Mitsuhiko Moriyama

Nihon University, Edo, Tōkyō, Japan

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Publications (202)444.33 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: A 69-year-old man with an 8-year history of hepatocellular carcinoma (HCC) was hospitalized for treatment of recurrent tumour. In 2010, the first transcatheter arterial chemoembolization (TACE) using miriplatin with agents (Lipiodol Ultra-Fluid) was performed and did not occur any adverse events. In 2014, since his HCC recurred, the TACE using miriplatin with agents was performed. Following this therapy, pyrexia occurred on day 3, followed by respiratory failure with cough and dyspnea on day 5. Chest radiography revealed scattered infiltration in the right upper lung fields, and chest computed tomography revealed ground grass attenuations, indicating fibrotic non-specific interstitial pneumonia. These findings progressively deteriorated, and a diagnosis of miriplatin-induced lung injury was made. His respiratory failure also progressively deteriorated. Treatment with pulse methylprednisolone therapy resulted in a dramatic improvement in both patient symptoms and radiological abnormalities.
    No preview · Article · Feb 2016 · Journal of Infection and Chemotherapy

  • No preview · Article · Oct 2015 · Liver Transplantation
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    ABSTRACT: Pyrrole-imidazole (PI) polyamide is a novel gene regulating agent that competitively inhibits transcription factor binding to the promoter of the specific target gene. Liver fibrosis is an integral stage in the development of chronic liver disease, and transforming growth factor β (TGFβ) is known to play a central role in the progression of this entity. The aim of this study was to evaluate the effect of PI polyamide targeting TGFβ1 on rat liver fibrosis. PI polyamide was designed to inhibit AP-1 transcription factor binding to the TGFβ1 gene promoter. The effect of PI polyamide on hepatic stellate cells was evaluated by real time PCR in RI-T cells. To determine the effect of PI polyamide in vivo, PI polyamide was intravenously administered at a dose of 3 mg/kg/week in dimethylnitrosamine (DMN)-induced rat model of liver fibrosis. Treatment of RI-T cells with 1.0 μM PI polyamide targeting TGFβ1 significantly inhibited TGFβ1 mRNA expression. Azan staining showed that DMN treatment significantly increased areas of fibrous materials compared with controls. PI polyamide targeting TGFβ1 significantly decreased the fibrous area compared with DMN group. mRNA expression levels of α-smooth muscle actin and matrix metalloproteinase2 were significantly increased in DNM-treated group compared with control. Treatment with TGFβ1 PI polyamide significantly decreased mRNA expression of these genes compared with DMN group. The novel gene regulator PI polyamide targeting TGFβ1 may be a feasible therapeutic agent for the treatment of chronic liver disease.
    No preview · Article · Sep 2015 · Biological & Pharmaceutical Bulletin
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    ABSTRACT: A 52-year-old man underwent partial splenic embolization (PSE) for hypersplenism. The intrasplenic artery targeted for the embolization was large, and the distance between its trifurcated branches was short; therefore, Guglielmi detachable coils (GDC) 360° Complex Shape(®) were used, as well as conventional metal coils, to prevent coil migration. GDC are equipped with a shape-memory function and are more physically stable than conventional metallic coils because they form three-dimensional loops. In this case, an ideal extent of the splenic infarction was successfully achieved using a small number of coils. This is the first report of the use of GDC in PSE for hypersplenism.
    Full-text · Article · Sep 2015 · Internal Medicine
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    ABSTRACT: An 80-year-old woman was admitted to our hospital with right hypochondralgia. Abdominal ultrasonography showed a well-circumscribed round lesion in segments 5 and 6 of the liver. Contrast-enhanced ultrasonography (CEUS) indicated that the tumor was enhanced in the arterial phase, changing to hypo-enhanced 30 seconds following contrast injection. After admission, the patient complained of epigastralgia, and CEUS subsequently demonstrated extravasation from the tumor. Although abdominal angiography was successful for achieving hemostasis, the tumor grew rapidly and the patient died. An autopsy revealed the presence of sarcomatoid hepatocellular carcinoma (HCC). The literature is lacking in details regarding CEUS findings for sarcomatoid HCC and rupture. We herein report a rare case of sarcomatoid HCC.
