Serratia were identified. Side effects were 2.5% (3/119), no serious cases appeared. Changes in laboratory examination results were elevated GOT (2.5%), GPT (1.7%), and ALP (0.8%) values, all being transient hanges.     

Current topics in surgery for multiple ventricular septal defects

In this review article, we describe several topics, including the sandwich technique, the transatrial re-endocardialization technique, the limited apical left ventriculotomy approach and device closure. The sandwich technique was introduced for the closure of muscular ventricular septal defects (VSD) by sandwiching the septum between two felt patches placed in the left and right ventricle. This technique requires neither the transection of muscular trabeculae nor ventriculotomy. Although the sandwich technique has resulted in the improvement of surgical outcomes, cases of postoperative cardiac dysfunction have been reported. Multiple smaller VSDs have been closed with transatrial re-endocardialization. Septal dysfunction may be avoided through this technique, in which the septal trabeculae are approximated in two layers of superficial, endocardial running sutures. Recently, a number of reports have recommended a limited apical left ventriculotomy approach. With this technique, a much shorter incision of around 1 cm at the apex of the left ventricle may be sufficient for achieving the complete closure of apical muscular VSDs. The transcatheter or perventricular device closure of muscular VSDs has increasingly been performed with good results. Although favorable early and mid-term results of device closure have been reported, this method is not always safer or less invasive than surgical closure. Long-term evaluations should be performed to determine whether the right and left ventricular functions are affected by treatment with relatively large devices in the heart.