Kanzo
Online ISSN : 1881-3593
Print ISSN : 0451-4203
ISSN-L : 0451-4203
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Volume 52, Issue 3
Displaying 1-6 of 6 articles from this issue
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Case Reports
  • A case of hepatitis C virus-associated liver cirrhosis with cryoglobulinemia, esophageal varices and ascites treated with pegylated interferon-α 2b and ribavirin
    Shin-ya Onohara, Kazufumi Dohmen, Hirofumi Tanaka, Masatora Haruno, Ma ...
    Article type: Case Report
    2011 Volume 52 Issue 3 Pages 163-168
    Published: 2011
    Released on J-STAGE: April 01, 2011
    DOIhttps://doi.org/10.2957/kanzo.52.163
    JOURNAL FREE ACCESS
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    A 43-year-old Japanese man with hepatitis C virus-liver cirrhosis was referred to our hospital because of massive ascites. He had been treated with insulin injection for diabetes mellitus since 29-year-old. His data on admission showed total bilirubin of 0.3 mg/dl, AST 25 IU/l, ALT 23 IU/l, serum albumin 2.1 g/dl and creatinin 2.4 mg/dl, which were compatible with hypoalbuminemia and chronic renal failure. HCV RNA showed genotype 2A and a load of 5.1 logIU/ml. Liver cirrhosis with cryoglobulinemia was diagnosed. After endoscopic variceal ligation and paracentesis, peginterferon-α 2b/ribavirin therapy was initiated. Four weeks after, HCV RNA and serum cryoglobulinemia disappeared, while protein of 5.1 g/day in urine decreased to 2.6 g/day. At the end of 24-week therapy, HCV RNA and serum cryoglobulinemia were confirmed to be negative. PEGIFN/RBV therapy was effective for hepatitis C virus-associated liver cirrhosis with cryoglobulinemia.
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  • Two cases of primary biliary cirrhosis associated with systemic lupus erythematosus
    Hironobu Saito, Atsushi Takahashi, Kazumichi Abe, Kyoko Monoe, Yukiko ...
    Article type: Case Report
    2011 Volume 52 Issue 3 Pages 169-175
    Published: 2011
    Released on J-STAGE: April 01, 2011
    DOIhttps://doi.org/10.2957/kanzo.52.169
    JOURNAL FREE ACCESS
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    The first case is a 65-year-old woman who was diagnosed in 1987 with SLE on the basis of malar rash, photosensitivity, high ANA titer and positive anti-DNA antibody. Treatment with prednisolone resulted in improvement of her symptoms. She was followed and remained in good condition with prednisolone (10 mg/every other day). In 2006, she was admitted to our hospital for examination of abnormal liver function tests. PBC was disclosed by elevated levels of ALP and γ-GTP, positive antimitochondrial M2 antibody and liver histology (compatible with stage 2 PBC). The second case is a 55-year-old woman who was suspected in 2003 of having PBC due to elevated biliary liver enzymes and positive antimitochondrial antibody. A liver biopsy was not performed. Ursodeoxycholic acid therapy was started and was effective. In 2006, she was admitted to our hospital due to complaints of arthralgia and fatigue. Abdominal ultrasonography disclosed ascites. She was diagnosed with SLE on the basis of exudative ascites, arthritis, and positive anti-DNA and anti-Sm antibodies. Liver biopsy showed fibrous enlargement and lymphocytic infiltration of the portal areas. She was started on medication with 20 mg of prednisolone daily, and her arthritis and exudative ascites improved. PBC complicated with SLE is rare, and we report two cases with a brief discussion based on the literature.
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  • Development of hepatocellular carcinoma after seroclearance of hepatitis surface antigen
    Aritune Ooho, Eiji Kajiwara, Naoki Yamashita, Ichiro Makino, Hidefumi ...
