Dose-Modified Ifosfamide, Epirubicin, and Etoposide is a Safe and Effective Salvage Therapy with High Peripheral Blood Stem Cell Mobilization Capacity for Poorly Mobilized Hodgkins Lymphoma and Non-Hodgkins Lymphoma Patients
Fukunaga A.,Kitano Hospital
Journal of clinical and experimental hematopathology : JCEH | Year: 2016
A dose modified ifosfamide, epirubicin, and etoposide (IVE) regimen was prospectively assessed for its efficacy in mobilizing peripheral blood stem cells for autologous transplantation. Two patients with Hodgkin's lymphoma and two with non-Hodgkin's lymphoma who were undergoing stem cell therapy were studied. All patients had a history of multiple treatments with insufficient stem cell mobilization. The dose modified IVE regimen consisted of ifosfamide 3 g/m(2) intravenously (IV) administered on days 1-2 in combination with epirubicin 50 mg/m(2) IV on day 1 and etoposide 200 mg/m(2) (100 mg/m(2) in two patients with complete remission) IV on days 1-3. The ifosfamide dosage was reduced to two-thirds of the original protocol. A substantial high yield of CD34(+) cells was achieved when patients were treated with a dose-modified IVE regimen, compared with that during the previous regimen (two with the ifosfamide, carboplatin, and etoposide [ICE] regimen, one with high-dose cyclophosphamide and one with the original IVE regimen). Two patients who had refractory and residual disease received a 200 mg/m(2) dose of etoposide, which resulted in tumor reduction (one patient with complete remission and one with further reduction in tumor size). After the IVE regimen, all four patients had a sufficient yield of CD34(+) cells in total, which was available for stem cell transplantation. Hematological and non-hematological toxicities were comparable in all regimens. This single-center prospective study demonstrated that the dose-modified IVE regimen can be used as a safe treatment with high mobilizing efficacy in heavily pretreated lymphoma patients.
Hata A.,Kitano Hospital |
Kuniyoshi M.,Kitano Hospital |
Ohkusa Y.,Japan National Institute of Infectious Diseases
Infection | Year: 2011
Purpose: To determine the incidence of Herpes zoster in patients with one of 17 specific underlying diseases compared with that in patients with other underlying diseases. Methods: We conducted a retrospective hospital-based cohort study using data from patients' electronic medical records for the period 2001-2007 of the Kitano Hospital Research Database. These analyses included 55,492 patients with one of 17 underlying diseases, which were those reported as related to the contraction of Herpes zoster. Of these, 769 patients contracted Herpes zoster. The main outcome measure was the clinical diagnosis of Herpes zoster. Results: The adjusted hazard ratios (95% confidence interval) for Herpes zoster in patients with the 17 diseases were compared with other patients, with the following results: brain tumor [3.84 (2.51-5.88)], lung cancer [2.28 (1.61-3.22)], breast cancer [2.41 (1.52-3.82)], esophageal cancer [4.19 (2.16-8.11)], gastric cancer [1.95 (1.39-2.72)], colorectal cancer [1.85 (1.33-2.56)], gynecologic cancer [3.45 (2.08-5.70)], malignant lymphoma [8.23 (6.53-10.38)], systemic lupus erythematosus [3.90 (2.66-5.70)], rheumatoid arthritis [2.00 (1.60-2.50)], diabetes mellitus [2.44 (2.10-2.85)], hypertension [2.04 (1.75-2.38)], renal failure [2.14 (1.65-2.79)], and disk hernia [2.18 (1.52-3.13)]. Conclusions: Patients with diabetes mellitus, renal failure, and malignancies have a 1.8-8.4-fold higher risk of a Herpes zoster event than patients with other diseases. Future studies should investigate alteration of the immune system in the underlying diseases and approaches for Herpes zoster prevention. © 2011 The Author(s).
Kitamura T.,Kyoto University |
Fujishita T.,Kyoto University |
Loetscher P.,Novartis |
Revesz L.,Novartis |
And 4 more authors.
