K. Hiruma

Tokyo Metropolitan Komagome Hospital, Edo, Tōkyō, Japan

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Publications (66)110.67 Total impact

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    ABSTRACT: We encountered patients who had static direction-changing positional nystagmus (DCPN) canceled at about 20-30° yaw head rotation from the supine position. This nystagmus was also canceled when the head was rotated 180° from this position. We termed these head positions neutral points. The positional nystagmus observed (except at the neutral points) was thought to occur due to a "heavy cupula" or "light cupula". The purpose of this study was to examine DCPN with neutral points as well as the pathomechanism of this condition. Retrospective case review of patients attending two hospitals. Sixteen patients who exhibited DCPN with neutral points were examined using an infrared camera (installed in goggles). Using this system, the vestibulo-ocular reflex (VOR) was recorded, and VOR gain was obtained. Vestibular function and the affected side were determined. In addition, the angle between the supine position and neutral point was measured in each patient. We also examined other positional nystagmus occurring at other times. In the heavy cupula type group, we noted positional nystagmus for which repositioning maneuvers were successful, whereas, in the light cupula type group, repositioning maneuvers were not effective. The angle between supine position and neutral point was 26.5 ± 11.6°. Heavy cupula type may occur as a result of otoconia while light cupula type may be due to the specific gravity of the endolymph. The VOR gain and side of the benign paroxysmal positional vertigo (BPPV) observed suggested that the affected side was that to which the neutral point was deviated.
    Auris, nasus, larynx 02/2011; 38(1):46-51. · 0.58 Impact Factor
  • Japanese Journal of Transfusion and Cell Therapy 01/2010; 56(3):381-385.
  • Kiyoshi Hiruma, Tsutomu Numata
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    ABSTRACT: To describe the diagnostic means and therapy employed in three cases of extracranial carotid aneurysms. Retrospective analysis of three cases. For the diagnosis we obtained real-time pictures of each aneurysm by color Doppler ultrasonography before the angiography. Based on the result of cerebral collateral flow evaluation, ligation of both ends of the aneurysm was performed in one case, embolization of the artery in another, and resection of the aneurysm in the other; vascular reconstruction was not necessary. Although a carotid artery balloon occlusion test must be done before the operation, color Doppler ultrasonography and/or a transcranial color Doppler-guided Matas' test were performed instead, because these patients needed immediate management. The diagnostic procedures were very useful to decide what action to take in such urgent cases.
    Auris, nasus, larynx 06/2009; 37(1):129-33. · 0.58 Impact Factor
  • Japanese Journal of Transfusion and Cell Therapy 01/2009; 55(5):596-603.
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    ABSTRACT: We describe herein two cases of delayed hematological recovery (DHR) following autologous peripheral blood stem cell transplantation (auto-PBSCT) using cells harvested during second molecular remission after treatment with arsenic trioxide (As(2)O(3)). Current therapeutic strategies with As(2)O(3) plus auto-PBSCT might be hampered by potential mechanisms of DHR. Our observations highlight the need for study of the real effects of As(2)O(3) on the kinetics of normal hematopoietic engraftment following auto-PBSCT.
    Pathology & Oncology Research 07/2008; 14(4):387-90. · 1.56 Impact Factor
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    ABSTRACT: To clarify the endoscopic findings of intestinal graft-versus-host disease (GVHD), we reviewed the endoscopic findings of 19 patients who underwent colonoscopy because of abdominal pain, watery diarrhea or bloody stool among 196 bone marrow transplant (BMT) recipients between 1986 and 1997. BMT had been performed for treatment of various hematopoietic disorders. Eleven patients were diagnosed as having intestinal GVHD, based on the pathological findings of biopsy specimens. Although the grade of inflammation differed among cases, the terminal ileum was most vulnerable to GVHD, based on our observations. Compared to the ileum, findings in the colon tended to be mild. Therefore, evaluation of intestinal GVHD requires observation of the terminal ileum when the colorectal findings are mild. The findings consisted of shallow ulcerations, erythema and easy bleeding. However, there were very few specific endoscopic findings of intestinal GVHD. Since intestinal GVHD and cytomegalovirus (CMV) enterocolitis share several clinical characteristics, including preferential involvement of the ileum, biopsy is indispensable for the final diagnosis.
