RESUMO
Sustained virological responses (SVR) by daclatasvir (DCV) and asunaprevir (ASV) therapy for genotype 1b hepatitis C virus (HCV) infected patients has been significantly affected by pre-existence of Y93 H resistance-associated variants (RAVs) in the non-structural protein 5A (NS5A) region. The aim of this study was to elucidate the dominancy of naturally occurring RAVs in viral quasispecies on treatment outcomes in patients with HCV. In total, 138 patients were prospectively selected from 152 patients treated with DCV and ASV, where evaluation of treatment outcomes at 12 weeks post-treatment was possible. Pre-treatment RAVs in the non-structural protein 3 and NS5A regions were detected by polymerase chain reaction (PCR)-Invader assays, and the ratio of Y93H RAVs in viral quasispecies was measured by quantitative PCR-Invader assay. Among 25 patients detected the Y93H RAV, the Y93H ratio was 1-25% in 5 patients, 26-75% in 7 patients, and ≥76% in 13 patients. Overall, SVR at 12 weeks after the completion of treatment (SVR12) was 91% (125/138), and those with Y93H ratios of <1%, 1-25%, 26-75%, and ≥76% were 99%, 100%, 71%, and 23%, respectively. Thus, the SVR12 decreased as the HCV Y93H ratio increased (P < 0.0001). The dominancy of pre-treatment RAVs of DCV and ASV affected its treatment outcomes, suggesting that evaluating the dominancy of HCV RAVs could be required for every other direct-acting antiviral agent treatments. J. Med. Virol. 89:99-105, 2017. © 2016 Wiley Periodicals, Inc.
Assuntos
Antivirais/uso terapêutico , Hepacivirus/classificação , Hepatite C Crônica/tratamento farmacológico , Imidazóis/uso terapêutico , Isoquinolinas/uso terapêutico , Mutação de Sentido Incorreto , Sulfonamidas/uso terapêutico , Proteínas não Estruturais Virais/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Carbamatos , Farmacorresistência Viral , Feminino , Genótipo , Técnicas de Genotipagem , Hepacivirus/genética , Hepacivirus/isolamento & purificação , Hepatite C Crônica/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Estudos Prospectivos , Pirrolidinas , Resposta Viral Sustentada , Resultado do Tratamento , Valina/análogos & derivadosRESUMO
The progression of chronic liver disease differs by etiology. The aim of this study was to elucidate the difference in disease progression between chronic hepatitis C (CHC) and nonalcoholic fatty liver disease (NAFLD) by means of fibrosis markers, liver function, and hepatic tissue blood flow (TBF). Xenon computed tomography (Xe-CT) was performed in 139 patients with NAFLD and 152 patients with CHC (including liver cirrhosis (LC)). The cutoff values for fibrosis markers were compared between NAFLD and CHC, and correlations between hepatic TBF and liver function tests were examined at each fibrosis stage. The cutoff values for detection of the advanced fibrosis stage were lower in NAFLD than in CHC. Although portal venous TBF (PVTBF) correlated with liver function tests, PVTBF in initial LC caused by nonalcoholic steatohepatitis (NASH-LC) was significantly lower than that in hepatitis C virus (C-LC) (p = 0.014). Conversely, the liver function tests in NASH-LC were higher than those in C-LC (p < 0.05). It is important to recognize the difference between NAFLD and CHC. We concluded that changes in hepatic blood flow occurred during the earliest stage of hepatic fibrosis in patients with NAFLD; therefore, patients with NAFLD need to be followed carefully.