Proceedings of the National Academy of Sciences of the United States of America | Year: 2010
Recent reports have suggested critical roles of myeloid cells in tumor invasion and metastasis, although these findings have not led to therapeutics. Using a mouse model for liver dissemination, we show that mouse and human colon cancer cells secrete CC-chemokine ligands CCL9 and CCL15, respectively, and recruit CD34+ Gr-1- immature myeloid cells (iMCs). They express CCL9/15 receptor CCR1 and produce matrix metalloproteinases MMP2 and MMP9. Lack of the Ccr1, Mmp2, or Mmp9 gene in the host dramatically suppresses outgrowths of disseminated tumors in the liver. Importantly, CCR1 antagonist BL5923 blocks the iMC accumulation and metastatic colonization and significantly prolongs the survival of tumor-bearing mice. These results suggest that CCR1 antagonists can provide antimetastatic therapies for patients with disseminated colon cancer in the liver.
Kaneko K.,Nagasaki University |
Kanai R.,Kitano Hospital
Journal of Craniofacial Surgery | Year: 2011
We report a rare case of a hemangioma arising from the accessory parotid gland. The patient, a 45-year-old woman, complained of a right midcheek mass. Magnetic resonance imaging showed a well-defined mass located in the right buccal space, anterior to the masseter muscle, and adjacent to the Stensen duct. The mass had high T2-weighted signal intensity and showed strong patchy enhancement with gadolinium. This mass was surrounded by a common capsule with the accessory parotid gland. These findings indicated a hemangioma originating from the accessory parotid gland. The mass was completely removed by an intraoral approach without postoperative facial palsy, skin deformity, and difficulty in secreting saliva. Histologic examination of the tumor revealed multiple, thin-walled, and dilated blood vessels, confirming the diagnosis of a cavernous hemangioma. Magnetic resonance imaging was extremely useful in diagnosing the mass as a hemangioma before surgery, clarifying relationships between the mass and adjacent structures and determining the surgical approach to the mass. Copyright © 2011 by Mutaz B. Habal, MD.
Hirata H.,Kitano Hospital
[Rinshō ketsueki] The Japanese journal of clinical hematology | Year: 2011
We investigated the hematopoietic status of aplastic anemia with FDG-PET before and after immunosuppressive therapy. FDG-PET showed a patchy uptake pattern before treatment, indicating residual compensatory hypercellular marrow. Three years after successful treatment with ATG plus CsA, the heterogeneity of bone marrow uptake persisted, suggesting that expanded reconstitution of hematopoiesis may require a long time even after the achievement of hematological remission.
Kanemaru S.,Kitano Hospital
Acta oto-laryngologica. Supplementum | Year: 2010
This new regenerative therapy shows great potential for the treatment of stenosis of the trachea and/or cricoids (STC). To estimate the potential of tissue-engineered artificial trachea (AT) for treatment of STC in clinical applications. We previously reported that AT was a useful material for implantation into a tracheal defect after resection of cancer. There are many causes of stenosis of the respiratory tract and STC is particularly difficult to treat. The AT was a spiral stent composed of Marlex mesh made of polypropylene and covered with collagen sponge made from porcine skin. Three patients with STC were treated by this tissue-engineering method. All of them suffered from STC caused by long endotracheal intubations. They underwent a two-stage operation. In the first operation, after resection of the stenotic regions, the edge of the tracheal cartilage was sutured to the edge of the skin. The tracheal lumen was exposed and a T-shaped cannula was inserted into the large tracheostoma. At 3 weeks to 2 months after the first operation, the trachea and skin were separated. The trimmed AT with venous blood and basic fibroblast growth factor (b-FGF) was then implanted into the cartilage defect. Postoperatively, all patients were able to breathe easily and had no discomfort in their daily activities. Six months after the second operation, we observed enough air space in the trachea and cricoid by computed tomography (CT) imaging and fiber endoscopy.
Muso E.,Kitano Hospital
Clinical and Experimental Nephrology | Year: 2014
LDL-apheresis is a method to correct dyslipidemia rapidly. It is expected to alleviate the tissue toxicity of persistent dyslipidemia in not only primary, but also in secondary dyslipidemia associated with refractory nephrotic syndrome, and to have a protective effect against glomerular and tubular injury as expected in atherosclerosis. In addition, the effectiveness of LDL-apheresis to promote the remission of nephrotic syndrome has been recognized. In Japan, LDL-A to control hyperlipidemia in patients with refractory nephrotic syndrome associated with focal segmental glomerulosclerosis is covered by national health insurance. Here, the hypothetical mechanism behind its effect and the evidence for its effectiveness over a long period are reviewed. © 2014 The Author(s).
