Nationwide surveillance of parenteral antibiotics containing meropenem activities against clinically isolated strains in 2002

The antibacterial activity of meropenem (MEPM) and other parenteral antibiotics against clinical isolates of 899 strains of Gram-positive bacteria, 1500 strains of Gram-negative bacteria, and 158 strains of anaerobic bacteria obtained from 28 medical institutions during 2002 was measured. The results were as follows; 1. MEPM was more active than other carbapenem antibiotics against Gram-negative bacteria, especially against enterobacteriaceae and Haemophilus influenzae. MIC90 of MEPM against Pseudomonas aeruginosa was the lowest of the drugs tested. MEPM showed low cross-resistant rate against both imipenem-resistant P. aeruginosa and ciprofloxacin-resistant P. aeruginosa. MEPM was active against most of the species tested in Gram-positive and anaerobic bacteria, except for multi-drug resistant strains including methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant Staphylococcus epidermidis (MRSE). 2. The proportion of extended-spectrum beta-lactamase (ESBL) strains was 3.1% (4 strains) in Escherichia coli and 1.9% (2 strains) in Klebsiella pneumoniae. Carbapenems including MEPM were active against these ESBL strains. In conclusion, the results from this surveillance study suggest that MEPM retains its potent and broad antibacterial activity and therefore is a clinically useful carbapenem; at present, 7 years after available for commercial use.     

24-hour system of the blood transfusion services at the university hospital

Blood transfusion is an essential medical treatment, from the everyday use in surgery to the treatment of large-scale bleeding accompanying external injury. Securing sufficient quantities of blood product and ensuring safe storage are critical. A 24-hour system of blood transfusion inspection by medical technologists has been enforced in our hospital since April, 1999 to improve the safety of blood transfusion treatment at night and on weekends. The medical technologists in the clinical laboratory and the division of blood transfusion carried out examinations in combination. There were no clinical problems after blood transfusion, and a safe blood supply has been maintained. As for medical technologists not specializing in the division of blood transfusion, blood type and crossmatching tests could be confirmed by the introduction of the Micro Typing System without problem. The execution of regular study meetings and maintenance of the manual are necessary so that the medical technologists not specializing in blood transfusion can carry out examinations confidently. An examination system is effective, but the safety of the blood transfusion treatment at night and on weekends can not be 100% secured. It is important to improve the consciousness of the clinical staff who perform blood transfusion treatment with regular training.     

Primary symptoms of 301 patients with prostate cancer: Nagoya Urology Hospital experience

PURPOSE: Primary symptoms were reviewed retrospectively in patients with prostate cancer diagnosed in our hospital with the aim of promoting early detection. MATERIALS AND METHODS: The subjects included 301 cases with prostate cancer diagnosed histologically in Nagoya Urology Hospital from August, 1988 to December, 2001. The mean age was 72.7 years, and the median PSA was 20.0 ng/ml. Primary symptoms were classified according to the General Rule for Clinical and Pathological Studies on Prostate Cancer (The 3rd Edition). RESULTS: Out of 301 cases, 274 (91%) visited our hospital with clinical symptoms. Of them, 272 had primary urological symptoms. In these 272 cases, 250 (92%) and 19 (7%) had lower urinary tract symptoms (LUTS) and macroscopic or microscopic hematuria, respectively. The majority of patients (82%) referred from other urologists had already undergone PSA measurement, compared to 50% in those referred from physicians other than urologists (p < 0.0005). CONCLUSION: The present data revealed that LUTS were important primary symptoms for the detection of prostate cancer, particularly in an area like Nagoya where the mass screening for prostate cancer is still unavailable. In terms of the early detection of prostate cancer, PSA has to be measured in patients with LUTS even when they visit physicians who are not urologists.     

A new surgical approach for control of pain in chronic pancreatitis: complete denervation of the pancreas

With the aim of pain control in chronic pancreatitis without the morbidity of insulin-dependent diabetes, a new procedure was devised to completely resect the postganglionic pancreatic nerves and to totally free the pancreas from the posterior abdominal wall. This procedure was performed on two patients with follow-up periods of 24 and 10 months. Pain was resolved in both patients, and their blood glucose levels were substantially unchanged. This new approach offers a means of relieving pain with preservation of endocrine function in selected patients with chronic pancreatitis, especially in patients who have a small pancreatic duct.     

An immunologic pathway for intravascular catabolism of creatine kinase subform MM3.

In vitro incubation of the MM3 subform of human creatine kinase (ATP:creatine N-phosphotransferase, EC 2.7.3.2, CK) with fresh human serum resulted in the formation of a complex of high relative molecular mass (Mr 320 kDa). The formed complex (macro CK-MM3) consists of both CK-MM3 and immunoglobulin A (IgA), and its amount of the formed complex was proportional to CK-MM3 activity and IgA concentration. Two molecules of CK-MM3 combined with one molecule of IgA, and the immunoglobulin inhibited the enzyme activity. As IgA does not form complexes with other subforms (CK-MM2 and CK-MM1) or CK-MB, the antigen specificity of IgA to CK-MM3 is definitely exacting. The circumstantial evidence suggests that macro CK-MM3 is a specific antigen-antibody complex. Macro CK-MM3 was detected in all of the examined sera of adult patients with more than 2001 U/1 CK activity (the positive percentage of macro CK-MM3 in all adult patients was 73%), but not detected in sera of patients who were younger than 12 months old. No relationship was observed between macro CK-MM3 and the patients' underlying diseases. Macro CK-MM3 formation suggested to be an immunologic pathway for intravascular catabolism of CK-MM3 when its activity increases.     

A pharmacokinetic study in (mature and premature) neonates treated with amikacin through intravenous drip infusion

A pharmacokinetic study was conducted in neonates (mature, premature) to which amikacin (AMK) was administered through intravenous drip infusion. The results of the study are summarized below. 1. Changes in blood concentrations of AMK obtained after intravenous drip infusion over a period of 30 or 60 minutes were comparable to those after intramuscular injection. 2. When AMK was administered to neonates (mature, premature) at a single intravenous (30 or 60 minutes) dose of 6 mg/kg, peak levels of 15.5 to 26.3 micrograms/ml were attained. These values were within the range of 15 to 30 micrograms/ml which are considered to be safe and effective peak levels. 3. In 0 day-neonates, half-lives of blood AMK levels rather long and widely varied (3 to 8 hours) but, in about 7 day-neonates, half-lives were 3 to 4 hours. 4. It is considered from the above results that the safe and effective blood concentrations of AMK in 0 to 7 day-old neonates can be obtained from intravenous administrations at each dose of 6 mg/kg repeated with intervals of 12 or 24 hours and, in 8 days or older neonates, from intravenous drip infusions over 30 or 60 minutes at each dose of 6 mg/kg repeated with intervals of 12 hours. 5. For neonates with very low birth weights, individual doses and intervals should be separately investigated.