本邦のアルコール総消費量は近年大きな変化はなく，欧米と同等の高い水準で推移している．今回，肝細胞癌（HCC）発症における飲酒の影響について検討した．全国の1496施設に対し，2014年度に診断・治療されたHCC患者についてアンケート調査を行った．7047例のHCC患者の成因は，HBV 13.9％，HCV 54.7％，HBV＋HCV 3.6％，アルコール単独によるもの（ALD-HCC）13.9％，非アルコール性脂肪性肝疾患関連4.6％，その他9.5％で，2009年度と比較してALD-HCCの割合が増加傾向にあった．背景因子が確認された333例の初回診断ALD-HCCでは，平均年齢は69.8歳，男性が94%，糖尿病有病率50%，肝硬変合併率85%であった．AFP低値例が多く，66歳以上で肝硬変がない例とChild-PughスコアAの割合が多かった．肝予備能が保たれたまま長期に飲酒し，高齢になって肝発癌が増えたことが予測される．ALD-HCCへの対策としては早期介入による飲酒量の低減が根本的な課題ではあるが，画像診断等により早期にHCCを診断し，治療に結び付けることも今後の課題である．

症例は48歳の男性．全身倦怠感，食思不振を主訴に当科を受診．総ビリルビン3.46 mg/dl，AST 384 IU/L，γGTP 1,067 IU/mlと肝障害を認め，超音波検査で肝内に多発性に集簇した高輝度結節がみられた．これらの病変はCT検査では低吸収域，MRIT1，T2強調画像で高信号域を呈し，脂肪抑制強調像で信号強度は共に低下した．集簇，多発したこれらの病変の組織像は大滴性脂肪沈着を示した．保存的療法で3週後には集簇した多発病変は消失し，肝胆道系酵素もほぼ正常化した．3カ月後の肝組織像では脂肪沈着はみられず，肝線維化像を認めるのみであった，

To clarify the long-term protective effect of hepatitis B (HB) vaccine, initial response to HBV vaccine, frequency of booster vaccine (when HBsAb decreased below 10 mIU/ml), and incidence of latent HBV infection (defined by the isolated reseroconversion of HBcAb) was evaluated in 105 children who were successfully protected from perinatal HBV infection via HBV carrier mothers. Forty children received booster vaccination and a group of low responders received booster vaccination more frequently than those of moderate and high responders. Latent HBV infection was found in five children (4.7%). Latent HBV infection was more frequently found in children born to HBeAg positive mothers than HBeAg negative mothers. A regular follow-up may be mandatory in children who showed low response to initial vaccination in the infancy and those born to HBeAg positive mothers.

Aplastic anemia (AA) is characterized by bone marrow hypoplasia and peripheral pancytopenia and is associated with increased susceptibility to infection and bleeding tendency. Here, we describe two patients with hepatocellular carcinoma (HCC) exhibiting severe pancytopenia caused by AA. They were successfully treated by transarterial embolization (TAE). To reduce the risk of complications, both component transfusion and intravenous administration of antibiotics were performed. Although they required repeated TAE after several recurrences, the tumors were eventually almost controlled. In conclusion, HCC was successfully treated by TAE in patients with severe pancytopenia caused by AA. In such cases, close cooperation with hematologists is required to improve long-term prognosis.

The aim of this study was to reveal the real-life effectiveness of sofosbuvir (SOF) with ribavirin (RBV) in Japanese patients with genotype 2 hepatitis C virus infection. A total of 153 patients were enrolled. The rates of SVR at 12 weeks after end of treatment were 94.1%. Of all 9 patients with treatment-failure were relapsers, and no breakthrough cases were observed. The starting RBV doses were reduced in 44 patients. However, RBV dose reduction has no impact on treatment outcome. Male and low-platelet counts were significantly higher in relapsed group than SVR12 group. Factors, which affect the outcome should be farther investigated. SOF plus RBV was found to be well-tolerated with high SVR rate in Japanese "real-life" cohort.

HCV often infects patients with chronic renal failure (CRF) on hemodialysis (HD) and significantly affects the prognosis of these patients. Recently, HCV treatment has been revolutionized by the new generation of direct-acting antivirals (DAAs) which offers short, IFN-free, highly efficacious, well-tolerated curative therapies, but data are limited on the efficacy of these therapies for HCV infection in patients with CRF on HD. Aim: We examined the efficacy and safety of Ombitasvir (OBV), Paritaprevir (PTV), Ritonavir combination therapy in 9 patients with CRF on HD and chronic HCV infection. Patients and Methods: Nine patients with CRF on HD and untreated HCV genotype 1 infection were treated with OBV/PTV/r combination therapy for 12 weeks. Results: All 9 cases completed the 12 weeks therapy and serum HCV-RNA became negative after 4 weeks of the therapy and continued to be negative even 12 weeks after the therapy in all cases (SVR12, 100%). Serum ALT values were normalized in all cases. Calcium channel blockers (CCB), which had been taken by 5 cases, were required to change to other anti-hypertensive drugs considering that CCB causes hypotension due to drug-drug interactions with ritonavir, but all adverse events were mild or moderate in this study.

Conclusion: The combination therapy of Ombitasvir, Paritaprevir, Ritnavir for 12 weeks in 9 CRF patients on HD with HCV infection was well tolerated and highly effective (SVR12, 100%).