Assuntos
Hemodinâmica , Hepatite C Crônica/fisiopatologia , Cirrose Hepática/fisiopatologia , Fígado/fisiopatologia , Hepatopatia Gordurosa não Alcoólica/fisiopatologia , Adulto , Idoso , Biomarcadores/análise , Progressão da Doença , Feminino , Hepacivirus/fisiologia , Hepatite C Crônica/diagnóstico por imagem , Hepatite C Crônica/metabolismo , Hepatite C Crônica/virologia , Interações Hospedeiro-Patógeno , Humanos , Fígado/irrigação sanguínea , Fígado/diagnóstico por imagem , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/metabolismo , Testes de Função Hepática/métodos , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/diagnóstico por imagem , Hepatopatia Gordurosa não Alcoólica/metabolismo , Curva ROC , Fluxo Sanguíneo Regional/fisiologia , Tomografia Computadorizada por Raios X/métodos , XenônioRESUMO
We investigated whether changes in salt reduction readiness are associated with changes in estimated daily salt intake and blood pressure (BP). We divided 86 hypertensive patients into groups with high and low readiness for salt-reducing behavior [an up (UP) and a down (DN) groups, respectively] based on the transtheoretical model (TTM) over a 12-month observation period. We then investigated the relationships between changes in the TTM stage and changes in daily salt intake and BP over 12 months. The patients in the UP group had significantly increased urine potassium concentrations (from 51.2â ±â 23.3â mEq/L at baseline to 56.9â ±â 25.5â mEq/L at 12 months; P â =â 0.048) and significantly decreased estimated 24-h urinary salt excretion (from 9.7â ±â 2.9 g/day at baseline to 8.4â ±â 2.8 g/day at 12 months; P â =â 0.045). In addition, they also had significantly lower changes in urine sodium concentration (-13.1â ±â 46.1 vs. -6.6â ±â 59.7â mEq/L; P â =â 0.048), significantly increased changes in urine potassium concentration (5.7â ±â 20.1 vs. -4.8â ±â 28.6â mEq/L; P â =â 0.030), and significantly decreased changes in estimated 24-h urinary salt excretion (-1.3â ±â 2.6 vs. -0.1â ±â 2.6 g/day; P â =â 0.045) compared with patients in the DN group. However, their home BP did not improve over 12 months. The hypertensive patients who increased their readiness or maintained a high readiness for salt reduction over 12 months showed a significant increase in daily potassium intake and significant decrease in daily salt intake.
Assuntos
Hipertensão , Cloreto de Sódio na Dieta , Humanos , Hipertensão/fisiopatologia , Hipertensão/urina , Masculino , Pessoa de Meia-Idade , Feminino , Estudos Prospectivos , Idoso , Cloreto de Sódio na Dieta/administração & dosagem , Adulto , Pressão SanguíneaRESUMO
Reports of pyogenic liver abscess (PLA) caused by the Streptococcus anginosus group (SAG) have increased. Coinfection with SAG and anaerobic bacteria enhances the tendency for abscess formation. Furthermore, it has been reported that SAG infection results in pylethrombophlebitis as a complication. We experienced 3 cases of PLA caused by SAG: one case was complicated by the development of pylethrombophlebitis and the other 2 cases had coinfection with anaerobic bacteria. We report these cases together with bibliographic consideration of 23 cases previously reported in Japan.
Assuntos
Abscesso Hepático/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus anginosus/isolamento & purificação , Idoso de 80 Anos ou mais , Bactérias Anaeróbias , Infecções Bacterianas/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
This is the first report about the association of readiness for salt reduction with daily salt intake or the salt check sheet score in hypertensive patients at a nonspecialized hypertension clinic. We investigated whether salt reduction readiness as evaluated based on the transtheoretical model (TTM) is associated with estimated daily salt intake or the salt check sheet score. The TTM allows evaluators to easily assess a subject's level of readiness for health-related according to five stages. There was no significant relationship between the TTM stages and estimated daily salt intake. A significant correlation was found between the TTM stages and salt check sheet scores (ρ = -0.409; P < 0.001). When providing salt reduction guidance to hypertensive patients, it is effective for healthcare professionals to use repeated urine tests and salt check sheets to take a salt reduction approach according to the level of readiness of the patients.
