Kanzo
Online ISSN : 1881-3593
Print ISSN : 0451-4203
ISSN-L : 0451-4203
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Volume 56, Issue 11
Displaying 1-11 of 11 articles from this issue
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Feature Article
Original Article
  • Alanine aminotransferase elevations during triple therapy with simeprevir, pegylated interferon plus ribavirin
    Yuki Tahata, Naoki Hiramatsu, Tsugiko Oze, Ayako Urabe, Naoki Morishit ...
    2015 Volume 56 Issue 11 Pages 567-574
    Published: November 20, 2015
    Released on J-STAGE: December 04, 2015
    DOIhttps://doi.org/10.2957/kanzo.56.567
    JOURNAL FREE ACCESS
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    In the clinical trials of triple therapy with simeprevir, pegylated interferon plus ribavirin, alanine aminotransferase (ALT) elevations have not been reported in detail during treatment. In the present study, we examined the frequencies and characteristics of ALT elevations in 321 chronic hepatitis C patients who were treated with triple therapy and became HCV-RNA negative during treatment. ALT elevations more than 100 U/L were observed in 5.0% (16/321) during treatment (100-200 U/L: 13 patients, 200-400 U/L: 2 patients, 400<U/L: 1 patient). Out of these patients, 8 patients showed that serum ALT levels rapidly increased between 8 and 12 weeks. All patients except one patient whose treatment was discontinued due to the marked elevation of ALT level (663 U/L), serum ALT levels decreased soon after simeprevir administration was finished. Periodic liver function tests were needed since ALT elevations can occur during simeprevir, pegylated interferon plus ribavirin therapy.
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Case Reports
  • A case of symptomatic primary biliary cirrhosis complicated by Behçet' s disease which emerged with joint swelling
    Sadatsugu Sakane, Takuya Miyagi, Hiroaki Azukizawa, Ryotaro Sakamori, ...
    2015 Volume 56 Issue 11 Pages 575-583
    Published: November 20, 2015
    Released on J-STAGE: December 04, 2015
    DOIhttps://doi.org/10.2957/kanzo.56.575
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    We herein report a case of symptomatic primary biliary cirrhosis (PBC) complicated by Behçet' s disease which became apparent with joint swelling. A 35-year-old man had suffered from repeated uvetitis of unknown origin since he was 29 years old. He was referred to us for itching sensation and biliary-tract-enzyme elevation when he was 32 years old. We diagnosed as symptomatic PBC based on symptoms, serologic tests, and histological findings of liver biopsy, and thereafter treated with ursodeoxycholic acid. One year later, he suffered from finger-joint swelling of unknown origin repeated with 6 month interval. Two years later, he was admitted to our hospital due to finger-joint swelling accompanied with repeated fever and oral aphtha. We found uveitis, oral aphtha, vulva ulceration, and multiple ulceration of ileum terminal, and diagnosed as Behçet' s disease. We subsequently treated with colchicine. This is the first case of advanced symptomatic PBC complicated by Behçet' s disease.
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  • Multiple hepatocellular adenomas: a case report
    Fumito Tamura, Yutaka Kawano, Koji Miyanishi, Tomohiro Kubo, Yusuke Ka ...
    2015 Volume 56 Issue 11 Pages 584-595
    Published: November 20, 2015
    Released on J-STAGE: December 04, 2015
    DOIhttps://doi.org/10.2957/kanzo.56.584
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    We report a rare case of multiple hepatocellular adenomas difficulty in ruling out well-differentiated hepatocellular carcinomas prior to resection. A 40s female was admitted to the hospital for examination of multiple liver tumors. CT and Gd-EOB-MRI showed that tumors were located in segment 2 and 5. We conducted a percutaneous tumor biopsy and tumor showed low atypical cells containing fat deposit. As the possibility of multiple hepatocellular carcinomas could not be denied, partial hepatectomy and RFA were done. All resected tumors showed a decreased expression of the liver fatty acid binding protein (L-FABP), and were finally diagnosed as multiple HNF1α-inactivated type hepatocellular adenomas. Multiple hepatocellular adenomas are rare tumors, so we report this case with review of the literatures.
