[Show abstract][Hide abstract] ABSTRACT: Subclinical hypothyroidism (SCH) has been associated with type 2 diabetes mellitus. However, it is unknown whether common complications of type 2 diabetes, such as diabetic nephropathy, are also present with SCH. Here, we investigated the association between SCH and diabetic nephropathy among Japanese patients with type 2 diabetes mellitus. In this multicenter cross-sectional study, we recruited 414 such patients who had no previous history of thyroid disease. Serum thyroid hormone levels and the urinary albumin:creatinine ratio were measured. SCH was defined as an elevated thyroid-stimulating hormone (TSH) level (>4.0 mIU/L), and diabetic nephropathy was defined as creatinine levels ≥300 mg/g. The prevalence of SCH was 8.7% (n = 36) among patients with type 2 diabetes mellitus. The SCH group had a higher prevalence of dyslipidemia (p = 0.008) and diabetic nephropathy (p = 0.014) than the euthyroid group. Multivariate analysis identified significant positive associations between diabetic nephropathy and SCH (odds ratio [OR], 3.51; 95% confidence interval [CI], 1.10-10.0; p = 0.034), hypertension (OR, 4.56; 95% CI, 1.69-14.7; p = 0.001), and smoking (OR, 3.02; 95% CI, 1.14-7.91; p = 0.026). SCH may be independently associated with diabetic nephropathy in Japanese patients with type 2 diabetes mellitus.
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVEWE ESTIMATED THE PREVALENCE OF NOCTURNAL INTERMITTENT HYPOXIA, A SURROGATE MARKER OF OBSTRUCTIVE SLEEP APNOEA, AMONG TYPE 2 DIABETES MELLITUS (T2DM) PATIENTS, AND EXAMINED THE ASSOCIATION BETWEEN NOCTURNAL INTERMITTENT HYPOXIA AND MICROVASCULAR DISEASES.DESIGN AND METHODSWE RECRUITED 513 JAPANESE PATIENTS (292 MEN, 221 WOMEN) WITH T2DM. NOCTURNAL INTERMITTENT HYPOXIA WAS DIAGNOSED USING THE 3% OXYGEN DESATURATION INDEX (ODI), WITH 5 EVENTS/H CORRESPONDING TO NORMAL, AND 5 EVENTS/H CORRESPONDING TO NOCTURNAL INTERMITTENT HYPOXIA.RESULTSTHE PREVALENCE OF NOCTURNAL INTERMITTENT HYPOXIA WAS 45.4% AMONG T2DM PATIENTS. THE NOCTURNAL INTERMITTENT HYPOXIA GROUP WAS OLDER, HAD A HIGHER BMI, GREATER WEIGHT CHANGE SINCE THE AGE OF 20 YEARS, HIGHER SMOKING RATE, AND INCREASED PREVALENCE OF HYPERTENSION, HYPERLIPIDAEMIA, MICROALBUMINURIA, AND MACROALBUMINURIA. MICROALBUMINURIA (MODEL 1: OR, 3.41; 95% CI, 1.85-6.40; model 2: OR, 3.69; 95% CI, 1.85-7.59; model 3: OR, 3.12; 95% CI, 1.45-6.95) and nephropathy (model 1: OR, 3.12; 95% CI, 1.45-6.95; model 2: OR, 7.31; 95% CI, 2.11-31.6; model 3: OR, 5.23; 95% CI, 1.45-23.8) were derived as factors from all 3 statistical models and constantly associated with nocturnal intermittent hypoxia only in women.Conclusions
Nocturnal intermittent hypoxia was highly prevalent among T2DM patients, and may be an independent associated risk factor for microalbuminuria in Japanese women with T2DM.
