Networking possibilities for waste recycling in Miyagi prefecture, Japan.

Successful case studies for waste recycling in Japan have not been evaluated. The evaluation of economic efficiency and environmental effects were lacking at the time the actual network was established. A waste/resource input/output (I/O) coincidence retrieval system called ZENESYS was developed to examine the usefulness of a waste-exchange network in a nonmanufacturing district. We analyzed data from the Miyagi prefecture, a region without heavy industry. The data were collected from 77 companies using a questionnaire and interviews. A total of 33 possible waste exchange links arose after analysis using ZENESYS. However, these were frail networks that relied heavily on the construction industry. Two waste recycling technologies were selected from the ZENESYS database: reclaiming fuel from waste plastic and making construction materials from bottom ash. Evaluation of the environmental effects and economics of these two technologies showed they were both suitable for the environment, but no profit was made from reclaiming fuel from waste plastics. We concluded that in an area with no heavy industry, it may be difficult to adopt recycling technologies that have high environmental and economic performance. Materials are difficult to circulate among manufacturing industries even if a waste-exchange network exists, and resources are consumed during transportation and recycling.

Clinical and bacteriological evaluation of Branhamella catarrhalis in respiratory infections.

The clinical significance of Branhamella catarrhalis in respiratory infections is evaluated. 175 strains were isolated, mainly from the sputum, in 71 patients with respiratory infections. B. catarrhalis was most frequently isolated in mixed infections with Haemophilus influenzae (38.3%), H. influenzae plus Streptococcus pneumoniae (10.3%) or S. pneumoniae (9.7%). The rate of isolation of B. catarrhalis alone was as low as 5.1% and from mixed infections with Pseudomonas aeruginosa, Escherichia coli, and Enterobacter and/or Klebsiella species it was 36.6%. More than 10(7) cfu/ml of B. catarrhalis were isolated from 71.4% of cases. In 29 cases the organism was determined to be causative according to our criteria, most often in secondary infections in patients with complicated pneumoconiosis, chronic bronchitis and bronchiectasis. 29 of 47 strains (61.7%) produced beta-lactamase of the penicillinase type. Against these strains, penicillin antibiotics and first and second generation cephalosporin antibiotics (except cefroxadine) showed weak activity compared with their activity against non-beta-lactamase-producing strains. The third generation cephalosporins showed a uniform spectrum of activity against both groups of organisms.

Human bone-cell proliferation in vitro decreases with human donor age.

We have measured the effect of age on the rate of outgrowth of cells from human trabecular bone, using a quantitative dye-binding technique. In cultures supplemented with autologous serum, there were significant negative correlations between the age of the donor and both the proportion of fragments from which outgrowths were seen after 7 days (r = -0.70; p < 0.001) and the total cell number after 14 days (r = -0.78; p < 0.005). The autologous serum supported greater cell proliferation than did fetal calf serum in all subjects regardless of age. Taken with previous observations that the in vitro growth kinetics of passaged human bone cells are independent of age, our results show that the number of proliferative precursor cells on trabecular-bone surfaces is higher in younger subjects. There is a marked decrease in precursor numbers in the second and third decades of life to a level which is maintained into old age.

Revised arthrographic index of deformity for Perthes' disease.

We report a new arthrographic index to quantitate the loss of sphericity of the femoral head during early Perthes' disease. The technique has been applied to 272 arthrograms of 131 normal and 141 affected hips. It measures marginal or segmental collapse as well as central collapse of the epiphysis, thus providing a more accurate assessment of deformity in 57.4% of anteroposterior and 46.8% of lateral radiographs as compared with the previous standard measurement (caput index). The measurement principle applies equally to other recent radiological developments such as magnetic resonance imaging.

Quantitative correlation between the initial and final femoral head deformity in Perthes' disease.

A review at maturity of 42 patients with Perthes' disease has allowed a correlation to be made between femoral head deformity during the initial phases of fragmentation and reparation, as quantified arthrographically, with the final shape and size of the femoral head measured on plain radiographs. Cases with loss of sphericity or coxa magna at maturity had significantly lower arthrographic indexes of deformity (p = 0.001 and p = 0.005 respectively), regardless of the age at presentation. All were treated uniformly by containment in recumbency and a daily exercise program.

