RESUMEN
OBJECTIVE: To investigate the relation between the vestibular system and vasopressin (AVP). MATERIAL AND METHODS: We examined the effects of electrical and caloric vestibular stimulation on plasma AVP levels in anesthetized rats. Plasma AVP levels of patients with intractable Ménière's disease who were subjected to endolymphatic drainage and steroid instillation surgery (EDSS) or intratympanic gentamicin (GM) injection were measured before and after these interventions. RESULTS: Electrical vestibular stimulation increased plasma AVP levels in a current intensity-dependent manner. Plasma AVP levels were also increased by caloric stimulation with cold water. Plasma AVP levels decreased rapidly after EDSS, and were maintained at a low level even 6-12 months following EDSS or intratympanic GM injection. CONCLUSIONS: Vestibular activation or inhibition-induced imbalance of intervestibular activities increased plasma AVP levels in rats. Therefore, vestibular disorder would seem to increase plasma AVP and thus worsen endolymphatic hydrops. EDSS rapidly decreased plasma AVP and would seem to reduce hydrops. Inhibition of vertigo spells by EDSS or intratympanic GM injection would reduce a possible stress response, resulting in a decrease in plasma AVP levels a long time after the treatments. This resultant decrease in AVP would beneficially inhibit the formation and/or maintenance of hydrops and thus prevent vertigo spells.
Asunto(s)
Enfermedad de Meniere/fisiopatología , Enfermedad de Meniere/terapia , Vasopresinas/sangre , Vestíbulo del Laberinto/fisiología , Animales , Antibacterianos/uso terapéutico , Frío , Drenaje , Estimulación Eléctrica , Saco Endolinfático/cirugía , Gentamicinas/uso terapéutico , Humanos , Instilación de Medicamentos , Enfermedad de Meniere/sangre , Ratas , Ratas WistarRESUMEN
Endolymphatic sac surgery is one of the most widely accepted techniques used to treat intractable Meniere's disease. To improve this surgery, we developed the following techniques: A simple mastoidectomy was used to expose the endolymphatic sac between the sigmoid sinus and inferior margin of the posterior semicircular canal. The sac was opened and filled with a mass of prednisolone. A bundle of absorbable gelatin films was then inserted into the sac lumen to expand it, followed by gelatin sponges dipped in a high concentration of dexamethasone. Long-term results (17-32 months) in 20 patients with intractable Meniere's disease treated with endolymphatic sac drainage and steroid-insertion surgery (EDSS) showed that definitive spells were completely controlled in 15 of 20 cases (75%); all reports of vertigo decreased; hearing improved in 12 of 20 cases (60%); and annoyance due to tinnitus decreased in 15 of 20 cases (75%). Steroids directly instilled into the endolymphatic cavity may thus be more effective with the diseased inner ear organs than those applied via any other route. Draining of endolymphatic fluid at the sac into the mastoid cavity also contributed to these satisfactory EDSS results.
