Kanzo
Online ISSN : 1881-3593
Print ISSN : 0451-4203
ISSN-L : 0451-4203
Volume 48, Issue 8
Displaying 1-7 of 7 articles from this issue
Original Article
  • Kazuo Notsumata, Manabu Tomita, Taku Sanada, Seitaro Kosaka, Daishu To ...
    Article type: Original Article
    2007 Volume 48 Issue 8 Pages 347-352
    Published: 2007
    Released on J-STAGE: August 29, 2007
    JOURNAL FREE ACCESS
    Subjects were 119 hepatitis C virus (HCV) carriers with a high level of HCV genotype 1b RNA, among whom 19 had shown persistently normal level of ALT (PNALT) while 100 were chronic hepatitis patients with obviously elevated ALT (EALT). We treated them with Peginterferon α-2b (PegIFN) in combination with ribavirin (RBV), and evaluated their virological responses by examining HCV RNA at 24 weeks after the end of treatment. As a result, the SVR (sustained virological response) rate in the PNALT patient group was significantly higher than that in the EALT patient group (68.4% vs 42.0%). Multivariate analysis for SVR-contributing factors revealed that the SVR rate was significantly higher in patients not older than 60 years, and in those free from hepatic fatty degeneration. Thus, our present results suggest the usefulness of PegIFN + RBV thrapy in HCV carriers with PNALT, and also that the PNALT subjects should better be treated before getting old.
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Case Reports
  • Motonobu Sugimoto, Kazushige Nakanishi, Yoshihisa Urita, Yoko Nagai, N ...
    Article type: Case Report
    2007 Volume 48 Issue 8 Pages 353-362
    Published: 2007
    Released on J-STAGE: August 29, 2007
    JOURNAL FREE ACCESS
    Four cases of liver cirrhosis with sustained normal serum ALT levels underwent liver biopsy for evaluation of etiology. They were all female aged from 60 to 81 (mean 70) year-old. They were all non-alcoholic and obese, and three of them were diabetic. HBs antigen and anti-HCV were negative in all cases. ANA was weakly positive (1 : 40 in three and 1 : 80 in one) and AMA was negative in all cases. Their serum AST/ALT levels (IU/l) were 30/27, 36/17, 33/20 and 47/23, respectively. Platelet counts (×103/mm3) ranged from 98 to 124, and hyarulonic acid (normal, less than 50 ng/ml) ranged from 135 to 469. CT showed irregular liver surface with nodules formation, and liver biopsy showed active liver cirrhosis (F4/A2-3) in all cases. Although etiology of cirrhosis remained unclear, it was strongly suggested that their cirrhosis was developed from nonalcoholic steatohepatitis. In old female cirrhotic patients, active inflammation may present in such liver presumably developed from nonalcoholic steatohepatitis, even in cases with normal serum ALT levels.
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  • Takeshi Terashima, Tatsuya Yamashita, Kuniaki Arai, Kaheita Kakinoki, ...
    Article type: Case Report
    2007 Volume 48 Issue 8 Pages 363-369
    Published: 2007
    Released on J-STAGE: August 29, 2007
    JOURNAL FREE ACCESS
    A 49-year-old man had undergone hepatic intra-arterial chemotherapy for hepatocellular carcinomas (HCCs) with vascular invasion in July 2005. Consequently, the viable lesions disappeared. On follow-up abdominal computed tomography, polypoid mass was detected in the gallbladder lumen and he was admitted to our hospital. After further examination, we diagnosed the lesion as gallbladder polyp, which seemed likely to be gallbladder cancer. Cholecystectomy was performed in April 2006. Pathological examination showed that the tumor consisted of trabecular and solid growth of polygonal atypical epithelial cells that invaded the submucosal lymph node and veins. Based on these histological features, we diagnosed metastasis from hepatocellular carcinoma. Since few cases of gallbladder metastasis from HCC have been reported to date, we document this extremely rare case.
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  • Hidenao Noritake, Fujito Kageyama, Yasunori Takehira, Masami Yamada, S ...