[Serum levels of healthy adult humans and changes of IgG subclass levels between infected and convalescent phase in respiratory infections].

We measured serum levels of IgG subclasses in 100 healthy adult humans and 64 patients with respiratory infections by utilizing the enzyme linked immunosorbent assay (ELISA). The patients were composed of 18 patients with acute bacterial pneumonia and bacterial infection of 9 patients with pulmonary emphysema, 27 patients with chronic bronchitis and 10 patients with bronchiectasis. In healthy adults, serum levels of IgG1 subclass decreased in proportion of age increase. Serum levels of IgG2 rose after 30 years of age. Serum levels of IgG3 and IgG4 showed no remarkable changes by age. In patients with respiratory infectious disease, serum levels of IgG1, IgG2 and IgG4 decreased significantly but IgG3 increased significantly. We also measured serum levels of IgG subclasses in 10 patients with acute bacterial pneumonia and bacterial infection of 5 patients with pulmonary emphysema, 12 patients with chronic bronchitis and 4 patients with bronchiectasis at both infected and convalescent phases. The serum levels of IgG2 in patients with pneumonia and pulmonary emphysema at convalescent phase were significantly lower than those in the patients of infected phase. Other subclasses showed no significant change. We summarized that IgG2 was consumed at the infected phase by protecting against bacterial infections. IgG2 probably has an important role of protecting against bacterial respiratory infections among all IgG subclasses.

[Mechanism of acquired resistance against Legionella--blastogenic responses of murine spleen lymphoid cells following the stimulation with Legionella antigens].

We have tried to characterize the blastogenic responses of murine spleen lymphoid cells from BALB/c mice immunized with Legionella pneumophila serogroup (SG) 1 (Philadelphia 1 strain) and non-treated mice. Lymphoid cells from immunized mice showed stronger blastogenic responses following stimulation with concanavalin A or formalin-treated L. pneumophila SG1 whole cell antigen than those showed by lymphoid cells from non-treated mice. These cells from immunized mice also responded strongly when stimulated in vitro with other SGs of L. pneumophila, while these responded weakly when stimulated with other species of Legionella. Serum antibody titers of immunized mice against each SG of L. pneumophila were examined and the cross reactions were also recognized. However, the relatedness of serum antibody titers and the blastogenic responses against each serogroup of L. pneumophila was small. The epitopes recognized by the cellular immunity might be different in part from those recognized by serum antibodies, and investigations should be made on what the cellular immunity recognizes and how it works.

[A comparative study of cefepime for bacterial pneumonia].

The efficacy, safety and usefulness of cefepime (CFPM), a new cephem antibiotic, in bacterial pneumonia, were evaluated in a comparative study against ceftazidime (CAZ). Each drug was administered by intravenous drip infusion at a dose of 1.0 g (nominal potency) twice daily for 14 days, and the following results were obtained. 1. A total of 183 cases were enrolled in this study. Efficacy rates ("good" or better responses) as evaluated by the subcommittee were 90.3% (65/72) in the CFPM group and 94.0% (63/67) in the CAZ group, with no significant difference between the 2 groups. 2. Efficacy rates ("good" or better responses), as evaluated by attending physicians, (in the same bacterial pneumonia cases which were subjected to evaluation by the subcommittee) were 87.5% (63/72) in the CFPM group and 89.6% (60/67) in the CAZ group, with no significant difference between the 2 groups. 3. Bacteriologically, eradication rates were 96.9% (31/32) in the CFPM group and 96.7% (29/30) in the CAZ group with no significant difference between the 2 groups. 4. The incidence of side effects was 5.9% (5/85) in the CFPM group and 4.8% (4/84) in the CAZ group, with no significant difference between the 2 groups. No significant difference was also found between the 2 groups in the incidence of abnormal laboratory findings; 28.4% (23/81) of the case in the CFPM group and 34.1% (28/82) in the CAZ group. 5. As for overall usefulness of the drug in bacterial pneumonia cases, utility rates ("useful" or better evaluations) as evaluated by the subcommittee were 88.9% (64/72) in the CFPM group and 92.5% (62/67) in the CAZ group. The rates as evaluated by investigators (in cases judged as evaluable by the subcommittee) were 87.5% (63/72) and 85.1% (57/67), respectively. There were no significant differences between the 2 groups. These results indicated that CFPM is very useful for the treatment of bacterial pneumonia.

