ラジオ波焼灼療法（以下，RFA；Radiofrequency ablation）中に，ラジオ波ニードルの絶縁被膜損傷によって体表面にIII度の熱傷を生じた症例を経験したので報告する．症例は50歳代，男性．肝細胞癌2結節（S7：14.8 mm, S8：15 mm）に対してRFAを行った．S7結節の焼灼時，焼灼開始から12分経過してもエコー上の焼灼変化および組織抵抗（以下，IMP；Impedance）の上昇が見られなかった．その後，穿刺部の患者体表面部にIII度の熱傷が発見された．使用したラジオ波ニードルを確認したところ，金属エコーガイドによって，絶縁被膜に擦れた痕跡と損傷している部分が見つかり，熱傷の原因と考えられた．この症例のIMP波形の経時的変化を解析すると，通常とは異なり，焼灼開始6分後に急低下し，その後プラトーとなる特殊波形となっていた．絶縁被膜損傷が起これば通常とは異なるIMPの経時的変化が起こるため，術中のIMPモニタリングは絶縁被膜損傷に起因する熱傷の早期発見，回避に有用となる．
Many nonB-nonC HCCs were found at an advanced stage because of the difficulties of surveillance. We examined the correlation between the follow-up status of 67 nonB-nonC HCCs and their clinical features. HCCs were found earlier when the patients were followed up at outpatients of Board Certified Hepatologist than in cases without regular check up by doctors or in cases followed up by uncertified physicians. We speculated that regular surveillance of HCC was necessary when the patients had the risk of HCC (NASH, alcoholic liver diseases et al.) regardless of their main diseases to achieve the early detection and to improve the prognosis of the patients with nonB-nonC HCC.
To investigate the regional difference in hepatitis E virus (HEV) infection in Nagano Prefecture, we tested a total of 260 blood donors that were collected in 2006 and 2011 (Northern region: 56, Eastern region: 55, Central region: 52, Southern region: 97) for the presence of anti-HEV IgG. Anti-HEV IgG was detected at 16.2%in Nagano Prefecture, being significantly higher in males. In 2006 anti-HEV IgG was higher in Southern region (31.9%) than in the other three regions (Northern, Central and Eastern region). However, other than the northern region was positive rate at the same level in 2011. Since there is a possibility that the actual eating habits and infection status of the region has changed during five years, it is necessary to conduct monitoring in the future.
We report a woman in her late 60s with hepatocellular carcinoma in whom the tumor was successfully treated by irreversible electroporation (IRE). Vascular-phase contrast-enhanced US (CEUS) with Sonazoid and dynamic CT at 1 day after treatment showed no tumor enhancement, but the safety margin of ablation appeared to be insufficient. On the other hand, in Kupffer-phase CEUS, the ablation zone showed a clear contrast defect with a sufficient ablation margin, indicating cell death of hepatocytes, cancer cells, and Kupffer cells in this area following IRE treatment. Very similar findings were observed in hepatobiliary-phase Gd-EOB-DTPA-enhanced MRI at 7 days after treatment. These results suggest that both Kupffer-phase CEUS and hepatobiliary-phase Gd-EOB-DTPA-enhanced MRI may be useful for assessing the ablation zone in patients who have undergone IRE.