    Preview · Article · Jul 2015 · Internal Medicine
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    ABSTRACT: The goal of the study was to evaluate the efficacy and safety of balloon-occluded transarterial chemoembolization (B-TACE) of hepatocellular carcinoma (HCC) using miriplatin (a lipophilic anticancer drug) and gelatin particles. B-TACE was performed for 62 HCC nodules in 33 patients who could not be treated by surgical resection or radiofrequency ablation. All 33 patients had a history of transarterial chemoembolization (TACE) treatment prior to B-TACE. As a historical comparison, we investigated 39 nodules in 28 patients treated by TACE using a conventional microcatheter (C-TACE), miriplatin, and gelatin particles. The therapeutic effect per tumor was compared between the groups based on the Response Evaluation Criteria in Cancer Study Group of Japan (RECICL) and side effects were compared based on the JCOG (ver. 4). The therapeutic efficacy after 4 to 12 weeks was evaluated in 59 nodules in the B-TACE group and in 37 nodules in the C-TACE group. Of these nodules, TE4 occurred in 29 (49.2%) in the B-TACE group and in 10 (27%) in the C-TACE group. Local efficacy was significantly higher in nodules treated by B-TACE than by C-TACE. The side effects on hepatic function were similar in the two groups. Our results suggest that B-TACE with miriplatin is a useful treatment for hepatocellular carcinoma. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    No preview · Article · May 2015 · Hepatology Research
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    ABSTRACT: Purpose: The aim of this study was to investigate the feasibility of quantitative image analysis to differentiate hepatic nodules on gray-scale sonographic images. Methods: We retrospectively evaluated 35 nodules from 31 patients with hepatocellular carcinoma (HCC), 60 nodules from 58 patients with liver hemangioma, and 22 nodules from 22 patients with liver metastasis. Gray-scale sonographic images were evaluated with subjective judgment and image analysis using ImageJ software. Reviewers classified the shape of nodules as irregular or round, and the surface of nodules as rough or smooth. Results: Circularity values were lower in the irregular group than in the round group (median 0.823, 0.892; range 0.641-0.915, 0.784-0.932, respectively; P = 3.21 × 10(-10)). Solidity values were lower in the rough group than in the smooth group (median 0.957, 0.968; range 0.894-0.986, 0.933-0.988, respectively; P = 1.53 × 10(-4)). The HCC group had higher circularity and solidity values than the hemangioma group. The HCC and liver metastasis groups had lower median, mean, modal, and minimum gray values than the hemangioma group. Multivariate analysis showed circularity [standardized odds ratio (OR), 2.077; 95 % confidential interval (CI) = 1.295-3.331; P = 0.002] and minimum gray value (OR 0.482; 95 % CI = 0.956-0.990; P = 0.001) as factors predictive of malignancy. The combination of subjective judgment and image analysis provided 58.3 % sensitivity and 89.5 % specificity with AUC = 0.739, representing an improvement over subjective judgment alone (68.4 % sensitivity, 75.0 % specificity, AUC = 0.701) (P = 0.008). Conclusion: Quantitative image analysis for ultrasonic images of hepatic nodules may correlate with subjective judgment in predicting malignancy.
    Full-text · Article · Mar 2015 · Journal of Medical Ultrasonics
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    ABSTRACT: Recent advances in interferon-free treatment could lead to the eradication of hepatitis C virus (HCV) from patients infected with HCV. One of the direct-acting anti-viral agents, HCV NS5A inhibitor, is available for these combination therapies. However, naturally occurring resistance-associated variants (RAVs) to HCV NS5A inhibitors in treatment-naïve patients chronically infected with HCV genotype 1b are still unknown. We performed ultra-deep sequencing and analysed previously reported RAVs in a total 132 HCV genotype 1b-infected Japanese patients who had never used HCV NS5A inhibitors. We also performed direct-sequencing by Sanger method in consecutively selected 50 of the total 132 samples, and the differences between the results of the two methods were compared. In the comparison of the variant frequencies of ultra-deep sequencing with RAVs of direct-sequencing by Sanger method in 50 patients, we identified 32 RAVs by direct-sequencing with the Sanger method; minimum variant frequency was shown by ultra-deep sequencing to be 9 %. A total of 110 RAVs were identified only by ultra-deep sequencing. In the samples from all 132 patients, L31W (2.3 %), L31V (49.2 %), L31F (41.7 %), L31M (1.5 %), L31I (5.3 %), L31S (2.0 %), L31P (3.0 %) and L31R (0.8 %), and Y93N (2.3 %), Y93H (25 %), Y93C (0.8 %), Y93P (2.3 %) and Y93D (0.8 %) were identified. We demonstrated naturally-occurring RAVs of HCV NS5A inhibitors by ultra-deep sequencing and that several mutations including Y93H are common in HCV NS5A inhibitor-treatment-naïve patients with chronic HCV genotype 1b. Careful attention should be paid to these RAVs, and further improvement of treatment options might be needed.
