[Hepatits B virus reactivation in patients receiving immunosuppressive therapy or chemotherapy and effective prophylactic management: a prospective observational study in a hospital over an 8-year period].

We investigated the development of hepatits B virus (HBV) reactivation in patients receiving immunosuppressive therapy or chemotherapy at our hospital for 8 years. Using the automatic checking system for HBV reactivation coded using medical information that has been in operation in our hospital since October 2012, we prospectively observed the occurrence status of HBV reactivation in immunosuppressive/chemotherapy cases for 8 years. HBV reactivation occurred in 31 of 1516 patients with HBV infection. It occurred annually between 1 and 7 cases in multiple clinical departments, and in 8 of 59 patients treated with rituximab, 10 of 653 patients treated with antineoplastic agents, 10 of 399 patients treated with steroids, and 3 of 212 patients treated with direct-acting antivirals. The cumulative incidence of HBV reactivation was 1.2%, 2.3%, and 3.4% at 1, 2, and 3 years, respectively. The results of Cox regression analysis showed that the incidence of HBV reactivation was significantly higher in patients who received rituximab (odds ratio:12.841) or steroid (hazard ratio:4.264) or those who tested positive for HBc antibody alone (hazard ratio:11.005). We observed the occurrence of HBV reactivation in HBV-infected patients treated with immunosuppressive therapy or chemotherapy. HBV reactivation by immunosuppressive therapy or chemotherapy still occurs, and further safety management and caution are required in the hospital.

[Ultra high-risk refractory multiple myeloma with a complex karyotype including t(14;19)].

A 78-year-old man was hospitalized because of rapid progression of chronic renal failure and diagnosed with multiple myeloma (MM) IgG-λ type ISS-III R-ISS-II with complex karyotype including t(14;19). Even after receiving bortezomib-based regimens, his renal failure progressed. He became dependent on dialysis, which was required three times a week. After introducing the daratumumab (DARA)-based regimen, his renal function improved, the frequency of dialysis decreased to twice a week, and the free light chain (FLC) ratio also improved. However, his myeloma eventually followed a refractory course; therefore, pomalidomide (POM)-dexamethasone (Pd) regimen was administered. Pd regimen had a marked effect and normalized the FLC ratio after three courses of the treatment. However, his myeloma reprogressed with multiple extramedullary masses and he became del(17p) positive; eventually, he died on the 470th day of disease. MM with t(14;19) is rare and has a poor prognosis with a highly aggressive course; however, early introduction of DARA or POM may provide long-term response.

Pericardial fat volume is an independent risk factor for the severity of coronary artery disease in patients with preserved ejection fraction.

OBJECTIVES: The aim of this study was to assess the relationship between the pericardial fat volume (PFV) and the characteristics of coronary plaques in patients with ischemic heart disease (IHD). BACKGROUND: It has been suggested that pericardial adipose tissue promotes plaque development in coronary artery disease (CAD). METHODS: We analyzed the cardiac computed tomography scans in consecutive patients suspected of CAD. PFV was quantified using validated software and indexed to body surface area, and the severity of coronary stenosis was evaluated in the patients who underwent coronary angiography. A total of 105 subjects (mean age, 68±10 years) with IHD were categorized into tertiles of body surface area-indexed PFV values (PFVi, cm3/m2): low-tertile, PFVi < 81.2 cm3/m2; mid-tertile, 81.2 cm3/m2 ≤ PFVi ≤ 114 cm3/m2; high-tertile, PFVi > 114 cm3/m2. Their body mass index (BMI), waist circumference, Gensini score (GS), and coronary plaque component were evaluated. RESULTS: The GS was significantly different between the high-tertile and the low-tertile groups, indicating a stepwise decrease in GS from high-tertile to mid-tertile and to low-tertile. PFVi had a significant positive correlation with BMI (p=0.0001) and GS (p<0.0001). However, no significant association was found between GS and BMI. On the multivariate analysis, high PFVi remained an independent predictor for the coronary artery disease severity (p<0.001), while BMI and waist circumference were not independent predictors. CONCLUSIONS: Obese patients were found to have more PFVi, and the characteristics of their coronary lesions were more severe. Pericardial adipose tissue as unique ectopic fat might be more highly associated with IHD progression.

1,5-Anhydroglucitol levels are low irrespective of plasma glucose levels in patients with chronic liver disease.

BACKGROUND: Serum 1,5-anhydroglucitol (1,5-AG) is a known marker reflecting recent glycaemic control. In this study, we examined serum 1,5-AG levels in chronic liver disease (CLD) patients with and without diabetes mellitus. METHODS: Eighty patients with CLD were compared with 667 subjects without CLD. Glycaemic control of the CLD patients was evaluated by estimated glycated haemoglobin (HbA(1C)) calculated using the equation by Rohlfing et al. from mean plasma glucose because CLD patients have apparently low HbA(1C). RESULTS: When the study participants were divided into subgroups stratified by HbA(1C) levels, the CLD patients whose estimated HbA(1C) levels were less than 7.0% showed significantly lower 1,5-AG than their counterparts of the control subjects. Stepwise multivariable analysis revealed that estimated HbA(1C) was the significant explanatory variable for 1,5-AG in the CLD patients. However, in the CLD patients with estimated HbA(1C) less than 5.8%, only hepaplastin test was the significant explanatory variable for 1,5-AG. CONCLUSIONS: Serum 1,5-AG levels are low irrespective of plasma glucose levels in the CLD patients with and without diabetes. The CLD patients who had low serum 1,5-AG levels were associated with deteriorated liver function.

Sloughing of intraductal tumor thrombus of hepatocellular carcinoma after transcatheter arterial chemoembolization.

Transcatheter arterial chemoembolization (TACE) is effective for hepatocellular carcinoma (HCC) with intrabile duct thrombus. After TACE, intraductal tumor thrombi occasionally detach from the intrahepatic tumor and drop into the bottom of the common bile duct, causing clinical symptoms similar to the impaction of choledocholithiasis. The investigators describe three cases of sloughing of HCC intraductal tumor thrombi after selective TACE. In each of the three cases, the necrotic tumor cast was successfully removed endoscopically, and the patient's symptoms were dramatically improved. Two patients survived without recurrence of the intraductal tumor thrombus for 8 and 11 months after TACE, respectively.