Kanzo
Online ISSN : 1881-3593
Print ISSN : 0451-4203
ISSN-L : 0451-4203
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Volume 50, Issue 6
Displaying 1-9 of 9 articles from this issue
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Editorial
Original Article
  • Prediction of the rate of complications after hepatectomy in hepatocellular carcinoma patients by preoperative assessment of liver damage and H-POSSUM
    Hideki Nakahara, Toshihiko Kohashi, Ichiro Omori, Asuka Tanaka, Masash ...
    Article type: Original Article
    2009 Volume 50 Issue 6 Pages 273-279
    Published: 2009
    Released on J-STAGE: July 06, 2009
    DOIhttps://doi.org/10.2957/kanzo.50.273
    JOURNAL FREE ACCESS
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    Case of hepatocellular carcinoma (HCC) and its resection have been increasing in the elderly population recent years, leading to an increase of various pre- and postoperative complications. The aim of this study was to predict the occurrence of postoperative complications by assessing preoperative conditions. Of 131 HCC patients who underwent initial hepatectomy at our institute between July 2002 and December 2008, 51 patients with postoperative complications were enrolled in this retrospective study as a complication group and 82 patients without complications were enrolled as a no-complication group. In the univariate analysis, serum levels of choline esterase, albumin and hepaplastin test were significantly lower and the levels of total bilirubin, AST, ZTT and ICG-R15 were significantly higher in the complication group: only albumin was significant in multivariate analyses. Tumor factors showed no correlations. Intraoperative blood loss of 500 g or more was found to be a risk factor for postoperative complications. The patients were then divided into four groups according to liver damage and H-POSSUM. The rate of complications in the group of [H-POSSUM <50% + liver damage A] (21.6%) was significantly lower than those in the groups of [H-POSSUM <50% + liver damage B or C] (60.0%), [H-POSSUM ≥50% + liver damage A] (50.0%) and [H- POSSUM ≥50% + liver damage B or C] (80.0%). In conclusion, hepatic resection can be performed safely in patients with H-POSSUM of less than 50% and liver damage A.
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Case Reports
  • A case of hepatic sarcoidosis caused by PEG-interferon alfa 2b and ribavirin combination therapy against chronic hepatitis C
    Yoshinori Ohno, Takao Watanabe, Eiji Takeshita, Yuuichi Kobayashi, Yos ...
    Article type: Case Report
    2009 Volume 50 Issue 6 Pages 280-288
    Published: 2009
    Released on J-STAGE: July 06, 2009
    DOIhttps://doi.org/10.2957/kanzo.50.280
    JOURNAL FREE ACCESS
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    A 51-year-old woman with a history of ocular sarcoidosis had started the treatment of PEG-interferon alfa 2b and ribavirin (PEG/RBV) combination therapy against chronic hepatitis C, however, this treatment was discontinued because of development of multiple liver tumors which were around 1 cm in diameter and detected clearly by enhanced CT. On abdominal ultrasonography (US), the tumors were very hard to be visualized, therefore, only small part of tumor could be obtained by a liver biopsy using US, and the specimen showed suspect of hepatic sarcoidosis, but no definite diagnosis was made. Because the tumors had not been changing during the 5 months observation, PEG/RBV combination therapy was started again and had been continued for 24 weeks. HCV was eradicated, but the tumors had been increasing in size on a CT scan taken 5 months after the end of the treatment. Because the tumors were clearly detected by enhanced US using Perflubutane, accurate tumor biopsy was possible and the diagnosis of hepatic sarcoidosis was fixed. Afterwards, the tumors in the liver had been decreasing in both size and number without any therapy, and eventually disappeared 12 months after the end of PEG/RBV therapy. Regarding PEG/RBV therapy against chronic hepatitis C, sustained virological response was achieved.
    We conclude that patients should be monitored for sarcoidosis during the course of interferon and/or ribavirin therapy.
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  • A necropsied case of primary hepatic malignant lymphoma associated with chronic hepatitis C
    Toshiyuki Sakata, Hisashi Yamada, Katsuhiko Tsukada, Takashi Hashimoto ...
