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Motokazu Mukaide,
Yasuhito Tanaka,
Tadasu Shin-I,
Man-Fung Yuen,
Fuat Kurbanov,
Osamu Yokosuka,
Michio Sata,
Yoshiyasu Karino, Gotaro Yamada,
Kohsaku Sakaguchi,
Etsuro Orito,
Manami Inoue,
Sumbella Baqai,
Ching-Lung Lai,
Masashi Mizokami
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Namiki Izumi,
Yasuhiro Asahina,
Masayuki Kurosaki, Gotaro Yamada,
Tsutomu Kawai,
Eiji Kajiwara,
Yukishige Okamura,
Takayuki Takeuchi,
Osamu Yokosuka,
Kazuya Kariyama, [......],
Hisataka Moriwaki,
Hiroshi Adachi,
Shinji Katsushima,
Masatoshi Kudo,
Kouichi Takaguchi,
Yoichi Hiasa,
Kazuaki Chayama,
Hiroshi Yatsuhashi,
Makoto Oketani,
Hiromitsu Kumada
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ABSTRACT: BACKGROUND: We investigated whether the administration of maintenance doses of interferon prevented hepatocellular carcinoma (HCC) in patients with chronic hepatitis C. METHODS: Study 1: A multicenter, retrospective, cooperative study was carried out to determine whether long-term administration of low-dose peginterferon alpha-2a (PegIFNα-2a) prevented HCC development in patients with chronic hepatitis C. In total, 594 chronic hepatitis C patients without a history of HCC were enrolled and treated with 90 μg PegIFNα-2a administered weekly or bi-weekly for at least 1 year. Study 2: HCC developed in 16 of 99 additional patients without PegIFNα-2a treatment during 3.8 years of observation. A propensity-matched control study was then carried out to compare the incidence of HCC between the 59 patients who received low-dose PegIFNα-2a (PegIFNα-2a group) and 59 patients who did not receive PegIFNα-2a treatment (control group), matched for sex, age, platelet count, and total bilirubin levels. RESULTS: Study 1: HCC developed in 49 patients. The risk of HCC was lower in patients with undetectable hepatitis C virus RNA, ≤40 IU/L alanine aminotransferase (ALT), or ≤10 ng/L alpha-fetoprotein (AFP) 24 weeks after the start of therapy. Study 2: The incidence of HCC was significantly lower in the PegIFNα-2a group than in the control group. CONCLUSIONS: Low-dose and long-term maintenance administration of PegIFNα-2a decreased the incidence of HCC in patients with normalized ALT and AFP levels at 24 weeks compared with patients without normal ALT and AFP levels.
Journal of Gastroenterology 08/2012; · 4.16 Impact Factor
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Miwa Kawanaka,
Takahito Oka,
Noriyo Urata,
Tomonari Kimura,
Jun Nakamura,
Daisuke Goto,
Ryumei Yamato,
Ken Nishino,
Mitsuhiko Suehiro,
Hirofumi Kawamoto, Gotaro Yamada
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ABSTRACT: The present study investigated the clinical characteristics of non-alcoholic steatohepatitis (NASH) patients who progressed from stage 3, zone 3 bridging fibrosis (F3 stage NASH) to cirrhosis. Of 95 NASH patients with repeated liver biopsies during a period of 4.6 years, 6 patients progressed to cirrhosis. The initial liver biopsies of these 6 patients were diagnosed as F3 stage NASH. Simple clinical variables and non-invasive biological tests were evaluated in 33 cases of F3 stage NASH. Increases in body mass index and fluctuations in transaminase levels, as well as the evaluation of homeostatic model assessment-insulin resistance, ferritin, and hyaluronic acid in F3 stage NASH patients may prove useful in identifying individuals at risk of progression to cirrhosis.
Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 01/2012; 109(12):2042-2048.
