RESUMO
Bacterial adhesion to the calcium phosphate surface is a serious problem in surgery. To prevent bacterial infection, the development of calcium-phosphate cements (CPCs) with bactericidal properties is indispensable. The aim of this study was to fabricate antibacterial CPCs and evaluate their biological properties. Silver-containing tricalcium phosphate (Ag-TCP) microspheres consisting of α/ß-TCP phases were synthesized by an ultrasonic spray-pyrolysis technique. The powders prepared were mixed with the setting liquid to fabricate the CPCs. The resulting cements consisting of ß-TCP and hydroxyapatite had a porous structure and wash-out resistance. Additionally, silver and calcium ions could be released into the culture medium from Ag-TCP cements for a long time accompanied by the dissolution of TCP. These data showed the bioresorbability of the Ag-TCP cement. In vitro antibacterial evaluation demonstrated that both released and immobilized silver suppressed the growth of bacteria and prevented bacterial adhesion to the surface of CPCs. Furthermore, histological evaluation by implantation of Ag-TCP cements into rabbit tibiae exhibited abundant bone apposition on the cement without inflammatory responses. These results showed that Ag-TCP cement has a good antibacterial property and good biocompatibility. The present Ag-TCP cements are promising for bone tissue engineering and may be used as antibacterial biomaterials.
Assuntos
Antibacterianos/química , Cimentos Ósseos/química , Microesferas , Animais , Antibacterianos/farmacologia , Cimentos Ósseos/farmacologia , Fosfatos de Cálcio/química , Hidroxiapatitas/química , Masculino , Coelhos , Prata/química , Staphylococcus aureus/efeitos dos fármacos , Tíbia/cirurgiaRESUMO
BACKGROUND: After previous earthquakes, a high prevalence of deep vein thrombosis (DVT) has been reported. We examined DVT prevalence and risk factors in evacuees of the Kumamoto earthquakes by performing mobile DVT screening at various evacuation centers around the epicenter. MethodsâandâResults: For 1 month after the Kumamoto earthquake on 14 April 2016, mobile DVT screening using portable ultrasonography (US) was performed at 80 evacuation centers. Questionnaires, physical examination, and US of the lower limb were carried out, and simple D-dimer measurements were undertaken for DVT-positive examinees. The total number of examinees was 1,673, of whom 178 (10.6%) had DVT. The prevalence of DVT seemed to be gradually decreasing in the screening period, but age, use of sleep medication, prevalence of hypertension, dyslipidemia, leg edema, and lower leg varix were significantly higher in the DVT positive group than in the negative group. On multivariable logistic regression analysis, high age (≥70 years old), use of sleep medication, lower leg edema, and lower leg varix were significant predictors of DVT. In examinees with these 4 predictors, the DVT positive rate was 71.4%. CONCLUSIONS: In the first month after the Kumamoto earthquakes, DVT prevalence and severity, evaluated on D-dimer level, decreased with the passage of time. Mobile DVT screening indicated significant factors stratifying DVT risk in the evacuees.
Assuntos
Terremotos , Trombose Venosa/etiologia , Adulto , Fatores Etários , Idoso , Edema , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Japão , Extremidade Inferior/patologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Ultrassonografia , Varizes , Trombose Venosa/diagnóstico , Trombose Venosa/epidemiologiaRESUMO
Cadmium (Cd) is a highly hepatotoxic heavy metal, which is widely dispersed in the environment. Acute Cd hepatotoxicity has been well studied in experimental animals; however, effects of prolonged exposure to Cd doses on the liver remain unclear. In the present study, to evaluate chronic Cd hepatotoxicity, we examined specimens from cases of itai-itai disease, the most severe form of chronic Cd poisoning. We compared 89 cases of itai-itai disease with 27 control cases to assess Cd concentration in organs. We also examined 80 cases of itai-itai disease and 70 control cases for histopathological evaluation. In addition, we performed immunohistochemistry for metallothionein, which binds and detoxifies Cd. Hepatic Cd concentration was higher than Cd concentration in all other organs measured in the itai-itai disease group, whereas it was second highest following renal concentration in the control group. In the liver in the itai-itai disease group, fibrosis was observed at a significantly higher rate than that in the control group. Metallothionein expression was significantly higher in the itai-itai disease group than that in the control group. Prolonged exposure to low doses of Cd leads to high hepatic accumulation, which can then cause fibrosis; however, it also causes high expression of metallothionein, which is thought to reduce Cd hepatotoxicity.
