Kanzo
Online ISSN : 1881-3593
Print ISSN : 0451-4203
ISSN-L : 0451-4203
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Volume 50, Issue 3
Displaying 1-9 of 9 articles from this issue
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Review Article
Original Article
  • Changes of hepatitis C virus-infected individuals in Saga prefecture during 1992-2006: current status and future prediction
    Iwata Ozaki, Seiji Kawazoe, Toshihiro Nakayama, Michiaki Koga, Toyoaki ...
    Article type: Original Article
    2009 Volume 50 Issue 3 Pages 122-131
    Published: 2009
    Released on J-STAGE: April 08, 2009
    DOIhttps://doi.org/10.2957/kanzo.50.122
    JOURNAL FREE ACCESS
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    Saga prefecture has been reported to be the most prevalent area of hepatitis C virus (HCV) infection in Japan and have highest hepatocellular carcinoma (HCC)-related mortality rate. Since 1992 anti-HCV antibody test was conducted in the population-based survey in Saga prefecture. Here we report the changes of HCV-infected individuals over 30 years old between 1995 and 2005, and estimated the changes of anti-HCV antibody-positive individuals at 2005. At 1995 anti-HCV was detected in 43,314 individuals over 30 (8.34%) in Saga prefecture and the number of anti-HCV positive individuals was decreased to 29,566 (4.44%). If the changes of anti-HCV positive individuals during 1995-2005 is same for further 10 years, the estimated number of anti-HCV positive individuals at 2015 will be 17,231 (2.86%). The estimated reduction of anti-HCV positive individuals during 1995-2005 was about 20% higher than that of general population in Saga prefecture. Although the HCC-related death is expected to be decreased, the mortality rate of HCC for next 10 years in Saga prefecture will be still higher than the current overall mortality of HCC in Japan. Therefore it seems to be necessary to introduce interferon treatment urgently for HCV carriers to reduce the HCC-related mortality by reducing HCC development.
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Case Reports
  • A case of autoimmune thrombocytopenic purpura induced by peg-interferon α-2b+ribavirin combination therapy for chronic hepatitis C
    Fumihito Toshima, Kouji Adachi, Katsuhisa Inamura, Toshiyuki Okamura, ...
    Article type: Case Report
    2009 Volume 50 Issue 3 Pages 132-138
    Published: 2009
    Released on J-STAGE: April 08, 2009
    DOIhttps://doi.org/10.2957/kanzo.50.132
    JOURNAL FREE ACCESS
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    Recent reports suggest that interferon therapy induce autoimmune disorders. We reported autoimmune thrombocytopenic purpura occurred in the course of interferon therapy for chronic hepatitis C.
    The case is a 66-years-old woman referred to our hospital for chronic hepatitis C. Peg-interferon α-2b+ribavirin combination therapy was begun in December, 2006. At week 32 of the therapy, petechial hemorrhage of her left forearm occurred and platelet counts decreased to 7,000/mm3 in the hematological examination. Red blood cell, white blood cell count and coagulation factors were normal. There was no abnormality in the bone marrow examination. Platelet associated immunoglobulin (PA-IgG) elevated in the investigations, then AITP was diagnosed. Her platelet count recovered after she was treated with prednisolone. We should note AITP, one of rare autoimmune disorders induced by interferon therapy.
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  • A patient with Gilbert's syndrome complicated with drug-induced liver injury by the over-the-counter drug and Fluvastatin Sodium: A case report
    Minoru Ayada, Tetsuya Ishikawa, Akihiko Okumura, Naoki Hotta, Akinori ...
    Article type: Case Report
    2009 Volume 50 Issue 3 Pages 139-144
    Published: 2009
    Released on J-STAGE: April 08, 2009
    DOIhttps://doi.org/10.2957/kanzo.50.139
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    A 56-year-old female was admitted to our hospital because of epigastralgia, vomiting, hyperbilirubinemia, and abnormalities in the hepatic function tests. After the discontinuation of an over-the-counter drug, her symptoms and the abnormalities in the blood tests were improved. Thus she was diagnosed as drug-induced liver injury by the over-the-counter drug. The second episode of drug-induced liver injury occurred when she took Fluvastatin Sodium for her hyperlipemia. The liver injury was improved by the discontinuation of the drug; however, only serum indirect bilirubin level remained abnormal. She was suspected to have constitutional jaundice, and diagnosed as Gilbert's syndrome by the analysis of gene polymorphism for UDP-glucuronyl transferase (UGT1A1). The polymorphism of UGT1A1 affects the efficiency of the lipophilic drug metabolism, and the activity of UGT1A1 is known to be low in the patients with Gilbert's syndrome. Therefore the present case suggests that the recurrent drug-induced liver injury might be related to the low UGT1A1 activity due to Gilbert's syndrome. We here report the case with Gilbert's syndrome complicated with the recurrent drug-induced liver injuries.
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  • A case of advanced haptocellular carcinoma with lung metastases successfully treated by TS-1® and CDDP
    Ryo Metoki, Yasuharu Imai, Shigeki Ichimura, Takatomo Sano, Yuki Miyat ...