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Haruhiko Kobashi,
Yasuhiro Miyake,
Fusao Ikeda,
Tetsuya Yasunaka,
Ken Nishino,
Akio Moriya,
Jyunichi Kubota,
Shinichiro Nakamura,
Akinobu Takaki,
Kazuhiro Nouso, Gotaro Yamada,
Kazuhide Yamamoto
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ABSTRACT: Aim: We conducted this prospective study to elucidate the long-term outcome and incidence of hepatocellular carcinoma (HCC) development after nucleos(t)ide analog (NA) treatment in patients with chronic hepatitis B (CHB) or cirrhosis.Methods: CHB or cirrhosis patients without past NA treatment or HCC were started on entecavir (ETV) or lamivudine (LVD), and prospectively followed up with monthly blood tests, and with abdominal imaging every 6 months in CHB and every 3 months in cirrhosis patients.Results: A total of 256 subjects with CHB (n = 194) or cirrhosis (n = 62) received ETV (n = 129) or LVD (n = 127) for 4.25 years (range: 0.41–10.0). After NA treatment, serum HBV DNA, alanine aminotransferase and α-fetoprotein (AFP) dropped significantly, along with significant increases in serum albumin and prothrombin time. Drug-resistance developed in 60 cases in the LVD group and in only one case in the ETV group. HCC developed in 35 patients, and the incidence at years 1, 3, 5, 7 and 10 was significantly higher in patients with cirrhosis (8.1%, 17.5%, 43.2%, 46.7% and 53.4%, respectively) than chronic hepatitis (1.6%, 3.5%, 3.5%, 7.1% and 29.6%, respectively), with no difference between ETV and LVD. After NA treatment, the sensitivity/specificity for HCC of AFP and des-γ-carboxy prothrombin (DCP) was 45.7%/97.3% and 33.3%/96.2%, respectively, with the specificity of AFP being higher than at baseline (64.4%), at the cut-off of 10 ng/mL.Conclusion: NA exerted a long-term efficacy and improved hepatic reservation in CHB and cirrhosis. After NA treatment, AFP dropped to lower than 10 ng/mL with marked elevation of specificity, leading to an earlier detection of HCC.
Hepatology Research 03/2011; 41(5):405 - 416. · 2.20 Impact Factor
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Tatsuya Ide,
Michio Sata,
Kazuaki Chayama,
Michiko Shindo,
Joji Toyota,
Satoshi Mochida,
Eiichi Tomita,
Hiromitsu Kumada, Gotaro Yamada,
Hiroshi Yatsuhashi,
Norio Hayashi,
Hiroki Ishikawa,
Taku Seriu,
Masao Omata
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ABSTRACT: Current Japanese guidelines recommend that patients should be switched from lamivudine to entecavir when they meet certain criteria. This analysis examines the efficacy and safety of long-term entecavir therapy in patients who were switched to entecavir after 24 weeks' lamivudine therapy in Japanese studies ETV-047 and ETV-060.
The Phase II Japanese study ETV-047 assessed the efficacy of different entecavir doses when compared with lamivudine. A total of 33 Japanese patients who received lamivudine 100 mg daily in ETV-047 entered the open-label rollover study ETV-060 and subsequently received treatment with entecavir 0.5 mg daily. Hepatitis B virus (HBV) DNA suppression, alanine aminotransferase (ALT) normalization, hepatitis B e antigen (HBeAg) seroconversion, and resistance were evaluated among patients with available samples for up to 96 weeks. Safety was assessed throughout the treatment period.
After 96 weeks of entecavir therapy in ETV-060, 90% of patients achieved HBV DNA <400 copies/mL as compared to 21% of patients who completed 24 weeks of lamivudine therapy in ETV-047. Increasing proportions of patients achieved ALT normalization and HBeAg seroconversion following long-term entecavir treatment. No patients experienced virologic breakthrough, and substitutions associated with entecavir resistance were not observed in patients with detectable HBV DNA. Entecavir was well tolerated during long-term treatment.
Switching lamivudine-treated patients with chronic hepatitis B to entecavir results in increased virologic suppression with no evidence of resistance through 2 years of entecavir therapy. These findings support recommendations in the current Japanese treatment guidelines that stable lamivudine patients should be switched to entecavir.
