Effect of meropenem on fecal flora in children]

Meropenem (MEPM, SM-7338), a novel parenteral carbapenem antibiotic, was examined for its effect on intestinal flora in children. Seven children with infectious diseases (3 male and 4 female children of age's ranging from 4 months to 8 years and 9 months weighing from 7.3 to 23.0 kg) were treated with MEPM at doses ranging 10.3 to 40.5 mg/kg 3 or 4 times a day for 6 to 12 days. Before, during and after the treatment, identities and numbers of various bacteria contained in 1 g of feces were determined and fecal beta-lactamase activity and Clostridium difficile D-1 antigen were also assayed. Changes in fecal flora during MEPM treatment was somewhat different depending on cases. Regarding Enterobacteriaceae among aerobes, all of 7 cases exhibited moderate or pronounced reductions in Escherichia coli. Some of the cases exhibited the tendency to increase in Klebsiella oxytoca. Enterobacter cloacae and Citrobacter freundii. E. coli which was reduced during the treatment increased rapidly after the treatment in 5 out of 7 cases, and the initial bacterial counts were restored. Diverse strains were observed within the genus Enterococcus, while the overall bacterial counts of this genus exhibited the tendency to increase during the treatment. As a result, no significant change in total aerobe count was observed in any case except 1 case where Enterococcus count was somewhat reduced. Among anaerobes, major bacteria such as Bacteroides, Bifidobacterium, Eubacterium and Peptococcaceae exhibited tendencies to decrease in some cases during the antibiotic treatment. Two infants and 1 child exhibited significant decreases in total anaerobe counts. In most of the cases, such changes in major anaerobes were transient and bacterial counts recovered to their initial values rapidly after completion of the treatment. In no cases, glucose non-fermentative Gram-negative bacilli or fungus became predominant. Although C. difficile D-1 antigen was observed in 4 cases, its changes had no relationship with characteristics of feces. C. difficile was not detected in any of the cases. MEPM was detected in feces in 4 cases being treatment, in concentrations ranging from 0.35 to 66.0 micrograms/g. Fecal MEPM levels were very low except in 1 case in which beta-lactamase was negative. From these results, effects of MEPM on intestinal flora in children were relatively minor compared to other new beta-lactam drugs. However, a care should be taken to minimize diarrhea and bacterial turnover when a prolonged use of the antibiotic, was practiced because of potential significant effects on intestinal flora.     

Urodynamic characteristics during animal hypnosis in the rabbit

In animal experiments, in assessing the vesicourethral function, it is desirable to keep the micturition reflex in a physiologic state. Most anesthetics used to immobilize the animals tend to suppress the micturition reflex. An alternative means is decerebration. However, a decerebrate animal is not easily prepared. Instead of anesthesia or decerebration, we applied animal hypnosis to rabbits for immobilization. The urodynamic characteristics during animal hypnosis were compared with those under anesthesia. Twenty male rabbits weighting 2.5 to 3.0 kg were used. Animal hypnosis was produced by placing the rabbit on its back and restraining it in a V-shape trough and maintaining it there until it relaxed. Under hypnosis, cystometry was performed by the suprapubic route. The external sphincter EMG was recorded simultaneously with bladder pressure using a needle electrode. The urethral pressure profile was also measured during hypnosis. These measurements were repeated under anesthesia induced by intravenous pentobarbital injection (30 mg/kg). Furthermore, the hypnotic degree was assessed from respiratory rate and pupil size during these urodynamic measurements. In the rabbit, hypnosis began within 1 min and lasted for 30 to 60 min. During hypnosis, insertion of a catheter, pricking with a needle electrode and suprapubic puncture did not interrupt the immobility. Urodynamic study under animal hypnosis showed that, as bladder volume increased, the sphincter EMG activity increased and that the EMG activity ceased with bladder contraction. Bladder contraction coincided with the expulsion of saline from the urethral meatus. The maximal bladder pressure during micturition was 23.5 +/- 8.0 mmHg. The maximal bladder capacity at which the micturition reflex occurred was 41.4 +/- 22.3 ml.(ABSTRACT TRUNCATED AT 250 WORDS)     

Significance of magnetic resonance imaging in acute head injury

One hundred seventy-seven patients who had incurred head trauma were studied with magnetic resonance imaging (MRI). Patients varied from those with mild injury without any focal neurological deficit to those with severe injury with post-traumatic coma. Altogether, 177 lesions were demonstrated by MRI in 123 of 177 patients within 3 days of injury using T2-weighted (SE2000/40,2000/111) and T1-weighted (IR1500/500/40) multislice sequences. In contrast, computerized tomography (CT) demonstrated 103 lesions in 90 patients. MRI was superior to CT in the diagnosis of nonhemorrhagic contusions demonstrated as a high-intensity area on T2-weighted imaging. MRI provided some information to evaluate the severity of diffuse axonal injury or to predict delayed traumatic intracerebral hematoma (DTICH).     

