One hundred four children with infection accompanying hematologic disorders and solid tumors were treated with aztreonam (AZT) (120-150 mg/kg), either alone or in combination with one of the ...following drugs; cefmetazole (CMZ) (120-150 mg/kg), piperacillin (PIPC) (120-150 mg/kg), or amikacin (AMK) (5-10 mg/kg). The overall efficacy rate was 69.2%. Efficacy rates by regimen were as follows: AZT alone was 63.2%, AZT plus CMZ was 73.6%, AZT plus PIPC was 74.1% and AZT plus AMK was 20.0%. Efficacy rates in different types of infections were 53.2% for sepsis and suspected sepsis, 78.9% for pneumonia and respiratory tract infection, 93.1% for fever of undetermined origin and 55.6% for other infections. The efficacy rate was 71.3% in 94 patients in whom causative organisms were not identified and 50.0% in 10 patients in whom causative organisms were identified. Most of infections in which causative organisms were identified were caused by Gram-negative pathogens. The response rate among infections caused by Gram-negative bacilli was 50.0%. A combination of AZT and CMZ or PIPC was effective in 3 (100.0%) out of 3 patients in whom Escherichia coli was the causative organism. Efficacies classified according to different neutrophil counts were 59.3% for less than or equal to 100/microliters, 78.6% for 101-500/microliters and 82.4% for greater than or equal to 501/microliters. No significant adverse reactions were observed. These results indicated that combination of AZT and 2nd generation cephalosporins or penicillins were well tolerated and effective for infections complicated with accompanying hematologic disorders and solid tumors.
Enviomycin (EVM, Tuberactinomycin) is a new anti-tuberculous agent isolated from the culture of Streptomyces griseoverticillatus var. tuberacticus N6-130. This report presents the result of a ...co-operative clinical study at 11 tuberculosis hospitals in Osaka region on therapeutic effect and side-effects of Enviomycin in 189 retreatment cases of drug resistant pulmonary tuberculosis with cavities. The duration of EVM treatment has been fixed for six months and the drug was administered by intramuscular injections at the dose of 1 gram once daily for the first three months and twice weekly thereafter combined with other antituberculous drugs which had been used orally just prior to EVM treatment. The results are summarized as follows: 1) Background factors of 189 cases are shown in Table 1. The majority of cases (71%) were far-advanced tuberculosis and 47% of total cases were resistant to four or more anti-tuberculous drugs. The time course of EVM therapy is summarized in Table 2 including 143 completed cases of six months treatment. 2) Negative conversion of bacilli in sputa by smear and culture are shown in Tables 3 and 4. The sensitive group which has been treated with EVM and other unused drugs gives the higher negative conversion rate at sixth month by culture (67%) than the resistant group in which only already-used drugs were combined with EVM (27%). 3) Changes in basic lesions and cavities on chest radiograms are shown in Table 5. Improvements on chest radiograms were scarcely observed, as the most cases had chronic lesions and cavities with sclerotic wall to which no chemotherapeutic agents had been expected to react effectively. 4) The resistance against EVM was measured at 25 and 100μg/mlglml EVM containing Ogawa's egg media. The emergence of EVM resistance to 100μg/mlg/ml EVM at sixth month was 27.6% in EVM sensitive group. On the other hand, in another group which had shown 25μg/ml resistance against EVM at the start, all cases showed resistance to 100μg/ml EVM at sixth month (Table6). 5) Side-effects such as tinnitus, hearing drop, dizziness and headache which were assumed to be caused by EVM were observed in 27 cases (14.3%), and 15 cases of them (7.9% of total 189 cases) had dropped out from the therapy. 6) Hearing drop over 20 db at 8, 000 cis was observed in 12 cases (6.5%), however, only one case dropped out by this reason. In conclusion, enviomycin (EVM, Tuberactinornycin) has been proved to be one of usefulanti-tuberculous drugs which can be used daily in combination with other effective oral drugs in retreatment of resistant pulmonary tuberculosis, as the incidence of side-effects, especially hearing impairment was relatively low.
Wedge biopsy of the testis was performed in 46 children who had received long-term chemotherapy for acute lymphoblastic leukemia. Occult testicular infiltration was noted in three children (6.5%). ...Two of three children with biopsy-proven infiltration died of systemic disease in spite of local irradiation and reinduction chemotherapy. Six of 43 children shown to be negative by testicular biopsy relapsed 11 months to 15 years later, and 3 of 6 patients died of systemic disease, but none of the cases developed testicular disease. Chemotherapy-induced gonadal damage was observed in 30 of 46 children, and tubular damage was occasionally still seen 4 years after cessation of treatment. Although gonadal damage usually depends on the cumulative dosage of cyclophosphamide, intact tubular fertility index was found in several children who had received a greater dose of cyclophosphamide intermittently. Induction and maintenance chemotherapy for acute lymphoblastic leukemia had little influence on hormonal function. Testicular biopsy at the time of cessation of chemotherapy seems to be worthwhile for the subsequent strategy of treatment, and long-term surveillance for gonadal damage of long-term survivors will be required.
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