Kanzo
Online ISSN : 1881-3593
Print ISSN : 0451-4203
ISSN-L : 0451-4203
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Volume 51, Issue 2
Displaying 1-5 of 5 articles from this issue
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Case Reports
  • A case of nonalcoholic steatohepatitis associated with sicca syndrome in that autoimmune hepatitis was initially suspected but was correctly diagnosed by means of liver biopsy under laparoscopy
    Toru Takahashi, Hisashi Yokoyama, Tomofumi Miura, Junichiro Nakamura, ...
    Article type: Case Report
    2010 Volume 51 Issue 2 Pages 65-70
    Published: 2010
    Released on J-STAGE: March 10, 2010
    DOIhttps://doi.org/10.2957/kanzo.51.65
    JOURNAL FREE ACCESS
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    A 61-year old woman was first diagnosed to have sicca syndrome and entered into periodical check-up in our hospital. She was referred to our division for her liver dysfunction. Urusodeoxycholic acid was empirically administered but showed no effect. Her revised autoimmune hepatitis (AIH) score was 15, suggesting the presence of possible AIH and therefore, steroid therapy was under consideration. Finally we decided to do liver biopsy under laparoscopy and consequently, she was morphologically diagnosed to be nonalcoholic steatohepatitis (NASH). The addition of α-tocopherol and bezafibrate onto ursodeoxycholic acid normalized her liver dysfunction. In the case of liver dysfunction especially observed in non-alcoholic steatohepatitis associated with non-hepatic autoimmune disorders therefore, we believe that liver biopsy under laparoscopy is crucial for obtaining a correct diagnosis.
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  • A case of cirrhosis due to pravastatin-induced autoimmune hepatitis
    Hirotaka Tajiri, Akihide Masumoto, Masayoshi Yada, Takeshi Senjyu, Ken ...
    Article type: Case Report
    2010 Volume 51 Issue 2 Pages 71-77
    Published: 2010
    Released on J-STAGE: March 10, 2010
    DOIhttps://doi.org/10.2957/kanzo.51.71
    JOURNAL FREE ACCESS
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    A 75-year-old female was admitted to our hospital because of the liver dysfunction with jaundice. She had received an administration of pravastatin for 8 years, and had a history of transient elevation of the levels of AST and ALT in serum 7 months prior to the admission. Her laboratory data showed AST 617 IU/l, ALT 407 IU/l, T-Bil 6.6 mg/dl, ANA×80, IgG 1,914 mg/dl and positive HLA DR4. Ultrasound and computed tomography examinations revealed appearance of cirrhosis. The diagnosis of autoimmune hepatitis (AIH) was made on the basis of liver biopsy findings as well as those laboratory data. Withdrawal of pravastatin followed by an administration of ursodeoxycholic acid resulted in the decrease of the levels of AST and ALT in serum. However, her blood platelet count gradually decreased and ascites appeared, indicating progression of hepatic failure. Subsequent administration of prednisolone led to rapid improvement and remission of the disease. Cirrhosis due to pravastatin-induced AIH was suggested.
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  • A case of hepatitis C related cirrhosis successfully treated with peginterferon-alpha 2b and ribavirin after balloon-occluded retrograde transvenous obliteration for ruptured gastric varices
    Haruo Ikeda, Nobuo Waguri, Tsuneo Aiba, Masahiro Hayashi, Isamu Hama, ...
    Article type: Case Report
    2010 Volume 51 Issue 2 Pages 78-83
    Published: 2010
    Released on J-STAGE: March 10, 2010
    DOIhttps://doi.org/10.2957/kanzo.51.78
    JOURNAL FREE ACCESS
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    We report a case of hepatitis C related cirrhosis with ruptured gastric varices successfully treated by endoscopic variceral ligation (EVL) and balloon-occluded retrograde transvenous obliteration (B-RTO) followed by Peg-interferon α-2b and ribavirin treatment. A female patient in her 50's with severe anemia and in a state of shock was transferred to our hospital because of hematemesis. Emergent upper GI endoscopy revealed spout-bleeding from gastric fundal varices. Primary hemostasis by EVL was successful and complete thrombotic obliteration of the gastric varices was obtained by B-RTO. She was then administered Peg-interferon α-2b and ribavirin to eradicate the high viral load of genotype 2a HCV-RNA. Sustained virological response was achieved after 24-weeks of this combination therapy. Her hepatic functional reserve improved dramatically after the eradication of HCV. We believe that our interventional therapy (EVL and B-RTO) for gastric varices followed by the antiviral treatment significantly contributed to her prognosis.
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  • A case report of the successful treatment by combined EVL and EIS following the evaluation of the hemodynamics of rectal varices using arterial portography
    Junichi Koyama, Shingo Honjo, Ryutaro Morizono, Kotaro Morita, Mitsuru ...
    Article type: Case Report
    2010 Volume 51 Issue 2 Pages 84-91
    Published: 2010
    Released on J-STAGE: March 10, 2010
    DOIhttps://doi.org/10.2957/kanzo.51.84
    JOURNAL FREE ACCESS
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    A 75-year-old man has been followed up at our outpatient clinic for liver cirrhosis and hepatocellular carcinoma (HCC) caused by chronic hepatitis C virus infection. He had hematochezia found on March 2008, and subsequent colonoscopy identified the bleeding from rectal varices. In July 2008, he admitted to our hospital for the treatment of HCC. Portography via superior mesenteric and splenic artery was performed during the treatment, and no hepatofugal flow was detected. Instead, inferior mesenteric arterial portography revealed that inferior mesenteric artery feeded rectum, and visualized rectal varices, then outflow from inferior mesenteric vein to splenic vein as a drainage route. Thereafter we performed the combinational treatment with both endoscopic varices ligation (EVL) and endoscopic injection sclerotherapy (EIS). In details, we first operated EVL targeted the possible site for the out-wall flow of rectum at the oral edge of rectal varices, followed by the EIS under radiographical guidance. Subsequent contrast-enhanced CT confirmed the disappearance of the flow of the rectal varices. This case represented the successful treatment strategy of combined EVL and EIS following the evaluation of the hemodynamics of rectal varices using arterial portography.
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Short Communication
  • Comparison of the Japanese and the international hepatitis B vaccine schedule
    Haruki Komatsu, Ayano Inui, Tsuyoshi Sogo, Tomoo Fujisawa
    Article type: Short Communication
    2010 Volume 51 Issue 2 Pages 92-94
    Published: 2010
    Released on J-STAGE: March 10, 2010
    DOIhttps://doi.org/10.2957/kanzo.51.92
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    We compared the international HB vaccine program with the Japanese HB vaccine program. A good responder was defined as having 100 mIU/ml or more of serum HBs antibodies. Eighty-one children were protected according to the international schedule and 60 children were treated with the Japanese schedule. The levels of serum HBs antibodies in children treated with the Japanese schedule were significantly higher than that in children treated with the international schedule one month after the 3rd vaccination and one year after birth. However, there was no significant difference in the proportion of good responders between the two schedules. In conclusion, the international HB vaccine program was as effective as the Japanese HB vaccine program.
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