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Biomedical subjects

H Harano

Publications and source records attributed to H Harano.

At least 37 records · Page 2Linked to original sources
PubMed1997

Torsades de pointes complicating pentamidine therapy of Pneumocystis carinii pneumonia in acute myelogenous leukemia.

Pentamidine isethionate induced torsades de pointes in a 33-year-old woman with acute myelogenous leukemia. This is the first report of Pentamidine-induced torsades de pointes in Japan for over ten years. On the 4th day of intravenous pentamidine for Pneumocystis carinii pneumonia, asymptomatic sinus bradycardia was noted with QT interval prolongation, and torsades de pointes were revealed on the 8th day. Although torsades de pointes was dissolved with discontinuation of the intravenous pentamidine and administration of magnesium sulfate, sinus bradycardia and prolonged QT interval persisted. Ventricular pacing resulted in no arrhythmia and normalization of the QT interval on the 10th day after discontinuation of pentamidine. Careful monitoring of the electrocardiogram should be carried out during intravenous pentamidine therapy.

Adult↗
PubMed1997

[Successful treatment of subdural hematoma with operation in a patient with acute promyelocytic leukemia].

A 51 year-old male admitted with petechiae and headache. Acute promyelocytic leukemia (APL) with disseminated intravascular coagulation (DIC) was diagnosed. He received all-trans retinoic acid (ATRA) with enocitabine and daunomycin for induction chemotherapy, and supportive therapy for DIC. On 2nd day after admission, subacute subdural hematoma was confirmed with CT scan. He had anisocoria and disturbance of consciousness, and was treated with neurosurgical operation for his life saving on the 3rd day. Although DIC was continued at this time, the operation was done without problem. The recurrence of hematoma has not occurred after the operation. Furthermore, the findings of DIC disappeared by the day 6 following induction therapy. He achieved a complete remission including cytogenetic findings on 35th day after administration of ATRA and received 3 times of combination chemotherapy as consolidation therapy. It may be difficult to do neurosurgical treatment in the setting of DIC. However, we should consider whether the indications for surgery operation according to the condition of each patient.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

[Graft-versus-leukemia effect induced by abrupt discontinuation of cyclosporine A following allogeneic bone marrow transplantation].

Cyclosporine A (CyA) was abruptly discontinued in an attempt to induce graft-versus-leukemia (GVL) effect following allogeneic bone marrow transplantation (BMT). It appeared that GVL effect was co-expressed with graft-versus-host disease (GVHD) in 2 of 4 patients and especially minimal residual disease was eliminated during GVHD in a patient with Philadelphia-positive acute lymphocytic leukemia. Subpopulation of cytotoxic T and natural killer cells increased significantly in patients with discontinuation of CyA. This finding suggests that GVL effect was increased following discontinuation of CyA. These results may provide a therapeutic strategy after BMT in patients with high-risk group for relapse of leukemia.

Acute Disease↗
PubMed1996

[Chronic myelocytic leukemia associated with cytomegalovirus induced sialoadenitis after unrelated allogeneic bone marrow transplantation].

A 26-year-old male with chronic myelocytic leukemia was admitted for unrelated allogeneic bone marrow transplantation (BMT). After BMT, he developed swelling of biateral submandibular glands accompanied with pneumonitis possibly due to cytomegalovirus (CMV). Biopsy from the left submandibular gland showed giant cells with nuclear inclusion bodies that were positive for anti-CMV-IE monoclonal antibody, there fore cytomegalic sialoadenitis was diagnosed. The administration of ganciclovir resulted in resolution of the pnumonitis and submandibular gland swelling. Although cytomegalic sialoadenitis is not a life-threating complication in BMT patients, it should be noted that biopsy is very useful for the diagnosis of systemic cytomegalovirus infection.

Adult↗
PubMed1996

[Hypoplastic mixed lineage leukemia successfully treated with low-dose cytosine arabinoside].

A 54-year-old male was admitted because of dyspnea on exercise. His peripheral blood revealed pancytopenia with severely hypoplastic bone marrow. Bone marrow aspiration showed a marked hypocellular marrow with 62.4% of blast cells. Cytochemical studies showed that peroxidase activity, alpha-nephtyl buthylate esterase activity and PAS reaction were negative, and that only ASD-chroloacetate esterase activity was positive. Surface marker analysis of blast cells showed positive result for CD5, 7, 33 and 34 antigens. The T-cell receptor beta gene was rearranged, but the immunoglobulin H chain gene showed a germ line configuration. Terminal Deoxynucleotydyl Transferase (TdT) was positive, but cellular surface and cytoplasmic immunoglobulin were not recognized. A diagnosis of hypoplastic mixed lineage leukemia was made and treated with low dose cytosine arabinoside, he resulted in complete remission. The relation between hypoplastic leukemia, AML-M0 and mixed lineage leukemia was also discussed.

