Kanzo
Online ISSN : 1881-3593
Print ISSN : 0451-4203
ISSN-L : 0451-4203
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Volume 54, Issue 1
Displaying 1-12 of 12 articles from this issue
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Review Article
Case Reports
  • A therapeutic effective case of bronchial arterial infusion of fine-powder cisplatin (IA-call®) for pulmonary metastases originated from hepatocellular carcinoma
    Junichi Koyama, Ryutaro Morizono, Tetsu Goto, Kotaro Morita, Hitoshi N ...
    2013 Volume 54 Issue 1 Pages 19-26
    Published: 2013
    Released on J-STAGE: January 29, 2013
    DOIhttps://doi.org/10.2957/kanzo.54.19
    JOURNAL FREE ACCESS
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    A 73 year-old man who was diagnosed as hepatocellular carcinoma (HCC) underwent extended right hepatic lobectomy. Four years after the hepatectomy, multiple nodules in bilateral lungs were detected. A diagnostic percutaneous biopsy revealed pulmonary metastases from HCC. The patient was treated with oral uracil/tegafur (UFT) first. However, his condition deteriorated because of refractory massive hemoptysis. Therefore, bronchial arterial infusion (BAI) of epirubicin (EPI) was performed twice for a metastatic mass at right pulmonary hilum. In contrast to decreasing trend of tumor burden, improvement of hemoptysis was not observed. The replacement of EPI with fine-powder cisplatin (IAC) finally contributed to complete disappearance of a metastatic mass and his symptom. Additional treatment for another nodule at right azygos lobe was successfully performed as well. The efficacy of BAI for the other metastatic nodules without hypervascular stain by angiography was not certified. BAI could be a useful therapeutic option for symptomatic pulmonary metastases, if the primary lesion is well-controlled.
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  • A case of acute-onset autoimmune hepatitis that showed false positive for IgM-HA antibody
    Ken Okai, Eisaku Kita, Nobuo Matsuhashi, Hidehiko Matsuoka, Osamu Ichi ...
    2013 Volume 54 Issue 1 Pages 27-32
    Published: 2013
    Released on J-STAGE: January 29, 2013
    DOIhttps://doi.org/10.2957/kanzo.54.27
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    A 76-year-old woman was admitted to our hospital for general malaise and liver dysfunction. At first she was diagnosed as acute hepatitis A by laboratory findings, such as positive for IgM-HA antibody and clinical findings. Her liver dysfunction was temporary improved, however, it deteriorated again. She was treated with pulsed methylprednisolone and subsequent oral prednisolone (PSL). Liver dysfunction improved after the treatment, thus, PSL was discontinued. However liver dysfunction reappeared after 30 days from discontinuation of PSL. Her clinical and laboratory findings were fulfilled the criteria of autoimmune hepatitis. We finally diagnosed as acute onset autoimmune hepatitis because of low titer of IgM-HA antibody, negative of HAV-RNA and high titer of IgG-HA antibody. This is a suggestive case to diagnose early phase of autoimmune hepatitis.
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  • A case of primary hepatic carcinoid tumor that growth was observed for 17 years
    Atsuko Maruno, Tatehiro Kagawa, Mia Fujisawa, Yoshiaki Kawaguchi, Mako ...
    2013 Volume 54 Issue 1 Pages 33-43
    Published: 2013
    Released on J-STAGE: January 29, 2013
    DOIhttps://doi.org/10.2957/kanzo.54.33
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    A 65-year-old male admitted to our hospital in July 2007 due to watery diarrhea, elevation of serum liver enzymes, and liver mass. In 1990 when he was 48 years old, health check ultrasonography revealed cystic liver mass with a diameter of 2 cm. He did not receive further examination although his liver mass gradually enlarged. He had experienced recurrent duodenal ulcer and diarrhea since his adulthood. Dynamic CT scan on admission revealed an 11 cm-diameter solid tumor with cystic components in the segment 4 of the liver. Endoscopic examination for upper and lower GI, and intestine, and FDG-PET could not localize primary tumor. Left lobectomy was performed. Pathological examination revealed that the tumor was composed of cuboidal cells with round-shaped nuclei arranged in a trabecular pattern. Tumor cells were positive for Grimelius, NCAM, chromogranin A, gastrin, and serotonin. Serum gastrin and serotonin, and urine 5-HIAA were elevated. We made a diagnosis of primary hepatic carcinoid tumor manifesting both carcinoid syndrome and Zollinger-Ellison syndrome. After surgery diarrhea and duodenal ulcer disappeared along with the normalization of serum gastrin and serotonin. The calculation, based upon the observation that tumor diameter increased from 2 cm to 11 cm through 17 years, resulted in doubling time of 27.6 months. This is a very rare case of primary hepatic carcinoid tumor that growth was observed for 17 years. We also discussed the mechanisms of the cystic formation in this disease.
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  • A case of anti-mitochondrial M2 antibody (AMA M2) positive AIH confused with PBC-AIH overlap syndrome
    Machiko Umemura, Atsushi Nagasaka, Yuichiro Fukasawa, Yomo Fujita, Aya ...
