FibroScan-AST (FAST) score, which is calculated based on aspartate transaminase, controlled attenuation parameter, and liver stiffness measurement, was recently reported to be useful as a non-invasive assessment for non-alcoholic fatty liver disease (NASH) patients with significant activity [non-alcoholic fatty liver disease (NAFLD) activity score of ≥4] and advanced fibrosis (F≥2). The aim of this retrospective study was to investigate the usefulness of FAST score for Japanese patients with NAFLD. A total of 34 patients who received liver biopsy between April 2018 and March 2020 at Gunma Saiseikai Maebashi Hospital were included. The cut-off value for FAST score was 0.43, with 92.9% sensitivity, 75.0% specificity, and area under the receiver operating characteristic curve (95% confidence interval) of 0.86 (0.74-0.99). In conclusion, FAST score is a useful tool for identifying NASH patients with significant activity and advanced fibrosis. Further study is warranted to establish the optimum cut-off value of FAST score in Japanese patients.

We present a case of hepatitis B virus (HBV) infection in a boy who had appropriate immunoprophylaxis starting at birth and an apparent protective immune response post-vaccination. His mother and elder sister were HBeAg-positive carriers with a high viral load. He received HB immunoglobulin at birth and HB vaccines at birth, 1, and 6 months. His HBs antigen was negative and anti-HBs was 333.8 mIU/ml at 1 year old. Then, at 2 years old, his HBs antigen became positive at 0.25 IU/ml, but anti-HBs was 115.6 mIU/ml. By direct sequencing gene analysis, G145R mutation and P120Q mutation, which are known as vaccine escape mutations, were found in HBV derived from him, his mother, and his sister. It was considered that the HBV had been transmitted horizontally from his mother or sister to him due to immune escape after 1 year of age. For children born to HBV carrier mothers with a high viral load, continuous follow-up after 2 years of age and aggressive booster vaccinations should be considered.

A 68-year-old man who had been treated for an injury sustained in a traffic accident in 2014 was admitted to our hospital because of an elevated serum gamma-GTP level and the suspicion of obstruction of the middle hepatic vein. Abdominal computed tomography revealed right diaphragmatic hernia and atrophic liver parenchyma due to obstruction of the middle hepatic vein. Previous images showed that the diaphragmatic hernia had worsened over time. Since few cases of hepatic vein obstruction secondary to diaphragmatic hernia have been reported to date, we document this rare case.

We herein report a case of inflammatory hepatocellular adenoma in a 22-year-old man associated with long-term antiepileptic therapies. The man was admitted to our hospital with a hepatic tumor identified by abdominal computed tomography (CT). Contrast-enhanced CT and Gd-EOB-DTPA magnetic resonance imaging showed a 23-mm-diameter hypervascular tumor of the liver. Serial images showed an increase in the tumor volume, implying the possibility of hepatocellular carcinoma. Hence, the patient underwent laparoscopic partial hepatectomy. Histopathological findings demonstrated that the liver tumor cells showed little atypia with a funicular structure, sinusoidal dilatation, and thick-walled abnormal vessels. Because immunohistochemical staining was positive for serum amyloid A and C-reactive protein, the tumor was diagnosed as inflammatory hepatocellular adenoma. This case suggests that abnormalities in sex hormones caused by antiepileptic therapies may be responsible for the development of hepatocellular adenoma.

Respiratory dysfunction is a main clinical symptom of COVID-19. Liver dysfunction is also frequently reported in patients with COVID-19 and considered to be related to a poor prognosis. However, the precise mechanisms behind these findings remain unclear. We investigated the clinical features and prognostic factors related to liver dysfunction in 26 COVID-19 patients. The patients with liver dysfunction had markedly higher WBC, neutrophils, CRP, and frequency of oxygen administration and markedly lower PaO₂/FIO₂ ratios. The patients with liver dysfunction had longer mean hospital stays. In conclusion, liver dysfunction at hospital admission may be an important prognostic factor for respiratory failure in patients with COVID-19. We must administer intensive care to these patients earlier to inhibit severe disease progression.

We examined percutaneous treatment for liver abscesses. Abscesses with a diameter of up to 50 mm can generally be treated conservatively or with fine-needle aspiration. When the abscess diameter is >50 mm, continuous drainage can be performed. In addition, for amebic liver abscesses, it is desirable to perform systemic administration of metronidazole immediately after the diagnosis has been made.