[Dose finding study of cefepime for chronic respiratory infections].

In order to determine the optimal dose of cefepime (CFPM) for respiratory tract infections, a dose finding study was conducted in patients with chronic respiratory tract infections, and the clinical properties of the drugs were compared with those of ceftazidime (CAZ). Each drug was administered by intravenous drip infusion at the dose of 2 g/day of CFPM, 4 g/day of CFPM or 2 g/day of CAZ for 14 days. 1. The overall efficacy rates evaluated by the committee were 82.6% (19/23) for the CFPM 2 g/day group, 85.0% (17/20) for the 4 g/day group and 79.3% (23/29) for the CAZ 2 g/day group, with no statistically significant difference among the three groups. 2. The overall efficacy rates evaluated by the attending physicians were 91.3% (21/23) for the CFPM 2 g/day group, 78.9% (15/19) for the CFPM 4 g/day group and 75.9% (22/29) for the CAZ 2 g/day group, with no significant difference among the three groups. 3. Bacteriological eradication rates were 88.2% (15/17) for the CFPM 2 g/day group, 68.8% (11/16) for the CFPM 4 g/day group and 63.2% (12/19) for the CAZ 2 g/day group, with no statistically significant difference among the three groups. 4. The incidences of adverse reactions were 3.8% (1/26) for the CFPM 2 g/day group, 9.1% (2/22) for the CFPM 4 g/day group and 3.4% (1/29) for the CAZ 2 g/day group, with no significant difference among the three groups. The incidences of abnormal laboratory findings were 37.5% (9/24) for the CFPM 2 g/day group, 15.0% (3/20) for the CFPM 4 g/day group and 3.4% (1/29) for the CAZ 2 g/day group. There was a significant difference among the three groups. 5. Utility rates assessed by the committee were 81.8% (18/22) for the CFPM 2 g/day group, 76.2% (16/21) for the CFPM 4 g/day group and 75.9% (22/29) for the CAZ 2 g/day group. Utility rates assessed by attending physicians were 90.9% (20/22), 78.9% (15/19) and 72.4% (21/29), respectively. There was no significant difference among the three groups. From the above results, it is concluded that the optimal dosage of CFPM is 2 g/day for chronic respiratory tract infections.

[A comparative study of cefepime for chronic respiratory tract infections].

The clinical efficacy, safety and usefulness of Cefepime (CFPM), a new cephem antibiotics, in chronic respiratory infections were evaluated in a comparative study against Ceftazidime (CAZ). Each drug was administered by intravenous drip infusion at a dose of 1.0 g (nominal potency), twice daily for 14 days, and the following results were obtained: 1. A total of 170 cases were enrolled in this study. Efficacy rates ("good" or better responses) as evaluated by the subcommittee were 86.2% (56/65) in the CFPM group and 84.5% (60/71) in the CAZ group, with no significant difference between the two groups. 2. Efficacy rates ("good" or better responses) as evaluated by attending physicians were 83.3% (55/66) in the CFPM group and 84.5% (60/71) in the CAZ group with no significant difference between the two groups. 3. Bacteriologically, eradication rates were 83.3% (40/48) in the CFPM group and 88.2% (45/51) in the CAZ group, with no significant difference between the two groups. 4. Side effects occurred in none of the patients in the CAZ group and in 4 of the 66 patients in the CFPM group. There was a significant difference between the two groups (Fisher's test p = 0.0489). The incidence of abnormal laboratory findings were 17.6% (12/68) in the CFPM group and 21.1% (16/76) in the CAZ group. There was no significant difference between the two groups. 5. The utility rates evaluated by the subcommittee were 81.8% (54/66) in the CFPM group and 84.5% (60/71) in the CAZ group with no significant difference between the two groups. Only in the incidence of side effects, there was a significant difference between the two groups (Fisher's test p = 0.0489), but there was no significant difference in other items of efficacy, safety and usefulness between the two groups. These results indicate that CFPM is useful for the treatment of chronic respiratory tract infections.

