Kanzo

Original Articles

Establishment of artificial liver support by on-line hemodiafiltration for patients with acute liver failure

Shinju Arata, Yoshihiro Moriwaki, Kazuhisa Takayama, Manabu Morimoto, ...

Article type: Original Article
2012 Volume 53 Issue 1 Pages 7-17
Published: 2012
Released on J-STAGE: February 02, 2012

DOIhttps://doi.org/10.2957/kanzo.53.7

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Background: We introduced a new artificial liver support (ALS), on-line hemodiafiltration, in patients with acute liver failure (ALF).
Methods: This case series study was conducted from May 2001 to March 2011. Twenty-eight patients were treated with ALS including daily on-line hemodiafiltration and plasma exchange.
Results: After 4.2±0.5 (mean±SD) sessions, 89.3% of patients completely recovered from encephalopathy and maintained consciousness until discontinuation of ALS. Significant correlation was observed between the degree of encephalopathy and number of sessions required for recovery of consciousness. Ten patients fully recovered, 6 died of complications of ALF except brain edema, and 4 received liver transplantation, 5 died without transplantation after discontinuation of ALS. The changes of prothrombin time, direct bilirubin/total bilirubin ratio, and serum ammonia level shows good information for prognosis.
Conclusions: On-line hemodiafiltration was effective for the management of encephalopathy in patients with ALF.

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Response-guided therapy based on reaction to the initial dose using administration of peginterferon α-2a alone or in combination with ribavirin in naïve patients with chronic hepatitis C of serotype 2 and high viral loads

Keizo Kato, Takeshi Yonezawa, Chizuko Tachibana, Hiroyuki Tachibana, S ...

Article type: Original Article
2012 Volume 53 Issue 1 Pages 18-27
Published: 2012
Released on J-STAGE: February 02, 2012

DOIhttps://doi.org/10.2957/kanzo.53.18

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Treatment with Peginterferon α-2a (PEG-IFNα2a) and α-2b (PEG-IFNα2b) was compared in naïve patients with chronic hepatitis C of serotype 2 and high viral loads (≥5 logIU/ml). In the PEG-IFNα2a group, PEG-IFNα2aα2a alone was administered for 24 weeks in patients negative for HCVRNA at week 4 (rapid viral response: RVR), while ribavirin (RBV) was added for patients who were still HCVRNA-positive at week 4 and given concomitantly with PEG-IFNα2a for further 24 weeks. In the PEG-IFNα2b group, RBV was administered concomitantly with PEG-IFNα2b for 24 weeks. The sustained virological response rates were 93.3% and 66.7% in the PEG-IFNα2a and PEG-IFNα2b groups, respectively, and PEG-IFNα2a alone or in combination with RBV gave similar results to PEG-IFNα2b+RBV. No patients in the PEG-IFNα2a group required discontinuation of administration due to adverse effects. Response-guided therapy based on RVR may be an effective and practical strategy with high efficacy, reduced costs, and fewer adverse events.

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Case Reports

An HBV-infected family with hepatocellular carcinoma found in all 4 brothers but none of 3 sisters

Hiromichi Imai

Article type: Case Report
2012 Volume 53 Issue 1 Pages 28-34
Published: 2012
Released on J-STAGE: February 02, 2012

DOIhttps://doi.org/10.2957/kanzo.53.28

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Here, I reported the case of a family cluster of hepatitis B virus infection; this family was followed up and treated for a long period. Four male siblings of the 7 siblings developed hepatocellular carcinoma (HCC). The eldest son in the family (second child), died from HCC at the age of 46; the second son (fourth child) died from alcoholic hepatic insufficiency at the age of 47, a year after successful hepatic resection for HCC. The third son (fifth child) underwent hepatic resection for HCC at the age of 75; the fourth son (seventh child) developed HCC at the age of 61, and he was treated with radiofrequency thermal ablation and a nucleotide analog. The third and fourth sons are alive and clinically healthy without HCC recurrence. However, the remaining 3 siblings, i.e., the female siblings, did not develop HCC. Among them, the first (first child) and third (sixth child) daughters are alive and disease free at he age of 92 and 70, respectively, but the second daughter (third child) died of stomach cancer at the age of 82.
Factors related to HCC high occurrence in these 4 brothers were discussed in focus with sex, alcohol consumption, smoking habit, diabetes and body mass index through a review of related literature. Further, the clinical course and treatment history of the fourth son (seventh child) was reported.

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A case report of successful therapy with tenofovir for a multi-drug resistant chronic hepatitis B patient complicated with malignant lymphoma

Tsunamasa Watanabe, Fuminaka Sugauchi, Shigeru Kusumoto, Noboru Shinka ...

