[A case of pulmonary embolism due to heparin-induced thrombocytopenia after the placement of hepatic arterial infusion catheter].

A 68-year-old woman developed acute pulmonary embolism after hepatic arterial infusion therapy for advanced hepatocellular carcinoma. Because the platelet count was significantly reduced, heparin-induced thrombocytopenia (HIT) due to heparin usage in hepatic arterial infusion therapy was clinically suspected. Subsequently, the patient tested positively for HIT antibodies, and a definitive diagnosis was obtained. Antithrombotic therapy with heparin was discontinued and treatment with argatroban was started. After the heparinized hydrophilic catheter was removed, the platelet count improved immediately. HIT should be considered when a decrease in platelet count and thrombosis are involved with the usage of heparin.

[A patient with an angiomyolipoma of the liver in whom the course of enlargement could be confirmed].

The patients was a 54-year-old woman. In the liver, a high-echo phyma was detected. The lesion increased from 5 to 23mm over 2 years and 4 months. On CT and MRI, it was difficult to differentiate the phyma from hepatocellular carcinoma. However, angiography revealed early outflow to the hepatic vein. In the late CTHA phase of angio-CT, there was no ring-like dark staining reaction (corona), as observed in hepatocellular carcinoma patients, outside the tumor. Hepatectomy was performed, suggesting angiomyolipoma. The course of enlargement could be followed-up, and we present findings that may be useful for differentiating this tumor from hepatocellular carcinoma.

Effective interferon therapy for chronic hepatitis C patients with low viral loads.

BACKGROUND/AIMS: Possible short-term interferon therapy was investigated in chronic hepatitis C patients with genotype 2a or 2b and low viral-loads. Furthermore, initial changes of hepatic C virus RNA levels in early phase interferon therapy, and the number of pretreatment mutated clones at hypervariable region-1 were determined in order to upgrade interferon therapy efficacy prediction rates. METHODOLOGY: Study subjects were 31 patients with histologically proven chronic hepatitis C, having less than 1 Meq/mL of hepatic C virus RNA levels. Daily dose was defined as 9 MU of interferon; patients with genotype lb were treated for 26 weeks, while those with genotype 2a or 2b were treated for 16 weeks. RESULTS: Sustained response rates showed no difference in efficacy between the 2 groups (66.7% vs. 62.5%). Response rates based on the number of hypervariable region-1 clones indicated that the fewer the number of mutated clones, more significant was the increase in efficacy. Efficacy as hepatic C virus RNA in early phase treatment showed no difference in response rates between negative and positive groups at any time point from day 1. CONCLUSIONS: In a low viral-load group, the number of hypervariable region-1 clones was a critical factor influencing interferon therapy efficacy. Thus, 16-week interferon therapy was effective and economical.

[Twenty-four weeks administration of interferon-alpha for chronic hepatitis B].

Twenty-four weeks administration of interferon-alpha has been performed to 23 patients of chronic hepatitis B. As the result, complete or partial responders reached to 47.8%, so that it was considered to be effective therapy for chronic hepatitis B. By the investigation of behaviors of HBV-DNA, the reduction of HBV-DNA below 4 x 10(2) copy/ml during the administration of interferon was considered to be one essential factor for inducing the effectiveness of interferon. Though lamivudine, which has a strong anti-viral effect, has been permitted, interferon is still considered as the good indication for relative young patients who do not have advanced hepatic fibrosis. As a newly strategy for the patients with high titer of HBV-DNA or breakthrough hepatitis, the combination therapy of interferon and lamivudine will be expected.