Kanzo
Online ISSN : 1881-3593
Print ISSN : 0451-4203
ISSN-L : 0451-4203
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Volume 55, Issue 1
Displaying 1-10 of 10 articles from this issue
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Review Article
Original Articles
  • Assessment of outcome of potential candidates for liver transplantation
    Michinori Matsumoto, Hiroaki Shiba, Yoshiaki Kita, Shigeki Wakiyama, Y ...
    2014 Volume 55 Issue 1 Pages 15-21
    Published: January 20, 2014
    Released on J-STAGE: February 07, 2014
    DOIhttps://doi.org/10.2957/kanzo.55.15
    JOURNAL FREE ACCESS
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    Of the 65 institutions registered with the Japanese Liver Transplantation Society in 2010, 13 institutions are located in Tokyo. Because of the shortage of deceased donors, the majority of liver transplantation (LT) are from live donors in Japan. To assess the patient outcome, we evaluated 105 patients who visited Jikei University Hospital for LT between 2003 and 2012. We judged 57 patients to be suitable LT candidates, of whom 22 patients had appropriate donors. Ten of the 11 patients underwent live donor LT (LDLT) at our hospital are alive, while the other patient died before LDLT. Nine of the 10 underwent LDLT at other institutions due to emergency or ABO blood type incompatibility, and 7 of the 11 underwent cadaveric LT (CLT) abroad are alive. Corporation with other institutions, development of a comprehensive transplant environment, and authorization to perform CLT seem to be important for a successful LT program.
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  • Japan Alcoholic Hepatitis Score can help management of patients with alcoholic hepatitis
    Yoshinori Horie, Yoshiyuki Yamagishi, Hirotoshi Ebinuma, Takanori Kana ...
    2014 Volume 55 Issue 1 Pages 22-32
    Published: January 20, 2014
    Released on J-STAGE: February 07, 2014
    DOIhttps://doi.org/10.2957/kanzo.55.22
    JOURNAL FREE ACCESS
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    Ability of a new scoring system for alcoholic hepatitis (AH) (Japan Alcoholic Hepatitis Score: JAS) to predict outcome was confirmed in the data of patients with AH in 2011. Twenty six hospitals provided full demographic data on 59 patients with AH (Moderate 26, Alive 22, Dead 4; Severe 33, Alive 16, Dead 17). There was no report of death in patients with mild AH (JAS score was 7 and less). Prevalence of renal failure, DIC and gastrointestinal bleeding was higher in patients who were died. Cr and PT (INR) were higher in severe AH patients who were died. These results suggest that JAS allows the stratification of the risk of death in AH, and can help the management of patients with AH. If there is any 3 points factor, intensive care such as corticosteroids, granulocytes/monocytes apheresis, plasma exchange and haemodialysis is recommended.
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  • Mechanism and prevention measures of renal impairment in triple therapy with peginterferon, ribavirin and telaprevir for chronic hepatitis C
    Kazuo Notsumata, Yasuyuki Ushiogi, Tatsuo Kumai, Teruyuki Ueda, Hisato ...
    2014 Volume 55 Issue 1 Pages 33-39
    Published: January 20, 2014
    Released on J-STAGE: February 07, 2014
    DOIhttps://doi.org/10.2957/kanzo.55.33
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    Mechanism and prevention measures of renal impairment that occurs in triple therapy with peginterferon, ribavirin and telaprevir for chronic hepatitis C were examined. Changes in renal function over time were observed in 78 patients with chronic hepatitis C treated for 12 weeks with triple therapy. In 40 of these patients, changes over time in blood cystatin C, urine liver type fatty acid binding protein (L-FABP), urine N-acetyl β-D-glucosaminidase (NAG), fractional excretion of sodium (FENa) and urine albumin were examined in addition to general biochemistry tests. Blood cystatin C was significantly decreased after 1 week of treatment. Urine L-FABP did not change until Week 4 and urine NAG was increased at Week 4. FENa was below 1 until Week 4. Urine albumin tended to increase until Week 4. These results suggested that, in triple therapy, decrease in the blood flow of renal arteriole first causes impaired glomerular filtration function and later results in impaired distal renal tubular function. Therefore, fluid replacement and administration of drugs that cause renal arteriolar dilation were considered to be used as prevention measures of renal impairment that occurs early after the start of triple therapy.
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Case Reports
  • A case of hepatic tuberculosis presented multiple masses which was disappeared by antituberculosis therapy
    Takehiro Mitsuishi, Hiroshi Abe, Nobuyoshi Seki, Tamihiro Miyazaki, Yu ...
    2014 Volume 55 Issue 1 Pages 40-50
    Published: January 20, 2014
    Released on J-STAGE: February 07, 2014
    DOIhttps://doi.org/10.2957/kanzo.55.40
    JOURNAL FREE ACCESS
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    A 41-year-old man presented at our division with low-density masses in the right lobe of the liver detected by computed tomography (CT) while screening for renal diseases. Enhanced CT demonstrated that these masses had slowly become isodense. Consent of histopathological examination was not obtained from the patient at that time. After 6 months, the masses showed a notable increase in size and number. Ultrasound-guided biopsy was performed, and non-caseous epithelioid granulomas with necrosis and multinucleate giant cells were observed. Based on these findings, we considered a probable diagnosis of liver tuberculosis or sarcoidosis. The QuantiFERON test and tuberculous polymerase chain reaction results were negative. Serum calcium and angiotensin-converting enzyme levels were normal, and bilateral hilar lymphadenopathy was not present. Although a diagnosis of liver tuberculosis was not confirmed, we decided to initiate anti-tuberculosis therapy to prevent morbid progression of tuberculosis. After 6 months of therapy, the masses decreased in size.
