We investigated the characteristics of patients with rectal variceal rupture who underwent emergency endoscopy. 21 patients with ruptured rectal varices (total, 27 cases) who underwent emergency endoscopy (within 24 h after admission) were examined. Shock (defined as systolic blood pressure ≤ 90 mmHg or heart rate ≥ 100 beats/min) was suspected in 6 cases (22%). When comparing the haemoglobin levels pre- and post-rectal variceal rupture, a decrease of 0.4 (-1.5-2.8) was observed in 6 cases (22%). Seven patients (26%) had packed red blood cell transfusions. Endoscopic findings of rectal varices were F1, F2 and F3, in 9, 12, and 6 cases, respectively. 14 cases (52%) had a red colour sign. 24 cases (89%) were morphologically classified as F2 or F3 or positive for red colour sign. There were few cases of bleeding requiring blood cell transfusion in cases of rectal varicose rupture, and a lot of cases had F2 or F3, or red colour sign in endoscopic findings.

Aim: To clarify clinical factors associated with liver steatosis and stiffness evaluated using transient elastography in patients with nonalcoholic fatty liver diseases (NAFLD).

Methods: Subjects were eighty patients with NAFLD receiving evaluation using FibroScan^® every year at least for 2 times. A XL probe was used in patients manifesting distances between the skin and liver capsule of 20 mm or more. Patients were diagnosed as having liver steatosis when the controlled attenuation parameter (CAP) value was calculated as 232 dB/m or more, while were defined as having liver fibrosis when liver stiffness (LS) was shown to be 7.9 kPa or more.

Results: Mean age of patients was 64 years old, and diabetes mellitus was underlaied in 30 patients. Transient elastography revealed that mean CAP and LS values were 280 dB/m and 8.5 kPa, respectively. CAP values were improved in 19 patients (24%) under mean observation period of 2.7 years, while were unchanged and aggravated in 46 patients (57%) and 14 patients (19%), respectively. Also, LS values were improved in 11 patients (14%), while were unchanged and aggravated in 61 patients (76%) and 8 patients (10%), respectively. According to multivariate regression analysis, the changes in CAP values were significantly correlated with those of body weight (BW) (p＜0.001), while the changes in LS values with those of AST, ALT and CAP values (p＜0.001, p＜0.001 and p＜0.05, respectively).

Conclusion: CAP values obtained by transient elastography examination were useful to predict the outcome of patients with NAFLD when evaluated in combination with body weight and AST and ALT values.

Percutaneous radiofrequency ablation (RFA) has been widely doing as a therapeutic procedure for hepatocellular carcinoma in Japan. Hepatic arterioportal fistula (APF), however, may occur after RFA procedures as a complication in a part of patients. When the shunt flow volume through APF increases, portal hypertensive events such as varices, ascites, encephalopathy and portal vein thrombosis might occur. In this study, clinical features of patients in whom APF developed after RFA procedures were investigated. Portal hypertensive events due to APF requiring therapies occurred in 9 patients (0.55%) among 1, 638 patients receiving RFA. When CT images were retrospectively evaluated, APF was observed before the onset of portal hypertensive events with a median duration of 3 days after RFA procedures. Thus, the appearance of APF should be evaluated following RFA procedures on CT images, and portal hypertensive events are required to be monitored in patients in whom APF developed. In these patients, transcatheter arterial embolization is recommended to be done for APF when portal hypertensive events occur.