[The effect of tonsillectomy on the level of circulating immune complexes and urine changes in patients with glomerulonephritis]. / Wplyw tonsylektomii na poziom krazacych kompleksów immunologicznych i zmiany w moczu u chorych na klebuszkowe zapalenie nerek.

The influence of tonsillectomy on circulating immune complexes (C.I.C.) level, proteinuria and erythrocyturia was studied in 42 patients with chronic tonsillitis (Ch.T.) and urine abnormalities. The level of C.I.C. was examined by two methods: the 3.5% polyethyleneglycol (PEG) precipitation method and the 125I-C1q binding method. After tonsillectomy, bacteriological analysis of removes facial tonsilla was performed in 7 patients and morphological analysis in 11. Renal biopsy was done in 28 patients. The control group was consisted of 18 patients with Ch.T. without urine abnormalities. The presence of C.I.C. was established in 48% of patients with urine abnormalities using PEG method and in 33% with 125I-C1q binding method. Mean values of C.I.C. in patients with proteinuria or erythrocyturia were statistically higher than in the control group. After tonsillectomy, transitory increase of C.I.C. level was observed in 60% of patients, accompanied by augmentation in urine changes, especially proteinuria. During one year of observation, significant decrease in C.I.C. levels detected by PEG method, as well as in proteinuria and in erythrocyturia was found. In 10 patients urine abnormalities disappeared. No differences between both groups of patients were found in the results of bacteriological and morphological studies of removed tonsilla. However, the normalisation of urine changes was noticed in patients without hypertension and in whom renal disease did not exceed two years. Renal histology revealed mesangocapillary proliferative Gn in 14, mesangial proliferative Gn in 11, and focal/segmental glomerulosclerosis in 3 patients. In one patient with mesangial proliferative Gn complete retreat of urine changes was observed. We suggest that the presence of Ch.T. influences on the C.I.C. detectability in patients with chronic glomerulonephritis. The tonsillectomy can lead do the decrease of C.I.C. levels, as well as to the decrease of proteinuria and/or erythrocyturia. Serum C.I.C. examination seems to be helpful in qualifying patients with Ch.T. for tonsillectomy, in immunological monitoring after the operation and in later prognosis in case of chronic glomerulonephritis.

Compliance with antibiotic therapy: a comparison of deuterium oxide tracer, urine bioassay, bottle weights, and parental reports.

OBJECTIVE: To compare three traditional measures of compliance with antibiotic therapy (parent report diary, preregimen and postregimen bottle-weight difference, and urine bioassay for antibiotic activity), with a deuterium oxide tracer measure of compliance. METHODS: Clinical trial in which all four compliance measures were used for subjects participating in a comparison of the efficacy of azithromycin and penicillin in treating group A beta-hemolytic streptococcal infection. Subjects were 41 children, aged 3 to 15 years (average age, 7.9 years), in a suburban pediatric private practice, who had positive rapid streptococcal antigen test results. RESULTS: Of the 41 subjects, 20 children were randomly assigned to receive azithromycin and 21 to receive penicillin. Compliance was uniformly high by all four measures. Parent diaries indicated that all doses were administered. Urine bioassays were obtained for 40 subjects, and all showed antibiotic activity. Differences in bottle weights were obtained for 27 subjects and showed that 142% of the prescribed medication was missing from the bottles at the end of the regimen. The deuterium oxide measure was obtained for 40 subjects and showed that 107% of the prescribed azithromycin and 92% of the prescribed penicillin were ingested. The correlation coefficient between measured and expected deuterium enrichment was 0.89. There was no significant correlation between the bottle-weight measure and the deuterium oxide tracer. CONCLUSIONS: The bottle-weight measure overestimates compliance; the deuterium oxide tracer is feasible for use in an office setting and produces a high correlation between the expected urinary enrichment and the measured enrichment. Increased use of this quantitative and direct measure would improve the accuracy of compliance measurement in trials of pediatric liquid medications.

[Overall clinical evaluation of cefpodoxime proxetil against infections in pediatric fields].

Dry syrup and tablet of newly developed cefpodoxime proxetil (CS-807, CPDX-PR) was investigated in the departments of pediatrics of 17 institutes and their related hospitals. 1. Pharmacokinetics of CPDX-PR in pediatrics were investigated. Peak blood levels of CPDX at dose levels of 3 mg/kg and 6 mg/kg were 2.24 +/- 0.21 and 4.68 +/- 0.54 micrograms/ml, respectively, in fasting and 1.65 +/- 0.07 and 3.71 +/- 0.41 micrograms/ml, respectively, after meal. Urinary recovery rates in 6 hours were 31.2 +/- 2.2% of dose in average. 2. Clinical efficacies of CPDX-PR on various infectious diseases were studied in 748 cases. Clinical efficacy rate in 499 cases with causative bacteria isolated was 94.6%: efficacy rates for individual infections were 96.8% (120/124) for tonsillitis, 96.0% (96/100) for urinary tract infection, 93.5% (58/62) for pneumonia, 92.4% (61/66) for impetigo, 100% (32/32) for scarler fever and 93.2% for pharyngitis or laryngitis. Bacteriological eradication rate for Gram-positive organisms was 91.0% (244/268); and for Gram-negative organisms, 89.7% (210/234). The clinical efficacy rate for cases which were non-responsive to previous antibiotic therapy was 88.1% (74/84). 3. Side effects and clinical laboratory findings were investigated in 779 cases. Two each of vomiting, loose stool and rash, 10 of diarrhea and 1 of diarrhea associated with candidiasis were reported, but no serious side effects were noted. There was no serious laboratory test abnormality except slight elevations of eosinophile, platelet, transaminase or prolongation of prothrombin time, totalling 34 occurrences.