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  • A case of hereditary hemorrhagic telangiectasia with dilatation of intrahepatic vessels without vascular lesions in other organs
    Kiyohiro Izumi, Kojiro Michitaka, Tomoe Kawamura, Toshihiko Aibiki, To ...
    2015 Volume 56 Issue 11 Pages 596-602
    Published: November 20, 2015
    Released on J-STAGE: December 04, 2015
    DOIhttps://doi.org/10.2957/kanzo.56.596
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    A 51-year-old woman consulted our hospital due to elevated γ-GTP and expanded intrahepatic vessels. Abdominal echo showed many dilated vessels, and color doppler ultrasound showed arterial flow in these vessels. Abdominal dynamic CT suggested the existence of arterioportal shunts. Though the findings of portal hypertension or angiectasia were not observed in esophagus and stomach by gastrointestinal endoscopy, precise history taking and detailed physical examination revealed her repeated nasal bleeding from childhood and telangiectasia in the tongue and in the left forearm. She was diagnosed with hereditary hemorrhagic telangiectasia (Osler disease). Chest CT and head MRI showed no vascular lesions in lungs or brain. Osler disease should be reminded if the abnormal dilations of intrahepatic vessels are observed even if vascular lesions are not found in other organs.
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  • A case of chronic hepatitis C accompanied by marked thrombocytopenia during combination therapy with daclatasvir and asunaprevir
    Masashi Namikawa, Satoru Kakizaki, Naoto Saito, Yuhei Suzuki, Yosuke A ...
    2015 Volume 56 Issue 11 Pages 603-609
    Published: November 20, 2015
    Released on J-STAGE: December 04, 2015
    DOIhttps://doi.org/10.2957/kanzo.56.603
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    The patient was a 70-year-old woman with chronic hepatitis C with genotype 1b and a low viral load. She had previously undergone treatment with several interferon regimens but could not achieve sustained virologic response (SVR). Treatment was initiated with a combination of daclatasvir (DCV) and asunaprevir (ASV). On the 18th day of treatment, she was admitted with suspected acute cholecystitis. Her platelet count was slightly low and continued to decrease after the improvement of acute cholecystitis. She required a platelet transfusion. From the clinical course and the laboratory data, we suspect that the patient experienced drug-induced thrombocytopenia due to DCV/ASV. The patient's platelet count showed gradual improvement one week after the discontinuance of DCV/ASV. She subsequently achieved SVR. We should pay attention to the possibility of drug-induced thrombocytopenia not only in patients who receive interferon regimens but also in those who receive interferon-free regimens with direct acting antivirals.
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  • A case of chronic hepatitis C reactivation and hepatocellular carcinoma after achievement of HCV RNA negative treated by combination therapy of IFN and ribavirin
    Norie Yamada, Minoru Kobayashi, Chiaki Okuse, Michihiro Suzuki, Yasuha ...
    2015 Volume 56 Issue 11 Pages 610-616
    Published: November 20, 2015
    Released on J-STAGE: December 04, 2015
    DOIhttps://doi.org/10.2957/kanzo.56.610
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    The case was a 71-years-old man with chronic hepatitis C. He was treated by pegylated interferon (Peg-IFN) and ribavirin, and achieved HCV RNA negative. After 9 years, he developed chronic hepatitis with HCV and hepatocellular carcinoma. The pairwise comparison and phylogenetic analysis revealed that HCV strains isolated before (2004) and after (2015) treatment were closely related and considered to be progenies from same origin. By the highly sensitive HCV RNA detection kit (real-time PCR), HCV RNA was detected at the point of 24 weeks after treatment. These results suggested that HCV was not eradicated by Peg-IFN and ribavirin, and persistent infection of HCV contributed to the hepatocarcinogenesis. This case indicates that the long-term surveillance for HCV RNA with highly sensitive detection method is indispensable even after achievement of SVR.
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Rapid Communications
  • Metachronous occurrence of two cases of acute hepatitis E after eating raw pig liver and heart at the same restaurant at Gifu city in Japan
    Shogo Shimizu, Junichi Sugihara, Yusuke Suzuki, Yoichi Nishigaki, Masa ...