    Article type: Case Report
    2009 Volume 50 Issue 6 Pages 289-296
    Published: 2009
    Released on J-STAGE: July 06, 2009
    DOIhttps://doi.org/10.2957/kanzo.50.289
    JOURNAL FREE ACCESS
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    A 81-year-old woman with angina pectoris and chronic hepatitis C admitted for epigastralgia had liver dysfunction. Ultrasonography showed multiple hypoechoic small masses. These tumors exhibited low density areas by abdominal plain computed tomography, and were not enhanced in the early phase. Moreover those were revealed lower density in the late phase. By magnetic resonance imaging, those appeared as low intensity lesions on T1-weighted image, as iso-intensity on T2-weighted image, and as slightly-enhanced only at marginal parts. She finally died, and we undertook a necropsy after an informed consent was obtained from her family. These tumors were diagnosed as diffuse large B cell malignant lymphoma by histological and immunohistological examinations of the necropsy specimen. No examinations detected space occupied lesions in the other organs or lymph nodes. Therefore, our case was diagnosed as primary hepatic lymphoma associated with chronic hepatitis C.
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  • A case of drug-induced liver injury successfully treated with plasma exchange therapy and ursodeoxycholic acid
    Kaori Ochiai, Hideaki Honda, Tamami Watanabe, Youhei Koushima, Ikuo Na ...
    Article type: Case Report
    2009 Volume 50 Issue 6 Pages 297-302
    Published: 2009
    Released on J-STAGE: July 06, 2009
    DOIhttps://doi.org/10.2957/kanzo.50.297
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    A 58-year-old woman was hospitalized for the treatment of acute cardiac infarction and foxhole type cardiomyopathy. After the implantation of a drug-eluting stent in the coronary artery, the patient was treated with medications including anticoagulant, antiarrhythmic and antihypertensive drugs. Impaired liver function was detected about 3 weeks after the start of drug administration. Based on the absence of other causes of liver dysfunction, the drug-related liver injury was highly suspected. Usually all drugs should be stopped when the drug-related liver injury was suspected, but in this case it was impossible to stop anticoagulant treatment due to acute phase of her heart disease. Assumedly this made the drug-related liver injury worsened and also difficult to treat. However, we introduced plasma exchange followed by ulsodeoxycholic acid therapy, resulting in a remarkable improvement of liver function.
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  • A case of hepatocellular carcinoma with bile duct invasion treated successfully by expandable metallic stents and transcatheter arterial chemoembolization (TACE)
    Takeshi Chida, Fujito Kageyama, Yasunori Takehira, Masami Yamada, Shig ...
    Article type: Case Report
    2009 Volume 50 Issue 6 Pages 303-311
    Published: 2009
    Released on J-STAGE: July 06, 2009
    DOIhttps://doi.org/10.2957/kanzo.50.303
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    A 68-year-old male with hepatocellular carcinoma (HCC) invading the left hepatic bile duct and forming multiple abscess was successfully treated by expandable metallic stents (EMS) and transcatheter arterial chemoembolization (TACE). Until September 2004, he had had multiple HCC treated by TACE. Then, HCC invaded the left bile duct and cholangitis occurred. We inserted a plastic stent (PS) for the stenosis endoscopically, and his cholangitis was improved. But the PS became obstructed 23 days later. In order to prevent recurrence of cholangitis, we removed the PS and tried to insert an EMS. First, we performed TACE for HCC to prevent complications, then removed the PS and inserted a S.M.A.R.T. Nitinol StentTM(diameter 8 mm, length 80 mm), covering the stenosis endoscopically. In June 2005, 309 days after inserting the first stent, he had a high fever and was readmitted. Computed tomography (CT) showed multiple abscess at distal sites of B3. We thought that tumor overgrowth caused the bile duct stenosis and abscess, so we inserted another S.M.A.R.T. Nitinol StentTM(diameter 8 mm, length 80 mm), at a site distal to the first one. Both of them were patent, and no complication occurred until April, 2006, when the patient died of hepatic failure. Sometimes, bleeding occurs from the HCC surface. However, TACE before inserting the EMS was useful to prevent bleeding and any other complications accompanying the procedures.
