Experimental and clinical studies of sulbactam/cefoperazone in pediatric field

Clinical trials were carried out with sulbactam/cefoperazone (SBT/CPZ) (combination ratio of 1:1) in pediatric infections. Results were as follows. The mean half-lives of SBT and CPZ in the serum following intravenous injection of SBT/CPZ were about 0.7 and 1.2 hours, respectively. Urinary excretions of SBT and CPZ within 6 hours after intravenous injection of SBT/CPZ were 81.9% and 28.1%, respectively. SBT/CPZ was administered to 33 pediatric patients with various infection; 18 respiratory tract infections, 12 urinary tract infections and 3 Salmonella enterocolitis. The overall efficacy rate was 87.9%. In particular, 7 of 8 urinary tract infections caused by beta-lactamase producing organisms were improved after administration of SBT/CPZ. Diarrhea in 8 and soft stool in 3 of 33 patients occurred, and slight elevation of GOT/GPT was observed in 2 patients.     

Comparative effects of antidepressants, amitriptyline, and maprotiline on intraventricular conduction, effective refractory period, and incidence of ventricular arrhythmias induced by programmed stimulation in dog hearts after myocardial infarction.

The effects of amitriptyline and maprotiline, standard tricyclic and tetracyclic antidepressants, on intraventricular conduction, the effective refractory period (ERP), and the incidence of ventricular arrhythmias induced by programmed stimulation were studied and compared in dog hearts after myocardial infarction. Amitriptyline at doses of 1-3 mg/kg significantly slowed ventricular conduction of the infarcted zones in a frequency-dependent and dose-dependent manner. Amitriptyline at doses of 2 and 3 mg/kg slowed conduction slightly in normal zones. The ERP was prolonged by amitriptyline at a dose of 2 mg/kg. Amitriptyline increased the incidence of ventricular arrhythmias induced by programmed stimulation. Maprotiline at doses of 1-3 mg/kg slowed conduction in infarcted zones to a lesser extent as compared with amitriptyline, although severely depressed conduction in the infarcted zone was obviously slowed by maprotiline. Maprotiline did not increase the incidence of ventricular arrhythmias significantly. From the present results, maprotiline appears to have less cardiac toxicity than amitriptyline, although maprotiline produces a slight decrease in conduction of infarcted zones.     

Cloning and characterization of the fmt gene which affects the methicillin resistance level and autolysis in the presence of triton X-100 in methicillin-resistant Staphylococcus aureus.

In methicillin-resistant Staphylococcus aureus (MRSA) strains, Triton X-100 reduced the oxacillin resistance level, although the degree of reduction varied from strain to strain. To study the responses of MRSA strains to Triton X-100, we isolated a Tn551 insertion mutant of the COL strain that became more susceptible to oxacillin in the presence of 0.02% Triton X-100. The Tn551 insertion of the mutant was transduced back to the parent strain, other MRSA strains (strains KSA8 and NCTC 10443), and methicillin-susceptible strain RN450. All transductants of MRSA strains had reduced levels of resistance to oxacillin in the presence of 0.02% Triton X-100, while those of RN450 did not. Tn551 mutants of KSA8 and NCTC 10443 also had reduced levels of resistance in the absence of 0.02% Triton X-100. The autolysis rates of the transductants in the presence of 0.02% Triton X-100 were significantly increased. Amino acid analysis of peptidoglycan and testing of heat-inactivated cells for their susceptibilities to several bacteriolytic enzymes showed that there were no significant differences between the parents and the respective Tn551 mutants. The Tn551 insertion site mapped at a location different from the previously identified fem and llm sites. Cloning and sequencing showed that Tn551 had inserted at the C-terminal region of a novel gene designated fmt. The putative Fmt protein showed a hydropathy pattern similar to that of S. aureus penicillin-binding proteins and contained two of the three conserved motifs shared by penicillin-binding proteins and beta-lactamases, suggesting that fmt may be involved in cell wall synthesis.     