Elevated anti-alginate serum titers in patients with acute cholangitis and gallstones imbedded withPseudomonas aeruginosa

Electron microscopy and bacteriological culture revealed viable bacteria covered with a glycocalyx (biofilm) in choledochal stones recovered from two patients with acute cholangitis. On the cut surface of the choledochal stones, the cholesterol stone component was surrounded with a layer of brown pigment stone. In each case, bacterial culture of the choledochal stone recoveredPseudomonas aeruginosa. Since alginate is the main component of the glycocalyx produced byP. aeruginosa, serum IgM, IgG and IgA anti-alginate antibodies were measured in each patient. The present study is the first to demonstrate acute and transient IgM seroconversion to alginate in cases of acute cholangitis. In one case, the elevation of anti-alginate IgM preceded the elevation of anti-alginate IgG. The authors propose that the bacterial glycocalyx may play a significant role in acute cholangitis.     

A case of crushing head injury showing bilateral abducens, facial and acoustic nerve palsies

Most head injuries are due to two basic mechanisms, contact or acceleration. On the other hand, static loading force makes another type of head injury, so called "crushing head injury". In this report, we discussed the mechanism of the crushing head injury and cranial nerve damage of our case. A 35-year-old male was admitted to our hospital suffering from a crushing head injury. In this accident, his head had been crushed between 1000-kg printing machine and truck bed on both temporal regions slowly. He remained fully conscious. On admission 25 minutes after the injury, he showed bilateral sixth-nerve, seventh-nerve palsies, bilateral hearing loss and obvious bleeding from nares and both ears. Gross motor examination was intact. Skull films demonstrated left temporal linear fracture. CT scan showed remarkable pneumocephalus in the basal cistern but no other intracranial lesions. At discharge, two weeks after the trauma, the patient was alert and remained bilateral sixth-nerve, seventh-nerve palsies, and bilateral hearing loss. At the time of 6 months after the initial injury, bilateral abducens nerve palsies and left facial nerve palsy were improved completely. But he demonstrated right slight facial nerve palsy and bilateral moderate hearing loss continuously. In this rare type of injury, the head of the patients had been crushed slowly by the huge power on both temporal regions. This force makes the avulsion of the petrous bone from the foramen lacerun to the outer side of the bone (Russell WR and Schiller F, 1949). This must tend to stretch the sixth nerve and produce abducens nerve injury.(ABSTRACT TRUNCATED AT 250 WORDS)     

Immunocytochemical Evidence of Amyloid-enhancing Factor (AEF) in Polymorphonuclear Leukocytes

Amyloid enhancing factor (AEF) was extracted from spleens of mice that had received amyloidogenic stimulation. Sephacryl S 300 gel filtration of the crude AEF yielded five fractions, among which strong AEF activity was present in the first peak (Fl), and confirmed by an amyloid induction experiment. An anti AEF antiserum was obtained from a rabbit by immunization with Fl. This antibody reacted strongly with splenic polymorphonuclear leukocytes (PML) from mice given amyloidogenic stimulation, and weakly with those from normal untreated mice. Isoelectric focusing (IEF) analysis of both Fl and sera from mice given amyloidogenic stimulation was performed. A single band was observed on IEF analysis of Fl, whereas many bands were seen on IEF analysis of the sera. After the substances in the gel had been transferred to nitrocellulose membranes by capillary blotting, the membranes were made to react with the anti-AEF antiserum. The results suggested that AEF is a high molecular-weight substance derived from PML and increases in the serum at the time of, or shortly prior to, amyloid deposition in the spleen. Acta Pathol Jpn 39: 349∼355, 1989.     

Insular Amyloid in a Case of Type HI Glycogenosis with a Special Reference to the Origin of Amyloid Fibrils

Amyloid depositions of pancreatic islets were investigated with electron microscopy in a case of type III glycogenosis.

Beta cells adjoining small amyloid depositions were shown to have cytoplasmic invaginations where closely packed amyloid fibrils were disclosed regularly orientated amyloid bundles. In the cytoplasm of the beta cells, some membrane-bounded vesicles contained amyloid fibrils and a few beta granules directly transformed into the fibrils within the vesicles.

These findings indicate that, at least in this case, the beta cells play a crucial role in the formation of insular amyloid.