    Digestive Endoscopy 12/2007; 10(2):105 - 109. · 1.61 Impact Factor
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    ABSTRACT: Nanometer-size quantum whiskers of InAs and GaAs have been fabricated by low-pressure MOCVD. Time-integrated and time-resolved photoluminescence of GaAs wires of diameters 200, 100, 70, and 50 nm have been studied. The temperature dependence of PL peak energy was found to follow the same variation as the bandgap of GaAs, and Varshni's theory has been used to explain the temperature dependence. The main channel of radiative recombination was found to be due to free excitons. The nonuniformity in diameter and lattice phonon interactions were considered to understand the origin of the linewidth. From the time-resolved PL the surface recombination lifetimes were measured directly. Surface recombination velocities were evaluated and were correlated to wire diameter. The quantum-size-dependent spatial part of the electronic wave function was thought to be responsible for the variation of surface recombination velocity with diameter. Surface treatment with sulphur reduced the surface depletion layer, as evidenced from the time-resolved and time-integrated spectra. The carrier lifetime was in picosecond time scales at 7 K and increased with temperature, thus confirming the quantum confinement effects. The polarization experiments revealed the one-dimensional nature of quantum whiskers. © 1994 John Wiley & Sons, Inc.
    Microwave and Optical Technology Letters 01/2007; 7(3):94 - 103. · 0.59 Impact Factor
  • Japanese Journal of Transfusion and Cell Therapy 01/2007; 53(3):365-373.
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    ABSTRACT: Although the mobilization of peripheral blood stem cells from normal donors using granulocyte colony-stimulating factor is widely used, the ideal method for the administration of filgrastim has not been determined. Therefore, we compared the efficacy of peripheral blood stem cell mobilization on day 4 of filgrastim between once-daily (group O) and twice-daily (group T) administration of filgrastim at 400 microg/m(2)/d. In all, 38 and 34 donors were randomly assigned to groups O and T, respectively. The number of CD34(+) cells collected on day 4 was not significantly different (1.74 x 10(6) cells/kg in group O and 2.08 x 10(6) cells/kg in group T, P = .37). The incidence and severity of adverse events were similar in the two groups. The baseline white blood cell count was the strongest predictor of poor mobilization. Donor age, sex, and serum concentrations of several cytokines did not significantly affect the CD34(+) cell yield. In conclusion, once-daily administration of filgrastim at 400 microg/m(2)/d appeared to be appropriate for the mobilization of CD34(+) cells in normal donors when apheresis is planned on day 4 of filgrastim. Selection of a donor with a steady-state white blood cell count of 5.0 x 10(9)/L or more may lead to a lower incidence of poor mobilization.
    Biology of Blood and Marrow Transplantation 05/2006; 12(4):408-13. · 3.94 Impact Factor
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    ABSTRACT: The current–voltage characteristics of GaAs whiskers with an average diameter of 100nm and a population of 100–1000 were measured using a device structure with two terminal electrodes. An ohmic contact to the tip of whiskers which were buried in spin-on glass between a metal electrode and n-type GaAs(111)As substrate was realized by heat treatment at 430°C. The measured results show that the current–voltage curve for the whiskers is better approximated by the polynomial of the voltage to the power of 1.5 than by the exponential of the voltage. The dependence of the current on the voltage suggests that a space-charge layer was formed in the nanowhiskers. Step-like current fluctuations were also observed at 77K, and this behavior was reproducible and unchanging even under a magnetic field. This suggests that the charge on the surface of the whiskers had a significant effect on carrier transport along the whiskers.
    Current Applied Physics - CURR APPL PHYS. 01/2006; 6(1):10-13.
  • Journal of The Electrochemical Society - J ELECTROCHEM SOC. 01/2006; 153(1).
  • International Journal of Hematology 08/2005; 82(1):79-81. · 1.68 Impact Factor
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    ABSTRACT: We carried out a survey on platelet transfusions performed in nine general hospitals. We evaluated 303 adults who received a total of 24455 units over 1864 platelet transfusions. The underlying diseases were hematologic disorders with chemotherapy (59.7%), hematologic disorders without chemotherapy (15.5%), hematopoietic stem cell transplantation (18.5%), and others (2.0%). The patient platelet count before transfusion (platelet trigger value) was measured in only 77.1%. The platelet trigger value differed greatly between the hospitals, with an average of 2.2 x 10(4)/microl, a minimum of 1.3 x 10(4)/microl, and maximum of 3.2 x 10(4)/microl. Only 55.3% of the platelet transfusions carried out complied with the Platelet Transfusion Guideline published by the Ministry of Health, Labour and Welfare. The hospitals surveyed could be divided into those who gave mainly around 10 units and those who gave over 10 units. The total dose of platelets transfused was more in the hospitals that used mainly 15 or more unit-PCs than in the hospitals that used mainly 10 unit-PCs. These results indicate that platelet transfusion may be greatly reduced by complying with the 2 x 10(4)/microl of platelet transfusion threshold and by selecting less than 10 units of PC per transfusion.
