Kanzo
Online ISSN : 1881-3593
Print ISSN : 0451-4203
ISSN-L : 0451-4203
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Volume 52, Issue 6
Displaying 1-12 of 12 articles from this issue
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Case Reports
  • A case of type 1 diabetes mellitus caused by low-dose, long-term natural interferon α therapy for a patient with chronic hepatitis C
    Takeo Hayashi, Mosaburo Kainuma, Hiroaki Taniai, Masayuki Murata, Kyok ...
    Article type: Case Report
    2011 Volume 52 Issue 6 Pages 335-343
    Published: 2011
    Released on J-STAGE: July 06, 2011
    DOIhttps://doi.org/10.2957/kanzo.52.335
    JOURNAL FREE ACCESS
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    A 69-year old female with a history of operation for hepatocellular carcinoma caused by chronic hepatitis C was treated with pegylated interferon α2b plus ribavirin combination therapy, but obtained no virological response. Three months after the completion of the combination therapy, her HCV-RNA level elevated, but decreased rapidly afterwards. Natural interferon α (nIFN α) monotherapy was started, and HCV-RNA became negative continuously 10 weeks later. About 23 months after the start of the monotherapy, she developed thirst, polydipsia and polyuria. Her blood glucose level was extremely high and urinary ketone body was positive. Type 1 diabetes mellitus was suspected from reduction of insulin secretion, positivity of HLA-DR4 and anti-glutamic acid decarboxylase antibody, which had become positive 19 months after the start of the monotherapy and gradually increased. Blood glucose levels was improved by intensive insulin therapy. These suggested nIFN α induced type 1 diabetes mellitus.
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  • A case of autoimmune hepatitis with polymyositis
    Manabu Hayashi, Kazumichi Abe, Rie Saito, Shuzo Sato, Kyoko Monoe, Yuk ...
    Article type: Case Report
    2011 Volume 52 Issue 6 Pages 344-350
    Published: 2011
    Released on J-STAGE: July 06, 2011
    DOIhttps://doi.org/10.2957/kanzo.52.344
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    We report the case of a 72-year-old woman diagnosed with autoimmune hepatitis (AIH) complicated by polymyositis (PM). She was admitted to the hospital owing to elevated serum aminotransferase. Serum IgG was 3617 mg/dl and anti-nuclear antibody was positive (×320). Liver needle biopsy findings were consistent with AIH and this was corroborated by her score of 18 on the International Autoimmune Hepatitis Group (IAIHG) scoring system, which is consistent with definite AIH. Serum creatinine kinase was also elevated and she complained of lower-extremity muscle weakness. Muscle biopsy histology was consistent with PM. Based on these findings, she was diagnosed with AIH complicated by PM. Serum aminotransferase improved after treatment with prednisolone. AIH complicated by PM should be considered when a patient complains of muscle weakness or exhibits elevated serum creatinine kinase.
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  • Drug-induced hepatic injury caused by an aldose reductase inhibitor, epalrestat
    Yuki Fujise, Masahiko Koda, Jun Kato, Shiho Tokunaga, Tomomitsu Matono ...
    Article type: Case Report
    2011 Volume 52 Issue 6 Pages 351-355
    Published: 2011
    Released on J-STAGE: July 06, 2011
    DOIhttps://doi.org/10.2957/kanzo.52.351
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    A 68-year-old woman was admitted to our hospital with acute liver injury. About 2 months before admission, she developed hyperlipidemia, diabetes mellitus, and peripheral neuropathy and was treated with insulin, rosuvastatin, and epalrestat. Laboratory data showed elevations of aspartate aminotransferase and alanine aminotransferase. According to the diagnostic scale proposed at the Digestive Disease Week-Japan 2004, her liver injury was classified as hepatocellular type and judged as "highly possible". The drug-lymphocyte stimulation test was positive for epalrestat. Liver biopsy showed portal inflammation with infiltrated lymphocytes and intralobular spotty necrosis. Taken together, the liver injury was diagnosed as epalrestat-induced hepatic injury. After the cessation of epalrestat, the liver injury gradually and slowly recovered.
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  • Case of suspected drug-induced liver injury caused by Inchinko-To
    Toshikuni Suda, Kazuyoshi Suzuki, Shogo Adachi, Kagemasa Kagawa, Hirok ...
    Article type: Case Report
    2011 Volume 52 Issue 6 Pages 356-360
    Published: 2011
    Released on J-STAGE: July 06, 2011
    DOIhttps://doi.org/10.2957/kanzo.52.356
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    A 69-year old woman was hospitalized because of drug-induced liver injury caused by salazosulfapyridine. Due to persistent jaundice after improvement of the liver function, Inchinko-To was administered. Inchinko-To was immediately effective for the jaundice; however, the liver injury was again aggravated. Liver function improved after discontinuation of Inchinko-To.