[A case of Pneumocystis carinii pneumonia with hyperinfection of Strongyloides stercoralis complicated with smoldering adult T-cell leukemia].

A 43-year-old woman visited a clinic for an attack of bronchial asthma which she had been suffering since her childhood. She was treated with prednisolone which was used for the first time. Two weeks later, she had a fever and her chest X-ray showed diffuse reticulonodular shadows on both middle to lower lung fields. In spite of the use of antibacterial drugs, her symptoms such as cough, dyspnea, malaise and fever increased. It was revealed that she had Stronglyoides sterocoralis in the stool. She was referred to our department for treatment and further examination. Transbronchial lung biopsy (TBLB) was performed, and cyst of Pneumocystis carinii were histologically detected in the lung specimen. Anti-human T-lymphotropic virus type 1 (HTLV-1) antibody in the serum was 1:4,096 less than. Typical adult T-cell leukemia (ATL) cells were also observed in the peripheral blood smear at the rate of 10-15% of leukocytes. The parasite was observed in the sputum too. We diagnosed her as having Pneumocystis carinii pneumonia with hyperinfection of Strongyloides stercoralis complicated with smoldering ATL, and the pneumonia might have been induced by steroid therapy (total doses of 500 mg, for 25 days). After sulfamethoxazole-trimethoprim (ST compound) was used for the Pneumocystis carinii pneumonia, her symptoms markedly subsided, and the chest X-ray findings turned to normal by 45 days after the treatment. Thiabendazole was initially administered for the Strongyloidiasis and the parasite temporarily disappeared from both sputum and stool. Then pyrvinium pamoate and mebendazole were used, but the parasite could not be completely eradicated in the stool. We did not treat the smoldering ATL because there were no symptoms. We have been looking after her as an outpatient now, and she has neither symptoms nor signs.

[A retrospective study of hospitalized patients with fever of unknown origin (FUO) past six years].

We analysed retrospectively 48 hospitalized patients with fever of unknown origin (FUO) from 1982 through 1988. The criteria of FUO were (1) temperature of more than 38.3 degrees C documented on several occasions (2) overall duration of illness more than three weeks, (3) uncertain diagnosis till one week after hospitalization. Of this group of FUO, 25 patients (52.1%) were found to have infections, 8 patients (16.7%) had collagen disorders, 7 patients (14.6%) had neoplastic disorders, 3 patients (6.3%) were crohn disease and 5 patients (10.4%) were undiagnosed. Among infectious diseases, chronic tonsillitis was the most frequent (5 patients: 20%) and they were diagnosed by the provocative examination. Non bacterial meningitis and cervical lymphadenitis were diagnosed in all 3 patients (12% in all), Adult Still's disease was found in 3 patients (37.5%) and systemic lupus erythematosus (SLE) in 2 patients (25%) in collagen disease. Immunoblastic lymphadenopathy was diagnosed in 3 patients (42.9%) of malignant diseases. Three cases of Crohn disease were revealed in all the patients of the miscellaneous group. Duration of fever was relatively short in infection diseases compared to malignant and Crohn diseases. The most common laboratory abnormality is an elevated erythrocyte sedimentation rate (89.6%). As the final diagnosis of FUO are changing with the development of diagnostic techniques, a new criteria of FUO is necessary.

[Clinical evaluation of cefpodoxime in respiratory tract infections].

