Kanzo
Online ISSN : 1881-3593
Print ISSN : 0451-4203
ISSN-L : 0451-4203
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Volume 55, Issue 2
Displaying 1-6 of 6 articles from this issue
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Original Article
  • Automated risk management of HBV reactivation by encoding patients' medical records
    Kazuo Notsumata, Tatsuo Kumai, Teruyuki Ueda, Hisato Matsuda, Taku San ...
    2014 Volume 55 Issue 2 Pages 91-99
    Published: February 20, 2014
    Released on J-STAGE: March 01, 2014
    DOIhttps://doi.org/10.2957/kanzo.55.91
    JOURNAL FREE ACCESS
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    We developed an automated system to prevent HBV reactivation by medical record encoding, and verified its usefulness. The system was designed to encode the status of the clinical practice of a patient who was receiving an immunosuppressive therapy and/or a chemotherapy as follows: each of the statuses below is encoded with 0, 1, 2 and 3 in a 10 digit number: test results and their timings for HBsAg, HBcAb, HBsAb, HBV-DNA, respectively, administration history of nucleic acid analogue, and use of high risk drug (ex: rituximab). The system automatically checks if the patient has been undergone tests and treatments that are consistent with the flow chart in the practical guidelines for hepatitis B, and detected defects in the practical history are reported to the primary doctor with messages of suggested tests and medications that are derived from the inconsistency. We applied the present system to a total of 5,403 cases from October 2012 to May 2013, and the percentages of untested cases for HBsAg and HBcAb/HBsAb on a monthly basis decreased significantly; from 49.4%to 19.4%and from 26.4%to 10.2%and compliance rate of HBV tests and treatments in line with the practical guidelines increased from 19.8%to 69.5%. In addition, we found that 5 patients receiving rheumatoid arthritis treatments were HBV positive or had de novo HBV, and immediate administration of a nucleic acid analogue led to successful prevention of HBV reactivation. Thus, the present automated system showed a promising result to prevent HBV reactivation.
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Case Reports
  • Complete response induced by half dose of sorafenib administration in advanced hepatocellular carcinoma with peritoneal dissemination
    Naoki Morimoto, Norio Isoda, Toshiya Ootake, Shunji Watanabe, Mamiko T ...
    2014 Volume 55 Issue 2 Pages 100-105
    Published: February 20, 2014
    Released on J-STAGE: March 01, 2014
    DOIhttps://doi.org/10.2957/kanzo.55.100
    JOURNAL FREE ACCESS
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    A 87-year-old man with chronic hepatitis C and hepatocellular carcinoma (HCC) treated by repeated transcatheter arterial chemoembolization (TACE) and/or percutaneous ethanol injection therapy in the other hospital was referred to our institution. One year after, recurrent HCC was pointed out in the segment 8 near the past treated lesion, we performed TACE twice. Six months later, rapidly elevated alpha-fetoprotein level as well as multiple nodules adjacent the liver were detected which were diagnosed as peritoneal dissemination of HCC. Considering his age, half dose of sorafenib (400 mg per day) was administered. Following sorafenib administration the lesions markedly shrank and complete response (CR) according to Response Evaluation Criteria In Solid Tumors (RECIST) was achieved within five months. Treatment with even reduced dosage (200 mg per day) has been continued over one year, there is no clinical evidence of recurrence. To our knowledge, this is the first case achieved CR in advanced HCC with peritoneal dissemination successfully treated with a half dose of sorafenib.
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  • A resected case of double cancer of hepatocellular carcinoma and intrahepatic cholangiocarcinoma with a component of cholangiolocellular carcinoma
    Hideyuki Takata, Hiroshi Yoshida, Yasuhiro Mamada, Nobuhiko Taniai, Ma ...
