Kanzo

Original Articles

Evaluation of outcomes with triple therapy consisting of PEG-IFN/Ribavirin/Telaprevir introduced by a team and provided at a pharmaceutical outpatient clinic

Yuka Aimono, Toshiro Kamoshida, Tsunehiko Maruyama, Yuji Oka

2014 Volume 55 Issue 8 Pages 454-458
Published: August 20, 2014
Released on J-STAGE: September 03, 2014

DOIhttps://doi.org/10.2957/kanzo.55.454

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With the advent of telaprevir, more favorable short-term efficacy has been achieved in the treatment of hepatitis C. On the other hand, concerns about serious adverse events and the complexity of treatments have arisen. In this study, we investigated the effectiveness and safety, as well as usefulness of multidisciplinary care, in 36 patients for whom triple therapy was introduced in our hospital. The percentage of patients in whom therapy was interrupted was 22.2% (8/36 patients), which is acceptable. Among 563 suggestions made by pharmacists to physicians, 549 (97.5%) were adopted. After providing supportive care for adverse reactions, all patients including those who withdrew from therapy showed improvement. Questionnaires for hepatologists revealed marked appreciation regarding the items of "reduced burden on physicians in the outpatient clinic", and all hepatologists responded that a pharmaceutical outpatient clinic could be "appreciated". Thus, the pharmaceutical outpatient clinic may be useful.

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Examination of the utility of the carnitine replacement therapy for hyperammonemia

Takuya Adachi, Shin-ichi Fujioka, Yasuyuki Shimomura, Manri Kawakami, ...

2014 Volume 55 Issue 8 Pages 459-467
Published: August 20, 2014
Released on J-STAGE: September 03, 2014

DOIhttps://doi.org/10.2957/kanzo.55.459

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A lot of opportunities when hyperammonemia in patients with cirrhosis meets by common practice often suffer from treatment. In late years reports that carnitine replacement therapy is useful for hyperammonemia increase. We examined 21 cases using the levocarnitine preparation for hyperammonemia in this hospital in January, 2013 from February, 2012. (p=0.0038) which a serum ammonia level one month later significantly decreased in a case with or more Child-Pugh score ten points. Also, in the group (following decrease group) which a serum ammonia level decreased, a serum albumin level, a serum whole cholesterol level, the serum cholinesterase level to express an alimentary index tended to be moderately as compared with a group (following non-decrease group) which did not decrease low, and the cross section of the psoas major muscle tended to be moderately small in decrease group. In cases a Child-Pugh score10 point or more, the likelihood that an effect to lower the serum ammonia level could expect was suggested by carnitine replacement therapy for a poor dietary intake case and a muscle weakness case.

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Case Reports

Repeated bile duct recurrence of hepatocellular carcinoma treated by repeated hepatic resection and transcatheter arterial chemoembolization: a report of super elderly case

Osamu Yamazaki, Hiroko Oka, Hiroji Shinkawa, Osamu Kurai

2014 Volume 55 Issue 8 Pages 468-478
Published: August 20, 2014
Released on J-STAGE: September 03, 2014

DOIhttps://doi.org/10.2957/kanzo.55.468

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The case is the super elderly patient with chronic hepatitis C. He recieved a posterior segmentectomy of the liver at age 83 for hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT). Nineteen months after surgery, we performed an anterior segmentectomy of the liver with the diagnosis of the HCC recurrence into the right anterior intrahepatic bile duct. Seventeen months after the re-operation, percutaneous transhepatic cholangioscopy (PTCS) revealed the BDTT occupying the hilar bile duct. We perfomed transcatheter arterial chemoembolization (TACE), and we made sure of the process that led to extinction from necrosis of the BDTT by PTCS. Thirty months after the TACE, hilar BDTT recurred and extended into the common bile duct, even though we added TACE three times. After percutaneous transhepatic cholangiodrainage (PTCD), he recieved a caudate lobectomy of the liver and thrombectomy at 92 years of age. In addition, we repot our experience in the management of 36 HCC patients with BDTT.

