To determine whether patient education contributes to patient perception of itching in chronic liver disease, to what extent health guidance such as skin care that medical staff can intervene can reduce itching, and further itching that cannot be solved by these interventions, two-step hand-written questionnaire surveys were conducted. A total of 238 patients were enrolled, and the presence or absence and intensity of itching were indicated on the visual analogue scale. A brief explanation on itching in chronic liver disease in the presurvey may reduce psychological resistance to consultation with healthcare professionals. Skin care guidance in patients who complain of itching significantly improved itch intensity compared to those who did not receive guidance, and an educational effect was observed. Interventions by medical staff with knowledge on chronic liver disease and associated pruritus played a major role in improving patient quality of life.

Oxaliplatin (OX), commonly used in the treatment of advanced colorectal cancer, can cause hepatic injury, with resultant sinusoidal damage and portal hypertension. We retrospectively evaluated changes in enhanced computed tomography (CT) and laboratory data in 86 patients with colorectal cancer treated with OX-based chemotherapy. Splenomegaly was noted in 31 patients, and collateral pathway (CP) was observed in 20 patients after chemotherapy. One of them required treatment for gastroesophageal varices. We classified patients into four groups by CT findings after chemotherapy as follows: A, neither splenomegaly nor CP; B,only splenomegaly; C, only CP; D, both splenomegaly and CP. Aspartate aminotransferase-to-platelet ratio index, which is an available tool for the assessment of sinusoidal injury, after chemotherapy was significantly higher than that before chemotherapy only in group D. Enhanced CT may be used in the assessment of not only chemotherapeutic effect but also indication for conversion surgical resection for colorectal liver metastasis by predicting the degree of liver damage.

A large-scale questionnaire survey was conducted in all medical institutions in Fukui prefecture to determine the medical care status of hepatitis virus-positive patients. The annual number of hepatitis C virus (HCV) tests was 99,207, and the number of HCV antibody positive cases was 2525 (2.6%), but the rate of referral to hepatologists was extremely low (35.0%). When classified by hospital category, the rate was extremely low: 44.0% for general hospitals with hepatologists, 2.4% for general hospitals without hepatologists, and 32.0% for general practitioners. It was also revealed that the system of referral to hepatologists in general hospitals has not been established and the awareness of referral of patients with hepatitis by physicians in general hospitals is still low. As a countermeasure, we held training seminars on determining hepatitis virus-infected patients separately for general hospitals and general practitioners. After the seminars, the determination system in general hospitals was established in almost all hospitals, and efforts such as implementation of a new questionnaire survey in each district were made to thoroughly disseminate information to physicians. To eliminate the hepatitis virus, tripartite collaboration among designated hospitals, administration, and medical associations seem to be greatly important.

A 49-year-old man visited an ex-doctor because of general fatigue for two weeks. Laboratory tests showed severe jaundice and liver dysfunction, but he refused in-hospital treatment. After one week, the condition deteriorated, and he was referred to our hospital. Because of excessive alcohol consumption, remarkable jaundice, leukocyte level elevation, and hepatomegaly, the patient was diagnosed with severe alcoholic hepatitis. Although steroid administration was started, his condition worsened gradually, and he died 30 days after the first visit. It was found that HEV-IgA antibody was positive, and the further examination of the serum stored at the first visit revealed acute infection with HEV genotype 4 (new Sapporo strain). Although this case was similar to severe alcoholic hepatitis, it is thought that acute infection with HEV was involved in the cause of acute liver failure in the patient with chronic liver injury.