Assuntos
Intoxicação por Cádmio/diagnóstico , Cádmio/efeitos adversos , Doença Hepática Crônica Induzida por Substâncias e Drogas/diagnóstico , Poluentes Ambientais/efeitos adversos , Fígado/efeitos dos fármacos , Metalotioneína/análise , Idoso , Idoso de 80 Anos ou mais , Autopsia , Cádmio/análise , Intoxicação por Cádmio/metabolismo , Intoxicação por Cádmio/mortalidade , Intoxicação por Cádmio/patologia , Estudos de Casos e Controles , Doença Hepática Crônica Induzida por Substâncias e Drogas/metabolismo , Doença Hepática Crônica Induzida por Substâncias e Drogas/mortalidade , Doença Hepática Crônica Induzida por Substâncias e Drogas/patologia , Distribuição de Qui-Quadrado , Poluentes Ambientais/análise , Feminino , Humanos , Imuno-Histoquímica , Fígado/química , Fígado/patologia , Cirrose Hepática/induzido quimicamente , Cirrose Hepática/diagnóstico , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Regulação para CimaRESUMO
Novel biodegradable ß-tricalcium phosphate (ß-TCP) cements with anti-washout properties were created on the basis of chelate-setting mechanism of inositol phosphate (IP6) using ß-TCP powders. The ß-TCP powders were ball-milled using ZrO2 beads for 0-6 h in the IP6 solutions with concentrations from 0 to 10,000 ppm. The chelate-setting ß-TCP cement with anti-washout property was successfully fabricated by mixing the ß-TCP powder ball-milled in 3,000 ppm IP6 solution for 3 h and 2.5 mass% Na2HPO4 solution, and compressive strength of the cement was 13.4 ± 0.8 MPa. An in vivo study revealed that the above cement was directly in contact with host and newly formed bones without fibrous tissue layers, and was resorbed by osteoclast-like cells on the surface of the cement. The chelate-setting ß-TCP cement with anti-washout property is promising for application as a novel injectable artificial bone with both biodegradability and osteoconductivity.
Assuntos
Cimentos Ósseos/química , Cimentos Ósseos/uso terapêutico , Fosfatos de Cálcio/química , Fosfatos de Cálcio/uso terapêutico , Fosfatos de Inositol/química , Osteoblastos/efeitos dos fármacos , Fraturas da Tíbia/terapia , Implantes Absorvíveis , Adesividade , Animais , Células Cultivadas , Dureza , Teste de Materiais , Osseointegração/fisiologia , Osteoblastos/citologia , Pós , Suínos , Fraturas da Tíbia/patologia , Fraturas da Tíbia/fisiopatologia , Resultado do TratamentoRESUMO
The resistance to transcription factor-mediated reprogramming into pluripotent stem cells is one of the distinctive features of cancer cells. Here we dissect the profiles of reprogramming factor binding and the subsequent transcriptional response in cancer cells to reveal its underlying mechanisms. Using clear cell sarcomas (CCSs), we show that the driver oncogene EWS/ATF1 misdirects the reprogramming factors to cancer-specific enhancers and thereby impairs the transcriptional response toward pluripotency that is otherwise provoked. Sensitization to the reprogramming cue is observed in other cancer types when the corresponding oncogenic signals are pharmacologically inhibited. Exploiting this oncogene dependence of the transcriptional "stiffness," we identify mTOR signaling pathways downstream of EWS/ATF1 and discover that inhibiting mTOR activity substantially attenuates the propagation of CCS cells in vitro and in vivo. Our results demonstrate that the early transcriptional response to cell fate perturbations can be a faithful readout to identify effective therapeutics targets in cancer cells.