Cefpodoxime (CPDX-PR) was evaluated clinically in respiratory tract infections. The results obtained are summarized as follows; 1. The total number of the patients who were treated with CPDX-PR was 61, out of whom 53 cases were evaluated for clinical efficacy and 55 cases were investigated for the safety of the drug. CPDX-PR was given orally twice a day at 100-200 mg for 5-21 days. 2. Clinical efficacies were excellent in 9 patients, good in 36, fair in 4 and poor in 4. The overall clinical efficacy was 84.9%. In particular, CPDX-PR showed satisfactory efficacy for acute respiratory infections and mild chronic respiratory infections, with efficacy rates of 88.6% (31/35) and 100% (8/8), respectively. 3. No adverse reactions was observed, but slight and transient elevation of BUN was noted. In conclusion, it has been confirmed that CPDX-PR is an excellent and safe drug for the treatment of the respiratory tract infections.

[Clinical studies of ofloxacin 300 mg once a day administration in chronic respiratory tract infections].

Forty patients with chronic respiratory infections were randomly assigned to 2 groups to compare the effect of once daily administration of 300 mg each and 3 times daily administration of 600 mg each of ofloxacin (OFLX). Twenty patients were administered with 300 mg OFLX a day and 18 cases received 600 mg. The number of underlying diseases in the 300 mg group was greater than that in the 600 mg group. The ratios of general amelioration of clinical symptoms were 80.0% in the 300 mg group and 88.9% in the 600 mg group. For bacteriological effects, the eradication rate was 80.0% in the 300 mg group and it was 84.6% in the 600 mg. The incidence of side effects in the 300 mg group was 0% and that of the 600 mg group was 5.6% (1 patient) but the symptom was mild. The incidence of abnormal laboratory test results was 15.0% in the 300 mg group and it was 11.2% in the 600 mg group, but all of these abnormalities were slight and transient. The safety rates in the 300 mg and the 600 mg groups were 95.0% and 94.4%, respectively. Efficacy rates in the 300 mg and the 600 mg groups were 80.0% and 88.9%, respectively. There was no statistically significant difference in all the results between the 2 treatment groups, and the both treatments were highly effective. From the above results, we consider that once daily administration of 300 mg is a useful therapy in respiratory tract infections.

[Clinical evaluation of imipenem/cilastatin sodium in the internal medicine].

Fifty-two patients with moderate or severe infections associated with internal medicine were treated with imipenem/cilastatin sodium (IPM/CS) and the efficacy and the safety of this drug were evaluated. There were 20 patients with pneumonia, 10 with acute exacerbation of chronic respiratory tract infections, 9 with sepsis, 2 with pyothorax, 3 with intraabdominal infection, 2 with urinary tract infection, 1 with pulmonary abscess, 1 with infective endocarditis, 4 with fever of unknown origin. Forty-four patients were evaluable for the efficacy. Clinical efficacies were excellent in 12 patients, good in 26, fair in 3 and poor in 3. The overall clinical efficacy was 86.4%. The efficacy rate was 63.6% in patients previously treated and 93.9% in patients previously untreated with other antibiotics. Bacteriologically, Staphylococcus aureus (8 strains), Streptococcus pneumoniae (5), Streptococcus pyogenes (1), other Gram-positive coccus (1), Klebsiella pneumoniae (8), Haemophilus influenzae (4), Pseudomonas aeruginosa (3), Serratia marcescens (3), Escherichia coli (3), Branhamella catarrhalis (1), Citrobacter freundii (1), Klebsiella oxytoca (1), Enterobacter sp. (1), and Peptostreptococcus sp. (1) were eradicated. P. aeruginosa (3) and Acinetobacter sp. (1) decreased. S. aureus (1), S. epidermidis (1), P. aeruginosa (5), and S. marcescens (1) persisted or appeared. The eradication rate was 83.7%. Six patients showed adverse reactions including general fatigue 1, epigastralgia 1, eruption 1, eosinophilia 1 and elevation of S-GOT 2. But all of the adverse reactions were mild or slight, and transient. These findings indicate that IPM/CS is a useful and safe drug against bacterial infections in internal medicine.

[Clinical evaluation of astromicin by intravenous drip infusion. Report I. Bacterial infections in the field of internal medicine].