    Article type: Case Report
    2011 Volume 52 Issue 3 Pages 176-183
    Published: 2011
    Released on J-STAGE: April 01, 2011
    DOIhttps://doi.org/10.2957/kanzo.52.176
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    We experienced three patients who developed hepatocellular carcinoma (HCC) after hepatitis B surface antigen (HBsAg) seroclearance. 73-year-old man underwent hepatectomy for HCC. HBsAg was positive with a low titer and the ALT value was normal 4 years ago. HBsAg was negative when he was diagnosed as HCC. Macroscopic finding of the liver was normal and histological examination of the non-tumorous portions showed no fibrosis. The others, 61 and 69 year-old men who had been diagnosed as chronic hepatitis and cirrhosis previously, respectively, were treated by hepatectomty and radiofrequency ablation for HCC that developed after HBsAg seroclearance for more than one year. All three cases had the antibodies against HBsAg in the absence of HBsAg. First patient might be the carcinogenesis case from healthy hepatitis B virus carrier. Therefore, it is necessary to take care of the development of HCC after HBsAg seroclearance in chronic hepatitis B patients, including healthy HBV carrier.
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  • A case of untreated poorly differentiated hepatocellular carcinoma of 1.9 cm in diameter
    Hidetake Amemiya, Masanori Matsuda, Masami Asakawa, Naohiro Hosomura, ...
    Article type: Case Report
    2011 Volume 52 Issue 3 Pages 184-192
    Published: 2011
    Released on J-STAGE: April 01, 2011
    DOIhttps://doi.org/10.2957/kanzo.52.184
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    A 61-year-old man having chronic hepatitis B consulted our hospital for the treatment of liver tumor. Dynamic CT and MRI showed a 1.9 cm tumor, which showed no early enhancement. On the other hand, the tumor showed hyperintensity in T2 and diffusion emphasis images of MRI. These findings suggested that the tumor was poorly differentiated but not well differentiated hepatocellular carcinoma (HCC). An anterior inferior segmentectomy of the liver was performed. Pathologically the tumor was diagnosed as poorly differentiated HCC as predicted preoperatively. Generally small hypovascular liver nodules, less than 2 cm in diameter, are dysplastic nodules or well differentiated HCCs which rarely showed poorly differentiated phenotype. In differential diagnosis of small hypovascular hepatic nodule, MRI should be performed in order not to miss poorly differentiated HCC that needs prompt treatment.
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  • A case of late-onset pseudoaneurysm of hepatic artery after percutaneous radiofrequency ablation for hepatocellular carcinoma
    Kei Yane, Kunihiko Tsuji, Jong-Hon Kang, Takeshi Matsui, Hayato Shida, ...
    Article type: Case Report
    2011 Volume 52 Issue 3 Pages 193-200
    Published: 2011
    Released on J-STAGE: April 01, 2011
    DOIhttps://doi.org/10.2957/kanzo.52.193
    JOURNAL FREE ACCESS
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    A 67-year-old woman underwent radiofrequency ablation (RFA) for a hepatocellular carcinoma located in segment 8 of the liver. She had no immediate complications, however 10 months later, dynamic MRI and abdominal angiography showed a pseudoaneurysm originating from the segment 8 branch of the hepatic artery. The aneurysm was embolized using gel foam and microcoils. There were no apparent complications such as hemobilia or pseudoaneurysm immediately after RFA, therefore the aneurysm was diagnosed as a late-onset complication due to thermal injury. Patients who have undergone RFA should be carefully followed up for possible pseudoaneurysm as a late complication.
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Short Communication
  • Clinical significance of arterial blood resistance in viral acute hepatitis
    Hiroshi Ikeda, Yoshitaka Takuma, Osamu Kikuchi, Yoichi Morimoto, Hiroy ...
    Article type: Short Communication
    2011 Volume 52 Issue 3 Pages 201-203
    Published: 2011
    Released on J-STAGE: April 01, 2011
    DOIhttps://doi.org/10.2957/kanzo.52.201
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    To clarify the significance of arterial blood resistance in viral acute hepatitis, we evaluated the pulsatility index (PI) with the pulsed-wave Doppler measurements.
    Mean PI was 1.23, 1.52 and 1.17, in hepatitis A, hepatitis B and hepatitis C, respectively. In hepatitis B, PI of the high viral load group was higher than that of the low viral load group (1.63 vs 1.08). PI was increased in fluctuating cases of hepatitis B and C. In some cases of hepatitis B, PI was decreased after the initiation of anti-viral drug.
    These data indicate that the measurement of PI is useful for the prediction of the prognosis of acute viral hepatitis and the choice of the antiviral drug.
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