Interferon therapy, widely used in chronic viral hepatitis and in various malignant diseases, has been known to induce autoimmune phenomena, the most frequent being autoimmune thyroid disease. We have studied the human leukocyte antigen (HLA) in patients who developed autoimmune thyroid dysfunction after interferon-alpha therapy for chronic hepatitis C. Seventeen of 439 patients (3.9%) developed symptomatic autoimmune thyroid dysfunction after interferon-alpha therapy, including nine cases of hyperthyroidism and eight cases of hypothyroidism. The incidence of HLA-A2 in those patients was significantly higher than that in general population in Japan. The present results suggest that HLA-A2 is associated with interferon-alpha therapy-induced autoimmune thyroid dysfunction in patients with chronic hepatitis C.
Surgical experience of a rare case of malignant retroperitoneal cyst is reported. A 41-year-old female was admitted on Feb. 26, 1986, complaining of left lower abdominal tumor and mild abdominal pain. She underwent complete removal of an abdominal tumor located at the left flank lateral to the sigmoid colon on March 5. The tumor was well encapsulated, cystic and oval, 12 X 10 X 9 cm in size. Histologic feature of the tumor is classified as mucinous cystadenoma of low grade malignancy by WHO classification.
MK615, a compound extracted from the Japanese apricot "Prunus mume " has been reported to have in vitro anti-tumor activities against several cancer cell lines, including hepatocellular carcinoma (HCC).However, the clinical effects and feasibility of administering MK615 for patients with HCC were unknown.We experienced a case with advanced HCC for which MK615 was effective against both lymph node and pulmonary metastases.A 60-year-old female underwent surgical resection of a 9 cm HCC in the right lobe.The pathological diagnosis was moderately differentiated HCC with vascular invasion.The HCC recurred in the liver 8 mo after the surgery.Radiofrequency ablation and transarterial infusion chemotherapy were performed, but the recurrence was not controlled.One year after the intrahepatic recurrence, pulmonary and lymph metastasis appeared.Sorafenib was administered, but was not effective.Then, MK615 was administered as a final alternative therapy after informed consent was obtained from the patient.Three months later, her alpha-fetoprotein level decrease and both the lymph node and pulmonary metastases decreased in size.The patient has survived for more than 17 mo after the MK615 administration, and was in good condition.Although further investigations are necessary to clarify its safety and efficacy in humans, MK615 may be useful for the treatment of HCC, without serious adverse effects.
To determine the relationship between host factors and host response to interferon (IFN) therapy, serum soluble Fas (sFas), soluble Fas ligand (sFas ligand), and tumor necrosis factor-alpha (TNF-alpha) were analyzed in 41 patients with chronic hepatitis C (CH-C) treated with IFN-alpha.Serum levels of sFas, sFas ligand, and TNF-alpha were measured at 0, 4, and 24 weeks of IFN therapy.Eighteen patients were complete responders (CR) and 23 patients were non-responders (NR). Serum levels of sFas and TNF-alpha in patients with CHC were significantly higher than those in healthy controls (p<0.01 and p<0.01, respectively). Serum sFas ligand levels were significantly lower in CH-C patients than in healthy controls (p<0.01). Before IFN therapy, serum levels of sFas in NR were significantly higher than those in CR (p<0.05). At 4 weeks of IFN therapy, serum levels of sFas of CR were significantly elevated compared with levels before IFN therapy (p<0.05). Serum levels of sFas correlated with the histological activity of the liver (p<0.05) and alanine aminotransferase (p<0.05). None of the three parameters, serum sFas, sFas ligand, or TNF-alpha levels, correlated with each other, with HCV-RNA genotype or with serum HCV-RNA load. Multiple logistic regression analysis showed that serum sFas levels before IFN therapy were a contributive factor to predict efficacy of IFN therapy.Serum sFas/sFas ligand and TNF-alpha play a possible role in pathogenesis of CH-C and also in IFN therapy. Serum sFas levels before IFN therapy may be one of the host-related factors used for evaluating the response of CH-C patients to IFN therapy.
Background: Branched-chain amino acids (BCAA) are nutrients with a bitter taste, which causes low compliance in patients who need BCAA supplementation. Moreover, chronic liver disease is frequently complicated by taste impairment. The present study was designed to improve patient noncompliance regarding nutrients in liver disease. Methods: A taste questionnaire was administered to healthy controls, chronic hepatitis patients, and cirrhotic patients. Eleven different flavored powders that can be added to BCAA nutrients to reduce their unpleasant taste and smell were evaluated and categorized into three groups: delicious, fair and not good to drink. Patient serum zinc levels were measured and analyzed regarding their relationship to taste dysfunction. Results: Twenty-two healthy controls, 11 chronic hepatitis patients, and 36 liver cirrhosis patients were enrolled. Of the study subjects, 81.8% of healthy controls, 72.7% of chronic hepatitis patients and 50% of liver cirrhosis patients reported that a usual meal was delicious. The fruit-derived flavor and the yogurt flavor were well liked among each group. The mean serum zinc value of liver cirrhosis patients (53.7 g/dl) was significantly lower than that of chronic hepatitis patients (69.6 g/dl, P < 0.01). Conclusions: Half of the cirrhotic patients were dissatisfied with the taste of the usual meal. Zinc deficiency could be one cause of taste dysfunction and poor appetite in chronic liver disease. Flavors derived from fruits, which provide acidity and sweetness to counteract the taste of the BCAA nutrients, could improve palatability of BCAA supplementation for patients with liver disease.
Background: While the current guidelines recommend laparoscopic deroofing for symptomatic simple liver cysts, percutaneous drainage may serve as a less invasive alternative method. In this study, the treatment effects of percutaneous drainage with or without sclerotherapy for symptomatic simple liver cysts were evaluated. Methods: Between April 2016 and March 2021, 79 patients who initially required hospitalization due to symptomatic simple liver cysts were enrolled in this multicenter retrospective study. They were treated percutaneously with or without sclerotherapy. The factors associated with symptom recurrence, clinical course and prognosis were investigated. Results: Of the 79 patients treated percutaneously, 11 (13.9%) had symptom recurrence due to liver cysts during the observation period. The maximum diameter of liver cysts at baseline was the only significant factor for the recurrence of these symptoms (p = 0.004). In a receiver operating characteristics analysis, the cut-off of the diameter for symptom recurrence was 16.5 cm. No additional effect of sclerotherapy on drainage was demonstrated in patients with a cyst diameter of <16.5 cm, and in patients with a cyst diameter of ≥16.5 cm, the cumulative recurrence rates of symptoms were significantly lower in the patients treated via sclerotherapy with 5% ethanolamine oleate or with minocycline hydrochloride than in those treated with drainage alone or via sclerotherapy with absolute ethanol. No problematic adverse effects were observed of sclerotherapy. Conclusions: Drainage with sclerotherapy with 5% ethanolamine oleate or minocycline hydrochloride was an effective and safe treatment for patients whose liver cysts had a maximum diameter of ≥16.5 cm. Considering both its efficacy and safety, sclerotherapy with either of these agents is recommended for patients with a maximum liver cyst diameter of ≥16.5 cm.
