[The clinical efficacy of antithrombin III concentrate in infections complicated by DIC].
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Biomedical subjects
Publications and source records attributed to I Hashimoto.
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Cefotiam dihydrochloride (CTM) in a dose of 2 g was given by intravenous bolus injection to 15 patients operated upon for acute or subacute abdominal organs. They were included to 5 cases of acute localized peritonitis due to perforative appendicitis, 3 of diffuse peritonitis due to perforative duodenal ulcer, 1 of diffuse peritonitis with intestinal obstruction, 1 of perforative sigmoid colon cancer, 2 of gastric cancer or polyp with cholelithiasis, and 3 of cholangitis with cholecyst-choledocholithiasis. The materials of exudate from drain were taken at intervals by sterilized paper disc and determined by paper disc bioassay method with Proteus rettgeri ATCC 9250 or Proteus mirabilis ATCC 21100 as the test organisms to CTM concentrations. CTM concentrations in purulent exudate from drain of patients with acute peritonitis, they were increased quickly after intravenous bolus injection, and reached higher levels at early time after injection in cases 2 or 3 days after operation. CTM concentration in purulent exudate from drain was tended to increase in proportion to the severity of the inflammation. The CTM levels in infected exudate were higher than the MICs against clinically isolated organisms for a long time after administration. Therefore, CTM was very useful drug when used for chemotherapy of postoperative peritonitis.
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The effectiveness of Bestatin on the prognosis of gastric cancer patients was investigated in a randomized controlled trial of postoperative adjuvant chemotherapy. One hundred and sixty-two cases of gastrectomized patients were divided into two groups; a Bestatin group (83 cases, 1/2MF'C [mitomycin C 2 mg and cytosine arabinoside 20 mg i.v. twice a week for 3 weeks, FT-207 400 mg/day i.v. for 3 weeks] followed by Bestatin 30 mg/day and FT-207 0.6 g/day p.o.) and a control group (79 cases, 1/2MF'C followed by FT-207 alone). No significant differences in background factors between the two groups were found. Bestatin was slightly effective in improving the three-year survival rates of gastric cancer patients, but this was not significant. However, survival rates in the Bestatin group in Stage II, curatively operated cases, and n (-) ps (+) cases were significantly higher than those of the control group during the same postoperative period. Bestatin prolonged the disease-free interval in curatively resected cases. Thus, efficacy of Bestatin in improving survival rates was observed in the early stages of disease, but it is suggested that combination a stronger chemotherapeutic regimen may be effective in advanced cases.
Cefminox sodium (CMNX, MT-141), a new semisynthetic cephamycin, having marked resistance to beta-lactamase, and a broad spectrum of antibacterial activity against various bacterial species, including Haemophilus influenzae, Serratia marcescens and Citrobacter freundii, CMNX has higher activity in vivo than in vitro. For therapeutic purpose, CMNX was given in a daily dose of 0.5 g (0.5 g X 1) to 2 g (1 X 2) by intravenous drip infusion for 4 to 8 days to 24 cases with acute peritonitis (17 cases with acute appendicitis, 1 with localized peritonitis after gastrectomy, 1 with diffuse peritonitis due to perforative duodenal ulcer and 5 with panperitonitis due to intestinal obstruction). The clinical response was rated excellent in 9 cases, good in 14 cases and fair in 1 case and poor in none. No adverse effect was observed. There were 29 strains isolated organisms included 12 Escherichia coli, some Enterococcus faecalis and Pseudomonas aeruginosa. These isolated organisms were eradicated after CMNX treatment, except a strain of E. faecalis was decreased. In 19 cases of them, 16 cases with acute peritonitis due to acute appendicitis and 3 cases with acute panperitonitis due to intestinal obstruction, CMNX was administered intravenously in a dose of 1 g (1 case was 0.5 g) before or during the operation, and tissue specimens and body fluids samples were taken during the operation. CMNX concentration was determined to a bioassay with Escherichia coli NIHJ or Vibrio vercolans ATCC 8461 as the test organisms. CMNX concentrations in purulent ascites were 47.2 +/- 38.5 micrograms/ml (n = 23), those in infected appendix wall were 32.2 +/- 21.7 micrograms/g (n = 16), that in pus in appendix were 22.1 +/- 24.3 micrograms/ml (n = 8) and that in other non infected tissues were 24.3 +/- 22.0 micrograms/g (n = 8). CMNX concentrations in infected tissues were higher than the non infected tissues. In the 3 cases with empyemic appendicitis, CMNX levels in pus in appendix were more higher than that in appendix wall itself. Therefore, CMNX sodium appears to be a very useful drug when used for chemotherapy on acute peritonitis.
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A 37-year-old man is presented with Budd-Chiari syndrome associated with a membranous obstruction of the inferior vena cava. Clinical symptoms were ascites, leg edema and dilatation of the superficial abdominal veins. Aggressive surgery was carried out for this case. Midsternal incision and right subcostal oblique incision were made, and hepatic segment of the inferior vena cava was reconstructed using pericardial patch after endovenectomy and partial cardiopulmonary bypass was used without temporary interruption of liver circulation. Blood flow from the right hepatic vein was restored. Postoperative course was not eventful and this patient remains free of any evidence of ascites and liver dysfunction after operation. This procedure may be useful particularly for protecting the liver function which is damaged by hemostasis.
