Kanzo
Online ISSN : 1881-3593
Print ISSN : 0451-4203
ISSN-L : 0451-4203
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Volume 51, Issue 6
Displaying 1-9 of 9 articles from this issue
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Editorial
Original Article
  • A nosocomial outbreak of hepatitis C in the general ward
    Nobuyuki Yamashita, Takashi Kamihira, Shinji Shimoda, Hideyuki Nomura, ...
    Article type: Original Article
    2010 Volume 51 Issue 6 Pages 277-284
    Published: 2010
    Released on J-STAGE: July 02, 2010
    DOIhttps://doi.org/10.2957/kanzo.51.277
    JOURNAL FREE ACCESS
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    Four patients suffered from acute hepatitis C and visited our hospital sequentially during August to October 2008. We immediately set up an investigating committee including members of outside our hospital. The four patients all had been hospitalized during April to May 2008, and the hepatitis C virus E1 sequence of the three patients matched each other with 98-99% identity. Therefore, we concluded this infection as a nosocomial infection. However, in spite of the intensive investigation, the route of transmission has not been clarified. In two of the four patients, hepatitis C healed spontaneously and HCV-RNA became negative, one patient was cured by interferon therapy, and one patient became chronic hepatitis. As an action for prevention of nosocomial infection, we trained all the medical staffs on the standard precaution, reassessed the medical work and procedures and the surroundings around the ward, and no patients of acute hepatitis C of nosocomial infection have been seen thereafter. In conclusion, to prevent nosocomial hepatitis C virus infection, the act plan over the hospital containing the surveillance is needed.
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Case Reports
  • Three cases of acute hepatitis associated with measles
    Manri Kawakami, Yasuhiro Umekawa, Chiharu Nishishita
    Article type: Case Report
    2010 Volume 51 Issue 6 Pages 285-291
    Published: 2010
    Released on J-STAGE: July 02, 2010
    DOIhttps://doi.org/10.2957/kanzo.51.285
    JOURNAL FREE ACCESS
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    We saw 3 adult cases of measles in March and April 2008, and found hepatic involvement in all of them. They were a 19-year-old, a 33-year-old women and a 26-year-old man complaining fever and general malaise, and presented generalized measles-like erythema sooner or later. Laboratory examinations revealed increased serum levels of AST, ALT and LDH, and positive IgM anti-measles antibodies in all. Hepatic involvement of measles is said to be more frequent in adults than in children. Measles should thus be considered in differential diagnosis of acute hepatic dysfunction in adults.
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  • Prevention of type 1 diabetes mellitus by early insulinization for chronic hepatitis C patient who has a high-titer Anti-GAD antibody before interferon plus ribavirin retherapy
    Hirofumi Tanaka, Kazufumi Dohmen, Masatora Haruno, Yoshiyuki Niho, Shi ...
    Article type: Case Report
    2010 Volume 51 Issue 6 Pages 292-299
    Published: 2010
    Released on J-STAGE: July 02, 2010
    DOIhttps://doi.org/10.2957/kanzo.51.292
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    A 68-year-old female with chronic hepatitis C (genotype 1b, 6.7 LogIU/ml in load) was observed who developed type 1 diabetes mellitus (T1DM) after 3 months of peginterferon (PEGIFN) plus ribavirin (RBV) therapy. She was operated for liver cancer three years ago. Therefore, PEGIFN+RBV retherapy was necessary to be implemented. Before the retherapy, she was found to have a high-titer of glutamic acid decarboxylase antibodies (anti-GAD ab). However, 75 g oral glucose tolerance test was confirmed within normal limit and glucagon loading test showed a preserved endogenous insulin secretion. Hence, the prevention of occurrence of T1DM was raised the important problem. Although an early insulinization was initiated to prevent the occurrence of T1DM, she developed T1DM. There has been no case report previously, that the prevention of occurrence of T1DM for IFN-treated chronic hepatitis C patient was tried with an early insulin administration. Thus, the progress of effective intervention for patients with chronic hepatitis C with anti-GAD ab is required.
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  • A case of Graves' disease following painless thyroiditis induced by pegylated-interferon and ribavirin therapy to a patient with chronic hepatitis C
    Shigeki Morita, Takuya Honda, Fumihiro Mawatari, Shotaro Tsuruta, Ryuj ...
    Article type: Case Report
    2010 Volume 51 Issue 6 Pages 300-304
    Published: 2010
    Released on J-STAGE: July 02, 2010
    DOIhttps://doi.org/10.2957/kanzo.51.300
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    68 years old female with chronic hepatitis C had been treated by pegylated interferon alpha2b and ribavirin from April in 2007 to April in 2008. Her serum HCV had turned negative (SVR). Although her thyroid function had been normal before IFN-ribavirin therapy, it had changed to transient thyrotoxicosis 7 months after starting therapy. As her thyroid function turned hypothyroidism without any treatment for the thyroid, she was diagnosed as painless thyroiditis. Her thyroid function turned again thyrotoxicosis at the end of IFN therapy, and this thyrotoxicosis had continued. At August in 2008, anti-TSH receptor antibodies were positive, increasing blood flow of the thyroid echogram and diffuse high uptake of thyroid scincigram showed Graves' disease. Our patient is a rare case of Graves' disease (thyroid stimulated disease) immediately following painless thyroididits (thyroid destractive disease) treated by pegylated interferon and ribavirin.
