The pseudogap and anisotropic thermal expansion in RMn(4)Al(8) (R = La,Y,Lu and Sc).

The temperature dependence of the magnetic susceptibility shows a broad maximum at ∼550 and 630 K for LuMn(4)Al(8) and ScMn(4)Al(8), respectively, which can be interpreted as due to the presence of a pseudogap in the effective bands as in LaMn(4)Al(8) and YMn(4)Al(8). The anisotropic thermal expansion observed for RMn(4)Al(8) (R = La, Y, Lu and Sc) and the sensitive volume dependence of the gap width throughout the RMn(4)Al(8) system suggest dominant magnetic coupling in Mn spin chains along the c axis.

Invasive Aspergillus stomatitis in patients with acute leukemia: report of 12 cases.

An 8-year retrospective analysis of invasive Aspergillus stomatitis in neutropenic patients with acute leukemia was performed to characterize the epidemiology and clinical features of the infection. Twelve cases of invasive Aspergillus stomatitis were identified with both clinicohistological and microbiological evidence, and the majority of cases were caused by Aspergillus flavus (10 [83%] of 12 patients). The infection was strongly suspected when a neutropenic patient developed persistent fever without a known source, symptoms of gingival pain and facial swelling, and a solitary ulcerating lesion of mucogingiva covered with a gray necrotic pseudomembrane. Aspergillus stomatitis was diagnosed a median 23 days after admission. In all 12 patients, the diagnosis was made during the period of neutropenia. Ten patients (83%) were treated with amphotericin B and surgery and survived with recovery of neutrophils. Two patients died, and disseminated aspergillosis was identified in 1 patient.

Synthesis and immunosuppressive activity of 2-substituted 2-aminopropane-1,3-diols and 2-aminoethanols.

A series of 2-substituted 2-aminopropane-1,3-diols was synthesized and evaluated for their lymphocyte-decreasing effect and immunosuppressive effect on rat skin allograft. A phenyl ring was introduced into the alkyl chain of the lead compound 3, which is an immunosuppressive agent structurally simplified from myriocin (1, ISP-I) via compound 2. The potency of the various compounds was dependent upon the position of the phenyl ring within the alkyl side chain. The most suitable length between the quaternary carbon atom and the phenyl ring was two carbon atoms. 2-Substituted 2-aminoethanols were successively synthesized and evaluated for their T-cell-decreasing effect and immunosuppressive effect using a popliteal lymph node gain assay in rats. The absolute configuration at the quaternary carbon affected the activity, and the (pro-S)-hydroxymethyl group of compound 6 was essential for potent immunosuppressive activity. Favorable substituents for the (pro-R)-hydroxymethyl group of 6 were hydroxyalkyl (hydroxyethyl and hydroxypropyl) or lower alkyl (methyl and ethyl) groups. 2-Amino-2-[2-(4-octylphenyl)ethyl]propane-1,3-diol hydrochloride (6, FTY720) was found to possess considerable activity and is expected to be useful as an immunosuppressive drug for organ transplantation.

Periodic fever compatible with familial Mediterranean fever.

A 55-year-old male presented with a recurrent fever of over 38 degrees C, occurring at irregular intervals 1-6 times a month with chest, back or abdominal pain. After admission to our hospital, we found the following characteristics: 1) the febrile attacks were accompanied by obvious inflammatory findings and pleuritis or peritonitis; 2) the patient's elder sister had a similar periodic fever; and 3) there were no apparent causative factors responsible for his symptoms. Therefore, we diagnosed this as a case compatible with familial Mediterranean fever. The febrile attacks have been completely suppressed by daily colchicine. This is the seventh case of familial Mediterranean fever reported in Japan.

[Asporogenic anaerobic empyema--clinical and bacteriological investigations of 31 patients with anaerobic empyema].

The author reviewed the records of 31 patients with asporogenic anaerobic empyema mostly seen in the wards of Internal Medicine, Juntendo University Hospital during the 27 years between 1961 and 1988, and obtained the following results. 1. There were 25 males and 8 females with an average age of 57.8 and 51.0 y/o (range, 25 to 79 y/o), respectively males more than forty years old occupied 74.2 percent of all cases. 28 patients (90%) had underlying conditions. 2. The cases of mixed infections with anaerobes and aerobes were only 22.6%. 3. The isolated bacteria were microaerophilic streptococcus, Bacteroides spp., Peptostreptococcus spp., Fusobacterium spp. etc. in this order. 4. There were no relationships between anaerobic infections with or without aerobes and putrid odor of pleural effusion. 5. Bacteroides spp. were isolated most in the group with putrid pleural effusion, however, they were not isolated in the group without putrid pleural effusion at all. This fact suggests that there is an intimate relationship between putrid odor and Bacteroides spp. 6. There was no deceased case which pleural effusion had been drained sufficiently with open or closed drainage. It suggests that sufficient drainage is the most important in therapeutic procedures of asporogenic anaerobic empyema.