Hepatology International 01/2010; 4(3):594-600. · 2.64 Impact Factor
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Motokazu Mukaide,
Yasuhito Tanaka,
Tadasu Shin-I,
Man-Fung Yuen,
Fuat Kurbanov,
Osamu Yokosuka,
Michio Sata,
Yoshiyasu Karino, Gotaro Yamada,
Kohsaku Sakaguchi,
Etsuro Orito,
Manami Inoue,
Sumbella Baqai,
Ching-Lung Lai,
Masashi Mizokami
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ABSTRACT: The mechanism by which entecavir resistance (ETVr) substitutions of hepatitis B virus (HBV) can induce breakthrough (BT) during ETV therapy is largely unknown. We conducted a cross-sectional study of 49 lamivudine (LVD)-refractory patients and 59 naïve patients with chronic hepatitis B. BT was observed in 26.8% of the LVD-refractory group during weeks 60 to 144 of ETV therapy. A line probe assay revealed ETVr substitutions only in the LVD-refractory group, i.e., in 4.9% of patients at baseline, increasing to 14.6%, 24.4%, and 44.8% at weeks 48, 96, and 144, respectively. Multivariate logistic regression analysis adjusted for age, gender, HBV DNA levels, and LVD resistance (LVDr) (L180M and M204V, but not M204I) indicated that T184 substitutions and S202G (not S202C) were a significant factor for BT (adjusted odds ratio [OR], 141.12, and 95% confidence interval [CI], 6.94 to 2,870.20; OR, 201.25, and 95% CI, 11.22 to 3608.65, respectively). Modeling of HBV reverse transcriptase (RT) by docking simulation indicated that a combination of LVDr and ETVr (T184L or S202G) was characterized by a change in the direction of the D205 residue and steric conflict in the binding pocket of ETV triphosphate (ETV-TP), by significantly longer minimal distances (2.2 A and 2.1 A), and by higher potential energy (-117 and -99.8 Kcal/mol) for ETV-TP compared with the wild type (1.3 A; -178 Kcal/mol) and LVDr substitutions (1.5 A; -141 Kcal/mol). Our data suggest that the low binding affinity of ETV-TP for the HBV RT, involving conformational change of the binding pocket of HBV RT by L180M, M204V plus T184L, and S202G, could induce BT.
Antimicrobial Agents and Chemotherapy 11/2009; 54(2):882-9. · 4.84 Impact Factor
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ABSTRACT: Wilson's disease is one of the most common hereditary causes of unclear hepatopathy. PATIENT #ENTITYSTARTX00026;
A 34-year old male patient with a history of hyperlipidemia was admitted with symptoms of abdominal pain and slight hematuria. Abnormal liver function tests, ultrasound reports and liver biopsy were suggestive of nonalcoholic steatohepatitis (NASH). The patient received preliminary treatment for NASH. However, on subsequent follow-up, NASH remained unresolved and liver histology showed fibrosis progression from fibrosis stage 1 to stage 3.
Biochemical tests revealed that the levels of serum ceruloplasmin were decreased (7mg/dl) while the urinary excretion of copper was found to be increased (174.2 μg/day). Wilson's disease was confirmed by diagnostic mutation analysis involving Direct Sequencing. Heterogeneity in the patient's ATP7B gene confirmed Wilson's disease. Administration of D-penicillamine resulted in a decrease in fat deposition in the liver and no further progression in fibrosis after 10 months.
Adult patient presenting NASH as first symptoms need to be examined for Wilson's disease and other metabolic conditions affecting the liver, prior to initiation of treatment.
North American journal of medical sciences. 07/2009; 1(2):74-6.