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  • A resected case of hepatocellular carcinoma during pregnancy
    Yasuhiko Yoshida, Juniti Yamanaka, Yuji Iimuro, Tadamichi Hirano, Sini ...
    Article type: Case Report
    2010 Volume 51 Issue 6 Pages 305-311
    Published: 2010
    Released on J-STAGE: July 02, 2010
    DOIhttps://doi.org/10.2957/kanzo.51.305
    JOURNAL FREE ACCESS
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    A 42 year-old woman, hepatitis B virus-positive female was referred to our hospital because of a hepatic nodule. She was at the 15th week of pregnancy. Various imaging modalities such as ultrasonography and contrast-enhanced CT demonstrated a tumor 5 cm in diameter in segment 5 and 6 in liver which was diagnosed as hepatocellular carcinoma (HCC). The patient hoped to reflect a mature accouchement, and she received hepatic resection after understanding the risk of the operation and poor prognosis of HCC during pregnancy. She underwent hepatic resection of segment 5 and 6 at the 19th week of pregnancy. The post-operative course was uneventful and the patient discharged the hospital 10 days after the operation. Although serum AFP level was elevated along with the pregnancy, it decreased to normal range after the Caesarean section at the 39th week of pregnancy. The patient is well without recurrence at 3 years after the surgery. A complication of HCC during pregnancy is rare, and the prognosis is reported to be poor. We herein report a case of resected HCC during pregnancy with 3 years of no recurrence after the surgery.
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  • The two cases of massive spontaneous necrosis of hepatocellular carcinoma after angiography
    Keita Kai, Atushi Miyoshi, Keisuke Ario, Kenji Kitahara, Toshihiko Miz ...
    Article type: Case Report
    2010 Volume 51 Issue 6 Pages 312-318
    Published: 2010
    Released on J-STAGE: July 02, 2010
    DOIhttps://doi.org/10.2957/kanzo.51.312
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    We experienced the two cases of large hepatocellular carcinoma (HCC) s which have fallen into massive necrosis after angiography. The first case is a 58-year-old woman with no hepatitis. The hepatic nodule measured 11 cm was significantly reduced after angiography. The second case is a 49-year-old man with hepatitis C. The hepatic nodule measured 6 cm was significantly reduced after angiography and portal embolization. Both of two cases underwent surgical resection. Although most of the two nodules were consisted of the coagulative necrosis and inflammatory granulation tissue, the nest of residual HCC was found in each case. The presence of coagulative necrosis is characteristic feature of spontaneous necrosis of HCC. Considering the possibility of residual tumor, intensive pathological examination and clinical follow-up is important in the cases of spontaneous necrosis of HCC.
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Rapid Communications
  • A novel 2b/1b-recombinant HCV found in a case with discrepancy between serotype and genotype assessed by conventional methods
    Hiromi Hoshino, Kunihiko Hino, Hiroshi Miyakawa, Kazuaki Takahashi, Sh ...
    Article type: Rapid Communication
    2010 Volume 51 Issue 6 Pages 319-321
    Published: 2010
    Released on J-STAGE: July 02, 2010
    DOIhttps://doi.org/10.2957/kanzo.51.319
    JOURNAL FREE ACCESS
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    A convenient ELISA method to classify hepatitis C virus (HCV) serologically by detecting antibodies against type-specific antigens on NS3-NS4 proteins has been widely used in Japan, but sometimes it produces results that disagree with what would be obtained by nucleotide analyses. In our present study, indeed, 3 out of 103 HCV-patients showed such "serotype/genotype discrepancy", one of which (designated M2123) was subjected to further analyses. PCR/sequencing at HCV core and NS5A regions and serological typing at NS3-NS4 region suggested that M2123 contains HCV with a core gene of genotype 2b while NS3-NS4-NS5 genes of genotype 1b. To see if this result is due to inter-genotypic recombination, we searched for a PCR fragment that should contain a crossover point from 2b to 1b, and found one. Nucleotide sequence of a 1,011-nt fragment (AB558135) amplified from NS2/NS3 region possessed the crossover point within NS2. HCV recombinants, probably underestimated to date, should be called into account particularly in cases with serotype/genotype discrepancy.
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  • Relationship between SNPs in the IL28B region and amino acid substitutions in HCV core region in Japanese patients with chronic hepatitis C
    Mariko Kobayashi, Fumitaka Suzuki, Norio Akuta, Yoshiyuki Suzuki, Hito ...
    Article type: Rapid Communication
    2010 Volume 51 Issue 6 Pages 322-323
    Published: 2010
    Released on J-STAGE: July 02, 2010
    DOIhttps://doi.org/10.2957/kanzo.51.322
    JOURNAL FREE ACCESS
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    IL28 locus polymorphisms have been reported to affect PEG-IFN plus ribavirin combination therapy for patients with genotype 1b hepatitis C virus (HCV) infection. We examined a relationship between IL28B SNPs (rs8099917 and rs12979860) and amino acid substitutions in core region of HCV in patients with genotype 1b chronic hepatitis C. In each SNP, frequency of core aa 70 mutation was higher rate in female patients carrying minor allele than in male or female patients carrying no minor allele. Measurement of IL28B and Core aa70 before treatment is useful in PEG-IFN plus ribavirin therapy.
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