K Sunami

Okayama University, Okayama, Okayama, Japan

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Publications (42)89.66 Total impact

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    ABSTRACT: A child with vertigo related to acute cerebellitis is reported. The patient was a 7-year-old boy who presented with ataxia and vertigo. Gaze nystagmus, in which the direction of nystagmus periodically alternated, was observed. This type of nystagmus was also observed in spontaneous nystagmus. MRI of the brain in the acute stage revealed no swelling of the cerebellum and no abnormal signal intensity. High serum IGM and IGG titers to Epstein-Barr virus were demonstrated. As a result of these tests and the clinical course, we diagnosed acute cerebellitis related to Epstein-Barr virus. It is very rare for young children to complain of vertigo, and it is necessary to keep in mind that vertigo and ataxia can be caused by acute cerebellitis.
    Equilibrium Research 12/2004; 63(6):549-554. DOI:10.3757/jser.63.549
  • Kishiko Sunami · Rie Tochino · Hideo Yamane ·
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    ABSTRACT: The canal repositional procedure (CRP) significantly relieves paroxysmal symptoms of benign paroxysmal positional vertigo (BPPV), and accurate diagnosis of BPPV as well as identification of the site of the debris improves the efficacy of the therapy. However, BPPV is not only cause of positional vertigo, other diseases could also cause positional vertigo. We studied 248 patients admitted to our department at Osaka City University Hospital with the positional vertigo, to determine the frequency of BPPV and other lesions. Of these, 143 (57.7%) had peripheral lesions and 105 (42.3%) had evidence of central lesions. BPPV was found in 87 (35%), 5 of these BPPV cases were associated with central lesions. Physicians must be aware that it may be difficult to distinguish central lesions from BPPV on the symptoms.
    Equilibrium Research 06/2003; 62(3):194-198. DOI:10.3757/jser.62.194
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    ABSTRACT: The incidence and severity of acute graft-vs-host disease after allogeneic transplantation of granulocyte colony-stimulating factor (G-CSF)-mobilized peripheral blood stem cells (PBSC) are not greater than those after conventional bone marrow transplantation despite infusion of more than one log greater number of donor T cells in PBSC. It has been postulated that monocytes from G-CSF-mobilized donors suppress alloreactivity of donor T cells. We investigated the phenotype and function of monocytes in normal individuals receiving 10 microg/kg of G-CSF for 4 days. Monocytes were phenotypically and functionally different after G-CSF administration from steady-state monocytes. They were characterized by an increased CD14(+)CD16(+) subpopulation, reduced expression of HLA-DR, and diminished ability to produce tumor necrosis factor-alpha and interleukin-10 to lipopolysaccharide, compared with steady-state monocytes. These alterations were not replicated by culturing monocytes with G-CSF in vitro, suggesting an indirect effect of G-CSF. In addition, the antigen-presenting function of G-CSF-mobilized monocytes was impaired. Hyporesponsiveness of G-CSF-treated monocytes to lipopolysaccharide with regard to tumor necrosis factor-alpha production, together with impaired antigen-presenting function, may be responsible for the unexpectedly low incidence of graft-vs-host disease after G-CSF-mobilized PBSC transplantation.
    Experimental Hematology 10/2001; 29(9):1117-24. DOI:10.1016/S0301-472X(01)00679-8 · 2.48 Impact Factor
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    ABSTRACT: Hepatic graft-versus-host disease (GVHD) generally presents as cholestatic jaundice, and increased serum alkaline phosphatase (ALP) is followed by hyperbilirubinemia and clinical jaundice. Currently accepted standards for evaluating the clinical severity of GVHD are based not on serum aminotransferase levels but on the serum bilirubin level. We describe a 17-year-old Japanese female who had increased aminotransferases without cholestasis on day 23 after allogeneic peripheral blood stem cell transplantation (allo-PBSCT). Liver biopsy revealed lymphocytic infiltration of the portal tracts and pericentral necrosis of the lobuli. The limiting plates were not clearly defined due to cellular infiltrates. There was periductal lymphocytic infiltration and vacuolization of the biliary epithelial cells with exocytosis, compatible with GVHD of cholangiohepatitic type. These findings indicate that acute hepatic GVHD may present as acute hepatitis and this should be included in the differential diagnosis for patients with increased aminotransferases after allogeneic stem cell transplantation.