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  • Analysis of tissue impedance waveform reflecting in a grounding pad burn during radiofrequency ablation
    Keita Ogake, Chiaki Yasui, Tsukasa Aihara, Shinichi Ikuta, Hidenori Yo ...
    Article type: Case Report
    2011 Volume 52 Issue 6 Pages 361-367
    Published: 2011
    Released on J-STAGE: July 06, 2011
    DOIhttps://doi.org/10.2957/kanzo.52.361
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    We experienced a patient, 70s old male, complicated by second-degree skin burns at the grounding pad site during percutaneous radiofrequency ablation therapy (RFA). The patient underwent two sessions of RFA for two hepatocellular carcinoma nodules. Monitoring of the impedance (IMP) in the tissue during ablation showed irregular waves, differing from regular normal pattern. During the first session, he showed restlessness and needed to be restrained, and a sudden increase in IMP without bubble appearance on ultrasound was observed.
    At the start of the second session, IMP increased, while in normal case it would decrease. On the following day, a skin burn was observed at the grounding pad site, and it was thought that the skin burn developed as a result of increased RF current density due to the partial detachment of the grounding pad during ablation. As the increase in the amplitude of the IMP wave during ablation in this case was caused by the partial detachment of the grounding pad, monitoring of IMP wave is useful in an early detection of grounding pad detachment and prevention of skin burns during RFA.
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  • A case of an intrahepatic huge hematoma due to rupture of hepatocellular carcinoma
    Shigeru Matsui, Chuichi Sekine, Hideaki Takasugi, Yoshiyuki Hirata, Ry ...
    Article type: Case Report
    2011 Volume 52 Issue 6 Pages 368-375
    Published: 2011
    Released on J-STAGE: July 06, 2011
    DOIhttps://doi.org/10.2957/kanzo.52.368
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    An 84-year-old male complained of epigastralgia, right chest pain and dyspnea. Abdominal CT showed a hypervascular tumor (3.5 cm) in the hepatic right lobe and an irregular low-attenuation area continuous with this tumor. A diagnosis of rupture of a hepatocellular carcinoma accompanied by an intrahepatic hematoma was made. This patient had no infection of HBV and HCV, and mild chronic liver disease change on image. Although the course was observed because of the patient's refusal of treatment, the intrahepatic hematoma disappeared after 2 months. A remaining viable tumor increase gradually. Abdominal angiography performed with his consent showed a tumor stain in the hepatic right lobe. Transcatheter arterial embolization (TAE) was conducted, and no recurrence has been observed to the present. A case of an intrahepatic huge hematoma due to hepatocellular carcinoma rupture is rare. It is suggested that the soft liver without cirrhosis in this case caused the intrahepatic huge hematoma.
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Short Communications
  • Revelation of near-complete genome of hepatitis A virus that caused "Osarizawa Hepatitis 1957" from a vintage sample kept frozen for 53 years
    Kazuaki Takahashi, Tsunehisa Suto, Masahiro Arai, Shunji Mishiro
    Article type: Short Communication
    2011 Volume 52 Issue 6 Pages 376-379
    Published: 2011
    Released on J-STAGE: July 06, 2011
    DOIhttps://doi.org/10.2957/kanzo.52.376
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    From June 1957 through January 1958, an etiology-unknown hepatitis was epidemic in a mineworkers' town Osarizawa, Akita-Prefecture, Japan, mainly affecting children. Twenty-two years later, a set of freeze-stored sera from patients involved in the "Osarizawa Hepatitis 1957" tested positive for antibodies to hepatitis A virus (HAV) by a radioimmunoassay that was brand-new at the time. Further 31 years thereafter, our present study revealed that 8 out of 16 freeze-stored sera from the outbreak were positive for HAV RNA, and the nucleotide sequences from these samples segregated to a single cluster within genotype IA. Although the 5' terminus is yet to be determined, a nearly complete 7459-nt genome of HAV was obtained from one of these vintage samples (isolate name HA286-Aki1957, accession AB623053). To our knowledge, HA286-Aki1957 represents the oldest HAV isolates that have ever been sequenced/published to date.
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  • Usefulness of quantitative HBsAg in outcome prediction of acute hepatitis B
    Hideaki Takahashi, Chiaki Okuse, Hiroshi Yotsuyanagi, Norie Yamada, Ki ...
