The bactericidal activity of M14659 against Escherichia coli in low-iron environments was investigated and compared with that of ceftriaxone and ceftazidime. The bactericidal activity of M14659 against E. coi in Mueller-Hinton broth was enhanced 30-to 20,000-fold by addition of transferrin, which is an iron-binding protein, whereas the activity of ceftriaxone or ceftazidime was much less strongly affected. This enhancement by transferrin was completely inhibited by saturating the iron-binding capacity of transferrin with FeCl3.

The therapeutic effectiveness of a combination therapy--pretreatment with transcatheter arterial chemoembolization (TACE) followed by percutaneous ethanol injection (PEI) therapy--for large (> 3 cm in diameter) unresectable hepatocellular carcinoma (HCC) was compared with that of TACE alone. PEI therapy was performed in 24 cases of unresectable HCC that had previously been treated with TACE using doxorubicin 30-60 mg or epirubicin 50-90 mg. In all, 2-10 ml of 90% ethanol mixed with carbocaine was repeatedly injected through a 21-gauge, closed-end needle (PEIT needle) for a median of 3.6 injections and 31.1 ml of ethanol. As adverse effects, transient localized pain and a burning sensation were observed in 75.0% of the cases; fever, in 66.7%; and transient hypotension, in two cases. A small unresectable tumor is a good indication for PEI therapy. In cases with a larger tumor, i.e., measuring more than 3 cm in diameter, or multiple tumors, the 1-year survival rate obtained with this combination therapy, i.e., TACE and PEI, was 87.0%, and the 2-year survival rate was 65.2%. These rates were greater than those obtained with TACE alone. Accordingly, additional PEI therapy was effective for larger tumors and multiple tumors previously treated with TACE.

Peroral cholangioscopy (PCS) has been performed in 22 cases using XCHF-B200 (Olympus Optical Co.) since June 1995 and in 77 cases using CHF-B20 (Olympus Optical Co.) after EST from Jan. 1989. XCHF-B200 has a longer rigid portion of distal end and a smaller channel diameter than CHF-B20. The successful rate of PCS using XCHF-B200 (82%) was lower than that of CHF-B20 (89%). The vascular pattern and fine vertical groove of the bile duct mucosa were shown more clearly on the photographs obtained with XCHF-B200 than those obtained with CHF-B20. However, not enough biopsy specimens could be obtained because the channel diameter of XCHF-B200 was rather small. If the length of rigid portion and biopsy channel of XCHF-B200 are improved, PCS using XCHF-B200 will be more useful for the diagnosis of bile duct disorders.

Bacteria have been implicated in recurrent choledocholithiasis associated with endoscopic sphincterotomy (EST). This study was designed to clarify whether bacterial examination of bile provides information useful in predicting the risk of recurrence of choledocholithiasis in patients undergoing EST. Bacteria in bile collected via a duodenoscope before cholangiography were cultured. We compared bacterial isolates and quantity among 41 patients with choledocholithiasis (7 with and 34 without a history of recurrent choledocholithiasis) who had undergone EST more than 3 months previously and 13 control patients with no evidence of pancreatobiliary disease. The bile samples were cultured under aerobic and anaerobic conditions. The bacterial quantity was expressed as the mean logarithm of the number of colony forming units (CFU)/ml. Furthermore, cholescintigraphic studies of bile flow were performed with the use of 99 mTC-HIDA to study the clinical implication of these variables. No bacteria were detected in 10 of the 13 patients in the control group. In the other three control patients the bacterial count was 2.2 log CFU/ml or less. The mean bacterial count was significantly higher in patients with recurrence than in those without recurrence. Cholescintigraphy revealed a trend toward a higher number of isolates and a higher bacterial count in bile in patients with delayed bile passage than in those with good passage. The results suggest that an increased number of biliary isolates and an increased bacterial count indicate decreased bile flow in patients with choledocholithiasis who are being followed up after EST. These variables may potentially serve as indicators of the risk of stone recurrence. Especially when the bacterial count is higher than 7.0 log CFU/ml, the risk of a decrease in bile flow and an increased stone recurrence would be possibly found.

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