journal article

Spontaneous rupture of hepatocellular carcinoma(HCC)is well known. However, rupture of HCC after transcatheter arterial chemoembolization(TACE)is a rare but potentially fatal complication. Herein, we report a case of ruptured HCC after TACE in a 73-year-old man with chronic liver injury(non-B and non-C).He had previously undergone subsegmental resection of S7 of the liver for HCC. One year later, multiple HCCs were detected. TACE was performed for the recurrent HCCs located on the surface of S2 of the liver. Epigastric pain and decreased blood pressure were observed after the treatment. Although his symptoms improved immediately, the patient gradually became anemic. Radiological examination after TACE revealed a hematoma around the S2 lesion. Therefore, we diagnosed rupture of HCC. We performed TAE and could control the bleeding. Few possible mechanisms of ruptured HCC after TACE include increasing pressure inside the tumor and capsular injury due to TACE. Consequently, HCC which has a high risk of rupture after TACE should be assured embolization and careful observation.

A 36-year-old man diagnosed with Charcot-Marie-Tooth(CMT)disease type 1B was treated in the department of neurology of this hospital. Due to a liver injury(AST 237IU/ml, ALT 496IU/ml)which occurred in November 200X, he was introduced to our department. As a result of scrutiny, we diagnosed him with chronic hepatitis C genotype 2a(HCV-RNA 5.4logIU/ml).He will be admitted to the hospital for Interferon(IFN)therapy in April next year. Although the mechanism is unknown, there are a few reports of peripheral neuropathy related to IFN therapy. Therefore, IFN therapy is generally unfavorable for patients with neuromuscular disorders. There are several IFN preparations used in Japan. IFN alfa associated peripheral neuropathy appears less than 0.1-5% of the time. While there is no report of peripheral neuropathy related to IFN beta, we performed IFN beta and Rivabirin combination therapy with a severe follow-up by a neurologist. We could accomplish treatment without the exacerbation of neurologic symptoms. He achieved sustained viral response. When IFN therapy was provided for chronic hepatitis B or chronic hepatitis C complicated with peripheral neuropathy, there is some possibility of performing antiviral therapy safely by using IFN beta.

Duodenal varices（DV）are the most common of ectopic varices. Although bleeding from DV is rare, it is difficult to control bleeding and sometimes fatal. We have encountered four clinical cases of ruptured DV. Case 1：A man in his 80s presented with a history of partial gastrectomy with Billroth-II reconstruction and LC due to chronic hepatitis C. We performed single-balloon endoscopy and injected 67% N-butyl-2-cyanoacrylate（NBCA）for DV on the afferent loop with red plug. Case 2：A woman in her 40s with primary biliary cirrhosis complained of tarry stool and anemia. We performed endoscopic injection sclerotherapy（EIS）with 67% NBCA for spurting bleeding point in duodenum. Case 3：A man in his 50s with liver cirrhosis（LC）due to chronic hepatitis B complained of tarry stool. We performed endoscopic variceal ligation（EVL）and balloon-occluded retrograde transvenous obliteration（B-RTO）for DV. Case 4：A man in his 60s with alcoholic LC complained of tarry stool. We performed EIS with 67% NBCA for DV. We added EVL, clipping, and argon plasma coagulation after EIS to control bleeding. To control bleeding was achieved in all cases.

We held medical seminars for high-school students who hope to become physicians to increase their motivation and to encourage them to enter Yamaguchi University. The seminars were held two or three times a year at hospitals in six locations in Yamaguchi prefecture between 2011 and 2014, and consisted of observation of facilities in hospitals, physician lectures, experience of medical practice, and Q&A sessions with physicians and medical students. A total of 210 high-school students participated in 11 seminars. The questionnaires for the participants showed 89.9% of the participants rated the seminars“very good”and 91.4% responded,“my motivation was strengthened”.Of the seminar participants, 20 of 69 high-school graduates entered the Yamaguchi University School of Medicine. The follow-up survey showed that the percentage of medical school students studying at Yamaguchi University was 69.0% (20/29) for seminar participants and 45.5% (46/101) for non-seminar participants. The results suggest that the medical seminars were as effective as expected in encouraging high-school students to become physicians and to enter Yamaguchi University.

