Kanzo
Online ISSN : 1881-3593
Print ISSN : 0451-4203
ISSN-L : 0451-4203
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Volume 46, Issue 7
Displaying 1-8 of 8 articles from this issue
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Original Article
  • Comparative study of transcatheter arterial embolization (TAE) for hepatocellular carcinoma using a lecithin-added Lipiodol emulsion
    Shinjiro KOBAYASHI, Takehito OTSUBO, Tatsuya FURUKAWA, Satoshi KOIZUMI ...
    Article type: Original Article
    2005 Volume 46 Issue 7 Pages 395-405
    Published: 2005
    Released on J-STAGE: November 24, 2006
    DOIhttps://doi.org/10.2957/kanzo.46.395
    JOURNAL FREE ACCESS
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    Objectives and methods : We studied the clinical efficacy of transarterial embolization (TAE) using a lecithin-added Lipiodol emulsion to treat hepatocellular carcinoma (HCC). Comparison was made between patients who received TAE using usual adriacin-added Lipiodol emulsion (Group A : 95 cases, 125 nodules) and patients who received TAE using a lecithin-added Lipiodol emulsion (Group B : 76 cases, 95 nodules). Results : Group B had a significantly higher rate of nodules with complete necrosis, on computed tomography (CT) at one year after the therapy (Group A : 28%, Group B 57%). The rate of complete necrosis in Group B evaluated on CT was as follows : single nodular type 71%, extra nodular growth type 67%, nodules with corona 67%, nodules without corona 38%, nodules less than 3 cm in diameter 67%, peripherally situated nodules 63%, and centrally situated nodules 29%. Conclusion : The lecithin-added Lipiodol emulsion enhances tumor necrosis in TAE for treatment of HCC. Single nodular type, nodules with corona, and peripherally situated nodules which can be evaluated on CT show higher tumor necrotic effects.
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Case Reports
  • A case of steroid-resistant autoimmune hepatitis effectively treated with cyclosporine
    Minil KIM, Takayoshi ITO, Hiroyuki MIKI, Seiichirou TAKAHASHI, Masayuk ...
    Article type: Case Report
    2005 Volume 46 Issue 7 Pages 406-413
    Published: 2005
    Released on J-STAGE: November 24, 2006
    DOIhttps://doi.org/10.2957/kanzo.46.406
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    Fifty years old female was admitted due to acute liver injury and diagnosed as having autoimmune hepatitis. She was treated with a high dose of metyhlprednisolone, and recovered from the liver injury. Reduction of steroid led to recurrence of liver injury. Since addition of azathioprine was not effective, we treated her with a high dose of steroid again. During tapering of steroid in the presence of azathioprine, she relapsed again. Because of the use of a large total amount of steroid and difficulty of tapering steroid, we replaced azathioprine with cyclosporine A. After the alteration, she has remained in remission with decreasing amount of steroid. About 10% of patients with autoimmune hepatitis are resistant to the steroid therapy, and there are some responders who cannot continue it due to its adverse effects. Combination therapy with cyclosporine A and a minimal amount of steroid may be useful for such patients.
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  • A resected case with tract seeding of HCC after percutaneous local treatment.
    Minoru KOBAYASHI, Michihiro SUZUKI, Yasuhito TAKAHASHI, Hiroki IKEDA, ...
    Article type: Case Report
    2005 Volume 46 Issue 7 Pages 414-419
    Published: 2005
    Released on J-STAGE: November 24, 2006
    DOIhttps://doi.org/10.2957/kanzo.46.414
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    A 55-year-old man was admitted with hepatocellular carcinoma (HCC) and HBV-positive liver cirrhosis. Following transarterial embolization (TAE), percutaneus local treatment with radiofrequency ablation (RFA) for S6 and ethanol injection (PEIT) for S5 was performed. Abdominal computed tomography (CT) 3 months after local treatment revealed nodular lesions between the liver surface and abdominal wall. Tiny intrahepatic recurrences in S5 were also noted. Gastroduodenal arteriography showed some tumor staining outside the liver. Partial omentectomy and subsegmentectomy of the liver were performed. Surgical specimens revealed moderately differentiated HCC, with similar findings for intrahepatic recurrences. Tumor seeding of HCC throughout the tract following PEIT was diagnosed. When local treatment for HCC is performed, the route must be confirmed on imaging beforehand. The care must be taken to avoid dissemination from the early stage of post-local treatment. Furthermore, surgical resection is supposed to be valuable treatment for tumor seeding of HCC.
