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Biomedical subjects

H Yabe

Publications and source records attributed to H Yabe.

At least 19 recordsLinked to original sources

Effects of naltrexone and ethanol on auditory event-related brain potentials.

Acute effects of ethanol (0.55 g/kg) and the opioid antagonist naltrexone (50 mg) on auditory event-related brain potentials (ERP) (i.e., electrical brain activity time-locked to sensory stimuli) were investigated in 13 healthy social drinkers, using a double-blind, placebo-controlled, design. The subjects' task was to attend to tones presented to a designated ear while ignoring tones to the other, and to detect deviant tones among the attended tones. When administered alone, naltrexone significantly reduced the amplitude of the later part of negative difference (Nd[l]), suggesting impaired selective attention. However, this effect might have been caused by naltrexone-induced nausea. Ethanol, when ingested alone, attenuated the amplitude of the N1, and increased the peak latencies of the mismatch negativity (MMN) and N2b that have been suggested to reflect automatic change detection in audition and allocation of attentional resources to processing of stimulus deviance, respectively. In contrast, the P1 amplitude was augmented by alcohol, but only when the tones were attended. When ethanol and naltrexone were simultaneously ingested, however, the alcohol-induced P1 amplitude augmentation was canceled, thus tentatively suggesting opioidergic mediation of this alcohol effect. In contrast, the MMN peak latency was increased significantly more in the interaction condition than in the ethanol condition, thus suggesting that the detrimental effects of alcohol on involuntary attention switching were augmented by naltrexone. Furthermore, the N2b amplitude was significantly suppressed in the interaction condition, suggesting attentional impairment.

Adult

Multiple smooth muscle tumors arising in deep soft tissue of lower limbs with uterine leiomyomas.

A 40-year-old woman had multiple smooth muscle tumors in the left inguinal region, the bilateral thighs, the omentum, the peritoneum, and the right infundibulum pelvic ligament associated with uterine leiomyomas. She had a history of uterine leiomyomas, which were resected 13 years ago. Histopathologic evaluation revealed tumor masses composed of smooth muscle cells with relatively low cellularity, which were consistent with a diagnosis of leiomyoma. Tumor necrosis and nuclear atypia were absent. Mitotic figures were very scarce (less than 1 mitotic figure per 10 high-power fields). Immunohistochemical evaluation revealed a positive reaction of the tumor cells to muscle markers, estrogen receptors, and progesterone receptors. No pulmonary lesion was found. Similar instances of uterine leiomyomas with histologically benign extrauterine smooth muscle tumors have been reported. This curious condition has been referred to as "benign metastasizing leiomyoma," in which most of the reported cases involve the lungs. The distribution of extrauterine tumors in our case is very unusual and may be the first case with multiple leiomyomas in deep soft tissue of the limbs. Consideration was given to the concept that these may be of multifocal origin, rather than metastases.

Adult

Temporal window of integration revealed by MMN to sound omission.

The central auditory system for event perception involves the integrating mechanism of sequential information addressed by the present study. The mismatch negativity (MMN) component of the event-related potentials (ERP) reflects the automatic detection of sound change. ERPs to occasionally omitted stimuli were measured when sequences with constant stimulus onset asynchronies (SOAs) were presented. In separate blocks, the SOA was from 100 to 350 ms. A clear MMN was elicited by a stimulus omission in a sequence of regularly spaced tone pips only when the SOA was shorter than 150 ms, yielding an estimate for the duration of the temporal window of integration used the perceptual segregation of auditory events.

Acoustic Stimulation

Fatal interstitial pulmonary disease in a patient with dyskeratosis congenita after allogeneic bone marrow transplantation.

Chronic restrictive lung disease in a 9-year-old boy with dyskeratosis congenita (DC) 7 years after allogeneic bone marrow transplantation (BMT) is described. When he was 1 year and 10 months old, severe aplastic anemia developed. He received a marrow transplant from his HLA serologically identical, but HLA-DP mismatched brother. He developed grade II acute graft-versus-host disease (GVHD) and thereafter chronic GVHD of progressive type, and was treated with both prednisolone and azathioprine resulting in clinical improvement. Thereafter he complained of dyspnea, and bilateral noncircumscribed interstitial shadows on chest CT scan were present. His pulmonary function showed restrictive changes. Prednisolone was not effective and he died of respiratory failure. Post-mortem examination confirmed interstitial fibrosis, lymphocytic infiltration of the bronchioles and alveoli with luminal fibrosis. There was no evidence of chronic GVHD in the skin and the liver. These findings raise the possibility that this pulmonary complication was associated with DC itself.