Background The lipid-lowering therapy by statins may stabilize and reduce coronary plaques. We compare the effect of strong or moderate statins on the coronary plaque characteristics by using 64-slice multidetector computed tomography (MDCT). Methods and Results We analyzed 13 subjects with non-calcified coronary plaques(NCP)as determined by MDCT. Pitavastatin(PTV:2mg/day)or pravastatin(PRA:10mg/day)were randomly administered. MDCT were performed at 0, 6 and 12 months after lipid-lowering therapy. In PTV group(n=6),CT density of NCP increased by 35.6 ± 28.8 HU after 6 months(p=0.037)and by 30.6 ± 29.8 HU after 12 months(NS).NCP area was decreased by 35.9 ± 15.2 % after 6 months and by 41.0 ± 16.5 % after 12 months(both P=0.001).In PRA group(n=7),CT density of NCP did not significantly increased after 6 months(NS)and after 12 months(NS).NCP area was not significantly decreased at 6 months(NS),but decreased by 23.1 ± 16.7 % at 12 months(P=0.001). Conclusions Serial CT angiography revealed that the regression of NCP occurs rapidly by strong lipid lowering therapy compared to the moderate statin therapy.

症例は46歳男性.近医の腹部エコーで膵尾部近傍に腫瘤を認めたため当科へ紹介された.腹部CTで小腸間膜根部に約50mm大の低吸収域の腫瘤性病変を認めた.腹部MRIではT1強調像で低信号,T2強調像で高信号の多房性腫瘍を認めた.悪性の可能性も否定できず,診断的意味も含め,外科的切除を施行した.腫瘍は表面平滑,弾性軟で,他の周囲臓器への癒着は認めなかった.腫瘍は組織学的に嚢胞状リンパ管腫と診断した.リンパ管腫は小児の頭頚部に好発する良性腫瘍であるが,成人の腸間膜に発生したリンパ管腫はまれであるため報告する.

AA型アミロイドーシスを合併したCrohn病の一例を経験した.症例は73歳女性.発熱,下痢症状の改善がないため紹介入院となった.入院時の腹部単純X線写真では著明な大腸拡張像を認め,腹部骨盤CTでも回腸から結腸にかけての浮腫状の壁肥厚と腸管周囲に膿瘍の形成,回腸の拡張像を認めた.十二指腸粘膜の内視鏡下生検を施行したところ,組織学的にAA型アミロイドーシスと診断された.大腸内視鏡検査では異常所見はなかった.小腸X線二重造影検査にて,小腸の管状狭窄と拡張,潰瘍瘢痕,類円形の潰瘍が多発していた.AA型アミロイドーシスを合併したCrohn病の診断のもとに入院･加療を行った.絶食と抗生剤点滴で腸管安静をはかると下痢などの症状は改善し,食事を流動食から固形食に変えると症状の増悪を認めた.Crohn病は栄養療法で寛解導入され,その後維持された.消化管アミロイドーシスの消化器症候もなく4年間経過良好である.

We performed this study to investigate whether serum cell-free DNA testing(liquid biopsy)of either methylated SEPT9 or methylated SST, which are possible biomarkers of HCC, in combination with AFP may improve clinical performance for the detection of HCC. Study subjects included 25 healthy controls, 15 patients with chronic liver disease without HCC, and 38 patients with HCC. Methylation level of serum cell-free SEPT9 and SST was measured by methylation-sensitive restriction enzymes followed by multiplex droplet digital polymerase chain reaction. According to receiver operating characteristic curve analysis to discriminate between non-HCC group(including control group and chronic liver disease without HCC group)and HCC group, area under the curve(AUC)was 0.73 by AFP and 0.73 by mSEPT9, whereas it was only 0.59 by mSST. Regarding combination tests, although negative predictive values were almost same between the AFP + mSEPT9 test and the AFP + mSST test(75.0% vs 72.2%),a positive predictive value of AFP + mSEPT9 test was higher than that of the AFP + mSST test(79.4% vs. 66.7%).In conclusions, methylated SEPT9 was a better companion marker of AFP for HCC screening than methylated SST.

A 78-year-old man underwent distal partial gastrectomy and Billroth I reconstruction for early gastric cancer in May 1995, then was followed up by us. In March 2005, he was found in upper gastrointestinal endoscopy to have an elevated Isp lesion of the duodenum. Histological examination of biopsy specimens showed on inflammatory polyp and no malignancy. After one year of observation, the lesion became a IIa+IIc lesion in upper gastrointestinal endoscopy. Biopsy specimens showed group V and suspected signet-ring cell carcinoma. After further examination, we conducted partial resection of the duodenum. Macroscopically, the 8×6 mm tumor appeared to be a IIa+IIc lesion located in the second portion of the duodenum. The histological diagnosis was signet-ring cell carcinoma, within the membrane, ly0 and v0. The surgical margin was negative. We conducted curative surgery. He is alive without recurrence almost 10years after the operation. Billroth I reconstruction enabled us to diagnose duodenal cancer early in this case.