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1.
Int J Hematol ; 2024 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-38951435

RESUMEN

Hematopoietic stem cell transplants for inherited metabolic disorders performed at Tokai University Hospital between June 5, 1986, and May 28, 2021, were analyzed and compared between the period before 2007 and the period from 2007 onward based on availability of medical resources. Transplants were performed for 38 patients with mucopolysaccharidosis, 33 with adrenoleukodystrophy, and 16 with another disorder. Before 2007, oral busulfan-based regimens were mainly used. From 2007 onward, intravenous busulfan-based regimens or 4 Gy of thoracoabdominal irradiation (TAI), fludarabine, and melphalan (Mel)/treosulfan were adopted. Between 2002 and 2010, adrenoleukodystrophy was treated with 12 Gy of TAI and Mel. HLA-identical sibling bone marrow was used in 43% of cases before 2007 and 15% from 2007 onward, while alternative donors were selected for other transplants. Overall survival and event-free survival (EFS) before 2007 and from 2007 onward were 76% and 62%, and 97% and 85%, respectively (P = 0.006 and 0.017). Transplant era predicted superior overall survival and EFS, while myeloablative conditioning also predicted EFS. The incidence of primary graft failure decreased from 2007 onward, especially in cord blood transplant when 4 Gy of TAI with 150 mg/m2 fludarabine and 180 mg/m2 Mel or 42 g/m2 treosulfan were used as conditioning.

2.
IJU Case Rep ; 7(2): 91-94, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38440720

RESUMEN

Introduction: Up to 10% of patients with renal cell carcinoma present with tumor thrombus in the inferior vena cava. We report that a case of small renal cell carcinoma with tumor thrombus extending above the diaphragm for which transvenous biopsy was performed for diagnosis. Case presentation: A 79-year-old man performed computed tomography to evaluate hepatic dysfunction, which revealed intravenous tumor extending above the diaphragm and a 15-mm-sized exophytic tumor in right kidney. Imaging suggested that the renal tumor was renal cell carcinoma. As this tumor was small and exophytic, confirmation of the intravenous tumor being tumor thrombus associated with renal cell carcinoma was difficult. We simultaneously performed transvenous biopsy on the intravenous tumor and percutaneous biopsy on the renal tumor for obtaining histologic diagnoses. The final diagnosis was small renal cell carcinoma accompanied by tumor thrombus above the diaphragm. Conclusion: Transvenous biopsy may be useful for the definitive diagnosis of inferior vena cava-tumor thrombus in cases of small renal cell carcinoma.

3.
Surg Today ; 49(11): 936-941, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31243553

RESUMEN

PURPOSE: To improve diagnostic accuracy in cases of a suspected inguinal hernia, we perform a "CT hernia study," with the patient lying prone to allow decompression of the structures in the inguinal region. METHODS: We reviewed the records of 914 patients with a suspected inguinal hernia who underwent prone non-contrast lower abdominal CT with two rolled-up towels, 20 cm in diameter, placed transversely beneath them, at the umbilicus and hips, respectively. RESULTS: The CT hernia study yielded a diagnosis of inguinal hernia in 861 (94.2%) patients and a condition other than inguinal hernia in 43 (4.7%) patients. Hernia was not detected preoperatively but found intraoperatively in 10 patients (1.1%). Surgery was performed for a collective total of 1029 hernias in 873 patients, and the CT hernia study-based hernia detection rate was 98.3%. We compared the preoperative diagnoses of various types of hernia (Japanese Hernia Society Types I-V) against the intraoperative diagnoses and found that the CT hernia study yielded 95.8% accuracy. CONCLUSION: The CT hernia study appears to provide a high detection rate and makes differentiating the various types of inguinal hernia possible. We believe our CT hernia study adds a level of objectivity that is diagnostically beneficial.