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Atsunori Kusakabe,
Yasuhito Tanaka,
Satoshi Mochida,
Nobuaki Nakayama,
Kazuaki Inoue,
Michio Sata,
Norio Isoda,
Jong-Hon Kang,
Yasukiyo Sumino,
Hiroshi Yatsuhashi, [......],
Yoshiyasu Karino,
Eiji Tanaka,
Junji Kato,
Isao Sakaida,
Namiki Izumi,
Fuminaka Sugauchi,
Shunsuke Nojiri,
Takashi Joh,
Yuzo Miyakawa,
Masashi Mizokami
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ABSTRACT: Background: Host and viral factors can promote the development of fulminant hepatitis B (FHB), but there have been no case-control studies for figuring out virological parameters that can distinguish FHB. Methods: In a case-control study, virological factors associated with the development of FHB were sought in 50 patients with FH developed by transient hepatitis B virus (HBV) infection (FH-T) and 50 with acute self-limited hepatitis B (AHB) who were matched for sex and age. In addition, 12 patients with FH developed by acute exacerbation (AE) of asymptomatic HBV carrier (ASC) (FH-C) were also compared with 12 patients without FH by AE of chronic hepatitis B (AE-C). Results: Higher HBV DNA levels, subgenotype B1/Bj, A1762T/G1764A, G1896A, G1899A and A2339G mutation were significantly more frequent (P < 0.05), while hepatitis B e-antigen was less frequent in the FH-T patients than AHB. In multivariate analysis, G1896A mutation (odds ratio [OR], 13.53; 95% confidence interval [CI], 2.75-66.64), serum HBV DNA more than 5.23 log copies/mL (OR, 5.14; 95% CI, 1.10-24.15) and total bilirubin more than 10.35 mg/mL (OR, 7.81; 95% CI, 1.77-34.51) were independently associated with a fulminant outcome by transient HBV infection. On the other hand, in comparison with the patients between FH-C and AE-C groups, there was no significant difference of virological factors associated with the development of FHB. Conclusion: A number of virological factors have been defined that may distinguish FH-T from AHB in a case-control study. The pathogenic mechanism of FHB between transient HBV infection and AE of ASC would be different.
Hepatology Research 05/2009; 39(7):648-56. · 2.20 Impact Factor
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ABSTRACT: The natural history of alcoholic cirrhosis, especially in Asian countries, has not been completely understood thus far.
We retrospectively compared the outcomes of compensated cirrhosis between Japanese alcoholic and hepatitis C virus (HCV)-infected patients.
A total of 227 patients (75 alcoholic and 152 HCV-infected patients) with compensated cirrhosis were enrolled. The median follow-up period was 4.9 years. The cumulative rates of hepatocellular carcinoma (HCC) development were significantly lower in the alcoholic patients than in the HCV-infected patients (6.8% vs 50.3% at 10 years, P = 0.0003), while the cumulative rates of hepatic decompensation (37.4% vs 51.7% at 10 years) and survival (53.8% vs 47.4% at 10 years) did not significantly differ between the two groups (Kaplan-Meir analysis). The main causes of death were hepatic failure and non-hepatic diseases in the alcoholic patients and HCC and hepatic failure in the HCV-infected patients. Multivariate analyses using the Cox proportional hazard model revealed that the risk of HCC was lower in alcoholic cirrhosis than in HCV-related cirrhosis (hazard ratio (HR), 0.46), while the risk of hepatic decompensation and mortality was the same. Predictors of decreased survival were non-abstinence (HR, 2.53) in the alcoholic patients and low serum albumin level (1.58) in the HCV-infected patients.
Survival of patients with alcoholic cirrhosis was similar to that of patients with HCV-related cirrhosis. The risk of HCC development was lower in alcoholic cirrhosis than in HCV-related cirrhosis. Abstinence from alcohol was important for improving the survival of patients with alcoholic cirrhosis.
Journal of Gastroenterology and Hepatology 05/2009; 24(7):1276-83. · 2.87 Impact Factor
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Kentaro Matsuura,
Yasuhito Tanaka,
Shuhei Hige, Gotaro Yamada,
Yoshikazu Murawaki,
Masafumi Komatsu,
Tomoyuki Kuramitsu,
Sumio Kawata,
Eiji Tanaka,
Namiki Izumi, [......],
Takeshi Okanoue,
Keisuke Hino,
Yoichi Hiasa,
Michio Sata,
Tatsuji Maeshiro,
Fuminaka Sugauchi,
Shunsuke Nojiri,
Takashi Joh,
Yuzo Miyakawa,
Masashi Mizokami
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ABSTRACT: Acute hepatitis B virus (HBV) infection has been increasing through promiscuous sexual contacts, and HBV genotype A (HBV/A) is frequent in patients with acute hepatitis B (AHB) in Japan. To compare the geographic distribution of HBV genotypes in patients with chronic hepatitis B (CHB) in Japan between 2005 and 2006 and between 2000 and 2001, with special attention to changes in the proportion of HBV/A, a cohort study was performed to survey changes in genotypes of CHB patients at 16 hospitals throughout Japan. Furthermore, we investigated the clinical characteristics of each genotype and examined the genomic characteristics of HBV/A isolates by molecular evolutionary analyses. Of the 1,271 patients, 3.5%, 14.1%, and 82.3% were infected with HBV/A, -B, and -C, respectively. In comparison with our previous survey during 2000 and 2001, HBV/A was twice as frequent (3.5% versus 1.7%; P = 0.02). The mean age was lower in the patients with HBV/A than in those with HBV/B or -C. Based on phylogenetic analyses of 11 full-length genomes and 29 pre-S2/S region sequences from patients, HBV/A isolates were imported from Europe and the United States, as well as the Philippines and India. They clustered with HBV/A from AHB patients and have spread throughout Japan. HBV/A has been increasing in CHB patients in Japan as a consequence of AHB spreading in the younger generation through promiscuous sexual contacts, aided by a tendency of HBV/A to induce chronic hepatitis. The spread of HBV/A infection in Japan should be prevented by universal vaccination programs.