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Aztreonam (AZT), a new synthetic monocyclic beta-lactam antibiotic, which is resistant to beta-lactamase and has a strong and specific activity against aerobic Gram-negative bacteria including Pseudomonas aeruginosa. The patients of 13 cases with localized peritonitis due to acute appendicitis, 3 cases with panperitonitis (1 case with perforative appendicitis, 1 with acute cholecystitis and 1 with pancreatic necrosis) and 4 cases with skin and soft tissue infection (anal fistula and abdominal abscess etc.) were treated by AZT. AZT was administered in a dose of 1 g twice a day by intravenous drip infusion using 100 ml-volume bottle preparation with saline for 4 to 10 days. Clinical efficacy was rated excellent in 2 cases, good in 16 cases, fair in 1 case and poor in 1 case (efficacy rate 90.0%). Adverse effects were small skin rash in 1 case, and increased GOT and GPT in 1 case. No adverse effect was recognized in other cases. Therefore, AZT appears to be very useful drug when used for chemotherapy of infectious diseases in surgery.
Fosfomycin (FOM) is a synthetic antibiotic having a unique structural formula and bactericidal mechanism and a broad spectrum of antimicrobial activity against various bacterial species. It has higher activity in vivo than in vitro. As therapy, FOM-Na in a daily dose of 4 g (2 g X 2) was given by intravenous drip infusion for 5 to 10 days to 6 cases with infectious diseases (2 cases of acute cholecystitis, 3 cases of acute localized peritonitis due to phlegmonous appendicitis and 1 case of acute diffuse peritonitis due to perforative appendicitis). The clinical response was rated as "excellent" in 1 case, "good" in 4 cases, "fair" in 1 case and "poor" in none. No adverse effects were observed in any of the patients. Six clinical isolates were obtained, and these consisted of 4 strains of Escherichia coli and 1 strain each of Klebsiella pneumoniae, and Bacteroides fragilis. The MICs of FOM were from 6.25 to 12.5 micrograms/ml for E. coli, 50 micrograms/ml for K. pneumoniae, and 100 micrograms/ml for B. fragilis. FOM-Na was administered to the 6 cases intravenously in a dose of 2 g before surgery, and tissue specimens and body fluid samples were taken during the operation. The FOM concentration was determined by bioassay with a Proteus sp. (MB 838) as the test organism. The mean FOM concentration in bile from the common bile duct was 61.85 +/- 17.13 micrograms/ml (n = 5) at 95 to 108 minutes after FOM-Na intravenous bolus injection. The mean FOM concentration in the gall bladder bile was 80.06 +/- 92.36 micrograms/ml, while that in the gall bladder wall was 146.65 +/- 39.10 micrograms/g. The mean FOM concentration in purulent ascites was 58.20 +/- 13.29 micrograms/ml, 36.22 +/- 14.63 micrograms/g in the appendix wall and 12.64 +/- 11.34 micrograms/ml in pus in the appendix. The FOM concentrations in the infected tissues and body fluids thus exceeded the MICs of FOM for the pathogenic bacteria. Therefore, FOM-Na appears to be a very useful drug when used for chemotherapy of infections encountered in the surgical field.
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Poliovirus was inoculated intraspinally into cynomolgus monkeys to determine whether nerve cell damage in the central nervous system (CNS) is due primarily to virus multiplication in the neuron or to secondary effects of virus multiplication in the supporting cells. Electron-microscopically, the development of cytopathogenesis and of membrane-bound vesicles and virus particles in the neurons of the CNS in monkeys infected with poliovirus was compared with that of infected cultured cynomolgus monkey kidney (CMK) cells. The structure of membrane-bound vesicles in cytoplasm of damaged motoneuron was examined and found to be similar to the vesicles in infected cultured CMK cells. Virus-like particles were detected occasionally around or within membrane-bound vesicles in the cytoplasm of degenerating motoneurons as well as cultured CMK cells, although intracytoplasmic crystals were not detected in the neuron. No virus particles or membrane-bound vesicles were found in astrocyte foot plates, microglia, oligodendrocytes, axons, vascular endothelial, and inflammatory cells. In addition, poliovirus antigen was detected only in the nerve cells of the CNS by the immunoperoxidase technique, although specific staining was never found in the supporting tissues. From the present results we suggest that membrane-bound vesicles in the cytoplasm of the motoneuron are closely correlated with virus multiplication and that damage of the nerve cell is due to the direct action of the poliovirus.
Biological and biochemical characters of seven enterovirus 71 (E71) isolates were compared. Four isolates (two from patients with hand, foot and mouth disease [HFMD] and two from patients with encephalitis) grew in cynomolgus monkey kidney cells both at 39.5 and 35 degrees C. However, the remaining three strains (from patients with HFMD) grew at 35 degrees C, but not at 39.5 degrees C. Three temperature-resistant and two temperature-sensitive strains were tested for neurovirulence in monkeys. Temperature-resistant strains were shown to be neurovirulent, whereas temperature-sensitive strains were less neurovirulent. The results suggest correlation between temperature-sensitive growth and neurovirulence in monkeys of E71. Variation in the electrophoretic mobility of the viral polypeptides was detected in three out of seven strains. The fingerprinting of oligonucleotides generated from the viral genome showed similar patterns in two isolates from patients with HFMD and one from patient with encephalitis and variable patterns in each genomic map of remaining four strains. These variations of polypeptide patterns and of oligonucleotide maps could not be correlated with pathogenicity (encephalitis or HFMD), temperature-sensitive growth and neurovirulence in monkeys.