Assuntos
Hipertensão , Cloreto de Sódio na Dieta , Humanos , Pressão SanguíneaRESUMO
AIM: To survey the efficacy and safety of dual therapy with daclatasvir and asunaprevir in the elderly hepatitis C virus (HCV) patients multicentricity. METHODS: Interferon-ineligible/intolerant patients and non-responders to previous pegylated-interferon/ribavirin therapy with chronic HCV genotype 1b infection were enrolled. Child B, C cirrhotic patients were excluded. Patients received oral direct acting antiviral treatment consisting of 60 mg daclatasvir once daily plus 200 mg asunaprevir twice daily for 24 wk. We divided the patients into two groups of 56 elderly patients (≥ 75 years-old) and 141 non-elderly patients (< 75 years old) and compared the efficacy and safety. RESULTS: Ninety-one point one percent of elderly patients and 90.1% of non-elderly patients achieved sustained virological response at 24 wk (SVR24). In the former, 1.8% experienced viral breakthrough, as compared with 3.5% in the latter (not significant). Adverse events occurred in 55.4% of the former and 56.0% of the latter. In the former, 7 cases (12.5%) were discontinued due to adverse events, and in the latter 9 cases were discontinued (6.4%, not significant). CONCLUSION: Dual therapy with daclatasvir and asunaprevir achieved the same high rates of SVR24 in HCV elderly patients without more adverse events than in the non-elderly patients.
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We present a case of deep venous thrombosis (DVT) during pegylated interferon (peg-IFN)-alpha2b plus ribavirin treatment of chronic hepatitis C (CHC). A 67-year-old man, who had been under treatment for hypertension and diabetes mellitus, was admitted to our hospital for peg-IFN-alpha2b plus ribavirin treatment for CHC. His serum hepatitis C virus (HCV) RNA level became undetectable 1 week after the initiation of peg-IFN-alpha2b plus ribavirin treatment. He suffered from severe pain, flare, and edema in both of his lower legs 6 weeks after the initiation of peg-IFN-alpha2b plus ribavirin treatment. He was diagnosed as having DVT because of the presence of a thrombus in the right soleus vein by ultrasonography. Peg-IFN-alpha2b plus ribavirin treatment was discontinued because a causal relationship between DVT and peg-IFN-alpha2b plus ribavirin treatment was suspected. DVT was not observed and the symptoms in both of his legs were improved after the administration of warfarin potassium. Subsequently, DVT has not recurred, and he has remained HCV-RNA negative.
Assuntos
Antivirais/efeitos adversos , Hepatite C Crônica/tratamento farmacológico , Interferon-alfa/efeitos adversos , Ribavirina/efeitos adversos , Trombose Venosa/induzido quimicamente , Idoso , Alanina Transaminase/sangue , Antivirais/uso terapêutico , Quimioterapia Combinada , Hepacivirus/genética , Humanos , Interferon alfa-2 , Interferon-alfa/uso terapêutico , Masculino , Tempo de Tromboplastina Parcial , Polietilenoglicóis , Tempo de Protrombina , RNA Viral/análise , Proteínas Recombinantes , Ribavirina/uso terapêuticoRESUMO
A 77-year-old man on systemic chemotherapy against postoperative bilateral multiple lung metastases of malignant solitary fibrous tumor of the pleura suffered from pruritus and jaundice. Blood examination showed elevated levels of hepatobiliary enzymes. Abdominal computed tomography showed a tumor with peripheral enhancement in the pancreatic head, accompanied with the dilatation of intra- and extra-hepatic bile ducts. He was diagnosed as having obstructive jaundice caused by a pancreatic head tumor. The pancreatic head tumor was presumably diagnosed as the metastasis of malignant solitary fibrous tumor of the pleura, because the findings on the pancreatic head tumor on abdominal CT were similar to those on the primary lung lesion of malignant solitary fibrous tumor of the pleura. The pancreatic tumor grew rapidly after the implantation of metallic stent in the inferior part of the common bile duct. The patient died of lymphangitis carcinomatosa of the lungs. Autopsy revealed a tumor that spread from the pancreatic head to the hepatic hilum. Microscopically, spindle-shaped cells exhibiting nuclear atypicality or division together with collagen deposition were observed. Immunohistochemically the pancreatic head tumor cells were negative for staining of alpha-smooth muscle actin (alpha-SMA) or CD117, but positive for vimentin, CD34 and CD99. These findings are consistent with those on malignant solitary fibrous tumor of the pleura. We report the first case of obstructive jaundice caused by a secondary pancreatic tumor from malignant solitary fibrous tumor of the pleura.