Article type: Case Report
2012 Volume 53 Issue 1 Pages 35-41
Published: 2012
Released on J-STAGE: February 02, 2012

DOIhttps://doi.org/10.2957/kanzo.53.35

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A 33-year-old man who diagnosed with malignant lymphoma was treated with lamivudine (LVD) for chronic hepatitis B in 2001. Because he experienced the first breakthrough hepatitis in 2005, adefovir (ADV) was added to the LVD regimen for dual therapy. In September 2007, LVD plus ADV combination therapy was replaced by entecavir (ETV) monotherapy. Eight months later, in May 2008, hepatitis B virus (HBV) DNA level elevated, followed by the second breakthrough hepatitis. After then, switching from ETV to LVD plus ADV could not suppress HBV-DNA level and ALT flare because sequencing analysis showed the evidence of multiple drug resistance with L80I, L180M, A181T, T184I and M204I/V mutations. In this case, after getting the approval of the ethical committee, we applied him the combination therapy with LVD and tenofovir (TDF), that decreased the serum HBV DNA and ALT concentration within a few months and obtained the complete remission of malignant lymphoma by allogenic bone marrow transplantation.

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A case of chronic hepatitis B which achieved hepatitis B surface antigen seroclearance during combination therapy with peginterferon alfa-2b and entecavir

Tadashi Inuzuka, Yukio Osaki, Fumihiro Matsuda, Azusa Sakamoto, Keiich ...

Article type: Case Report
2012 Volume 53 Issue 1 Pages 42-47
Published: 2012
Released on J-STAGE: February 02, 2012

DOIhttps://doi.org/10.2957/kanzo.53.42

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A 65-year-old Japanese male with chronic hepatitis B (CH-B) diagnosed in December 2008 was referred to our department in July 2009. He started combination therapy with peginterferon alfa-2b (80 μg/week) and entecavir (0.5 mg/day) for 48 weeks from December 2009. At the initiation of therapy, his significant laboratory test results were as follows: alanine aminotransferase (ALT) 55 IU/l, aspartate aminotransferase (AST) 37 IU/l, hepatitis B surface antigen (HBsAg) positive, hepatitis B e antigen (HBeAg) positive, hepatitis B virus (HBV) DNA levels 7.9 Log copies/ml. HBV DNA, HBsAg and HBeAg levels decreased progressively with therapy. After 36 weeks, HBV DNA, AST and ALT levels flared up, but after 44 weeks, HBV DNA levels decreased below 2.1 Log copies/ml and HBeAg seroconversion and HBsAg seroclearance were achieved. After 72 weeks he maintained HBsAg seroclearance and achieved a sustained viral response. Cases of spontaneous HBsAg seroclearance have been reported previously, but HBsAg seroclearance caused by combination therapy with peginterferon alfa-2b and entecavir has not been reported. Pre- and post-treatment cccDNA load in liver tissue, hepatitis B virus core-related antigen (HBcrAg) concentration in serum and expression of hepatitis B core antigen (HBcAg) in hepatocyte were compared, and it was found that all were drastically decreased. The present study suggests that these reduction appeared to contribute to the successful outcome of this therapy.

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Two cases of chronic hepatitis C positive for anti-interferon α antibody successfully treated by interferon β plus ribavirin

Satoko Tsuda, Masafumi Komatsu, Kunio Nakane, Tsuyotosi Tsuji, Hajime ...

Article type: Case Report
2012 Volume 53 Issue 1 Pages 48-54
Published: 2012
Released on J-STAGE: February 02, 2012

DOIhttps://doi.org/10.2957/kanzo.53.48

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We measured to see high anti-IFNα antibody titers of two cases of chronic hepatitis C with genotype 2 who had non-end-of-treatment response (non-ETR) with pegylated interferon (PEG-IFN) plus ribavirin, so we treated by IFNβ. However HCV-RNA had good response to IFNβ, we couldn't get sustained virological response (SVR). Then we selected a combination therapy of IFNβ and ribavirin, and could get SVR. It is expected that the cases had anti-IFN antibody increase with an increase in retreatment and long-term administration of IFN. If HCV-RNA not decrease or decrease but reincrease during the combination therapy of PEG-IFN and ribavirin, you need to check the existence of anti-IFN antibody and measure that. In the case of positive anti-IFNα antibody, it is hoped IFNβ should be selected for IFN therapy of chronic hepatitis C.

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A case of pseudoaneurysm formed 10 years after segmental liver resection for hepatocellular carcinoma

Takeharu Asano, Ikuo Nakamura, Mari Okajima, Kenichi Yamanaka, Shinich ...

Article type: Case Report
2012 Volume 53 Issue 1 Pages 55-63
Published: 2012
Released on J-STAGE: February 02, 2012

DOIhttps://doi.org/10.2957/kanzo.53.55

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A 73-year-old man with chronic hepatitis C was diagnosed as hepatocellular carcinoma in segment 5 of the liver. Then anterior segmental liver resection was performed in 1999. He was checked by abdominal US or CT every 4-6 months after resection. In March 2009, abdominal CT showed a heterogeneous lesion with partially enhanced area at the right hepatic lobe after the resection. The lesion had enlarged with follow up CT in May 2009, and was diagnosed as pseudoaneurysm. Abdominal angiography showed a hepatic arterial pseudoaneurysm, 3 cm in diameter originating from the anterior segmental branch. The pseudoaneurysm was embolized using microcoils for prevention of rupture.
The risk of rupture of pseudoaneurysm and mortality after rupture were very high. Therefore, earlier treatment might be preferable. Patients who have performed liver resection should be carefully followed up for not only detection of HCC recurrence but that of possible pseudoaneurysm as a late complication.

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