Treatment of hepatocellular carcinoma by subsegmental transcatheter arterial embolization

Local medical treatment, primarily using subsegmental TAE, was attempted as the initial treatment for overt HCC. Local responses, local tumor recurrence and survival rates were analyzed for 56 patients who underwent this treatment after 1991. Of the 56 patients, 51 (91 %) showed satisfactory local responses to the therapy. For 4 patients (8%), tumor recurred locally during the approximately 22 months follow up period, although the diagnostic images taken soon after treatment had suggested adequate local responses. Multiple tumor recurrence was found in 19 cases (34%). Seventeen patients were retreated. The cumulative survival rate was 89% after one year, 70% after 3 years, 47% after 5 years and 23% after 8 years. Considering that the subjects of this study included patients with poor hepatic reserves and patients with extensive HCC, the results of this therapy can be deemed to be comparable or superior to the outcome of surgical treatment. Therefore local therapy using IVR is expected to be useful for treating HCC

Assessment of Ultra-Early-Stage Liver Fibrosis in Human Non-Alcoholic Fatty Liver Disease by Second-Harmonic Generation Microscopy

Non-alcoholic fatty liver disease (NAFLD) is associated with the chronic progression of fibrosis. In general, the progression of liver fibrosis is determined by a histopathological assessment with a collagen-stained section; however, the ultra-early stage of liver fibrosis is challenging to identify because of the low sensitivity in the collagen-selective staining method. In the present study, we demonstrate the feasibility of second-harmonic generation (SHG) microscopy in the histopathological diagnosis of the liver of NAFLD patients for the quantitative assessment of the ultra-early stage of fibrosis. We investigated four representative NAFLD patients with early stages of fibrosis. SHG microscopy visualised well-matured fibrotic structures and early fibrosis diffusely involving liver tissues, whereas early fibrosis is challenging to be identified by conventional histopathological methods. Furthermore, the SHG emission directionality analysis revealed the maturation of each collagen fibre of each patient. As a result, SHG microscopy is feasible for assessing liver fibrosis on NAFLD patients, including the ultra-early stage of liver fibrosis that is difficult to diagnose by the conventional histopathological method. The assessment method of the ultra-early fibrosis by using SHG microscopy may serve as a crucial means for pathological, clinical, and prognostic diagnosis of NAFLD patients

Historical changes of hospitalization in patients with hepatocellular carcinoma considering for clinical path preparation

We examined the hospitalization time in 346 patients with hepatocellular carcinoma who were treated between January 1991 and March 2002 (486 admissions). A newly introduced IVR CT system and an advanced catheter shortened the mean time from 65.0 (1991) to 35.6 (2001) days in patients who underwent transcatheter arterial embolization (TAE). For patients having TAE combined with percutaneous ethanol infusion (PEI), the mean time was shortened from 156.5 to 48.7 days. In those who underwent PEI, the values were 56.0 and 36.8 days, respectively. In those who underwent radio frequency ablation (RFA), the mean time in 2001 was 25.3 days. Overall, the mean time was shortened from 60.5 to 38.0 days. In particular, the mean time (41.0 days) after 1999, when the IVR CT system and RFA were introduced, was significantly shorter than that before their introduction (58.9 days). Advances in instruments and procedures for TAE have greatly shortened the hospitalization period. In patients who underwent PEI, the rate of decrease in the mean time was small and it is difficult decrease their length of hospital stay ; therefore, RFA may be frequently employed in the future

Astaxanthin prevents and reverses diet-induced insulin resistance and steatohepatitis in mice: A comparison with Vitamin E

Hepatic insulin resistance and nonalcoholic steatohepatitis (NASH) could be caused by excessive hepatic lipid accumulation and peroxidation. Vitamin E has become a standard treatment for NASH. However, astaxanthin, an antioxidant carotenoid, inhibits lipid peroxidation more potently than Vitamin E. Here, we compared the effects of astaxanthin and Vitamin E in NASH. We first demonstrated that astaxanthin ameliorated hepatic steatosis in both genetically (ob/ob) and high-fat-diet-induced obese mice. In a lipotoxic model of NASH: mice fed a high-cholesterol and high-fat diet, astaxanthin alleviated excessive hepatic lipid accumulation and peroxidation, increased the proportion of M1-type macrophages/Kupffer cells, and activated stellate cells to improve hepatic inflammation and fibrosis. Moreover, astaxanthin caused an M2-dominant shift in macrophages/Kupffer cells and a subsequent reduction in CD4+ and CD8+ T cell recruitment in the liver, which contributed to improved insulin resistance and hepatic inflammation. Importantly, astaxanthin reversed insulin resistance, as well as hepatic inflammation and fibrosis, in pre-existing NASH. Overall, astaxanthin was more effective at both preventing and treating NASH compared with Vitamin E in mice. Furthermore, astaxanthin improved hepatic steatosis and tended to ameliorate the progression of NASH in biopsy-proven human subjects. These results suggest that astaxanthin might be a novel and promising treatment for NASH

Study of the causes of higher mortality rates from chronic liver diseases in Tokushima Prefecture