Antimetabolites, Antineoplastic↗
PubMed1996

[Acute appendicitis caused by mucorales in a patient with severe aplastic anemia: report of an autopsy case].

A male patient with severe aplastic anemia was admitted for bone marrow transplantation. While waiting for a donor, high doses of methylprednisolone, anabolic steroid and granulocyte colony stimulating factor were given without response. Deferoxamine was administered for prophylaxis of hemochromatosis because of high level of ferritin. Acute right lower abdominal pain and pyrexia developed. A diagnosis of acute appendicitis was made and appendectomy was performed. The histopathological examination of the resected appendix revealed necrotizing hemorrhagic appendicitis with numerous hyphae of Mucorales. Though anti-fungal agent (amphotericin B) administration was continued, he subsequently developed ileo-cecal abscess and eventually died due to myoglobinuric nephropathy caused by extensive necrosis of the iliopsoas muscle. Autopsy revealed dissemination of hyphae of Mucorales in lungs, kidneys, large vessels and muscle of the bilateral lower limbs. Systemic vascular invasion and embolization of fungal hyphae were also observed. However, culture of exudate sampled from ileocecum yielded no Mucorales. It was emphasized that antemortem diagnosis and effective anti-fungal treatments are essential for the management of intestinal mucormycosis. The relation ship between mucormyocosis and deferoxamine was also discussed.

Acute Disease↗
PubMed1996

Acquired type 2A von Willebrand disease in chronic myelocytic leukemia.

Acquired von Willebrand disease (vWD) has been described in a few patients with chronic myelocytic leukemia (CML). We present here acquired type 2 vWD associated with CML and provide characterization of an inhibitor to von Willebrand factor (vWF) from this patient. His bleeding time was prolonged. Ristocetin-induced platelet agglutination was abolished whereas botrocetin-mediated aggregation was normal. Multimeric analysis of vWF from patient's plasma showed that larger sizes of multimers were reduced. His past and family histories were negative for bleeding tendency. These results suggested that acquired type 2 vWD was present during his clinical course. The inhibitor was purified by Staphylococcal protein A, suggesting an IgG antibody. Both binding of 125I-vWF to GPIb and platelet agglutination by ristocetin were inhibited by the patient IgG with the concentrations of competing substances necessary to inhibit specific binding by 50% (IC50s) of 260 micrograms/ml and 420 micrograms/ml, respectively. However, the IgG had no effect on these studies mediated by botrocetin. The IgG only reacted with intact vWF and a 39/34 kDa fragment of vWF. These results indicate that the recognition of GPIb binding site(s) on vWF by the IgG is a central pathogenesis of acquired type 2 vWD in this case.

Bleeding Time↗
PubMed1995

Predicting relapse of chronic myelogenous leukemia after allogeneic bone marrow transplantation by bcr-abl mRNA and DNA fingerprinting.

Fourteen patients treated by allogeneic bone marrow transplantation for chronic myelogenous leukemia (CML) were evaluated by the polymerase chain reaction (PCR) for bcr-abl-specific transcripts. Nine patients were transplanted in the first chronic phase, three in the second chronic phase, and two in the accelerated phase. All patients achieved a complete cytogenetic and hematologic remission after bone marrow transplantation. Twelve patients are alive (median, 18 months; range, 5-54 months) and two patients died early. bcr-abl mRNA was persistently detectable for 6 to 54 months in four patients (patients 1, 3, 4, 6). From two of them, DNA fingerprint analysis showed only donor type DNA although bcr-abl mRNA was detectable. bcr-abl mRNA was never detectable posttransplant in three patients (patients 2, 5, 13). Six patients had detectable bcr-abl mRNA (patients 8-12, 14): by 6 months, all of these patients were bcr-abl mRNA negative. One patient (patient 7) had detectable full bcr-abl mRNA again at 12 months, but was then negative at 20 months. Ten patients (patients 2, 4-8, 10-13) had never detectable Philadelphia (Ph1) chromosome t(9.22) translocation, whereas four patients had detectable Ph1 (patient 1, 3, 9, 14); by 6 months, three of four cases were negative. One patient (patient 1) had detectable Ph1 at 44 months, but was negative at 50 months. Three of six patients who initially had bcr-abl mRNA detectable posttransplant (patient 7-9) became negative for bcr-abl mRNA at the time of development of chronic graft-versus-host disease (GVHD). These results suggest that the detection of subclinical Ph1 positive cells by PCR is not associated with imminent clinical or cytogenetic relapse. Moreover, graft-versus-leukemia (GVL) activity may contribute to the treatment of minimal residual disease in CML after allogeneic bone marrow transplantation.

