Nonalcoholic steatohepatitis（NASH）のPioglitazone治療において2年以上の長期治療効果は不明である．今回，NASH 23例に7.5∼30 mgの投与量で2年以上（平均46.5カ月）治療を行い，15例に2年後の肝生検で検討した．ALTは治療前平均値106 IU/l，3カ月後58 IU/l，2年後35 IU/lと3カ月ですみやかに改善し（P<0.001），その後も長期効果を維持した．2年後の中性脂肪（P=0.012），HbA1c（P=0.006），HOMA-IR（P<0.001）で有意に改善をみた．組織学的にも脂肪滴（P=0.006），小葉内炎症および線維化（P=0.02）で有意に改善を認めた．副作用として，体重増加を12例（52%）に認め，2年間で平均1.5 kg増加した．
以上，本邦のNASH患者にPioglitazone治療を行い2年以上の長期効果を検討したところ，生化学的組織学的改善効果が持続した．

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ペグインターフェロン（Peg-IFN）は，通常のインターフェロン（IFN）に比してインフルエンザ様症状や食思不振などの自覚症状が軽く，高齢者にも使用可能である．一方で，皮疹の頻度は高いと報告されている．本稿では，C型慢性肝炎に対しPeg-IFNα-2aを単独投与，全身性紅斑を生じたが，6-7週間の休薬にて同一IFNの再投与が可能であった2症例を報告する．1例は75歳男性，抗結核剤による薬剤性肝障害の既往あり，3カ所の肝細胞癌根治治療後である．他1例は70歳女性．いずれも高齢者で，45および90 μgの少量投与にてPeg-IFNα-2aは著効した．

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症例は52歳男性で，慢性B型肝炎を背景とする肝細胞癌に対して肝右葉切除術を施行した．術後病理検査の結果，胆嚢頸部のリンパ節に転移を認めStage IVb進行肝細胞癌と診断された．術後残肝再発に対して肝動脈化学塞栓術を，腹部大動脈リンパ節再発に対して全身化学療法を併用しつつ，放射線療法とリンパ節切除術の組み合わせを施行した結果，初回治療後3年9カ月目の現在，明らかな再発兆候なく経過している．肝細胞癌におけるリンパ節再発は予後不良とされ，治療方針に確立したものはない．本症例では肝内病変が制御されており，肝外病変としてのリンパ節再発に対する集学的治療が奏効したものと考えられた．

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症例は55歳，女性．2002年4月，卵巣癌に対し，某院にて初回手術施行．IIIb期，類内膜腺癌，ダグラス窩転移陽性にて術後TC療法（PTX+CBDCA）を6コース施行．11月second look operation施行．腹腔内細胞診陰性．TC療法2コース施行後，CBDCAに対する副作用が出現し，CPT-11+PTXに変更し，加療された．2007年6月腹部CTにて，肝円索の転移性病変指摘．その後経過観察中に同病変の増大を認め，10月当院紹介入院となった．
肝円索の播種性病変に対し，DSM-TAE施行後，RFAを施行．11月にDSM-TAE 2回目施行後，2回目のRFAによる追加治療を施行した．術後，炎症所見上昇，肝機能増悪し，CTにて左葉は肝梗塞に陥るものの保存的治療で改善した．術後3カ月後のCTにて肝円索浸潤肝転移播種性病変は完全嚢胞化し，CA125は正常化した．加療後20カ月の現在再発所見は認められていない．卵巣癌肝円索浸潤肝転移に対し，DSM-TAE，RFAにて治療した報告例はない．一方，その問題点を含め，示唆的な症例と考えられ報告する．

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We investigated the early virological response (EVR) to peginterferon (Peg-IFN) α-2a plus ribavirin (RBV) and Peg-IFNα-2b plus RBV therapy in 125 Japanese patients infected with hepatitis C virus (HCV) genotype1b. The rate of EVR, defined as HCV-RNA undetectable by COBAS TaqMan HCV test at 12 weeks after the start of treatment, was not significantly different between Peg-IFNα-2a plus RBV therapy and Peg-IFNα-2b plus RBV therapy (50.0% vs. 52.4%). However, the effect of previous interferon therapy did not influence the EVR rate in both groups. Multiple regression analysis showed that only serum albumin concentration (>4.1 g/dL) was a factor to contribute EVR. Further investigation is necessary, to compare the SVR rate, adverse events, and those in extended combination therapy between the two groups.

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The tumor recurrence rate of hepatocellular carcinoma (HCC) is still high even in patients who receive a curative therapy. We analyzed predictive value of HBV-related viral markers, including HBcrAg, HBV DNA, and HBeAg, for HCC recurrence in the patients who developed HCC during antiviral nucleot(s)ide analogues therapy. By univariate analysis, HBV DNA, HBcrAg, tumor number and presence of portal vein invasion were significant predictive factors. By multivariate analysis, HBcrAg and presence of portal vein invasion were independent and significant predictive factors of recurrence after curative therapy for HCC. We conclude that HBcrAg is useful as a predictor of post-treatment recurrence of HCC after curative therapy in patients who received antiviral therapy.

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Interferon monotherapy is considered to have limited effectiveness in patients with HCV of a high viral load. Here, we reported a 21-year old male of chronic hepatitis C with a high viral load of HCV genotype 1b. He received both peg-interferon α-2b plus ribavirin and peg-interferon α-2a plus ribavirin combination therapy. But there were no virological response. Nevertheless, after starting natural interferon α(human lymphoblastoid interferon (HLBI), Sumiferon; Dainippon Sumitomo Pharmaceutical Co., Osaka, Japan), he became HCV-RNA negative at 4 week. The therapy is continued and HCV-RNA negativity is sustained for over 40 weeks. Eradication of HCV might be expected. Natural IFN α contains more than 20 subtypes, and one or more of them may have therapeutic effect against HCV virus of this patient.

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Sonazoid, an ultrasonography contrast agent which consists of perflubutane microbubbles with shells, is stable in blood vessels and remains for a long time. We investigated time intensity curves of Sonazoid in portal vein in the patients with chronic liver disease and healthy volunteers. Among 25 patients with chronic liver disease, Sonazoid remained at the rates of 54.8±15.2%, 32.5±13.3%, 25.2±12.2%, 8.8±7.1% in the portal vein, 10, 20, 30, and 60 minutes after injection, respectively. In healthy volunteers, Sonazoid remained at the rates of 60.1±12.9%, 41.4±11.4%, 32.0±10.3%, 7.8±4.5% in the portal vein, 10, 20, 30, and 60 minutes after injection, respectively. It is recommended that Kupffer images of Sonazoid-enhanced contrast ultrasonography is evaluated 60 minutes after injection of Sonazoid to avoid an influence of sonazoid remaining in the vessels.

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We experienced a case which was died of metabolic encephalopathy on the early course of oral treatment with sorafenib. The patient was 60's-year-old with advanced-stage of hepatocellular carcinoma. After 14 days of oral treatment with sorafenib, we found that the patient had disorientation and asterixis, which developed to deep coma, without serious hepatic failure. The patient died after 17 days of sorafenib treatment. We diagnosed as metabolic encephalopathy because he did not display obvious signs of hepatic failure. There was no factor which caused metabolic encephalopathy except for sorafenib administration. We have to consider the causal relationship between sorafenib administration and metabolic encephalopathy.

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