A case of liver abscess caused by Fusobacterium nucleatum in a patient with periodontitis

We report a case of liver abscess due to Fusobacterium nucleatum in a 68-year-old man with periodontitis. He was admitted to our hospital complaining of high fever. Abdominal ultrasound sonography and computed tomography scan revealed a single liver abscess. Fusobacterium nucleatum was isolated from liver aspirates. He had no dental symptoms but periodontitis was diagnosed. After extraction of a tooth, he had high fever again suffered from sepsis. Fusobacterium nucleatum is anaerobic gram-negative bacilli found in normal flora of oral cavity and gastrointestinal tract, but it has rarely proven as a causative pathogen of liver abscess or systemic infection associated with periodontal disease. It should be noted that poor dental hygiene could lead to serious systemic infection

Vitamin K2 Has No Preventive Effect on Recurrence of Hepatocellular Carcinoma after Effective Treatment

Hepatocellular carcinoma (HCC) has a poor prognosis because of its high recurrence rate. Recently, vitamin K2 has been reported to inhibit the growth of HCC cell lines. To clarify the preventive effect of vitamin K2 on HCC recurrence, we studied 72 HCC patients who had been treated with surgical resection, local ablation or transarterial embolization: their etiologies were hepatitis B virus (n = 21), hepatitis C virus (n = 47), both B and C viruses (n = 2) and non-B or non-C virus (n = 2). We divided them into 2 groups: in one group, patients were treated with 45-mg/day vitamin K2 [K2-treated group (n = 23)], and in another, patients were not given vitamin K2 or a placebo [non-treated control group (n = 49)]. The obtained results between the 2 groups were compared. HCC recurred in 12 (52.2%) of the 23 K2-treated patients, and 22 (44.9%) of the 49 control patients. The differences in cumulative recurrence-free rate and cumulative survival rate between both groups were not significant (P = 0.92 and P = 0.08, respectively). As observed, chemopreventive effects of vitamin K2 at a clinically relevant dose on HCC recurrence were ineffective after effective treatment for HCC. Different regimens such as higher doses of vitamin K2 or combination therapy with other drugs may be worth testing to further explore the preventive effect on HCC recurrence

Renal shear wave velocity by acoustic radiation force impulse did not reflect advanced renal impairment

[Aim] Acoustic radiation force impulse is a noninvasive method for evaluating tissue elasticity on ultrasound. Renal shear wave velocity measured by this technique has not been fully investigated in patients with renal disease. The aim of the present study was to compare renal shear wave velocity in end‐stage renal disease patients and that in patients without chronic kidney disease and to investigate influencing factors. [Methods] Renal shear wave velocities were measured in 59 healthy young subjects (control group), 31 subjects without chronic kidney disease (non‐CKD group), and 39 end‐stage renal disease patients (ESRD group). Each measurement was performed 10 times at both kidneys, and the mean value of eight of 10 measurements, excluding the maximum and minimum values, was compared. [Results] Renal shear wave velocity could be measured in all subjects. Renal shear wave velocity in the control group was higher than in the non‐CKD group and in the ESRD group, and no difference was found between the non‐CKD group and the ESRD group. Age and depth were negatively correlated to the renal shear wave velocity. In multiple regression analysis, age and depth were independent factors for renal shear wave velocity, while renal impairment was not. There was no difference between the non‐CKD group and the ESRD group, even when ages were matched and depth was adjusted. [Conclusion] Renal shear wave velocity was not associated with advanced renal impairment. However, it reflected alteration of renal aging, and this technique may be useful to detect renal impairment in the earlier stages

Ultrasound Assessment of Kidney Volume in Patients with Acute Decompensated Heart Failure: A Predictor of Diuretic Resistance

［Background］Diuretics are essential for treating acute decompensated heart failure (ADHF), but the response is inconsistent. This study aimed to clarify whether kidney volume as assessed by ultrasound (US) predicts diuretic resistance in patients with ADHF. ［Methods］We enrolled 29 patients with ADHF and 32 controls. Height-adjusted kidney volume was assessed by US. We divided patients into two groups based on the median value of total daily use of furosemide (intravenous dose plus 0.5 × oral dose of furosemide equivalents) during 3 days from admission. ［Results］Patients with ADHF had a significantly smaller left kidney volume than did control subjects (27.7 ± 10.0 vs. 32.8 ± 8.8 mL/m, P < 0.05). Patients in the highdose furosemide group (? 51.7 mg/d) had a significantly lower estimated glomerular filtration rate (eGFR) and a significantly smaller kidney volume than did those in the low-dose furosemide group (eGFR: 43.9 ± 20.4 vs. 60.8± 21.6 mL/min/1.73 m2, left kidney volume: 23.2 ± 5.2vs. 32.6 ± 11.0 mL/m, right kidney volume: 26.5 ± 7.5vs. 32.6 ± 7.9 mL/m, all P < 0.05). Multivariate logistic analysis showed that left kidney volume, but not eGFR,was independently associated with the requirement of high-dose furosemide (odds ratio: 0.856, 95% confidence interval: 0.735?0.997, P < 0.05). ［Conclusion］Kidney volume as assessed by US is a useful predictor of diuretic resistance in patients with ADHF