    Bone Marrow Transplantation 06/2001; 27(9):1007-10. DOI:10.1038/sj.bmt.1702997 · 3.57 Impact Factor
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    ABSTRACT: We report our experience with allogeneic peripheral blood stem cell transplantation (allo-PBSCT) following a nonmyeloablative conditioning regimen consisting of cytarabine (8 g/m2) and cyclophosphamide (120 mg/kg) in the treatment of 2 patients aged 50 and 55 years with refractory chronic myelomonocytic leukemia and chronic myeloid leukemia in accelerated phase, respectively. Our nonmyeloablative regimen was well tolerated by older patients at high risk of regimen-related toxicity by the conventional conditioning regimen but was immunosuppressive enough to achieve mixed chimerism. After allo-PBSCT, we monitored chimerism in these patients by fluorescence in situ hybridization using X- and Y-specific probes and polymerase chain reaction-based analysis of a variable number of tandem repeats. We found that full chimerism and graft-versus-leukemia (GVL) effects could be induced in these patients by donor lymphocyte infusions and withdrawal of posttransplantation immunosuppressive therapy. Our observations suggest that a nonmyeloablative conditioning regimen can establish mixed chimerism and that donor lymphocyte infusion may induce GVL effects in older patients at high risk of regimen-related toxicity.
    International Journal of Hematology 01/2001; 72(4):499-503. · 1.92 Impact Factor
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    ABSTRACT: The prognosis of chronic active Epstein-Barr virus infection (CAEBV) is very poor. We describe a 24-year-old male with severe CAEBV who was treated with allogeneic peripheral blood stem cell transplantation (allo-PBSCT). On admission, EBER-1 in lymphocytes infiltrating the liver, EBV-DNA in peripheral blood mononuclear cells (PBMC) and monoclonal NK cell proliferation were confirmed. After unsuccessful chemotherapy, he received an allo-PBSCT from his HLA-identical sister. Although he died of pulmonary hemorrhage on day +19, EBV-DNA was undetectable by PCR in PBMC, and the post-mortem liver showed no EBER-1-positive lymphocytes. This experience suggests that EBV-positive lymphocytes in CAEBV may be eradicated by allo-PBSCT, thereby raising the possibility of a new treatment modality. Bone Marrow Transplantation (2000) 26, 805-808.
    Bone Marrow Transplantation 11/2000; 26(7):805-8. DOI:10.1038/sj.bmt.1702600 · 3.57 Impact Factor
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    ABSTRACT: We describe a single-center experience of 23 consecutive patients (median age, 35 years) with hematologic malignancies who received allogeneic peripheral blood stem cell transplants (alloPBSCTs) from HLA-identical siblings. Ten patients had standard-risk disease and 13 had high-risk disease. Twenty-one patients received alloPBSCT as a primary transplant, and the remaining 2, with high-risk disease, as a second transplant after posttransplantation relapse. All donors received daily subcutaneous injections of granulocyte colony-stimulating factor at a dose of 10 microg/kg, and peripheral blood stem cells were collected by 1 to 3 aphereses. Median numbers of CD34+ and CD3+ cells infused were 5.8 x 10(6)/kg (range, 1.3-19.7 x 10(6)/kg) and 4.9 x 10(8)/kg (range, 1.9-8.6 x 10(8)/kg), respectively. Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporin A (CyA) and methotrexate (18 patients) or CyA and methylprednisolone (5 patients). Rapid hematologic engraftment was observed in 20 of the 23 patients. Median days to absolute neutrophil counts >0.5 x 10(9)/L and platelet counts >20 x 10(9)/L were 12 (range, 9-18 days) and 14 (range, 10-128 days), respectively. Acute GVHD of grade 2-4 was observed in 6 of 20 evaluable patients (30%) and extensive chronic GVHD in 8 of 15 evaluable patients (53%). Ten of the 23 patients (44%) were surviving in continuous complete remission 191 to 1492 days (median, 643 days) posttransplantation. Treatment-related death within 100 days posttransplantation was observed in 6 of the 23 patients (26%). Six of the 23 patients (26%) developed relapse at a median 81 days (range, 38-160 days) posttransplantation. Further study is needed to assess the precise benefits of alloPB-SCT compared with allogeneic bone marrow transplantation.
