[New antimicrobial agent series XXXVII: potassium clavulanate/Ticarcillin sodium].
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Biomedical subjects
Publications and source records attributed to I Fujimori.
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Patients with legal communicable diseases admitted to Kawasaki Municipal Hospital between 1981 and 1986 were studied. Ages of patients were over 15 year-old. During this period 115 patients were admitted. Out of these patients 84 had Shigellosis, and 9 had amebiasis. Out of 20 Salmonellosis, 18 were due to Salmonella typhi and 2 were due to Salmonella paratyphi-A, respectively. Two were admitted because of Cholera. Out of the patients with Shigellosis, 27 were domestic and 57 were foreign infections, respectively. Most of patients were infected in South Asia or India and its neighbour countries. Shigella flexneri were mainly isolated from these patients. On the contrary, Shigella sonnei was the main causative organism of patients infected in Japan. Three amebiasis patients had liver abscesses with peritonitis, and 1 patient was a bisexual person. Out of Salmonellosis, 11 were patients with typhoid fever and 9 were carrier. One Cholera patient with severe diarrhea and acute renal failure was successfully treated and already reported elsewhere.
Septicemia encountered at Kawasaki Municipal Hospital between 1985 and 1986 were studied clinically. Forty six patients had monomicrobial and 5 has polymicrobial infections, respectively. Out of these 46 patients with septicemia, 17 were due to Escherichia coli, 7 were due to Klebsiella pneumoniae and 4 were due to Staphylococcus aureus. Ten patients had hepatobiliary, 7 had hematological, 7 had malignant diseases as underlying diseases, respectively. Out of 10 patients complicated with septic shock, 7 died. Twenty three patients were community acquired infections. The age of most of the patients were over 50. The mortality rate of more than 65-year-old patients were higher than that of other patients. Our of 5 patients with septicemia due to polymicrobial infection, only 1 patient with erythroleukemia died. Fifty patients were treated mainly with beta-lactam antibiotics such as piperacillin or cefmetazole alone or in combination with aminoglycosides and so on. Three patients with infective endocarditis were encountered during this period. Two were due to alpha-streptococcus and 1 was due to Enterococcus. A 41-year-old patient with mitral valve insufficiency and metastatic gastric carcinoma to the bone marrow were complicated with disseminated intravascular coagulation. This patient, however, was successfully treated with a daily dose of 24 mega units of benzylpenicillin, and was given gabexate mesilate, concomitantly.
Several investigations have been reported on the interactive relation between the normal flora and the pathogenic micro-organisms in the human upper respiratory tracts (Thompson, Sanders, etc). It has also been known that some alpha-streptococci have inhibitory effect on the growth of group A beta-hemolytic streptococci. A study upon the role of alpha-streptococci in the throat (tonsil and pharynx) was performed using 73 culture specimens (throat swabs) obtained from 42 patients. Forty-four specimens were taken from the patients who received tonsillectomy, pre- and postoperatively, and 29 were from the patients who did not receive the operation. In the group of patients who received tonsillectomy, alpha-streptococci with inhibitory effect on the growth of group A beta-streptococci were detected less frequently preoperatively, when compared with the patients without tonsillectomy. On the other hand, postoperatively, marked increase of alpha-streptococci of these types was found in the normal flora of the throat. However, further detailed study on this subject is necessary because of the exceptional results in our observations.
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We have carried out randomized 12-week multicentre study to compare the effects of prazosin and propranolol on blood pressure and serum lipids in 70 patients with essential hypertension after a 4 week minimum period of treatment with thiazide diuretics. After 12 weeks treatment with prazosin (n = 40, 1.5-12.0 mg per day) or propranolol (n = 30, 30-120 mg per day) with diuretics there was a significant blood pressure reduction from 165.1/97.9 mmHg to 151.2/90.6 mmHg and from 167/96.5 mmHg to 153/91.9 mmHg, respectively. In the 12th week a significant decrease was noted in triglyceride and in low-density lipoprotein cholesterol (LDL + VLDL-C), but no significant effects were seen in high-density lipoprotein cholesterol (HDL-C) in patients receiving prazosin. On the other hand, a significant decrease in lecithin cholesterol acyltransferase (LCAT) was seen in patients receiving propranolol. Twenty-six of 40 patients receiving prazosin were given an additional 12 weeks of treatment. Twenty-two of 30 patients initially treated with propranolol were switched from propranolol to prazosin after 13 weeks and given prazosin up to the 24th week. At 24 weeks, the blood pressure was 149/93.0 mmHg in the prazosin group and 155/89.2 mmHg in the group which switched from propranolol to prazosin. Triglyceride remained reduced in the prazosin group at the 24th week. In the group which switched from propranolol to prazosin, triglyceride decreased significantly over the next 12 weeks.
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Out of the 10 patients with infective endocarditis (IE) at Kawasaki Municipal Hospital, 8 had IE due to streptococcus viridans. Out of 8 patients with streptococcus IE, 6 were successfully treated with benzyl penicillin alone or in combination with kanamycin. One patient was cured with cephaloridine. Two hundred and thirty IE patients admitted to hospitals at Kantou District were also studied. Ninety nine of 116 patients with streptococcus viridans IE were successfully treated with potentially active in vitro against streptococcus viridans. Out of 16 staphylococcus IE patients, 11 patients died. Eight patients died within 8 days from the beginning of the antibiotic administration. Out of 7 enterococcal IE patients, 5 were successfully treated with ampicillin alone or in combination with aminoglycosides. Forty three patients were diagnosed as IE despite negative blood culture. The echo cardiogram showed 23 patients had vegetation. Benzyl penicillin was given to 28 patients and 23 were cured. Out of 9 patients with culture negative IE treated with ampicillin, 8 were cured. Four patients were successfully treated with cephems.
A new human gamma-globulin for intravenous use, SM-4300, was administered to 13 patients with infectious diseases. Five grams of SM-4300 was drip infused to each patient whose infection was not controlled by previous administered antibiotics. All of 13 patients had primary diseases besides infections. Thirteen patients were composed of 4 with pyelonephritis, 2 with pneumonia, 1 with bronchopneumonia, 1 with bronchitis, 1 with pyothorax, 2 with sepsis and 2 with cholecystitis. The results obtained were good in 3 cases, fair in 2 cases and poor in 7 cases. The results of a patient was not determined. No side effect was found including in laboratory findings.
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Forty-three children and 4 adults with Campylobacter enteritis were studied in the treatment of fosfomycin (FOM). FOM was administered per orally in doses ranging from 50 to 100 mg/kg/day for children and 3 g/day for adults for 5 days. Main symptoms such as diarrhea and fever were disappeared within 2 days on the average. Campylobacter jejuni in stool specimen disappeared within a week in 95% of these patients. The duration of main symptoms and the period of positive stool culture were evidently shortened in FOM-treated group compared with non-treated group. All of the isolated strains were sensitive to FOM by mono-concentration disk method. MIC50 of these strains remained between 1.56 and 3.13 micrograms/ml. None of these MIC was beyond 12.5 micrograms/ml.
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