Journal of clinical microbiology 04/2009; 47(5):1476-83. · 4.16 Impact Factor
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ABSTRACT: Although both primary biliary cirrhosis (PBC) and idiopathic thrombocytopenic purpura (ITP) are autoimmune diseases, the association of the 2 diseases is rare. Here, we report a case of ITP that developed during the follow-up of PBC in a 74-year-old man. The patient had been diagnosed with PBC 12 years previously, and had received treatment with ursodeoxycholic acid. The platelet count decreased from approximately 60 x 10(9)/L to 8 x 10(9)/L, and the association of decompensated liver cirrhosis (PBC) with ITP was diagnosed. Steroid and immune gamma globulin therapy were successful in increasing the platelet count. Interestingly, human leukocyte antigen genotyping detected the alleles DQB1*0601 and DRB1*0803, which are related to both PBC and ITP in Japanese patients. This case suggests common immunogenetic factors might be involved in the development of PBC and ITP.
World Journal of Gastroenterology 05/2008; 14(15):2451-3. · 2.47 Impact Factor
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Takeshi Okanoue,
Yoshito Itoh,
Masahito Minami,
Hiroaki Hashimoto,
Kohichiro Yasui,
Hiroshi Yotsuyanagi,
Tetsuo Takehara,
Takashi Kumada,
Eiji Tanaka,
Shuhei Nishiguchi,
Namiki Izumi,
Michio Sata,
Morikazu Onji, Gotaro Yamada,
Kiwamu Okita,
Hiromitsu Kumada
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ABSTRACT: Aim: We aimed to identify the candidates for antiviral therapy, among patients who are hepatitis C virus (HCV) carriers with normal serum aminotransferase (ALT), focused on the inhibition of hepatocellular carcinoma (HCC). Methods: Four hundred and sixty-four HCV carriers with normal serum ALT and 129 HCV carriers with persistently normal ALT (PNALT) and platelet (PLT) counts >/=150 000/muL who received liver biopsies were enrolled. HCV carriers with normal serum ALT were divided into four groups according to their ALT levels (</=30 U/L or 31-40 U/L) and PLT counts (>/=150 000/muL or <150 000/muL). Results: In 129 HCV carriers with PNALT, the rate of progression of fibrosis stage was 0.05/year and no HCC was detected during the follow up for 10 years. Approximately 20% of patients with ALT </=40 U/L and PLT counts >/=150 000/muLwere at stage F2-3; however, approximately 50% of patients with ALT </= 40 U/L and PLT counts <150 000/muL were at stage F2-4. An algorithm for the management of HCV carriers with normal serum ALT was advocated based on ALT and PLT counts. Conclusion: The combination of ALT and PLT counts is useful for evaluating the fibrosis stage in HCV carriers with normal serum ALT. Most patients with PLT counts <150 000/muL are candidates for antiviral therapy, especially those with ALT levels >/=31 U/L when we focus on the inhibition of the development of HCC.