    Full-text · Article · Mar 2015 · Hepatology International
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    ABSTRACT: Treating latent tuberculosis infection is a strategy for eliminating tuberculosis, and isoniazid is recommended as preventive therapy. However, concerns have been raised regarding the application of isoniazid due to its toxicity, particularly hepatotoxicity; however, biochemical monitoring is not routinely performed during treatment. We herein present a case of fatal isoniazid-induced acute liver failure. The patient's liver function was not periodically examined and isoniazid therapy was continued for 10 days despite the onset of symptoms associated with hepatitis. The patient died four months after hospitalization. It is essential to consider the potential toxicities of isoniazid and establish strategies to prevent acute liver failure.
    Preview · Article · Mar 2015 · Internal Medicine
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    ABSTRACT: A 67-year-old man presented for an evaluation after experiencing right hypochondrial pain lasting for two months. Abdominal ultrasonography showed a hepatic tumor in the right liver and extremely mild hepatic steatosis. The imaging findings indicated that the tumor (43 mm in size) was ischemic, and the lesion was surgically resected and examined. The histopathological findings demonstrated 95% necrosis with moderately differentiated hepatocellular carcinoma (HCC). The diagnosis was HCC with spontaneous regression. There was also pathological evidence of thrombus formation in the peripheral arteries and portal veins. In addition, the non-cancerous regions of the liver were diagnosed as exhibiting non-alcoholic steatohepatitis. The pathological findings obtained after resection of the HCC lesion showed spontaneous regression.
    Preview · Article · Mar 2015 · Internal Medicine
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    ABSTRACT: Objective: To determine the impact of phlebotomy on the laboratory values and the incidence of hepatocellular carcinoma (HCC) in patients with hepatitis C. Methods: Study patients with chronic hepatitis C were treated with glycyrrhizin injection and oral ursodeoxycholic acid and either with (n=52) or without (n=50) phlebotomy during the period of 2005-2012. Six phlebotomized patients had previously received interferon therapy and were subsequently excluded from the data analysis. The serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, alkaline phosphatase, gamma-glutamyl transpeptidase, lactate dehydrogenase, ferritin, iron and albumin, as well as the hemoglobin concentration, platelet count and prothrombin time, were determined. We compared the long-term outcomes based on the incidence of HCC and laboratory values, including the baseline serum ferritin levels, in patients treated with versus without phlebotomy. Results: In the phlebotomy group, the mean AST and ALT levels decreased significantly at each one-year interval over five years (p<0.01), whereas the platelet counts did not. The incidence of HCC in the phlebotomized patients was significantly lower than that observed in the patients treated without phlebotomy: 10.3% vs. 43.7%, respectively, during the 8-year observation period (p=0.04). The incidence of HCC was also lower in the phlebotomized patients with a normal baseline ferritin level: 0.0% vs. 36.0% in the matched subgroup treated without phlebotomy at year 8. Phlebotomy offered a risk ratio of 0.13, thus suggesting protection against the development of HCC. Conclusion: The incidence of HCC can be reduced by phlebotomy treatment, which should be performed in patients with chronic hepatitis C not receiving or not responding to antiviral therapy.
    Preview · Article · Mar 2015 · Internal Medicine
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    ABSTRACT: A 64-year-old man was admitted to our hospital complaining of melena and anemia. Gastrointestinal endoscopy and colonoscopy were performed, but the source of hemorrhage was not detected. Abdominal computed tomography showed enhanced mass in pelvis, that seemed to develop from the small bowel. Capsule endoscopy and single balloon endoscopy were performed, and a submucosal tumor with erosion and redness was found. A partial resection of small intestine was performed. Histopathologically, the tumor cells were spindle-shaped. Immunopathological study of tumor was positive for c-kit and CD-34, so we finally diagnosed with small intestinal gastrointestinal stromal tumor (GIST) . The postoperative course was uneventful. It is considered that CE and BE may be useful to diagnose the small intestinal GIST.
    No preview · Article · Jan 2015
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    ABSTRACT: Peritoneal metastasis is a relatively rare manifestation of metastasis from hepatocellular carcinoma. The prognosis of peritoneal metastasis is generally poor, because multiple metastases can occur. It has been reported that hepatocellular carcinoma can be treated with balloon-occluded transarterial chemoembolization. However, there have been no reports of the treatment of peritoneal metastasis from hepatocellular carcinoma with transarterial chemoembolization. A 65-year-old man had a history of partial hepatic resection of segment 8 for hepatocellular carcinoma. At that time, a percutaneous tumor biopsy was performed. Follow up computed tomography showed hepatocellular carcinoma in segment 4, and peritoneal metastasis. Therefore, the patient was admitted for treatment of the hepatocellular carcinoma and its peritoneal metastasis. The feeding arteries to the peritoneal metastasis were identified and treated with balloon-occluded transarterial chemoembolization. Two months after transarterial chemoembolization, contrast-enhanced computed tomography showed greater than 50% tumor necrosis.