Assuntos
Oncogenes , Sarcoma de Células Claras , Humanos , Sarcoma de Células Claras/genética , Transdução de Sinais , Serina-Treonina Quinases TOR , Fatores de Transcrição/genéticaRESUMO
Arteriovenous malformation (AVM) in the pancreas rarely causes acute pancreatitis. However, even when it does cause pancreatitis, the pathogenesis is unclear. A 61-year-old man was admitted to our hospital for acute pancreatitis. The findings of computed abdominal tomography, magnetic resonance imaging, and endoscopic ultrasonography revealed pancreatic AVM and hematoma in the tail of the pancreas. These lesions were suspected to be associated with pancreatitis. Although endoscopic retrograde pancreatography could not confirm hemosuccus pancreaticus, distal pancreatectomy was performed because of repeated pancreatitis. The histopathological findings of the resected specimen revealed rupture of the AVM vessels into the main pancreatic ducts. Finally, we considered that intermittent bleeding due to AVM rupture and hematoma formation in the main pancreatic duct caused the repeated pancreatitis.
Assuntos
Malformações Arteriovenosas , Pancreatite , Doença Aguda , Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/diagnóstico por imagem , Pâncreas/cirurgia , Pancreatectomia , Ductos Pancreáticos , Pancreatite/etiologiaRESUMO
The increased use of immune-checkpoint inhibitors to treat various types of cancer has increased the incidence of immune-related adverse events (irAEs). Hepatic irAEs are frequent and can lead to serious conditions. Among the various types of hepatic irAEs reported to date, bile duct injury has been shown refractory to steroid treatment. This study describes 2 patients with hepatic irAEs manifesting as intrahepatic bile duct injury. Immunostaining with antibodies to both CD8 and cytokeratin-7 was useful for the diagnosis, and both patients were refractory to steroid treatment. Prompt diagnosis and active immunosuppressive therapies are required in such cases.
RESUMO
BACKGROUND: We previously reported that there were no differences between the lung-protective actions of pressure-controlled inverse ratio ventilation and volume control ventilation based on the changes in serum cytokine levels. Dead space represents a ventilation-perfusion mismatch, and can enable us to understand the heterogeneity and elapsed time changes in ventilation-perfusion mismatch. METHODS: This study was a secondary analysis of a randomized controlled trial of patients who underwent robot-assisted laparoscopic radical prostatectomy. The inspiratory to expiratory ratio was adjusted individually by observing the expiratory flow-time wave in the pressure-controlled inverse ratio ventilation group (n = 14) and was set to 1:2 in the volume-control ventilation group (n = 13). Using volumetric capnography, the physiological dead space was divided into three dead space components: airway, alveolar, and shunt dead space. The influence of pressure-controlled inverse ratio ventilation and time factor on the changes in each dead space component rate was analyzed using the Mann-Whitney U test and Wilcoxon's signed rank test. RESULTS: The physiological dead space and shunt dead space rate were decreased in the pressure-controlled inverse ratio ventilation group compared with those in the volume control ventilation group (p < 0.001 and p = 0.003, respectively), and both dead space rates increased with time in both groups. The airway dead space rate increased with time, but the difference between the groups was not significant. There were no significant changes in the alveolar dead space rate. CONCLUSIONS: Pressure-controlled inverse ratio ventilation reduced the physiological dead space rate, suggesting an improvement in the total ventilation/perfusion mismatch due to improved inflation of the alveoli affected by heterogeneous expansion disorder without hyperinflation of the normal alveoli. However, the shunt dead space rate increased with time, suggesting that atelectasis developed with time in both groups.