Anemia, Aplastic

[Umbilical cord blood transplantation for a patient with Diamond-Blackfan syndrome].

A five-year-old girl with Diamond-Blackfan syndrome received cord blood transplantation from an HLA-identical sibling. The patient showed pale face at birth, and was diagnosed to have Diamond-Blackfan syndrome. She had been treated with prednisolone (PSL), high dose of methylprednisolone, erythropoietin, and anti-lymphocyte globulin. Despite of these intensive therapies, erythropoiesis did not entirely improve, and transfusion of red blood cells had been required every third or fourth week until cord blood transplantation. Conditioning regimen consisted of thoraco-abdominal irradiation (TAI; 8 Gy), cyclophosphamide (CY; 50 mg/kg x 4), and anti-thymocyte globulin (ATG; 2.5 mg/kg x 4), Cyclosporin (CyA 3 mg/kg) was administered for the prophylaxis of graft-versus-host disease (GVHD). 4.14 x 10 (7)/kg of cord blood mononuclear cells were infused to the patient. White blood cell (WBC) and reticulocyte counts increased promptly, but recovery of platelet count was delayed. Skin GVHD (grade I) appeared on day +9, which responded to the administration of PSL (2 mg/kg). Chromosomal analyses of bone marrow cells for sex mismatch revealed complete chimerism on day +14, on day +28 and thereafter. Umbilical cord blood cells can be an alternative source of hematopoietic stem cells for allogeneic transplantation.

Child, Preschool

[Therapeutic effect of donor leukocyte transfusion in relapsing marrow transplants in Japan].

The immune reactivity of allogeneic lymphocytes plays a major role in control of leukemia after bone marrow transplantation. We studies the efficacy of donor leukocyte transfusion (DLT) on acute and chronic leukemia in relapse after bone marrow transplantation in Japan. Sixty nine patients with chronic myelocytic leukemia (N = 17), acute lymphoblastic leukemia (N = 25), acute myelocytic leukemia (N = 26), myelodysplastic syndrome (N = 5), non-Hodgkin lymphoma (N = 2) and rhabdomyosarcoma (N = 1) were treated with transfusions of donor lymphocytes. Therapeutic effects were induced by donor leukocyte transfusion in 20 patients (29%) including 3 patients out of 4 (75%) with CML in cytogenetic and chronic phase relapse, 4 out of 5 (80%) patients with myelodysplastic syndrome, 3 out of 13 (23%) patients with CML in transformed phase, 5 out of 25 (20%) patients with acute myelocytic leukemia, and 4 out of 20 (20%) patients with acute lymphoblasic leukemia. Twenty two patients (30%) developed acute GVHD (> or = 2) and 6 out of 73 (8.2%) patients developed fatal GVHD after donor leukocyte transfusion. Patients relapsed within 6 months after marrow transplantation had a probability of having severe acute GVHD (> or = 2) after DLT. Fourteen out of 24 (58%) patients with GVL response were re-relapsed thereafter. Minimal dose of donor leukocytes infused in successfully treated 9 patients without cytoreductive therapy was 2 x 10(7)/kg in total and minimal dose of that in 6 patients with fatal GVHD was 7 x 10(7)/kg in total. The anti-leukemia effect of donor leukocyte transfusion was strongest against CML in cytogenetic and chronic phase and induce a durable complete remission.

Adolescent

The results of surgery on primary malignant tumors of the spine.

The results of surgery on primary malignant tumors of the spine in 18 patients treated in our hospital between 1976 and 1993 were reviewed. Curettage was less effective in controlling primary malignant lesions than wide excision, and the condition of the resected margin was closely related to the prognosis of the disease. Some patients in the hematopoietic tumor group receiving combined adjuvant therapy survived for a long time. The role of surgery is important in tumors such as chordoma and chondrosarcoma that have low sensitivity to adjuvant therapy, and it is essential to secure tumor-free resected margins.

Adolescent

Relapsing hemorrhagic varicella.