    [Rinshō ketsueki] The Japanese journal of clinical hematology 12/2004; 45(11):1187-92.
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    ABSTRACT: Human Valpha24+ natural killer T (NKT) cells have an invariant T-cell receptor-alpha chain and are activated in a CD1d-restricted manner. Valpha24+ NKT cells are thought to regulate immune responses and to play important roles in the induction of allograft tolerance. In this report, we analyzed the recovery of Valpha24+ NKT cells after hematopoietic stem cell transplantation and its correlation with graft-versus-host disease (GVHD). Patients who received a dose-reduced conditioning regimen, antithymocyte globulin- or CAMPATH-1H-containing conditioning regimen were excluded. NKT cells were reconstituted within 1 month after transplantation in peripheral blood stem cell transplantation recipients, while their numbers remained low for more than 1 year in bone marrow transplantation (BMT) recipients. The number of Valpha24+ NKT cells in BMT recipients with acute GVHD was lower than that in patients without acute GVHD, and both the CD4+ and CD4- Valpha24+ NKT subsets were significantly reduced. With regard to chronic GVHD, BMT recipients with extensive GVHD had significantly fewer Valpha24+ NKT cells than other patients. Furthermore, the number of CD4+ Valpha24+ NKT cells was also significantly reduced in patients with chronic extensive GVHD. Our results raise the possibility that the number of Valpha24+ NKT cells could be related to the development of GVHD.
    Bone Marrow Transplantation 11/2004; 34(7):595-602. · 3.54 Impact Factor
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    ABSTRACT: A feasibility study on high-dose therapy with autologous peripheral blood stem cell transplantation (HDT/PBSCT) was performed in Japanese patients with multiple myeloma (MM). Twenty evaluable patients younger than 65 years old with stage II/III MM were enrolled in this study. Three courses of VAD were used as initial chemotherapy. High-dose etoposide or cyclophosphamide followed by G-CSF was used for PBSCH, and 1.2-89.3 (median 23.4) x 106/kg of CD34+ cells were collected. Single (11 patients) or tandem (9 patients) HDT with melphalan (MEL) 200 mg/m2 or MEL 140 mg/m2 plus TBI 10 Gy were performed. The incidence of grade 4 toxicity (COG) was 10% and treatment-related mortality was 5%. Complete response and tumor reduction of more than 75% were obtained in 4 (21%) and 16 (84%) out of 19 patients, respectively. The actuarial 3-year overall survival (OS) and event-free survival (EFS) after PBSCT/HDT were 65.6% and 22.0%, respectively. The median EFS duration was 18 months. These preliminary results indicated that HDT/PBSCT is feasible for Japanese MM patients. A prospective randomized clinical trial will be required to assess the efficacy.
    [Rinshō ketsueki] The Japanese journal of clinical hematology 08/2004; 45(7):524-9.
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    ABSTRACT: To clarify whether nonmyeloablative allogeneic stem cell transplantation (NST) can produce the graft versus tumor (GVT) effect in patients with pancreatic cancer. A pilot trial of NST was conducted in 5 patients with unresectable pancreatic cancer. Preparative conditioning consisted of administration of 60 mg/kg cyclophosphamide on days 6 and 7 before transplantation, followed by 25 mg fludarabine per square meter of body surface on each of the last 5 days prior to transplantation. Cyclosporine was started 4 days before transplantation. Peripheral blood stem cells from the patients' HLA-identical siblings were transfused into the patients. Complete donor T-cell chimerism in peripheral blood was obtained in 4 patients on day 15 after transplantation. NST resulted in tumor reduction in 2 patients as determined by CT, decreasing levels of tumor markers in 2 patients, pain relief in 2 patients, and a decrease in pleural fluid in 1 patient. Two patients developed acute graft versus host disease (GVHD) of grade II or III and 2 had chronic GVHD involving skin and/or liver. Administration of immunosuppressive drugs for the treatment of GVHD resulted in the elevation of tumor marker levels. These findings are the first to suggest that NST induces a GVT effect on pancreatic cancer.
