Kanzo

Original Article

Validation of the Japanese version of the Fisk Fatigue Severity Score (FFSS) in Japanese patients with primary biliary cirrhosis

Atsushi Tanaka, Hiroki Takahashi, Saeko Nezu, Yoshiyuki Ueno, Kentaro ...

Article type: Original Article
2009 Volume 50 Issue 2 Pages 51-59
Published: 2009
Released on J-STAGE: March 02, 2009

DOIhttps://doi.org/10.2957/kanzo.50.51

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Fatigue is considered to be a specific symptom of primary biliary cirrhosis (PBC), while the prevalence of fatigue in Japanese PBC patients remain unclear, probably due to lack of objective scales for assessment of fatigue in Japanese. In this study, we developed the Japanese version of Fisk Fatigue Severity Score (FFSS), frequently employed in the previous studies, and examined the validity and reliablity in 166 Japanese PBC patients. Cronbach's alfa coefficients in each subscale of the FFSS ranged from 0.94 to 0.96. The correlations between each subscale of FFSS and SF-36 were well acceptable. In particular, the 'vitality' and 'role physical' subscales of SF-36 were well correlated with subscales of FFSS. The factor analysis of the FFSS yielded 4 factors which explain 66% of the total variance. This study validated the Japanese version of FFSS, which provide a powerful tool for the evaluation of fatigue of Japanese PBC patients.

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Case Reports

A case of Japanese pregnant woman who developed severe acute hepatitis E right after back from India

Akishi Kourin, Kazuaki Inoue, Kazuaki Takahashi, Tsunamasa Watanabe, M ...

Article type: Case Report
2009 Volume 50 Issue 2 Pages 60-64
Published: 2009
Released on J-STAGE: March 02, 2009

DOIhttps://doi.org/10.2957/kanzo.50.60

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Hepatitis E virus (HEV) causes large-scale outbreaks in endemic areas and sporadic infections in developed countries: the latter includes "imported infection" by travelers back from endemic areas. In men and non-pregnant women, HEV infection is usually self-limited. It is reported, however, that acute hepatitis E in pregnant women is more severe, often resulting in fulminant hepatic failure. We experienced the first case of the pregnancy-associated acute hepatitis E in Japan: our patient was at 21st week of pregnancy and had stayed in India until 2 weeks before developing hepatitis. The HEV isolate recovered from her serum (JHN-Kan07R, AB447389) segregated to genotype 1, prevalent in India. Result of a predictive formula for development of fulminant hepatitis was positive on admission. Therefore we started daily administration of interferon and steroid pulse treatment, and the patient recovered rapidly. She was delivered of a baby without serious perinatal complications in spite of preterm delivery that is one of the reported obstetric complications of HEV infection.

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A case of autoimmune hepatitis presents giant cell hepatitis on liver histology

Makoto Suzuki, Toshimitsu Murohisa, Daisuke Arai, Yuichi Majima, Touru ...

Article type: Case Report
2009 Volume 50 Issue 2 Pages 65-70
Published: 2009
Released on J-STAGE: March 02, 2009

DOIhttps://doi.org/10.2957/kanzo.50.65

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A 59-year-old man was admitted to the emergency unit in Dokkyo University Hospital on 24^th, December, 2004 with anorexia and dark-colored urine. Physical examination revealed jaundice and hepatomegaly. Abnormal liver function test and EBV-VCA-IgG elevation implied possible first EBV infection. Serological tests also showed positive results in anti-nuclear antibody and anti-mitochondrial M2 antibody, which suggested of autoimmune hepatitis. To determinate etiology of liver dysfunction, echo-guided liver biopsy was performed. The pathology of interface hepatitis with abundant lymphocytes and plasma cells is strongly suggestive for its autoimmune etiology and multi-nucleated giant liver cells were recognized. Therefore the present case suggests that the autoimmune mechanism appears to be important etiology for giant cell hepatitis.

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A successful Balloon-occluded retrograde transvenous obliteration (B-RTO) for the gastric varices with double balloon obliteration using micro balloon catheter together

Toru Ishikawa, Michitaka Imai, Kazuo Higuchi, Hiroteru Kamimura, Kouji ...

Article type: Case Report
2009 Volume 50 Issue 2 Pages 71-74
Published: 2009
Released on J-STAGE: March 02, 2009

DOIhttps://doi.org/10.2957/kanzo.50.71

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A 43-year-old woman with alcoholic liver cirrhosis was hospitalized with gastric varices, which brought about transient bleeding 1 week ago. Enhanced CT and esophago-gastro duodenoscopy revealed gastric fundal varices with some gastrorenal shunt. Balloon-occluded retrograde transvenous obliteration (B-RTO) was offered as the treatment. A 6.0-Fr balloon was introduced from the right internal jugular vein into the gastro-renal shunt. However, the main gastro-renal shunt could not completely blocked with a 6.0-Fr balloon catheter because another small shunt that branched from the gastro-renal shunt developed and drained the blood flow into the left renal vein.
Therefore, a 6.0-Fr catheter was introduced from the right femoral vein to left renal vein and 3.2Fr balloon catheter was inserted into the 6.0-Fr catheter and positioned in the small gastrorenal shunt described above. Inflation of the two balloons resulted in occlusion of the both gastrorenal shunts. After occulusion of these shunts, B-RTO was performed. One-week after the treatment, follow-up CT scans revealed thrombosed gastric varices. Simultaneously blocking of the branched gastro-renal shunt occluded successfully the blood flow into the renal vein, resulting in complete sclerosis of fundal gastric varices.