    Article type: Case Report
    2009 Volume 50 Issue 3 Pages 145-152
    Published: 2009
    Released on J-STAGE: April 08, 2009
    DOIhttps://doi.org/10.2957/kanzo.50.145
    JOURNAL FREE ACCESS
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    A 70-year-old man was referred to our hospital with suspected hepatocellular carcinoma (HCC). On initial presentation, HCC lesions were present in hepatic segment 2-3 (4.5 cm) and segment 7 (1.0 cm), and hepatic venous invasion was also detected. Transarterial chemoembolization therapy was administered initially, but 3 months later portal venous invasion and multiple pulmonary metastases were detected, therefore systemic chemotherapy (TS-1®+CDDP) was commenced. After one course of chemotherapy, the tumor marker levels decreased and the pulmonary lesions also decreased in size. No serious side effects occurred during the treatment period, and the only adverse event observed was grade 1 thrombocytopenia. The results in this case suggest that TS-1®+CDDP chemotherapy may be effective in the treatment of HCC with distant organ metastases.
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  • Olanzapine as an antiemetic in intractable nausea and anorexia in patients with advanced hepatocellular carcinoma: three case series
    Takuya Kitada, Takashi Narimatsu, Seiko Yamaguchi
    Article type: Case Report
    2009 Volume 50 Issue 3 Pages 153-158
    Published: 2009
    Released on J-STAGE: April 08, 2009
    DOIhttps://doi.org/10.2957/kanzo.50.153
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    Nausea and anorexia are difficult symptoms to manage in patients with advanced cancer. Recent studies have suggested the efficacy of olanzapine, an atypical antipsychotic, for refractory nausea and vomiting in advanced cancer. Here we report a case series of three patients with advanced hepatocellular carcinoma who suffered nausea and anorexia which were resistant to initial treatment with standard antiemetics. In all cases, olanzapine (2.5-5 mg/day) relieved nausea and anorexia. No adverse effect was observed. These results suggest that olanzapine may be a useful agent for the management of nausea and anorexia in advanced hepatocellular carcinoma.
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Short Communications
  • Retrospective detection of hepatitis E virus RNA and antibodies in the sera from patients with etiology-obscure acute liver injury
    Manri Kawakami, Makoto Kuboki, Yasuhiro Umekawa, Kazuhide Yamamoto, Na ...
    Article type: Short Communication
    2009 Volume 50 Issue 3 Pages 159-162
    Published: 2009
    Released on J-STAGE: April 08, 2009
    DOIhttps://doi.org/10.2957/kanzo.50.159
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    We have seen 25 cases of etiology-obscure acute liver injury from January 2004 through December 2007 in our hospital, among which 22 cases could be subjected to a retrospective investigation for hepatitis E virus (HEV) infection since their sera had been cryopreserved. As a result, 2 (9.1%) of the 22 cases were positive for both IgM and IgA anti-HEV antibodies (as well as for HEV RNA in one case), suggesting HEV infection as the cause of their liver injuries. Notably, 1 of the 2 cases had been misdiagnosed as "drug-induced hepatitis" (another one as "etiology-unknown hepatitis"). These results warrant implementation of HEV testing as a routine one in primary care settings or city hospitals like ours.
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  • A first case of pregnant woman who contracted infection of indigenous genotype 3 hepatitis E virus in Japan
    Tatsuya Aikawa, Kunihiko Yamagata, Kuniko Miyamoto, Fumio Tsuda, Masah ...
    Article type: Short Communication
    2009 Volume 50 Issue 3 Pages 163-165
    Published: 2009
    Released on J-STAGE: April 08, 2009
    DOIhttps://doi.org/10.2957/kanzo.50.163
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    A 35-year-old woman who was 14 weeks pregnant visited a gynecology hospital to undergo a surgical abortion. Although she was not jaundiced, and had no signs of hepatitis, liver function was abnormal (ALT, 100 IU/L; AST, 96 IU/L). The serum obtained was negative for markers of hepatitis A, B, and C viruses. However, based on the positive results of non-routine IgM/IgA anti-HEV and HEV RNA assays, the patient was occasionally diagnosed with sporadic acute hepatitis E. The HEV isolate recovered from the patient was phylogenetically close to known genotype 3 HEV strains circulating in Japan, with the highest identity of 93.2%. We believe that testing for hepatitis E should be routine in Japan, in cases of suspected viral hepatitis.
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Rapid Communication
  • Hepatitis B virus core-related antigen is a putative predictive marker of hepatocarcinogenesis for the patient with nucleos(t)ide analogues therapy
    Kunihiko Tsuji, Hiroyuki Nishimori, Takeshi Matsui, Kei Yane, Kang Jon ...
    Article type: Rapid Communication
    2009 Volume 50 Issue 3 Pages 166-167
    Published: 2009
    Released on J-STAGE: April 08, 2009
    DOIhttps://doi.org/10.2957/kanzo.50.166
    JOURNAL FREE ACCESS
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    Serum HBcrAg concentration has been reported to be well correlated with intrahepatic covalently closed circular DNA (cccDNA) and a useful marker for monitoring the antiviral effect of lamivudine.
    We investigated a total of 24 HBeAg-negative patients who were treated with nucleos(t)ide analogues for more than 2 years (2.2-8.1 years). Eleven patients developed hepatocellular carcinoma (HCC) and the remaining patients did not. Serum HBcrAg concentration was significantly higher in the 11 patients with HCC than in the remaining patients without HCC (4.0±0.7 logIU/ml vs 3.2±0.4 logIU/ml) (p=0.002). The clinical and virological characteristics were not significantly different between two groups.
    Thus, the present study suggests that HBcrAg can be a useful predictor of HCC for HBeAg-negative patients who had complete virological response on nucleos(t)ide analogues therapy though further study may be needed.
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