European Journal of Endocrinology 05/2013; DOI:10.1530/EJE-13-0086 · 3.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Hepatitis C virus (HCV) infection alters fatty acid synthesis and metabolism in association with HCV replication. The present study examined the effect of serum fatty acid composition on interferon (IFN)-based therapy. Fifty-five patients with HCV were enrolled and received IFN-based therapy. Patient characteristics, laboratory data (including fatty acids), and viral factors that could be associated with the anti-HCV effects of IFN-based therapy were evaluated. The effects of individual fatty acids on viral replication and IFN-based therapy were also examined in an in-vitro system. Multivariate logistic regression analysis showed that the level of serum palmitic acid before treatment and HCV genotype were significant predictors for rapid virological response (RVR), early virological response (EVR), and sustained virological response (SVR). High levels of palmitic acid inhibited the anti-HCV effects of IFN-based therapy. HCV replication assays confirmed the inhibitory effects of palmitic acid on anti-HCV therapy. The concentration of serum palmitic acid is an independent predictive factor for RVR, EVR, and SVR in IFN-based antiviral therapy. These results suggest that the effect of IFN-based antiviral therapy in patients with HCV infection might be enhanced by treatment that modulates palmitic acid levels.
[Show abstract][Hide abstract] ABSTRACT: Aim: Patients infected with hepatitis C virus (HCV) genotype 2 are more sensitive to interferon (IFN) therapy than those infected with genotype 1, but 10-20% of patients do not achieve a sustained viral response (SVR) to combination therapy with pegylated (PEG) IFN and ribavirin (RBV). This study examines the prognostic factors associated with SVR in patients infected with HCV genotype 2 treated with PEG IFN and RBV. Methods: We treated 149 patients with chronic hepatitis C caused by HCV genotype 2. The patients received s.c. PEG IFN-α-2b (1.5 µg/kg) and a weekly weight-adjusted dose of RBV (600, 800 and 1000 mg per <60, 60-80 and >80 kg, respectively) for 24 weeks and then prognostic factors associated with the SVR were examined. Results: Among the 149 patients, 138 completed the combination therapy and a sustained viral response was achieved in 71.8% of them. Univariate analysis showed that age, as well as mean RBV and PEG IFN doses were factors affecting the SVR (P = 0.012, =0.021, =0.014). Multivariate analysis identified age and mean PEG IFN dose (P = 0.021, =0.018, respectively) as factors involved in the SVR, but not mean RBV dose. Conclusion: The SVR of patients infected with HCV genotype 2 depended on the dosage of PEG IFN, but not of RBV. Selecting sufficient doses of PEG IFN for combination with RBV is critical for treating such patients.
Hepatology Research 06/2011; 41(8):722-730. DOI:10.1111/j.1872-034X.2011.00816.x · 2.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We describe laparoscopic findings of tuberculous peritonitis in a 68-year-old man and those at follow-up 8 months later. The initial laparoscopic findings revealed typical yellowish-white nodules on the liver surface, and histological findings showed granulomas with caseous necrosis. Laparoscopy 8 months later showed that anti-tubercular drugs had diminished the nodules and adhesions with a fibrin net appearance were evident. Laparoscopy and biopsy are useful for a rapid diagnosis of tuberculous peritonitis.
Internal Medicine 01/2010; 49(4):293-7. DOI:10.2169/internalmedicine.49.2809 · 0.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Intrahepatic lymphocyte subpopulations were studied in eight cases of drug-induced allergic hepatitis (DIAH) by the immunoenzymatic technique using monospecific T cell antibodies and other reagents. In peripheral blood, the CD4: CD8 ratio in DIAH was higher than that in normal controls. In liver tissue, CD8 positive lymphocytes were predominant, and these cells were attached to the surface of hepatocytes. Leu 7, CD4 and CD11 positive lymphocytes were scarce and were not attached to hepatocytes. HLA-class I was displayed on the cell membrane of hepatocytes. These results suggest that cytotoxic T cells, which are CD8 positive, CD4 negative and CD11 negative, may play an important role in the pathogenesis of liver cell injury in patients with DIAH.
Journal of Gastroenterology and Hepatology 03/2008; 2(5):407 - 412. DOI:10.1111/j.1440-1746.1987.tb00183.x · 3.63 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: There is a lack of information regarding the laparoscopic features and interobserver variation of histological diagnosis in patients with non-alcoholic fatty liver disease (NAFLD).
