Effect of low-density lipoprotein apheresis on patients with peripheral arterial disease. Peripheral Arterial Disease LDL Apheresis Multicenter Study (P-LAS).

AIM: The effectiveness of low-density lipoprotein (LDL) apheresis for patients with peripheral arterial disease (PAD) was investigated to confirm a hypothesis based on subjective evidence that the amelioration of blood rheology would be the most contributing factor for improvement in clinical symptoms. Evaluation of the severity of intermittent claudication is difficult because of the lack of an accurate parameter to assess muscle ischemia during exercise, thus we objectively evaluated by non-invasive near-infrared spectroscopy (NIRS) on a treadmill in this study. METHODS: Thirty-one patients with PAD were evaluated for hemostatic function and physiological parameters such as ankle-brachial pressure index (ABI), maximum tolerated walking distance (MTWD) and recovery time (RT) or recovery ability index (RAI) on NIRS. Laboratory tests included plasma assays of total cholesterol, LDL-cholesterol, high-density lipoprotein (HDL) cholesterol, triglyceride, and fibrinogen. The change in red-cell filtration rate was evaluated for the improvement of microcirculation. Statistical analysis was performed using the paired Student's t-test with Bonferroni's correction. RESULTS: A significant improvement in ABI and MTWD was observed after average 9.6+/-0.8 sessions of LDL apheresis treatment and the amelioration of microcirculation in ischemic muscle was objectively evaluated as significant improvement in RAI on NIRS. Rest pain was improved in all 5 patients with Fontaine's classification III or IV. A severe ulcer refractory to usual medications was dramatically diminished in the area by 10 sessions of LDL apheresis and fully healed 5 months after the final LDL apheresis treatment followed by medication. No angiographical change was observed in the arterial occlusive lesions in any patients. CONCLUSIONS: The effectiveness of LDL apheresis on the improvement in physiological parameters such as ABI, MTWD and clinical symptoms in patients with PAD was confirmed. The severity of intermittent claudication was objectively evaluated using non-invasive NIRS. The RT or RAI was useful parameter to evaluate the improvement in the ischemic symptoms of the extremities.

[Antimicrobial activities of roxithromycin against recently obtained clinical isolates].

The purpose of our investigation was to monitor current trends in the susceptibility patterns of clinical bacterial isolates to roxithromycin (RXM). We measured the MICs of macrolide antibiotics, such as RXM, erythromycin (EM), clarithromycin (CAM), rokitamycin (RKM) and midecamycin (MDM), and other classes of antibacterial compounds against various clinical isolates at seven institutions between October and December in 1994 and 1995. RXM had excellent antibacterial activities for S. pyogenes, S. agalactiae, M. (B.) catarrhalis and methicillin sensitive S. aureus. Against methicillin sensitive S. epidermidis, RXM activity was fairly good but about 20% of the strains had MIC > or = 128 micrograms/ml. The activity against S. pneumoniae was not so potent and similar to activities of EM, CAM, MDM, and clindamycin. The vast majority of methicillin resistant S. aureus and S. epidermidis were also resistant to macrolide antibiotics and other classes of compounds tested. In conclusion, RXM is an unique macrolide antibiotic by retaining potent activity against S. pyogenes, S. agalactiae, S. aureus except MRSA, M. (B.) catarrhalis and M. pneumoniae.

[Comparative studies of serological test for Mycoplasma pneumoniae on 73 cases of lower respiratory infection disease].

The purpose of this report is to evaluate a test kit based on the High Density Composite Particle Agglutination Test Method (HDPA method, Newly developed by Tokuyama Soda Co., Ltd). Diagnosis of Mycoplasmosis has been done with clinical symptoms, breast x-ray examination, serum anti-M. pneumoniae antibody detection and bacteriological test result. Recently, we had the chance to use this HDPA method (IMMUNOTICLES MYCO) and compared the results with bacteriological test, complement fixation method (CF) and particle agglutination method (PA) using the cases of seventy-three (73) lower respiratory infected patients. The evaluation outcomes (positive rate, sensitivities and specificities) comparing with the conventional methods based on the clinical cultured results and clinical diagnostic results respectively are shown as follows. 1) The evaluation outcomes based on the cultured results. Forty-one (41) cases of 73 samples, we could isolate the M. pneumoniae (56.2%). a) The HDPA method is correlated with CF (r = 0.885, n = 73) and PA (r = 0.764, n = 73) respectively. b) The positive rate of HDPA, PA and CF are 45.2%, 31.5% and 20.5% respectively. 2) The evaluation outcomes based on the clinical diagnosis. a) The sensitivity of the HDPA method is 66.0% and this one is much higher than the one of CF and PA. b) The specificity of the HDPA method is 92.3%. c) The positive rate of the HDPA method is higher than the one of PA and CF even though the assay was done within seven-days. In conclusion, the HDPA method is a very sophisticated method for diagnosis of M. pneumoniae and able to be substituted to any other conventional methods.

Treatment of postoperative respiratory distress syndrome.

We have studied 45 patients with postoperative adult respiratory distress syndrome (ARDS) who were treated by mechanical ventilation during the last four years. This period was divided into two periods, and the mortality and progress after treatment were analysed. The overall, mortality was 56%. In the first period this rate was as high as 76%, while in the second period this rate improved to 43%. This improvement in the second period was thought to have resulted from aggressive cardiorespiratory treatment and the diminution of infection. According to the course of ARDS after treatment, four types could be classified. Type 1 showed rapid improvement in respiratory function. Type 2 showed gradual improvement. Type 3 showed relapse of respiratory failure. Type 4 resisted mechanical ventilation. Patients of types 3 and 4 had extremely poor prognoses. Stricter management to avoid infection, specific treatment of multiple organ failure (which was seen frequently) seemed advantageous. High frequency positive pressure ventilation (HFPPV) may have some role in improving the respiratory function of the patients with ARDS.