At Nagoya Medical Center, 10 patients co-infected with HIV and HCV received peginterferon α (PEG-IFNα) plus ribavirin therapy. Three of the cases were HCV genotype 1b, 2 cases were HCV 3b, and 1 case each were 2b, 2c, 3a, 4a and 6n. Nine patients received anti HIV therapy from the beginning. In 5 of these patients, anti HIV therapy was modified when PEG-IFNα plus ribavirin treatment was started. Of the above, 7 patients completed the protocol. No patients had severe adverse effects. Sustained virological response was achieved in 1 of 4 (25%) of the patients with genotypes 1 or 4, and in 5 of 6 (83%) of the patients with other genotypes. PEG-IFNα plus ribavirin therapy is considered a safe and efficacious treatment for patients co-infected with HIV and HCV.
We collected data from 2070 patients who had undergone cholecystectomy for acute cholecystitis, investigating the circumstance of preoperative antimicrobial therapy. The duration of preoperative antimicrobial therapy was significantly longer in delayed cholecystectomy than early cholecystectomy (p<0.001). The number of types of antimicrobial drugs was also significantly greater in delayed cholecystectomy patients. The length of preoperative hospital stay in accordance with the number of antimicrobial drugs used in delayed cholecystectomy (p<0.001). This study suggests the importance of early cholecystectomy and the appropriate use of preoperative antimicrobial drugs for acute cholecystitis.
A 69-year-old man was admitted with fatigue, anorexia, and slight fever. Gastroscopy showed a tumor in the stomach, and biopsy revealed a poorly differentiated adenocarcinoma. CT scan revealed a tumor of the stomach, a tumor in the lower lobe of the right lung, and multiple tumors in the liver. Moreover, he was drowsy, probably caused by severe hypocalcemia thought to be caused by parathyroid hormone related protein. We treated him with S-1, but the gastric tumors progressed rapidly and massive pleural effusion developed. He died on the 16th day after admission. At autopsy, the histology of the lung tumor was found to be pleomorphic carcinoma, and that had metastasized to the stomach, the liver, and other abdominal organs. We treated a rare case of pleomorphic carcinoma with hypercalcemia that was discovered due to gastric metastasis.
We report a case of a 68-year-old woman with chronic hepatitis C who presented with a small hepatocellular carcinoma in segment 8 (S8) of liver and a portal hepatic tumor. Transhepatic arterial infusion therapy was performed, followed by partial hepatic resection of S8 and excision of the portal hepatic tumor with lymph node metastasis. Histologically, the lymph nodes showed marked infiltration of large histiocytes with clear cytoplasm and emperipolesis in the specimen stained with hematoxylin-eosin. These findings were generally compatible with the histological features of Rosai-Dorfman disease (RDD). However, immunohistochemical analysis revealed the proliferating histiocytes were negative for CD1a, CD68 and S-100 protein, but positive for only lysozyme. Therefore, we finally diagnosed it as a disease similar to RDD. This was a difficult case diagnostically distinguish between metastasis and benign disease.
A 30-year-old man was admitted to Osaka University Hospital for the treatment of gastric varices and assessment of indication for liver transplant. When he was 6 years old, liver dysfunction was pointed out and diagnosed as chronic inactive hepatitis by liver biopsy. At 13 years of age, the second liver biopsy proved congenital hepatic fibrosis (CHF). The third liver biopsy was performed when he was 30 years old, and the progression of hepatic fibrosis was confirmed. Besides CHF, we recognized oligophrenia, cerebellar ataxia, hypoplasia of cerebellar vermis and coloboma, leading to the diagnosis of COACH syndrome. COACH syndrome is quite rare, and our case is especially valuable because he was diagnosed as an adult case and the progression of hepatic fibrosis could be followed through several liver biopsies. We should be aware of COACH syndrome in mind when we encounter CHF patients.
A 62-year-old woman presented with left abdominal pain. A large and multi-cystic lesion at the pancreas tail was recognized on imaging examinations. MRI revealed low and high signal intensity on T1- and T2-weighted imaging, with focal and bright components in the nodule adjacent to the septum on T2-weighted imaging. Distal pancreatectomy was performed, and the cystic lesion was diagnosed as serous cystic adenoma with hemorrhage. The characters of serous cystic components on imaging examinations could help to distinguish the lesion from mucinous cystic neoplasm.
A 29-year-old pregnant woman was referred to our hospital with suspected acute pancreatitis. On admission, the serum levels of pancreatic enzyme, total cholesterol and triglyceride were markedly elevated, which suggesting acute pancreatitis with hyperlipidemia. Treatment consisted of continuous hemodiafiltration, LDL apheresis, heparin and insulin combination therapy. On the 24th day of hospitalization, a cesarean section delivery resulted in the birth of a healthy infant. We reported a case of hyperlipidemia-induced acute pancreatitis in a woman with second trimester pregnancy, where multidisciplinary treatment was quite effective.
A 78-year-old man with hepatocellular carcinoma treated by chemoembolization and percutaneous ethanol injection was admitted to our hospital because of acute abdomen. The CT scan showed biliary fistula caused by hepatocellular carcinoma protruding from S3. Endoscopic retrograde cholangiopancreatography showed disruption of an intrahepatic duct and the main pancreatic duct, and contrast agent leaked into the peritoneal cavity from each duct. Omental panniculitis with biliary fistula and pancreatic fistula was diagnosed. The symptoms improved by endoscopic nasobiliary drainage and endoscopic pancreatic stenting. On the 13th day after admission, we added endoscopic nasopancreatic drainage because his abdominal pain had been exacerbated by pancreatic juice leakage. Omental panniculitis by hepatocellular carcinoma complicated by biliary fistula and pancreatic fistula is extremely rare. Endoscopic transpapillary pancreaticobiliary drainage was effective for omental panniculitis in this case.