Although combination therapy of percutaneous ethanol injection (PEI) and monopolar radiofrequency ablation (M-RFA) has been shown to enlarge the area of coagulation necrosis, we have experienced problems associated with insufficient ablation using bipolar RFA (B-RFA) in combination with PEI (PEI-B-RFA).

Using ex-vivo porcine liver, this study was performed to verify the coagulated necrosis volumes, tissue electrical conductivity and cyto-destructive effects of RFA with or without PEI. Prior injection of ethanol before RFA decreased tissue impedance with respective increase and decrease of the electrical conductivity and heating efficiency. Because endpoint for B-RFA usually has been given by the total delivered energy, instead of the tissue impedance rise, PEI-B-RFA has a potential risk in terms of incomplete ablation. In clinical settings, when the end-point of PEI-B-RFA was set at the time when the impedance between electrodes became higher than that of baseline, no incomplete ablations were found after PEI-B-RFA.

Pruritus is reported to be complicated with chronic liver diseases and greatly worsens quality of life. However, the current status of pruritus in chronic liver diseases has not been sufficiently clarified. We performed questionnaire survey in 504 patients with chronic liver diseases and investigated factors associated with pruritus. We further analyzed effectiveness of nalfurafine hydrochloride in 20 chronic liver disease patients with pruritus. The incidence of pruritus in chronic liver diseases was 30.8% (155/504). Multivariate analysis revealed that cirrhosis and female gender were independent factors associated with pruritus. In patients with cirrhosis, the incidence and degrees of pruritus increased in accordance with the deterioration of Child-Pugh grade. Nalfurafine hydrochloride improved pruritus in 75% (15/20) of the cases. In conclusion, we should pay attention to pruritus in chronic liver diseases, particularly for cirrhotic and female patients. Nalfurafine hydrochloride was effective for pruritus in chronic liver diseases.

A 48-year-old man with chronic hepatitis C developed ascites, leg edema, and lymphadenopathy within a short duration, and was admitted to our hospital. Biopsy of the right axillary lymph node revealed diagnosis of the hyaline-vascular variant of Castleman disease. Because the findings of liver biopsy corresponded to A1F2, progression of liver cirrhosis was excluded as the cause of the symptoms. The patient's condition, including not only lymphadenopathy, but also pancytopenia, hypoalbuminemia, and renal dysfunction, recovered gradually with corticosteroid therapy. Furthermore, two years after completion of corticosteroid therapy, the patient received antiviral therapy for chronic hepatitis C using Direct acting antivirals (DAAs), which resulted in sustained viral response. All hepatologists should bear in mind that, in patients with chronic hepatitis C presenting with ascites, edema, and lymphadenopathy, hepatitis C virus-related lymphoproliferative disorders, including Castleman disease, should be considered in the differential diagnosis.

A 43-year-old woman with alcoholic liver cirrhosis experienced abdominal distention, respiratory distress, and vomiting in May 2016 and visited the emergency room of the hospital. Her left hand had been injured by her cat, and we observed bites and scratches on her hand. Ascitic fluid culture and blood culture were positive for Pasteurella multocida, and she was diagnosed with P. multocida bacteremia and peritonitis. Antibiotic treatment with ceftriaxone/minocycline and ampicillin/sulbactam was effective and improved the bacteremia and peritonitis. Immunocompromised hosts with conditions like liver cirrhosis, diabetes, and malignancy are at increased risk of contracting a P. multocida infection. For patients with liver cirrhosis, a detailed interview about the history of animal exposure can contribute to the rapid diagnosis of a P. multocida infection. Additionally, health education for pet owners should be provided to prevent P. multocida infection.

Spontaneous tumor rupture is a serious complication of hepatocellular carcinoma. In order to avoid such a situation and to recover serious condition, it is very important whether hemostasis can be achieved by stopping tumor bleeding.

Recent reports revealed that transarterial embolization, we can successfully stop bleeding with high probability, but there are difficult cases to embolize due to anatomical problems. Here, we report a case of percutaneous transhepatic intra-arterial ethanol injection therapy for ruptured hepatocellular carcinoma. In this case, tumor feeding artery diverged from the cystic artery, so we could not performed selective catheter cannulation into the tumor feeding artery. So we attempted arterial puncture under color doppler echo, the artery was identified by ultrasonography using sonazoid. After arterial puncture, we injected ethanol in to the tumor feeding artery until the color doppler signal disappeared, and then we performed dynamic computed tomography. Computed tomography revealed that the tumor stain had disappeared completely. At present this method is not a general treatment, because this approach may lead to serious complications, such as bleeding from the hepatic artery.

In this case report, we think that to establish a treatment method, it is very important to accumulate the resemble cases. And when this treatment is performed, good understanding of not only the overall clinical status but also the hemodynamic profile of the patient is essential.

We report a case of hepatocellular carcinoma developed in a 58-year-old man whose Wilson's disease (WD) was diagnosed at the age of 12 years. The patient was treated with D-penicillamine for over 40 years. Contrast-enhanced CT and MRI revealed two nodules in liver segment 4 (S4) and 8 (S8). The nodule in S8 was confirmed as moderately differentiated hepatocellular carcinoma by targeted liver biopsy. Biopsy specimen from non-tumorous area showed mild fibrosis but the liver was not cirrhotic. Rhodanine stain and Berlin blue stain showed copper and iron accumulation in hepatocytes. Hepatocellular carcinoma was successfully treated with transcatheter arterial chemoembolization and radiofrequency ablation. Development of liver cancer in WD patients is regarded as scarce, especially in non-cirrhotic cases. Herein we discuss hepatic iron accumulation and possible contribution of iron to hepatocarcinogenesis in WD.

Trousseau's syndrome has been reported in 1965 by Armand Trousseau and known as systemic thrombosis complicated with the malignancy. We have experienced two cases of cholangiocellular carcinoma complicated with the Trousseau's syndrome. The cases were 90 years-old male and 58 years-old female with approximately 40 mm-sized liver tumor diagnosed with cholangiocellular carcinoma by various imaging modalities and histological analysis. The tumors progressed significantly in short period and both cases showed Trousseau's syndrome which resulted in patients' death. The patients with malignancy which showed significant progression must be followed up for the thrombosis and if necessary, anti-coagulant therapy should be considered.

To investigate the value of shear wave (SW) speed (m/s) and dispersion slope ([m/s]/kHz), which is related to viscosity obtained by a prototype ultrasound elastography system in rat livers with various degrees of inflammation and fibrosis. SW speed was significantly higher in the fibrosis model rats (G3) than in the inflammation model rats (G1). Dispersion slope was significantly higher in the inflammation model rats (G2) than in the fibrosis model rats (G4). These results indicate that SW speed is more effective than dispersion slope in assessing the degree of fibrosis and also suggest that dispersion slope is more effective than SW speed in assessing the degree of inflammation. Dispersion slope measurements may provide additional pathophysiological insights into liver tissue.