    2014 Volume 55 Issue 2 Pages 106-114
    Published: February 20, 2014
    Released on J-STAGE: March 01, 2014
    DOIhttps://doi.org/10.2957/kanzo.55.106
    JOURNAL FREE ACCESS
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    We report a resected case of double cancer of hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) with a component of cholangiolocellular carcinoma (CoCC). The 71-year-old male patient was referred and admitted to our hospital for further examination of the liver tumor of 50-mm in diameter detected on abdominal ultrasound at health examination. Serum tumor markers, such as AFP and PIVKA-II were elevated. Abdominal computed tomography (CT), magnetic resonance imaging (MRI) and CT during angiography revealed that tumor was located in segment 7 and segment 3 of the liver. Based on those preoperative examinations, the liver tumors were diagnosed as multiple primary HCC. The patient underwent a posterior superior subsegmentectomy and a partial resection of segment 3. Histopathological examination revealed that the tumor in segment 7 was moderately differentiated HCC, while the tumor in segment 3 contained ICC and CoCC-like area. From the immunohistochemistry results, the tumor in segment 3 was diagnosed as ICC with CoCC differentiation. The clinicopathological features of CoCC have not been studied in detail due to the rarity of the tumor. We herein present a rare case of HCC and ICC with a component of CoCC.
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  • A surgical case of synchronous double cancer of combined hepatocellular-cholangiocarcinoma and hepatocellular carcinoma
    Kazuhiro Suzumura, Yuji Iimuro, Tadamichi Hirano, Ikuo Nakamura, Yuich ...
    2014 Volume 55 Issue 2 Pages 115-121
    Published: February 20, 2014
    Released on J-STAGE: March 01, 2014
    DOIhttps://doi.org/10.2957/kanzo.55.115
    JOURNAL FREE ACCESS
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    The case pertains to a 66-year-old man that was referred to our hospital for close inspection and treatment purposes upon being indicated as having a hepatic mass by a local doctor. Upon abdominal ultrasonography, a mass lesion was observed in three locations: the liver S6 and the cranial side of S7, as well as the caudal side of S7; wherein, the S6 mass was observed to be a mass having contrast enhancement in the surrounding region thereof, while the mass on the cranial side of S7 and caudal side of the S7 were observed as masses with poor contrast enhancement. The patient was diagnosed to have combined hepatocellular-cholangiocarcinoma upon a biopsy conducted on the S6 mass, leading to posterior segment resection of the liver being carried out. The S6 mass was found to be combined hepatocellular-cholangiocarcinoma upon histopathologic examination, while the masses on the cranial side of S7 and caudal side of the S7 were hepatocellular carcinomas. The patient is still alive today approximately seven years following surgery. Cases in which both combined hepatocellular-cholangiocarcinoma and hepatocellular carcinoma are both present at the same time in different locations of the same liver, a so-called double cancer, are rare. We herein report on our experience with an excision example of this case, with the addition of some bibliographical considerations.
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  • Autoimmune hepatitis deteriorated by anastrozole, an aromatase inhibitor, for breast cancer adjuvant chemotherapy
    Hideki Utagawa, Hiroshi Mitsui, Sei Kimura, Kenichiro Nakachi, Masao O ...
    2014 Volume 55 Issue 2 Pages 122-131
    Published: February 20, 2014
    Released on J-STAGE: March 01, 2014
    DOIhttps://doi.org/10.2957/kanzo.55.122
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    Anastrozole is a potent aromatase inhibitor, and is used for breast cancer adjuvant chemotherapy. We report two breast cancer patients, who replaced autoimmune hepatitis (AIH) in the use of anastrozole chemotherapy after surgical operation. Both patients were characterized by 1) middle~high aged woman, 2) diagnosis of " AIH probable" after international criteria in 1999, 3) effectiveness of steroid therapy, 4) having HLA DRB1*0405, and 5) from half to one year use of anastrozole before AIH was deteriorated. The case 1 showed jaundice, and was diagnosed as AIH for the first time, although liver biopsy specimen showed chronic hepatitis. The case 2 had been suffering from AIH for 11 years with successful steroid treatment before deterioration by anastrozole. In international clinical trial, anastrozole showed arthralgia in over 25%patients, which resembled rheumatoid arthlitis (RA) in some patients. Since anastrozole is suggested to induce autoimmunity, it may relapse or deteriorate AIH, might be through estrogen depletion.
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Meeting Report
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