    Article type: Case Report
    2007 Volume 48 Issue 8 Pages 370-376
    Published: 2007
    Released on J-STAGE: August 29, 2007
    JOURNAL FREE ACCESS
    A 77-year-old man was referred to our hospital for fever and appetite loss that appeared at the end of September 2005. He showed an inflammatory reaction and enzyme elevation of hepatobiliary origin, and was hospitalized. Since a biliary tract infectious disease was considered, a general antibiotic dosage was started. However, the leukocyte elevation and fever continued. After several days of hospitalization, MRI revealed that a group of small cystic lesions were scattered in both lobes of the liver: some of them showed a contrasting effect in their circumferences. The inflammatory reaction improved when the medication was changed to a combination of wider-spectrum antibiotics and antifungus, although a diagnosis of multiple liver abscess was still possible from the imaging. The contrasting effect recognized in the cyst circumference disappeared promptly, but the small cystic lesions were still present multiply in both lobes of the liver when MRI was done at 1 month of hospitalization and at 6 months later. It was thought, thus, to be an infection of pre-existing cysts. Biliary hamartoma is usually symptom-free, but in this case, together with the cystic infection, the differentiation from multiple hepatic abscess was difficult. In this case, the diagnosis was possible based on the clinical course and imaging.
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Short Communication
  • Akihiro Nasu, Ryuichi Kita, Yasuaki Sakamoto, Hiroo Matsuo, Sumio Sait ...
    Article type: Short Communication
    2007 Volume 48 Issue 8 Pages 377-379
    Published: 2007
    Released on J-STAGE: August 29, 2007
    JOURNAL FREE ACCESS
    Recently several cases of hyper-attenuating nodules on CT during arterial portography (CTAP) have been reported as the chance of meticulous examination has been increasing. For the study reported here, seven cases of hyper-attenuating nodules on CTAP were analyzed by means of single-level dynamic CTAP (sCTAP). Peak values of the time-density curve from the 7 cases were 110, 106, 71, 75, 65, 45, 246 HU for the ROIs (regions of interest) placed on the nodule, and 63, 73, 41, 35, 20, 28, 22 HU for those placed on the surrounding liver parenchyma, respectively. Average peak value in another set of 46 cases as a control, including chronic hepatitis, liver cirrhosis and normal liver, was 55.3±17.6 HU. These results seem to indicate that portal flow shows an absolute increase in some cases of hyper-attenuating nodules on CTAP and that a decreased portal flow in the sorrounding parencyma may cause the visual effect of hyper-attenuation on CTAP in some cases.
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Rapid Communications
  • Yoshio Sumida, Takako Wada, Naohisa Yoshida, Kyoko Sakai, Kazuyuki Kan ...
    Article type: Rapid Communication
    2007 Volume 48 Issue 8 Pages 380-381
    Published: 2007
    Released on J-STAGE: August 29, 2007
    JOURNAL FREE ACCESS
    Patients with chronic hepatitis C who do not respond rapidly to therapy have a low chance of acquiring sustained virological response (SVR). We tried a new regimen of treatment with peginterferon α2b plus ribavirin, arranged to continue it for 44 weeks after HCV RNA has disappeared in the patient's circulation. Subjects were 17 consecutive patients with chronic hepatitis C (50.8 [21-68] years of age, 10 females and 7 males, HCV genotype 1, HCV RNA>100KIU/ml) whose serum HCV RNA remained positive at week 4 but became undetectable between weeks 5 and 24 of treatment. SVR rate for all patients enrolled in this study was 76.5%. Among patients with HCV clearance between weeks 5 and 12 (n=13), SVR rate was 76.9% (10/13), and among those with HCV clearance between weeks 13 and 24 (n=4), SVR rate was 75.0% (3/4). These data suggest that this prolonged therapy (i.e., 5∼24+44=49∼68 weeks in total) will be of use in patients who first cleared HCV RNA between weeks 5 and 24, though a larger number of patients should be examined to clarify whether this therapy is really superior to the current standard 48-week treatment.
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  • Mariko Kobayshi, Fumitaka Suzuki, Norio Akuta, Yoshiyuki Suzuki, Tetsu ...
    Article type: Rapid Communication
    2007 Volume 48 Issue 8 Pages 382-383
    Published: 2007
    Released on J-STAGE: August 29, 2007
    JOURNAL FREE ACCESS
    COBAS AmpliPrep/COBAS Taq Man HCV Test is a new method to detect HCV RNA with higher sensitivity and broader range of quantitation (0.015∼69000 KIU/ml) than conventional methods (e.g., 0.05 KIU/mlfor Amplicore HCV v2.0 and 5∼5000 KIU/ml for COBAS Amplicor HCV Monitor v2.0). Using this new method, we re-evaluated 76 interferon/ribavirin-treated chronic hepatitis C patients who had shown an end-of-treatment response (ETR) when HCV RNA was measured previously by Amplicore HCV v2.0 Test. As a result, 8 patients (10.5%) were newly identified to be positive for HCV RNA. Thus, our present results suggest that COBAS AmpliPrep/COBAS Taq Man HCV Test is more preferable than conventional methods to determine ETR and of prognostic values as well.
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