    2015 Volume 56 Issue 11 Pages 617-620
    Published: November 20, 2015
    Released on J-STAGE: December 04, 2015
    DOIhttps://doi.org/10.2957/kanzo.56.617
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    In Gifu city, Japan, an acute hepatitis E case occurred in 2012 (previously reported in Kanzo 55: 713-716, 2014) and another hepatitis E case occurred in 2014. Both cases developed hepatitis E after eating raw pig liver and heart at the same restaurant. The patients had no other clear risk factors for hepatitis E virus (HEV) infection. The two HEV strains were totally different, suggesting that the pig farms which provided the pig products were contaminated by different HEV strains. Japanese government issued an order forbidding restaurants to serve raw pig offal in June 2015. However, the sources and the routes of HEV infection remain unknown in most hepatitis E cases in Japan. We must still be cautious for HEV infection.
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  • Direct-acting antiviral agent-resistant mutants in patients with type C chronic liver diseases: Detection and its clinical significance
    Tatsuya Aikawa, Chisato Ueno, Yohko Kikuchi, Fumio Tsuda, Hiroshi Ohni ...
    2015 Volume 56 Issue 11 Pages 621-624
    Published: November 20, 2015
    Released on J-STAGE: December 04, 2015
    DOIhttps://doi.org/10.2957/kanzo.56.621
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    To investigate the clinical usefulness in detecting direct-acting antiviral agent (DAA) -resistant mutations, resistant mutations in the hepatitis C virus NS3/NS5A regions were determined by direct sequencing in baseline serum samples obtained from 97 patients with type C chronic liver diseases, who were treatment-naïve or had previously received interferon-based therapy. Various resistant mutations were found in 23 patients (24%), including 8 patients in NS3 and 18 in NS5A. When 36 patients treated with simeprevir (SMV)/peginterferon/ribavirin were evaluated, none of five patients with SMV-resistant mutations at baseline were cured, while 65% of the remaining 31 patients without resistant mutations at baseline achieved sustained virologic response, the difference being statistically significant (p=0.0116). These results suggest the clinical usefulness of detecting pre-existing resistance mutations.
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  • Two cases of acute hepatitis E in the same geographical area infected with different viral strains
    Susumu Morita, Kaname Yoshizawa, Natsuki Uchiyama, Kazuya Fujimori, Ta ...
    2015 Volume 56 Issue 11 Pages 625-627
    Published: November 20, 2015
    Released on J-STAGE: December 04, 2015
    DOIhttps://doi.org/10.2957/kanzo.56.625
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    We recently encountered 2 cases of acute hepatitis E virus (HEV) infection occurring within a span of one year. Both patients resided within a radius of several kilometers of each other. Neither patients had eaten wild meat or uncooked pork. Phylogenetic analysis revealed that the two HEV strains were 3b/3jp but belonged to different lineages, which indicated that multiple HEV strains could have existed as a source of infection in the same area. HEV infection without any apparent symptoms may occur more commonly than previously believed. To prevent acute hepatitis E, further clarification of viral sources and routes is needed.
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  • Successful treatment of three elderly patients aged ≥90 years with hepatocellular carcinoma
    Tomoko Saito, Tetsuhiro Chiba, Toru Wakamatsu, Masanori Inoue, Yuko Ku ...
    2015 Volume 56 Issue 11 Pages 628-631
    Published: November 20, 2015
    Released on J-STAGE: December 04, 2015
    DOIhttps://doi.org/10.2957/kanzo.56.628
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    In Japan, patients affected by malignancies, including hepatocellular carcinoma (HCC), are growing older. Although therapeutic approaches for HCC have been continuously improving, there is little evidence to support an optimal treatment strategy for elderly patients with HCC. Here, we describe three elderly patients aged ≥90 years with HCC successfully treated by non-surgical therapies, such as radiofrequency ablation and transarterial chemoembolization. Although they were complicated by several underlying diseases, all patients exhibited favorable performance status, liver function, and cognition function. In conclusion, the administration of therapy for HCC should be considered even in patients aged ≥90 years in view of the characteristics of the tumor and patient's condition. In such cases, both the prevention of comorbidity deterioration and management of postoperative complications are highly important.
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