Methods: Thirty-five patients with NAFLD were studied for laparoscopic and histological findings. For the study of interobserver variation of histological diagnosis, two pathologists from different hospitals independently observed the 35 liver samples with patient names blinded to the pathologists. Assessment of laparoscopic findings on the diagnosis of non-alcoholic steatohepatitis (NASH) was also investigated.
Results: Histological diagnoses of the two pathologists were identical in 28 (five fatty liver, 23 NASH) patients, whereas they were not identical in seven patients (20%). The difference of diagnosis was mainly caused by the difference of judgment of minimal fibrosis and minimal necroinflammatory grade. Analysis of the laparoscopic findings revealed that small regular depressions were frequently found on the liver surface in patients with NASH. Scatter of dye on the liver surface facilitated the observation of this finding. Sensitivity and specificity of small depressions in the diagnosis of NASH was 73.9% and 80.0%, respectively.
Conclusion: Interobserver variation of the diagnosis was found in 20% of patients with NAFLD. Small regular depressions were characteristic findings of NASH. Laparoscopy is assessed to be useful for diagnosis of NAFLD, especially of early stage of NASH.
[Show abstract][Hide abstract] ABSTRACT: A 27-year-old man was admitted due to abdominal fullness. He had ascites and subcutaneous nodules on his head, with liver dysfunction and eosinophilia. Abdominal imaging revealed obstruction of the hepatic veins and stenosis of the inferior vena cava. Histological diagnosis of a subcutaneous nodule revealed obstructive thrombophlebitis with eosinophils. Tyrosine kinase created by fusion of the FIP1L1 and PDGFRA genes, which is characteristic of hypereosinophilic syndrome (HES), was detected. He was diagnosed with Budd-Chiari syndrome associated with HES. Liver function tests improved after interventional therapy followed by steroid therapy. It is important to diagnose the cause of Budd-Chiari syndrome.
Internal Medicine 02/2007; 46(14):1095-100. DOI:10.2169/internalmedicine.46.6438 · 0.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Autoimmune hepatitis (AIH) is an inflammatory disease of the liver that usually develops in middle-aged women. However, due to the increasing aging of the population and better diagnostic facilities, AIH is now diagnosed in older patients as well. This analysis compared the clinical and pathologic characteristics of older and middle-aged patients with AIH.
Thirteen older patients with AIH (mean age, 75.0+/-5.3 years; range, 70-89 years) and 27 middle-aged patients (mean age, 51.3+/-5.8 years; range, 41-60 years) were included in this study. In addition, the use of different treatment regimens, including prednisolone therapy and ursodeoxycholic acid (UDCA), was examined.
There were no significant differences in gender, complications of other autoimmune diseases, and liver function tests between groups. However, the degree of hepatic fibrosis was significantly higher in older patients compared with middle-aged patients (P<0.05). Four patients with AIH in the older age group were successfully managed by UDCA alone.
This study shows that older patients with abnormal liver function should be checked for AIH. In addition, UDCA may be an effective drug for management of older patients with AIH.
Hepatology Research 10/2006; 36(2):139-42. DOI:10.1016/j.hepres.2006.06.007 · 2.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The prognosis for patients with decompensated hepatitis B virus (HBV) related liver cirrhosis (LC-B), especially for those with LC-B complicated with hepatocellular carcinoma (HCC), is poor. We investigated the effects of lamivudine in patients with decompensated LC-B, with and without HCC. Decompensated LC-B patients (n=55) with Child-Pugh classification scores (CPS) >7 points were enrolled. All were admitted to the hospitals of the authors between January 1997 and December 2004. Decompensated cases due to a severe exacerbation of hepatitis with CH-B and patients with HCC showing an extra hepatic metastasis or portal vein tumor thrombus were excluded. Some 19 cases (including 5 cases complicated with HCC at the start of therapy) were treated with lamivudine at 100 mg/day (L group), and 36 (including 7 cases with HCC at time of admittance) were treated without lamivudine (non-L group). The median of CPS points in the L group was higher than that of non-L group (11 points versus 9 points, p<0.02). Prothrombin time (%), albumin, ascites, CPS, and HBV-DNA quantity were each significantly improved after 6 months in the L group (p<0.05). A mutation in the YMDD motif was observed in 5 patients in the L group, however liver function did not deteriorate. Further, the survival rate was significantly higher in the L group (p<0.05). HCC was found in 3 L group and 4 non-L group patients during the study. In the L group, all patients complicated with HCC were treated repeatedly or until cured, whereas 91% of those in the non-L group could not be treated (p<0.01). Our results suggest that lamivudine is a useful and important therapy for patients with decompensated LC-B with and without HCC, as well as those who are restricted from having liver transplantation.