    International Journal of Hematology 10/2000; 72(3):362-70. · 1.92 Impact Factor
  • K Sunami · T Fujiwara · C Yoshida · S Fujii · S Fukuda · T Sezaki ·
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    ABSTRACT: A 22-year-old man with non-Hodgkin's lymphoma (B-cell lymphoblastic lymphoma, Stage IVA) received chemotherapy and radiation therapy and achieved complete remission. He was admitted for allogeneic bone marrow transplantation (BMT) using a graft from his completely HLA-matched mother. Although he had HBV infection, allogeneic BMT was performed because he still had normal liver function and strongly requested the procedure. He developed both acute and chronic GVHD after the procedure, but showed no liver damage related to HBV. Treatment with lamivudine (150 mg/day) was started because the HBV-DNA level increased gradually after allogeneic BMT. Although the HBV-DNA then decreased gradually and there was no evidence of severe liver damage, the patient died following relapse of NHL. It seems that in this case, treatment of HBV with lamivudine may have prevented serious liver damage after allogeneic BMT. Therefore, allogeneic BMT may be done safely in patients with HBV infection if lamivudine is administered.
    [Rinshō ketsueki] The Japanese journal of clinical hematology 10/2000; 41(9):733-8.
  • T Yano · Y Katayama · K Sunami · F Ishimaru · K Shinagawa · K Ikeda · E Omoto · K Niiya · M Harada ·
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    ABSTRACT: Although the use of allogeneic transplants of peripheral blood stem/progenitor cells (PBSCs) is increasing, the precise mechanism of PBSC mobilization has not yet been fully clarified. We examined the expression of some adhesion molecules on CD34+ cells from steady-state bone marrow (BM), granulocyte colony-stimulating factor (G-CSF)-mobilized PBSCs, and cytotoxic drugs plus G-CSF-mobilized PBSCs. Irrespective of mobilization method, very late antigen (VLA)-4 expression on circulating CD34+ cells was significantly lower than on steady-state BM CD34+ cells. To elucidate the influence of lineage commitment on VLA-4 expression of circulating CD34+ cells, we analyzed VLA-4 expression on different subsets of CD34+ cells with or without CD33, CD38, CD5, or CD10 antigens, or Glycophorin A in G-CSF-mobilized PBSCs and steady-state BM from related donors, using 3-color flow cytometry. VLA-4 on circulating CD34+ subsets was less expressed than on each corresponding subset of steady-state BM CD34+ cells. Furthermore, VLA-4 positive rates showed no significant difference among the CD34+ subsets. Finally, the data comparing CD34+ cells from steady-state and G-CSF-mobilized PBSCs revealed no differences in terms of VLA-4 expression. These data suggest that reduced expression of VLA-4 may be a result of peripheralization of CD34+ cells from bone marrow, which occurs in a G-CSF- and lineage-independent fashion.