Hepatology Research 01/2008; 38(1):27-36. · 2.20 Impact Factor
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ABSTRACT: BACKGROUND and objective: In Japan the prevalence of the hepatitis C virus (HCV) antibody is highest in the elderly population. Therefore, it is important for elderly patients to undergo interferon (IFN) therapy. In patients with HCV genotype 1b and a high viral load, the sustained virological response (SVR) rate is lower in older compared with younger patients receiving combination antiviral therapy. In addition, inadequate adherence to combination therapy is often seen in elderly patients, and is associated with reduced response rates. The aim of this retrospective analysis was to evaluate the effects of host-related factors (i.e. sex, age, baseline HCV RNA level, bodyweight and fibrosis stage) and peginterferon (PEG IFN)-alpha-2a plus ribavirin dose reductions on SVR rates.
A total of 192 treatment-naive patients with a HCV genotype 1b infection and a high viral load were included in the analysis. Patients had been enrolled into a phase III trial of 48 weeks of treatment with PEG IFN-alpha-2a plus ribavirin or PEG IFN-alpha-2a plus placebo. All patients were evaluated for effect of drug exposure on SVR. In addition, the impact of host-related factors or dose reductions on SVR was assessed.
Approximately 30% of patients were considered elderly (> or =60 years of age). The overall SVR rate was significantly higher in patients treated with combination therapy versus monotherapy (59.4% vs 24.0%, p < 0.001). Attainment of an SVR following combination therapy was not influenced by any factor evaluated in the analysis, although elderly males were associated with decreased SVR rates. Younger age (odds ratio [OR] 1.081; 95% CI 1.125, 1.034; p = 0.0009), lower baseline HCV RNA levels (OR 1.003; 95% CI 1.006, 1.001; p = 0.006) and a severe fibrosis stage (F3/4) [OR 6.194; 95% CI 1.037, 37.000; p = 0.0455] significantly increased the likelihood of achieving an SVR with monotherapy. In the combination therapy group, patients maintaining a full dosage schedule of PEG IFN-alpha-2a and ribavirin and those requiring dose reductions of either study drug had similar SVR rates (64.5% vs 61.9%). However, the SVR rate was reduced to 33.3% among patients who discontinued combination therapy. Three out of the 31 patients who received the full dosage schedule were elderly patients. In addition, of the 15 patients who discontinued combination therapy, three were <50 years of age and six were > or =60 years of age. The SVR rate was reduced in patients with cumulative PEG IFN-alpha-2a and ribavirin doses of <60%; the majority of these patients were elderly.
The attainment of an SVR following PEG IFN-alpha-2a plus ribavirin combination therapy was not influenced by any of the host-related factors evaluated in this analysis, although elderly males were associated with a decreased SVR rate. Younger age, male sex and lower baseline HCV RNA levels significantly increased the likelihood of achieving an SVR with monotherapy. In addition, dose reductions appeared to have a negative impact on SVR in elderly patients. Therefore, it is important to minimize PEG IFN-alpha-2a and ribavirin dose reductions by effectively managing treatment-related adverse events in elderly patients.
Clinical Drug Investigation 01/2008; 28(1):9-16. · 1.82 Impact Factor
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ABSTRACT: The risk of Hepatocellular carcinoma (HCC) is high in HCV-infected patients who have biochemically and histologically active chronic hepatitis. To observe the long prognosis of Chronic Hepatitis C (CHC) patients with stage 3 fibrosis (F3), 55 CHC patients after initial Interferon (IFN) therapy were followed up for up to 12 years (average 9.8 +/- 2.3 years). According to the annual average alanine aminotransferase (ALT) levels, patients were grouped into, low (ALT <or= 30 IU/l); moderate (ALT >30 <80 IU/l) and high (ALT >or= 80 IU/l) ALT groups. Eleven patients were re-treated with IFN. During the follow-up period of 12 years, HCC developed in 26 patients with an average annual incidence of 3.9%. Biochemical responders to initial IFN therapy (n = 8) and those re-treated with IFN (n = 10), except 1, did not develop HCC. Cox regression analysis to evaluate risk factors for HCC occurrence, found development of Liver Cirrhosis within 3 years of initial IFN therapy(P = 0.05) and the 3 year annual average ALT post initial IFN therapy (P = 0.033) to be significant. The 12 year annual average ALT was also found to be significantly related to HCC occurrence (P = 0.016), on univariate analysis. Patients belonging to the continuously low ALT group (ALT <or= 30 IU/l for >or=3 years), did not develop HCC or receive IFN re-treatment. In CHC patients with F3, after initial IFN therapy, keeping ALT continuously low, below 30 IU/l for 3 years or more seems important. Continuing treatment with anti-inflammatory drugs along with subsequent IFN re-treatment may prevent or delay HCC even in elderly patients.