    Pancreas 05/2004; 28(3):e65-9. · 2.95 Impact Factor
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    ABSTRACT: The term "malignant mixed tumor" is usually synonymous with "carcinoma in pleomorphic adenoma," a secondary carcinoma developing in pre-existing pleomorphic adenoma. However, it sometimes indicates a group of tumors consisting of carcinoma in pleomorphic adenoma, carcinosarcoma (true malignant mixed tumor) and metastasizing benign mixed tumor, the latter 2 being the most infrequent. According to the data of the Japanese committee on TNM classification for salivary gland carcinomas, carcinoma in pleomorphic adenoma accounted for about 10% of all salivary gland carcinomas, both in the parotid and submandibular glands. The main type of carcinomas arising in pleomorphic adenoma were undifferentiated carcinoma, adenocarcinoma and squamous cell carcinoma. Crude 5- and 10-year survival rates were 54.7% and 42.7%, respectively. Invasive carcinomas and carcinomas of high grade malignancy carried worse prognoses. The treatment of choice for carcinoma in pleomorphic adenoma has consisted of en-bloc excision with wide margin. Invasive growth, facial nerve involvement, lymph node metastasis or high-grade malignant tumor are grounds for postoperative radiation therapy. The role of chemotherapy has not yet been well established.
    Gan to kagaku ryoho. Cancer & chemotherapy 04/2004; 31(3):314-7.
  • Kiyoshi Hiruma, Tsutomu Numata
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    ABSTRACT: We encountered patients who had their static direction-changing positional nystagmus canceled at about 20-30 degrees yaw head rotation from the supine position. This nystagmus was also canceled when the head was rotated 180 degrees from this position. We call these head positions neutral points. At the neutral points, the cupula of the horizontal semicircular canal of the affected ear is positioned vertical to the gravitational plane and no deflection of the cupula occurs. The positional nystagmus observed (except the neutral points) was thought to occur due to a "heavy cupula" or "light cupula", which may be determined by the specific gravity of its endolymph.
    ORL 02/2004; 66(1):46-50. · 1.10 Impact Factor
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    ABSTRACT: The case of a 32-year-old female with relapsed myelodysplastic syndrome (MDS) after second course of allogeneic transplantation is described. The peripheral blood stem cell transplantation was performed as early as 3 months after the initial bone marrow transplantation because of rejection and relapse; however, the patient again relapsed 2 months later. Immediate discontinuation of cyclosporine resulted in the progression of pancytopenia and the development of high fever, liver dysfunction and skin eruption. The patient was then treated with dexamethasone, which successfully stabilized these symptoms. After these clinical events, a dramatic hematological response was obtained; the blast rate was reduced from 10.6 to 0% in bone marrow aspiration, and pancytopenia was restored to normal levels. Moreover, fluorescence in situ hybridization analyses with X and Y chromosome-specific probes revealed that hematopoietic precursor cells were predominantly of donor origin. The patient subsequently received donor lymphocyte infusion (DLI) from the original donor. Currently, 2 years after DLI, the patient continues to be in remission.
    [Rinshō ketsueki] The Japanese journal of clinical hematology 12/2003; 44(11):1085-9.
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    ABSTRACT: Gastric antral vascular ectasia (GAVE) may occur after hematopoietic stem cell transplantation (HSCT) and cause severe and prolonged gastric bleeding. The underlying pathology of transplant-associated GAVE (HSCT-GAVE) is poorly understood and an effective therapeutic strategy has not been established yet. We retrospectively reviewed the medical records of 230 consecutive allogeneic transplant recipients in our institution between January 1997 and June 2002. We identified five patients who developed HSCT-GAVE (2.2%). Four patients had bleeding from HSCT-GAVE and one patient had HSCT-GAVE discovered incidentally. The clinical features of these patients were similar in that they all received conditioning treatment with busulfan and had history of thrombotic microangiopathy. Furthermore, treatment with a beta-blocker apparently improved the outcome of HSCT-GAVE in three patients.
    Bone Marrow Transplantation 09/2003; 32(4):417-21. · 3.54 Impact Factor