    2013 Volume 54 Issue 1 Pages 44-50
    Published: 2013
    Released on J-STAGE: January 29, 2013
    DOIhttps://doi.org/10.2957/kanzo.54.44
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    A 71-years-old woman visited us in March 2011 for moderately abnormal levels of biliary enzymes developed from January 2011. The patient was diagnosed as asymptomatic primary biliary cirrhosis (PBC) because of abnormal level of biliary enzymes and a presence of anti-mitochondrial M2 antibody (AMA M2). The patient accused thick urine and malaise from April 2011. Blood sample collected at April 13 revealed 3.7 mg/dl of T-bilirubin and an abrupt increase of transaminases such as 224 IU/L of AST and 1095 IU/L of ALT.
    Interface hepatitis and hepatoocytic necrosis were found in liver biopsy specimen. Proliferation of bile ductules was remarkable, but destruction of bile ducts was minimal at the portal area. Based on these findings, the patient was diagnosed as autoimmune hepatitis (AIH) with positive AMA M2. Liver function rapidly recovered by the treatment of UDCA (ursodeoxycholic acid) (600 mg/day) and prednisolone (PSL; 30 mg/day), and the treatment level of PSL was gradually reduced thereafter. The patient is currently under clinical follow-up without deterioration of liver function.
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  • A case of acute deterioration associated with humoral rejection and platelet transfusion refractoriness due to anti-HLA antibodies in living-donor liver transplantation
    Taiji Tohyama, Hitoshi Inoue, Masahide Hatano, Eitaro Ito, Yoshikuni Y ...
    2013 Volume 54 Issue 1 Pages 51-59
    Published: 2013
    Released on J-STAGE: January 29, 2013
    DOIhttps://doi.org/10.2957/kanzo.54.51
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    A 50-year-old woman developed decompensated liver cirrhosis caused by hepatitis C virus and underwent living-donor liver transplantation with her son as the donor. Donor and patient had the same blood type. Preoperative lymphocyte cross-matching was negative. Postoperatively, the patient developed liver damage characterized by the gradual elevation of lactate dehydrogenase and bilirubin levels, and platelet transfusion refractoriness. Subsequently, she developed thrombotic microangiopathy and died from an intracerebral hemorrhage. A preoperative blood sample was analyzed retrospectively for anti-HLA antibodies using a high-sensitivity Flow-PRA evaluation and single antigen beads on a Luminex. Broad-spectrum anti-HLA antibodies, including those against donor HLA-Cw9, were confirmed. The liver biopsy on postoperative day 8 showed humoral rejection. We diagnosed the cause of acute liver failure, platelet transfusion refractoriness, and secondary thrombotic microangiopathy as the presence of anti-HLA antibodies. We believe that this case will facilitate preoperative examination and liver transplantation in anti-HLA antibody-positive patients.
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  • A case of post-transfusion hepatitis by an occult HBV carrier
    Nobuyuki Yamashita, Hironori Tanimoto, Hideyuki Nomura
    2013 Volume 54 Issue 1 Pages 60-66
    Published: 2013
    Released on J-STAGE: January 29, 2013
    DOIhttps://doi.org/10.2957/kanzo.54.60
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    We report a case of acute hepatitis B caused by blood transfusion. The case is a male patient of 50s who underwent cardiac operation. Hepatitis B surface (HBs) antigen, HBs antibody and HB core antibody were all negative at 80 days after the transfusion but the liver function tests became abnormal at 6 months. HBs antigen and HBV-DNA turned positive and he was diagnosed as having acute hepatitis B. He recovered without antiviral therapies and HBV-DNA became negative within several weeks. HBV-DNA was detected in a pack of used fresh-frozen plasma. The nucleic acid sequence of HBV was matched with that obtained from the patient. The blood donor had frequently performed blood donation and this case is considered as occult HBV infection. Several cases of post-transfusion type B hepatitis are occurring every year in Japan in spite of improvement of a nucleic acid amplification test.
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  • A case of vanishing bile duct syndrome complicated with toxic epidermal necrolysis performed liver biopsy three times subsequently
    Kosuke Sumida, Kazufumi Dohmen, Shinichi Aishima, Sho Iwasaka, Satomi ...
    2013 Volume 54 Issue 1 Pages 67-73
    Published: 2013
    Released on J-STAGE: January 29, 2013
    DOIhttps://doi.org/10.2957/kanzo.54.67
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    A 19-year-old Japanese woman who had high fever, systemic rashes, erosions and blisters was referred to our hospital. We diagnosed as a toxic epidermal necrolysis due to ibuprofen or acetaminophen based on the histopathology of skin biopsy, and started to administrate the intravenous methylprednisolone. Though the skin lesions improved soon after treatment, the hepatic dysfunction and jaundice continued. One month after admission, we diagnosed as vanishing bile duct syndrome complicated with toxic epidermal necrolysis through the result of liver histopathology. We observed on outpatient with administration of ursodeoxycholic acid, and the hepatic dysfunction and jaundice improved nine monthes after the first admission. In our case, we examined liver histopathology after the month and the six monthes and the eleven monthes after the first admission. Although almost bile ducts were disappeared in liver histopathology of the first biopsy, we observed the proliferation of regenerated bile ducts in histology of the second and the third biopsy. In care of toxic epidermal necrolysis, sometimes vanishing bile duct syndrome is known to be complicated, however it is rare to follow the clinical course of vanishing bile duct syndrome with the liver histopathology.