Intravenous drip infusion of a new aminoglycoside agent, astromicin (ASTM), was used against various infections in the field of internal medicine, and its clinical efficacy and safety were studied. Clinical effects were evaluated in 105 among 111 patients administered with ASTM. Almost all the patients were given 200 mg of ASTM twice a day by intravenous drip infusion for 60 minutes. Among 105 cases, clinical effects of ASTM were excellent in 15, good in 56, fair in 10 and poor in 24. The number of cases who were judged as excellent or good was 71, and the efficacy rate was 67.6%. Efficacy rates classified by diseases were as follows; 80% (4/5 cases) in sepsis, 55.6% (5/9 cases) in urinary tract infections, and 68.1 (62/91 cases) in respiratory tract infections (RTI). In 91 cases with RTI, clinical effects of ASTM were excellent in 14, good in 48, fair in 9 and poor in 20. The efficacy rates classified by diseases of RTI were 77.3% (34/44 cases) in pulmonary parenchyma infection and 59.6% (28/47 cases) in chronic RTI and others. As subjective and objective side effects, tinnitus and malaise were observed in 5 (4.5%) of 110 patients evaluated for side effects. But, either symptom was mild and disappeared after the end or withdrawal of administration. Slight elevations of S-GPT, BUN and others were observed in 7 cases (6.4%) as abnormal laboratory test values. Safety and efficacy of intravenous drip infusion of ASTM were confirmed.

[Clinical evaluation of the TMS-19-Q.GC tablet on superficial suppurative disease. A comparative double blind study with midecamycin].

Clinical efficacy and safety of TMS-19-Q.GC tablet (TMS), a new macrolide preparation, were compared with those of midecamycin (MDM) in superficial suppurative skin and soft tissue infections. The study was made by the double-blind controlled trial at the dosage of daily 600 mg in TMS group and 1,200 mg in MDM group. Total 218 cases (106 in TMS, 112 in MDM) were analyzed and the final global improvement rating were 82.1% in TMS and 83.9% in MDM. The clinical effectiveness of TMS was favorable and significantly different from MDM in the aged patients (greater than or equal to 60 years old) and the patients infected with susceptible strains (MIC less than or equal to 3.13) of Staphylococcus aureus. TMS is prepared with a specific formulation to make the absorption easier in the patients with lower acidity of gastric juice, and the favorable effect of TMS is considered to be a contribution of the devise in older patients. Slight adverse reactions were observed at 5.0% (6 cases) in TMS and 2.4% (3 cases) in MDM. In conclusion, TMS at the daily half dose of MDM is as effective as MDM in superficial suppurative skin and soft tissue infections.

[Clinical studies on TMS-19-Q.O tablet in respiratory tract infection].

A new macrolide antibiotic preparation, TMS-19-Q.O tablet, was used to investigate the efficacy in the treatment of patients with respiratory tract infection, and the results obtained were as follows: Three hundred and seven cases were included in this report, and overall efficacy rate was 76.2%. Especially high clinical effect (86.0%) was observed in the treatment of patients with pneumonia including mycoplasmal pneumonia. Bacteriological effect was 87.5% in 51 cases identified as single infection of Gram-positive cocci and was 48.0% in 34 cases Gram-negative rods infection. Side effects were observed in 11 cases (3.50%): gastrointestinal disorder in 8, eruption in 2 and other in 1. Abnormality in laboratory tests was observed in 23 cases, hepatic disorder in 13, renal disorder in 3 and other laboratory tests in 7. It was considered from the results of clinical and bacteriological efficacy in different dose study that dose of TMS-19-Q should be 600 mg.

[The concomitant effect of a newly developed gamma-globulin preparation (SM-4300) with some antibiotics on severe bacterial infections].

Twenty-six patients with bacterial infections, mainly respiratory infections, were treated with newly developed gamma-globulin preparation (SM-4300), as a combination therapy with some antibiotics. The result was as follows. Clinical effects of 18 cases evaluated were excellent in 1 case (5.6%), good in 10 (55.6%), fair in 4 (22.2%) and poor in 3 (16.7%). No remarkable adverse reactions and abnormal value in laboratory data due to administration of SM-4300 were observed. Significant changes of complement system before and after administration of SM-4300 were not observed. It was considered that SM-4300 was effective as a combination therapy with some antibiotics for the treatment of severe or refractory bacterial infections.