Kanzo
Online ISSN : 1881-3593
Print ISSN : 0451-4203
ISSN-L : 0451-4203
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Volume 48, Issue 9
Displaying 1-7 of 7 articles from this issue
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Feature Article
Case Reports
  • A case of liver cirrhosis type B accompanied by hepatocellular carcinoma under lamivudine and adefovir treatment
    Shuji Nambu, Teiichi Terasaki, Yoshinari Atarashi, Kazuhiro Matsui, Ka ...
    Article type: Case Report
    2007 Volume 48 Issue 9 Pages 429-438
    Published: 2007
    Released on J-STAGE: September 27, 2007
    DOIhttps://doi.org/10.2957/kanzo.48.429
    JOURNAL FREE ACCESS
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    A 56 year-old male with liver cirrhosis type B started lamivudine (LMV) treatment against acute exacerbation of the hepatitis on March in 2002. Although his liver function improved, LMV-resistant HBV appeared, leading to breakthrough hepatitis on November in 2002. Administration of adefovir dipivoxil (ADV) in combination with LMV began on January in 2003. Since then, HBV DNA levels in his serum gradually decreased to less than measurement sensitivity and his liver function improved. On September in 2003, namely 18 months and 8 months after starting LMV monotherapy and the combination treatment respectively, he developed a small HCC and underwent resection of the HCC on November. Histologically, the tumor tissue was composed of moderately differentiated HCC, and the non-tumor tissue showed liver cirrhosis with mild inflammation. HBsAg and HBcAg were immunohistochemically detected not only in normal hepatocytes but also in HCC cells. He has taken LMV and ADV continuously and been alive without recurrence for more than three years after the surgery. This case suggests that it is important to pay attention to development of HCC in patients with liver cirrhosis type B under nucleotide analogues administration, even if their blood HBV DNA concentrations are continuously less than measurement sensitivity, leading to improvement of their liver functions.
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  • A case of refractory hepatic hydrothorax complicated with spontaneous bacterial empyema in a type C liver cirrhosis patient, successfully treated with transjugular intrahepatic portosystemic shunt
    Haruhiko Shugo, Takashi Kagaya, Naoki Oishi, Kuniaki Arai, Kazuya Kita ...
    Article type: Case Report
    2007 Volume 48 Issue 9 Pages 439-445
    Published: 2007
    Released on J-STAGE: September 27, 2007
    DOIhttps://doi.org/10.2957/kanzo.48.439
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    A 69 years old male, having suffered from decompensated liver cirrhosis caused by hepatitis C virus (HCV) infection, was admitted to our hospital for fever and dyspnea. On admission, massive right pleural effusion was found by X-ray and massive ascites by ultrasound. Puncture study revealed that the pleural effusion was brown and turbid (i.e., an exudate type), while the ascites was yellow and clear (a transudate type), suggesting the diagnosis of spontaneous bacterial empyema (SBEM); namely a hepatic hydrothorax complicated with bacterial infection. Since the SBEM in this patient was hardly improved by diuretics and antibiotics alone, we added a treatment with transjugular intrahepatic portosystemic shunt (TIPS). After the TIPS insertion, despite a very transient hepatic encephalopathy, both the pleural effusion and ascites gradually decreased. Now at 23 months after the TIPS, the patient is free from any of the pleural effusion and ascites. Here we report our own case suggesting the effectiveness of TIPS in SBEM, a disease with poor prognosis in general.
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  • A case of juvenile advanced liver cirrhosis due to primary sclerosing cholangitis diagnosed on a gastric varices rupture
    Midori Nakazawa, Yoshihiko Nagase, Gaku Igarashi, Yasunobu Fukuda, Sat ...
    Article type: Case Report
    2007 Volume 48 Issue 9 Pages 446-451
    Published: 2007
    Released on J-STAGE: September 27, 2007
    DOIhttps://doi.org/10.2957/kanzo.48.446
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    We experienced a case of juvenile advanced liver cirrhosis due to primary sclerosing cholangitis (PSC) diagnosed on a gastric varices rupture. A 23 years old man, suffering from type 2 diabetes treated by pharmacotherapy since 12 years old, visited our hospital due to hematemesis. Gastroduodenoscopy revealed esophago-gastric varices arising from middle of the esophagus to the squamocolumnar junction, and blood clots were observed in the stomach. A red plug existed on the cardiac varices. We treated them by endoscopic sclerotherapy (EIS). Abdominal CT showed an irregular surface of the liver, and dilations of intrahepatic bile ducts in both lobes. Splenomegaly and dilatated umblical vein were also recognized. Endscopic retrograde cholangiopancreatography (ERCP) revealed a beaded appearance of the intrahepatic duct. We performed a liver needle biopsy, and found a pseudolobular fomation with ductular bilirubin stasis as well as an onion-skin type periductal fibrosis around interlobular bile ducts in portal areas. Enentually we diagnosed him as PSC on the basis of these findings. Despite his young age, he developed type 2 diabetes and advanced liver cirrhosis with portal hypertension due to PSC. Hence we should carefully follow him with consideration of liver transplantation as a treatment option.