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A case of hepatopulmonary syndrome derived from nonalcoholic fatty liver disease with severe liver fibrosis, in which hypoxia could be recovered by the improvement of liver fibrosis

Hiroshi Miyata, Satoru Miyata

2014 Volume 55 Issue 8 Pages 479-487
Published: August 20, 2014
Released on J-STAGE: September 03, 2014

DOIhttps://doi.org/10.2957/kanzo.55.479

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Hepatopulmonary syndrome is observed in 4% to 80% of patients with liver cirrhosis. Hypoxia with cyanosis happened in a 65-year-old female with nonalcoholic fatty liver disease (NAFLD) seven years after the first examination and it was diagnosed as hepatopulmonary syndrome. When home oxygen therapy (HOT) was started, liver fibrosis was estimated to be stage 3 or 4 by FIB4 index. FIB4 index, type 4 collagen, and procollagen 3 peptide were showed to be highest at two or three years after HOT. But from then they were gradually decreased. Simultaneously hypoxia was improved. Finally HOT was finished five years after beginning. On the other hand it was observed in the period of hypoxia that Des-γ-carboxyprothrombin (DCP) levels were significantly high. In a case of hepatopulmonary syndrome derived from NAFLD with severe liver fibrosis, hypoxia could be reversibly recovered by the improvement of liver fibrosis.

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Idiopathic thrombocytopenic purpura in HCV case caused by interferon α-2b

Haruka Tatsukawa, Atsushi Hiraoka, Yuichiro Nawa, Toshihiko Aibiki, To ...

2014 Volume 55 Issue 8 Pages 488-494
Published: August 20, 2014
Released on J-STAGE: September 03, 2014

DOIhttps://doi.org/10.2957/kanzo.55.488

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A 65-year-old Japanese male came to us because of fatigue, anemia and thrombocytopenia (2000/μL). He had been treated with peg-interferon α-2b and ribavirin in 2005, though sustained virological response was not obtained. After curative treatment for hepatocellular carcinoma in 2010, interferon α-2b treatment (3 million units/injection, twice a week) was started. He was diagnosed with idiopathic thrombocytopenic purpura (ITP) based on elevation of PA-IgG and no abnormal findings in bone marrow. Because of no response to stoppage of interferon and steroid therapy, eltrombopag olamine was added and platelet count improved. ITP must be kept in mind in interferon therapy.

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A case of angiosarcoma which was difficult to differentiate from peliosis hepatis

Natsuko Tsutsumi, Tomohiro Fukuda, Keiko Ohno, Yuya Tsunoda, Tsuyoshi ...

2014 Volume 55 Issue 8 Pages 495-502
Published: August 20, 2014
Released on J-STAGE: September 03, 2014

DOIhttps://doi.org/10.2957/kanzo.55.495

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A 73-year-old woman who went to hosipital by peliosis hepatis regularly admitted to our hospital for aggravation of ascites and enlargement of liver tumor. She died with rapid progression to liver failure after a month in a hospital. The results of autopsy showed that the liver tumor was hepatic angiosarcoma and it caused extensive intraabdominal hemorrhage. Although peliosis hepatis is benign tumor, hepatic angiosarcoma is poor-prognosis tumor which does not have any confirmed treatments. Since both of them are included differential diagnosis of hepatic tumors, they should be diagnosed definitely by pathological procedure.

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Rapid progression of hepatocellular carcinomas after combined transcatheter arterial chemoembolization and stereotactic body radiotherapy for a primary tumor in the liver

Rina Tsutsui, Hiroaki Nagamatsu, Naohisa Mizukami, Ziro Watanabe, Akih ...

2014 Volume 55 Issue 8 Pages 503-511
Published: August 20, 2014
Released on J-STAGE: September 03, 2014

DOIhttps://doi.org/10.2957/kanzo.55.503

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We report a case of rapid progression of hepatocellular carcinomas (HCCs) after combined transcatheter arterial chemoembolization (TACE) and stereotactic body radiotherapy (SBRT) for a primary tumor in the liver. A 78-year-old woman previously had chronic hepatitis B. In August 2013, HCCs were detected in the S1 and S6 segments of the liver by using Gd-EOB-DTPA-enhanced magnetic resonance imaging of the abdomen, and treated with TACE. In September, abdominal dynamic computed tomography revealed a decrease in lipiodol accumulation and an early enhancing lesion in the S1 segment. The lesion in the S1 segment was assumed an HCC recurrence, and we performed TACE via the right inferior phrenic artery, followed by SBRT. The tumor recurred and was complicated with lymph node metastases, lung metastases, and pleural dissemination 2 weeks after SBRT; the patient died 111 days after the initial TACE. This is the first case, to our knowledge, showing rapid progression of an HCC after combined TACE and SBRT.

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