Assuntos
Icterícia Obstrutiva/etiologia , Neoplasias de Tecido Fibroso/patologia , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/secundário , Neoplasias Pleurais/patologia , Idoso , Autopsia , Biomarcadores Tumorais/sangue , Evolução Fatal , Humanos , Icterícia Obstrutiva/patologia , Masculino , Neoplasias Pancreáticas/patologiaRESUMO
Following interferon-based therapy for chronic hepatitis C, the negativity of hepatitis C virus RNA is essential to achieve viral clearance at the end of treatment. We report a case of clearance of chronic hepatitis C virus infection following early discontinuation (at 6 weeks) of peginterferon plus ribavirin therapy, without negativity for hepatitis C virus RNA during the treatment period. The patient was a 76-year-old Japanese male infected with hepatitis C virus genotype 1b and TT of IL28B rs8099917. Hepatitis C virus RNA remained positive at persistently low levels for more than 2 months after the cessation of therapy and became negative at 7 months after the discontinuation of therapy. Spontaneous clearance of hepatitis C virus RNA can occur following antiviral failure in patients with persistently low viral loads, and virological follow-up is therefore necessary in chronic hepatitis C virus infection, even after antiviral failure.
RESUMO
De novo hepatitis B is associated with a high risk of hepatic failure often resulting in fatal fulminant hepatitis even when nucleotide analogues are administered. A 77-year-old female developed de novo hepatitis B after R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) treatment for diffuse large B-cell lymphoma. Hepatitis B virus (HBV) isolated from the patient was of genotype Bj, with a precore mutation (G1896A) exhibiting an extremely high viral load at the onset of hepatitis. She showed markedly high levels of transaminase with mild jaundice on admission and rapid decrease of prothrombin activity after admission. Although acute liver failure was averted by the administration of entecavir and corticosteroid pulse therapy, liver volume decreased to 860 ml, and marked hypoalbuminemia accompanying massive ascites occurred 2 months after the onset of hepatitis and persisted for 3 months with high levels of HBV DNA and mild abnormal alanine aminotransferase levels. Frequent infusions of albumin solution, nutrition support, and alleviation therapy showed limited effect. However, overall improvement along with HBV DNA reduction was observed after increasing the dose of entecavir and completion of prednisolone that was administered with a minimum dose for adrenal insufficiency. An immediate and sufficient suppression of virus replication with potent antiviral therapy is critical, particularly in patients infected with HBV precore mutation (G1896A) and/or Bj genotype, which may have a high viral replication and direct hepatocellular damage.
RESUMO
Daclatasvir (DCV) plus asunaprevir (ASV) treatment, an oral therapy for chronic hepatitis C virus (HCV) genotype 1b infection, can achieve a high sustained viral response (SVR) rate within a 24-week treatment period. A 55-year-old Japanese female with cirrhosis and null response for peginterferon plus ribavirin therapy received DCV plus ASV therapy, but she reported a slight fever beginning on treatment day 4. The fever increased to >38.0 °C beginning on treatment day 15 and could not be controlled with antipyretics; thus, the treatment was discontinued on day 17. Although the patient was still positive for HCV RNA 6 days after treatment discontinuation, she achieved an SVR at week 24 after treatment cessation. In some patients with HCV genotype 1b infection, an SVR can be achieved with short-term DCV plus ASV treatment, and HCV RNA positivity at the end of treatment does not always indicate virological failure.
Assuntos
Antivirais/uso terapêutico , Hepatite C Crônica/tratamento farmacológico , Imidazóis/uso terapêutico , Isoquinolinas/uso terapêutico , Sulfonamidas/uso terapêutico , Administração Oral , Antivirais/efeitos adversos , Carbamatos , Esquema de Medicação , Feminino , Genótipo , Hepacivirus/genética , Hepatite C Crônica/genética , Hepatite C Crônica/virologia , Humanos , Imidazóis/efeitos adversos , Interferons/uso terapêutico , Isoquinolinas/efeitos adversos , Pessoa de Meia-Idade , Pirrolidinas , Ribavirina/uso terapêutico , Sulfonamidas/efeitos adversos , Falha de Tratamento , Valina/análogos & derivados , Carga ViralRESUMO
BACKGROUND: Decreased hemoglobin (Hb) level has been supposed to be a relatively rare side effect of a combination therapy against hepatitis C virus that consists of the NS5A inhibitor daclatasvir (DCV) and the NS3/4A protease inhibitor asunaprevir (ASV). METHODS: The study was conducted in 75 patients with genotype 1b chronic hepatitis C virus infection who had started combination therapy with DCV and ASV at St. Marianna University School of Medicine Hospital between September 2014 and December 2014. RESULTS: Among the patients examined, decreased Hb level by ≥1.5 g/dL from the values at treatment initiation was observed in 11 individuals. This was accompanied by decreased mean corpuscular volume, and iron and ferritin levels. CONCLUSIONS: These findings suggest that the mechanism of the phenomenon is caused by iron deficiency. The underlying mechanism and clinical impacts will need to be further examined.
