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Biomedical subjects

H Minami

Publications and source records attributed to H Minami.

At least 91 records · Page 5Linked to original sources

PCR-RFLP analysis as an aid to genetic counseling of families of Japanese patients with group A xeroderma pigmentosum.

Because Japanese patients with complementation group A xeroderma pigmentosum (XP-A) show early skin cancer and severe neurologic dysfunction, their family members are greatly concerned about the risk of inherited disease. In contrast to western XP-A patients, almost all Japanese XP-A patients have two of the three mutations (nonsense mutation in exon 3, splicing mutation in intron 3, and non-sense mutation in exon 6), which are easily detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. This work was aimed to see whether PCR-RFLP analysis is useful for genetic counseling of XP patients' siblings who are potential carriers of an XP-A gene mutation. In two of the three case studies presented, the probands were homozygous for the splicing mutation in intron 3 of the gene. In their siblings receiving genetic counseling, no mutation was found in the mutation site in one case, and one splicing mutation was found in the second case. In the third case, the proband was a compound heterozygote for the splicing mutation and for an unidentified mutation; in her sibling, no mutation was found in either of these mutation sites. No mutation was found in the siblings' spouses. On the basis of these findings, we reassured the prospective parents that there was little probability of having XP children, but in the second and third cases, we told them that their apparently unaffected children might be carriers. Each couple subsequently had one unaffected child. Thus, PCR-RFLP analysis is useful for genetic counseling of family members of XP-A patients.

Adult↗

Pharmacokinetic study of carboplatin given on a 5-day intravenous schedule.

We investigated whether carboplatin pharmacokinetics is altered when the drug is delivered daily over 5 days, compared to a single-day infusion. Carboplatin was infused in 11 patients with lung cancer, who were randomly assigned to 2 groups. In the first group, the agent was administered on a conventional single-day schedule in the first course and then on a 5-day schedule in the second course. In the second group, the order was reversed (crossover design). The dose was calculated using Calvert's formula with 24 h creatinine clearance (Ccr, ml/min) as a substitute for glomerular filtration rate (GFR): carboplatin (mg) = AUCx(Ccr+25), where AUC denotes the area under the concentration versus time curve (mg ml-1 min). No difference of carboplatin clearance between the single-day and 5-day schedule was observed (94.8 +/- 19.9 versus 96.1 +/- 29.9 ml/min, P = 0.818, paired t test). The formula systematically overestimated the carboplatin clearance: the ratio of estimated clearance/ observed clearance ranged from 1.01 to 1.58 (median 1.28; 95% confidence interval, 1.18 to 1.39). We concluded that the individual dosing strategy based on renal function can be applied with a 5-day schedule as well as a single-day schedule. Carboplatin is overdosed when Ccr is substituted for GFR in Calvert's formula.

Aged↗

Prediction of drug responses in schizophrenia: a method using a test dose of chlorpromazine.

Thirty-seven newly admitted schizophrenic patients were treated with an open and flexible dosage of chlorpromazine for 3 months after receiving a test dose. Levels of chlorpromazine, demethylated chlorpromazine and chlorpromazine sulfoxide 3 h after the test dose were measured. Twenty-three patients responded to long-term chlorpromazine treatment but 14 did not, a rate of 62.2%. A discriminant function analysis was performed using variables relating to the patients, backgrounds added to the ratios of plasma drug levels separately by sex to increase predictability over the level of previous studies. The obtained equations were applied to 23 newly admitted schizophrenic patients, with the prescription of chlorpromazine for designated responders and haloperidol for designated non-responders for 4 weeks. The patients in the latter study responded better than those of the former with chlorpromazine alone; 71.4 and 88.9% of chlorpromazine- and haloperidol-treated groups improved, respectively, for an overall rate of 78.3%. However, the chlorpromazine-treated group had a lower level of positive symptoms than the haloperidol-treated group before treatment and this and other differences between the groups should be further examined.

Adult↗

A phase II study of carboplatin and prolonged administration of oral etoposide in patients with small-cell lung cancer.

Prolonged oral administration of etoposide may have a theoretical advantage over intravenous infusion, and carboplatin has a more favorable toxicity profile than cisplatin. A combination of carboplatin 300 mg/m2 and oral etoposide 40 mg/m2/day for 21 days was assessed in 74 (42 limited, 32 extensive disease) previously untreated patients with small-cell lung cancer. Response rate was 69% (CR 19%, PR 50%,) for limited disease and 72% (CR 9%, PR 63%) for extensive disease. Median response duration and overall survival was 6.6 and 10.1 months for limited disease, and 5.3 and 9.1 months for extensive disease, respectively. One-year and two-year survival was 36 and 10% for limited disease and 31 and 2% for extensive disease, respectively. The major toxicity was hematological with grade 4 or greater neutropenia in 36% and grade 4 thrombocytopenia in 16%, and one patient died of neutropenic fever. Non-hematologic toxicities were mild and grade 3 emesis was observed in 5% of patients. Carboplatin combined with 21-day oral etoposide showed only modest activity against small-cell lung cancer with high toxicity and did not merit further evaluation.