Sato Y.,Kitano Hospital
Nihon Jinzo Gakkai shi | Year: 2012
We report a case of a 59-year old Japanese woman with short bowel syndrome, whose hypokalemia and hypocalcemia were successfully treated with magnesium (Mg) supplementation. Two years previously, she underwent Mile's operation for advanced rectal cancer, which could have been the cause of subsequent extensive resection of the small intestine by strangulation. After serial resection, she gradually developed chronic diarrhea and anorexia. Three weeks before admission, she developed general fatigue and tetany, and was hospitalized at another hospital. On admission, her serum K and Ca were 2.5 mEq/L and 4.3 mg/dL, respectively, hence regular fluid therapy containing potassium (K) and calcium (Ca) was provided following admission. However, her hypokalemia and hypocalcemia persisted, and she also displayed renal dysfunction and thereafter was transferred to our department for further evaluation and treatment. Since the laboratory tests revealed severe hypomagnesemia (0.4 mg/dL), we started intravenous Mg supplementation together with fluid therapy containing K and Ca. After the combination therapy, her clinical symptoms and electrolyte disorders were remarkably improved within a week. As Mg is essential for PTH secretion in response to hypocalcemia and to inhibit the K channel activity that controls urinary K excretion, hypomagnesemia can cause hypocalcemia and hypokalemia, which is refractory to repletion therapy unless Mg is administered. Therefore, for patients who present with signs of Mg deficiency, early and accurate diagnosis of Mg deficiency should be made and corrected.
Hattori K.,Kitano Hospital
Asian journal of endoscopic surgery | Year: 2012
Single-incision laparoscopic surgery (SILS) has been performed on children for various procedures. However, few reports are available about SILS for small bowel resection, particularly involving conventional instruments in the pediatric population. Herein, we report four cases of small bowel resection with single umbilical incision and a three-trocar approach. From October 2010 to September 2011, we performed small bowel resection with SILS on four cases, including a boy with an intestinal duplication cyst and three children with Meckel's diverticulum. An intraumbilical arcuate incision was made to expose the abdominal wall fascia, and one 5-mm and two 3.5-mm trocars were inserted. It was not necessary to extend the initial incision to exteriorize the lesion except in one case in which we applied the so-called Y-V closure plasty. All procedures were successful and did not require conversion, and all patients recovered smoothly without any complications. Small bowel resection using the SILS approach is suitable for these diseases. © 2012 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.
Sato K.,Tokyo Medical University |
Adachi T.,Kitano Hospital |
Shirai N.,Kitano Hospital |
Naoi N.,Kitano Hospital
Regional Anesthesia and Pain Medicine | Year: 2014
BACKGROUND AND OBJECTIVES: The benefit of adding sciatic nerve block (SNB) to femoral nerve block to improve analgesia after total knee arthroplasty (TKA) is uncertain. We hypothesized that the effective duration of single-injection SNB is too short to improve postoperative analgesia and that this contributes to conflicting results on the efficacy of SNB after TKA. We evaluated this hypothesis in a prospective double-blind randomized controlled trial. METHODS: Sixty patients undergoing TKA were randomly allocated to a continuous SNB group or a single-injection SNB group. All patients received femoral nerve block (0.5% ropivacaine 20 mL) and SNB (0.2% ropivacaine 20 mL) and catheters were inserted into both peripheral nerve block sites before surgery. Both groups received continuous femoral nerve block and patient-controlled intravenous analgesia with morphine. Continuous SNB (0.2% ropivacaine 5 mL/h; continuous SNB group) or sham continuous SNB (0.9% normal saline 5 mL/h; single-injection SNB group) was provided after surgery. The primary outcome was total morphine consumption for 48 hours after surgery. RESULTS: Total morphine consumption in the 48-hour period after surgery was significantly lower in the continuous SNB group compared with the single-injection SNB group [4.9 (5.9) vs 9.7 (9.5) mg, P = 0.002]. Visual analog scale pain scores at rest were also significantly lower in the continuous SNB group (P = 0.035). CONCLUSIONS: The combination of continuous femoral and SNB provides a superior opioid sparing effect and improves analgesia after TKA. © 2014 American Society of Reginal Anesthesia and Pain Medicine.