Mortality rates from chronic liver diseases (CLD) such as liver cirrhosis and hepatocellular carcinoma have been reported to be higher in Tokushima prefecture, although its causes remain unclear. To clarify the causes of CLD in Tokushima prefecture, we evaluated the positive rates of HBs antigen and anti-HCV antibody and the mortality rates from CLD in patients with liver diseases and blood donors after dividing the entire Tokushima prefecture into 8 district boundaries of health centers. In addition, to evaluate the causes of the higher frequency of CLD and the relationship between the development of CLD and viruses, medical examinations were performed in 2 mountain villages in Tokushima prefecture where the drift of population was limited and the mortality rates from CLD differed from each other. As a result, it was found that HCV infection was the major cause of the higher mortality rates from CLD in Tokushima prefecture. Although there were marked regional differences in the mortality rates from CLD, they were mainly due to different rates of HCV infection

Cガタカンエン ウイルス ジゾク カンセン カンジャ ノ カンセンイカ ニオケル ジョセイ ホルモン ノ ヤクワリ

The most common cause of hepatic fibrosis is chronic hepatitis C virus infection, the characteristic feature of which is hepatic steatosis. Hepatic steatosis leads to an increase in lipid peroxidation in hepatocytes, which in turn activates hepatic stellate cells (HSCs). HSCs are also thought to be the primary target cells for inflammatory stimuli, and produce extracellular matrix components. Clinical observations and death statistics support the view that chronic hepatitis C appears to progress more rapidly in men than in women, and cirrhosis is predominately a disease of men and postmenopausal women. It should be noted in this respect that estradiol (E2) is a potent endogenous antioxidant. Our studies showed that E2 suppressed hepatic fibrosis in hepatic fibrosis models, and attenuated HSC activation in primary culture. Recently, variant estrogen receptors (ERs) were found to be expressed to a greater extent in male patients with chronic liver disease than in female subjects. We also demonstrated decreased levels of ERs in postmenopausal women and cirrhotic patients of both genders. The present review summarizes our current knowledge of the biological functions of E2 and ER status as it relates to fibrogenesis in the liver

The utility and limitations of an ultrasonic miniprobe in the staging of gastric cancer

To determine the utility and limitations of an ultrasonic miniprobe (UMP) in the staging of gastric cancer, we evaluated 46 patients who underwent endoscopic ultrasonography (EUS) using an UMP and who were histologically determined to have gastric cancers. In every case, UMP findings were compared with histopathological findings after treatment. The total accuracy of UMP relative to the depth of tumor invasion was71.7% (33/46 cases). Accuracy with respect to T1-m tumor diagnosis was 75.7% (22/29cases), and for T1-sm, 76.9% (10/13 cases), but accuracy for T2 tumor diagnosis was low, due to ultrasound attenuation. When the analysis was carried out based on the size of tumor, the accuracy for UMP was 50.0% (9/18cases) for all tumors over 20mm and 85.7%(24/28 cases) for all tumors smaller than 20mm. We conclude that UMP is suitable for investigation of tumor extension when the lesion is superficial and / or small gastric cancers which do not cause ultrasonic attenuation, but not when the tumor is large or located in certain sites, although conventional EUS is useful in some of these cases

Double-Stranded RNA of Intestinal Commensal but Not Pathogenic Bacteria Triggers Production of Protective Interferon-β

SummaryThe small intestine harbors a substantial number of commensal bacteria and is sporadically invaded by pathogens, but the response to these microorganisms is fundamentally different. We identified a discriminatory sensor by using Toll-like receptor 3 (TLR3). Double-stranded RNA (dsRNA) of one major commensal species, lactic acid bacteria (LAB), triggered interferon-β (IFN-β) production, which protected mice from experimental colitis. The LAB-induced IFN-β response was diminished by dsRNA digestion and treatment with endosomal inhibitors. Pathogenic bacteria contained less dsRNA and induced much less IFN-β than LAB, and dsRNA was not involved in pathogen-induced IFN-β induction. These results identify TLR3 as a sensor to small intestinal commensal bacteria and suggest that dsRNA in commensal bacteria contributes to anti-inflammatory and protective immune responses

トウカ ニオケル ラジオハ ショウシャク リョウホウ オ モチイタ カンシュヨウ チリョウ : preliminary report

Radiofrequency ablation (RFA) has recently been used to treat liver tumors. RFA is a safe and effective treatment of liver tumors and requires fewer treatment sessions. Between June 2000 and April 2003, hepatocellular carcinoma (77 patients with 106 lesions) and metastatic liver tumors (21 patients with 30 lesions) and cholangiocellular carcinoma (1 patient with 1 lesion) were treated with RFA. The liver tumors were treated percutaneously or during surgery under ultrasound guidance using a LeVeen needle (55 lesions) and cool tip RF needle (82 lesions). To evaluate the response, contrast-enhanced CT scans or MRI were obtained. Most patients experienced moderate pain during RFA procedure, especially when the tumor was superficially located. Complete necrosis was achieved in all HCCs with RFA.This result was obtained with an average of 1.12 sessions per HCC. With a median follow-up of 15 months, HCCs have recurred in 6 of 90 treated lesions (6.7%), and metastatic liver tumors have recurred in 2 of 17 treated lesions (11.8%). We are initiating a combining RFA of hepatic malignancies with regional or systemic chemotherapy will reduce hepatic and extrahepatic recurrence rates and enhance long-term survival rates. We believe that RFA will be effective treatment to achieve in patients with unresectable meastatic liver tumors