    Preview · Article · Jan 2015 · Nichidai igaku zasshi
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    ABSTRACT: We performed balloon-occluded retrograde transvenous obliteration (B-RTO) before hepatocellular carcinoma (HCC) therapy in cases with HCC and gastric varices (GV) containing porto-systemic shunts. We conducted retrospective analyses on effects of B-RTO on hepatic functional reserve and HCC, as well as associated complications, and verified HCC treatment timing. B-RTO was performed before HCC therapy after confirming disappearance or shrinkage of gastro-renal shunt with 3-dimensional computed tomography (3D-CT). Hepatic resection (HR) was performed in 7 of 12 cases, and transcatheter chemo-embolization (TACE) was used in 5 cases. B-RTO significantly improved GV (P=0.002). Improvement in grade/form was observed by endoscopy after 84.1 days, and that in gastro-renal shunt was observed by 3D-CT after 13.9 days. HCC size (P=0.862) and stage didn't change after B-RTO. Two cases showed improved Child-Pugh classification, and no deterioration in hepatic functional reserve was observed. B-RTO was performed 37.9 days before HCC therapy in surgical cases, and 45 days in TACE cases. Performing B-RTO before HCC therapy did not exacerbate HCC and allowed its safe performance. Evaluation with 3D-CT after B-RTO to determine HCC therapy timing was possible after 2 weeks. However, care is needed as esophageal varices worsened in some cases.
    No preview · Article · Nov 2014 · Hepato-gastroenterology
  • Shunichi Matsuoka · Akinori Tamura · Hirosi Nakagawara · Mitsuhiko Moriyama
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    ABSTRACT: This study was performed to evaluate any improvement in the nutritional state and clinical symptoms in patients with liver failure and advanced cirrhosis after consumption of a liver diet with restricted energy and protein, in combination with a branched chain amino acids (BCAA)-enriched elemental diet. A BCAA-enriched elemental diet, in combination with a liver diet, characterized by restricted energy and protein, was administered in divided meals to 20 patients with liver failure associated with ascites or hepatic encephalopathy for 4 weeks. The symptom of ascites abated as a result of increased total serum protein and albumin levels after the nutritional intervention in comparison with baseline levels. Ammonia levels were slightly increased without exacerbating hepatic encephalopathy, and the protein nutrition state consequently improved. Divided meals of a BCAA-enriched elemental diet combined with a liver diet improved the nutritional state and clinical symptoms of patients with liver failure.
    No preview · Article · Jul 2014 · Hepato-gastroenterology
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    ABSTRACT: Though carcinomatous metastasis to various organs, such as the lung and liver, occurs frequently in the end stage of cancer, gastric metastasis is relatively rare. We examined the endoscopic findings and pathological analyses of 16 metastatic gastric cancers from our hospital during the past twenty years. Out of 16 cases, there were a total of 10 primary organs, of which lung and breast cancers were the most frequent sources. In endoscopic diagnosis of the 16 gastric lesions, there were 7 (44%) cases of suspected metastatic tumor, compared with 4 (25%) and 5 (31%) primary and non-tumor lesions, respectively. There were 5 multiple and 11 single lesions of the stomach. There were 5 (31%) cases of metastasis to the stomach alone. Eight cases (50%) were found to be primary cancer and gastric metastasis during the same period. The longest term from the onset of primary cancer to the detection of gastric metastasis was 8 years 4 months. It is difficult to distinguish gastric metastasis from primary gastric cancer and benign ulcerative lesion endoscopically. Strict follow-up observation and pathological assessment of both primary site gastric lesions were important.
    Preview · Article · Jan 2014 · Nichidai igaku zasshi
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    ABSTRACT: B-flow is a non-Doppler-based technology for visualizing blood flow and has a high spatial resolution. The aim of this study is to evaluate the blood flow information of liver tumors using B-flow in comparison with color Doppler sonography (CDS).Seventy-nine patients with 82 hepatic nodules were studied using B-flow and CDS. The study group included 45 HCC nodules, 23 liver metastasis nodules, four intrahepatic cholangiocarcinomas (ICC), and 13 hemangiomas. The visualized vascularity and morphological findings of the hepatic tumor vessel were evaluated.B-flow showed multiple vessels in 48 nodules (58.5 %) and a single vessel in 13 nodules (15.9 %). CDS showed multiple vessels in 44 nodules (53.7 %) and a single vessel in 23 nodules (28.0 %). Multivariate analysis showed basket pattern was significant for HCC (OR 49.263; p = 0.0002), and penetrating vessel was significant for liver metastasis or ICC (OR 14.545; p B-flow detects hepatic tumor blood flow with sensitivity as high as that of CDS. Vascular structure information obtained using B-flow could be potentially used to diagnose liver tumors.