Asunto(s)
Hernia Inguinal/diagnóstico por imagen , Posición Prona , Tomografía Computarizada por Rayos X/métodos , Anciano , Anciano de 80 o más Años , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sensibilidad y Especificidad
4.
Jpn J Radiol ; 37(3): 245-254, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30554302

RESUMEN

PURPOSE: To test the tagging efficacy, patient acceptability, and accuracy of computed tomographic colonography (CTC) with a reduced dose of laxative using a novel barium sulfate (BaSO4) contrast agent. MATERIALS AND METHODS: CTC followed by optical colonoscopy (OC) was performed on 73 patients with positive results in fecal occult blood tests. They were administrated a BaSO4 suspension and a magnesium citrate solution for bowel preparation. Patients completed a questionnaire about the acceptability of bowel preparation. Tagging efficacy was estimated using a novel categorization system, which classified all segments into 8 categories. The accuracy of detecting protruded lesions ≥ 6 mm was calculated from the comparison of CTC and OC results, using the latter as a reference standard. RESULTS: Tagging efficacy was good in 77.3% of colonic segments where residue was observed. The acceptability of bowel preparation for CTC was significantly higher than that for OC. The sensitivity, specificity, and positive and negative predictive values were 0.778, 0.945, 0.824, and 0.929, respectively. All lesions ≥ 7 mm were successfully detected by CTC. CONCLUSION: CTC with a reduced dose of laxative using a novel BaSO4 contrast agent has a favorable tagging efficacy, patient acceptability, and accuracy.


Asunto(s)
Sulfato de Bario , Colonografía Tomográfica Computarizada/métodos , Medios de Contraste , Intensificación de Imagen Radiográfica/métodos , Adulto , Anciano , Femenino , Humanos , Japón , Laxativos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Encuestas y Cuestionarios
5.
Ann Hematol ; 98(2): 271-280, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30368588

RESUMEN

Fanconi anemia (FA) is a genetically and clinically heterogeneous disorder that predisposes patients to bone marrow failure (BMF), myelodysplastic syndromes (MDS), and acute myeloid leukemia (AML). To study which genetic and phenotypic factors predict clinical outcomes for Japanese FA patients, we examined the FA genes, bone marrow karyotype, and aldehyde dehydrogenase-2 (ALDH2) genotype; variants of which are associated with accelerated progression of BMF in FA. In 88 patients, we found morphologic MDS/AML in 33 patients, including refractory cytopenia in 16, refractory anemia with excess blasts (RAEB) in 7, and AML in 10. The major mutated FA genes observed in this study were FANCA (n = 52) and FANCG (n = 23). The distribution of the ALDH2 variant alleles did not differ significantly between patients with mutations in FANCA and FANCG. However, patients with FANCG mutations had inferior BMF-free survival and received hematopoietic stem cell transplantation (HSCT) at a younger age than those with FANCA mutations. In FANCA, patients with the c.2546delC mutation (n = 24) related to poorer MDS/AML-free survival and a younger age at HSCT than those without this mutation. All patients with RAEB/AML had an abnormal karyotype and poorer prognosis after HSCT; specifically, the presence of a structurally complex karyotype with a monosomy (n = 6) was associated with dismal prognosis. In conclusion, the best practice for a clinician may be to integrate the morphological, cytogenetic, and genetic data to optimize HSCT timing in Japanese FA patients.


Asunto(s)
Aldehído Deshidrogenasa Mitocondrial/genética , Secuencia de Bases , Anemia de Fanconi/genética , Anemia de Fanconi/mortalidad , Genotipo , Eliminación de Secuencia , Factores de Edad , Aldehído Deshidrogenasa Mitocondrial/metabolismo , Alelos , Aloinjertos , Pueblo Asiatico , Supervivencia sin Enfermedad , Anemia de Fanconi/enzimología , Anemia de Fanconi/terapia , Proteína del Grupo de Complementación A de la Anemia de Fanconi/genética , Proteína del Grupo de Complementación A de la Anemia de Fanconi/metabolismo , Proteína del Grupo de Complementación G de la Anemia de Fanconi/genética , Proteína del Grupo de Complementación G de la Anemia de Fanconi/metabolismo , Femenino , Frecuencia de los Genes , Trasplante de Células Madre Hematopoyéticas , Humanos , Japón , Masculino , Tasa de Supervivencia
6.
Jpn J Radiol ; 36(12): 698-705, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30218252