Asunto(s)
Antiinflamatorios/administración & dosificación , Saco Endolinfático/cirugía , Enfermedad de Meniere/terapia , Prednisolona/administración & dosificación , Adulto , Drenaje/métodos , Anastomosis Endolinfática/métodos , Femenino , Humanos , Instilación de Medicamentos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
To evaluate objectively clinical efficacy, safety and usefulness of cefuroxime axetil (CXM-AX) in acute dental infections (periodontitis, pericoronitis and gnathitis), we carried out a comparison study using cefaclor (CCL) as the control. Both drugs were orally given after meals in a dose level of 250 mg (potency) t.i.d. for 3-7 days. 1. Clinical efficacy rates in all the treated cases were 81.6% (102/125) in the CXM-AX group and 82.5% (104/126) in the CCL group according to the assessment by physicians in charge, and 89.6% (112/125) and 83.3% (105/126), respectively, according to the assessment based on scores. No significant difference was found between the 2 treatment groups. In clinical efficacy (assessment by score) classified by background factors, efficacy rate in the CXM-AX group (90.6%, 58/64) was significantly higher (P less than 0.05) than that in the CCL group (75.0%, 48/64) in cases receiving no surgical treatment on the first day of drug administration. Other background factors than the above (no surgical treatment) factor or scores on the first day of drug administration, however, did not appear to influence clinical efficacies of 2 treatment groups. 2. As for the bacteriological response in all the treated cases, elimination rate in the CXM-AX group was 73.7% (28/38) and that in the CCL group, 78.3% (36/46), without significant difference between the 2 groups. 3. Regarding the safety, no significant difference was found between the 2 treatment groups. Adverse reactions were observed in 1 out of 128 cases (0.8%) in the CXM-AX group and 6 out of 132 cases (4.5%) in the CCL group. Abnormal laboratory test values were noted in 8 out of 86 cases (9.3%) in the CXM-AX group and 5 out of 91 cases (5.5%) in the CCL group. None of these differences between 2 treatment groups was statistically significant. 4. Usefulness rates in all the treated cases were 81.6% (102/125) in the CXM-AX group and 81.7% (103/126) in the CCL group, thus significant difference was observed between the 2 groups. From the above results, CXM-AX is considered to be a useful drug like CCL in the treatment of acute dental infections.
Asunto(s)
Infecciones Bacterianas , Cefuroxima/análogos & derivados , Enfermedades Maxilomandibulares/tratamiento farmacológico , Pericoronitis/tratamiento farmacológico , Periodontitis/tratamiento farmacológico , Profármacos/uso terapéutico , Enfermedad Aguda , Adolescente , Adulto , Anciano , Bacterias/efectos de los fármacos , Bacterias/aislamiento & purificación , Cefaclor/efectos adversos , Cefaclor/farmacología , Cefaclor/uso terapéutico , Cefuroxima/efectos adversos , Cefuroxima/farmacología , Cefuroxima/uso terapéutico , Método Doble Ciego , Farmacorresistencia Microbiana , Femenino , Humanos , Enfermedades Maxilomandibulares/microbiología , Masculino , Persona de Mediana Edad , Pericoronitis/microbiología , Periodontitis/microbiología , Profármacos/efectos adversos , Profármacos/farmacologíaRESUMEN
The distribution of cefuroxime (CXM) was examined in NZW rabbits after oral administration at a dose of 20 mg/kg of cefuroxime axetil. CXM was detected in blood, oral tissues (tongue, gingiva, parotid gland, submandibular gland, cervical lymph nodes and lower jaw bone), liver and kidney. The results were analyzed through pharmacokinetic calculation. Ratio of pharmacokinetic parameters in the tissues and those in the serum (free) were as follows: Cmax: 0.26 to 0.62, AUC: 0.70 to 1.53, MRT: 2.6 to 3.0, VRT: 7.7 to 12.2.
Asunto(s)
Cefuroxima/farmacocinética , Cefalosporinas/farmacocinética , Boca/metabolismo , Animales , Cefuroxima/análogos & derivados , Cefuroxima/sangre , Riñón/metabolismo , Hígado/metabolismo , Masculino , Conejos , Distribución TisularRESUMEN
The distribution of T-3262 (tosufloxacin tosilate) in salivary glands of rats was investigated with frozen-microautoradiography. One and 4 hours after oral administration of 14C-T-3262 at 100 mg/kg to rats submandibular glands, parotid glands and sublingual glands were removed, and a microautoradiogram of each was made. In the submandibular gland and the parotid gland 14C-T-3262 was distributed at high levels throughout the glands taken at 1 and 4 hours after administration, but lower levels than the other glands were found in the sublingual gland at 1 hour. The results of this study suggested that T-3262 penetrates effectively into the saliva, because 14C-T-3262 is distributed well into glandular acinus, striated duct and excretory duct. The microautoradiography was a useful and reliable method for investigating the distribution of antimicrobial agents in salivary glands.