[Show abstract][Hide abstract] ABSTRACT: The genotype-related differences between genotype C and genotype D of the hepatitis B virus (HBV) remain unknown. The relationship was studied between the HBV genotypes and their clinical features, paying special attention to genotypes C and D. Serum samples from 413 HBV carriers were genotyped using an enzyme immunoassay (EIA) and by restriction fragment length polymorphism. The nucleotide sequences at the basic core promoter (BCP) and precore (PreC) regions were analysed by direct sequencing. The full genome sequences of three HBV genotype D cases were also examined. Almost all carriers with HBV genotype D were asymptomatic carriers (84.2%). Genotype D was not found in patients with liver cirrhosis and hepatocellular carcinoma. In contrast, carriers with genotype C had mainly chronic liver disease (63.2%; P<0.001). The ratio of hepatitis B e antigen (HBeAg)/anti-HBe was significantly higher in genotype C than in genotype D in the young age-matched group (P<0.01). The mutation at BCP (T1762, A1764) was significantly lower in genotype D than in genotype C among HBeAg-negative patients (P<0.05). The HBV full-genome sequences are very similar to certain HBV genotype D sequences from Europe. In conclusion, genotype C was associated with chronic liver disease, whereas genotype D was related to asymptomatic carriers with earlier HBeAg seroconversion. Thus, the outcome of chronic HBV infection may be different in persons infected with HBV genotypes C and D.
Journal of Medical Virology 04/2004; 72(4):551-7. DOI:10.1002/jmv.20044 · 2.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We found that α-interferon significantly decreased unconjugated bilirubin levels in five patients with Gilbert's syndrome and in 21 patients with chronic hepatitis B who did not have Gilbert's syndrome. Endogenous interferon also appeared to decrease serum unconjugated bilirubin levels in four patients with Gilbert's syndrome who developed upper respiratory tract infection (influenza). Exogenous and endogenous interferons decrease the levels of serum unconjugated bilirubin.
International Hepatology Communications 05/1993; 1(2):91-96. DOI:10.1016/0928-4346(93)90054-J
[Show abstract][Hide abstract] ABSTRACT: To increase the sustained response (SR) rate in chronic hepatitis C (CHC), we tried a combination therapy with interferon (IFN) alpha and beta. Fifty patients were grouped into 4 groups: group 1H (n=9), HCV serotype 1 and high HCV-RNA titer (over 6 log copies/ml); group 1L (n=11), HCV serotype 1 and low HCV-RNA titer (less than 6 log copies/ml); group 2H (n=23), HCV serotype 2 and high HCV-RNA titer; group 2L (n=7), HCV serotype 2 and low HCV-RNA titer. They were given a total dose of 768 MIU which included natural IFN beta (6 MIU) once daily for 28 consecutive days and then natural IFNalpha (10 MIU) three times a week for 20 weeks. Forty-nine patients with CHC receiving IFN alpha at total dose of 480 MIU served as single therapy group. In combination group, SR rate was achieved in 62%, 44% in 1H, 45% in 1L, 70% in 2H, and 86% in 2L, respectively. In single group, SR rate was achieved in 45, 14, 58, 60, and 82%, respectively. There was no significant difference for SR rate between combination group and single group. However, in patients with HCV-RNA titer between 6-7 log copies/ml of 1H group, SR rate in combination group (67%, 4/6) was significantly higher than that of single group (18%, 3/17) (p<0.05). These data suggest the usefulness of combination therapy with IFN alpha and beta in CHC with serotype 1 having moderately high HCV-RNA titer.