Long-term administration of SGLT2 inhibitors may be useful for metabolic dysfunction-associated steatotic liver disease (MASLD) in patients with diabetes. A considerable decrease in alanine transaminase levels was observed with the administration of SGLT2 inhibitors in patients with low levels of fibrosis markers, such as M2BPGi, type IV collagen 7S, and hyaluronic acid at the start of administration. Additionally, patients require guidance on maintaining a regular diet and exercise therapy to improve hepatic steatosis as well as reduce alanine transaminase and HbA1c levels during long-term administration of SGLT2 inhibitors.

A woman in her 60s visited our department with a chief complaint of dyspnea on exertion and pain in the right hypochondrium. Ten intrahepatic cysts, one with a maximum diameter of 14 cm, were found in her liver. Angiosarcoma in conjunction with simple hepatic cysts is rare. The intrahepatic cystic lesions were undetected three years earlier. Endoscopic ultrasonography, computed tomography, magnetic resonance imaging, integrated positron emission tomography/computed tomography, gastroscopy, colonoscopy, contrast-enhanced ultrasonography, and cytology by cystocentesis were performed to investigate malignancy, but none of those tests revealed malignant findings. Nevertheless, based on the patient's clinical course, a diagnosis of malignancy was made, and an extended resection of the right hepatic lobe was performed. The large cyst was a neoplastic lesion with a vascular-like structure, whose inner surface was lined with atypical CD31- and CD34-positive cells. The lesion was pathologically diagnosed as angiosarcoma.

We present the case of a 43-year-old male with metabolic dysfunction-associated steatotic liver disease (MASLD) who developed hepatocellular carcinoma (HCC). He was regularly followed by a primary care practitioner for morbid obesity, type 2 diabetes mellitus, and MALSD. Contrast-enhanced computed tomography and gadoxetic acid-enhanced magnetic resonance imaging revealed a mass in liver segment 5, suspected for HCC. Histopathologic examination of the tumor resected by laparoscopic-assisted partial hepatectomy led to the diagnosis of moderately differentiated steatohepatitic HCC. The noncancerous lesion was diagnosed as stage 4 metabolic dysfunction-associated steatohepatitis according to Brunt's classification. Eight months after initial admission, he underwent transcatheter arterial chemoembolization for recurrent HCC. The patient is currently considered a candidate for living-donor liver transplantation due to deteriorated liver functional reserve.

Owing to the high cost of direct-acting antivirals (DAAs), most patients with hepatitis C virus (HCV) infection seeking antiviral therapies frequently utilize a government subsidy. This subsidy can only be obtained through doctors who are authorized by prefectural governments, and the patient must fill out a medical certificate. Since doctors in Suzu General Hospital are unauthorized, patients admitted for HCV infection had difficulty obtaining adequate antiviral therapies. At that time, some authorized and specialized doctors in Ishikawa Prefecture helped five admitted patients with HCV infection apply for the subsidy using telemedicine. Finally, using the subsidy, the patients were treated with DAAs and achieved a sustained viral response. Proving telemedicine's utility in availing antiviral therapies to patients with HCV infection.