Adolescent↗
PubMed1995

Case report: inhalation therapy of paromomycin is effective for respiratory infection and hypoxia by cryptosporidium with AIDS.

A 24-year-old man with AIDS and hemophilia A had intractable diarrhea and fever. Upon examination of stool and of a sigmoidal biopsy specimen, cryptosporidium was revealed. Approximately 2 months after admission, respiratory infection with hypoxia due to cryptosporidium developed. Paromomycin inhalation was effective therapy. To the authors' knowledge, this is the first case of respiratory cryptosporidiosis treated successfully by paromomycin inhalation.

AIDS-Related Opportunistic Infections↗
PubMed1995

[Familial occurrence of von Hippel-Lindau disease--a case report].

It is well known that von Hippel-Lindau disease is defined as the association of retinal angiomatosis and cerebellar hemangioblastomas. This disease is frequently associated with extra-neural vascular neoplasma, especially visceral angiomatous tumors. In this paper we report the familial occurrence of von Hippel-Lindau disease in a 55-year-old mother and her 24-year-old son. The mother had simultaneous multiple angiomas of the liver, stomach and head of the pancreas. The initial symptom was sudden onset of vertigo, possibly caused by a slow-growing cystic cerebellar lesion. An apparent genetic factor indicates that clinical settings begin in the early life of the patients.

Adult↗
PubMed1994

Liver function tests of recipients with hepatitis C virus infection after bone marrow transplantation.

We used the polymerase chain reaction (PCR) to determine the presence of hepatitis C virus (HCV)-RNA in serum samples obtained from 19 patients with leukaemia or severe aplastic anaemia and investigated the correlation between HCV status and the results of liver function tests after bone marrow transplantation. PCR analysis of serum samples obtained before transplant showed that 10 of 18 patients were HCV-RNA-positive; 5 of these patients had developed acute post-transfusion hepatitis 1-11 months before transplant. An additional patient was HCV-RNA-positive on post-transplant day 62. Eight HCV-RNA-positive patients had pre-transplant GPT levels above the upper limit of normal. In these patients the GPT decreased significantly from a median of 104 IU/l (54-822 IU/l) pre-transplant to 23 IU/l (15-56 IU/l) on post-transplant days 8-12. In 9 of 11 HCV-RNA-positive patients, the GPT increased transiently from days 40 to 50 and again increased after day 100. Two of these patients died from hepatic failure; the GPT levels normalised in 3 patients after day 300 but continued to fluctuate in 4 patients. In the remaining 2 HCV-RNA-positive patients, the GPT remained close to the normal range throughout the follow-up period. Three HCV-RNA-positive patients became HCV-RNA-negative after 1-3 years. In these patients, the GPT remained normal for > 3 years after day 300.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Triclonal gammopathy (IgA kappa, IgG kappa, and IgM kappa) in a patient with plasmacytoid lymphoma derived from a monoclonal origin.

We report the case of a 64-year-old woman with plasma cytoid lymphoma of the ileum and gastric wall. Serum protein electrophoresis and immunoelectrophoresis showed a triclonal IgG kappa, IgA kappa, and IgM kappa gammopathy. Biopsy of the tumor revealed three different cell types, which were stained with antibodies specific for IgG, IgA, and IgM. However, DNA analysis of immunoglobulin gene rearrangements using JH, C mu, and C kappa gene probes showed a monoclonal pattern. These results suggest that the three types of malignant cells producing different classes of immunoglobulins were derived from a single clone of B-cells that had undergone a "class switch".

Blotting, Southern↗
PubMed1993

Evaluation of chimerism after bone marrow transplantation with single locus minisatellite DNA probes.