[Eight cases of diphyllobothriasis].

Eight cases of diphyllobothriasis have been experienced in the Juntendo University Hospital. Seven of the 8 patients excreted tapeworm fragments. Eggs of Diphyllobothrium latum were found in the feces in 5 cases. One patient had a history of ingestion of raw trout (Sushi), and 2 raw salmon. One might have been infected in foreign countries, and 3 could not tell the source of infection. Bithoinol was administered orally to 7 patients. Four of the 7 excreted the worm and the scolex was recognized in three of the four. Neither recurrence nor abnormal findings have been recognized so far.

[Study on tissue transfer of ceftriaxone in the field of obstetrics and gynecology].

Ceftriaxone (Ro 13-9904, CTRX) was studied about the tissue transfer in the gyneco-obstetric field and the following results were obtained. The transfer of CTRX into the uterine tissues and adnexa was favorable following an intravenous injection with 1 g. The mean serum level 1 hour after administration was 123.3 micrograms/ml while the tissue level ranged from 26 to 48 micrograms/g. The level in the pelvic dead space exudate reached a peak 3 to 6 hours after administration and got higher than the serum level at 5 to 6 hours.

[Experience with cefuzonam in the field of obstetrics and gynecology].

Cefuzonam (CZON, L-105) was studied clinically in the field of obstetrics and gynecology, and the results obtained are summarized below: 1. The concentration of the drug in blood decreased rapidly after drip infusion was completed, and the concentration diminished after 1 hour to one tenth of the level detected at 5-9 minutes, and to an almost undetectable level after 3 hours. The rapid decrease of blood concentrations appears to indicate that the excretion of CZON was much faster than other antibiotics. No conclusive data were obtained on changes of concentrations with time in tissues due to the small number of cases analyzed and scattering of the data obtained. 2. The concentration in the pelvic dead space exudate reached a peak of 18.5 micrograms/ml at 30 minutes after the end of infusion and decreased to 0.092 microgram/ml after 10 hours. 3. CZON was administered to 5 cases of obstetric and gynecological infections. The efficacy was good in 4 cases and poor in 1 case. No side effects or laboratory test abnormalities were observed.

[Experience with ceftazidime in the field of obstetrics and gynecology].

Ceftazidime ( CAZ ), a new cephalosporin antibiotic, was studied for transference into tissues and clinical efficacy in the field of obstetrics and gynecology, and the following results were obtained: After one shot intravenous injection of CAZ 1 g, favourable transference of CAZ into uterine tissues was observed. While the mean serum level at 1 hour after the administration was 50.2 micrograms/ml, the levels in oviduct, ovary, endometrium, myometrium, cervix uteri and portio vaginalis were 25.9, 31.6, 24.9, 24.5, 34.2 micrograms/g and 40.6 micrograms/g, respectively. The half-life of CAZ in these tissues ranged from 1.16 to 1.65 hours while that in serum was 1.24 hours. The peak level in retroperitoneal space exudate (25.3 micrograms/ml) was obtained at 3 hours after one shot intravenous injection of CAZ 1 g. The level was still as high as 2.68 micrograms/ml even 12 hours after the administration. Out of 4 cases of obstetric and gynecological infections, 3 cases were assessable, CAZ was effective in these 3 assessable cases. Neither adverse effects nor abnormalities in laboratory findings due to CAZ were observed. Based on these results, CAZ is considered to be an highly effective antibiotic with good transference into uterine tissues and clinical efficacy in obstetric and gynecological infections.

[Tissue penetration and clinical experiences of aztreonam in obstetrics and gynecology].

Tissue penetration and clinical efficacy were studied on aztreonam (SQ 26,776, AZT) in obstetrics and gynecology with the following results. Number of cases was too small to sufficiently review the penetration into each uterine tissue, the ovary and the tube after the intravenous injection of AZT 1 g. Overall clinical effect for all the 6 cases reviewed was more than "good". Also, neither side effect nor abnormal laboratory findings were reported. From the above results, AZT was considered to be a highly useful antibiotic in obstetrics and gynecology.

[Experience with imipenem/cilastatin sodium in the field of obstetrics and gynecology].

