Michio Yamane

Radiation therapy in combination with transcatheter arterial chemoembolization for hepatocellular carcinoma with extensive portal vein involvement

The aim of this study was to examine the effectiveness and toxicity of radiation therapy in combination with transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) with extensive portal vein tumor thrombus (PVTT).

Diabetes mellitus may be associated with hepatocarcinogenesis in patients with chronic hepatitis C.

It is unknown whether diabetes mellitus is a risk factor of the hepatocarcinogenesis in patients with chronic hepatitis C. Three hundred eleven anti-hepatitis C virus (HCV) -positive patients who had undergone liver biopsies were studied. Patients with histologically proven cirrhosis or withdrawing within 12 months were excluded. Thus, the remaining 279 patients were followed-up for 65.9 ± 29.4 months until the occurrence of hepatocellular carcinoma (HCC). During the observation period, HCC developed in 13 patients. Diabetes, age, sex, habitual alcohol intake, history of blood transfusion, serum α-fetoprotein level, histological findings, HCV genotype, viral load, and interferon therapy were assessed as potential risk factors. The Cox proportional hazard model identified that diabetes mellitus, histological staging, and age were independently associated with the occurrence of HCC. With multivariate analysis, only diabetes mellitus and age were associated with the occurrence of HCC. Diabetes mellitus may be associated with hepatocarcinogenesis in patients with chronic hepatitis C.

Long-term observation after transjugular intrahepatic portosystemic stent-shunt in two patients with hepatocellular carcinoma.

Two patients with hepatocellular carcinoma (HCC) were treated with transjugular intrahepatic portosystemic stent-shunt (TIPS) and followed for 22 and 58 months thereafter. HCC was well controlled by transcatheter arterial chemoembolization. Hepatic failure or metastasis, especially in the lung, was not observed in the long-term observation. TIPS seems to be useful even in patients with HCC, provided HCC is controlled.

Clinical Significance of Arterial Ketone Body Ratio in Chronic Liver Disease

Background: Arterial ketone body ratio (acetoacetate/3-hydroxybutyrate, AKBR) has been reported to be a useful tool for the estimation of liver functional reserve, but a more recent report has cast doubt on the clinical significance of this redox theory. Furthermore, the effect of a diminution of liver functional reserve on AKBR has not been documented in chronic liver disease. Methods: AKBR was measured in normal control subjects (n = 10), heavy alcohol drinkers (n = 19), patients with chronic hepatitis (n = 18) and patients with liver cirrhosis (n = 25). Results: Though AKBR was lower in heavy alcohol drinkers (1.66 ± 0.82) than in the other noncirrhotic groups (1.97 ± 0.93 in normal control subjects, 2.25 ± 1.11 in patients with chronic hepatitis), this discrepancy did not reach a level of significance. AKBR in patients with liver cirrhosis (1.18 ± 0.52) was significantly lower than that in normal controls (p < 0.01). AKBR in Child’s class A, Child’s class B, and Child’s class C was 1.20 ± 0.60, 1.07 ± 0.56, and 1.27 ± 0.45, respectively, and there were no significant differences among them. Conclusion: AKBR may be parallel to liver mitochondrial redox potential and hepatic functional reserve to some extent, but it does not appear to be an accurate parameter for their estimation.

Choledochal cyst with adenocarcinoma in the cystically dilated intrahepatic bile duct.

Abstract. A rare case of choledochal cyst complicated by papillary adenocarcinoma in the cystically dilated intrahepatic bile duct is reported. The tumor was located in the neck of the cystic lesion, and imaging modalities failed to show communication between the cystic lesion and the bile ducts.

Leukemic mature B-cell neoplasm observed during the treatment with romiplostim in patient with thrombocytopenia and liver cirrhosis

We report here a new adverse event of romiplostim which is a protein analog of thrombopoietin. Leukemic mature B‐cell neoplasm was observed during the treatment of thrombocytopenia in a patient with liver cirrhosis. Their relationship was suggested clinically but the mechanism of leukemic expansion of lymphoma cells was not clarified.

Prompt treatment with peroral N-acetylcysteine for acute yellow phosphorus-induced liver injury: A rescued case report.

致死量をこえる黄リンを服用し, 肝機能障害とビタミンK不応性の凝固障害をきたしながら, N-acetylcysteine (以下NAC) の早期経口投与により救命しえた1例を経験した. 症例は56歳, 女性. 自殺目的にて“猫イラズ”1/2本以上 (黄リン800mg相当以上) をジュースに溶解し服用約2時間後, 嘔吐を主訴に受診した. 服薬状況より致死的と判断し, 同意を得たうえで服用9時間30分後にNACを胃管より投与した. 投与量は急性アセトアミノフェン中毒に準じた. 凝固因子はビタミンK投与にかかわらず, 第4病日にはPT43%, トロンボテスト18%まで低下した. GPTは第5病日に 191IU/lとピークに達したが, 黄疸は認めなかった. 回復期の肝生検では, 肝細胞内のリポフスチンの増加やクッパー細胞の腫大等を認め, 電顕上はrERの減少を認めた. 抗酸化剤のNACには内因性NOの産生・活性化作用が知られており, 黄リンによる急性肝不全を軽減しうる可能性が示唆された.