Assuntos
Ventilação com Pressão Positiva Intermitente/métodos , Espaço Morto Respiratório , Idoso , Capnografia , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Prostatectomia , Ensaios Clínicos Controlados Aleatórios como Assunto , Procedimentos Cirúrgicos Robóticos , Volume de Ventilação PulmonarRESUMO
PURPOSE: To evaluate the potential of drug-eluting bead (DEB)-transcatheter arterial chemoembolization (TACE) as a treatment option for patients with refractory to conventional lipiodol-based TACE (c-TACE) especially with decreased liver function. PATIENTS AND METHODS: We retrospectively evaluated the treatment results of DEB-TACE for 89 HCC nodules in 27 patients with c-TACE refractory according to liver function. RESULTS: Although overall survival was significantly better in Child-Pugh A patients than in Child-Pugh B patients (median survival time, MST: 561 vs 347 days, p=0.031), progression-free survival was almost similar in both patients between Child-Pugh A and B (MST: 79 vs 87 days, p=0.534). Regarding antitumor response, the objective response rate (ORR) and disease-control rate (DCR) were 5.3/12.5% and 52.7/87.5% in Child-Pugh A/B, respectively. In each 89 HCC nodules, ORR and DCR were almost similar between Child-Pugh A and B (ORR, 20.3 vs 13.3%; DCR, 77.0 vs 73.3%, respectively). Adverse events of DEB-TACE were well-tolerated, and liver function was reserved during DEB-TACE procedures. CONCLUSION: DEB-TACE could be a therapeutic option for advanced HCC patients with c-TACE refractory and decreased liver function.
RESUMO
PURPOSE: The purpose of this study was to evaluate the effectiveness and tolerability of "on-demand" combination therapy with sorafenib and hepatic arterial treatments, such as transarterial chemoembolization and hepatic arterial infusion chemotherapy, in patients with hepatocellular carcinoma (HCC). PATIENTS AND METHODS: Eighty consecutive patients with advanced HCC, 58 administered sorafenib monotherapy and 22 administered on-demand combination therapy, were retrospectively evaluated. RESULTS: The disease control rate was significantly higher in the combination group than in the monotherapy group (86.3% vs 51.7%, p=0.01). Elevated alanine aminotransferase levels were significantly more frequent in the combination group (40.9% vs 12.1%, p=0.01), but it was tolerable. Progression-free survival (180 vs 45 days, p=0.045) and overall survival (983 vs 452 days, p=0.004) were significantly longer in the combination group, as was the duration of sorafenib treatment (367 vs 66 days, p<0.001). Multivariate analysis showed that hepatitis C virus infection, disease control, and combination therapy were positive independent prognostic factors for survival, whereas alpha-fetoprotein >400 ng/mL was negatively prognostic. In patients receiving combination therapy, male sex, hepatitis B virus infection, performance status deterioration, Barcelona clinic liver cancer-B, and major vascular invasion were prognostic of survival. CONCLUSION: On-demand combination therapy was tolerated and may be a therapeutic option for patients with advanced HCC.
RESUMO
We herein report a case of glossopharyngeal neuralgia with repeated syncope caused by the recurrence of esophageal carcinoma. The typical symptoms of glossopharyngeal neuralgia are paroxysmal, stabbing, electric shock-like pain in the pharynx and/or base of the tongue on swallowing and talking. In addition, syncope can also be caused by glossopharyngeal neuralgia. The diagnosis of glossopharyngeal neuralgia is not always easy because of its rarity. In the present case, we suspected that repeated syncope was caused by glossopharyngeal neuralgia due to the recurrence of esophageal carcinoma. Concurrent chemoradiation therapy was effective in reducing the tumor size, which resulted in the complete resolution of the symptoms.
Assuntos
Neoplasias Esofágicas/patologia , Carcinoma de Células Escamosas do Esôfago/secundário , Doenças do Nervo Glossofaríngeo/etiologia , Síncope/etiologia , Quimiorradioterapia/métodos , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/terapia , Carcinoma de Células Escamosas do Esôfago/complicações , Carcinoma de Células Escamosas do Esôfago/patologia , Carcinoma de Células Escamosas do Esôfago/terapia , Nervo Glossofaríngeo/patologia , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Invasividade NeoplásicaRESUMO
Sorafenib, a multiple kinase inhibitor, has been established as first-line standard systemic chemotherapy for patients with advanced hepatocellular carcinoma (HCC). We encountered a patient with combined hepatocellular and cholangiocarcinoma (CHC) who achieved complete remission in response to sorafenib treatment. A 58-year old man with hepatitis C virus (HCV)-induced liver cirrhosis was diagnosed with CHC in segments 6th and 7th of the liver and underwent partial surgical resection. Three months later, CHC recurred as metastases at multiple intrahepatic sites, lymph nodes, and bones, making surgery impossible. Treatment with sorafenib was initiated at 400 mg b.i.d., later reduced to 400 mg/day. After 6 months of sorafenib administration, he no longer showed abnormal uptake on fluorodeoxyglucose positron emission tomography. He was continued on sorafenib for 2.5 years, but later discontinued due to adverse events. He has shown no evidence of tumor recurrence more than 1 year after sorafenib discontinuation. His HCV was eradicated by direct-acting antivirals, and he remains in good health.
