Kanzo
Online ISSN : 1881-3593
Print ISSN : 0451-4203
ISSN-L : 0451-4203
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Volume 51, Issue 8
Displaying 1-9 of 9 articles from this issue
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Original Article
  • Efficacy and safety of sorafenib in advanced hepatocellular carcinoma patients: a multicenter study of Kanagawa Liver Study Group
    Manabu Morimoto, Kazushi Numata, Masaaki Kondo, Hisashi Hidaka, Juichi ...
    Article type: Original Article
    2010 Volume 51 Issue 8 Pages 411-417
    Published: 2010
    Released on J-STAGE: September 02, 2010
    DOIhttps://doi.org/10.2957/kanzo.51.411
    JOURNAL FREE ACCESS
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    We evaluated the efficacy and safety of sorafenib in 76 patients with advanced hepatocellular carcinoma in 4 centers in Kanagawa prefecture. Among the 67 patients evaluable for tumor response, 5 patients (6.6%) had complete or partial responses, and 20 patients (26.3%) had stable disease. The median duration of treatment was 1.7 months, and average daily dose was 552 mg. The median time to radiological progression was 2.9 months, and the median overall survival was 8.1 months. The incidence of overall and grade 3-4 drug-related adverse events were 97.4% and 47.4%, respectively. In 22.4% of the patients, the treatment was discontinued because of the drug-related adverse events. The factors responsible for the incidence of grade 3-4 drug-related adverse events were the initiation period (early cases), Child-Pugh grade (B), and macroscopic vascular invasion. The prognostic factors for overall survival were age (<75 years), Eastern Cooperative Oncology Group Performance Status (ECOG PS, 0), and tumor response (CR, PR, and SD).
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Case Reports
  • Three cases of hepatitis E after eating deer meat or wild boar liver in West Shizuoka, Japan
    Kinya Kawamura, Yoshimasa Kobayashi, Kazuaki Takahashi, Kenichi Souda, ...
    Article type: Case Report
    2010 Volume 51 Issue 8 Pages 418-424
    Published: 2010
    Released on J-STAGE: September 02, 2010
    DOIhttps://doi.org/10.2957/kanzo.51.418
    JOURNAL FREE ACCESS
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    We experienced 3 cases of hepatitis E, where the patients developed their disease about two months after eating wild boar or deer captured in Shizuoka prefecture, Japan. All three were middle-aged men, and two ate raw wild boar's liver by chance in the same restaurant. One often ate the raw meat of deer in his son's hunting life. On admission, the hepatic dysfunction was mild in all of them (total bilirubin 1.0-10.0 mg/dl, AST 754-953 U/l, ALT 696-1182 U/l, prothrombin time 78-113%) and improved promptly with fluid infusion and rest. They were all positive for IgM and IgG HEV antibodies and HEV-RNA. Viral genome sequencing indicated that their HEV segregated to a cluster within genotype 4, with 99.8% or greater identity to each other. Interestingly, these isolates showed 98.5-99.8% identity to "Aichi Strain of HEV Genotype 4" previously recovered from humans and wild boars in Aichi prefecture, clearly different from those that are predominant in Japan, particularly in Hokkaido.
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  • A case of acute hepatitis due to Lyme disease
    Hirotaka Tajiri, Akihide Masumoto, Taiga Miyake, Kenichi Nakamura, Yuk ...
    Article type: Case Report
    2010 Volume 51 Issue 8 Pages 425-430
    Published: 2010
    Released on J-STAGE: September 02, 2010
    DOIhttps://doi.org/10.2957/kanzo.51.425
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    A 34-year-old male, a veterinarian, was referred to our hospital because of the low-grade fever, general malaise, and mild jaundice. His laboratory data showed AST 215 IU/l, ALT 465 IU/l, T-Bil 2.9 mg/dl, CRP 0.38 mg/dl. After the admission, the levels of blood CRP, liver function tests, and peripheral leukocyte counts revealed gradual increase. The patient had high fever, severe arthralgia, and erythematous eruptions on the right back with tiny scars due to bites by an ixodid tick. The diagnosis of Lyme disease was made on the basis of those symptoms as well as the positive serological tests for anti-Borrelia IgM and IgG antibodies. Administrations of an oral Doxycycline followed by an intravenous Ceftriaxone resulted in improvement of the disease. This is the first report of acute hepatitis due to Lyme disease in Japan.
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  • A case of acute-onset-type autoimmune hepatitis concomitant with idiopathic thrombocytopenic purpura for which diagnosis laparoscopy was useful
    Osamu Arai, Hiroshi Ikeda, Kazuhiro Matsueda, Youji Wani, Kenji Notoha ...
    Article type: Case Report
    2010 Volume 51 Issue 8 Pages 431-438
    Published: 2010
    Released on J-STAGE: September 02, 2010
    DOIhttps://doi.org/10.2957/kanzo.51.431
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    We describe a rare case of acute-onset-type autoimmune hepatitis concomitant with idiopathic thrombocytopenic purpura. The patient was a 63-year-old woman admitted because of elevated transaminase level and thrombocytopenia. Laboratory tests showed hepatitis A, B, C virus and Epstein-Barr virus and antinuclear antibody were all negative. As she had medication history, we considered drug induced hepatitis was most likely diagnosis. Liver biopsy specimens done because of prolonged disorder of liver function revealed infiltration of inflammatory cells around central vein. Liver biopsy under laparoscope was done owing to making a definite diagnosis. Biopsies specimens showed not only centrizonal inflammation but also interface hepatitis and fibrosis characteristic of autoimmune hepatitis. We diagnosed acute-onset autoimmune hepatitis and started medication of predonisolon and ursodeoxycolic acid. Accordingly, disorder of liver function and thrombocytopenia improved.
