Kanzo

Case Reports

Two cases of diaphragmatic hernia following percutaneous radiofrequency ablation of hepatocellular carcinoma

Chiharu Tomonaga, Akira Kawano, Youto Taguchi, Takashi Matsunaga, Tosh ...

Article type: Case Report
2007 Volume 48 Issue 11 Pages 529-537
Published: 2007
Released on J-STAGE: November 29, 2007

DOIhttps://doi.org/10.2957/kanzo.48.529

JOURNAL FREE ACCESS

Show abstractHide abstract

Radiofrequency ablation (RFA) is a minimally invasive treatment for small hepatocellular carcinoma. Although RFA of the liver has a low complication rate, thermal damage from heating has been documented as a specific complication of RFA. Here, we report two cases of diaphragmatic hernia following percutaneous RFA of hepatocellular carcinoma. Thermal damage to the diaphragm was confirmed to be adjacent to the RFA treated region. Diaphragmatic hernia occurred 78weeks (Case1) and 112weeks (Case2) after ablation. But defects of the diaphragms had already occurred 65weeks (Case1) and 42weeks (Case2) after treatment, and remained quiescent until bowel herniated through the defects. Adding to the defect of diaphragm, a mechanism that induces the interposition of the intestine between the liver and the diaphragm (liver atrophy, ascites, abdominal pressure, etc.) are thought to be necessary to trigger herniation. We recommend that hepatocellular carcinoma adjacent to diaphragm should be treated using procedures such as artificial ascites or a laparoscopic approach to separate the lesion from diaphragm.

View full abstract

Download PDF (773K)
A case of hepatic infarction with portal venous gas after percutaneous radiofrequency ablation therapy for hepatocellular carcinoma with HBV-related liver cirrhosis

Chiharu Miyabayashi, Masao Neishi, Yoshihiro Kawanishi, Ayako Kusaba, ...

Article type: Case Report
2007 Volume 48 Issue 11 Pages 538-545
Published: 2007
Released on J-STAGE: November 29, 2007

DOIhttps://doi.org/10.2957/kanzo.48.538

JOURNAL FREE ACCESS

Show abstractHide abstract

A 60's year-old male was referred to our hospital for a close examination of liver tumors. The tumors (S7/8 and S3) were treated with transcatheter arterial chemoembolization (TACE) and percutaneous radiofrequency ablation (RFA). After 6 months, new 2 lesions were found. One was located in S6, and the other was a recurrence of the S7/8 tumor, which was adjacent to the posterior branch of portal vein. As the two tumors were located on the same puncture line, we conducted RFA treatment separately: the S6 tumor first, and the S7/8 tumor a week later. Then, a day later, CT examination revealed a wedge-shaped low-attenuation area in the posterior segment of right lobe of the liver, together with a gas image with a pattern of arborization inside. It was diagnosed hepatic infarction with portal venous gas, and we thought it was caused by the RFA treatment. Occurrence of hepatic infarction after RFA treatment is quite rare. As we haven't found in literature any report on the hepatic infarction with portal venous gas after RFA treatment, we hereby report our own case.

View full abstract

Download PDF (670K)
A case of multiple hepatic cysts that presented a cystadenocarcinoma-like hemorrhagic lesion during follow-up

Yuko Ishikawa, Hiroko Oka, Katsuhiko Horii, Yumi Nakadohri, Shigeki Yo ...

Article type: Case Report
2007 Volume 48 Issue 11 Pages 546-552
Published: 2007
Released on J-STAGE: November 29, 2007

DOIhttps://doi.org/10.2957/kanzo.48.546

JOURNAL FREE ACCESS

Show abstractHide abstract

A 49-year-old woman, complaining back pain on the right side, showed multiple hepatic cysts on ultrasonography (US) and computed tomography (CT); one of the cysts in segment 8 of the liver contained a solid mass. Four months after the first examination, US showed no change. Ten months after the first examination, however, an increase in the size of the concerned cyst was revealed by US, together with an echogenic mass therein. Based on these findings, a cystadenocarcinoma was suspected, and anterior segmentectomy of the liver was done. Eventually, however, it was revealed histologically that the cyst wall was consisted of fibrous tissue, and the echogenic mass in the cystic lesion corresponded to a blood clot with proliferation of capillaries; not a picture of the cystadenocarcinoma at all.

