JaLCDOI 10.18926/AMO/48568
FullText URL 66_3_279.pdf
Author Nishimura, Mamoru| Nouso, Kazuhiro| Kariyama, Kazuya| Wakuta, Akiko| Kishida, Masayuki| Wada, Nozomu| Higashi, Toshihiro| Yamamoto, Kazuhide|
Abstract The artificial ascites technique is often used during radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) treatment because it prevents visceral damage and improves visualization by minimizing interference of the lungs and mesentery. This study determined the efficacy and safety of RFA using the artificial ascites technique in HCC patients. We examined 188 HCC patients who were treated by RFA and fulfilled the Milan criteria. Treatment outcomes (complete ablation rate, local recurrence rate, complication rate, liver function including total bilirubin level, alanine aminotransferase level, albumin level, and prothrombin time) were compared among patients divided into 3 groups based on the volume of artificial ascites injected:GroupⅠ (n=86), no artificial ascites injected;GroupⅡ (n=35), <1,000ml artificial ascites injected;and Group Ⅲ (n=67), >1,000ml artificial ascites injected. No significant difference was observed in complete ablation or local recurrence rates among the 3 groups, or in the extent of liver function damage after RFA. Artificial ascites disappeared within 7 days; additional diuretics were needed only in 5 (all from Group Ⅲ) of 102 patients. No serious complications such as intestinal perforation or intraperitoneal bleeding were observed. Thus, we found that artificial ascites injection during RFA is effective and safe, and can be used to prevent major procedural complications.
Keywords radiofrequency ablation hepatocellular carcinoma artificial ascites
Amo Type Original Article
Published Date 2012-06
Publication Title Acta Medica Okayama
Volume volume66
Issue issue3
Publisher Okayama University Medical School
Start Page 279
End Page 284
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2012 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 22729109
Web of Sience KeyUT 000305669700012
JaLCDOI 10.18926/AMO/52790
FullText URL 68_4_243.pdf
Author Wada, Nozomu| Yasunaka, Tetsuya| Ikeda, Fusao| Nishina, Sohji| Korenaga, Masaaki| Hino, Keisuke| Fujioka, Shin-ichi| Osawa, Toshiya| Itoshima, Tatsuya| Kawanaka, Miwa| Yamada, Gotaro| Kariyama, Kazuya| Takayama, Hiroki| Kubota, Junichi| Morimoto, Yoichi| Mizushima, Takaaki| Yamashita, Haruhiko| Tanioka, Hiroaki| Negoro, Yuji| Toshimori, Junichi| Kobashi, Haruhiko| Hirano, Atsushi| Itano, Yasuo| Takaki, Akinobu| Yamamoto, Kazuhide|
Abstract Hepatitis B virus (HBV) is one of the major viruses causing acute hepatitis. Recently, the incidence of acute hepatitis with genotype A has been increasing in Japan. The aim of this study was to investigate acute hepatitis B (AHB) in Okayama prefecture, with special attention to HBV genotype A. AHB patients who visited one of 12 general hospitals in Okayama prefecture between 2006 and 2010 were retrospectively analyzed. Over the course of the study period, 128 patients were diagnosed with AHB. Sexual transmission was supposed in the majority of patients (78 patients, 61%), including 59 (76%) having sex with heterosexual partners. The genotypes of HBV were assessed in 90 patients (70%), of whom 27 patients were infected with genotype A, 5 with genotype B, and 58 with genotype C. The prevalence of genotype A was significantly higher among male patients (28.7%), aged 20-29 (35.6%, p<0.01), among men who had sex with men (100%, p<0.005), and among patients having sex with unspecified partners (44.8%, p<0.005). Genotype A was not a significant factor associated with delayed HBsAg disappearance. Caution should be exercised with regard to sexually transmissible diseases in order to slow the pandemic spread of AHB due to genotype A.
