Kanzo
Online ISSN : 1881-3593
Print ISSN : 0451-4203
ISSN-L : 0451-4203
Volume 50, Issue 12
Displaying 1-10 of 10 articles from this issue
Original Articles
  • Noritomo Shimada, Kai Yoshizawa, Makiko Ika, Akira Dobashi, Naoto Nomu ...
    Article type: Original Article
    2009 Volume 50 Issue 12 Pages 687-702
    Published: 2009
    Released on J-STAGE: January 27, 2010
    JOURNAL FREE ACCESS
    We investigated "Response-guided therapy" 48 weeks vs. 72 weeks in 250 Japanese chronic hepatitis C patients infected with genotype 1b and high viral load to peginterferon (Peg-IFN) α-2b plus ribavirin (RBV). SVR rate was 100% of patients with RVR. Although patients with cEVR did not significantly improve SVR rate with extended treatment to 72 weeks, patients with pEVR were significantly improved with extended treatment (8.0% vs. 59.6%, p<0.0001). In patients with non-RVR except for NVR, extended treatment to 72 weeks significantly improved SVR rate compared with 48-week treatment (57.8% vs. 72.4%, p=0.0413). Multivariate analysis identified low-density lipoprotein cholesterol (≥86 mg/dL), total dose of RBV per body weight (≥3 g/kg), cEVR, periods to the intial HCV-RNA negative to 20 weeks as significant determinants of SVR. When non-RVR cases with HCV-RNA reduction during 0-4 weeks less than 2 Log10 IU/mL and that achieved LVR, total dose of RBV per body weight more than 3 g/kg and extended treatment to 72 weeks may increase SVR rate. Response-guided therapy is useful strategy in the treatment for chronic hepatitis C with genotype 1b and high viral load.
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  • Kazuhiko Koike, Hisao Tajiri, Mariko Itsubo
    Article type: Original Article
    2009 Volume 50 Issue 12 Pages 703-710
    Published: 2009
    Released on J-STAGE: January 27, 2010
    JOURNAL FREE ACCESS
    We retrospectively evaluated the detectability of hypervascular hepatocellular carcinoma (HCC) on diffusion-weighted MR imaging (DWI) in 52 patients, and compared that on contrast-enhanced CT (enhanced CT). One hundred and seventy tumor lesions, showing hypervascular tumor on CT during hepatic arteriography and hypoperfusion area on CT dyring arterial portography prior to achievement of transcatheter arterial chemoembolization, were referred as the gold standard for the comparison of DWI with enhanced CT. Sensitivity for the detection of tumors was 78.2% on DWI and 80.0% on enhanced CT. The detected number of tumors in each patient was equal in 65.3% of them on both modalities and superior in 13.5% of them on DWI without significant difference. The superiority of DWI to enhanced CT in the patients with previous treatment was shown in 20.8% of patients. We suggest that DWI could be useful modality for the detection of hypervascular HCC without using contrast agent and radiation exposure.
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Case Reports
  • Misato Shiratori, Koji Ishii, Ryuji Takayama, Masahiro Kanayama, Katsu ...
    Article type: Case Report
    2009 Volume 50 Issue 12 Pages 711-718
    Published: 2009
    Released on J-STAGE: January 27, 2010
    JOURNAL FREE ACCESS
    A 66-year-old Japanese woman was referred to our hospital because of acute severe hepatitis B with acute renal dysfunction. She developed grade II encephalopathy on hospital day 2, and was diagnosed as having fulminant hepatitis B. She recovered from acute hepatic failure with intensive treatment, including artificial liver support, antiviral drugs such as entecavir and interferon-beta, and corticosteroid pulse therapy. However, multiple round lesion were detected in both lungs and a right renal mass was also found. The renal lesion was aspirated for drainage and aspergillus (Asp) was detected. Therefore, she was diagnosed as having invasive pulmonary Aspergillosis (IPA) with a retroperitoneal abscess and a subcutaneous nodule. Thereafter, her fever persisted, and pneumothorax and cerebral hemorrhage occurred together on the next day. Despite recovery from those complication, subarachnoid hemorrhage with involvement of the bilateral ventricles occurred and she died on hospital day 75. Asp is an opportunistic fungal pathogen that can cause fetal IPA in immunocompromised individuals. Since it is difficult to detect Asp early, the prognosis is usually poor even if intensive anti-fungal therapy is performed. Monitoring and prophylactic anti-fungal therapy should be recommended for high-risk patients.
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  • Tomomitsu Matono, Shiho Tokunaga, Takaaki Sugihara, Takakazu Nagahara, ...