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A case of refractory hepatic encephalopathy due to the mesenteric shunt, successfully treated by percutaneous transhepatic portal venous collateral obliteration

Yasunari Hiramine, Yasushi Imamura, Ichiro Kanetsuki, Kaori Hosoyamada ...

Article type: Case Report
2009 Volume 50 Issue 2 Pages 75-83
Published: 2009
Released on J-STAGE: March 02, 2009

DOIhttps://doi.org/10.2957/kanzo.50.75

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A 67-year-old woman, previously treated for alcoholic liver cirrhosis and diabetes mellitus, was admitted to our hospital because of exacerbation of hepatic encephalopathy and diabetes mellitus but she gradually lapsed into hepatic coma. A giant collateral circulation was found traversing the splenic and mesenteric veins and flowing into the inferior vena cava. Collateral circulation was attempted via a percutaneous transhepatic portal route for embolization. Three days after admission, hemorrohage occurred at the hepatic puncture. A giant arterioportal shunt (A-P shunt) developed, disobliterating the collateral circulation. The artery of the A-P shunt was embolized, resulting in hemostasis. The patient regained consciousness and the ability to converse normally three and seven days, respectively, after abdominal angiography with a Hasegawa Scale of 12. We reported a case of refractory hepatic encephalopathy for which percutaneous transhepatic obliteration of the portal collateral circulation was proven to be effective.

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A case of hepatic angiomyolipoma showing hypoechoic image in abdominal ultrasonography and growth during follow-up period

Mitsuro Kanda, Shin Takeda, Hiroyuki Sugimoto, Shuji Nomoto, Akimasa N ...

Article type: Case Report
2009 Volume 50 Issue 2 Pages 84-89
Published: 2009
Released on J-STAGE: March 02, 2009

DOIhttps://doi.org/10.2957/kanzo.50.84

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The case presented here is a 46-year-old male. A liver tumor 20 mm in diameter on liver segment 6 was pointed out when he underwent a regular examination with abdominal ultrasonography in December 2006. After observation, the tumor grew to 36 mm in diameter and showed an entirely hypoechoic image with abdominal ultrasonography, so he was referred to our hospital for a thorough checkup and treatment. In blood test on admission, the liver functions and tumor markers were within the normal range and hepatitis virus markers were negative. We made a preoperative diagnosis of hepatocellular carcinoma due to the course of tumor growth and thorough examinations such as abdominal enhanced CT and MRI. Then we performed resection of the posterior segment. Histopathologically, it was diagnosed as angiomyolipoma of the liver. It is often difficult to distinguish angiomyolipoma of the liver from hepatocellular carcinoma because of their common hypervascularity. Especially, in this case correct diagnosis was very difficult because the tumor showed an entirely hypoechoic image by abdominal ultrasonography and the course of tumor growth.

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Hypofractionated stereotactic radiotherapy for same segment intrahepatic recurrence of HCC spreading along the subsegmental portal vein after percutaneous radiofrequency ablation therapy: a case report

Kento Imajo, Kazuhiro Atsukawa, Atsuya Takeda, Takashi Sakaguchi, Tada ...

Article type: Case Report
2009 Volume 50 Issue 2 Pages 90-95
Published: 2009
Released on J-STAGE: March 02, 2009

DOIhttps://doi.org/10.2957/kanzo.50.90

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Percutaneous radiofrequency ablation (RFA) is a minimally invasive treatment for non-surgical patients with early-stage hepatocellular carcinoma (HCC) and becoming increasingly more popular because of its effectivity and repeatability. However, intrahepatic recurrence of HCC after RFA is frequent. In this report we describe a case of same segment intrahepatic recurrence of HCC spreading from the treated nodule to the periphery along the subsegmental portal vein after RFA. He had received hypofractionated stereotactic body radiotherapy (SBRT). The dose was 35 Gy in 5 fractions prescribed to the 80% isodose line. The radiotherapy had significant effects on growth inhibition of recurrent HCC and he achieved complete disease remission. Hypofractionated SBRT seems to be an acceptable therapeutic option for same segment intrahepatic recurrence of HCC after percutaneous procedure.

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A case of liver cancer progressed rapidly with the change of enhanced- pattern after percutaneous radiofrequency ablation

Yutaka Yata, Suguru Takeuchi, Daisuke Kanda, Satoshi Takakusaki, Takes ...

Article type: Case Report
2009 Volume 50 Issue 2 Pages 96-102
Published: 2009
Released on J-STAGE: March 02, 2009

DOIhttps://doi.org/10.2957/kanzo.50.96

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An 81-year-old woman who had been treated with percutaneous radiofrequency ablation (PRFA) for hepatocellular carcinoma (HCC) in the hepatic segment 4 (S4) was referred to our hospital 6 months later from PRFA because of liver dysfunction, obstructive jaundice and ascites. Dynamic CT revealed a hypovascular tumor in the hepatic S4. Although the characteristics of tumoral vascularity pattern have been different from the original one, we diagnosed this case as local tumor recurrence of HCC after PRFA. The metallic stent was placed into the obstructed common bile duct, and her jaundice was improved once. However she died from hepatic failure because of the rapid progressed tumoral growth. Necropsy of the hypovascular tumor revealed intrahepatic cholangiocarcinoma. It suggested that the original tumor of this case was mixed type of liver cancer, and its character had been changed by the ablated therapy. It was suggested RFA to the mixed type liver cancer may induce the rapid progression of the tumoral growth and should be avoided.

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