Administration, Oral↗

[Three patients with Gilbert's syndrome associated with constitutional excretory defect of indocyanine green].

We routinely perform, as a preoperative liver function test, the indocyanin green (ICG) test in patients scheduled for operations under general anesthesia. Doubts have been raised, however, concerning the necessity for this test, since no abnormalities have ever been detected by it. Nonetheless, we noted a high level of ICG retention and a slight increase in indirect bilirubin in 3 patients, and further investigation led to a diagnosis of Gilbert's syndrome accompanied by constitutional impairment of ICG excretion. This syndrome can be associated with perioperative jaundice in patients with malnutrition and those who received halothane, morphine, or some other agents. Although the indirect bilirubin level increased briefly after surgery, no other abnormalities occurred in the 3 patients. Since this syndrome is asymptomatic and is detected incidentally, the preoperative ICG test was considered to be useful.

Adolescent↗

[Coronary artery bypass surgery in patients aged 75 years and older].

Coronary artery bypass grafting (CABG) has been performed for elderly patients with increasing frequency. Several studies have shown that the rate of complications and mortality in elderly patients are higher than in younger ones. This report presents results of CABG in patients over 75 years old. From January 1989 to February 1997, 604 patients underwent CABG, of whom 20 patients (3.3%) were 80-86 years old (group A) and 57 patients (9.4%) were 75-79 years old (group B). We compared these two groups with 100 younger patients (group C). Preoperative use of intraaortic balloon pumping and the emergency operation were more frequent in patients of group A (emergency 45%, IABP 20%). And the proportion of the no blood transfusion procedures was lower in elderly patients (group A 20%, group B 18%, group C 82%). The number of grafts per patient (group A 2.45 +/- 0.62, group B 2.2 +/- 0.6, group C 3.2 +/- 0.6) and the number of arterial grafts (group A 1.25 +/- 0.62, group B 1.25 +/- 0.66, group C 2.1 +/- 0.53) were different between the groups. But CABG in elderly patients was performed with low hospital mortality (group A 0%, group B 0.18%) and significant symptomatic benefit. We conclude that CABG can be performed in elderly patients with acceptable mortality and acceptable quality of life, so patients should not denied operation because of an advanced age.

Adult↗

[Sleeve lobectomy for tuberculous bronchial stenosis: a case report].

We describe a patient with tuberculous bronchial stenosis who was subjected to bronchoplasty. The patient was a 33-year-old man who had stenosis of the left main bronchus. Because the lesion was associated with bronchomalacia, previous balloon dilatation therapy had failed. At thoracotomy, the left upper lobe was found not to be saved for the tuberculous lesion. Although there were many inflamed nodules in the left lower lobe due to repeated episodes of pneumonia, we decided to save it using bronchoplasty expecting its respiratory functional recovery. He ran uneventful course postoperatively and his lung function improved. We conclude that bronchoplasty may prove effective for patients with tuberculous bronchial stenosis associated with bronchomalacia; and thus, to avoid pneumonectomy, bronchoplasty should be attempted even if the reconstructed lung is mildly inflamed.

Adult↗

Prognostic value of pleural effusion in patients with non-small cell lung cancer.

This study was performed to determine whether pleural effusion in patients with advanced non-small cell lung cancer (NSCLC) has a negative impact on survival. We evaluated 12 prognostic factors in 197 patients with stage IIIB or IV NSCLC. Each factor was dichotomized, and survival curves calculated by the Kaplan-Meier technique were compared using the log-rank test. The Cox proportional hazards regression model was used to confirm the significance of each prognostic factor selected by univariate analysis. We compared the survival times for stage IIIB with pleural effusion with those of stage IIIB without effusion and stage IV. To determine the impact of the cytological results of the effusion on survival, we compared the survival times for cytologically positive and negative effusions. Univariate analysis identified eight significant prognostic factors: pleural effusion, node status, stage, performance status, weight loss, hemoglobin, albumin, and lactate dehydrogenase. Pleural effusion was selected as a prognostic factor in the multivariate analysis, together with stage, performance status, albumin, and node status. Median survival times for stage IIIB without effusion, stage IIIB with effusion, and stage IV were 15.3, 7.5, and 5.5 months, respectively (P < 0.0001). Survival time for stage IIIB with effusion was significantly different from that of stage IIIB without effusion (P = 0.0129) but not from that of stage IV (P = 0.0797). Among patients with effusion, no significant difference in survival time was observed between cytologically positive and negative effusions. We conclude that pleural effusion in advanced NSCLC is a prognostic factor. Survival time for stage IIIB with pleural effusion is more similar to that of stage IV rather than that of stage IIIB without effusion.