Keywords acute hepatitis hepatitis B virus
Amo Type Original Article
Published Date 2014-08
Publication Title Acta Medica Okayama
Volume volume68
Issue issue4
Publisher Okayama University Medical School
Start Page 243
End Page 247
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2014 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 25145410
Web of Sience KeyUT 000340687500006
JaLCDOI 10.18926/AMO/53558
FullText URL 69_4_219.pdf
Author Toshimori, Junichi| Nouso, Kazuhiro| Nakamura, Shinichiro| Wada, Nozomu| Morimoto, Yuki| Takeuchi, Yasuto| Yasunaka, Tetsuya| Kuwaki, Kenji| Ohnishi, Hideki| Ikeda, Fusao| Shiraha, Hidenori| Takaki, Akinobu| Yamamoto, Kazuhide|
Abstract We conducted a retrospective cohort study to investigate the predisposing factors for local recurrence and complications after percutaneous radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC). HCC patients (n=397) consecutively treated with RFA (256 males, 141 females, median age 69 years) were enrolled. In these patients, 1,455 nodules (median size 17mm) were ablated. Predisposing factors for overall recurrence and local recurrence in the context of tumor location and complications were examined. Local recurrence was observed for 113 of the 1,455 nodules. The 1-, 3- and 5-year local recurrence rates were 2.2オ, 7.4オ and 9.5オ, respectively. A multivariate Cox proportional hazard analysis revealed that large tumor size (>2cm), tumor location (adjacent to the major portal branch or hepatic vein), and small ablated margin (<3mm) were independent predisposing factors for local recurrence after RFA (HR=1.70-2.81). Tumor location (adjacent to the major portal branch, hepatic vein, or diaphragm) was also revealed as a risk factor for liver damage due to RFA. HCC adjacent to the major portal vein or hepatic vein was associated with a higher risk for local recurrence and for complications;therefore, special precautions are necessary when applying RFA to HCC near vessels even when the tumors are located at an easy-to-puncture site.
Keywords hepatocellular carcinoma radiofrequency ablation ablated margin tumor location
Amo Type Original Article
Published Date 2015-08
Publication Title Acta Medica Okayama
Volume volume69
Issue issue4
Publisher Okayama University Medical School
Start Page 219
End Page 226
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2015 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 26289913
Web of Sience KeyUT 000365519100005
JaLCDOI 10.18926/AMO/53677
FullText URL 69_5_307.pdf
Author Wada, Nozomu| Nouso, Kazuhiro| Kariyama, Kazuya| Wakuta, Akiko| Kishida, Masayuki| Nishimura, Mamoru| Higashi, Toshihiro|
Abstract Sarcoidosis is a systemic disease characterized by the formation of non-caseating granulomas in multiple organs. In the diagnosis of sarcoidosis, imaging modalities such as ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI) are useful;however, there are few reports of MRI imaging using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB) MRI. A 46-year-old Japanese female with suspected pulmonary sarcoidosis was admitted to our hospital because low-density mottles in the liver were observed incidentally by chest CT. The low-density mottles were not enhanced at the arterial phase or portal phase by abdominal CT and MRI, and decreased uptake was observed in the hepatobiliary phase of Gd-EOB MRI. No hematological disorder was observed except for a slight increase of biliary enzymes. The lesion was diagnosed as liver sarcoidosis by the liver biopsy. Since the patient refused steroid therapy, we prescribed ursodeoxycholic acid (UDCA). 600mg/day. The serum levels of biliary enzymes were normalized and the abdominal CT findings gradually improved after the initiation of UDCA medication. Gd-EOB MRI showed unique hypointense areas in the liver at the hepatobiliary phase, which might be useful in the diagnosis of liver sarcoidosis.
