Yasutaka Iguchi

Spontaneous regression of focal nodular hyperplasia of the liver

Focal nodular hyperplasia (FNH) of the liver is a rare benign lesion that probably reflects a local hyperplastic response of hepatocytes to a vascular abnormality. Currently, the natural history of the disease remains largely unknown. We present a patient with FNH of the liver who was followed up for 4 years. A 22-year-old woman with a 3-year history of oral contraceptive use was referred to our hospital in September 1996 for further examination of a liver tumor. A diagnosis of FNH was made using various imaging methods, such as ultrasonography, enhanced computed tomography (CT) scanning, MR imaging, and hepatic angiography, as well as fine-needle biopsy. A decrease in the size of the lesion was observed by enhanced CT scanning during the 4-year observation period. In this patient, oral contraceptive use and its discontinuation may have influenced the natural history of FNH. The present case suggests that an accurate diagnosis is of the utmost importance, and a patient with FNH should be managed conservatively rather than by resection, because FNH has the potential for spontaneous regression with the discontinuation of oral contraceptives.

Long-term evaluation of partial splenic embolization for liver cirrhosis and hepatocellular carcinoma accompanied by hypersplenism

Abstract The long-term effectiveness of partial splenic embolization (PSE) was assessed in patients with liver cirrhosis (LC) and hepatocellular carcinoma (HCC) accompanied by hypersplenism. A total of 54 patients with LC accompanied by hypersplenism were classified into the following three groups: 18 LC patients without HCC who received PSE (group 1); 18 LC patients with unresectable HCC who were simultaneously treated with PSE and transcatheter arterial embolization (TAE) (group 2); and 18 LC patients with unresectable HCC who received TAE alone (group 3). In 36 patients (groups 1 and 2), PSE was indicated when a patient presented with splenomegaly and thrombocytopenia or leukopenia. The group 2 patients continued to show significant increases in the platelet and white blood cell counts and improvement in the hepatic reserve even 2 years after PSE, similar to the group 1 patients. The blood flow through the portal trunk was not significantly affected by PSE, but the splenic venous flow volume decreased significantly, probably reflecting a relative increase in nutritious blood supply from the alimentary tract. These hemodynamic changes may be involved in the post-PSE improvement of the hepatic reserve. As for the group 2 patients, a combination of PSE and TAE resulted in a significantly better prognosis than in the group 3 patients who received TAE alone. However, because of the significantly poor prognosis, PSE is unlikely to be indicated for Child C patients.

Plasma taurine concentration in liver cirrhosis with painful muscle cramps

Abstract To assess the mechanism of painful muscle cramps (MC) associated with liver cirrhosis (LC), the plasma taurine concentration was examined in 28 cases with LC, among which there were 15 cases with MC and 13 cases without MC. The mean plasma taurine level in LC with MC was 56.9 ± 17.3 nmol/ml, whereas that in LC without MC was 79.3 ± 16.7 nmol/ml. In normal controls, the level was 90.1 ± 12.1 nmol/ml. The plasma taurine concentration in LC with MC was significantly lower than in LC without MC or in normal controls. There was no significant difference between normal controls and LC without MC. Following oral administration of taurine to nine cases with MC in doses of 3 g/day for 4 weeks, a 2.2-fold increment of plasma taurine was noted with improvements of MC. These data indicate that MC and the concentration of plasma taurine seem to correlate well and that taurine therapy is justifiable for MC in patients with LC.