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  • A case of primary biliary cirrhosis with progressive jaundice due to Basedow's disease
    Tetsuro Shimakami, Tatsuya Yamashita, Yoshio Sakai, Kuniaki Arai, Hiro ...
    Article type: Case Report
    2007 Volume 48 Issue 9 Pages 452-457
    Published: 2007
    Released on J-STAGE: September 27, 2007
    DOIhttps://doi.org/10.2957/kanzo.48.452
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    In 2002, a female patient was diagnosed as suffering from primary biliary cirrhosis (PBC), with liver biopsy finding indicating the stage III of Scheuer's classification. Following this diagnosis, she was treated with ursodeoxycholic acid uneventfully for 3 years. But from February 2005, she started to experience palpitations and tremors, together with progressive elevation of serum total bilirubin (T-Bil). At age 57, in May 2005, she was eventually admitted to our hospital with symptoms of progressive jaundice and diagnosed with Basedow's disease. She was put on a course of treatment with thiamazole, and one month later, thyroid function became euthyroid and T-Bil had decreased to 2.4mg/dl from the peak value 5.7 mg/dl in April 2005. Basedow's disease complicates PBC less frequently than Hashimoto's thyroiditis. However, in cases where progressive jaundice is observed in PBC patients as in the present case, we should consider the possibility of complication of Basedow's disease.
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  • A patient who developed diaphragmatic hernia one year after percutaneous radiofrequency ablation for hepatocellular carcinoma
    Hitoshi Takeuchi, Takashi Arata, Kiyoto Takehara, Kunitoshi Shigeyasu, ...
    Article type: Case Report
    2007 Volume 48 Issue 9 Pages 458-462
    Published: 2007
    Released on J-STAGE: September 27, 2007
    DOIhttps://doi.org/10.2957/kanzo.48.458
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    A 73-year-old man underwent percutaneous radiofrequency ablation (RFA) in our hospital in January 2006, for a hepatocellular carcinoma (HCC) of 1.8cm in size, located near the surface of S4. About 1 year later, in March 2007, he was re-admitted to our hospital for dyspnea, and underwent operation under the diagnosis of ileus with pleuritis. On laparotomy, we found a perforation of the intestine which had prolapsed through a defect of the diaphragm burned by RFA. Reports of diaphragmatic hernia associated with RFA have been very rare, but now we know at least five cases including our present case during these 5 years, suggesting a gradual increase in its incidence.
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  • A case of mesocaval shunt with hepatic encephalopathy after pancreaticoduodenectomy, successfully treated by transcatheter embolization
    Tetsuro Nakazawa, Keigo Osuga, Toru Matsumura, Hiroki Higashihara, Nob ...
    Article type: Case Report
    2007 Volume 48 Issue 9 Pages 463-468
    Published: 2007
    Released on J-STAGE: September 27, 2007
    DOIhttps://doi.org/10.2957/kanzo.48.463
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    A 45 year-old man presented with flapping tremor and other neurologic manifestations such as dementia and amnesia since three years ago. He had previously undergone pancreaticoduodenectomy for mass-forming pancreatitis eight years before. Laboratory data suggested hepatic encephalopathy with hyperammonemia. Contrast-enhanced CT revealed mesocaval shunt between the superior mesenteric vein (SMV) and the inferior vena cava through the right testicular vein. Percutaneous transhepatic portography demonstrated slight irregularity of SMV probably due to the previous surgery but no significant stenosis or pressure gradient was shown. The shunt was retrogradely occluded with stainless-steel coils through the right jugular venous approach. On the next day, serum ammonia level started to decrease, and remained within normal level thereafter for four years without medication. Neurologic manifestation disappeared completely. Pancreaticoduodenectomy-induced adhesion and inflammation may have led to the development of the mesocaval shunt. Transcatheter embolization is less invasive and should be considered as an effective treatment in the conditions as seen in the present case.
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