Fundamental and clinical studies on a new carbapenem antibiotic, imipenem/cilastatin sodium (MK-0787/MK-0791), were carried out in the field of obstetrics and gynecology. The following results were obtained. The concentration of MK-0787 in uterine tissue was 3.5 approximately 8.2 micrograms/g at about 30 minutes after an administration of 0.5 g/0.5 g of MK-0787/MK-0791 by a 30-minute intravenous drip infusion. The concentration decreased to less than 0.5 microgram/g by approximately 3 hours. The level of MK-0787 in the pelvic dead space exudate reached a peak of 24.0 +/- 4.4 micrograms/ml at 1 hour after an administration of MK-0787/MK-0791 0.5 g/0.5 g and was higher than the plasma level at 1 hour. The level in the pelvic dead space exudate was 2.0 +/- 0.8 microgram/ml at about 6 hours. The MK-0787/MK-0791 was administered to 4 patients with gynecologic infections (2 patients with pelvic peritonitis, 1 patient with salpingitis, 1 patient with a vulvar abscess). The clinical efficacy was good in all 4 patients. Neither adverse effects nor abnormal laboratory findings were observed. It appears that MK-0787/MK-0791 is a safe and useful antibiotic for the treatment of obstetrical and gynecological infections.

[Experience with sulbactam/cefoperazone in the field of obstetrics and gynecology].

Sulbactam/cefoperazone (SBT/CPZ) was studied for clinical efficacy in the field of obstetrics and gynecology, and following results were obtained: In the treatment of 6 cases of gynecological infection, the clinical efficacy of SBT/CPZ was assessed as excellent in 1 case and effective in 5 cases. Neither adverse effects nor abnormalities in laboratory findings due to SBT/CPZ were observed. Based on these results, SBT/CPZ is considered to be a highly effective antibiotic with clinical efficacy in obstetric and gynecological infections in the daily dosage of 2 g given in two divided doses.

[Study on antibiotics susceptibility and mechanism of carbapenem-resistance in clinical isolates of Pseudomonas aeruginosa].

The susceptibility of 260 strains of Pseudomonas aeruginosa to several antibiotics and the mechanism of resistance to carbapenems were investigated. The number of strains of P. aeruginosa moderately resistant or resistant to ofloxacin, ceftazidime and imipenem (IPM) were 76 (29.2%), 31 (11.9%) and 30 (11.5%), respectively. There was no clear relationship between the drug resistance of P. aeruginosa and serum type. Fourteen strains (46.6%) out of 30 IPM-resistant strains were susceptible to meropenem (MEPM). Twenty seven (90.0%) IPM-resistant strains showed cross resistant to panipenem (PAPM), and 12 strains (44.4%) out of the 27 strains showed high susceptibility to MEPM. P. aeruginosa becomes resistant to IPM and PAPM only by the decrease in the outer membrane permeability of these carbapenems. In contrast, P. aeruginosa becomes equally resistant to MEPM by concurrent occurrence of the increase in the efflux of the antibiotics and the decrease in the outer membrane permeability of the antibiotics. The possibility that both mechanisms are taken place concurrently in P. aeruginosa is considered to be low, and it was also supported by the results of the present study.

[Fluconazole treatment of systemic mycoses].

Efficacies of fluconazole, a new triazole antifungal agent, were evaluated in 11 cases of systemic mycoses (1 case each of candiduria, pulmonary cryptococcosis, pulmonary aspergillosis, pulmonary penicilliosis and suspected fungal pulmonary infection, and 3 cases each of candidemia and Candida endophthalmitis). The clinical efficacies were excellent or good in 8 out of 9 cases and poor in 1. Side effects observed were mild with 1 incident each of gastrointestinal symptom and reversible leukopenia. This drug appears to be promising in treatment of systemic mycoses.

[Results of antimicrobial susceptibilities of strains clinically isolated at 8 institutions in Hiroshima City to major oral antimicrobial drugs, mainly new quinolone drugs. Hiroshima Levofloxacin Susceptibility Surveillance Group].

To evaluate the resistance for major oral antimicrobial agents, mainly new quinolones, we carried out a drug susceptibility surveillance of 3,050 strains of 11 microbial species clinically isolated at 8 institutions such as general hospitals and examination centers in Hiroshima city. 10 antimicrobial agents were used: 3 new quinolone drugs, 5 beta-lactam drugs, minocycline and clarithromycin. Among Gram-positive bacteria, methicillin resistant Staphylococcus aureus (MRSA) and Enterococcus faecalis showed low susceptibility to the new quinolone drugs, while methicillin susceptible Staphylococcus aureus (MSSA) and Streptococcus pneumoniae were highly sensitive to these drugs. Among Gram-negative bacteria, Pseudomonas aeruginosa showed high resistance for the new quinolone drugs, but enteric bacteria and Haemophilus influenzae did not show marked resistance, maintaining almost good sensitivity to these drugs. To reduce the appearance of resistant bacteria, appropriate antimicrobial agents should be selected. Drug susceptibility surveillance in the community will be also important in the future.