We clarify the frequency of carnitine and zinc deficiency in chronic liver diseases. Carnitine and zinc as well as ammonia, albumin and BTR (BCAA/Tyr) were measured in 41 patients with chronic hepatitis (CH) and 88 with liver cirrhosis (LC) with or without hepatocellular carcinoma. No differences were found in free carnitine level among the three groups, but acylcarnitine was high and zinc was low in two LC groups. No cases fulfilled the criteria for carnitine deficiency, but mild deficiency was found in approximately 20% of LC cases. Zinc deficiency and mild zinc deficiency were found in 0% and 31.7% of CH cases, respectively, and in approximately 30% and 40% of LC cases, respectively. Correlation was found between zinc, acylcarnitine, and several biological markers described above, but not between free carnitine and these markers. Our study clarified the frequency of carnitine and zinc deficiency in chronic liver diseases.

We determined the presence of anti-HEV IgM antibody, anti-HEV IgA antibody, and HEV RNA in serum samples of 73 notified cases that were recorded on the day of disease onset. HEV RNA was detectable until 3 weeks after disease onset. Both IgM and IgA anti-HEV antibodies were positive until 40 days after the disease onset. Among the HEV RNA positive patients, 41 out of 60 symptomatic and 2 out of 54 asymptomatic ones had genotype 4 HEV, respectively. Only 23.3% (14/60) of HEV RNA positive patients in the asymptomatic group were confirmed the presence of anti-HEV antibodies. Testing for the presence of both anti-HEV antibodies and HEV RNA would be beneficial for the comprehensive diagnosis of hepatitis E infections.

A 49-year-old man with decompensated alcoholic cirrhosis was hospitalized because of severe gluteal and lower back pain. He was diagnosed to have an iliopsoas abscess based on the results of blood examination and contrast enhanced CT imaging. We selected antibiotics as the sole treatment in consideration of the bleeding risk. However, the patient showed no improvement. Therefore, we added hyperbaric oxygen (HBO) with antibiotics, and the iliopsoas abscess disappeared. HBO is commonly used in the orthopedics departments, but no reports have shown its efficacy for an iliopsoas abscess complicated with decompensated cirrhosis. Here, we describe our experience treating an iliopsoas abscess with HBO in a patient with decompensated cirrhosis and vouch for the safety and efficacy of the approach.

We examined a 65 year-old-man diagnosed with hepatocellular carcinoma (HCC) 6 years ago, who had undergone repeated transcatheter arterial chemoembolization and radiofrequency ablation procedures. The patient was taking warfarin for the portal vein thrombosis, and thus lacked PIVKA-II measurements. Contrast-enhanced ultrasonography and computed tomography showed a 30-mm unenhanced liver tumor in the right hepatic lobe. We prescribed edoxaban instead of warfarin and measured his PIVKA-II values. The serum PIVKA-II level was high (952 mAU/mL). PET-CT revealed a high level of ¹⁸F-FDG accumulated in the tumor. Therefore, we diagnosed the patient to have HCC recurrence and assumed that the poorly differentiated hepatocellular carcinoma had rapidly progressed. In HCC patients, PIVKA-II has been useful as an index maker of the progression and of the malignant potential of tumors. We recommend the use of direct oral anticoagulants for patients with HCC.

Direct-acting antivirals (DAA) are an effective treatment for hepatitis C virus infection. Hepatocellular carcinoma (HCC), however, has also been reported to occur after sustained virologic response (SVR) and the clinical features remain unknown. We investigated the characteristics on imaging of HCC that developed after achieving SVR with DAAs. As results, all 12 patients (DAA-SVR HCC) showed high intensity on diffusion-weighted magnetic resonance imaging (DWI) and the DWI positivity was significantly higher than that in HCC patients without viral eradication (HCV-RNA positive HCC). Moreover, all DAA-SVR HCC cases showed hypoechoic results in the Kupffer phase of contrast-enhanced ultrasonography with Sonazoid. Our results suggested that the biological nature of DAA-SVR HCC would be different from that of HCV-RNA positive HCC.