Assuntos
Antineoplásicos/uso terapêutico , Carcinoma Hepatocelular/tratamento farmacológico , Colangiocarcinoma/tratamento farmacológico , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Primárias Múltiplas/tratamento farmacológico , Inibidores de Proteínas Quinases/uso terapêutico , Sorafenibe/uso terapêutico , Antivirais/uso terapêutico , Carcinoma Hepatocelular/secundário , Colangiocarcinoma/secundário , Hepatite C Crônica/complicações , Hepatite C Crônica/tratamento farmacológico , Humanos , Cirrose Hepática/etiologia , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Indução de RemissãoRESUMO
Sleep apnea syndrome (SAS) is an important risk factor for hypertension and cardiovascular diseases. Diurnal blood pressure (BP) changes are evaluated by 24 h ambulatory blood pressure monitoring (ABPM). The purpose of this study was to clarify the relationship between diurnal BP variation and SAS severity, as well as the impact of antihypertensive therapy on diurnal BP variation. Patients seen at our clinic between April and September 2006 with excessive daytime sleepiness or apnea were enrolled. All patients had polysomnography and ABPM. Mean 24 h BP and nighttime BPs were significantly higher in the SAS group than in the non-SAS group. No significant differences were observed in daytime BPs between the two groups. SAS patients had a high mean 24-h BP and an elevated nighttime BP, both of which increased as SAS severity increased. Nighttime BPs were significantly higher in the moderate SAS group than in the non-SAS group. Nighttime BP and morning BP were significantly higher in the severe SAS group than in the non-SAS group. With respect to antihypertensive agents' effects on diurnal BP changes, there were no significant differences between the SAS and non-SAS groups. In conclusion, compared with non-SAS patients, patients with SAS had a higher 24-h BP, especially nighttime BP. Patients with moderate SAS tended to have elevated nighttime BP. In patients with severe SAS, elevated BP was sustained during the night despite the use of antihypertensive agents.
Assuntos
Pressão Sanguínea , Ritmo Circadiano/fisiologia , Síndromes da Apneia do Sono/fisiopatologia , Adulto , Idoso , Anti-Hipertensivos/farmacologia , Monitorização Ambulatorial da Pressão Arterial , Doença das Coronárias/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
BACKGROUND: There is a strong impetus for the development of alternative treatments for bone disease that avoid the complications associated with autografts and allografts. To address this, we previously developed porous apatite-fiber scaffolds (AFSs) which have three-dimensional interconnected pores, and constructed tissue-engineered bone by culturing rat bone marrow cells (RBMCs) using AFSs in a radial-flow bioreactor (RFB). OBJECTIVE: To generate additional baseline data for the development of tissue-engineered bone constructed for clinical application using a RFB, we cultured RBMCs using AFSs under static conditions (hereafter, RBMC AFS culture), and monitored RBMC growth and differentiation characteristics in vitro, and two weeks after subcutaneous inoculation into recipient rats. METHODS: RBMCs were seeded to AFSs and growth, differentiation and calcification were monitored in vitro and in vivo by histological evaluation using hematoxylin eosin, alkaline phosphatase and alizarin red S stains. RESULTS: RBMCs in/on AFSs proliferated and differentiated normally in vitro and in vivo, and calcification was evident two weeks after subcutaneous AFS culture implantation. Histological assays revealed that AFSs and RBMC AFS cultures were biocompatible, and did not induce inflammation or immunological rejection in vivo. CONCLUSIONS: These findings suggest that AFSs are a conducive microenvironment for bone regeneration and are well tolerated in vivo. The results provide valuable baseline data for the design of implant studies using tissue-engineered bone constructed by RFB.
