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A 63-year-old asymptomatic woman was diagnosed with multiple liver tumors and a left pulmonary tumor by CT. Colonoscopy( CS)showed a Type 2, quarter circular tumor on Rb. The diagnosis was cT3N1aM1b(H3, PUL1), cStage Ⅳb rectal cancer. She was administered 8 courses of induction-adjuvant chemotherapy with CAPOX and bevacizumab(BEV). After the chemotherapy, CT and CS revealed shrinkage(up to 50%)of the metastatic liver tumor and primary tumor, and decreasing tumor marker levels. Laparoscopic abdominoperineal resection and partial hepatectomy(S5/6, S8)were performed. After the operation, she was administered 2 courses of chemotherapy with UFT and LV, after which thoracoscopy-assisted upper lobectomy of the left lung was performed. Currently, at 1 and a half years after treatment, no recurrence has been observed, and she is being followed up as an outpatient.

Cefotaxime (CTX) was used in the treatment and prophylaxis of infections in neonates and immature infants. The following results were obtained. 1. Mean serum concentrations (bioassay) 30 minutes after a single intravenous injection of about 20 mg/kg of CTX were 44.5 mcg/ml in neonates and 47.2 mcg/ml in immature infants aged 0-3 days, 45.8 mcg/ml in neonates and 56.4 mcg/ml in an immature infant aged 4-7 days and 40.6 mcg/ml in neonates and 38.1 mcg/ml in immature infants aged 8 or more days. Six hour values were respectively 10.9 mcg/ml, 17.0 mcg/ml, 4.6 mcg/ml, 13.4 mcg/ml, 3.8 mcg/ml and 2.7 mcg/ml. 2. Mean serum concentration half-lives were 3.0 hours in neonates and 3.2 hours in immature infants aged 0-3 days, 1.8 hours in neonates and 3.2 hours in an immature infant aged 4-7 days, and 1.5 hours in neonates and 1.6 hours in immature infants aged 8 or more days. 3. Urinary recovery rates were 0.8-78.0% for 0-6 hours after treatment. 4. Adequate clinical efficacy can be expected by the intravenous injection of CTX in doses of 20 mg/kg 2 times daily, every 12 hours, in neonates and immature infants aged 0-3 days, 20 mg/kg 3 times daily, every 8 hours, in neonates and immature infants aged 4-7 days, and 20 mg/kg 3 to 4 times daily, every 6-8 hours, in neonates and immature infants aged 8 or more days. 5. The clinical efficacy of CTX was good in all 4 cases of sepsis (including suspected case), excellent in 1 case of urinary tract infection, and good in all 4 cases of fever of unknown origin for a cure rate of 100%. 6. Adverse reactions were not noted in any cases.

We report here, a novel method for internal carotid (IC) bypass between C2 and C5, by using the autologous saphenous vein. The patient was a 58 year-old female, complaining of pain and motor disturbance in her right ocular region. She suddenly developed left-sided hemiparesis during her stay in our hospital. The following CT examination demonstrated a high density homogenous round mass, which occupied the right side of the parasellar region with no perifocal edema. The contrast enhancement CT, however, suggested there was still a certain degree of blood flow in the mass. On the other hand, carotid angiography showed an occlusion of blood flow at the C5 level (interosseous portion), which seemed to indicate either giant aneurysm or cavernous angioma. The mass was identified as a giant aneurysm during surgery, and the decompression procedure by removing the intra-aneurysmal blood clot was attempted first. However, this trial failed due to an accidental severe bleeding. Because of this, we then decided to perform the grafting of autologous saphenous for a length of 10 cm between C2 and C5. Intraoperative heavy bleeding mentioned above seemed to have occurred due to release of compression by the aneurysm against the internal carotid artery through which there was restricted blood flow. Postoperative angiography demonstrated that the graft remained patent enough to be approximately equal in size to the original artery. From our experiences in this case, two important points are, we suggest, to be kept in mind while applying this method; (1) to carefully expose the C5 segment, (2) to avoid damage of the surrounding structures such as the Eustachian tube, facial nerve and cochlear nerves, and so forth. In conclusion, we strongly recommend this IC bypass technique for other types of tumors in the cavernous portion as well.

1. Cefmetazole was administered to mature and immature neonates for the purpose of treatment and prophylaxis of infections, and the blood level was examined. The mean blood level (moni-trol I standard) of cefmetazole after a single administration, 20 mg/kg intravenously, were 63.9 mcg/ml in 0 to 3 days old neonates and 57.4 mcg/ml in 4 to 7 days old neonates after 30 minutes, and 24.2 mcg/ml and 12.4 mcg/ml, respectively, after 6 hours. 2. The mean half-life of the blood level was 5.42 hours in 0 to 3 days old neonates and 2.55 hours in 4 to 7 old neonates. 3. The urinary excretion was varied, but approximately 80% of the administered dose seemed to be excreted during 0 to 12 hours. 4. Cefmetazole is seemed to be clinically effective by a single dose of 20 mg/kg giving twice daily in every 12 hours in 0 to 3 days old neonates, a dose of 20 mg/kg giving three times daily in every 8 hours in 4 to 7 days old infants, and a single dose of 20 mg/kg giving 3 to 4 times in every 6 to 8 hours in older than 8 days old neonates.

For the purpose of verifying the effectiveness of peplomycin, one of the derivatives of bleomycin, against carcinoma of the esophagus and the safety of it, the analysis of the data for total 113 cases collected from 25 institutions in Japan was made. The results are as follows. It was effective in 19 out of 74 evaluable cases of carcinoma of the esophagus (25.7%). In case of treatment with peplomycin alone, it was effective in 6 out of 39 cases (15.4%). In case of the combination treatment with peplomycin and some other therapy, it was effective in 13 out of 35 cases (37.1%). As for the side effects, the incidence of fever was the highest in both the cases of peplomycin alone and the combination treatment such as 39.6% and 37.0%, respectively. Anorexia, nausea, vomiting, respiratory symptoms and tiredness were found in relatively many cases. In the clinical laboratory tests, the vital capacity after the treatment tended to be lower than that before the treatment, but there was little change in the hematological tests, pulmonary function test and renal function test.