Keywords liver sarcoidosis ursodeoxycholic acid (UDCA) gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB)
Amo Type Case Report
Published Date 2015-10
Publication Title Acta Medica Okayama
Volume volume69
Issue issue5
Publisher Okayama University Medical School
Start Page 307
End Page 311
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2015 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 26490028
Web of Sience KeyUT 000365519600007
Author Katayama, Akihiro| Nakatsuka, Atsuko| Eguchi, Jun| Murakami, Kazutoshi| Teshigawara, Sanae| Kanzaki, Motoko| Nunoue, Tomokazu| Hida, Kazuyuki| Wada, Nozomu| Yasunaka, Tetsuya| Ikeda, Fusao| Takaki, Akinobu| Yamamoto, Kazuhide| Kiyonari, Hiroshi| Makino, Hirofumi| Wada, Jun|
Published Date 2015
Publication Title Scientific reports
Volume volume5
Content Type Journal Article
Author Nakatsuka, Atsuko| Matsuyama, Makoto| Yamaguchi, Satoshi| Katayama, Akihiro| Eguchi, Jun| Murakami, Kazutoshi| Teshigawara, Sanae| Ogawa, Daisuke| Wada, Nozomu| Yasunaka, Tetsuya| Ikeda, Fusao| Takaki, Akinobu| Watanabe, Eijiro| Wada, Jun|
Published Date 2016-02-17
Publication Title Scientific Reports
Volume volume6
Content Type Journal Article
JaLCDOI 10.18926/AMO/53996
FullText URL 70_1_1.pdf
Author Yasunaka, Tetsuya| Ikeda, Fusao| Wada, Nozomu| Morimoto, Yuki| Fujioka, Shin-ichi| Toshimori, Junichi| Kobashi, Haruhiko| Kariyama, Kazuya| Morimoto, Yoichi| Takayama, Hiroki| Seno, Tomonori| Takaguchi, Koichi| Moriya, Akio| Miyatake, Hirokazu| Okamoto, Ryoichi| Yabushita, Kazuhisa| Takaki, Akinobu| Yamamoto, Kazuhide|
Abstract Chronic hepatitis B (CHB) leads to cirrhosis and hepatocellular carcinoma (HCC). With a cohort of 1,206 CHB patients who visited Okayama University Hospital and related hospitals in 2011 and 2012, we compared the incidence rates of HCC among the patients grouped by age, hepatitis B virus (HBV) DNA, hepatitis B e antigen (HBeAg), and treatment. HCCs were observed in 115 patients with the median observation period of 1,687 days. Among the HCC patients aged ≥ 35 years, HBV DNA ≥ 4 log copies/mL and positive HBeAg at diagnosis (n=184), the HCC incidence rate was 8.4% at 5 years in the entecavir (ETV)-treated patients, 21.8% in the lamivudine (LVD)-treated patients, and 26.4% among the patients not treated with drugs. The cumulative HCC incidence was significantly reduced in the ETV-treated patients compared to those treated with LVD or not treated (p=0.013). Among the patients aged ≥ 35 years with HBV DNA ≥ 4 log copies/mL and negative HBeAg (n=237), the cumulative HCC incidence was 14.6% in 5 years in ETV group and 13.9% among those not treated with a drug (p>0.05). Only small numbers of HCCs occurred in other patients. In CHB patients aged≥35 years with HBV DNA ≥4 log copies/mL and positive HBeAg, ETV treatment is recommended for the suppression of HCC development.
Keywords entecavir hepatitis B virus lamivudine hepatocellular carcinoma
Amo Type Original Article
Published Date 2016-02
Publication Title Acta Medica Okayama
Volume volume70
Issue issue1
Publisher Okayama University Medical School
Start Page 1
End Page 12
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2016 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 26899604
Web of Sience KeyUT 000371288700001
JaLCDOI 10.18926/AMO/55662
FullText URL 72_1_47.pdf
Author Ako, Soichiro| Nakamura, Shinichiro| Nouso, Kazuhiro| Dohi, Chihiro| Wada, Nozomu| Morimoto, Yuki| Takeuchi, Yasuto| Yasunaka, Tetsuya| Kuwaki, Kenji| Onishi, Hideki| Ikeda, Fusao| Shiraha, Hidenori| Takaki, Akinobu| Okada, Hiroyuki|
Abstract Transcatheter arterial chemoembolization (TACE) is often performed before radiofrequency ablation (RFA) for the treatment of early-stage hepatocellular carcinoma (HCC). TACE prior to RFA can expand the ablated area and reduce the tumor size, facilitating complete ablation. However, the factors correlated with size reduction remain uncertain. The aim of this study was to identify the factors associated with size reduction by TACE and develop a formula to predict the reduction rate. A total of 100 HCC patients treated with TACE followed by RFA at least 20 days later were enrolled. The tumor size was measured at the time of TACE and RFA, and correlations between the reduction rate and 13 clinical factors were examined. A formula to predict the reduction rate was built using the factors obtained by the analysis. Reduction in the tumor size was observed in 69 nodules, and the median reduction rate was 16.2%. A multivariate regression analysis revealed that a large tumor size (p< 0.01) and a long interval between the therapies (p= 0.01) were factors for a high tumor reduction rate, with tumor size more strongly related to the degree of reduction. A size reduction of more than 10% can be expected by waiting 20 days after TACE when the size of the tumor at TACE is over 25 mm in diameter. The tumor size