    Article type: Short Communication
    2011 Volume 52 Issue 6 Pages 380-382
    Published: 2011
    Released on J-STAGE: July 06, 2011
    DOIhttps://doi.org/10.2957/kanzo.52.380
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    We evaluated the usefulness of quantitative evaluation of HBsAg in outcome prediction among 133 patients with acute hepatitis B (AH-B). Patients were classified into 4 groups according to duration of HBsAg positivity as follows: less than 3 months (Group I); less than 6 months (Group II); over 6 months (Group III); and over 12 months (Group IV). An abrupt decrease in HBsAg levels was observed and HBsAg levels at 2 weeks were significantly lower than those at the initial visit in Group I (p<0.001). On the other hand, levels of HBsAg remained high at 4 weeks and 8 weeks in Groups III and IV. Furthermore, HBsAg levels showed an increase from 2 weeks to 4 weeks in Group IV. These results suggest that quantitation of HBsAg at 4 or 8 weeks after initial visit may be useful in the prediction of clinical outcome in AH-B.
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  • Usefulness of combination of platelet count and AST/ALT ratio (PAAR index) for excluding advanced fibrosis in nonalcoholic fatty liver disease
    Yoshio Sumida, Tomoyuki Ohno, Kyoko Sakai, Kazuyuki Kanemasa, Shunsuke ...
    Article type: Short Communication
    2011 Volume 52 Issue 6 Pages 383-386
    Published: 2011
    Released on J-STAGE: July 06, 2011
    DOIhttps://doi.org/10.2957/kanzo.52.383
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    A reliable and inexpensive noninvasive marker of hepatic fibrosis is required in patients with nonalcoholic fatty liver disease (NAFLD). AST/ALT ration (AAR) and platelet (PLT) count have been expected to detect or exclude advanced fibrosis in chronic liver diseases. A total of 259 patients with biopsy-proven NAFLD were involved in the present study. ROC analysis revealed that the optimal cutoff values of PLT count and AAR to differentiate advanced stage (stage 3 or 4) from no or mild fibrosis (stage 0 to 2) were 19.5×104/μL and 0.8, respectively. Patients with PLT ≥19.5×104/μL and AAR <0.8 were more unlikely to have advanced stage of NAFLD (negative predictive value: 98%).
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Rapid Communications
  • The role of hepatitis B virus core-related antigen for predicting the incidence of HCC
    Mitsuru Nakanishi, Makoto Chuma, Shuhei Hige, Tomoe Kobayashi, Masato ...
    Article type: Rapid Communication
    2011 Volume 52 Issue 6 Pages 387-389
    Published: 2011
    Released on J-STAGE: July 06, 2011
    DOIhttps://doi.org/10.2957/kanzo.52.387
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    The usefulness of HB core-related antigen (HBcrAg) for the surveillance of hepatocellular carcinoma (HCC) has not been fully elucidated. We analyzed factors associated with the occurrence of HCC. High HBcrAg level for patients with nucleotide analogue (NA) administration, and high HBV-DNA level and high HBcrAg level for those without NA were revealed to be the significant factors for HCC occurrence by multivariate analysis. These data suggested that HBcrAg is the predictive factor for HCC occurrence regardless of NA administration. In conclusion, HBcrAg is a useful marker for the HCC surveillance.
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  • The distribution of FIB-4 index in Japanese subjects undergoing a health checkup who are diagnosed as having nonalcoholic fatty liver disease
    Yoshio Sumida, Sonoko Sakuragi, Tomoyuki Ohno, Kyoko Sakai, Kazuyuki K ...
    Article type: Rapid Communication
    2011 Volume 52 Issue 6 Pages 390-392
    Published: 2011
    Released on J-STAGE: July 06, 2011
    DOIhttps://doi.org/10.2957/kanzo.52.390
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    A reliable and inexpensive noninvasive marker of hepatic fibrosis is required in patients with nonalcoholic fatty liver disease (NAFLD). FIB4 index (based on age, aspartate aminotransferase [AST] and alanine aminotransferase [ALT] levels, and platelet counts) is expected to be useful for evaluating hepatic fibrosis. We examined the distribution of FIB4 index in Japanese subjects with NAFLD which were diagnosed by ultrasonography at health checkups. Advanced fibrosis was defined as stage 3-4 fibrosis. FIB4 index was assessed as: age (yr) ×AST (IU/L)/(platelet count (109/L) ×√ALT (IU/L)). After 346 patients with alcohol consumption more than 20 g/day, positivity of HBsAg and/or HCV Ab, or incomplete data were excluded, 4130 patients who were diagnosed with NAFLD were enrolled. Of them, 3277 (79.3%) patients showed a FIB4 index below the proposed low cut-off index (COI) (<1.30), and 37 (0.9%) above the high COI (>2.67). Implementation of the FIB4 index in the Japanese population with NAFLD would avoid approximately 80% of liver biopsies.
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Special Report
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