View full abstract

Download PDF (581K)
A case of primary hepatic actinomycosis with a presumed invasion to abdominal wall, diagnosed with image examinations by chance

Hidetomo Muto, Tetsuya Ichijo, Noriko Kobayashi, Naoki Tanaka, Takeji ...

Article type: Case Report
2007 Volume 48 Issue 11 Pages 553-558
Published: 2007
Released on J-STAGE: November 29, 2007

DOIhttps://doi.org/10.2957/kanzo.48.553

JOURNAL FREE ACCESS

Show abstractHide abstract

A hepatic tumor (S4) was found by CT in a 64-year-old man with tenderness and swelling of abdominal wall at right hypochondrium. He had type 2 diabetes mellitus and a history of gastrectomy and pancreatoduodenostomy due to gastric cancer and chronic pancreatitis. His nutritional status was poor, and a hepatic malignant tumor was suspected initially. However, the tumor mass contained a portal region and a liquid component without contrast-enhancement, and, in addition, there was a direct extension of the mass to the adjacent abdominal wall. So we suspected an abscess, particularly of actinomycosis, and performed percutaneous liver biopsy for diagnosis. As a result, mycobacterial sulfur granule was identified in the biopsy tissue, leading to the definite diagnosis of primary hepatic actinomycosis. Oral administration of natural type penicillin for 1 year resulted in disappearance of the hepatic abscess as well as the skin lesion. Primary hepatic actinomycosis, though a rare disease, should be thought when image findings show lesions extending directly from a liver abscess into adjacent tissues.

View full abstract

Download PDF (630K)

Short Communication

A study on dividing doses of ursodeoxycholic acid (UDCA) for patients with chronic hepatitis C

Satoko Uegaki, Masaki Mikami, Yoshihiko Morisawa, Shin-ichiro Negoro, ...

Article type: Short Communication
2007 Volume 48 Issue 11 Pages 559-561
Published: 2007
Released on J-STAGE: November 29, 2007

DOIhttps://doi.org/10.2957/kanzo.48.559

JOURNAL FREE ACCESS

Show abstractHide abstract

We studied whether the frequency of daily dosing of ursodeoxycholic acid (UDCA) affects its efficacy in patients with chronic hepatitis C. Twenty-nine patients with chronic hepatitis C having received UDCA (600mg) three times a day were randomized to 3 groups with different frequency of the UDCA dosing for another 8 weeks: once a day (qd, n=6), twice a day (bid, n=11), and three times a day (tid, n=10). No significant side effects were noted in all groups, although the compliance was not well in the qd group. Serum ALT levels did not change between 0 and 8 weeks in all groups, suggesting that the efficacy of UDCA was not affected by the divided dosing. Serum levels of total bile acid and UDCA fraction were not significantly changed, either. Thus we conclude that UDCA given bid would be preferable in terms of efficacy as well as compliance.

View full abstract

Download PDF (193K)

Special Report

Dissemination of clinical practice guidelines for hepatocellular carcinoma among Japanese hepatologists and liver surgeons

Norihiro Kokudo, Masatoshi Makuuchi, Takeo Nakayama, Shigeki Arii, Mas ...

Article type: Special Report
2007 Volume 48 Issue 11 Pages 562-570
Published: 2007
Released on J-STAGE: November 29, 2007

DOIhttps://doi.org/10.2957/kanzo.48.562

JOURNAL FREE ACCESS

Show abstractHide abstract

"Clinical practice guidelines for hepatocellular carcinoma (HCC)," the first evidence-based guidelines for the treatment of HCC in Japan (the J-HCC Guidelines) have been compiled and English translation has just been completed (http://www.jsh.or.jp/). In March 2006, approximately a year after publication of the J-HCC Guideline Book, a questionnaire survey was conducted to investigate the level of awareness and influence of the guidelines among 2,279 members of the Liver Cancer Study Group of Japan. Of the 843 responders (37.0%), the J-HCC Guidelines have been acknowledged by 72% and 78.8% considered the guidelines useful for their daily practice. Algorithm for the treatment was most commonly used. After the introduction of the guidelines, only 20.8% of the responders changed their practice pattern; 40.3% did not change and were convinced that their choice of treatment was similar to the recommendations in the guidelines. In conclusion, one year after their publication, the J-HCC Guidelines have become well disseminated among specialists for HCC in Japan. As expected, these guidelines have begun to be applied at every level of clinical decision-making for HCC.

View full abstract

Download PDF (1348K)

Register with J-STAGE for free!