Collaboration between Hepatologists and Primary Care Physicians in Treating Patients with Chronic Hepatitis C / Journal of Rural Medicine

<b>Objective:</b> The purpose of this study was to assess the treatment outcome in patients with chronic hepatitis C (CHC) using the current standard antiviral therapy when patient were treated in collaboration between hepatologists and primary care physicians (PCPs).<b>Patients and Methods:</b> One hundred and ten patients with CHC were treated with a combination therapy of peginterferon-alpha 2b and ribavirin. Among them, 25 patients were treated by a collaboration between hepatologists and PCPs (collaboration group), whereas 85 patients were treated with exclusively by hepatologists (noncollaboration group). The duration of the therapy was 48 weeks for 58 'difficult- to-treat' patients (genotype 1 with a high load of HCV-RNA; 1H patients) and 24 weeks for the remaining 52 patients (non-1H patients). In the collaboration group, antiviral therapy was initiated and adjusted, if needed, by hepatologists (visits every four weeks), whereas the weekly administration of peginterferon-alpha 2b was performed by PCPs. Clinical characteristics and the treatment outcome were compared between these two groups.<b>Results:</b> The two groups had similar baseline characteristics. By intention to treat, the two groups showed similar rates of treatment-related serious adverse effects (0% vs. 1%, respectively) and dropout rates for adverse effects (8% vs. 13%, respectively). Sustained virologic response rates were also similar between the two groups, being 42% vs. 39% in the 58 1H patients (NS) and 62% vs. 64% in the 52 non-1H patients (NS), respectively.<b>Conclusions:</b> Collaboration between hepatologists and PCPs may be a valid treatment alternative to treat patients with CHC using the current standard antiviral therapy.

Hepatitis C Virus Infection in Outpatient Clinic / 日本農村医学会雑誌

The whole spectrum of patients infected with hepatitis C virus (HCV) who visited hospitals has not been fully clarified. It is also unknown whether such patients have visited the hospitals regularly thereafter for a long period. We studied 844 consecutive patients with liver diseases who visited our outpatient clinic located in the southern region of Ibaraki Prefecture. Five hundred eighty-three patients were HCV-infected. Among them, three patients were HBsAg-positive and another patient was IgM anti-HAV positive. Thus, 579 patients (68.6%) were considered to have HCV solely as a hepatotropic virus.Of these HCV patients, 60 were asymptomatic carriers and 15 others were unclassified because of the absence of either biopsy or imaging test records of the liver. As to the rest of the HCV patients, acute hepatitis was diagnosed in one patients, chronic hepatitis in 332 patients, cirrhosis in 130 patients and cancer of the liver in 41 patients.About half of the patients undergoing liver biopsy showed F1 in the degree of liver fibrosis. The rate of virological response to interferon mono-therapy in patients infected with genotype 2 was worse than the national average. The poor response was considered to be due to high viral load. It was suggested that the distribution of patients with each genotype was uneven in this region. After five years, the rate of patients still visiting our clinic were 68.1% for those with chronic hepatitis, and 50% for the healthy carriers. We deemed that it was important to clarify whether patients not visiting our clinic are followed up closely in other hospitals.

Massive Hemorrhage from an Ulcer at Gastric Body where an Adhesion of a Hepatoma was Observed-An autopsied case / 日本農村医学会雑誌

We encountered a case of far advanced hepatomas involving the lungs and portal veins. The patient was a 38-year-old woman. Chemoembolization had transient effects. Cachexia occurred. After repeated episodes of upper gastrointestinal bleeding, she died. An autopsy revealed a deep gastric ulcer to which a nodule of the hepatocellular carcinoma adhered. Histopathologically, the infiltration of the hepatoma was not evident. These findings suggested that circulatory distarbances of the gastric wall due to the adhesion of the growing hematoma had caused the ulceration.

A Case of Drug-induced Liver Injury with Positive Anti-Mitochondrial Antibody for more than Two Years / 日本農村医学会雑誌

A 58-year-old man, who was under treatment for urticaria with emedastin fumarate for seven days, was admitted to our hospital because of jaundice. On admission, laboratory data showed the cholestatic type of liver dysfunction, AST 106 U/1, ALT 274 U/1, T-Bil 6.8 mg/dl, γ-GTP 857IU/1, and ALP 807IU/1. Anti-mitochondrial antibody (AMA) was positive with titer of 1: 80, whereas anti-pyruvate dehydrogenase (PDH) antibody was negative. Histologically, mild lymphocytic infiltration in portal area was noted. There was no fibrosis or cholangitis. A lymphocyte stimulation test for emedastin fumarate was positive and the diagnosis of drug-induced liver injury was established. Administration of the drug was immediately withheld followed by an immediate improvement in the most of the liver function tests, whereas both AMA and γ-GTP were constantly abnormal for the following two years. Anti-PDH antibody was still negative. The second biopsy of the liver showed minimal expansion of the portal area with fibrosis and mild lymphocytic infiltration. Pseudo-ductular formation and vanished bile ducts were also confirmed although no granulomas were found. These findings were atypical for primary biliary cirrhosis. This seems to be a rare case of drug-induced liver injury with long-standing anti-mitochondrial antibody without primary biliary cirrhosis as an underlying disease.