We investigated about the efficacy and problems in bezafibrate treatment for patients with primary biliary cirrhosis (PBC). Bezafibrate was administered to 26 patients with PBC and 4 with cholestasis condition, and we observed ALP reduction by 36 to 78% in 3 months in all but one with hyperbilirubinemia. We also observed the additional ALP reduction in the patients who had been treated with UDCA, and the combination therapy with bezafibrate and UDCA was considered favorable. But the effects of bezafibrate for 3 patients with hyperbilirubinemia were various and we need further investigation for patients with such conditions. Moreover, we observed transaminase elevation in 6 patients including 2 with hyperbilirubinemia, and rhabdomyolysis in an aged patient, so we need to pay attention to the bezafibrate treatment especially for the patients with hyperbilirubinemia or the elderly.

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A 58-year-old woman was admitted to a hospital due to epigastral pain and jaundice. Diagnostic imaging examinations revealed pancreatic cancer and a giant tumor in the liver. She was referred to our department for further evaluation. Computed tomography during arterial portography showed tumor staining except the partially belly part. Liver biopsy specimen from the tumor showed hyperplasia of hepatocytes, the narrowness and disapperance of portal vein in the portal area, the overgrowth of hepatic arterial branch and minute bile duct, and slight infiltration of inflammatory cells. We diagnosed the liver tumor as a hyperplastic nodule located at caudate lobe, extending to segment IV and VIII.

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A 70 years old male underwent partial hepatectomy in 1999 for hepatocellular carcinoma in S4, followed by an uneventful period until June 2001, when a relapsed tumor of 2 cm in diameter was found in S5. This tumor was treated with percutaneous radiofrequency ablation (PRFA), after an unsuccessful trial of transcatheter arterial chemoembolization (TACE), with satisfactory effects: the PRFA-induced necrosis was apparently sufficient in its area size. Two months after that, however, dynamic CT scan revealed a faint tumor-staining in the periphery of the ablated area. During additional 3 months, the tumor showed a rapid growth, protrudingly toward perihepatic space, with an increase in the levels of serum tumor markers. TACE was done for this tumor, resulting in disappearance of the tumor and decrease in the serum tumor marker levels to normal range. No relapse has been noted until now (February 2004). Similar cases have been reported, but cases with happy outcomes such as ours, here we report, are rare.

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A total of 10 Japanese patients with acute sporadic hepatitis E in Tokyo and Kanagawa area from 1998 to 2004 were analyzed for epidemiological and viro-genetic characteristics of their HEV infections. Our findings therefrom corroborated the previous ones on the middle-aged male predominance. Noteworthy was that all were alcohol drinkers except for one female patient. Two of the drinkers had a fondness for eating uncooked or undercooked pork meat or liver. The one and only non-drinker among the subjects was engaged in the job of building-sanitation. Molecular analyses indicated that most of the HEV isolates from these patients segregated to a cluster within genotype III, suggesting these strains (if not all) might be autochthonous in the Tokyo and Kanagawa area.

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Most recent modalities for diagnosing hepatic tumors are based on evaluation of the arterial and portal flow of the tumors. However, pseudo-lesions resulting from A-P shunting, and aberrant circulation of splancnic veins may occur, which often make it difficult to reach a definitive diagnosis. Real-time virtual ultrasonography, however, presents a virtual cross-section reconstructed from CT data. This modality has proven to be very useful for the detection of lesions which are difficult to find with the usual methods. With this modality, we could identify a pseudo-lesion co-existing with HCC from an actual tumor. The dignosis was based on both the image showing the continuation of the lesion to the cyctic wall and the results of a histological examination performed with reference to the virtual US image.

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The aim of this study was to clarify the frequency of severe toxicity in hepatic arterial cisplatin infusion chemotherapy for far advanced hepatocellular carcinoma patients. Study subjects were consecutive 18 patients with hepatocellular carcinoma no longer amenable to transcatheter arterial chemoembolization. Hepatic arterial infusion using cisplatin 100 mg alone was repeated at 4 to 6-week intervals until disease progression. According to National Cancer Institute Common Toxicity Criteria version 2, the grade 3 or worse hematological and non-hematological adverse events (reactions) were observed in 7 (6) and 14 (12) of the 18 patients, respectively. Two patients died within 2 months due to possible toxicities of the treatment. This treatment was so toxic that candidates should be selected among patients with good hepatic reserve.

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The objectives of this study were to determine whether hepatitis virus affects chronic alcoholic hepatitis. A nationwide survey of hospitals qualified by the Japanese Society of Gastroenterology was conducted to determine the status of alcoholic liver disease (ALD) in-patients since 1998. The prevalence of hepatitis virus infection in each kind of ALD patient was also investigated. Regarding chronic alcoholic hepatitis, we confirmed it was diagnosed by liver biopsy or not. Only 45 in 204 patients were diagnosed by liver biopsy as chronic alcoholic hepatitis. The percentage of chronic alcohol hepatitis patients without viral hepatitis was 24.5%. Hepatitis virus continues to play a crucial role in the pathogenesis of chronic alcohol hepatitis. Patients without liver biopsy were diagnosed by high ALT level in patients with ALD who were not enough for criteria of alcoholic hepatitis. New criteria are required for such patients.

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[in Japanese]

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