    International Journal of Hematology 07/2000; 71(4):328-33. · 1.92 Impact Factor
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    ABSTRACT: Despite a 10-fold increase of T cell dose, the incidence and severity of acute GVHD following allogeneic transplantation of G-CSF-mobilized PBSC is not increased compared to BMT. Experimental murine studies demonstrate that G-CSF polarizes donor T cells toward a type 2 cytokine response. To determine whether G-CSF alters T cell cytokine responses, we investigated the effects of G-CSF administration on T cell proliferative and cytokine responses to alloantigen and Con A in nonadherent PBMC (NAC) and CD3+ T cells obtained from normal individuals before and after G-CSF administration (10 μg/kg × 4 days). Although T cell proliferative and cytokine (IFN-γ and IL-4) responses to alloantigen stimulation and Con A were significantly reduced in post-G-CSF NAC, they were restored by the removal of non-T cells from post-G-CSF NAC. Furthermore, there was less T cell alloreactivity in MLR in the presence of autologous post-G-CSF monocytes than in the presence of pre-G-CSF monocytes. This alteration was not replicated in vitro by culturing PBMC with G-CSF. These results suggest that G-CSF administration suppresses T cell proliferative and cytokine (IFN-γ and IL-4) responses to allogeneic stimulation by indirectly modulating monocyte function. Bone Marrow Transplantation (2000) 25, 1035–1040.
    Bone Marrow Transplantation 05/2000; 25(10):1035-1040. DOI:10.1038/sj.bmt.1702402 · 3.57 Impact Factor
  • S Fukuda · K Sunami · T Sezaki ·
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    ABSTRACT: High-dose chemotherapy combined with autologous hematopoietic stem cell transplantation (ASCT) has brought about high complete remission rates (about 40%), reduction of transplant-related toxicity in the patients with multiple myeloma, and it has spread rapidly. Moreover, it has demonstrated that overall survival times of high-dose chemotherapy with ASCT are significantly more extended than conventional chemotherapy. The indications of transplantation should be determined on the basis of various prognostic factors and sensitivity of the induction chemotherapy, and it is important that a therapeutic strategy should take the timing of ASCT into consideration before induction therapy. However, some problems of tumor cell contamination in the peripheral stem progenitor graft and its contribution to relapse have arisen. Some new trials including positive selection of CD34+ cells within its grafts and double auto-transplantation are ongoing to solve these problems. If the patient is under 50 years of age and an HLA identical donor is available, an allogeneic bone marrow transplantation (allo-BMT) may be considered. However, the indication of allo-BMT should be carefully selected because the transplant-related mortality is high (about 40%), and allo-BMT is not superior to ASCT in overall survival. New trials with nonablative hematopoietic stem cell transplantation with donor lymphocyte infusions (DLI) to induce a graft-versus-myeloma (GVM) effect are awaited.
    Gan to kagaku ryoho. Cancer & chemotherapy 10/1999; 26(10):1407-14.
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    ABSTRACT: Involvement of nitric oxide (NO) has been reported in physiological and pathological conditions in the inner ear. Recently, the presence of nitric oxide synthase (NOS) was demonstrated in the vestibular epithelium. In this study we used nicotinamide adenine dinucleotide phosphate-diapholase staining to monitor NOS activity during degeneration of guinea pig vestibular epithelia affected by streptomycin. Increased NOS activity was observed in affected epithelia in a dose- and time-dependent manner and a NOS inhibitor could protect hair cells from apoptosis. Additionally, cycloheximide significantly reduced NOS activity and the occurrence of apoptosis. These findings suggest that NO is involved in the degenerative process of vestibular epithelia caused by aminoglycosides.
    Neuroscience Letters 06/1999; 267(1):57-60. DOI:10.1016/S0304-3940(99)00317-1 · 2.03 Impact Factor
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    ABSTRACT: A 65-year old woman presented with nasal obstruction and on examination was found to have a huge mass in the maxillary sinus. This was removed, and histological examination revealed a mixture of trabecular structures consisting of inner dark cells, outer clear cells and solid structures consisting of only clear cells. Immunohistochemical examination showed the clear cells to be positive for alpha-smooth muscle actin. Ultrastructural examination confirmed the myoepithelial cell origin. The characteristic morphological, immunohistochemical and ultrastructural features aided in the diagnosis of epithelial-myoepithelial carcinoma.