Cancer informatics 01/2008; 6:381-7.
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ABSTRACT: Laparoscopic microwave coagulation (LMC) has recently been indicated for hepatocellular carcinoma (HCC). LMC was performed in 14 patients with a total of 22 HCCs in the 18-month period from November 1996 to April 1998. The size of HCCs ranged from 10 mm to 100 mm, with an average diameter of 29.3 mm. The duration of microwave emission ranged from 8 min to 54 min; average 26.4 mm. Sufficient microwave emission was possible even in cases of multiple HCC large HCC, and HCC located deep within the liver, with the aid of laparoscopy and intraperitoneal ultrasound. Recurrence was observed in 4 out of 22 HCCs, and was treated by transcatheter arterial embolization (TAE) or percutaneous ethanol injection (PEI). LMC facilitates local control of HCC, and is a promising new therapeutic modality for HCC. (Dig Endosc 1999; 11: 137–143)
Digestive Endoscopy 12/2007; 11(2):137 - 143. · 1.19 Impact Factor
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Takeshi KAKIO,
Minoru UKIDA,
Toshio ITO,
Kazuhide YAMAMOTO,
Masahito TANIMIZU,
Koukichi MIZUTAMARI,
Youichi MORIMOTO,
Haruhiko KOBASHI,
Ryuichi MATSUO,
Nobuyuki SAKAI,
Rieko MIYAMOTO, Gotaro YAMADA,
Takao TSUJI
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ABSTRACT: The laparoscopic and histological findings of a patient suffering from dimethylformamide (DMF) intoxication are discussed. A 20-year-old man was admitted to our department for further evaluation of a liver injury. A laparoscopy revealed that the liver was markedly deformed by a combination of depressions and protuberances, and this finding was compatible with the funnel liver reported by H. Kalk. After an intravenous injection of high dose indocyanine green, broad whitish depressions appeared as a non-staining area and surrounding protuberances were stained a dark green color. A biopsy specimen taken from the site of the depression showed massive hepatic necrosis and a scar under the capsule. The histological diagnosis was a convalescent stage of toxic liver injury. The present report is apparently the first to consider the detailed laparoscopic findings of a liver injury induced by DMF.
Digestive Endoscopy 08/2007; 4(1):76 - 81. · 1.19 Impact Factor
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Nihon Naika Gakkai Zasshi 02/2006; 95(1):66-9.
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ABSTRACT: Hepatitis B virus (HBV) is an important factor in the development of hepatocellular carcinoma (HCC). We studied the influence of HBV viral load on HCC occurrence in HBV related liver cirrhosis (LC).
Ninety-one LC patients were followed up over a period of 7 years. Twenty three patients received Interferon (IFN) therapy.
In 7 years, 23 patients developed HCC. Of them twenty-two (95.6%) were of genotype C. HBV DNA was found to be the only significant variable associated with HCC occurrence on both univariate (P = 0.029) and multivariate analysis (odds ratio 2.33; P < 0.033). The cumulative survival at 5 years was 83% and the annual rate of hepatitis B surface antigen clearance was 0.9 %. All of 17 HCC patients observed over a period of 5 years or more belonged to the continuously high HBV DNA group (annual average >3.7 log copies/ml) and all but one belonged to the continuously high alanine aminotransferase group (annual average >40 IU/l).
Patients with genotype C and a continuously high HBV DNA for 5 years or more are at a high-risk group for HCC development. Maintaining continuously low HBV DNA for 3 years or more with anti-viral therapy, may be useful in preventing or delaying HCC occurrence.
Liver international: official journal of the International Association for the Study of the Liver 04/2005; 25(2):220-5. · 3.82 Impact Factor
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Gotaro Yamada
Nippon rinsho. Japanese journal of clinical medicine 09/2004; 62 Suppl 8:349-53.
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Gotaro Yamada
Nippon rinsho. Japanese journal of clinical medicine 09/2004; 62 Suppl 8:290-2.