Assuntos
Genótipo , Hemoglobinas/metabolismo , Hepacivirus/genética , Hepatite C Crônica/sangue , Hepatite C Crônica/tratamento farmacológico , Imidazóis , Deficiências de Ferro , Isoquinolinas , Sulfonamidas , Adulto , Idoso , Idoso de 80 Anos ou mais , Carbamatos , Feminino , Hepatite C Crônica/genética , Humanos , Imidazóis/administração & dosagem , Imidazóis/efeitos adversos , Isoquinolinas/administração & dosagem , Isoquinolinas/efeitos adversos , Masculino , Pessoa de Meia-Idade , Pirrolidinas , Sulfonamidas/administração & dosagem , Sulfonamidas/efeitos adversos , Valina/análogos & derivadosRESUMO
BACKGROUND/AIMS: We compared the predictive abilities of the Abbott Real Time hepatitis C virus (HCV) assay (ART) with those of standard serum HCV ribonucleic acid (RNA) detection methods in patients undergoing triple therapy, which involves treatment with a protease inhibitor combined with pegylated interferon and ribavirin. MATERIALS AND METHODS: In this study, 28 patients underwent triple therapy. The hepatitis C virus ribonucleic acid (HCV RNA) level of each patient was measured at weeks 0, 4, 8, and 12 after the initiation of therapy using the Roche COBAS AmpliPrep/COBAS TaqMan HCV assay version 1.0 (CAP/CTM v1.0) and ART. RESULTS: At week 8 after the initiation of therapy, the sustained virological response (SVR) rate among patients who tested negative and positive for HCV RNA using CAP/CTM v1.0, was 80.0% (20/25) and 33.3% (1/3), and using ART, it was 91.3% (21/23) and 0.0% (0/5), respectively. Although at week 8, the predictive capability of CAP/CTM v1.0 was 78.5%, ART was found to be a more accurate predictor of future SVR status with a rate of 92.9%. CONCLUSION: These results indicate that the presence or absence of serum HCV RNA, evaluated using ART at week 8 after the initiation of therapy, may be useful for predicting therapeutic outcomes in patients receiving triple therapy.
Assuntos
Antivirais/administração & dosagem , Hepacivirus/efeitos dos fármacos , Hepatite C/tratamento farmacológico , RNA Viral/sangue , Carga Viral/métodos , Adulto , Idoso , Quimioterapia Combinada , Feminino , Hepacivirus/genética , Hepatite C/virologia , Humanos , Interferon alfa-2 , Interferon-alfa/administração & dosagem , Masculino , Pessoa de Meia-Idade , Oligopeptídeos/administração & dosagem , Polietilenoglicóis/administração & dosagem , Valor Preditivo dos Testes , Proteínas Recombinantes/administração & dosagem , Ribavirina/administração & dosagem , Resultado do Tratamento , Adulto JovemRESUMO
The present communication deals with information regarding the practice of the oral glucose tolerance test and determination of serum fructosamine in laboratory beagles. In the oral glucose tolerance test, a 180-min level was found to be crucial following a gavage administration of 50% glucose solution at 5 mL/kg per body weight under fasting conditions. Serum fructosamine concentration as 'determined by enzymatic assay ranged between 82 and 123 micromol/L (mean of 104 micromol/L), which was about 0.285 to 0.25 times the value obtained by the chemical method described by Johnson and colleagues. Reasons for differences are ascribed to the presence of substances with reducing potential other than fructosamine in the serum.