Asunto(s)
Antiinfecciosos/farmacocinética , Fluoroquinolonas , Naftiridinas , Saliva/metabolismo , 4-Quinolonas , Animales , Autorradiografía , Evaluación de Medicamentos , Masculino , Ratas , Ratas EndogámicasRESUMEN
The clinical effectiveness and safety of roxithromycin (RU 28965, RU), a new macrolide antibiotic, were compared with those of josamycin (JM) using a double-blind method in the treatment of orofacial odontogenic infections. The diseases covered in this study were periodontal infections, pericoronal infections and osteitis of jaws. Drugs were administered for 3 to 7 days at daily doses of 300 mg (RU) and 1,200 mg (JM). A total of 270 cases was evaluated in this study. Results obtained are summarized as follows: 1. The clinical efficacy was evaluated through the judgement of doctors in charge of 247 cases (128 in the RU group and 119 in the JM group) and by a committee on the 3rd day of treatment in 243 cases (126 in the RU group and 117 in the JM group). Clinical efficacy rates according to the committee judgement were 78.6% for the RU group and 82.1% for the JM group. As for the evaluation through the doctors' judgement, they were 79.7% for the RU group and 73.1% for the JM group. There was no significant difference in clinical effectiveness between 2 groups according to these 2 methods of judgement. 2. Some side effects were observed in 4 cases (2.9% out of 136) treated with RU and in 3 cases (2.4% out of 126) treated with JM. No severe symptoms were observed. Abnormal changes in laboratory test values were noted among 7.9% in the RU group and 4.0% in the JM group. There were no significant differences in their safety between the 2 groups. 3. In terms of clinical usefulness, there were no significant differences between the 2 groups as well. From these results, it has been concluded that RU (daily dose 300 mg) is as effective as JM (daily dose 1,200 mg) in the treatment of orofacial odontogenic infections.
Asunto(s)
Leucomicinas/uso terapéutico , Osteítis/tratamiento farmacológico , Pericoronitis/tratamiento farmacológico , Periodontitis/tratamiento farmacológico , Administración Oral , Adolescente , Adulto , Anciano , Bacterias/aislamiento & purificación , Ensayos Clínicos como Asunto , Método Doble Ciego , Femenino , Humanos , Leucomicinas/administración & dosificación , Masculino , Persona de Mediana Edad , Estudios Multicéntricos como Asunto , Osteítis/microbiología , Pericoronitis/microbiología , Periodontitis/microbiologíaRESUMEN
Clarithromycin (TE-031, A-56268), a new macrolide antibiotic, was administered to rats, and the distribution of the drug in the submandibular gland was studied using microautoradiography. The study revealed good accumulation of 14C-TE-031 in both the acini and the excretory ducts. TE-031 was administered to each of 3 healthy male volunteers in a single dose of 300 mg, and its concentrations in the serum and saliva was detected. Mean values of various pharmacokinetic parameters were as follows for the serum and saliva, respectively. Cmax 1.49 micrograms/ml and 1.93 micrograms/ml; Tmax 2.91 hours and 2.66 hours; T 1/2 6.31 hours and 4.15 hours; AUC 18.58 micrograms.hr/ml and 17.70 micrograms.hr/ml. Regarding the salivary bacterial flora, the total bacterial count decreased as the salivary TE-031 concentration increased, but it recovered to the initial level in 12 hours after administration. During the 24-hour period following an administration of TE-031, the salivary bacteria did not acquire resistance to the drug. Therefore, TE-031 is an antibiotic which exerts little effect on the normal salivary bacterial flora in short-term administration. Although the results differed among the individuals, the penetration of TE-031 to saliva was superior to that to the serum. Thus, TDM of TE-031 using salivary samples is possible.