RESUMEN

PURPOSE: To prospectively correlate the preoperative vessel anatomy in three-dimensional computed tomographic angiography with computed tomographic colonography (3D-CTA with CTC) with that in laparoscopic surgery for colorectal cancer. METHODS: The study protocol was approved by our institutional review board. The study population consisted of 101 patients with colon cancer who underwent 3D-CTA with CTC between June 2016 and January 2018. Two radiologists assessed the branching patterns of sigmoid arteries (SAs) and right colonic artery (RCA), the position between the ileocolic artery (ICA) and superior mesenteric vein (SMV), and the existence of an accessory middle colonic artery (aMCA). The vessel anatomy on 3D-CTA with CTC was correlated with that of intraoperative findings. RESULTS: Ninety-eight examinations (97.0%) were technically successful. Between preoperative and intraoperative vessel anatomy, the branching patterns of SAs were concordant in all 29 cases with rectosigmoid and descending colon cancer. The branching patterns of RCA and the position between the ICA and SMV were completely concordant in 32 cases of cecal and ascending colon cancer. No aMCA was identified either intraoperatively or by imaging analysis. CONCLUSIONS: 3D-CTA with CTC guided the surgeons to determine the resection margin of the relevant vessels for laparoscopic colorectal surgery.


Asunto(s)
Neoplasias del Colon/cirugía , Colonografía Tomográfica Computarizada/métodos , Angiografía por Tomografía Computarizada/métodos , Imagenología Tridimensional/métodos , Laparoscopía/métodos , Cuidados Preoperatorios/métodos , Adulto , Anciano , Anciano de 80 o más Años , Colon/irrigación sanguínea , Colon/diagnóstico por imagen , Colon/cirugía , Neoplasias del Colon/irrigación sanguínea , Neoplasias del Colon/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Reproducibilidad de los Resultados
7.
Acta Radiol Open ; 7(2): 2058460118757578, 2018 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-29487748

RESUMEN

BACKGROUND: Pericolic fat stranding on computed tomography (CT) scans has been an important feature for staging colon cancer. However, the factors associated with pericolic fat stranding have not been elucidated to date. PURPOSE: To determine factors associated with pericolic fat stranding of colon cancer on CT colonography (CTC). MATERIAL AND METHODS: Overall, 150 patients with 155 colon cancer lesions were retrospectively assessed by two radiologists for pericolic fat stranding on CTC. Circumferential proportion of the tumor (CPtumor; <50%, 50-75%, and ≥75%), longitudinal length, depth of invasion (≤T2, T3, T4), lymph node and distant metastasis, and lymphovascular invasion were recorded. Univariate and multivariate logistic regression analyses were performed between pericolic fat stranding and each factor. Multi-group comparisons were performed for the CPtumor and depth of invasion. RESULTS: Pericolic fat stranding was identified in 57 lesions (36.8%). Univariate analysis revealed significant associations of pericolic fat stranding with all factors (P < 0.027), except for lymph node metastasis (P = 0.087). Multi-group comparisons revealed that pericolic fat stranding was more frequent with increasing CPtumor (P < 0.001); however, no significant differences were observed beyond subserosal infiltration (P = 0.225). Logistic regression analysis revealed the CPtumor (<75% vs. ≥75%; P = 0.008, <50% vs. 50-75%; P = 0.047) and longitudinal length (P = 0.001) as explainable variables. CONCLUSION: Pericolic fat stranding identified on CT images of colon cancer is demonstrated more frequently with increasing circumferential proportion of the tumor and longitudinal length.