Assuntos
Frutosamina/sangue , Teste de Tolerância a Glucose/métodos , Teste de Tolerância a Glucose/veterinária , Administração Oral , Animais , Cães , Jejum , Feminino , Privação de Alimentos , Glucose/administração & dosagem , MasculinoRESUMO
A 47-year-old female with a 17-year history of autoimmune hepatitis had been treated with prednisolone, azathioprine, and ursodeoxycholic acid. Although her alanine aminotransferase level occasionally showed mild abnormality, the prednisolone dose could not be increased because she had developed cataract during the course of her illness. In May 2012, she developed severe normochromic normocytic anemia without hemorrhage, and azathioprine was discontinued because it was suspected of being the cause. However, anemia recurred frequently even after discontinuation, necessitating repeated blood transfusions. Bone marrow analysis revealed selective erythroblastopenia, thus leading to a diagnosis of pure red cell aplasia. Cyclosporine A was administered, which led to a dramatic recovery from anemia, and stabilized her alanine aminotransferase levels. Furthermore, the prednisolone dose could be gradually tapered. Pure red cell aplasia associated with autoimmune hepatitis is extremely rare. The present case shows that patients with autoimmune hepatitis refractory to the standard treatment regimen and those with concomitant pure red cell aplasia may be treated with cyclosporine A.
Assuntos
Ciclosporina/uso terapêutico , Hepatite Autoimune/tratamento farmacológico , Hepatite Autoimune/etiologia , Imunossupressores/uso terapêutico , Aplasia Pura de Série Vermelha/complicações , Aplasia Pura de Série Vermelha/tratamento farmacológico , Adulto , Feminino , Humanos , Indução de RemissãoRESUMO
A 71-year-old female patient with hepatitis C virus genotype 1 had previously discontinued interferon (IFN)-α plus ribavirin therapy, pegylated IFN-α (pegIFN-α) monotherapy, and natural IFN-α monotherapy because of arrhythmia, interstitial pneumonia, and severe neurovegetative symptoms. She subsequently completed 72 weeks of natural IFN-ß plus ribavirin therapy without remarkable adverse effects and achieved a sustained viral response, suggesting differences in the pharmacological properties and biological effects of IFN-α and IFN-ß. Thus, natural IFN-ß plus ribavirin therapy may be a treatment option for patients with poor tolerance to IFN-α or pegIFN-α treatments.
Assuntos
Antivirais/uso terapêutico , Hepatite C Crônica/tratamento farmacológico , Interferon beta/uso terapêutico , Ribavirina/uso terapêutico , Arritmias Cardíacas/induzido quimicamente , Quimioterapia Combinada , Feminino , Humanos , Interferon-alfa/efeitos adversos , Doenças Pulmonares Intersticiais/induzido quimicamente , Pessoa de Meia-Idade , Indução de RemissãoRESUMO
As the first step to get historical background data for physiological examinations in juvenile dogs, hematology and blood chemistry data obtained from juvenile beagle dogs (less than 3 months of age) used in the control group of toxicity studies conducted in our laboratory were summarized and compared with those obtained from adult beagle dogs (6 months of age). In the hematological examination, growth of beagle dogs was shown to be associated with increases in erythrocyte parameters and with decreases in reticulocyte and leukocyte counts. In the blood chemical examination, growth of beagle dogs was shown to be associated with increases in aspartate aminotransferase, alanine aminotransferase, and creatinine and with decreases in creatine phosphokinase, glucose, total cholesterol, and calcium. The differential leukocyte ratio showed no age relation, but the actual count showed a tendency toward decrease. Alkaline phosphatase showed a tendency to increase from 0 months of age to 3 months of age, but it decreased at 6 months of age. The present results were roughly similar to those previously reported.
