Satoshi Itano

Value of fusing PET plus CT images in hepatocellular carcinoma and combined hepatocellular and cholangiocarcinoma patients with extrahepatic metastases: preliminary findings.

Abstract: Background/Aims: This study aimed to evaluate the usefulness of 18F‐fluoro‐2‐deoxy‐d‐glucose positron emission tomography (PET) and PET plus computed tomography (CT) fusion images for the detection of extrahepatic metastases of hepatocellular carcinoma (HCC) and combined hepatocellular and cholangiocarcinoma (combined HCC/CC).

Investigation of associating factors in exacerbation of liver damage after chemotherapy in patients with HBV-related HCC

BACKGROUND/AIMS: Flare-up of hepatitis due to the reactivation of hepatitis B virus (HBV) is a well-known complication in patients with malignant disease who receive chemotherapy. Despite the widespread use of chemotherapy for patients with HBV-related hepatocellular carcinoma (HCC), there is little corresponding data on exacerbation of liver damage in these patients. In the present study, we investigated the associating factors in exacerbation of liver damage in patients with HBV-related HCC who were undergoing trans-hepatic arterial infusion chemotherapy (THAIC). PATIENTS AND METHODS: Thirty-three patients who received THAIC for HCC were investigated. All patients were hepatitis B surface antigen positive. Hepatitis e antigen and antibody were generally tested at baseline and within 1 month of final chemotherapy. Serum alanine aminotransferase, asparate aminotransferase, albumin, total bilirubin, and prothrombin time were estimated once a week or every 2 weeks. HBV-DNA levels were measured at baseline and once a month. Mutation in the regions of precore and core promoter in HBV DNA was generally estimated at baseline and within 1 month of final chemotherapy. RESULTS: Eight patients with hepatitis Be antigen positive and hepatitis Be antibody negative at baseline were found to have exacerbation of liver damage during or after chemotherapy. Of these, three patients died of progressive liver failure. There was no association between exacerbation of liver damage and age, sex, hepatic reserve function, HBV-DNA levels, precore and core promoter sequencing, therapeutic regimen, or tumor stage. The only associating factor was HBeAg positivity. CONCLUSIONS: These results suggest that hepatitis B e antigen positivity is a significant associating factor in exacerbation of liver damage during or after chemotherapy in patients with HBV-related HCC.

Prophylactic Lamivudine Administration Prevents Exacerbation of Liver Damage in HBe Antigen Positive Patients with Hepatocellular Carcinoma Undergoing Transhepatic Arterial Infusion Chemotherapy

BACKGROUND AND AIMS:Exacerbation of liver damage during transhepatic arterial infusion chemotherapy (THAIC) is a critical complication in patients with hepatitis B virus (HBV) related hepatocellular carcinoma (HCC). We previously reported that HBe antigen positivity was the associating factor for the exacerbation of liver damage. In the present study, we investigated the effect of lamivudine administration for exacerbation of liver damage in such patients.PATIENTS AND METHODS:Seventeen patients with HBV-related hepatocellular carcinoma who received THAIC were reviewed. Eight of these patients received lamivudine administration. Nine patients did not receive lamivudine administration. All patients were HBe antigen positive. Liver function tests, liver enzymes, HBV-DNA levels, HBe antigen, HBe antibody, and mutation in the precore and core-promoter regions of HBV DNA were evaluated.RESULTS:In the lamivudine-treated group, HBV-DNA levels were significantly reduced and did not increase throughout chemotherapy. Lamivudine did not induce any changes in precore or core-promoter regions. Although levels of alanine aminotransferase (ALT), asparate aminotransferase (AST), total bilirubin, and prothrombin time (PT) in the lamivudine-treated group did not change, levels of ALT, AST and total bilirubin increased, and PT were prolonged in the untreated group by chemotherapy. No patients receiving lamivudine administration showed exacerbation of liver damage. Exacerbation of liver damage was detected in six patients without lamivudine administration. Of these, three patients died of progressive liver failure due to reactivation of HBV.CONCLUSION:These results indicate that prophylactic lamivudine administration reduces HBV-DNA levels and prevents exacerbation of liver damage throughout the period of chemotherapy in HBe antigen positive patients with hepatocellular carcinoma.

Acute appendicitis caused by amebiasis

Abstract: We report a case of appendicitis caused by amebiasis in a 45-year-old Japanese man. He presented to our hospital with bloody stools in June 1998. Sigmoidoscopy disclosed erosion, and a biopsy of the erosion showed colitis caused by Entamoeba histolytica infection. Four months later, he was admitted to our hospital with a small elastic mass and severe pain in the lower quadrant of the abdomen, which was diagnosed as acute appendicitis. He underwent appendectomy. Histopathological examination revealed numerous E. histolytica trophozoites, and we diagnosed acute appendicitis caused by E. histolytica. The patient has been free of symptoms, colonoscopy has revealed no erosion, and biopsy has revealed no E. histolytica for 12 months after the operation.

Temporary indwelling catheter system via the left brachial artery: evaluation in 83 patients with hepatic tumors.