8.
Acta Radiol Open ; 7(2): 2058460118760361, 2018 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-29511573

RESUMEN

BACKGROUND: Selective venous sampling (SVS) is an invasive localization study for persistent or recurrent hyperparathyroidism. PURPOSE: To assess the role of SVS in addition to non-invasive imaging for primary hyperparathyroidism (pHPT). MATERIAL AND METHODS: This study was approved by the institutional review board and included 14 patients who underwent SVS and subsequent parathyroidectomy between January 2014 and April 2017 following a clinical diagnosis of pHPT. All patients underwent pre-SVS non-invasive imaging, including ultrasound, computed tomography (CT), and 99mTc-MIBI scintigraphy, and sensitivity was assessed using the operative and pathological findings. RESULTS: In all but one case, a single parathyroid adenoma was responsible for the pHPT; the remaining case exhibited a chemical response following surgical removal of parathyroid tissue. The sensitivity (%) for ultrasound, CT, 99mTc-MIBI scintigraphy, and SVS was 76.9, 84.6, 69.2, and 76.9, respectively. SVS yielded positive results in four patients with discordant results and one patient with non-detectable results on imaging. In seven patients, a significant increase in the intact parathyroid hormone level was recognized only in the thyroid veins. The procedure time was in the range of 52-183 min (median = 89.5 min). CONCLUSION: The addition of SVS to a non-invasive imaging study would be helpful to locate the responsible lesion of pHPT with discordant or non-detectable results on imaging for initial surgical treatment as well.

9.
Jpn J Radiol ; 35(8): 409-416, 2017 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-28639211

RESUMEN

Primary hyperparathyroidism (pHPT) causes hypercalcemia. The treatment for pHPT is surgical dissection of the hyperfunctioning parathyroid gland. Lower rates of hypocalcemia and recurrent laryngeal nerve injury imply that minimally invasive parathyroidectomy (MIP) is safer than bilateral neck resection. Current trends in MIP use can be inferred only by reference to preoperative localization studies. Noninvasive imaging studies (typically preoperative localization studies) show good detection rates of hyperfunctioning glands; however, there have also been cases of nonlocalization or discordant results. Selective venous sampling (SVS) is an invasive localization method for detecting elevated intact parathyroid hormone in the thyroid and/or internal jugular and brachiocephalic veins. SVS was developed mainly for postoperative patients with persistent or recurrent pHPT; however, SVS could also be useful before initial operations due to its high sensitivity to pHPT. Currently, SVS is generally indicated for recurrent HPT, and for cases with negative imaging study results for HPT or discordant results. Multi-detector row helical CT is useful for imaging the anatomy of the jugular and thyroid veins. Knowledge of the thyroid vein anatomy enables the creation of sampling points in the internal jugular and brachiocephalic veins for catheterization of the thyroid veins and venous anastomoses.


Asunto(s)
Hiperparatiroidismo Primario/sangre , Hiperparatiroidismo Primario/diagnóstico por imagen , Hormona Paratiroidea/sangre , Glándula Tiroides/irrigación sanguínea , Venas/anatomía & histología , Venas Braquiocefálicas/anatomía & histología , Humanos , Venas Yugulares/anatomía & histología , Sensibilidad y Especificidad
10.
Medicine (Baltimore) ; 96(2): e5818, 2017 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-28079809

RESUMEN

Colorectal perforation has a high rate of mortality. We compared the incidence and fatality rates of colorectal perforation among different hospitals in Japan using data from the nationwide surgical database.Patients were registered in the National Clinical Database (NCD) between January 1st, 2011 and December 31st, 2013. Patients with colorectal perforation were identified from surgery records by examining if acute diffuse peritonitis (ADP) and diseases associated with a high probability of colorectal perforation were noted. The primary outcome measures included the 30-day postsurgery mortality and surgical mortality of colorectal perforation. We analyzed differences in the observed-to-expected mortality (O/E) ratio between the two groups of hospitals, that is, specialized and non-specialized, using the logistic regression analysis forward selection method.There were 10,090 cases of disease-induced colorectal perforation during the study period. The annual average postoperative fatality rate was 11.36%. There were 3884 patients in the specialized hospital group and 6206 in the non-specialized hospital group. The O/E ratio (0.9106) was significantly lower in the specialized hospital group than in the non-specialized hospital group (1.0704). The experience level of hospitals in treating cases of colorectal perforation negatively correlated with the O/E ratio.We conducted the first study investigating differences among hospitals with respect to their fatality rate of colorectal perforation on the basis of data from a nationwide database. Our data suggest that patients with colorectal perforation should choose to be treated at a specialized hospital or a hospital that treats five or more cases of colorectal perforation per year. The results of this study indicate that specialized hospitals may provide higher quality medical care, which in turn proves that government policy on healthcare is effective at improving the medical system in Japan.


