Akihiro Okano

Risk of HCV transmission after needlestick injury, and the efficacy of short-duration interferon administration to prevent HCV transmission to medical personnel

Background. We carried out this study to assess the risk of hepatitis C virus (HCV) transmission after needlestick injuries in medical personnel, and to evaluate the efficacy of short-duration interferon administration to prevent HCV transmission. Methods. A total of 684 personnel who had been occupationally exposed to an anti-HCV-positive source and followed for more than 3 months were retrospectively examined. Results. Of the 684 subjects, 279 (41%) were treated with 1 to 3 days of interferon either just after or 1 to 12 days after the injury. One case of HCV infection was found in each of the treated (1/279; 0.4%) and nontreated (1/405; 0.2%) groups. There was no significant difference in the transmission of HCV between the two groups. Both infected patients were treated with interferon after developing acute hepatitis, and HCV was subsequently cleared. Conclusions. There is a lower risk of HCV transmission after needlestick accident than previously reported, and short-duration interferon administration at an early stage after the needlestick injury, to prevent HCV transmission, is unnecessary.

Alcohol sclerotherapy of hepatic cysts: its effect in relation to ethanol concentration

While ultrasonically guided percutaneous aspiration and ethanol injection therapy has proved useful for non-neoplastic giant hepatic cysts that cause symptoms, the optimum quantity of ethanol injected into hepatic cysts has not been established. In eight patients with non-neoplastic giant hepatic cysts who were treated by ethanol injection, ethanol concentration in cystic fluid after treatment was estimated. Ethanol concentrations ranged from 5.9 to 47.6%. Hepatic cyst regressed almost completely in five cases; in all of which, the estimated ethanol concentrations were more than 40%. Our results suggest that it is desirable to drain cystic fluid as much as possible and to inject ethanol as little as possible, so that the estimated ethanol concentration in the cyst exceeds 40% for maximal effect and minimal side effects.

Fibrolamellar carcinoma of the liver with a mixture of ordinary hepatocellular carcinoma: a case report.

Fibrolamellar carcinoma (FLC) of the liver is a rare variant of hepatocellular carcinoma (HCC), and only 13 cases have been reported in Japan up to 1997. We described a histologically unusual case of FLC. A 52-yr-old man was admitted to our hospital for work-up of hepatic mass. Laboratory examinations revealed no abnormalities except elevated serum alpha-fetoprotein (AFP) (2098 ng/ml). A diagnosis of HCC was made by imaging findings, and left lobectomy of the liver was performed. Histologically, the tumor was composed of areas of FLC mixed with ordinary HCC and those of pure ordinary HCC. Staining for AFP was positive in the HCC component and negative in the FLC component. Some cases of such mixed tumors have been reported in Europe and the United States, but not in Japan. We regarded our case as the first of the mixed tumor in Japan.

Focal nodular hyperplasia of the liver without central scar

An unusual case of focal nodular hyperplasia (FNH) of the liver is presented. A 31-year-old male was admitted to our hospital for the evaluation of an hepatic mass 10 cm in diameter located in segment 4. Routine examinations including liver function tests were all normal. Hepatitis B surface antigen, hepatitis C virus antibody, alpha-fetoprotein were all negative. Imagining studies could not detect specific findings of FNH such as a central scar structure or a spoke-wheel appearance due to dilated tumor vessels coursing centrally followed by radiating peripheral coursing vessels. Extensive left lobectomy of the liver was performed. Histological examination of the specimen cut into 1-cm-thick slices revealed no central stellate scars. Preoperative diagnosis of FNH with imaging studies was difficult because of the absence of central scars.

Spontaneous Regression of Hepatocellular Carcinoma due to Disruption of the Feeding Artery

We present an unusual case of spontaneous regression of hepatocellular carcinoma (HCC). A 77-year-old man with alcoholic liver cirrhosis presented with a 50-mm tumor in the Couinauds segment 8 (S8) of the liver, a 15-mm tumor in the S8-7 and 10-mm tumors in the other segments (S4, S6). The tumors were diagnosed as HCC by typical imaging findings and elevated serum alpha-fetoprotein (AFP, 1,825.0 ng/ml) and protein induced by vitamin K absence II (PIVKA II, 3,043 mAU/ml). One month later, AFP and PIVKA II decreased to 51.1 ng/ml and 411 mAU/ml, respectively, and the 50-mm tumor in the S8 became small and completely necrotic on angiography and computed tomography arteriography without any treatment. On the other hand, the 15-mm tumor in the S8-7 decreased in size to 10 mm and received blood supply from the right posterior superior arteries (A7). The other 10-mm tumors remained. Ischemia of the tumors due to disruption of the feeding artery (A8) might have induced tumor regression in the present case.