Use of pulse oximetry for monitoring tracheostomy tube obstruction

Experimental studies were performed on dogs for monitoring postoperative tracheostomy tube obstruction using a pulse oximeter. While a 25% obstruction of the cross-sectional area of the tube did not alter the oxygen saturation, obstruction of 40% and above resulted in a drop in the oxygen saturation level which corresponded to the degree of obstruction. The greater the degree of obstruction, the sooner was the fall of oxygen saturation. Therefore a pulse oximeter could be effectively put to use to monitor tracheostomy tube obstruction.     

Two different types of antimitochondrial antibodies (anti-M2 and anti-M4) may not differentiate primary biliary cirrhosis (PBC) with prominent piecemeal necrosis from classical PBC

Clinical and morphological features in 13 patients with primary biliary cirrhosis (PBC) who had two different types of antimitochondrial antibodies (PBC-specific, anti-M2 and mixed-form, anti-M4) in serum tested, were studied. Patients were allocated to two groups purely on the basis of the presence or absence of prominent piecemeal necrosis (PN) to elucidate the clinical significance of PN for differentiating mixed forms of chronic active hepatitis and PBC from classical PBC. Histological staging showed 10 stage I and 3 stage II. All cases had histological features of chronic non-suppurative destructive cholangitis. Prominent PN was encountered in 8 and bridging hepatic necrosis in 6. Granulomas were present in all cases without PN, but only in 3 of 8 cases with PN. Antimitochondrial antibody (AMA) was positive in all cases and anti-M2 was also positive in all but one. On the contrary, anti-M4 was positive in 2. Both anti-M2 and anti-M4 were simultaneously positive in 2, of which PN was present in only one. Therefore, anti-M4 did not relate to the presence or morphological severity of PN in PBC. Simultaneous increases in IgG and IgM were prominent features in PBC with PN.     

Salivary peptide P-C modulates both insulin and glucagon release from isolated perfused rat pancreas

The effect of salivary peptide P-C, saliva-derived peptide on glucose-induced insulin release was studied using perfused rat pancreas. Salivary peptide P-C (194 nM) remarkably potentiated glucose (8.3 and 16.7 mM)-induced insulin release, whereas the same concentration suppressed arginine (10 mM)-induced glucagon release. Both effects of salivary peptide P-C occurred in a concentration-dependent manner. These findings suggest that salivary peptide P-C may modulate both the levels of insulin and glucagon in vivo.     

Germinoma in cerebral hemisphere associated with Down syndrome

A Down syndrome patient with germinoma developing in the cerebral hemisphere is reported. A review of the literature yielded only 14 cases of Down syndrome with brain tumors, including our case. This finding of brain tumors in patients with Down syndrome may reflect chance occurrence. However, it is of interest in this regard that in 6 of the 14 (43%) reported cases the lesions were intracranial germ cell tumors. Received: 15 March 1996 Revised: 20 May 1996     

Case report of an anomalous arrangement of the pancreaticobiliary ducts and nuclear DNA ploidy analysis

Two cases with an anomalous arrangement of the pancreaticobiliary ducts (APBD) are reported in order to investigate the mechanism of carcinogenesis of the extrahepatic biliary tract from the aspect of DNA ploidy analysis. Highly elevated biliary enzymes were found in both cases. Although inflammatory changes without any metaplasia or neoplasia were observed histologically, a cytofluorometric nuclear DNA ploidy analysis showed an aneuploid low ploidy pattern in a histogram of the gall bladder, an aneuploid high ploidy pattern in a histogram of the common bile duct in one patient, and a diploidy pattern in the gall bladder, an aneuploid low pattern in the common bile duct in another case. These results may show that APBD may play a role in the development in DNA ploidy abnormality with refluxed pancreatic juice which may induce repeated irritation and inflammation. Radical surgery including a complete excision of the extrahepatic biliary tract followed by reconstruction may achieve better results with regard to undesirable consequences with an abnormal nuclear DNA ploidy pattern and decrease the likelihood of developing carcinoma.