Asunto(s)
Bacterias/efectos de los fármacos , Eritromicina/análogos & derivados , Saliva/metabolismo , Animales , Claritromicina , Farmacorresistencia Microbiana , Eritromicina/farmacocinética , Eritromicina/farmacología , Humanos , Masculino , Ratas , Ratas Endogámicas , Saliva/microbiología , Glándula Submandibular/metabolismoRESUMEN
In order to objectively evaluate the usefulness of clarithromycin (TE-031, A-56268), a new oral macrolide antibiotic, in the treatment of acute dental infections, a double-blind comparative clinical trail was conducted using josamycin (JM) as the control drug. TE-031 was administered at a daily dosage of 400 mg in 2 divided doses, and JM was given at a daily dosage of 1,200 mg in 3 divided doses. The administration period was, as a rule, 7 days. A total of 302 patients were administered with the test substances (TE-031 and JM), and the clinical efficacy was evaluated by investigators for 284 patients and by a committee using a score method for 273 patients. Efficacy rates as evaluated by the investigators were 77.2% (105/136) in the TE-031 group and 69.6% (103/148) in the JM group. Efficacy rates as evaluated by the committee by the score method were 86.0% (111/129) in the TE-031 group and 80.6% (116/144) in the JM group. The differences between the 2 drug groups were not statistically significant. The investigators' evaluation of the clinical efficacy in the treatment of osteitis of the jaw gave an efficacy rate of 83.0% (44/53) in the TE-031 group and 64.7% (33/51) in the JM group. The efficacy rate in the TE-031 group was statistically higher than that in the JM group. Side effects were recorded in 7 patients (4.8%) in the TE-031 group and 3 patients (2.0%) in the JM group, while abnormal laboratory test values were detected in 3 cases each in the TE-031 and JM groups. None of these differences were statistically significant. The usefulness rates ("satisfactory" plus "very satisfactory" cases) were 73.9% in the TE-031 group and 70.3% in the JM group and were thus almost the same for the 2 drug groups. On the basis of the above results, TE-031 was concluded to be a useful drug in the treatment of acute dental infections and is expected to be able to achieve almost identical clinical efficacy as JM at only one-third of the usual dosage of JM.
Asunto(s)
Infecciones Bacterianas/tratamiento farmacológico , Eritromicina/análogos & derivados , Enfermedades Dentales/tratamiento farmacológico , Enfermedad Aguda , Adolescente , Adulto , Anciano , Bacterias/efectos de los fármacos , Bacterias/aislamiento & purificación , Infecciones Bacterianas/microbiología , Claritromicina , Ensayos Clínicos como Asunto , Método Doble Ciego , Farmacorresistencia Microbiana , Eritromicina/efectos adversos , Eritromicina/farmacología , Eritromicina/uso terapéutico , Femenino , Humanos , Leucomicinas/farmacología , Leucomicinas/uso terapéutico , Masculino , Persona de Mediana Edad , Estudios Multicéntricos como Asunto , Enfermedades Dentales/microbiologíaRESUMEN
Reconstruction of the oral cavity after extended surgery poses many difficult problems. The vital functions of the oral cavity, especially swallowing, mastication and breathing, are seriously impaired by resection of the tongue, floor of the mouth, gingiva or jaw bone. We have used the free revascularized jejunal transfer for reconstruction of the oral cavity in 10 patients and have had good functional and cosmetic results. The advantages of this method are as follows: 1) it is a one-stage operation; 2) the flexibility of the graft preserves maximal tongue function; 3) the graft can be applied to difficult anatomic sites, and 4) the mucosal defect is covered with jejunal mucosa and induration is minimum. Our success rate with this procedure has been 90%. In our experience, this transfer is useful for reconstruction of a massive defect in the oral cavity.