Adult↗

Incorporation of proteins in sphingomyelin-water gel phases.

Sphingomyelin from bovine milk and water form lipid gel phases at room temperature. A sample was used which incorporated of about 55% water, and X-ray diffraction data indicate an aqueous layer thickness of about 28 Angstrom. In order to accommodate proteins in the gel phase, the aqueous layer thickness was increased by solubilizing sodium palmitate into the sphingomyelin bilayer. In this way the gel phase could take up about 80% water. The incorporation of lysozyme, beta-lactoglobulin, and alpha-lactalbumin, was followed and the protein concentration for phase separation to occur was determined. It was found that the degree of incorporation was dependent on the salt concentration, thus the protein used was extensively dialysed. The amount of protein which can be dissolved in the thin aqueous layer of the gel phase was suggested to be limited by the dimensions of the layer. These are likely to be reduced as a consequence of the osmotic stress exerted by the 'outside' solution phase at high enough protein concentration.

Animals↗

Is there a circadian variation in plasma concentrations of etoposide given by prolonged continuous infusion?

The prolonged continuous infusion of low-dose etoposide is a new approach to treating cancer. Whether or not a circadian variation in the plasma levels of etoposide existed was investigated in nine patients with non-small-cell lung cancer. Etoposide was infused for 14 days and blood samples were obtained every 4 h for 1 day. There was no significant circadian variation, and the observed small within-day variations seemed to lack clinical significance.

Aged↗

Pharmacodynamic modeling of prolonged administration of etoposide.

PURPOSE: A refined pharmacodynamic model for toxicity is necessary for successful adaptive control of the administration of an anticancer drug to avoid toxicity. We sought to establish a pharmacodynamic model of leukopenia in a 14-day administration of etoposide. METHODS: Pharmacokinetic data of 32 patients treated with etoposide infused over 14 days in a phase I study (20 patients) or in an adaptive control study (12 patients) were used to develop a model for the prediction of a leukocyte nadir count. The concentrations of both estimated unbound and total etoposide at steady state, as well as patient demographic factors, were included in linear and nonlinear models. The unbound fraction of etoposide was estimated using an equation based on serum albumin and total bilirubin. The efficacy of the models was evaluated in terms of correlation coefficient (r), mean predictive error (MPE) and root mean square error (RMSE). RESULTS: For both total and unbound drug concentration, a nonlinear model predicted leukopenia more precisely and with less bias than a linear model, and unbound drug explained more variability of leukopenia than total drug concentration in both linear and nonlinear models. The best model was a nonlinear model with three variables of unbound concentration, pretreatment leukocyte count and prior treatment (r = 0.76, MPE +/- SEM = 0.07 +/- 0.17 x 10(3)/microl, RMSE = 0.95 x 10(3) microl), which was better than the best linear model. CONCLUSIONS: The nonlinear model using unbound etoposide concentration explained the interpatient variability of leukocyte nadir count to a fairly large extent. Although the model provided useful information on the pharmacodynamics of etoposide, it was still imprecise and a more refined model is necessary for application to an adaptive control study.

Antineoplastic Agents, Phytogenic↗

Elevated plasma superoxide dismutase activity in patients with systemic sclerosis.

Injury to vessel walls, especially microvascular damage due to free radicals, has been a focus of interest concerning the pathogenesis of systemic sclerosis. Excess reactive oxygen species may induce antioxidant defenses. We therefore measured plasma superoxide dismutase (SOD) activity in patients with systemic sclerosis and found average SOD activity of plasma in 16 patients with systemic sclerosis (5.00 +/- 3.10 U/ml) to be significantly (P < 0.001) higher than those in 89 healthy volunteers (1.56 +/- 0.234 U/ml). Patients with Raynaud's phenomenon and/or skin sclerosis had particularly high SOD activity. These findings suggest that plasma SOD activity may serve as a useful parameter for assessment of sclerotic progression and the presence of Raynaud's phenomenon.

Adult↗

Acceptability of patients with brain metastases for clinical trials of chemotherapy for metastatic non-small-cell lung cancer.