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  • A case of cholangiocarcinoma detected in a patient with chronic hepatitis C after the elimination of HCV-RNA due to interferon therapy
    Hikaru Oguri, Satoru Fujimoto, Toru Ii, Shigehiro Tanaka, Kazuto Kakum ...
    Article type: Case Report
    2010 Volume 51 Issue 8 Pages 439-446
    Published: 2010
    Released on J-STAGE: September 02, 2010
    DOIhttps://doi.org/10.2957/kanzo.51.439
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    A 66-year-old male with chronic hepatitis C was treated with interferon therapy and achieved a sustained viral response. Two years and two months later, a liver tumor was detected in liver segment 8. Upon closer examination, the tumor was found to be atypical for hepatocellular carcinoma, we therefore performed a hepatic resection of S8. Both histopathologically and immunohistochemically, the tumor was diagnosed to be cholangiocellular carcinoma. Hepatocellular carcinoma after the elimination of HCV-RNA due to interferon therapy has sometimes been reported, but cholangiocellular carcinoma is rare. Previous findings suggest that the hepatitis C virus affects the carcinogenesis of cholangiocellular carcinoma, and therefore both close and long term observations are required for patients who have achieved a sustained viral response of the hepatitis C virus.
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  • A case report of hepatocellular carcinoma showing rapid infiltrative growth after transcatheter arterial infusion chemotherapy using cisplatin-lipiodol suspension
    Taku Matsuo, Yu-Lai Wang, Takahiro Igarashi, Yoshihiko Saito, Koji Suz ...
    Article type: Case Report
    2010 Volume 51 Issue 8 Pages 447-453
    Published: 2010
    Released on J-STAGE: September 02, 2010
    DOIhttps://doi.org/10.2957/kanzo.51.447
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    A 66-year-old male with hepatocellular carcinoma (HCC) and alcoholic liver cirrhosis was treated with repeated transcatheter arterial chemoembolization (TACE) for the HCC since 2005. In July of 2008, he was administered to our hospital because of the transcatheter arterial infusion chemotherapy using cisplatin-lipiodol suspension (TAI) for the multiple HCC via left hepatic artery in July 2008. The CT at the time showed the total of five hypervascular tumors appearing frequently in S3, S4 and S8, however they were all less than 2 cm in size. His condition was well after the TAI, but three months later, he had to be re-hospitalized for the epigastralgia, sense of fullness in the abdomen and jaundice. According to the CT which was taken after the re-hospitalization, a large hypovascular tumor with ambiguous border showed expansive growth mainly around S4, and a tumor embolus at the main trunk of the portal vein as evident. His general status became deteriorated day by day, and then on the 19th day of his hospitalization, he passed away for the hepaic failure. Autopsy revealed the highly infiltrative tumor almost all around the liver and the multiple micro metasatases in the both lungs and bone marrow. Histologically, they were composed of large pleomorphic cells, and they were the poorly differentiated HCC showing a trabecular and pseudoglandular pattern. Although a HCC which grows rapidly after TAI is rare event, we must keep in mind such possibility.
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Short Communications
  • Hepatitis B-associated cryoglobulinemia and antiphospholipid antibodies
    Masaru Enomoto, Nobuo Negoro, Hideki Fujii, Sawako Kobayashi, Shuji Iw ...
    Article type: Short Communication
    2010 Volume 51 Issue 8 Pages 454-456
    Published: 2010
    Released on J-STAGE: September 02, 2010
    DOIhttps://doi.org/10.2957/kanzo.51.454
    JOURNAL FREE ACCESS
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    A 57-year-old woman presented with a purpuric rash. Cryoglobulins were detected, and a skin biopsy showed leukocytoclastic vasculitis. The alanine aminotransferase level was 119 IU/L, and the platelet count 63,000/mm3. The hepatitis B virus (HBV) DNA was 6.4 log10 copies/mL and became negative by week 6 of entecavir therapy. The antiphosphatidylserine-prothrombin complex antibody (anti-PS/PT) was 390-510 U/mL, and decreased to 69 U/mL at week 24, after cryoglobulin had become negative and the rash resolved. Among 20 HBV-infected patients without extrahepatic manifestations, low titers of anti-PS/PT were detected in 8 (40%). Clinical characteristics were similar in patients with or without anti-PS/PT. Low titers of anti-PS/PT in chronic hepatitis B have little clinical significance, whereas high titers may promote cryoprecipitate formation.
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  • The causes of the failure of the prevention against perinatal transmission of hepatitis B virus
    Ayano Inui, Haruki Komatsu, Eitaro Hiejima, Tsuyoshi Sogo, Toshiro Nag ...
    Article type: Short Communication
    2010 Volume 51 Issue 8 Pages 457-459
    Published: 2010
    Released on J-STAGE: September 02, 2010
    DOIhttps://doi.org/10.2957/kanzo.51.457
    JOURNAL FREE ACCESS
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    Since the national program of immunoprophylaxis against perinatal transmission of hepatitis B virus (HBV) was started in 1986, the HBV carrier rate in children was dramatically decreased. However, the cases of failure of the prevention still exist. In this study, we retrospectively analyzed the reasons of 56 cases of the failure of the prevention after the initiation of national program. Seventeen (31%) were not received the immunoprophylaxis of the national program by mistake. Seven (12%) were received the inappropriate doses of schedule. Our national program is relatively complicated compared to the method adopted by almost all other countries. Because of the universal vaccination program is easy to finish the schedule, we should consider converting our prevention schedule to the universal vaccination program.
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Special Report
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