Asunto(s)
Carcinoma de Células Escamosas/cirugía , Yeyuno/trasplante , Mucosa Bucal/cirugía , Neoplasias de la Boca/cirugía , Neoplasias de la Lengua/cirugía , Lengua/cirugía , Anciano , Carcinoma de Células Escamosas/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Suelo de la Boca/cirugía , Neoplasias de la Boca/patología , Neoplasias de la Lengua/patologíaRESUMEN
Cefotiam (CTM) is a new synthetic cephem antibiotic developed in Japan. The results of the fundamental and clinical studies are as follows. 1. CTM showed antibacterial activity, in terms of MIC, as strong as those of cephalothin (CET) and cefazolin (CEZ) for Gram-positive cocci, and several times superior to for Gram-negative bacilli. 2. CTM serum levels approximately reached the peaks on completion of 60 minutes intravenous drip infusion of 1 g of this preparation dissolved in 5% glucose solution of 250 ml; the mean value was 65.00 micrograms/ml. Then the levels dropped rather quickly up to 180 minutes after the start of drip infusion. After that, the levels dropped gradually up to 360 minutes. 3. As for the passage of CTM in the oral tissues, satisfactory passage was observed in both maxillomandibular marrow and gingiva, which adequately exceeded MICs of the clinically isolated strains of oral infections. 4. This preparation was administered 1 g of 2 g daily by intravenous drip infusion in 18 cases of moderate or more serious infections in the field of oral surgery; the clinical efficacy rate obtained was 94.4%. 5. No manifestations of side effect were observed clinically. As for laboratory findings, 1 case of large increases in GOT and GTP (a hepatitis B antigen positive patient) and 2 cases of slight increase in GTP were observed. On the basis of these results of the fundamental and clinical studies, it was concluded that CTM is an excellent antibiotic for the treatment of oral infections.
Asunto(s)
Antibacterianos/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Cefotaxima/análogos & derivados , Enfermedades de la Boca/tratamiento farmacológico , Adolescente , Adulto , Cefotaxima/sangre , Cefotaxima/uso terapéutico , Cefotiam , Celulitis (Flemón)/tratamiento farmacológico , Femenino , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Osteomielitis/tratamiento farmacológico , Infección de la Herida Quirúrgica/prevención & controlRESUMEN
Experimental and clinical studies were carried out on cefmetazole (CMZ), a synthetic antibiotic of cephamycin group, and the following results were obtained. 1) The minimal inhibitory concentrations (MICs) of CMZ against Gram positive cocci (30 strains) isolated from the patients with oral infections showed slightly inferior to those of ABPC, CEZ, while MICs against Gram negative bacilli (166 strains) of CMZ exhibited stronger activity than ABPC, CEZ. 2) The mean serum concentration of CMZ at 60 minutes after drip infusion showed 65.6 micrograms/ml. The concentration of CMZ in oral tissues varied in 4--60% of serum level at 60 minutes after drip infusion. The concentration in pus showed 15.2 micrograms/g at 60 minutes after drip infusion. 3) CMZ was administered by the drip infusion to 22 patients with various infections in the oral surgical field. The efficacy rate was 90.9%. 4) No side effect was observed.
Asunto(s)
Bacterias/efectos de los fármacos , Cefalosporinas/farmacología , Cefamicinas/farmacología , Adulto , Anciano , Infecciones Bacterianas/tratamiento farmacológico , Cefmetazol , Cefamicinas/metabolismo , Cefamicinas/uso terapéutico , Niño , Evaluación de Medicamentos , Farmacorresistencia Microbiana , Femenino , Humanos , Masculino , Persona de Mediana Edad , Boca/metabolismo , Enfermedades de la Boca/tratamiento farmacológico , Supuración/metabolismo , Infección de la Herida Quirúrgica/tratamiento farmacológicoRESUMEN
Experimental and clinical studies on ceftizoxime (CZX), a new cephalosporin derivative, were carried out and the following results were obtained. 1. The minimal inhibitory concentrations of CZX, cefazolin (CEZ), cephalothin (CET), cefotiam (CTM) and cefmetazole (CMZ) against Gram-positive cocci (31 strains) and Gram-negative rods (169 strains) isolated from the patients with oral infections were determined. CZX, though somewhat less active against Gram-positive cocci than the other cephalosporins, was the most active of the antibiotics tested against Gram-negative rods. 2. The mean serum levels in 19 patients who received 1 g of CZX by intravenous drip infusion for 1 hour were as follows. 19.6 micrograms/ml 30 minutes after the start of intravenous drip infusion, 52.2 micrograms/ml after 1 hour, 25.0 micrograms/ml after 1.5 hours, 20.3 micrograms/ml after 2 hours, 7.9 micrograms/ml after 4 hours, 3.5 micrograms/ml after 6 hours. The mean peak tissue levels of CZX after 1 g dose by intravenous drip infusion for 1 hour were 14.3 micrograms/g (n = 5) in gingiva and 8.5 micrograms/g (n = 2) in bone marrow at the end of intravenous drip infusion. 3. CZX was administered to 17 patients with various infections in the oral surgical field at daily dose of 1 approximately 2 g for 3 approximately 6 days. The therapeutic effect was as follows: 'excellent' in 6 cases, 'good' in 9, 'fair' in 1 and 'poor' in 1. The final rate of effectiveness was 88.2%. No adverse reaction was observed except for 2 cases of slight elevation of S-GPT.