OBJECTIVE The purpose of our study was to evaluate retrospectively the usefulness and complications associated with a temporary indwelling catheter system through the brachial artery for patients with liver tumors. CONCLUSION The temporary indwelling catheter system via the left brachial artery can be used not only for CO2-enhanced sonographically guided aspiration biopsy, radiofrequency ablation, and percutaneous ethanol injection, but also for short-term hepatic arterial infusion chemotherapy and transcatheter arterial chemoembolization.

Phase II Trial of Hepatic Arterial Infusion Chemotherapy Using Cisplatin and 5-Fluorouracil in Patients with Advanced Hepatocellular Carcinoma

We investigated the effect of hepatic artery infusion (HAI) chemotherapy on advanced hepatocellular carcinoma. Ten milligrams per hour of cisplatin for 1 h and subsequently 250mg/h for 5h of 5-fluorouracil were administered using a subcutaneously implanted vascular access device (an injection port) for 5 consecutive days followed by 2 days rest. One course consisted of repetition of the above dosage regimen for 4 weeks. We treated 77 patients with advanced hepatocellular carcinoma (HCC), excluding nodular-type tumors indicated for chemoembolization, percutaneous ethanol injection therapy, or hepatic resection. Vascular invasion was seen in 28 patients and distant metastasis was seen in 7 patients. Of patients with advanced HCC, 77% were at tumor stage IV. Ten patients (13%) had a complete response, 25 (32%) had a partial response, 30 (39%) exhibited no change, and 12 (16%) had progressive disease. The response rate was thus 46%. Estimated 1-year, 2-year, and 3-year survival by the Kaplan-Meier method in 77 patients was 56%, 28%, and 19%, respectively. According to a multivariate analysis, the effects of initial therapy (P > .0001) and the Child-Pugh grade (P = .0012) were significant prognostic factors. A survival benefit was noted in patients with portal vein invasion (1-year survival rate: 43%, 2- year survival rate: 24%) when compared with reported results, and HAI was considered to be the first choice for unresectable cases. Adverse reactions of patients were tolerable and included transient nausea, loss of appetite, and mild thrombocytopenia. In conclusion, HAI chemotherapy with the regimen described achieved favorable results, and is useful in treating patients with advanced HCC not indicating chemoembolization, hepatic resection, or ethanol injection therapy.

MRI in thorotrastosis

Magnetic resonance imaging (MRI) and computed tomography (CT) were performed in four patients with thorotrastosis. On CT scan, Thorotrast (thorium oxide) deposition was shown as high-density areas in the liver and spleen and the abdominal lymph nodes. These deposits were not found on MRIs. Splenic volume was significantly small due to atrophy. The contrast-noise ratio in the spleen on T1-weighted images was significantly lower. Thorotrast deposition does not affect MRI appearance; therefore it may be useful for the early detection of malignant tumors as a complication of thorotrastosis.

A case of an undifferentiated small cell carcinoma of the esophagus with a primary abdominal mass

SummaryThis paper reports a case with an undifferentiated carcinoma of the esophagus which primarily developed symptoms due to metastatic lesions. The case was a 59-year-old woman with a primary manifestation of an abdominal mass and with subsequent dysphagia. A protruding lesion with ulceration was found at the lower third of the thoracic esophagus by endoscopic examination and was histologically proved to be an undifferentiated carcinoma by biopsy. The abdominal mass was initially thought to be due to metastasis to an abdominal lymph node based on the diagnosis image finding at admission, but it was consequently found by autopsy to be a metastatic tumor in the liver. Therefore, undifferentiated carcinoma of the esophagus should be take into account for differential diagnosis of an abdominal mass.

Functional liver imaging with asialoglycoprotein receptors and serum hyaluronate in a patient with amyloidosis

A 47-year-old man with primary amyloidosis was admitted with abdominal pain. A new radionuclide liver imaging technique using Technetium-99 m diethylenetriamine-pentaacetic acid-galactosyl human serum albumin, was performed and the serum hyaluronate concentration was measured. Although ordinary laboratory tests revealed only slight abnormalities, the uptake of the radiolabelled ligand for hepatocyte asialo-glycoprotein receptors was dereased, and marked hepatomegaly was revealed. Furthermore, the serum hyaluronate level was elevated. Histological examination of a hepatic needle biopsy specimen revealed a marked deposition of amyloid in the hepatic perisinusoidal spaces. These results indicate, that this new radionuclide liver imaging technique (using Technetium-99 m diethylenetriamine-pentaacetic acid-galactosyl human serum albumin) and the measurement of serum hyaluronate may be useful supplementary tools for identifying amyloid deposition in the hepatic perisinusoidal spaces in patients with amyloidosis.

Factors associated with advanced hepatic fibrosis in patients with various internal diseases: A multicenter community-based survey: Hypertension relates to hepatic fibrosis

Advanced hepatic fibrosis can occur in patients with various diseases, including diabetes mellitus and hypertension. We aimed to investigate the prevalence and risk factors of advanced hepatic fibrosis in patients with various internal diseases.