A 15 year old boy with a past history of chickenpox in infancy was complicated by lethal varicella during the course of chemotherapy against recurrent acute myeloblastic leukemia. He had received allo-bone marrow transplantation and had overcome a graft-versus-host disease. The skin eruptions were hemorrhagic and progressive during the last 3 weeks, with numerous intranuclear inclusions histologically confirmed in the involved epidermis, hair follicles and endothelial cells. Immunohistochemical and electron microscopic studies confirmed the infection of varicella-zoster virus.

Adolescent

Successful engraftment of allogeneic CD34-enriched marrow cell transplantation from HLA-mismatched parental donors.

The CD34 antigen is expressed on pluripotent stem cells and the CD34+ cell has been shown to be capable of hematopoietic reconstitution in animal and human autologous grafts. We asked if CD34+ cells could reconstitute hematopoiesis in human allogeneic transplantation from a HLA-mismatched donor. Three pediatric patients with advanced leukemia received allogeneic CD34-enriched marrow cell graft from HLA two (two patients) or three (one patient) loci-mismatched parental donors. CD34+ cell selection was performed with mouse anti-CD34 antibody 9C5 and magnetic beads coated sheep anti-mouse IgG1. 1.53 to 2.48 x 10(9) marrow cells were processed and 2.53 to 7.89 x 10(7) positively selected cells were recovered. The selected population showed 93.7 to 99.0% CD34+ cells and total recovery of CD34+ cells from the starting population was 54.6 to 62.3%. CD34+ cell selection resulted in more than 99.9% depletion of CD5+ cells from the bone marrow. The patients received 2.53 to 7.25 x 10(6) CD34-enriched cells/kg after myeloablative therapy. All patients achieved trilineage engraftment that was confirmed by various genetic markers. Acute graft-versus-host disease (GVHD) was grade 0 (two patients) or grade I (one patient), and hematological recovery was successfully achieved as follows; the days to reach granulocytes over 0.5 x 10(9)/I were 11 to 13 days, reticulocytes over 2% was 18 to 28 days, platelets over 50 x 10(9)/I was 33 to 58 days. One patient is surviving without relapse of leukemia and two patients died after either mixed hematopoietic chimerism or leukemia relapse was observed. These studies suggest that CD34+ marrow cells are capable of hematopoietic reconstitution from HLA two or three loci-mismatched donors even with the lowest dose of mature T cells.

Adult

[Direct detection of human cytomegalovirus in urine specimens from bone marrow transplant patients by polymerase chain reaction].

Human cytomegalovirus (HCMV) infection is a major causative life-threatening agent that results in opportunistic infections in bone marrow transplant patients. Since antiviral therapy is available for severe HCMV infections, methods to rapidly identify infected patients are needed so that therapy can be promptly instituted. In this study, we used direct method to detect HCMV in urine specimens by nested polymerase chain reaction (nested-PCR) to monitor urinary excretion of HCMV in patients undergoing bone marrow transplantation. The viral DNA was amplified directly from preheated urine without further treatment prior to amplification. Five microliter of urine proved to give the most efficient amplification. The detection limit of the PCR assay for detection of HCMV was 10 copies/microl. The positive rate of the PCR assay and the tissue culture method for detection of HCMV were 15 of 61 (24.6%) and 4 of 61 (6.6%), respectively. Sensitivity and specificity of the PCR assay were 100% and 81% respectively. Based on these data, urinary excretion of HCMV in 21 patients undergoing bone marrow transplantation were monitored weekly by the PCR assay. As a result, in addition to a higher sensitivity, the PCR assay allowed to identify HCMV infection 3.1 (1 approximately 5) weeks earlier than culture method or antibody elevation. Repeated monitoring of virus excretion by this rapid and simple method was useful to promptly detect HCMV infection, allowing proper institution of antiviral drug therapy in patients undergoing bone marrow transplantation.

Adolescent

[Cord blood stem cell transplantation for a patient with acute myelogenous leukemia (M1)].