Asunto(s)
Enfermedades del Colon/mortalidad , Mortalidad Hospitalaria , Hospitales/estadística & datos numéricos , Perforación Intestinal/mortalidad , Enfermedades del Recto/mortalidad , Apendicectomía , Enfermedades del Colon/epidemiología , Colostomía , Hospitales/normas , Hospitales Especializados/normas , Hospitales Especializados/estadística & datos numéricos , Humanos , Incidencia , Perforación Intestinal/epidemiología , Japón/epidemiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/mortalidad , Calidad de la Atención de Salud , Enfermedades del Recto/epidemiología
11.
J Dermatol ; 44(4): 465-467, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-27864829

RESUMEN

A 5-year-old girl noticed a rapidly growing reddish nodule on her right forearm. Although oral antibiotics had been administrated for 2 weeks, the tumor enlarged. Skin biopsy revealed excessive infiltration of atypical neoplastic cells expressing CD4, CD30 and anaplastic lymphoma kinase (ALK). These histological and immunohistochemical findings were consistent with anaplastic large cell lymphoma (ALCL). Computed tomography showed multiple lymphadenopathy, but lymph node biopsy and bone marrow examination did not show any evidence of systemic dissemination. However, due to the positive results for ALK and multiple lymphadenopathy, we diagnosed ALK-positive ALCL forming a solitary skin tumor on the forearm. The patient received chemotherapy and presented marked improvement. This paper discusses the difficulty of diagnosing pediatric ALK-positive ALCL limited to the skin and reviews the medical published work.


Asunto(s)
Antineoplásicos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Linfoma Anaplásico de Células Grandes/diagnóstico , Proteínas Tirosina Quinasas Receptoras/metabolismo , Neoplasias Cutáneas/diagnóstico , Quinasa de Linfoma Anaplásico , Biopsia , Núcleo Celular , Preescolar , Citoplasma , Femenino , Antebrazo , Humanos , Inmunohistoquímica , Linfoma Anaplásico de Células Grandes/metabolismo , Linfoma Anaplásico de Células Grandes/patología , Linfoma Anaplásico de Células Grandes/terapia , Piel/patología , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/metabolismo , Neoplasias Cutáneas/patología
12.
Haematologica ; 102(1): 118-129, 2017 01.
Artículo en Inglés | MEDLINE | ID: mdl-27634205

RESUMEN

Fusion genes involving ZNF384 have recently been identified in B-cell precursor acute lymphoblastic leukemia, and 7 fusion partners have been reported. We further characterized this type of fusion gene by whole transcriptome sequencing and/or polymerase chain reaction. In addition to previously reported genes, we identified BMP2K as a novel fusion partner for ZNF384 Including the EP300-ZNF384 that we reported recently, the total frequency of ZNF384-related fusion genes was 4.1% in 291 B-cell precursor acute lymphoblastic leukemia patients enrolled in a single clinical trial, and TCF3-ZNF384 was the most recurrent, with a frequency of 2.4%. The characteristic immunophenotype of weak CD10 and aberrant CD13 and/or CD33 expression was revealed to be a common feature of the leukemic cells harboring ZNF384-related fusion genes. The signature gene expression profile in TCF3-ZNF384-positive patients was enriched in hematopoietic stem cell features and related to that of EP300-ZNF384-positive patients, but was significantly distinct from that of TCF3-PBX1-positive and ZNF384-fusion-negative patients. However, clinical features of TCF3-ZNF384-positive patients are markedly different from those of EP300-ZNF384-positive patients, exhibiting higher cell counts and a younger age at presentation. TCF3-ZNF384-positive patients revealed a significantly poorer steroid response and a higher frequency of relapse, and the additional activating mutations in RAS signaling pathway genes were detected by whole exome analysis in some of the cases. Our observations indicate that ZNF384-related fusion genes consist of a distinct subgroup of B-cell precursor acute lymphoblastic leukemia with a characteristic immunophenotype, while the clinical features depend on the functional properties of individual fusion partners.


