Kanzo
Online ISSN : 1881-3593
Print ISSN : 0451-4203
ISSN-L : 0451-4203
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Volume 53, Issue 3
Displaying 1-6 of 6 articles from this issue
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Original Articles
  • Efficacy and safety of treatment with peginterferon alfa-2a for chronic hepatitis B patients
    Norio Hayashi, Kendo Kiyosawa, Hirohito Tsubouchi, Takeshi Okanoue, Hi ...
    Article type: Original Article
    2012 Volume 53 Issue 3 Pages 135-146
    Published: 2012
    Released on J-STAGE: April 03, 2012
    DOIhttps://doi.org/10.2957/kanzo.53.135
    JOURNAL FREE ACCESS
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    We investigated the efficacy and safety of PEG-IFN alfa-2a (PEG-IFN) in chronic hepatitis B patients.
    In this randomized study, HBeAg-positive patients received: PEG-IFN (90 μg/week or 180 μg/week for 24-weeks or 48-weeks) or IFN (6MIU 3×/week for 24-weeks). The primary endpoint was triple response (HBeAg seroconversion, HBV DNA <5 log copies/mL and ALT normalization) at 24-weeks post-treatment.
    Triple response rates were increased according to the dose and treatment duration in PEG-IFN treatment group. Difference of response rates between PEG-IFN 48-week treatment group and IFN group was 11.3% (95% CI: 0.0-22.6) and confirmed non-inferiority in efficacy and tolerability of PEG-IFN compare to the IFN.
    In HBeAg-negative patients, PEG-IFN 90 μg/week or 180 μg/week for 48-weeks treatment showed 37.5% or 37.9% of HBV-DNA suppression (<4.3 log copies/mL at 24-weeks post-treatment) respectively.
    This study confirmed efficacy and safety of PEG-IFN in chronic hepatitis B.
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  • Appropriateness and limitations of modified Response Evaluation Criteria in Solid Tumors (mRECIST) in evaluating the efficacy of molecular-targeted therapy for patients with hepatocellular carcinoma
    Haruhiko Takeda, Yukio Osaki, Tadashi Inuzuka, Jun Nakajima, Fumihiro ...
    Article type: Original Article
    2012 Volume 53 Issue 3 Pages 147-154
    Published: 2012
    Released on J-STAGE: April 03, 2012
    DOIhttps://doi.org/10.2957/kanzo.53.147
    JOURNAL FREE ACCESS
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    Modified Response Evaluation Criteria in Solid Tumors (mRECIST), which was proposed by Lencioni et al, is novel criteria used to evaluate the efficacy of molecular-targeted therapy (MTT) in patients with hepatocellular carcinoma by measuring the largest diameter of the enhanced area in the arterial phase of dynamic computed tomography. We have encountered several limitations of mRECIST. Here, we discussed these limitations and presented some impressive cases. One of the main limitations is whether we can regard the disappearance of arterial blood flow as a complete response. Moreover, several other limitations were noted as well. It is thought that mRECIST may be more useful than conventional RECIST in many cases. However, it should be recognized that mRECIST is not appropriate in all cases. We need to evaluate the clinical effects with medical images and tumor markers in clinical practice.
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Case Reports
  • A case of adult-onset Still's disease with macrophage activation syndrome and acute liver failure
    Hideki Fujii, Shogo Takeda, Satoru Asai, Yoshiki Hayashi, Hisayoshi Im ...
    Article type: Case Report
    2012 Volume 53 Issue 3 Pages 155-163
    Published: 2012
    Released on J-STAGE: April 03, 2012
    DOIhttps://doi.org/10.2957/kanzo.53.155
    JOURNAL FREE ACCESS
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    A 26-year-old Japanese woman was admitted to our hospital because of spiking fever, eruption, and liver dysfunction. High fever continued after admission, and antibiotics were not effective. The patient was diagnosed as adult-onset Still's disease after excluding leukemia and malignant lymphoma. Because the patient was complicated with acute liver failure, steroid pulse therapy was started. Although steroid pulse therapy was transiently effective for clinical symptoms, oral predonisolone was not. Moreover, the patient was complicated with severe cytopenia. We diagnosed with macrophage activation syndrome complicated with adult-onset Still's disease. She was treated with cyclosporine A and liposteroid, resulted in complete remission for macrophage activation syndrome and adult-onset Still's disease. In summary of our case, combination of cyclosporine A and liposteroid was effective for the treatment of macrophage activation syndrome with acute liver failure in a patient with adult-onset Still's disease.
