A 78-years-old woman with decompensated cirrhosis died of hepatic failure in 2007. Notably, her necropsied liver tissue tested positive for HCV antigen by immunohistochemistry although her sera had been negative for HCV RNA in life. She had received an interferon therapy in 2002 for her chronic hepatitis C, and it could be postulated that she acquired sustained virological response by the treatment although it was only a very short one (IFN con-1; 12 MU×8). But, in reality, her liver disease progressed very rapidly during the 5-year period of the apparent virological response, and the necropsy finding suggested that she had been persistently infected with HCV. Thus, this case adds to a caution against putting too much weight on serum levels of HCV RNA in evaluating virological response.

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A 51-year-old female with chronic hepatitis C was observed who developed type 1 diabetes mellitus after 40 weeks of treatment with recombinant alpha-2b pegylated interferon (PEGIFN) combined with ribavirin. She was subsequently well controlled with insulin administration. Serum samples were collected before the start of antiviral therapy and at week 40 when the patient was diagnosed with type 1 diabetes mellitus. The value of glutamic acid decarboxylase antibodies (anti-GAD ab) was less than 1.5U/ml and 714U/ml, respectively. Her anti-GAD ab remained high after the antiviral treatment was withdrawn. Another observed case was a 58-year-old male with chronic hepatitis C whose anti-GAD ab was positive before the therapy. He did not develop diabetes mellitus during and after treatment with PEGIFN combined with ribavirin. It is difficult to make prediction about who develop type 1 diabates mellitus with this therapy using anti-GAD ab.Therefore, we clinicians should be aware the importance of follow-up for cases of type 1 diabetes mellitus as a serious side-effect during or after the therapy with IFN and/or ribavirin.

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A 77-year-old man who was being followed up at a local hospital after partial colectomy for ascending colon cancer was referred to our hospital for hepatocellular carcinoma (HCC) treatment. Eight months after partial hepatectomy, obstructive jaundice was observed because of local recurrence of HCC. The patient received radiotherapy after endoscopic nasal biliary drainage. Endoscopy after radiotherapy revealed good bile discharge from the papilla Vater. The patient is still alive at 22 months after radiotherapy without local recurrence. The efficacy of radiotherapy for HCC has not been clarified, and there are no published guidelines for radiotherapy. There is also no fixed standard for evaluation of the remnant hepatic reserve after radiotherapy. However, there have been some case reports in recent years on the efficacy of radiotherapy for HCC, and it is thought that radiotherapy may become one of the effective modalities in the multidisciplinary treatment of HCC.

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A 79-years-old HCV-infected patient with an implanted pacemaker generator underwent radiofrequency ablation therapy (RFA) for hepatocellular carcinoma (HCC). He underwent transarterial chemoembolization (TACE) and percutaneous ethanol injection therapy for HCCs in other hospitals in the past. A relapsed tumor of 30mm in diameter was found in S7. As the patient had sufficient self-heart beat when reducing pacing rate, we performed RFA under AAI-pacing mode. Electromagnetic interference was not observed during and after RFA. With careful management, RFA is potentially useful treatment strategy for patients with implanted pacemaker generator.

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