    Article type: Case Report
    2009 Volume 50 Issue 12 Pages 719-724
    Published: 2009
    Released on J-STAGE: January 27, 2010
    JOURNAL FREE ACCESS
    A 54-year-old man was admitted because of general fatigue and liver dysfunction. Positive results were obtained from serological testing for syphilis. An induration was identified on the penis, and small, white nodules were observed on the liver surface by laparoscopy. Pathological examination of the small nodules showed granulomatous inflammation. Spirochetes were not seen around the portal area in liver tissue. Early syphilitic hepatitis was diagnosed and amoxicillin administered for 4 weeks. Serum levels of transaminases and alkaline phosphatase rapidly normalized with treatment.
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  • Manri Kawakami, Yasuhiro Umekawa, Norikuni Shibata, Makoto Kuboki
    Article type: Case Report
    2009 Volume 50 Issue 12 Pages 725-730
    Published: 2009
    Released on J-STAGE: January 27, 2010
    JOURNAL FREE ACCESS
    A 41-year-old female was received percutaneous liver needle biopsy because of suspected of nonalcoholic steatohepatitis on abdominal computed tomography. She has obesity with body mass index of 36.2 kg/m2 accompanied with hypertension, diabetes mellitus and hypercholesterolemia. On three days after liver needle biopsy, she felt right leg swelling and pain. Computed tomography revealed pulmonary thrombosis and right femoral thrombosis. She had no previous thrombophilic disorders. Deep venous thrombosis might be produced during keeping rest after liver needle biopsy. Complication of diabetes mellitus, hypercholesterolemia, obesity, and the use of antifibrinolytic agent were also related with thrombosis.
    Though liver needle biopsy is indispensable to make diagnosis of nonalcoholic steatohepatitis, it has the risk of the deep venous thrombosis. So, we must also pay attention during the rest after the liver needle biopsy not to be complicated with the deep venous thrombosis.
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  • Rinako Kawamura, Ryosuke Nagamatsu, Rina Ohashi, Dai Ito
    Article type: Case Report
    2009 Volume 50 Issue 12 Pages 731-735
    Published: 2009
    Released on J-STAGE: January 27, 2010
    JOURNAL FREE ACCESS
    A 71-year-old woman with advanced HCC had been treated by transarterial chemoembolization with epirubicin and mitomycin from 2000 to 2005, however tumor progression was not controlled and HCC was found in the portal vein. So she was treated with six times by transcatheter arterial infusion chemotherapy with cisplatin powder (IA-call®). HCC was disappeared and tumor makers were markedly decreased. No adverse effect was found and she is doing well for 9 years. The treatment will be useful for patient with advanced HCC.
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Rapid Communications
  • Kazutomo Suzuki, Hiroshi Takada, Kagemasa Kagawa, Hajime Kuwayama, Yos ...
    Article type: Rapid Communication
    2009 Volume 50 Issue 12 Pages 736-737
    Published: 2009
    Released on J-STAGE: January 27, 2010
    JOURNAL FREE ACCESS
    The serum free fatty acid levels were 571±240 μEq/L in patients with chronic hepatitis and 780±240 μEq/L; the serum free fatty acid levels were significantly higher in chronic hepatitis than in chronic hepatitis than in cirrhosis. The elevation of serum free fatty acid in cirrhosis is caused by starvation.
    The serum free fatty acid levels were significantly decreased after the meal. 200 kcal of a nutritional supplement (Calorie Mate JERRY; Otsuka Pharmace-utical, Japan) was given to the patients before abdominal ultrasonography.
    The free fatty acids levels were significantly decreased after a nutritional supplement.
    Calorie Mate JERRY as a nutritional supplement improve metabolic disorder caused by fasting before abdominal ultrasonograhy.
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  • Noboru Hirashima, Masaaki Shimada, Hiroaki Iwase, Hidemi Goto
    Article type: Rapid Communication
    2009 Volume 50 Issue 12 Pages 738-740
    Published: 2009
    Released on J-STAGE: January 27, 2010
    JOURNAL FREE ACCESS
    We investigated lipid metabolism in nine patients with chronic hepatitis C virus (HCV), not responded by previous interferon therapy (IFN), undergoing double filtration plasmapheresis (DFPP) and peginterferon plus ribavirin (PEG·Rib) combination therapy. Three patients were non-responder of previous IFN monotherapy and 6 were PEG·Rib. HCV RNA became negative within 24 weeks in 5 out of 9. In the HCV RNA negative group, Triglyceride (TG) and Total-Cholesterol (T-Chol) or LDL-Chol levels increased gradiently after DFPP and were higher than those before treatment, but not in HCV positive group. DFPP plus PEG·Rib combination therapy might not only produce a reduction of HCV but also improve the environment of lipid metabolism effective for PEG·Rib during the early stage of treatment.
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