Assuntos
Apatitas/química , Osso e Ossos/citologia , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/citologia , Tela Subcutânea/ultraestrutura , Engenharia Tecidual/métodos , Alicerces Teciduais/química , Animais , Materiais Biocompatíveis/química , Células Cultivadas , Masculino , Transplante de Células-Tronco Mesenquimais/métodos , Osteogênese , Ratos , Ratos Wistar , Tela Subcutânea/cirurgiaRESUMO
We have succeeded in improving the material properties of a chelate-setting calcium-phosphate cement (CPC), which is composed of hydroxyapatite (HAp) the surface of which has been modified with inositol hexaphosphate (IP6) by adding α-tricalcium phosphate (α-TCP) powder. In order to create a novel chelate-setting CPC with sufficient bioresorbability, gelatin particles were added into the IP6-HAp/α-TCP cement system to modify the material properties. The effects of adding polysaccharides (chitosan, chondroitin sulfate, and sodium alginate) into the sodium dihydrogen phosphate mixing solution on the material properties of the gelatin-hybridized CPC were evaluated. The results of mechanical testing revealed that chondroitin sulfate would be the most suitable for fabricating the hybridized CPC with higher compressive strength. Moreover, further addition of an appropriate amount of citric acid could improve the anti-washout capability of the cement paste. In summary, a gelatin-hybridized IP6-HAp/α-TCP cement system prepared with a mixing solution containing chondroitin sulfate and citric acid is expected to be a beneficial CPC, with sufficient bioresorbability and material properties.
RESUMO
Rectal neuroendocrine tumor (NET) is a relatively rare tumor. NET is classified as G1, G2, or G3 according to the degree of mitosis or Ki-67 proliferation index, which reflect the malignant potential of the tumor, such as metastasis. Advanced cases with metastasis are indicated for chemotherapy treatment. However, the efficacy of chemotherapy is limited. Therefore, resection is considered, even in metastatic cases, if complete resection is possible. We herein report a case of small rectal NET discovered with hepatic metastasis classified as G1. The patient showed good progress with no recurrence after undergoing hepatectomy and endoscopic resection of rectal NET.
Assuntos
Neoplasias Hepáticas/diagnóstico , Tumores Neuroendócrinos/diagnóstico , Neoplasias Retais/diagnóstico , Diagnóstico Diferencial , Hepatectomia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/secundário , Tumores Neuroendócrinos/cirurgia , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/patologia , Neoplasias Retais/cirurgiaRESUMO
Hepatic sinusoidal obstruction syndrome (SOS), a serious complication that mainly occurs after hematopoietic-stem cell transplantation (HSCT), is caused by damage to the sinusoidal endothelial cells after the obstruction of the sinusoid. Recently, hepatic SOS was reported to occur after non-HSCT chemotherapies. This report describes a patient who experienced hepatic SOS after non-HSCT chemotherapy for non-Hodgkin lymphoma. A liver biopsy showed the slight dilatation of the hepatic sinusoid, which may be indicative of hepatic SOS. Hepatic SOS should be included in the differential diagnosis of patients with severe liver injury following the administration of chemotherapy regimens that are toxic to the vascular endothelial cells.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Hepatopatia Veno-Oclusiva/induzido quimicamente , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biópsia , Evolução Fatal , Transplante de Células-Tronco Hematopoéticas , Hepatopatia Veno-Oclusiva/diagnóstico por imagem , Hepatopatia Veno-Oclusiva/patologia , Humanos , Fígado/patologia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
Daclatasvir (DCV) and asunaprevir (ASV) are direct-acting antivirals (DAAs) used in the treatment of chronic hepatitis C virus (HCV) infection. Combined therapy with DCV and ASV shows high efficacy and safety even in patients with cirrhosis. We encountered a patient exhibiting severe hyperbilirubinemia during combined therapy, which is an unreported side effect of DCV and ASV. A 78-year-old woman with cirrhosis developed hyperbilirubinemia >10 mg/dl without transaminitis 3 weeks after starting combined therapy. We suspected DAAs-induced liver disorder and discontinued treatment, which resulted in the improvement of hyperbilirubinemia. Caution is required in the use of DAAs for patients with advanced cirrhosis.