Hideshi Komori

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.

Relationship between asthma and gastro-oesophageal reflux: Significance of endoscopic grade of reflux oesophagitis in adult asthmatics

Background: The association between asthma and gastro‐oesophageal reflux disease (GERD) is well known. The aim of this study was to elucidate the causal relationship between reflux oesophagitis (RE) and asthma.

Histological grading and staging in chronic hepatitis: Its practical correlation

Although the histological features of various causes of chronic liver disease have been well described, usually the inflammatory activity of the disease is important after the cause has been established. Some patients have co‐infection or concomitant liver disease and on occasion it is difficult to decide the treatment. In order to clarify the histological differences, we investigated the inflammatory activity among autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), chronic hepatitis C (CHC) and chronic hepatitis B (CHB) in a standardized way using the modified histological activity index (HAI). According to the modified HAI, inflammatory activity is divided into four categories; categories A/D explains portal/periportal inflammation and categories B/C explains lobular activity. The inflammatory score of AIH tended to be greater in all categories from the early stage of fibrosis, whereas scores of PBC were lower, except for portal inflammation. Chronic hepatitis C patients had portal or periportal inflammation, and their inflammatory scores were linked to the development of fibrosis. Chronic hepatitis B patients tended to have severe lobular injury, but did not have a relationship between the inflammatory score and their stage. To know the distribution of inflammation using the modified HAI scoring system may be helpful and convenient in evaluating patients with chronic inflammatory liver disease.

Power Doppler imaging of hepatic tumours: Differential diagnosis between hepatocellular carcinoma and metastatic adenocarcinoma

We evaluated the usefulness of power Doppler imaging in the differential diagnosis between hepatocellular carcinoma and metastatic adenocarcinoma. Forty‐seven patients with hepatocellular carcinoma and 18 patients with metastatic adenocarcinoma were evaluated using power Doppler imaging. The colour signals of hepatic tumours were graded as follows: 1, colour signals only in the marginal area; 2, small dot or dotted line colour signals within the tumours; 3, continuous solid line colour signals within the tumours. The grade 3 colour signals were classified in the following three patterns; winding line pattern, stretched line pattern and mixed pattern. The colour signals of hepatocellular carcinoma were grade 1 in seven patients, grade 2 in 11 and grade 3 in 29. The colour signals of metastatic adenocarcinoma were grade 1 in three patients and grade 3 in 15. Of the 29 hepatocellular carcinoma patients with a grade 3 signal, 26 patients had winding line patterns and three had mixed patterns. Of the 15 metastatic adenocarcinoma patients with a grade 3 signal, 12 patients had stretched line patterns and three had mixed patterns. In conclusion, power Doppler imaging is useful in the differential diagnosis between hepatocellular carcinoma and metastatic adenocarcinoma to evaluate the colour signal pattern within the tumour.

Growth speed of hepatocellular carcinoma. Relationship with arterial vascularity evaluated by US angiography.

病理学的に組織診断されたHCC 41症例41結節について腫瘍容積倍加時間(TVDT)を求め,US angiographyで評価した動脈性vascularityとの関連について検討した.これら結節のTVDTは対数正規分布の傾向にあった.US angiographyにより,25結節はhypervas-cular,7結節はisovascular, 9結節はhypovascularに分類された.Hypervascular HCC (n=25)のTVDTは21～531日に分布し,対数平均は71日,isovascular HCC (n=7)のTVDTは85～699日に分布し,対数平均149日,hypovascular HCC (n=9)のTVDTは125～1,066日に分布し対数平均374日であった.Hypervascular HCCのTVDTはisovascular HCCに比べ,さらにisovascular HCCのTVDTはhypovascular HCCに比べ有意に短かった.これらの結果より,HCCは動脈性vascularityが高いほど発育速度は速いと考えられた.

Vascularity of advanced gastric carcinoma: evaluation by using power Doppler imaging.

Background: We investigated the vascularity of advanced gastric adenocarcinomas by using percutaneous power Doppler imaging.

Portal venous volume flow: in vivo measurement by time-domain color-velocity imaging

The portal venous velocity and flow volume in 39 patients (16 with liver cirrhosis, 11 with chronic hepatitis, 12 without liver disease) were measured using both color velocity imaging quantification (CVI-Q) and conventional Doppler flowmetry. The average portal venous velocity and flow volume values obtained using the two methods were similar. The correlation coefficients for the paired measurements show positive correlations (velocity: 0.73, p < 0.0001; volume: 0.50, p = 0.001). However, the coefficients of variation between the two methods were not good (velocity: 14.9%, volume: 26.4%). In conventional Doppler flowmetry, the mean velocity to maximum velocity ratio (Vmean:Vmax) is assumed to be constant (Vmean:Vmax = 0.57 in this study). However, the Vmean:Vmax ratios calculated from the flow profile in CVI-Q were 0.67 +/- 0.13 in the patients with liver cirrhosis, 0.58 +/- 0.13 in the patients with chronic hepatitis, and 0.53 +/- 0.08 in the patients without liver disease. Therefore, a measurement method that takes the blood flow profile into account, such as CVI-Q, might be useful for the quantitative measurement of the portal venous velocity and volume.