Keywords hepatocellular carcinoma transcatheter arterial chemoembolization radiofrequency ablation interval size reduction
Amo Type Original Article
Published Date 2018-02
Publication Title Acta Medica Okayama
Volume volume72
Issue issue1
Publisher Okayama University Medical School
Start Page 47
End Page 52
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2018 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 29463938
JaLCDOI 10.18926/AMO/56178
FullText URL 72_4_401.pdf
Author Wada, Nozomu| Ikeda, Fusao| Mori, Chizuru| Takaguchi, Koichi| Fujioka, Shin-ichi| Kobashi, Haruhiko| Morimoto, Yoichi| Kariyama, Kazuya| Sakaguchi, Kosaku| Hashimoto, Noriaki| Moriya, Akio| Kawaguchi, Mitsuhiko| Miyatake, Hirokazu| Hagihara, Hiroaki| Kubota, Junichi| Takayama, Hiroki| Takeuchi, Yasuto| Yasunaka, Tetsuya| Takaki, Akinobu| Iwasaki, Yoshiaki| Okada, Hiroyuki|
Abstract Daclatasvir (DCV) + asunaprevir (ASV) combination therapy has become available for patients with hepatitis C virus (HCV) serogroup 1 infection. We studied the efficacy of this therapy by focusing on the factors associated with sustained virological responses (SVR) including resistance-associated variants (RAVs) and mixed infection of different HCV genotypes. We enrolled 951 HCV serogroup 1-positive patients who received this combination therapy at our hospital or affiliated hospitals. The presence of RAVs in non-structural (NS) regions 3 and 5A was analyzed by direct sequencing. HCV genotypes were determined by PCR with genotype-specific primers targeting HCV core and NS5B regions. SVR was achieved in 91.1% of patients. Female sex, age > 70 years, and RAVs were significantly associated with non-SVR (p<0.01 for all). Propensity score-matching results among the patients without RAVs regarding sex, age, and fibrosis revealed that mixed HCV infection determined by HCV NS5B genotyping showed significantly lower SVR rates than 1B-mono infection (p=0.02). Female sex and RAVs were significant factors associated with treatment failure of this combination therapy for patients with HCV serogroup 1 infection. Mixed HCV infection other than 1B-mono infection would be useful for predicting treatment failure.
Keywords mixed genotype daclatasvir asunaprevir HCV serogrouping 1 infection
Amo Type Original Article
Published Date 2018-08
Publication Title Acta Medica Okayama
Volume volume72
Issue issue4
Publisher Okayama University Medical School
Start Page 401
End Page 406
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2018 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 30140089
JaLCDOI 10.18926/AMO/56457
FullText URL 73_1_43.pdf
Author Ikeda, Ailee| Takaki, Akinobu| Yasunaka, Tetsuya| Oyama, Atsushi| Adachi, Takuya| Wada, Nozomu| Onishi, Hideki| Ikeda, Fusao| Shiraha, Hidenori| Yoshida, Kazuhiro| Kuise, Takashi| Nobuoka, Daisuke| Yoshida, Ryuichi| Umeda, Yuzo| Yagi, Takahito| Fujiwara, Toshiyoshi| Okada, Hiroyuki|
Abstract Post-orthotopic liver transplantation (OLT) hepatitis B recurrence is well-controlled with a nucleos(t)ide analogue and hepatitis B immunoglobulin (HBIG) combination, but the high cost and the potential risk of unknown infection associated with HBIG remain unresolved issues. Low-cost recombinant hepatitis B virus (HBV) vaccine administration is a potential solution to these problems. We retrospectively analyzed the rate and predictive factors of HBV vaccine success in 49 post-OLT patients: liver cirrhosis-type B (LC-B), n=28 patients; acute liver failure-type B (ALF-B), n=8; and non-HBV-related end-stage liver disease (non-B ESLD) who received a liver from anti-hepatitis B core antibody-positive donors, n=13. A positive anti-hepatitis B surface antibody response was achieved in 29% (8/28) of the LC-B group, 88% (7/8) of the ALF-B group, and 44% (4/9) of the adult non-B ESLD group. All four non-B ESLD infants showed vaccine success. The predictive factors for a good response in LC-B were young age, marital donor, and high donor age. ALF-B and non-B ESLD infants are thus good vaccination candidates. LC-B patients with marital donors are also good candidates, perhaps because the donated liver maintains an efficient immune memory to HBV, as the donors had already been infected in adulthood and showed adequate anti-HBV immune responses.
