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Hepatic encephalopathy with status epileptics: A case report

World Journal of Gastroenterology 2006年第11期12卷 1793-1794页

作者： Hiroto Tanaka Hiroki Ueda Yohei Kida Hiroko Hamagami Tomikimi Tsuji masakazu ichinose The Third Department of Internal Medicine Wakayama Medical University 811-1 KimiideraWakayama City641-0015Japan the Department of Neuropsychology Wakayama Medical University 811-1 KimiideraWakayama City641-0015Japan

A 62-year-old male with decompensated liver cirrhosis due to hepatitis C virus developed severe hepatic encephalopathy with status epileptic us. The blood ammonia level on admission was more than twice the normal level. Brain computed tomography and magnetic resonance imaging were normal. In addition, electroencephalogram showed diffuse sharp waves, consistent with hepatic encephalopathy. The status epilepticus was resolved after antiepileptic therapy （phenytoin sodium） and treatment for hepatic encephalopathy （Branched chain amino acids）. The blood ammonia level normalized with the clinical improvement and the patient did not have a recurrence of status epilepticus after the end of the antiepileptic treatment. Additionally, the electroencephalogram showed normal findings. Thus, we diagnosed the patient as hepatic encephalopathy with status epilepticus. We consider the status epilepticus of this patient to a rare and interesting finding in hepatic encephalopathy.

关键词： Status epilepticus Hepatic encephalopathy Decompensated liver cirrhosis Electroencephalogram

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Autoimmune hepatitis triggered by acute hepatitis A

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World Journal of Gastroenterology 2005年第38期11卷 6069-6071页

作者： Hiroto Tanaka Hiroto Tujioka Hiroki Ueda Hiroko Hamagami Youhei Kida masakazu ichinose 3rd Department of Internal Medicine

The patient was a 57-year-old woman presenting with jaundice as the chief complaint. She began vomiting on July 10, 2003. Jaundice was noted and admitted to our hospital for thorough testing. Tests on admission indicated severe hepatitis, based on： aspartate aminotransferase （AST）, 1 076 IU/L; alanine aminotransferase （ALT）, 1 400 IU/L; total bilirubin （TB）, 20.9 mg/dL; and prothrombin time rate （PT%）, 46.9%. Acute hepatitis A （HA） was diagnosed based on negative hepatitis B surface antigen and hepatitis C virus RNA and positive immunoglobulin （Ig） M HA antibody, but elevation of anti-nuclear antigen （×320） and IgG （3 112 mg/dL） led to suspicion of autoimmune hepatitis （AIH）. Plasma exchange was performed for 3 d from July 17, and steroid pulse therapy was performed for 3 d starting on July 18, followed by oral steroid therapy. Liver biopsy was performed on August 5, and the results confirmed acute hepatitis and mild chronic inflammation. Levels of AST and ALT normalized, so dose of oral steroid was markedly reduced. Steroid therapy was terminated after 4 mo, as the patient had glaucoma. Starting 3 mo after cessation of steroid therapy, levels of AST and ALl began to increase again. Another liver biopsy was performed and AIH was diagnosed based on serum data and biopsy specimen. Oral steroid therapy was reinitiated. Levels of AST and ALT again normalized. The present case was thus considered to represent AIH triggered by acute HA.

关键词： Acute hepatitis A Autoimmune hepatitis International criteria for AIH HLA

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Reactive oxygen/nitrogen species in airways inflammation

Reactive oxygen/nitrogen species in airways inflammation

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第十五届国际药理学大会

作者： YAMAGATA TOSHTYUKI ichinose masakazu Third Department of Internal Medicine Wakayama Medical University Third Department of Internal Medicine Wakayama Medical University

＜正＞ Although the participant cells and mediators are different, bronchial asthma （BA） and chronic obstructive pulmonary disease （COPD） are both characterized by chronic airway inflammation. Oxidative/nitrosative stress play an important role in the pathophysiology in both diseases. In BA. the production of nitric oxide （NO） is increased probably via the upregulation of inducible NO synthase. It has been reported that the level of exhaled NO is correlated with the severity of airflow limitation, airway hyperresponsiveness or eosinophils infiltration. The antiinflammatoryagent, corticosteroid. which is a key drug for BA. can reduce the NO production as well as airway inflammation and hyperresponsiveness. On the contrary, in COPD airways, the formation of 3 - nitrotyrosine rather than NO is much more increased than bronchial *** have found that the several agentsincluding theophylline. corticosteroid and allopurinol can inhibit the oxidative/nitrosativestress. These agents improve the airway inflammation and may prevent the progression of COPD. In this symposium, the importance of oxidative/nitrosative in the airway inflammation and its pharmacotherapeutic modification will be reviewed.

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Mutations in hepatitis B virus core regions correlate with hepatocellular injury in Chinese patients with chronic hepatitis B

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World Journal of Gastroenterology 2005年第30期11卷 4693-4696页

作者： Hiroto Tanaka Hiroki Ueda Hiroko Hamagami Susumu Yukawa masakazu ichinose Motoshige Miyano Keiji Mimura Iwao Nishide Bo-Xin Zhang Su-Wen Wang Shi-Oing Zhou Bei-Hai Li The Third Department of Internal Medicine Wakayama Medical University 811-1 Kimiidera Wakayama City Wakayama 641-0012 Japan Nishide Hospital 236 Umizuka Kaizuka City Osaka 597-0083 Japan Jinan Central Hospital 105 Jiefang Road Jinan 250013 Shandong Province China

AIM: To elucidate the relationship between the frequency of core mutations and the clinical activity of hepatitis B virus (HBV)-related liver disease and to characterize the amino acid changes in the core region of ***: We studied 17 Chinese patients with chronic hepatitis B according to their clinical courses and patterns of the entire core region of ***: Amino acid changes often appeared in the HBV core region of the HBV gene in patients with high values of alanine aminotransferase (ALT) or with the seroconversion from HbeAg to anti-HBe. The HBV core region with amino acid changes had high frequency sites that corresponded to HLA Ⅰ/Ⅱ restricted recognition epitopes reported by some ***: The core amino acid changes of this study occur due to influence of host immune system. The presence of mutations in the HBV core region seems to be important for predicting the clinical activity of hepatitis B in Chinese patients.

关键词： Hepatitis B virus Core region Mutation Serum ALT DNA sequences HBe antigen Chronic hepatitis B Activity

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