Therapeutic effects on intestinal Behçet's disease of an intravenous drug delivery system using dexamethasone incorporated in lipid emulsion

Recurrent intestinal ulcer is a frequent problem in the management of Behçet’s disease. However, no standard therapy for intestinal Beheçt’s disease has been established. We report two patients with intestinal Behçet disease and recurrent ileal ulcers who were treated successfuly with a lipid emulsion of dexamethasone. In one patient, the cecal ulcer did not relapse after the intravenous administration initiation of a lipid emulsion of dexamethasone once a week, despite the discontinuation of prednisolone. In the other patient, the cecal ulcer showed a healing tendency, and oral administration of prednisolone was reduced from 40 to 15 mg/day after intravenous administration of a lipid emulsion of dexamethasone. Both patients experienced no complications associated with the administration of the emulsion. These results suggest that an intravenous drug delivery system using a lipid emulsion of dexamethasone is useful for treatment of intestinal Behçet’s disease.

Erratum to: Early diagnosis of pancreatic necrosis based on perfusion CT to predict the severity of acute pancreatitis

Yoshihisa Tsuji • Naoki Takahashi • Hiroyoshi Isoda • Koji Koizumi • Sho Koyasu • Miho Sekimoto • Yuichi Imanaka • Shujiro Yazumi • Masanori Asada • Yoshihiro Nishikawa • Hiroshi Yamamoto • Osamu Kikuchi • Tsukasa Yoshida • Tetsuro Inokuma • Shinji Katsushima • Naoki Esaka • Akihiro Okano • Chiharu Kawanami • Nobuyuki Kakiuchi • Masahiro Shiokawa • Yuzo Kodama • Ichiro Moriyama • Takafumi Kajitani • Yoshikazu Kinoshita • Tsutomu Chiba Published online: 26 April 2017 Japanese Society of Gastroenterology 2017

Spontaneous Regression of Hepatocellular Carcinoma: Its Imaging Course Leading to Complete Disappearance

Spontaneous regression of hepatocellular carcinoma (HCC) is a rare phenomenon. We followed a detailed clinical course of a spontaneous and complete disappearance of HCC during a short interval. A 73-year-old man with hepatitis B virus infection presented with a 15-mm mass in the right anterior superior segment of the liver. The mass was diagnosed as HCC by imaging findings. We found an elevated serum α-fetoprotein (AFP) level of 748 ng/ml. The tumor regressed to 6 mm on imaging examination, and the AFP serum level decreased to 87.8 ng/ml 1 month after the diagnostic hepatic angiography. Therefore, the patient was followed up without any treatment for HCC. The tumor disappeared 5 months later when the AFP serum level was 5.0 ng/ml. The diagnostic hepatic angiography might have had some effect on the spontaneous regression of HCC in the present case.

Immunoglobulin G4-related hepatic inflammatory pseudotumor invading the abdominal wall

A 50-year-old woman presented with epigastralgia. Computed tomography (CT) of the abdomen revealed a 6-cm well-enhanced mass extending from the left lobe of the liver to the abdominal wall, suggestive of cholangiocarcinoma. Liver and skin mass biopsies did not provide evidence of hepatic malignancy but were rich in plasma cells and sclerotic lesions. Subsequent detection of elevated serum immunoglobulin G4 (IgG4) led to a diagnosis IgG4-related inflammatory pseudotumor (IPT) of the liver. Treatment with systemic corticosteroids resulted in rapid clinical improvement. This case is the first report of an IgG4-related hepatic IPT invading the abdominal wall.

Rectosigmoid xanthoma as a predictive marker for sporadic rectosigmoid cancer.

REFERENCES 1. George S. NHS Direct audited. BMJ. 2002;324:558–559. 2. Gogel HK, Lynn RM, Burdon JA, et al. Telephone use and costs in a group subspecialty practice. West J Med. 1995;163:183–184. 3. Johnson BE, Johnson CA. Telephone medicine: a general internal medicine experience. J Gen Intern Med. 1990;5:234–239. 4. Grigsby J, Sanders J. Telemedicine: where it is and where it’s going. Ann Intern Med. 1998;129:123–127. 5. Mair F, Whitten P. Systematic review of studies of patient satisfaction with telemedicine. BMJ. 2000;320:1517–1520. 6. Cohen MD, Hawes DR, Hutchins GD, et al. Activity-based cost analysis: a method of analyzing the financial and operating performance of academic radiology departments. Radiology. 2000;215: 708–716. 7. Dowless RM. Using activity-based costing to guide strategic decision making.Healthc Financ Manage. 1997;51:86–90.