Assuntos
Análise Química do Sangue , Cães/crescimento & desenvolvimento , Testes Hematológicos , Envelhecimento , Alanina Transaminase/sangue , Animais , Aspartato Aminotransferases/sangue , Contagem de Células Sanguíneas , Glicemia , Cálcio/sangue , Colesterol/sangue , Creatina Quinase/sangue , Creatinina/sangue , Feminino , Masculino , Testes de ToxicidadeRESUMO
BACKGROUND: Xenon computed tomography (Xe-CT) provides quantitative information on tissue blood flow (TBF). In the present study, Xe-CT was performed in patients with esophagogastric varices (EGV) before and after endoscopic injection sclerotherapy (EIS) to evaluate hepatic blood flow (HBF), hepatic arterial TBF (HATBF) and portal venous TBF (PVTBF). METHODS: Subjects comprised of 88 patients with EGV (49 men, 39 women, average age 65.8 ± 11.5 years, median age 68 years, 30-86 years) and liver cirrhosis related to either hepatitis C virus (C) (n = 33), hepatitis B virus (B) (n = 3), alcohol (AL) (n = 22), AL + C (n = 7), AL + B (n = 1), B + C + AL (n = 1), nonalcoholic steatohepatitis (NASH) (n = 4), autoimmune hepatitis (AIH) (n = 5), primary biliary cirrhosis (PBC) (n = 2), or cryptogenic (n = 10) were enrolled. All patients, who were enrolled in this study, were performed EIS for prophylaxis. Xe-CT and measurement of the retention rate of indocyanine green 15 min after administration (ICG R15) were performed before and after EIS. Total hepatic TBF (THTBF) and PVTBF/HATBF ratio (P/A) were also calculated. RESULTS: PVTBF, HATBF, THTBF, P/A and ICG R15 before EIS were 28.3 ± 8.91, 22.5 ± 14.4 and 50.8 ± 17.6 ml/100 ml/min, 1.62 ± 0.71 and 28.8 ± 12.7 %, respectively and those after EIS were 31.9 ± 10.0, 19.3 ± 11.6, and 51.2 ± 17.0 ml/100 ml/min, 1.92 ± 0.84 and 23.6 ± 11.3 %, respectively. PVTBF and P/A after EIS were significantly higher than those before EIS (p = 0.00444, p = 0.0179, respectively), and HATBF and ICG R15 after EIS were significantly lower than those before EIS (p = 0.00129, p < 0.001, respectively). CONCLUSIONS: Xenon computed tomography showed that PVTBF increased after EIS for EGV and HATBF decreased in response to an increase in PVTBF.
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Varizes Esofágicas e Gástricas/terapia , Escleroterapia/métodos , Tomografia Computadorizada por Raios X/métodos , Xenônio , Adulto , Idoso , Idoso de 80 Anos ou mais , Endoscopia/métodos , Varizes Esofágicas e Gástricas/patologia , Feminino , Artéria Hepática/metabolismo , Humanos , Fígado/irrigação sanguínea , Fígado/patologia , Cirrose Hepática/etiologia , Cirrose Hepática/patologia , Masculino , Pessoa de Meia-Idade , Veia Porta/metabolismo , Estudos Prospectivos , Fluxo Sanguíneo RegionalRESUMO
AIM: Recently, patients positive for the low-titer hepatitis B surface antigen (HBsAg) have been found occasionally owing to the increase in the accuracy of detection methods. The aim of this study is to clarify the clinical status of acute hepatitis B virus (HBV) infection in patients positive for low-titer HBsAg. METHOD: Eight patients, who were positive for HBsAg at low titers and diagnosed as having acute HBV infection, were enrolled in this study. Assays of HBsAg, hepatitis B core antibody (anti-HBc), hepatitis B e-antigen (HBeAg), hepatitis B e-antibody (anti-HBe), hepatitis B surface antibody (anti-HBs) and HBV DNA, and biochemical tests were basically conducted every 4 weeks for at least 24 weeks. RESULT: The average cut-off index of HBsAg was 8.7 ± 9.6 (range, 1.0-25.7). All the patients were negative for anti-HBc, HBeAg, anti-HBe and HBV DNA on their initial visit. The genotype of HBV could be determined in four patients: two were infected with genotype B/HBV, one was infected with genotype A/HBV, and the remaining patient was infected with genotype C/HBV. Although HBsAg clearance was observed within 4 months in all the patients, none of the other HBV markers seroconverted during the observation period. CONCLUSION: HBV infection terminating with seronegativity for HBV markers may occur in transient HBV infection.