Chidori Kubota

Changes in thyroid function after bone marrow transplant in young patients.

Abstract Background : Changes in thyroid function among young patients who received bone marrow transplantation (BMT) were evaluated.

Growth after bone marrow transplantation in children.

Growth of the patients with hematological malignancies, aplastic anemia, Fanconis anemia, and Wiscott-Aldrich syndrome who had been treated with bone marrow transplantation (BMT) was studied. Fourteen out of 21 patients showed suppression of linear growth after BMT. Recovery of the growth velocity after 1-2 years tended to occur if BMT was performed at younger age. Six of eight patients with chronic graft-versus-host-disease (CGVHD) had impaired growth after BMT, whereas eight of 13 (61%) without CGVHD did. Provocative tests for growth hormone (GH) performed 5-72 months after BMT revealed three boys who showed poor response to more than two different stimuli. Two of these three boys had prolonged suppression of growth. Neither the age at BMT, difference in disease, nor presence of posttransplant growth retardation gave significant difference in the response of GH to provocative tests. It was concluded that approximately two-thirds of marrow-grafted children experienced transient decrease in growth velocity after BMT.

Spontaneous reduction of a recurrent craniopharyngioma in an 8-year-old female patient: case report.

OBJECTIVE AND IMPORTANCE The spontaneous rupture of a craniopharyngioma is an extremely rare condition confined to adults. This is the first report of a patient younger than 10 years who experienced spontaneous reduction (possibly rupture) of a craniopharyngioma. CLINICAL PRESENTATION An 8-year-old female patient with a recurrence of a craniopharyngioma experienced fever, headache, and visual disturbance that lasted a few days. Concurrent with the improvement of these symptoms, marked reduction in the size of the tumor was revealed using magnetic resonance imaging, suggesting the occurrence of a rupture. INTERVENTION Subsequent magnetic resonance imaging of the hypothalamic-pituitary region was performed while the patient received growth hormone therapy. CONCLUSION There was no increase in the size of the tumor 1 year after the reduction occurred. Prompt evaluation of the hypothalamic-pituitary region using magnetic resonance imaging is warranted to rule out the possibility of spontaneous reduction (including rupture) of the tumor in a situation in which the patient with a craniopharyngioma shows meningeal signs or a rapid change of neurological symptoms (such as headache, fever, or visual disturbance).

Enhancement of differentiation of rat adipocyte precursor cells by pertussis toxin

To examine whether GTP-binding protein(s) is (are) involved in adipocyte differentiation, the effect of pertussis toxin (PT) was studied in rat adipocyte precursor cell culture. PT potentiated adipose conversion induced by dexamethasone, insulin, and 1-methyl-3-isobutylxanthine in a dose- and time-dependent fashion. Attenuation of an inhibitory control of adenylate cyclase was not the mechanism of action of PT. The dose-dependent inhibition of PT-catalyzed ADP-ribosylation of the Mr 40,000 protein of the cell membrane by preincubation of the toxin was inversely related to the potentiating effect on differentiation. PT-sensitive G protein(s) may be involved in adipocyte differentiation in a negative fashion.

Changes in hypothalamic-pituitary function following bone marrow transplantation in children

Patients who undergo bone marrow transplantation (BMT) frequently experience impaired pituitary function, but precise assessment using repeated provocative tests has not been described. We studied 32 children (16 boys) who had BMT after receiving preparative irradiation. Assessment of pituitary function was performed by infusing insulin, luteinizing hormone‐releasing hormone (LHRH), and thyrotropin‐releasing hormone (TRH) on several occasions at various intervals during the follow‐up period.

Growth and growth hormone secretion in children after bone marrow transplantation.

Long‐term sequelae of bone marrow transplantation (BMT) are a major concern among long‐term survivors since the procedure has been considerably developed over the past decade. In this study, linear growth and growth hormone (GH) secretion were evaluated in 25 children (14 males and 11 females) with various neoplastic or non‐neoplastic hematological disorders who had survived for more than 3 years after BMT. Impaired linear growth after BMT, as defined by a change in height standard deviation score (SDS) by more than − 1.0 SD, was observed in 14 patients (56%). Four children showed severe growth suppression with a decrease in SD score by more than 2.0, and 10 exhibited a moderate reduction by between 1.0 and 2.0 SD. A recovery of normal height velocity was observed in those who had received BMT at a younger age. The type of disease, a difference in preconditioning regimen, the presence of chronic graft‐versus‐host disease or a GH secretory capacity 1 year after BMT were not contributing factors for impaired growth. A serial examination of GH secretion with insulin‐induced hypoglycemia demonstrated that poor GH secretion was not necessarily a prerequisite for impaired growth. These results indicate that the secretory status of GH does not predict the future growth pattern of children who received BMT.

Allogeneic bone marrow transplantation in childhood leukemia.

Allogeneic bone marrow transplantation was performed in 94 patients with hematologic malignancies or other various diseases during the period between March 1982 and November 1990 at Tokai University Hospital. Projected disease‐free survival rates of HLA genotypically identical marrow recipients were 88.9% for chronic myeloid leukemia transplanted in the first chronic phase (N = 9), 90.9% for acute leukemia in the first complete remission (N = 15), 54.5% for acute leukemia in later remissions (N = 14), 62.5% for solid tumors (N = 8) and 0% for patients transplanted in relapse (N = 7). The rate for HI A‐mismatched marrow recipients with leukemia was 27.8% (N = 16). For patients with non‐neoplastic diseases it was 100% regardless of HLA‐compatibility (N = 26). The quality of life in long‐term surviving pediatric marrow recipients has been acceptable. Common abnormalities among survivors are long‐lasting hypogonadism due to radiation and subclinical impairment of lung function in the first year post‐BMT. About two‐thirds of children experienced a transient decrease in growth velocity in the immediate posttransplant period.

Bone Marrow Transplantation in Children and Quality of Life in Long-Term Survivors

Allogeneic bone marrow transplantation (BMT) has been performed in 70 patients with hematological malignancies or other various diseases during the last seven years at Tokai University. The projected survival rates of HLA genotypically compatible marrow recipients were 100% for chronic myelogenous leukemia (N = 10), 81.5% for acute nonlymphocytic leukemia (N = 13), 37.6% for acute lymphocytic leukemia (N = 14), 40.0% for solid tumors (N = 5) and 100% for non-neoplastic diseases (N = 12). Survival rates of patients who received marrow grafts from donors other than HLA genotypically identical siblings were 18.8% for leukemia (N = 8) and 100% for non-neoplastic diseases (N = 6). The quality of life in pediatric long-term surviving marrow recipients has been good and acceptable in general. Profound common abnormalities among survivors are long-lasting hypogonadism due to radiation and subclinical impairment of lung function in the first several months post-BMT. About two thirds of children experienced a transient decrease in growth velocity in the immediate post-transplant period.