    Full-text · Article · Oct 2013 · Journal of Medical Ultrasonics
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    ABSTRACT: To evaluate the histopathological findings of type C liver disease to determine risk factors for development of hepatocellular carcinoma (HCC). We studied 232 patients, who underwent liver biopsy for type C chronic liver disease between 1992 and 2009, with sustained virological response (SVR) after interferon therapy. The patients were divided into two groups according to the F stage 0 + 1 + 2 group (n = 182) and F3 + 4 group (n = 50). We prospectively observed and compared the incidence of HCC of the patients with SVR in the F0 + 1 + 2 and F3 + 4 groups. Then, the background factors and liver histopathological findings, including the degree of fibrosis, F stage, inflammation, necrosis, bile duct obstruction, fat deposition, and degree of irregular regeneration (IR) of hepatocytes, were correlated with the risk of developing HCC. HCC developed in three of 182 (1.6%) patients in the F0 + 1 + 2 group, and four of 50 (8.0%) in the F3 + 4 group. The cumulative incidence of HCC in the former group was found to be significantly lower than in the F3 + 4 group (log rank test P = 0.0224). The presence of atypical hepatocytes among IR of hepatocytes in the F3 + 4 group resulted in a higher cumulative incidence of HCC, and was significantly correlated with risk of HCC development (RR = 20.748, 95%CI: 1.335-322.5, P = 0.0303). Atypical hepatocytes among the histopathological findings of type C liver disease may be an important risk factor for HCC development along with progression of liver fibrosis.
    Preview · Article · Aug 2013 · World Journal of Gastroenterology
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    ABSTRACT: Background: Prophylactic treatment for esophageal varices has been performed without adequate supporting evidence. We assessed the feasibility of prophylactic and follow-up treatment for high-risk esophageal varices in patients with hepatocellular carcinoma (HCC). Methods: Patients with HCC were screened prospectively and followed up for esophageal varices and gastroduodenal ulceration. High-risk esophageal varices (huge F3 varices or intermediate F2 varices positive for red color signs) were treated prophylactically. Follow-up endoscopy was performed to assess the impact of prophylaxis and changes in varices at 1 week, 1 month, and 6 months after operation. If high-risk varices were found during follow-up, secondary prophylaxis was performed according to the same criteria. Results: Among 251 patients with HCC, 81 (32.3 %) had esophageal varices on screening endoscopy. Prophylactic endoscopic treatment was required by 13 patients (1 with F3 varices and 12 with F2 varices positive for red color signs). Ten varices worsened, and 4 varices progressed to high-risk varices requiring endoscopic treatment. No F0 or F1 varices at screening endoscopy progressed to high-risk varices, and no bleeding event occurred during 6 months of preplanned follow-up. A preoperative platelet count of less than 10 × 10(4)/μL (odds ratio: 4.21, 95 % confidence interval 3.11-10.6; p < 0.001), the presence of splenomegaly (2.87, 2.16-21.8; p = 0.011), and an indocyanine green retention rate at 15 min of greater than 30 % (2.31, 1.88-24.6; p = 0.026) were independent predictors of worsening varices. Conclusions: Our protocol for prophylactic and follow-up treatment of high-risk esophageal varices was feasible in patients with HCC.
    No preview · Article · Jun 2013 · Journal of Gastroenterology

  • No preview · Article · Apr 2013 · Gastrointestinal endoscopy

Publication Stats

3k Citations
444.33 Total Impact Points

Institutions

  • 1998-2015
    • Nihon University
      • • Department of Gastroenterology and Hepatology
      • • School of Medicine
      • • Department of Internal Medicine II
      Edo, Tōkyō, Japan
  • 2013
    • Tokyo Medical and Dental University
      • Department of Gastroenterology and Hepatology
      Edo, Tōkyō, Japan
  • 2006-2007
    • The University of Tokyo
      • Department of Gastroenterology
      Edo, Tōkyō, Japan
    • Okayama University
      Okayama, Okayama, Japan
  • 1993
    • Oita University
      • Department of Microbiology
      Ōita, Oita, Japan