We performed a small phlebotomy (50ml) intermittently just before intravenous injection of glycyrrhizin (GL) in eight patients with chronic hepatitis C and continued this therapy until their serum ferritin levels dropped below 20 ng/ml without any changes of GL dosage. No patients had complications but one patient holded treatment according to their wishing. In seven patients who completed this therapy, the average amount of phlebotomized blood was 1221±1055ml, their serum ferritin value significantly fell from 253±233ng/ml to 18±5ng/ml (p=0.038). Serum ALT levels also significantly decreased from 74±22IU/L to 41±12IU/L (p=0.001). Small intermittent phlebotomies before GL injection may be a effective treatment for hepatitis C.
The endoscopic examination of a 63-year-old man revealed a IIc lesion, 5mm in diameter, in the lesser curvature of the gastric body. His serum alpha-fetoprotein (AFP) level was high at 14.3ng/ml. Immunohistological studies on the biopsy specimens showed a positive reaction for AFP. Endoscopic ultrasonography revealed that the tumor was limited to the second layer of the gastric wall and this tumor was diagnosed as mucosal cancer. The final diagnosis was AFP-producing mucosal gastric cancer (AFPMGC). Cases of AFPMGC are rarely encountered. The present case suggested that even minute mucosal gastric cancer could produce AFP.
A 40-year-old man complaining of epigastralgia for one week was admitted. Subacute chronic idiopathic portal thrombosis was diagnosed and he improved by anti-coagulation and fibrinolytic therapy. No predisposing factor was identified. As there are many idiopathic portal thrombosis cases in Japan, and there is a possibility that some inherent thrombus predisposing factors are hidden, further study of this condition is necessary.
A 62-year-old man with a 20-year history of diabetes mellitus presented with appetite loss was found and a large niveau was found in the right subphrenic space on abdominal X-ray film. Ultrasonography and computed tomography showed a large hepatic abscess with gas formation and cholecystitis with a gallstone. Klebsiella pneumoniae was isolated from the abscess, which communicated with the bile duct and was treated with antibiotics and percutaneous drainage. It should thus be noted that increased anaerobic catabolism by microbes and impaired transport of end products may cause gas-formation in patients with diabetes mellitus.
We reported a case of advanced malignant melanoma with multiple metastases to the liver and the gastrointestinal tract. A 69-year-old man was found to have multiple liver tumors and was referred to our hospital. He had a history of chronic hepatitis C, but HCV-RNA was negative and AFP and PIVKA-II were not elevated. Metastatic liver tumors were suggested by abdominal dynamic CT and ultrasonography. Multiple small blackish spots were detected in the gastrointestinal tract. Malignant melanoma was diagnosed by biopsy from the liver tumor and the gastrointestinal tract and remarkable elevation of 5-S-CD 436.4nmol/l. A blackish, slightly elevated lesion was detected in the oral cavity and was thought to be primary site. The patient chose palliative therapy and died 69 days after his first visit to his local doctor.
We report a case of a 34-year-old woman who tested positive for HBs Ag with fibrolamellar hepatocellular carcinoma of the liver. The sister of this patient, who was also positive for HBs Ag, died of hepatocellular carcinoma (HCC). The patient showed elevation of alpha-fetoprotein. Abdominal CT scan showed a tumor in the posterior segment of the liver and hepatic angiography revealed marked neovascularity in the tumor. Partial resection of the liver was performed, and the histological diagnosis was fibrolamellar hepatocellular carcinoma. The patient is now tumor free and doing well 20 months after the operation.
Pancreatic metastasis of malignant melanoma is rarely diagnosed while the patient is alive. We report a case of metastatic melanoma of the pancreas in a 35-year-old woman presenting with a solid mass of the pancreas. Her past medical history included a radical hysterectomy 2 years previously for malignant melanoma of the vagina. Twelve months later, lung metastasis was also resected. EUS-guided fine needle aspiration (EUS-FNA) identified that the pancreatic tumor was histologically and immunohistochemically identical to the surgical specimen of her lung neoplasm. Imaging studies including US, CT, and MRI have limited value to distinguish the tumors from primary ductal adenocarcinoma. EUS-FNA can provide tissue diagnosis from pancreatic masses, specifically when other modalities have failed.