Keywords acute liver failure hepatitis B hepatitis B vaccine liver cirrhosis liver transplantation
Amo Type Original Article
Published Date 2019-02
Publication Title Acta Medica Okayama
Volume volume73
Issue issue1
Publisher Okayama University Medical School
Start Page 41
End Page 50
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2019 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 30820053
JaLCDOI 10.18926/AMO/56935
FullText URL 73_4_333.pdf
Author Kuwaki, Kenji| Nouso, Kazuhiro| Miyashita, Manabi| Makino, Yasuhiro| Hagihara, Hiroaki| Moriya, Akio| Adachi, Takuya| Wada, Nozomu| Yasunaka, Yuki| Yasunaka, Tetsuya| Takeuchi, Yasuto| Onishi, Hideki| Nakamura, Shinichiro| Ikeda, Fusao| Shiraha, Hidenori| Takaki, Akinobu| Okada, Hiroyuki|
Abstract Steroids are often administered at the time of transcatheter arterial chemoembolization (TACE), a standard treatment of hepatocellular carcinoma (HCC), with the expectation of preventing postembolization syndrome. Here we investigated the precise effects of steroids on TACE. We prospectively enrolled 144 HCC patients from 10 hospitals who underwent TACE. Three hospitals used steroids (steroid group, n=77) and the rest did not routinely use steroids (control group, n=67). The occurrence of adverse events and the algetic degree at 1-5 days post-treatment were compared between the groups. Fever (grades 0-2) after TACE was significantly less in the steroid group (56/21/0) compared to the control group (35/29/3, p=0.005, Cochran-Armitage test for trend). The suppressive effect of steroids against fever was prominent in females (p=0.001). Vomiting (G0/G1/ G2-) was also less frequent in the steroid group (70/5/2) versus the control group (53/10/3), but not significantly (p=0.106). The algetic degree and the grade of hematological adverse events, including hyperglycemia, did not differ between the groups. We conclude that the administration of steroids was useful for the prevention of adverse events after TACE in patients with HCC.
Keywords antipyretic hepatocellular carcinoma therapeutic chemoembolization steroid
Amo Type Original Article
Published Date 2019-08
Publication Title Acta Medica Okayama
Volume volume73
Issue issue4
Publisher Okayama University Medical School
Start Page 333
End Page 339
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2019 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 31439956
JaLCDOI 10.18926/AMO/56940
FullText URL 73_4_367.pdf
Author Mifune-Morioka, Tomoyo| A. Uchida, Haruhito| Fukushima, Kazuhiko| Watanabe, Mayu| Ouchi, Chihiro| Mise, Koki| Kawakita, Chieko| Kano, Yuzuki| Onishi, Akifumi| Toma, Kishio| Eguchi, Jun| Wada, Nozomu| Ikeda, Fusao| Sasaki, Erika| Suganami, Yu| Kishida, Masayuki| Sugiyama, Hitoshi| Okada, Hiroyuki| Wada, Jun|
Abstract Eight years prior to her present admission, a 61-year-old Japanese woman was diagnosed with autoimmune hepatitis, slowly progressive insulin-dependent diabetes mellitus, and chronic thyroiditis; she had been treated with oral prednisolone (PSL). After she suddenly discontinued PSL, she newly developed systemic lupus erythematosus. A combination therapy of oral PSL and intravenous cyclophosphamide resulted in remission. She was finally diagnosed with autoimmune polyglandular syndrome (APS) type 3 (3A ,3B, 3D), complicated with four different autoimmune diseases. Since patients with type 3 APS may present many manifestations over a long period of time, they should be carefully monitored.
Keywords autoimmune polyglandular syndrome type 3 systemic lupus erythematosus autoimmune hepatitis slowly progressive insulin-dependent diabetes mellitus chronic thyroiditis
Amo Type Case Report
Published Date 2019-08
Publication Title Acta Medica Okayama
Volume volume73
Issue issue4
Publisher Okayama University Medical School
Start Page 367
End Page 372
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2019 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 31439961