Asunto(s)
Inmunofenotipificación , Proteínas de Fusión Oncogénica/genética , Proteínas de Fusión Oncogénica/metabolismo , Leucemia-Linfoma Linfoblástico de Células Precursoras B/genética , Leucemia-Linfoma Linfoblástico de Células Precursoras B/metabolismo , Transactivadores/genética , Transactivadores/metabolismo , Adolescente , Biomarcadores de Tumor , Niño , Preescolar , Análisis por Conglomerados , Biología Computacional/métodos , Femenino , Perfilación de la Expresión Génica , Frecuencia de los Genes , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Lactante , Recién Nacido , Estimación de Kaplan-Meier , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras B/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras B/mortalidad , Pronóstico , Transcriptoma , Translocación Genética
13.
Pediatr Int ; 58(10): 1072-1076, 2016 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27577674

RESUMEN

Mixed-phenotype acute leukemia (MPAL) is a rare type of leukemia expressing both myeloid and lymphoid markers. There is limited information, especially on pediatric cases. Therefore, the optimal therapeutic approach to pediatric MPAL has not been defined. Here, we report two pediatric cases of MPAL. According to the 2008 World Health Organization (WHO) classification and European Group for the Immunological Characterization of Leukemias (EGIL) criteria, patient 1 was diagnosed with overt MPAL positive for the myeloid marker myeloperoxidase (MPO), and B-lymphoid markers. Patient 2 was diagnosed with T-cell acute lymphoblastic leukemia (T-ALL) using EGIL criteria. According to the 2008 WHO classification, however, patient 2 was diagnosed with overt MPAL positive for CD3, T-lymphoid markers and MPO. We chose an ALL-type therapy consisting of both lymphoid- and myeloid-directed agents; these patients have maintained complete remission following treatment. Further information on pediatric MPAL is needed to establish an appropriate therapeutic strategy including stem cell transplantation for this rare condition.


Asunto(s)
Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Enfermedad Aguda , Biopsia , Células de la Médula Ósea/patología , Niño , Terapia Combinada/métodos , Femenino , Humanos , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Resultado del Tratamiento
14.
Br J Haematol ; 175(3): 457-461, 2016 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-27377053

RESUMEN

Studies using Fanconi anaemia (FA) mutant mouse models suggested that the combination of a defective FA pathway and aldehyde dehydrogenase-2 (ALDH2) dysfunction could provoke bone marrow failure, leukaemia and developmental defects, and that both maternal and fetal aldehyde detoxification are crucial to protect the developing embryo from DNA damage. We studied the ALDH2 genotypes of 35 Japanese FA patients and their mothers. We found that a normal maternal ALDH2 allele was not essential for fetal development of ALDH2-deficient patients, and none of the post-natal clinical parameters were clearly affected by the maternal ALDH2 genotype in these patients.


Asunto(s)
Aldehído Deshidrogenasa Mitocondrial/genética , Pueblo Asiatico/genética , Anemia de Fanconi/diagnóstico , Anemia de Fanconi/genética , Genotipo , Fenotipo , Alelos , Inestabilidad Cromosómica , Daño del ADN , Femenino , Frecuencia de los Genes , Humanos , Lactante , Recién Nacido , Japón , Masculino , Mutación
15.
Int J Hematol ; 104(2): 245-55, 2016 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-27086352