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  • A liver/colon double cancer patient who underwent simultaneous resection at age 91, and lived up to 100 years old by multimodal therapies for relapses
    Hiroko Oka, Takashi Nakai, Osamu Yamazaki, Takao Manabe, Yasuko Kawasa ...
    Article type: Case Report
    2009 Volume 50 Issue 6 Pages 312-319
    Published: 2009
    Released on J-STAGE: July 06, 2009
    DOIhttps://doi.org/10.2957/kanzo.50.312
    JOURNAL FREE ACCESS
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    Here we report our experience of an extremely elderly patient with liver/colon double cancer. He underwent hepatectomy and sigmoidectomy simultaneously at age 91 under the diagnosis of hepatocellular carcinoma (HCC) and sigmoid colon cancer. But the HCC relapsed repeatedly thereafter (at age 93, 95, 97, and 98), and he was treated by multimodal therapies over time: combination of transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEIT) on the first three occasions of the relapse; and only TACE on the relapse at age 98. He expired at 100 years old. To our knowledge, this is the eldest case (91 years old) of simultaneous hepatectomy/sigmoidectomy for the liver/colon double cancer. Moreover, there have been no reports on PEIT at age 97 or TACE at age 98.
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Short Communication
  • HBV genotype distribution in blood donors in all prefectures of Japan
    Masako Tanaka, Yoshiharu Suzuki, Akira Yoshikawa, Hisao Yugi, Yuko Got ...
    Article type: Short Communication
    2009 Volume 50 Issue 6 Pages 320-323
    Published: 2009
    Released on J-STAGE: July 06, 2009
    DOIhttps://doi.org/10.2957/kanzo.50.320
    JOURNAL FREE ACCESS
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    HBs-antigen positive Japanese blood donors from October 2006 to September 2007 (n=2001) were examined for HBV genotype. Of 1887 blood donors whose HBV was successfully genotyped, the rate of HBV genotype was A (5.6%), B (30.8%), C (62.6%) and others (1.0%). The prefectures with an over-60% predominance of HBV genotype B were Akita, Yamagata, Niigata, and Okinawa. Although most prefectures showed 60% or greater rate of genotype C, Hokkaido, Aomori, Iwate, Miyagi, Ibaraki, Tochigi, Saitama, Chiba, Tokyo and Kanagawa showed almost same rate of genotype B and C. To our knowledge, this is the first report describing HBV genotype distribution in every prefecture of Japan.
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Special Article
  • A verification of the assumptive thesis, "HCV kinetics is conform to Gompertzian model"
    Keiji Matsui
    Article type: Special Article
    2009 Volume 50 Issue 6 Pages 324-338
    Published: 2009
    Released on J-STAGE: July 06, 2009
    DOIhttps://doi.org/10.2957/kanzo.50.324
    JOURNAL FREE ACCESS
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    Objective. The author presented previously an assumption about HCV kinetics as follows; when HCV's growth obeys Gompertzian model and its decay by interferon (IFN) occurs in an exponential-decay manner, decrease of HCV can be expressed as lnH (t) =lnGmax- (D0/k) + (D0/k) exp (-kt), where lnH (t) is a logarithm of HCV-viral load, lnGmax is a logarithm of baseline viral load, D0 is an initial deceleration rate, k is a dumping constant of the deceleration rate, and t is time. The objective of this study is to verify the assumption by using actual clinical data.
    Method. Patients with chronic hepatitis C were enrolled to this study. Patients underwent injection of beta-IFN for 2 weeks. HCV-viral load of the baseline, 1/2 week, 1 week, and 2 weeks were assessed by TaqMan method.
    Results. The actual viral load of 2 weeks was lower than the calculated value. When HCV obeys Gomp-Ex model, that is, replication is exponential under a threshold but obeys Gompertzian model above the threshold, the calculated value is well matched with actual value and the threshold is 3.5 log/ml.
    Conclusion. Eventually, HCV kinetics by Gomp-Ex model was analogous to conventional two-phase model. The advantage of the present model is that the long-term prognosis can be estimated by only a 3-point measurement of the viral load in the first week. When a theoretical minimal value is below the threshold (3.5 log/ml), we can achieve the eradication of HCV in a long-term.
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