Risk factors for hepatocellular carcinoma in Japanese patients with autoimmune hepatitis type 1

Background

Hepatocellular carcinoma (HCC) is occasionally seen even in patients with autoimmune hepatitis (AIH) without prior infection either with hepatitis C virus (HCV) or hepatitis B virus. The aim of this study was to identify the incidence of and risk factors for HCC with AIH in a large-scale population with a long-term follow-up in Japan.

Methods

One hundred and eighty patients diagnosed with AIH were enrolled (F/M?=?159/21; mean age, 59.9?years; mean observation period, 80.2?months). Patients with positive HCV antibody/serum HCV RNA and/or positive HBs Ag were excluded. Initial treatment included immunosuppressant therapy (n?=?147), other drugs (n?=?28), and no drug (n?=?5). Patients underwent abdominal ultrasonography at intervals of 3–6?months during observation. Patients’ demographic factors, biochemical data, liver histology, medications, response to treatment, and complications were evaluated in relation to HCC.

Results

During the observation period, six patients (3.3%) developed HCC. Univariate analysis showed that risk factors for HCC were cirrhosis at diagnosis with AIH (p?=?0.0002), absence of a treatment response (p?=?0.033), abnormal alanine aminotransferase (ALT) at the final observation (p?=?0.0002), and diabetes (p?=?0.0015). Multivariate analysis showed that risk factors for HCC were cirrhosis at diagnosis of AIH (odds ratio 4.08) and abnormal ALT at final observation (odds ratio 3.66).

Conclusion

This retrospective study showed that cirrhosis at diagnosis of AIH and abnormal ALT at final observation were independently associated with HCC development. It is important to pay attention to the presence of cirrhosis at diagnosis of AIH and to normalize ALT.     

Prognosis of pneumocystis pneumonia complicated in patients with rheumatoid arthritis (RA) and non-RA rheumatic diseases

Clinical presentation of pneumocystis pneumonia (PCP) during immunosuppressive therapy for rheumatic diseases was compared between patients with rheumatoid arthritis (RA; n = 7) and those without RA (non-RA; n = 12) based on a chart review. Both RA and non-RA patients with PCP were treated with methotrexate (n = 7) combined with steroids (n = 6) and/or biologics (n = 4). RA-PCP patients were found to have a higher mortality rate than non-RA-PCP patients (3/7 vs. 0/12, respectively; p?=?0.036) due to a later exacerbation of interstitial pneumonia and a higher presentation rate of diffuse pulmonary lesions (4/7 vs. 1/12, respectively; p?=?0.036) despite lower mean levels of serum beta-D: -glucan (314?±?214 vs. 1139?±?1114?pg/ml, respectively; p?=?0.02) that suggested a lower burden of Pneumocystis jirovecii. In conclusion, PCP in RA patients with existing pulmonary lesions may trigger subsequent progression to lethal interstitial pneumonia.     

Totally laparoscopic complete resection of the remnant stomach for gastric cancer

Background

In patients having carcinoma in the remnant stomach, total resection of the remnant stomach with lymph node dissection is a prerequisite.

Materials and methods

We present the first series of successful totally laparoscopic complete gastrectomy (TLCG) for gastric remnant cancer.

Results

TLCG was successfully performed without adverse events during surgery in five patients with gastric remnant cancer. The median age of the patients was 72 years (range, 56-84 years), and there were three men and two women. Three of them had a Billroth I reconstruction and two had a Billroth II reconstruction, and in four cases following partial gastrectomy for gastric cancer and one for gastroduodenal ulcer. The median operative time was 360 min; blood loss was 20 ml. The median number of retrieved lymph nodes was 19. No complications occurred postoperatively, and all of the patients were discharged within the ninth postoperative day.

Conclusions

Although TLCG for gastric remnant cancer is a technically difficult and challenging operation that requires careful lysis of adhesion and dissection along the major vessels, as well as intracorporeal anastomosis, this procedure is technically feasible. Long-term follow-up is mandatory to validate oncological outcome.     

Esthetic orthodontic treatment with a double J retractor and temporary anchorage devices

This clinical article reports an esthetic treatment option for managing a Class II malocclusion in an adult. The patient, a woman aged 24 years 2 months, had crowding and a convex profile. She was treated with maxillary first premolar extractions, a double J retractor, and temporary skeletal anchorage devices in the maxillary arch. Posttreatment records after 2 years showed excellent results with good occlusion and long-term stability.     

Effects of adenoviral-mediated hepatocyte growth factor on liver regeneration after massive hepatectomy in rats

Resection is the only curative treatment for liver metastasis of colorectal cancers. Despite the supreme regenerative potential of the liver, major hepatectomy sometimes leads to liver failure, and the limitation of resectable liver volumes makes advanced tumors inoperable. This study was attempted to promote liver regeneration using hepatocyte growth factor (HGF) gene transfection by venous-administered adenovirus and to improve the survival of rats after massive hepatectomy. The adenovirus that encodes HGF was administered to rats before 85%-hepatectomy. The administration of HGF gene improved the survival of rats after massive hepatectomy, while the administration of control adenovirus deteriorated their survival. Gene transfection of HGF showed up-regulation of serum HGF, stimulation of hepatocellular proliferation and rapid liver regeneration. Moreover, HGF administration reduced apoptosis of hepatocytes. The administration of HGF gene prevented liver dysfunction after major hepatectomy and may be a new assist for surgery.