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  • Spontaneous regression of hepatocellular carcinoma after improving diabetes mellitus: possibly responsible for immune system
    Satoshi Yamamoto, Taigo Tokuhara, Masahiro Nishikawa, Satoshi Nishizaw ...
    Article type: Case Report
    2012 Volume 53 Issue 3 Pages 164-174
    Published: 2012
    Released on J-STAGE: April 03, 2012
    DOIhttps://doi.org/10.2957/kanzo.53.164
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    A 60's man was diagnosed as hepatocellula carcinoma at S4/8 and S6 in the liver. Because he suffered from poor control of diabetes mellitus (HbA1c was over 8% for long time), medication of di-peptidyl peptidase-IV (DPP-4) inhibitor was started preoperatively. Befere intaking the DPP-4 inhibitor, the size of tumor in dynamic CT was following; the tumor of S4/8 was 5.0 cm and that of S6 was 2.5 cm. Three weeks after starting medication, the tumor was shrinked respectively; the tumor of S4/8 was 2.5 cm and that of S6 was 2.0 cm. AFP and PIVKA-II were both significantly reduced. Histologically, large number of lymphocytes were infiltrated in a hepatocellular carcinoma, and the infiltrating lymphocytes were proved as CD8 positive T cell by immunohistochemistry staining. We report an extremely rare case of spontaneous regression of hepatocellular carcinoma that is strongly thought to associate with immunoresponse.
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  • An autopsy case of hepatocellular carcinoma, which developed a fatal massive hemolysis as a complication of Clostridium perfringens infection after transarterial chemoembolization
    Shin Kashimura, Yuriko Fujita, Satoshi Imamura, Tomoki Shimizu, Jin Im ...
    Article type: Case Report
    2012 Volume 53 Issue 3 Pages 175-182
    Published: 2012
    Released on J-STAGE: April 03, 2012
    DOIhttps://doi.org/10.2957/kanzo.53.175
    JOURNAL FREE ACCESS
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    A 74-year-old woman was diagnosed as HCV cirrhosis and diabetes mellitus in 2003. She received transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) 4 times from 2006. Recurrence of HCC was suspected from a subsequent abdominal CT scan. HCC was diagnosed from angiography, and TACE was performed. After TACE, she experienced frequent vomiting and epigastric pain. From the fourth day after TACE, she showed a high fever and was treated with symptomatic therapy. At the 6th night after TACE, she experienced cardiopulmonary arrest. Cardiopulmonary resuscitation was performed immediately, but it was unsuccessful. Laboratory data for cardiopulmonary arrest showed severe anemia and jaundice.
    Autopsy was performed. The aorta was reddish. Pathological findings showed growth of gram-positive bacilli in each organ of the body. Clostridium perfringens (C. perfringens) was detected in a blood culture taken at post-TACE day 5. The cause of her death was considered to be C. perfringens septicemia and massive hemolysis. There are few case reports of C. perfringens sepsis complicated with massive hemolysis after TACE. This report is added for consideration.
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  • An autopsy case of primary squamous cell carcinoma of the liver
    Kazufumi Dohmen, Hirofumi Tanaka, Masatora Haruno, Hiroaki Fujiwara, I ...
    Article type: Case Report
    2012 Volume 53 Issue 3 Pages 183-190
    Published: 2012
    Released on J-STAGE: April 03, 2012
    DOIhttps://doi.org/10.2957/kanzo.53.183
    JOURNAL FREE ACCESS
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    An 88-year-old Japanese female was referred to our hospital because of multiple tumors in the liver. On admission, her temparature was 37.2°C. Her data on admission were: white blood cell counts 14,960/μl, C-reactive protein 10.57 mg/dl, total bilirubin 0.42 mg, ALT 24 IU/l, ALP 384 IU/l, γ GTP 109 IU/l, serum albumin 3.2 g/dl. Hepatitis B antigen and hepatitis C antibody in serum were both negative. Alpha-fetoprotein and carcinoembryonic antigen were within normal range, however, CA19-9 was slightly elevated to 73.6 U/ml. Enhanced computed tomography revealed multiple low attenuation masses with enhanced peripheral rims. She was suspected as having gallbladder cancer and metastatic liver cancer. She took a palliative therapy and died of hepatic failure 73 days after the admission. An autopsy was performed. The cut surface of the expansive tumor occupying the right lobe of the liver contained necrotic lesions. Histologically, the tumor revealed a well to poorly-differentiated squamous cell carcinoma showing keratinized cells. Existing liver had no evidence of chronic hepatitis, cysts or intrahepatic stones. To our knowledge, only seven cases of primary squamous cell carcinoma of the liver have been reported in Japan.
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