RESUMEN

A phase 1 study was conducted to evaluate the safety, pharmacokinetics (PK), efficacy and pharmacogenetic characteristics of clofarabine in seven Japanese pediatric patients with relapsed/refractory acute lymphoblastic leukemia (ALL). Patients in Cohort 1 received clofarabine 30 mg/m(2)/day for 5 days, followed by 52 mg/m(2)/day for 5 days in subsequent cycles. Cohort 2 patients were consistently treated with 52 mg/m(2)/day for 5 days. No more than six cycles were performed. Every patient had at least one ≥Grade 3 adverse event (AE). AEs (≥Grade 3) related to clofarabine were anaemia, neutropenia, febrile neutropenia, thrombocytopenia, alanine aminotransferase increased, aspartate aminotransferase increased, haemoglobin decreased, and platelet (PLT) count decreased. C max and AUC of clofarabine increased in a dose-dependent fashion, but its elimination half-life (T 1/2) did not appear to be dependent on dose or duration of treatment. Clofarabine at 52 mg/m(2)/day shows similarly tolerable safety and PK profiles compared to those in previous studies. No complete remission (CR), CR without PLT recovery, or partial remission was observed. Since clofarabine is already used as a key drug for relapsed/refractory ALL patients in many countries, the efficacy of clofarabine in Japanese pediatric patients should be evaluated in larger study including more patients, such as by post-marketing surveillance.


Asunto(s)
Nucleótidos de Adenina/administración & dosificación , Arabinonucleósidos/administración & dosificación , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Nucleótidos de Adenina/efectos adversos , Nucleótidos de Adenina/farmacocinética , Adolescente , Arabinonucleósidos/efectos adversos , Arabinonucleósidos/farmacocinética , Niño , Preescolar , Clofarabina , Relación Dosis-Respuesta a Droga , Semivida , Humanos , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Recurrencia , Resultado del Tratamiento
16.
ACS Nano ; 10(5): 5550-9, 2016 05 24.
Artículo en Inglés | MEDLINE | ID: mdl-27124717

RESUMEN

Increasing attention has been dedicated to the development of nanomaterials rendering green and sustainable processes, which occur in benign aqueous reaction media. Herein, we demonstrate the synthesis of another family of green nanomaterials, layered double hydroxide (LDH) nanoclusters, which are concentrated (98.7 g/L in aqueous solvent), stably dispersed (transparent sol for >2 weeks), and catalytically active colloids of nano LDHs (isotropic shape with the size of 7.8 nm as determined by small-angle X-ray scattering). LDH nanoclusters are available as colloidal building blocks to give access to meso- and macroporous LDH materials. Proof-of-concept applications revealed that the LDH nanocluster works as a solid basic catalyst and is separable from solvents of catalytic reactions, confirming the nature of nanocatalysts. The present work closely investigates the unique physical and chemical features of this colloid, the formation mechanism, and the ability to act as basic nanocatalysts in benign aqueous reaction systems.

17.
Pediatr Int ; 58(5): 390-393, 2016 May.
Artículo en Inglés | MEDLINE | ID: mdl-27076380

RESUMEN

Hemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory condition resulting from an uncontrolled and ineffective immune response. Here, we report a case of HLH caused by disseminated herpes simplex virus (HSV)-1 infection. The patient was initially treated with prednisolone and high-dose acyclovir. Although liver enzymes, coagulation abnormalities, and inflammatory markers were remarkably improved, the platelet count remained low. Prednisolone was therefore switched to dexamethasone palmitate. Thereafter, the platelet count normalized. Inflammatory markers normalized 30 days after admission and serum HSV-DNA became undetectable on day 41. The patient was discharged on day 91 and no developmental delay was evident at 7 months of age. These findings suggest that dexamethasone palmitate is effective for neonatal HLH.

18.
Jpn J Radiol ; 34(5): 321-30, 2016 May.
Artículo en Inglés | MEDLINE | ID: mdl-26968999

RESUMEN

Except for squamous cell carcinoma and adenocarcinoma, lesions that protrude into the esophagus are rare, and include benign and malignant tumors. The imaging findings of these lesions on esophagography, computed tomography (CT), and magnetic resonance imaging (MRI) are often non-specific. However, some of them reveal characteristic imaging findings. In addition, esophagography, CT, and MRI are useful to evaluate location, extent, invasion, vascularity, lymphadenopathy, and metastasis. Knowledge of the imaging features of protruding esophageal lesions helps to narrow the differential diagnosis. We describe the main features of esophageal protruding lesions.


