This study aims to identify the nutrients affecting the FAST score in nonalcoholic fatty liver patients. Between July 2018 and June 2019, 85 patients who had fatty liver on abdominal computed tomography or ultrasonography were investigated for dietary nutrient intake. There were low intakes of total energy, dietary fat, unsaturated fatty acid, and vitamin E in patients with a high FAST score compared to those with a low FAST score. The logistic regression analysis performed for factors associated with the FAST score showed that age and intake of polyunsaturated fatty acids were significant. In patients with a high FAST score, polyunsaturated fatty acids might be necessary.
A 60-year-old man with HBs antigen-positive disease was admitted to our hospital for treatment of multiple hepatocellular carcinoma (HCC) with portal vein tumor thrombosis. Although transcatheter arterial infusion was performed repeatedly, AFP and PIVKA-II were elevated, and intrahepatic tumors progressed. Therefore, sorafenib was introduced, but HCC kept progressing. Thereafter, we changed from sorafenib to either regorafenib or lenvatinib but returned to sorafenib due to the side effects of these alternatives. Ramucirumab was introduced following sorafenib because of HCC progression. On the fifth day after ramucirumab induction, liver damage and renal dysfunction, elevated uric acid, and decreased blood flow of HCC were observed; as such, the occurrence of tumor lysis was suggested. These laboratory data were improved with a sufficient quantity of infusions and febuxostat. After that, as no abnormality of the data appeared despite ramucirumab re-infusion, he could continue the treatment. Although there are no reports of tumor lysis syndrome due to ramucirumab for HCC, the patient should be monitored for tumor lysis.
Thrombocytopenia is a common feature of decompensated liver disease, with a multifactorial etiology, including decreased thrombopoietin production and splenic sequestration. Severe thrombocytopenia can significantly increase the risk of bleeding during invasive procedures. Recent studies have shown that lusutrombopag is effective in improving thrombocytopenia in patients with cirrhosis needing invasive procedures. However, there is little information on the efficacy of the repeated use of lusutrombopag.
We present a 53-year-old male with decompensated cirrhosis secondary to hepatitis C virus infection. He had a complicated admission requiring endoscopic injection sclerotherapy for esophageal varices, endoscopic submucosal dissection of a colorectal tumor, and percutaneous liver biopsy. Lusutrombopag was successfully administered before each procedure; platelet counts were increased, allowing us to avoid giving him platelet transfusions. This case indicates that the repeated administration of lusutrombopag may be a safe and effective alternative to transfusions in patients with cirrhosis requiring multiple procedures.
The first case was that of a 71-year-old female patient who was referred to our hospital due to a sense of palpitation. Her data were as follows: hemoglobin 7.7 g/dl, haptoglobin less than 10 mg/dl, positivity for Coombs test, which were compatible with autoimmune hemolytic anemia (AIHA). The administration of steroids was effective. One year later, the increases in ALP and gGTP and the positivity of mitochondrial m2 antibody, were recognized. The histology of liver biopsy showed primary biliary cholangitis (PBC) with Nakanuma Stage 2. The second case was that of a 67-year-old male patient who was referred to our hospital due to a brownish color of urine. His data were as follows: hemoglobin 10.3 g/dl, haptoglobin less than 10 mg/dl, positivity for Coombs test, which were compatible with AIHA. The administration of steroids was effective. However, the continuous increases of ALP and gGTP, together with the positivity of mitochondrial m2 antibody were recognized. The histology of the liver biopsy showed PBC with Nakanuma Stage 2. The administration of ursodeoxycholic acid was effective for both cases.
A 76-year-old woman developed jejunal loop varices caused by portal vein occlusion after pancreatoduodenectomy for duodenal cancer. She was referred to our hospital because of recurrent gastrointestinal bleeding from the jejunal loop varices. Endoscopic treatment was difficult because of the anastomosis, as was trans-portal treatment because of the risk of portal vein occlusion. As such, transvenous ileocolic vein obliteration was performed via laparotomy under general anesthesia. There has been no rebleeding subsequently, and careful observation is necessary to monitor for the development of new collaterals and rebleeding.
A 68-year woman sustained a right patellar fracture after falling from a bicycle and was admitted to an orthopedic hospital. Abdominal computed tomography (CT) revealed a hepatic cystic mass measuring 12 cm in diameter. Ultrasonography (US) revealed the mobility of the papillary septum. Magnetic resonance imaging (MRI) revealed the papillary septum and a mural nodule, which showed continuous enhancement in the vascular phase on Sonazoid contrast-enhanced US (CEUS). The papillary septum was not revealed on CT. Due to the tumor enlargement (14 cm) and elevated CA19-9 levels (198.9 U/ml), partial hepatectomy was performed. Histopathological examination of the tumor revealed no malignant component, and the tumor contained fibrin and collesterine caused by hemorrhage without any malignant component. A comparison of the preoperative and postoperative histopathological images revealed features typical of a hemorrhagic hepatic cyst, including the mobility of the papillary septum on US that was not detected by CT, and continuous enhancement of the mural nodule from early to late vascular phase on Sonazoid CEUS.
We developed an artificial intelligence (AI)-based system that enables automated analyses of food intake in patients with cirrhosis and examined its use in terms of acceptance by patients and the analytical power of the system. Using the system, patients would take photos of the food they ate, and the cloud AI system processed the photos and performed nutritional calculations. Patients took photos of their food and subsequently participated in dietary counseling and filled out a questionnaire. A total of ten patients with cirrhosis were enrolled in the study. We demonstrated that AI-based nutritional guidance was well-perceived by patients with cirrhosis and gave them the opportunity to improve their dietary habits. The analytical power of the AI system for nutritional analysis was 65.0%.