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  • Reactivation of hepatitis B virus in a hepatitis B surface antigen-negative patient with membranous nephropathy treated with immunosuppression
    Yoshinori Ozono, Satoru Hasuike, Kenji Nagata, Yuri Yamada, Mai Tsuchi ...
    2013 Volume 54 Issue 1 Pages 74-80
    Published: 2013
    Released on J-STAGE: January 29, 2013
    DOIhttps://doi.org/10.2957/kanzo.54.74
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    A 75-year-old man receiving immunosuppressive therapy due to membranous nephropathy was admitted to our hospital with liver dysfunction in October 2011. Though laboratory data in November 2010 showed HB surface antigen negative, anti-HB surface antibody negative, anti-HB core antibody positive, on admission data showed HB surface antigen positive and HBV-DNA positive. He was diagnosed as de novo B hepatitis and administration of entecavir was started and his liver function recovered. Though reactivation of hepatitis B virus in the patients with renal diseases is rare, more attention should be paid when treating immunosuppressive therapy for patients with renal disease and further studies are needed.
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Rapid Communication
  • Balloon-occluded transcatheter arterial chemoembolization using miriplatin for hepatocellular carcinoma
    Hirotaka Arai, Takeshi Kobayashi, Tamon Nagashima, Daichi Takizawa, Mi ...
    2013 Volume 54 Issue 1 Pages 81-83
    Published: 2013
    Released on J-STAGE: January 29, 2013
    DOIhttps://doi.org/10.2957/kanzo.54.81
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    The efficacy and safety of balloon-occluded transcatheter arterial chemoembolization (B-TACE) using miriplatin were investigated in 26 patients with hepatocellular carcinoma, and compared with conventional TACE (C-TACE). In the B-TACE group, a treatment effect (TE) of 4 was obtained in 61.5%, TE3 in 34.6%, TE2 in 3.8%, and TE1 in 0%. In the C-TACE group, the respective results were 44.2%, 34.6%, 19.2%, and 1.9%. Efficacy was significantly higher in the B-TACE group. There were no significant differences in the incidence of adverse events of grade 3 or more severe between the two groups. B-TACE using miriplatin is more useful than C-TACE, and B-TACE is as safe as C-TACE.
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Short Communications
  • A follow-up survey of hepatitis virus carriers after notification of their infection in Okayama prefecture
    Sohji Nishina, Junko Kurihara, Toshiaki Noriyasu, Tatsuya Itoshima, Ka ...
    2013 Volume 54 Issue 1 Pages 84-86
    Published: 2013
    Released on J-STAGE: January 29, 2013
    DOIhttps://doi.org/10.2957/kanzo.54.84
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    In Okayama prefecture we investigated by questionnaires whether hepatitis B virus (HBV) (n=549) or hepatitis C virus (HCV) carriers (n=803) consulted a doctor after they had been informed of their infection at their initial checkup for viral hepatitis between 2002 and 2006. The ratio of patients who consulted a doctor after notification of infection was 38.4% (211/549) of HBV carriers and 49.4% (397/803) of HCV carriers, respectively. Among those patients, 53.1% of HBV carriers and 73.4% of HCV carriers were on follow care at the start of this investigation. These results indicated a need to establish a more effective follow up system for hepatitis virus carriers following notification at the initial medical checkup.
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  • The efficacy of percutaneous radiofrequency ablation using flat-panel detector angiographic CT for hepatocellular carcinoma
    Keizo Kato, Satoshi Adachi, Hiroyuki Tachibana, Yoshiyuki Sato, Makiko ...
    2013 Volume 54 Issue 1 Pages 87-91
    Published: 2013
    Released on J-STAGE: January 29, 2013
    DOIhttps://doi.org/10.2957/kanzo.54.87
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    To evaluate the efficacy of percutaneous radiofrequency ablation (RFA) using flat-panel detector angiographic CT (FACT) for hepatocellular carcinoma (HCC), we performed RFA using FACT for 23 HCC lesions in 16 patients. After transcatheter arterial chemoembolization or infusion chemotherapy using miriplatin as a sustained-release suspension in iodized oil and/or gelatin sponge, we performed RFA. RFA needle was inserted into the target lesion under US guide. Using FACT, we could confirm whether the needle tip inserted at the target assuming enough coagulative necrosis area from all angles in all lesions. Enough ablative margins could be obtained in all lesions. No serious adverse events were observed. RFA using FACT contributed more accurate insertion for HCC. Therefore, FACT would be a more useful tool for RFA.
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