Asunto(s)
Neoplasias Esofágicas/diagnóstico por imagen , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Esófago/diagnóstico por imagen , Humanos
19.
Int J Hematol ; 99(4): 429-36, 2014 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-24609717

RESUMEN

Data on long-term outcomes of children with refractory immune thrombocytopenia (ITP) treated with rituximab are limited. We retrospectively analyzed the long-term effect of rituximab on 22 pediatric ITP patients (11 boys and 11 girls). Compete response (CR) (platelet count ≥100 × 10(9)/L) and partial response (PR) (platelet count 30-99 × 10(9)/L) were achieved in nine (41 %) and two (9 %) patients, respectively. Of the 11 responders, eight subsequently relapsed 2-26 months after initial rituximab treatment. The 5-year relapse-free rate was 14 % (3/22, 95 % confidence interval: 0-27 %) with a median follow-up period of 6.4 years. Five initial responders with subsequent relapse and one non-responder received multiple rituximab treatments of nine courses; all patients responded to the second rituximab therapy without any significant toxicity. All eight patients who relapsed after an initial response and six of 11 non-responders achieved CR or PR with subsequent treatment, including repeated courses of rituximab, splenectomy, steroids, and other immunomodulating agents. Our findings indicated that the sustained effect of rituximab on children with refractory ITP is low, but that the long-term outcome of ITP itself is not poor. Furthermore, repeated rituximab administration may be a promising therapy for those who relapse after an initial response.


Asunto(s)
Anticuerpos Monoclonales de Origen Murino/uso terapéutico , Factores Inmunológicos/uso terapéutico , Púrpura Trombocitopénica Idiopática/tratamiento farmacológico , Anticuerpos Monoclonales de Origen Murino/administración & dosificación , Anticuerpos Monoclonales de Origen Murino/efectos adversos , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Factores Inmunológicos/administración & dosificación , Factores Inmunológicos/efectos adversos , Lactante , Masculino , Recuento de Plaquetas , Púrpura Trombocitopénica Idiopática/complicaciones , Recurrencia , Retratamiento , Estudios Retrospectivos , Rituximab , Resultado del Tratamiento
20.
Tokai J Exp Clin Med ; 38(1): 33-6, 2013 Apr 20.
Artículo en Inglés | MEDLINE | ID: mdl-23564574

RESUMEN

OBJECTIVE: To investigate the effects of a commercial electronic prescribing system on medical and medication errors. METHODS: We conducted a retrospective before-and-after study in a teaching hospital by applying a U control chart to monthly error rates that were calculated from the number of both medical and medication errors divided by the number of patient days. RESULTS: The process mean medical error rate from April 2008 to December 2010 was 0.0213±0.0004 (mean±SD), and consecutive data points after September in 2010 were under the process mean from April 2008 to December 2010. The process mean value from January 2011 to March 2012 was 0.0177±0.0005. A significant difference was seen in the process mean medical error rate between consecutive months before December 2010 and values after January 2011 (p<0.001). From April 2008 to December 2010, the process mean medication error rate was 0.0060±0.0002, and from January 2011 to March 2012, the mean value was 0.0045±0.0002 (p<0.001). CONCLUSION: We showed that it requires time to reach a significant reduction in medical and medication error rates after implementation of an electronic prescribing system. It is important to check and support ways to adjust to procedures involved in using a new system.


Asunto(s)
Prescripción Electrónica/estadística & datos numéricos , Hospitales de Enseñanza/estadística & datos numéricos , Errores Médicos/estadística & datos numéricos , Errores de Medicación/estadística & datos numéricos , Humanos , Errores Médicos/prevención & control , Errores de Medicación/prevención & control , Análisis de Regresión , Estudios Retrospectivos , Factores de Tiempo
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