    ORL 03/1999; 61(2):113-6. DOI:10.1159/000027652 · 0.88 Impact Factor
  • K Sunami · H Yamane · M Takayama · T Nakagawa · K Konishi · H Iguchi ·
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    ABSTRACT: We previously reported that long-term exposure to glutamate (Glu) induced death of cochlear outer hair cells (OHCs). However, the mechanisms of OHC death induced by Glu were unclear. In the central nervous system, Glu is known to interfere with a cystine-Glu antiporter, leading to a decrease in cystine uptake and reducing the intracellular glutathione level. We therefore investigated the effect of cystine supplementation on degeneration of OHCs caused by long-term exposure to Glu. Supplementation of cystine significantly decreased the number of dying OHCs. These findings suggest that a cystine-Glu interaction may be involved in the mechanism of OHC degeneration caused by Glu.
    Acta Oto-Laryngologica 02/1999; 119(6):671-3. DOI:10.1080/00016489950180612 · 1.10 Impact Factor
  • K Sunami · H Yamane · T Nakagawa · M Takayama · K Konishi ·
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    ABSTRACT: The aim of this study was to examine the roles of glutamate (GLU) toxicity and involvement of nitric oxide (NO) in the pathogenesis of cochlear degeneration. We examined guinea pig cochleae following chronic exposure to GLU. Trypan blue extrusion and transmission electron microscopy were performed to evaluate degeneration in the organ of Corti. In parallel, nitric oxide synthase (NOS) activity was demonstrated by histochemical staining of NADPH diapholase. GLU treatment caused time-dependent degeneration of outer hair cells (OHCs) in conjunction with a temporal increase of NOS activity in the organ of Corti. This suggests that GLU may be involved in OHC degeneration under toxic conditions, with NO production possibly playing a role in this process.
    Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 02/1999; 256(7):323-9. DOI:10.1007/s004050050156 · 1.55 Impact Factor
  • A Bessho · H Ueoka · K Kiura · M Tabata · K Sunami · Y Katayama · H Yamane · A Hiraki · M Harada ·
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    ABSTRACT: We investigated the feasibility and efficacy of high-dose chemotherapy consisting of ifosfamide, carboplatin and etoposide (HD-ICE) facilitated by autologous peripheral blood progenitor cell transplantation (ABPCT) for the treatment of small-cell lung cancer (SCLC). Eleven patients aged 44 to 63 years old (5 with extensive disease [ED] and 6 with limited disease [LD]) were entered into this study. Induction chemotherapy consisted of 3 to 4 cycles of cisplatin and irinotecan for ED-SCLC, and cisplatin and etoposide for LD-SCLC. Patients with LD-SCLC received concurrent chest radiotherapy along with the first cycle of induction chemotherapy. After induction therapy, peripheral blood progenitor cells (PBPC) were collected following G-CSF administration during a recovery phase from high-dose etoposide (1,500 mg/m2). Eight patients (4 with ED and 4 with LD) with adequate organ function were treated with HD-ICE (15 g/m2 ifosfamide, 1,200 mg/m2 carboplatin and 1,500 mg/m2 etoposide) followed by ABPCT. Hematologic recovery was rapid and non-hematological toxicities were acceptable without treatment-related mortality. In ED-SCLC, all of the 4 patients achieved complete response (CR) or near CR but developed a relapse of the disease. In LD-SCLC, 2 of 4 patients with LD-SCLC are alive in continuous CR for 18 and 21 months after the beginning of induction therapy. Despite a limited number of patients and short follow-up time, these preliminary results indicate that marrow-ablative therapy (HD-ICE) supported by ABPCT is feasible in the treatment of elderly patients with LD- and ED-SCLC.