A case of localized primary sclerosing cholangitis mimicking intrahepatic bile duct cancer

A 75-year-old woman with chronic hepatitis was regularly followed-up in our hospital. A computed tomography (CT) scan revealed an obviously enlarged intrahepatic bile duct in the posterior branch of the left lateral segment. Percutaneous cholangiography revealed an enlarged posterior branch of the left lateral segment and a narrow stenotic region at the root of this branch. We diagnosed her as having intrahepatic bile duct cancer, and a left lateral segmentectomy of the liver was performed. However, microscopic examination of the resected specimens revealed peribiliary fibrosis in the stenotic bile duct and other areas of the intrahepatic bile duct with no malignant cells. Thus, the final diagnosis was made to be primary sclerosing cholangitis. We must consider primary sclerosing cholangitis in the differential diagnosis of localized stenosis of the intrahepatic bile duct.

Budd-Chiari syndrome and extrahepatic portal obstruction associated with congenital antithrombin III deficiency

We report a patient with Budd-Chiari syndrome (BCS) and extrahepatic portal obstruction (EHO) associated with congenital antithrombin (AT) III deficiency. A 35-year-old man was admitted to Nishi Kobe Medical Center for evaluation of abnormal intrahepatic veins. By various imaging modalities, BCS and EHO were diagnosed. Laboratory data revealed parallel decreases in activity and antigen concentration of AT III despite normal liver function. Taken together, the etiology of both BCS and EHO was considered to be thrombosis, associated with congenital AT III deficiency. Two years after beginning warfarin therapy, the patient has no symptoms and his liver function remains normal. Anticoagulant therapy is considered useful for preventing progression of the disease.

SUCCESSFUL TREATMENT OF SEVERE ACUTE PANCREATITIS BY THE COMBINATION THERAPY OF CONTINUOUS ARTERIAL INFUSION OF A PROTEASE INHIBITOR AND CONTINUOUS HEMOFILTRATION: Letters to the Editor

level of 1040 IU/L (normal range, < 400 IU/L). An abdominal X-ray showed the presence of a ‘colon cutoff ’ sign, which means a localized ileus of the transverse colon. An abdominal CT revealed swelling of the pancreas and a small amount of ascites, but no stone in the biliary tract. Under the diagnosis of acute alcoholic pancreatitis, 150 mg mesilate nafamostat (MN; Futhan, Torii, Pharmaceutical Co. Ltd, Tokyo, Japan) and 0.5 g imipenem (IPM) twice per day were infused intravenously. On the third hospital day after his admission, he complained of dyspnea and persistent abdominal pain. An abdominal CT on that day revealed necrosis of the adipose tissue of both the peripancreas and prerenal space (Fig. 1a). Laboratory data revealed the elevation of WBC, LDH and CPK, and the serum calcium level was 7.7 mg/dL. A specimen of arterial blood revealed that the oxygen partial pressure was 58 mmHg, base excess -4 mEq. By using the Japanese standard criteria for the severity of acute pancreatitis, this case was considered to be severe. To inhibit the further deterioration of pancreatitis, we started a CRAI with 200 mg MN during 24 h, 0.5 g IPM twice a day and CH. Two days after the initiation of this combination therapy, abdominal pain disappeared and the laboratory data gradually improved (Fig. 1b). On the fifth hospital day, CH was discontinued because the patient’s condition stabilized. On the 10th hospital day, CRAI was discontinued and the intravenous administration of 40 mg MN was started. His condition further improved, and he was discharged on the 30th hospital day. The effect of intravenous administration of PI for severe acute pancreatitis is controversial. However, it was reported that CRAI yielded approximately fivefold higher levels of PI in the pancreatic tissue than intravenous administration, and markedly decreased the extension of pancreatic necrosis on the experimental pancreatic model. Therefore, CRAI for severe acute pancreatitis has been performed in some facilities since Takeda et al. first reported the effect. In contrast, CH has been performed as one of the treatments for acute pancreatitis for the purpose of removing cytokines and pancreatic enzymes from the blood, and maintaining a patient’s fluid balance. In this case, because the patient’s condition did not improve despite intravenous administration of NM, we started the combination therapy of both CRAI and CH.Two days after this combination therapy was initiated, the patient’s condition was rapidly stablized. As a result, he was treated successfully. An emergent surgical treatment for acute pancreatitis should be avoided as much as possible considering the high occurrence rate of postoperative complications. SUCCESSFUL TREATMENT OF SEVERE ACUTE PANCREATITIS BY THE COMBINATION THERAPY OF CONTINUOUS ARTERIAL INFUSION OF A PROTEASE INHIBITOR AND CONTINUOUS HEMOFILTRATION