This study was conducted to determine whether patients with brain metastases from non-small-cell lung cancer (NSCLC) should be included in clinical trials of chemotherapy. Patients with metastatic NSCLC and good performance status were studied. The survival of patients with brain metastases was compared with that of patients without brain metastases. Of 100 eligible patients, 22 had brain metastases at diagnosis. The median survival time was poorer in patients with brain metastases than in other patients with metastatic NSCLC (96.5 vs. 181.5 days). However, the difference in survival was not significant on univariate analysis (p = 0.106). Multivariate analysis confirmed that the prognostic value of brain metastases was limited in this sample (p = 0.129). There was little difference in survival curves during the first 8 weeks. Patients with brain metastases who have good performance status and minimal neurologic symptoms can be observed for approximately 8 weeks in clinical trials to determine their response to chemotherapy. However, it is doubtful that patients with brain metastases would be eligible for phase III trials, in which survival is an endpoint.

Adult↗

Developmental stage-specific and nitrate-independent regulation of nitrate reductase gene expression in rapeseed.

cDNA clones for two isogenes of nitrate reductase (NR) have been isolated from rapeseed (Brassica napus L.) androgenetic haploid embryos induced by microspore culture. NR mRNA accumulation can be detected by northern hybridization at 14 d after culture initiation when embryos develop to the heart/torpedo-shaped stage. Whole-mount in situ hybridization experiments demonstrate that the mRNA accumulation is developmental stage specific. In addition, even when cultured in media containing no nitrate, embryos accumulated NR mRNA to almost the same level as the control. This indicates the unique regulation of NR in embryogenesis in which NR mRNA transcription is activated in a developmental stage-specific manner that is independent of nitrate induction. In zygotic embryogenesis, a stage-specific accumulation of NR mRNA was also observed. By contrast, the obvious effect of nitrate on NR expression that has been reported in many plant species was also confirmed in rapeseed leaf. Quantitative combined reverse transcription-polymerase chain reaction analysis suggests that the flexible and variable regulation of NR expression, which is organ specific, nitrogen metabolite specific, and developmental stage specific, is caused principally by regulation of one major structural gene.

Base Sequence↗

Therapeutic drug monitoring in 21-day oral etoposide treatment for lung cancer.

We aimed to determine whether or not therapeutic drug monitoring is applicable to 21-day oral etoposide treatment for lung cancer. As the starting dose, a 25-mg capsule of etoposide was taken orally three times daily (75 mg/body). To achieve the target concentration range of 1.0 to 1.5 micrograms/ml, the dose was changed to two (50 mg/body) or four (100 mg/body) times a day from day 5, depending on the mean concentration obtained on days 3 and 4 (Cbefore). The mean concentration was calculated by use of a limited sampling model we constructed previously. Among 26 courses in 15 patients, two patients experienced grade 4 leukopenia plus neutropenia, and one of them died on day 20. Because nausea/emesis prevented the planned dose escalation in one patient, we excluded two courses of this patient from the pharmacokinetic analysis of dose modification. Among 5 courses with dose reduction, the Cbefore of 1.7 +/- 0.1 (microgram/ml, mean +/- SE) was decreased to 1.3 +/- 0.2 after day 5 (Cafter). Among 7 courses with dose escalation, the Cbefore of 0.9 +/- 0.0 was increased to the Cafter of 1.2 +/- 0.1. Among the remaining 12 courses without dose modification, the Cbefore and the Cafter were 1.2 +/- 0.0 and 1.3 +/- 0.1, respectively. Hematologic toxicities tended to correlate with the drug concentration. TDM is thus applicable to oral etoposide given according to this schedule, and a larger study is now needed to confirm that the therapeutic efficacy is improved by introducing TDM.

Administration, Oral↗

Therapeutic drug monitoring of etoposide in a 14-day infusion for non-small-cell lung cancer.

We investigated whether a constant plasma concentration could be obtained by the individualized administration of low-dose, prolonged-infusional etoposide. Etoposide was infused for 14 days at 40 mg/m2/day initially in patients with inoperable non-small-cell lung cancer. The infusion rate was modified based upon the etoposide concentration at 24 h following the initiation of the infusion (C24) to achieve a target concentration of 1.5 microgram/ml. We postulated that severe toxicities could be avoided by maintaining the steady-state concentration at less than 2 microgram/ml, while antitumor activity could be expected if the steady-state concentration was maintained at more than 1 microgram/ml. In a total of 21 courses in 12 patients, the mean etoposide dose was 35+/-6 mg/m2 daily. The C24 was 1.8+/-0.4 microgram/ml and ranged from 1.1 to 2.9 microgram/ml. Following dose modification, the mean concentration from 96 to 336 h (C mean) was 1.6+/-0.2 microgram/ml and ranged from 1.2 to 2.0 microgram/ml. The toxicities were well-tolerated except for one patient with WHO grade 4 leukopenia and neutropenia who developed infectious complications. There were no treatment-related deaths. Following dose modification, the inter-patient variability was decreased successfully. Although this pharmacologically-guided method needs to be validated using more patients, it could be used for therapeutic drug monitoring.

Aged↗