The origin of cells in almost all allogeneic donor-recipient pairs can be determined through the use of highly polymorphic minisatellite DNA probes. Single-locus probes were cloned from hypervariable fragments in a human DNA fingerprint detected with a multi-locus probe. While each probe is highly polymorphic and locus specific, they all contain repetitive sequences. The properties of single-locus probes have improved the sensitivity of detecting mixed chimerism in comparison with multi-locus probes. The use of single-locus probes permitted detection of mixed chimerism (MC) at levels as low as 0.625%, approaching that obtained by PCR methods. In the present study, five patients who received allogeneic BMT for hematologic malignancies were analyzed. Two patients exhibited MC after BMT. One developed acute GVHD and chronic GVHD and remained in CR while the second patient who had no signs of GVHD suffered a relapse.

Adult↗
PubMed1993

[A comparative study of VEPA and ACOMEP-BD regimen for the patients with non-Hodgkin's lymphoma].

Between 1981 and 1990, ACOMEP-BD regimen (adriamycin, cyclophosphamide, vincristine, methotrexate, etoposide, prednisolone, bleomycin, dacarbazine) was compared with VEPA regimen (vincristine, cyclophosphamide, prednisolone, adriamycin) in 66 newly diagnosed patients younger than 65 of age, with non-Hodgkin's lymphoma (NHL). The median age of the patients was 47.5 years (range 22-64 years), 43 males and 23 females. One patients were in stage I, 6 were in II, 27 were in III, 32 were in IV. Twenty-seven patients received VEPA and 39 received ACOMEP-BD. The therapeutic results of 66 patients with ACOMEP-BD or VEPA were as follows: complete remission (CR) rate of 54% and 48%; relapse rate of 29% and 77%; CR duration of 2-34 months (mean: 22 months) and 2-74 months (16 months); freedom-from-relapse survival (at 3 years) of 71% and 38%; and overall survival (at 4 years) of 62% and 26%, respectively. In these results, only relapse rate was significant and the others were not. Prognostic factors were performance status (PS) and lactate dehydrogenase level for ACOMEP-BD, and PS and marrow involvement for VEPA. Received dose intensity was 0.85 in ACOMP-BD and 0.41 in VEPA. It was expected that outcome of patients with NHL can be improved by increasing dose intensity.

Adult↗
PubMed1993

[Neutrophilic myelofibrosis; a case report].

A 53-year-old male was admitted to our hospital with abdominal pain. Physical examination revealed marked splenomegaly. The white blood cell count increased to 5.8 x 10(4)/microliters. Bone marrow biopsy showed hypercellularity with a moderate increase in reticulin fiber. Chromosomal analysis showed 47, XY, +9q-, -9q- without Ph1 chromosome and bcr-abl rearrangement. MCNU therapy was successful in reducing the white blood cell count and splenomegaly. It is likely that the diagnosis of our patient is compatible with the neutrophilic myelofibrosis described by Stewart, et al.

Blood Cell Count↗
PubMed1992

Low-dose cytosine arabinoside for treating hypocellular acute leukemia in the elderly.

Ten previously untreated elderly patients with hypocellular acute leukemia received a low dose of cytosine arabinoside (Ara-C), 10 mg/m2 injected subcutaneously every 12 hours for 14-28 days. Six patients achieved a complete remission (CR) for periods ranging for 6-23 months (median 8.5 months) and the others had a partial remission (PR). Relapse has occurred in three patients to date. The median survival ranged from 10-24 months (median 14.5 months). Only two of the six patients, in whom bone marrow biopsy was performed at CR, had a normal cellularity. This change, however, did not appear to be a significant prognostic factor in those patients. In seven patients who achieved a CR or PR low-dose Ara-C was administrated as maintenance therapy at the same low dose for 10 days each month. Treatment was well tolerated in all patients despite for myelosuppression. There were no drug-related deaths. These observations suggest that low-dose Ara-C is effective in treating elderly patients with hypocellular acute leukemia.

Acute Disease↗
PubMed1992

Case report: fulminant hepatitis C viral infection after allogeneic bone marrow transplantation.

The authors describe two patients with acute leukemia who died of fulminant hepatitis caused by hepatitis C virus (HCV) after an allogeneic bone marrow transplant, the first such cases reported in Japan. Both had developed posttransfusion hepatitis during chemotherapy to induce remission and for consolidation. Six months after blood transfusion, the blood serum of each patient was positive for HCV antibody and HCV RNA. In each case, there was a transient improvement in liver function after the transplant. However, within 5 months of receiving the transplant and coincident with the withdrawal of cyclosporin A, each patient developed an acute exacerbation of hepatitis. The fulminant hepatitis in our patients may, therefore, have been caused by the reactivation of HCV induced by the immunosuppressive therapy followed by a reconstitution of the immune system.

Adult↗