K Sunami

Okayama University, Okayama, Okayama, Japan

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Publications (47)89.66 Total impact

  • K. Konishi · H. Yamane · K. Sunami
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    ABSTRACT: Tuberculous sinusitis is a very rare disease in extrapulmonary tuberculosis. But we have to consider tuberculosis as one of the differential diagnosis, especially in compromised hosts such as malignant patients receiving chemotherapy, autoimmune disease cases using glucocorticoid and/or immunosuppressive drugs, and so on. We report a rare case of maxillary tuberculosis with rheumatic arthritis diagnosed before a surgical treatment. A 45-years old female was referred to us with a complaint of numbness on the left cheek. She had been administrated prednisolone and methtrexate for rheumatic arthritis. CT revealed unilateral sinusitis in the left maxillary sinus including partially enhanced lesion. We planned endoscopic sinus surgery, and chest X-ray (one of the preoperative examination) showed bilateral abnormal pulmonary shadows. Acid-fast bacilli were detected in the smear of sputum, and Mycobacterium tuberculosis was identified by PCR. Similarly M. tuberculosis was detected in the discharge obtained from her left middle meatus, and she was diagnosed as lt-maxillary tuberculosis. The patient was treated with antituberculous drugs according to the guideline of the Ministry of Public Welfare including INH, RFP, EB and PZA. We observe her maxillary sinus with a flexible fiberscope through the ostium. Fiberscopic findings revealed that caseuos necrostic region and granulation were reduced by the efficacy of antituberculous therapy and normal mucosa regenerated with time. Usually the diagnosis of tunerculoes sinusitis was made by the pathological examination after surgical treatment. But appropriate examinations such as bacteriological examination, PCR, γ-INF response assay for tuberculosis (QuantiFERON®-TB) and so on can lead to the earlier detection and therapy. It will contribute to the prevention of hospital infections. Therapeutic delay will reduce its efficacy especially in compromised hosts. Therefore we have to pay consideration to tuberculosis when usual treatments fail to effect. By contrast, we must explore the lesion of paranasal sinus pathologically when antituberculous treatments don't improve clinical symptoms and findings.
    No preview · Article · Mar 2009 · Medical Journal of Minami Osaka Hospital
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    ABSTRACT: A case of acute cerebellitis related to Epstein-Barr Virus (EBV) is reported. The patient was a 32-year-old man who presented with ataxia and vertigo, which had worsened over a 10-day period. Spontaneous and positional nytagmus was observed, in which the direction of nystagmus periodically alternated. No abnormal signal intensity was found on MRI of brain in the acute stage. High serum IGM titers to Epstein-Barr virus were detected. Based on these tests and the clinical course, we diagnosed acute cerebellitis related to Epstein-Barr virus. He recovered following treatment with steroid.
    No preview · Article · Mar 2007 · Medical Journal of Minami Osaka Hospital
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    ABSTRACT: Congenital external auditory canal stenosis (CAS) is usually considered one of the slight malformations related to congenital external auditory canal atresia (CAA). However, the clinical symptoms caused by the slight malformation may not be mild. Destructive external ear canal cholesteatoma commonly occurs in CAS, but is infreguent in CAA. For several reasons CAS tends to receive an inappropriately low estimate of risk compared to that for CAA. The other malformations accompanying CAS and CAA such as microtia confound the decision regarding future treatment for doctors as well as for the patients themselves. A consensus regarding the clinical entity of CAS is required among doctors not only in otorhinolaryngology but also in relevant fields such as pediatrics and plastic surgery. These two malformations, the pathological conditions and clinical treatment of CAS and CAA should be considered separately.
    No preview · Article · Jan 2007 · Practica oto-rhino-laryngologica
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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.
    No preview · Article · Dec 2004 · Equilibrium Research
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    ABSTRACT: High jugular bulbs are classified into 2 types, lateral and medial. The lateral type protrudes into the tympanic cavity, whereas the medial type protrudes into the medial petrous bone and may cause senorineural hearing loss, tinnitus and Meniere's disease. We present a rare case of combined lateral and medial type in this repot. A 56-year-old man was referred to us with complaints of dizziness and left middle ear cholesteatoma. He also had an approximately 30-year history of hearing disturbance and tinnitus on the same side after a traffic accident. CT revealed findings of cholesteatoma and an extremely enlarged high jugular bulb on the left side. The high jugular bulb protruded into not only the tympanic cavity, but also the medial petrous bone. Massive bleeding was avoided during tympanoplasty. It is important to detect the positions of the jugular bulbs with precision before surgery involving the temporal bones.
    No preview · Article · Sep 2004 · Medical Journal of Minami Osaka Hospital
  • S.-K. Pan · K. Sunami · H. Yamane · Z.-M. Wang
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    ABSTRACT: Aim: To explore the effect and mechanism of nitric oxide synthase (NOS) in the regulation of nerve conduction and capillary blood flow in guinea pig cochlea. Methods: After paraformaldehyde perfusion of the heart in 6 guinea pigs, the cochleas taken to prepared frozen sections following decalcification with edetic acid. The sections were incubated in nicotinamide adenine dinucleotide phosphate hydrogen(NADPH) for charactering the distribution and activity of NADPH-diaphorase by means of enzyme-linked immunosorbent assay(ELISA). Results: Obvious NADPH-diaphorase activity was found in the guinea pig cochlea, cochlea nerve ending underlying the outer hair cells, and the endothelial cells of the capillary glomus. In addition, NADPH-diaphorase activity was also detected in the outer and inner pillar cells, supporting cells, spiral ligaments, and spiral ganglion cells. Conclusion: Nitric oxide is crucial in maintaining normal nerve conduction and capillary blood flow in the cochlea of guinea pigs.
    No preview · Article · Feb 2004 · Chinese Journal of Clinical Rehabilitation
  • 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.
    No preview · Article · Jun 2003 · Equilibrium Research
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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.
    No preview · Article · Oct 2001 · Experimental Hematology
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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.
    No preview · Article · Jun 2001 · Bone Marrow Transplantation
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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.
    No preview · Article · Jan 2001 · International Journal of Hematology
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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.
    Preview · Article · Nov 2000 · Bone Marrow Transplantation
  • 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.
    No preview · Article · Oct 2000 · [Rinshō ketsueki] The Japanese journal of clinical hematology
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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.
    No preview · Article · Oct 2000 · International Journal of Hematology
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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.
    No preview · Article · Jul 2000 · International Journal of Hematology
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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.
    Full-text · Article · May 2000 · Bone Marrow Transplantation
  • 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.
    No preview · Article · Oct 1999 · Gan to kagaku ryoho. Cancer & chemotherapy
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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.
    No preview · Article · Jun 1999 · Neuroscience Letters
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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.
    No preview · Article · Mar 1999 · ORL
  • 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.
    No preview · Article · Feb 1999 · Acta Oto-Laryngologica
  • 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.
    No preview · Article · Feb 1999 · Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde

Publication Stats

548 Citations
89.66 Total Impact Points


  • 1998-2001
    • Okayama University
      • • Division of Biological Science
      • • Medical School
      Okayama, Okayama, Japan
    • Okayama City Hospital
      Okayama, Okayama, Japan
  • 1997-1998
    • Osaka City University
      Ōsaka, Ōsaka, Japan