    Anticancer research 01/1999; 19(1B):693-8. · 1.83 Impact Factor
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    K Kojima · Y Inoue · Y Katayama · M Kataoka · K Sunami · S Fukuda · T Sezaki · E Omoto · M Harada ·
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    ABSTRACT: We report a case of hyperimmunoglobulin E syndrome (HIE) complicated by neutrophil deficiency which was successfully treated with oral administration of disodium cromoglycate. A 48-year-old Japanese man with HIE developed Streptococcus pneumoniae meningitis. Laboratory tests after the meningitis revealed persistent neutropenia (300-800/mm3) and defects of phagocytosis and bacterial killing by neutrophils. Administration of disodium cromoglycate was started, and neutrophil counts gradually increased to 1200-1600/mm3. The impaired neutrophil activities returned to normal. The patient improved clinically; during the 2-year treatment, he had only two brief episodes of the common cold. Disodium cromoglycate may have potential clinical use in the treatment of cases of HIE even with neutrophil deficiency.
    Allergy 12/1998; 53(11):1101-3. DOI:10.1111/j.1398-9995.1998.tb03823.x · 6.03 Impact Factor
  • T Nakagawa · H Yamane · M Takayama · K Sunami · Y Nakai ·
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    ABSTRACT: Although the involvement of apoptosis has been suggested in the loss of vestibular hair cells due to aminoglycosides, dose-dependent effects of aminoglycosides have not been determined. We therefore examined dose-dependent effects of streptomycin on the degeneration of hair cells of guinea pig ampullar cristae using TUNEL stain and Hoechst nuclear stain. Streptomycin induced apoptosis of hair cells in a dose-dependent manner. Even following high-dose applications, most of the affected cells showed apoptotic features. Apoptosis may therefore play a predominant role in the deletion of vestibular hair cells affected by aminoglycosides.
    Acta Oto-Laryngologica 08/1998; 118(4):530-3. DOI:10.1080/00016489850154676 · 1.10 Impact Factor
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    ABSTRACT: Engraftment failure following allogeneic bone marrow transplantation (BMT) is rare in patients with acute leukemia, after frequent conditioning with marrow-lethal chemoradiotherapy. We evaluated the efficacy of a preparatory regimen consisting of fractionated total body irradiation (TBI) (12 Gy in six fractions) and high dose etoposide (60 mg/kg) administered as an 8-h infusion for allogeneic BMT in 16 consecutive patients with acute leukemia. Although 14 patients showed complete and sustained engraftment, the remaining two patients rejected bone marrow grafts from HLA-identical sibling donors and showed subsequent recovery of host-derived hematopoiesis. Despite the limited number of patients, this observation suggests that the immunosuppressive potential of etoposide may be inferior to that of cyclophosphamide (CY) and that etoposide as an alternative to CY as an antileukemic and immunosuppressive agent in allogeneic BMT may increase the risk of graft rejection.
    International Journal of Hematology 08/1998; 68(1):95-100. · 1.92 Impact Factor
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    ABSTRACT: We report a case of B-cell chronic lymphocytic leukemia (B-CLL) in which trisomy 12 and t(14;18)(q32;q21) were simultaneously detected in the same leukemic clone. Southern blot analysis showed that the BCL2/IgJH rearrangement occurred at the major breakpoint region in the hot spot of the BCL2 gene. Double color fluorescence in situ hybridization analysis using multiple probes indicated that clonal B-cell with t(14;18) represented a subpopulation of the total leukemic cells and that trisomy 12 followed t(14;18) as the cytogenetic aberration in the development of B-CLL. Our findings suggests that both the t(14;18) and the trisomy are secondary chromosomal changes in the leukemogenesis of B-CLL.
    International Journal of Hematology 03/1998; 67(2):199-203. DOI:10.1016/S0925-5710(97)00110-2 · 1.92 Impact Factor