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  • A case report of advanced hepatocellular carcinoma with tumor thrombus in the inferior vena cava that was treated with surgical hepatectomy after systemic chemotherapy (low-dose FP)
    Yasuo SHIMA, Sojiro MORITA, Teruhito TSUJI
    Article type: Case Report
    2005 Volume 46 Issue 7 Pages 420-424
    Published: 2005
    Released on J-STAGE: November 24, 2006
    DOIhttps://doi.org/10.2957/kanzo.46.420
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    We report a 79-year-old man who presented with abdominal fullness. Computed tomography scan demonstrated a 12 cm huge mass with tumor thrombus extending into the inferior vena cava, for which resection was judged impossible. Systemic chemotherapy (low-dose FP) was carried out. The low-dose FP therapy consisted of 5-FU (250 mg/body/day on days 1 to 7/week, continuous infusion) and CDDP (10 mg/body/day in 100 ml normal saline, infusion more than 30 minutes, on days 1 and 4/week) for 4 consecutive weeks with a subsequent one-week rest period. After 4 cycles of systemic chemotherapy, the main tumor markedly regressed. The tumor thrombus in the inferior vena cava was not detectable. The extended left hepatic lobectomy was performed. The postoperative course was good, and the patient was discharged from the hospital on postoperative day 21. Two years after resection, a new hepatic lesion was seen in a recurrence.
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  • A Case of spontaneous rupture of ectopic hepatocellular carcinoma
    Naohiro NOMURA, Masahiro SUENAGA, Yuki TAKEUCHI, Junichi TOBINAGA, Tak ...
    Article type: Case Report
    2005 Volume 46 Issue 7 Pages 425-430
    Published: 2005
    Released on J-STAGE: November 24, 2006
    DOIhttps://doi.org/10.2957/kanzo.46.425
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    We report an extremely rare case of spontaneous rupture of ectopic hepatocellular carcinoma. A 58-year-old man was admitted to the hospital because of abdominal pain. CT scan showed a lot of fluid collection in the abdominal cavity. We perfomed an emergency operation under the diagnosis of diffuse peritonitis. Operative findings revealed approximately 700 ml of blood was collected from the abdominal cavity and ruptured tumor 25×20 mm in size was found in the left triangle ligament of liver. This tumor had no connection with the liver parenchyma. Histological examination revealed that the tumor was a well differentiated hepatocellular carcinoma. Thus we confirmed that ectopic hepatocellular carcinoma arising in the left tiangle ligament ruptured spontaneously.
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  • Possible advantages of Helicobacter pylori eradication for idiopathic (autoimmune) thrombocytopenic purpura in a patient with uncompensated cirrhosis by hepatitis C virus
    Takahiro ZENDA, Takaharu MASUNAGA, Kimihide SHINOZAKI, Toshihide OKADA ...
    Article type: Case Report
    2005 Volume 46 Issue 7 Pages 431-436
    Published: 2005
    Released on J-STAGE: November 24, 2006
    DOIhttps://doi.org/10.2957/kanzo.46.431
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    A 79-year-old Japanese woman, who had a past history of hemorrhagic gastric ulcer with Helicobacter pylori (HP) infection, was admitted because of significant thrombocytopenia and uncompensation of hepatitis C virus (HCV) cirrhosis. Critical thrombocytopenia progressing to 1.3×104 platelets/μl, an extremely high titer of platelet-associated immunoglobulin G (PA-IgG) at 8814 ng/107 cells (<25) and megakaryocytic hyperplasia in the marrow suggested idiopathic (autoimmune) thrombocytopenic purpura (ITP). Although corticosteroid therapy with 0.5 mg/kg of prednisolone (20 mg/body) partly restored thrombocytopenia and PA-IgG titer, it had to be discontinued because of newly manifested serious diabetes mellitus requiring high dose of insulin therapy and fever on occasion probably due to urinary tract infection. Alternative HP eradication therapy improved ITP without any relapses. In addition, discontinuance of steroid therapy improved the diabetic milieu and fever. The case presented here suggests possible advantages of HP eradication therapy for ITP in a patient with uncompensated liver cirrhosis, which imposes many restrictions on therapy.
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  • A case of primary biliary cirrhosis with sarcoid reaction in the regional lymph nodes after surgery of early gastric cancer
    Tadashi YOSHIDA, Atsushi NAGASAKA, Yayoi OGAWA, Syuji NISHIKAWA, Akifu ...
    Article type: Case Report
    2005 Volume 46 Issue 7 Pages 437-442
    Published: 2005
    Released on J-STAGE: November 24, 2006
    DOIhttps://doi.org/10.2957/kanzo.46.437
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    A 69-year-old man complaining of left lower abdominal pain was admitted to our hospital with a diagnosis of early gastric cancer and underwent a segmental gastrectomy. Liver dysfunction, which had been found before the surgery, became worse temporarily and the titers of serum antinuclear antibody and antimitochondrial antibody were elevated. The diagnosis of primary biliary cirrhosis (PBC), stage I, was made on the basis of liver biopsy findings, as well as the laboratory data. Enlarged regional lymph nodes of the stomach were found on CT scan 13 months after surgery and became larger 3 months later. Thus, we performed exploratory laparotomy and biopsy of the lymph node. It disclosed no metastasis but existence of granulomatous tissues comprising of non-caseating epithelioid cells. This case was diagnosed as exhibiting sarcoid reaction with PBC after surgery because sarcoidosis was unfavorable considering the clinical features.
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