Asunto(s)
Infecciones Bacterianas/tratamiento farmacológico , Cefotaxima/análogos & derivados , Enfermedades de la Boca/tratamiento farmacológico , Adulto , Anciano , Bacterias/efectos de los fármacos , Cefotaxima/metabolismo , Cefotaxima/farmacología , Cefotaxima/uso terapéutico , Ceftizoxima , Evaluación de Medicamentos , Farmacorresistencia Microbiana , Femenino , Humanos , Masculino , Persona de Mediana Edad , Distribución TisularRESUMEN
Investigation was made on the therapeutic effect of a new antibiotic, cefatrizine(CFT), in oral infections according to the following procedure. Results are summarized as follows. Determination was made on the MIC of CFT against 8 clinical isolates of S. epidermidis, 5 of S. aureus and 7 of E. coli in comparison with those of CEX and PBPC. MICs of CFT against S aures were demonstrated 3.13 to 6.25 mcg/ml which were superior to those of CEX and ABPC. CFT was administered orally in a dose of 500 mg at an hour and a half before the extraction of the impacted wisdom tooth in the mandibula. During the operation, gingival and blood specimens were collected and each CFT level was determined. The mean CFT level in the gingiva reached to 0.95 mcg/ml and that in the blood to 5.77 mcg/ml. According to these experimental results, CFT was administered to patients with moderate oral infection at a dose of 500 mg and clinical assessment was made according to the criteria established by Japanese Society of Oral Surgeons. As the results, the effectiveness rate of CFT was 85%. No serious side effect was observed. From the results of the present study, CFT may be effective for moderate oral surgery infections.
Asunto(s)
Cefatrizina/uso terapéutico , Cefalosporinas/uso terapéutico , Estomatitis/tratamiento farmacológico , Adulto , Bacterias/efectos de los fármacos , Cefatrizina/metabolismo , Cefatrizina/farmacología , Evaluación de Medicamentos , Farmacorresistencia Microbiana , Femenino , Humanos , Masculino , Persona de Mediana Edad , Boca/metabolismoRESUMEN
L-Keflex is a newly manufactured cephalexin product in order to maintain effective blood level of the drug for a long period of time. The results of the fundamental and clinical studies are as follows: 1. Mean blood levels of the drug after its single oral dose of 1 g in fasting in 22 cases before operations were: 7.19 mcg/ml at 2 hours (peak), 4.35 mcg/ml at 4 hours, 4.21 mcg/ml at 6 hours, 2.47 mcg/ml at 8 hours and 1.81 mcg/ml at 12 hours, respectively. Existence of the drug in blood was observed for a long period of time. 2. The distribution into the tissues of L-Keflex was generally good. The tissue levels in 19 of 22 samples ranged from 1.30 to 18.0 mcg/g, but 3 samples did not detect the drug in the tissues. Tissue level/blood level ratios were 0.19 approximately 2.67. 3. Half of 30 cases with mild dental infections was treated with a daily dose of 1 g with clinical response of 60.0%, and the other half with 2 g was 78.6% in clinical response. The overall efficacy rate was 69.0%. 4. As a side effect of the drug, only one of 52 cases (fundamental 22 cases, clinical 30 cases) complained of edema on both eyelids. No. abnormality was observed in blood finding, hepatic and/or renal function. From the above results, it is considered that L-Keflex is an effective antibiotic product in infections in the field of oral surgery. Also, L-Keflex has an advantage in that its administration frequence (b.i.d) is less than that of regular cephalexin (q.i.d.).