A five-year-old boy with acute myelogenous leukemia in relapse was treated by HLA-matched cord blood stem cell transplantation. The patient was preconditioned with 16 mg/kg of busulfan, 15 mg/kg of thiotepa and 90 mg/kg of cyclophosphamide and 2.45 x 10(7)/kg of cord blood mononuclear cells were infused to the patient on October 19th 1995 without the prophylaxis of graft-versus-host disease (GVHD). From the fifth day following the transplant, rG-CSF was administered at a dose of 300 micrograms/m2/day. Hematopoietic recovery was obtained as following; WBC over 1000/microliters was on +18 day, neutrophil over 500/microliters was on +20 day, reticulocyte over 20/1000 was on +28 day and platelet over 50 x 10(2) microliters was on +91 day. Engraftment was confirmed by DNA restriction fragment length polymorphism (VNTR) on +28 day. In spite of absence of prophylaxis of GVHD, the patient did not develop any signs of GVHD, and leukemia relapsed on +105 day. The patient died of leukemia relapse on +251 day. This is the first case of cord blood stem cell transplantation in Japan.

CD4-CD8 Ratio

[Recent progress in treatment and prophylaxis of graft-versus-host disease].

Graft-versus-host disease (GVHD) is one of major causes of mortality in allogeneic bone marrow transplantation (BMT). GVHD prophylaxis for HLA matched sibling BMT is widely done by methotrexate and/or cyclosporine. More intensive modalities are necessary for HLA mismatched related or HLA matched unrelated BMT; T cell depletion, ALG/ATG in preconditioning or following BMT and FK-506 with short term methotrexate are currently used with certain success. Moderate to severe GVHD may develop despite of these preventions, and standard to high dose of steroid with or without ALG/ATG is currently used as the first line therapy. GVHD, however, is an important component to cure malignant diseases through its anti-tumor effect called graft-versus-leukemia (GVL) effect. Several attempts have been made to induce mild to moderate GVHD both in allogeneic and in autologous BMT; low dose of cyclosporine, IL-2, ubenimex and donor buffy coat or peripheral lymphocyte transfusion are shown to be effective with some limitation.

Bone Marrow Transplantation

Bispecific antibody-mediated cytotoxicity by CD4+ and CD8(+)-activated T cells generated from leukemia patients after allogeneic bone marrow transplantation.

The F(ab')2 bispecific antibody (BSAb) was prepared from anti-CD3 moAb and anti-CD10 moAb. The BSAb could react with both CD3+ T cells and CD10+ leukemia cells and triggered T cell-mediated cytotoxicity. To apply the BSAb to prevention of leukemic relapse after BMT, we investigated the generation of both CD4+ and CD8+ anti-tumor effector T cells from patient's PBMC 14 days after BMT. Neither CD4+ T cells nor CD8+ T cells, which were activated with immobilized anti-CD3 moAb plus IL-2, could lyse CD10+ leukemia cells by themselves, but they showed augmented cytotoxicity against CD10+ leukemia cells by targeting with anti-CD3 x anti-CD10 BSAb. Moreover, the activated CD4+ T cells were demonstrated to produce IL-2 and IFN-gamma when they were cultured with CD10+ leukemia cells in the presence of the BSAb. The BSAb-mediated cytotoxicity of activated T cells was demonstrated not only against the recipient leukemia cells but also against third party leukemia cells. These results suggested that anti-CD3 x anti-CD10 BSAb might be a good tool to prevent relapse after BMT in combination with activated CD4+ T cells and CD8+ T cells.

Antibodies, Monoclonal

The strategy to treat disseminated neuroblastoma utilizing bone marrow transplantation: what is the surgeon's role?

The current role of surgery was evaluated in seven consecutive patients with high-risk neuroblastoma (six stage 4 patients and one stage 3, abdominal origin, and all over 12 months of age at diagnosis) treated with new modalities utilizing bone marrow transplantation (BMT). In six of these seven patients, a grossly complete excision of the primary tumor was achieved, and four have survived for 133, 69, 39, and 28 months with no further evidence of disease. The remaining patient with celiac neuroblastoma only underwent a biopsy during a second-look laparotomy after chemoradiotherapy, and thereafter developed local and distant recurrences and ultimately succumbed to the tumor. The timing of surgical intervention varied, either before or after chemotherapy, and did not appear to affect the ultimate survival. Although surgical excision of the primary tumor remains a very high priority in the overall treatment scheme, the most important factor remains the eradication of the tumor by well-planned courses of intensive chemotherapy (e.g., A1 Protocol of the Study Group of Japan). Thus, after having induced complete remission, for consolidation, it is necessary to kill all remaining tumor cells by giving supralethal doses of chemotherapy including total body irradiation (TBI) assisted by BMT.

Adrenal Gland Neoplasms