A 75-year-old male who was diagnosed as epilepsy in 1958 and started antiepileptic drugs containing valproic acid. γ-GTP high level and hyperammonemia were pointed out in 2011. No data or findings suggesting liver cirrhosis were observed with blood test, abdominal echo, abdominal contrast CT. Carnitine showed a markedly low value. He was diagnosed with hyperammonemia secondary to carnitine deficiency due to valproic acid therapy. Improvement of serum carnitine concentration, blood ammonia level and subjective symptoms was observed after the administration of levocarnitine. In the case of valproic acid administration, hyperammonemia should be noted and carnitine is needed to be measured to judge adaptation of carnitine replacement therapy.
A 59-year-old woman was admitted to our hospital with a complaint of abdominal pain. Ultrasonography (US) revealed a mass (measuring 3 cm) in segment VII of the liver. The tumor was subsequently diagnosed as hepatocellular adenoma (HA) by histological examination of a liver biopsy specimen. She was routinely followed-up with US assessment every 6 months. Six years later, the tumor had progressed to 4 cm in size. Contrast-enhanced computed tomography and magnetic resonance imaging showed features suspected to indicate malignant transformation of the tumor. We performed laparoscopic hepatectomy of liver segment VII. The final diagnosis, based on pathological examination, was focal nodular hyperplasia-like lesion, rather than malignant transformation of HA.
We conducted a retrospective, single-center, observational study to estimate the positive detection rate for HCV antibodies in the people who underwent an HCV antibody test as part of their physical checkup (comprehensive health checkup). The people who underwent the HCV antibody test as part of their comprehensive health checkup at our hospital between April 1, 2014 and March 31, 2017 were included as subjects. Of the 61578 people who underwent a comprehensive health checkup, 3938 people underwent an HCV antibody test (excluding those who underwent the test again), of which 42 people were positive for HCV antibodies, resulting in a positive rate of 1.07%. The positive rate gradually increased with age up to a peak value of 2.54% (12 of 472 subjects) in the age group of 60-64 year olds, and decreased past that age group.
In terms of future issues, it is considered necessary to confirm whether HCV-RNA is detected in the subjects who were positive for HCV antibodies. As almost the same people undergo regular health checkups every year, a new approach from regular health checkups such as going to a local community to provide health checkups is considered necessary in order to more widely detect still undiagnosed patients infected with HCV.
48 patients with chronic HCV genotype 3a, 3b, 3k, 4 infection were evaluated HCV serological group (serotype). In 25 patients with 3a, serotype 1, serotype 2, and undetected were 28.0%, 4.0%, and 68.0%, respectively. In 21 patients with 3b, serotype 1, serotype 2, and undetected were 38.1%, 4.8%, and 57.1%, respectively. One patient with 3k was serotype 2, and one patient with 4 was serotype 1. In HCV patients except for genotype 1 and 2, there are patients of undetected, or inconsistency between genotype and serotype.
In non-cirrhotic patients without prior NS5A inhibitors regimen, treatment duration of glecaprevir plus pibrentasvir for genotype 1 or 2 (8weeks) is different from that for genotype 3-6 (12weeks). Hence, we emphasized the importance of genotyping in patients except for genotype 1 or 2, at the time of selection of NS5A inhibitors regimen.