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  • A case of resolved hepatitis B who was observed HBV viremia transiently during HSV hepatitis immediately after steroid pulse therapy
    Koichiro Miyagawa, Michihiko Shibata, Shinsuke Kumei, Tooru Matsuhashi ...
    2014 Volume 55 Issue 1 Pages 51-56
    Published: January 20, 2014
    Released on J-STAGE: February 07, 2014
    DOIhttps://doi.org/10.2957/kanzo.55.51
    JOURNAL FREE ACCESS
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    A 55-year-old woman with resolved hepatitis B virus (HBV) infection underwent steroid pulse therapy for thyroid-associated ophthalmopathy. 18 days later, she suffered from fever and chest exanthema and visited a local hospital. She was diagnosed as acute hepatitis and serum HBV-DNA was negative. But serum HBV-DNA level was 2.8 log copies/mL, when she admitted to our hospital on the next day. Serum herpes simplex virus (HSV) IgM antibody was positive. Therefore, we judged that acute liver injury was caused by not HBV but HSV, because liver injury preceded viremia of HBV and serum HBV-DNA was low titer. Serum HBV-DNA immediately disappeared with improvement of HSV hepatitis. It was estimated that the transient viremia of the present case was a result of the HBV replication by steroid in hepatocytes and the hepatocyte destruction due to hepatitis caused by HSV. This is an interesting case suggesting that steroids can effect incrementally to cccDNA in hepatocytes in a short term even in resolved hepatitis B patients. We should carefully analyze the result of serum HBV-DNA appearance in patients with resolved HBV infection.
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  • Pioglitazone therapy could improve histology of a lean patient with advanced nonalcoholic steatohepatitis. A case report
    Haruo Nakayama, Shiniti Ikeya, Daisuke Okamoto, Daisuke Komazawa, Taka ...
    2014 Volume 55 Issue 1 Pages 57-65
    Published: January 20, 2014
    Released on J-STAGE: February 07, 2014
    DOIhttps://doi.org/10.2957/kanzo.55.57
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    A 46-year-old female who was treated for hypertension, hypertriglicemia, was admitted to our hospital in 2010 due to elevation of serum liver enzyme. She was thin on BMI 15.8 (kg/m2), and had no history of alcoholic abuse and anorexia. Compared to her trunk, she has loss of subcutaneous fat in her face and limbs. In 1990 when she was 27 years old, liver biopsy was performed, and showed simple steatosis. Nineteen years later, her Liver histology had advanced to NASH with stage 3 on Brunt criteria. Pioglitazone therapy was started with a dose of 15 mg. Liver biopsy was performed after 2 years of treatment. Pioglitazone therapy has improved aminotransferase level and histology including steatosis, lobular inflammation and fibrosis. This case suggest that pure simple steatosis with nonobese patient may be progressed to advanced NASH, and pioglitazone therapy can lead to the improvement in biochemical and histological features of nonobese NASH.
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  • A Case of refractory hepatic encephalopathy with poor residual liver function effectively treated with trans-ileocolic venous obliteration (TIO) using Doppler ultrasonography
    Yasunari Hiramine, Yasushi Imamura, Sho Ijuin, Norifumi Nishi, Ichiro ...
    2014 Volume 55 Issue 1 Pages 66-75
    Published: January 20, 2014
    Released on J-STAGE: February 07, 2014
    DOIhttps://doi.org/10.2957/kanzo.55.66
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    We report a refractory hepatic encephalopathy case effectively treated with TIO. The patient was an 82-year female, diagnosed as having Child-Pugh class C. Her platelet count was 51,000. Abdominal contrast CT revealed a huge portosystemic shunt (paraumbilical vein). Given her residual liver function, complete obliteration of the collateral circulation and concomitant decompression were judged to be difficult. A catheter was inserted via the ileocolic vein, and shunt obliteration was performed using a metal coil, adjusted to the maximum velocity of blood flow in the portal vein (Vmax) with continuous intraoperative measurement by Doppler ultrasonography. As of 5 months after surgery, neither hepatic encephalopathy recurrence nor remarkable complications have occurred. This clinical experience suggested that both therapeutic effects and safety can be expected with obliteration of the collateral circulation if portal blood flow is carefully monitored by Doppler ultrasonography.
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Short Communication
  • Experience using levocarnitine chloride in treatment of hepatic encephalopathy
    Shunsuke Tsubata, Kohei Ogawa, Masaaki Hirano, Akira Sakamaki, Yukio A ...
    2014 Volume 55 Issue 1 Pages 76-78
    Published: January 20, 2014
    Released on J-STAGE: February 07, 2014
    DOIhttps://doi.org/10.2957/kanzo.55.76
    JOURNAL FREE ACCESS
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    We investigated the effects of levocarnitine chloride (L-CA) in cirrhotic patients repeatedly suffering episodes of refractory hepatic encephalopathy. This study included 5 patients with cirrhosis requiring maintenance therapy with BCAA infusion because of recurrent episodes of hepatic encephalopathy despite combined oral medications. The use of L-CA, though at a relatively low dose of 900 mg/day, lowered the serum ammonia level, thereby decreasing the frequency of BCAA infusions in all the patients. These results suggest that L-CA may be a useful treatment choice for patients failing to show symptomatic amelioration in response to conventional therapy regimens.
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Meeting Report
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