Biomedical subjects

Keiichiro Yoneyama

Publications and source records attributed to Keiichiro Yoneyama.

6 recordsLinked to original sources

PubMed2006

[A case of repeated seroconversion to HBe antibody due to co-infection with Mutant- and wild-type hepatitis B virus clones].

It is reported that co-infection with different hepatitis B virus (HBV) clones in a patient with chronic hepatitis B induces rare serotypes (adywr) or abnormal laboratory data such as negative HBs antigen, in the presence of positive HBV DNA. In this study, we experienced a case of repeated seroconversion to HBe antibody in a patient with chronic hepatitis B. Since seroconversion is considered to be related to genetic mutations, we investigated the HBV genes in this male patient in his 30's. We amplified and cloned parts of the HBV genes by the polymerase chain reaction (PCR), and sequenced the PCR products. As a result, mutated HBV genes were found in the serum of each specified period. By DNA sequencing we confirmed the coexistence of different HBV clones (wild-type clone and pre-S deletion mutant) and that both clones had the same genotype C. These clones took turns to be dominant; when the wild-type clone was dominant, HBe antigen was positive, and when the mutant clone was dominant, HBe antibody was positive. These findings demonstrated that repeated seroconversion of HBe antigen to HBe antibody was induced by co infection with mutant- and wild-type HBV clones. It is interesting that increased aspartate aminotransferase (AST) and alanine aminotransferase (ALT) was noted at the time of the change from positive wild-type HBV clone to positive mutant clone.

Adult↗

PubMed2005

[Rubella vaccine].

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Antibodies, Viral↗

PubMed2004

Prognostic index of cirrhotic patients with hepatic encephalopathy with and without hepatocellular carcinoma.

This study was carried out in Japanese patients to clarify the state of liver cirrhosis complicated by hepatic encephalopathy with and without hepatocellular carcinoma and its prognosis. The subjects were 100 patients with liver cirrhosis complicated by hepatic encephalopathy. Clinical data were investigated, and prognostic factors were extracted using Cox's proportional hazard model. The cumulative survival rate after the first episode of hepatic encephalopathy was 59.1% after 1 year, 48.3% after 2 years, and 22.2% after 5 years. The prognostic index (PI) was calculated using the following formula consisting of these six factors. PI = 0.806 x Child-Pugh classification + 1.149 x presence or absence of HCC + 0.024 x BUN + 0.036 x LDH + 0.093 x WBC + 0.381 x PIVKA-II. The PI value was suggested to be useful for the prognosis of liver cirrhosis after the first episode of hepatic encephalopathy.

Aged↗

PubMed2002

Risk factors for infections in cirrhotic patients with and without hepatocellular carcinoma.

BACKGROUND: Patients with liver cirrhosis (LC) frequently have complications with bacterial infections, and these infections increase the mortality rate. However, a detailed analysis of infections associated with LC patients has not yet been performed. METHODS: We analyzed 325 patients with LC with and without hepatocellular carcinoma (HCC) who were hospitalized between 1997 and 1999. RESULTS: Infections developed in 70 (21.5%) patients and 48 (68.6%) of these developed infections during hospitalization. The mortality rate of 28.6% (20/70) in patients with infectious complications was higher than that of 12.5% (32/255) in patients without infectious complications. Forty (57.1%) of the 70 patients had infections of unknown causes; 11 (15.7%) had sepsis; 6 (8.6%) had intravenous hyperalimentation (IVH) infection; 3 (4.3%) each had spontaneous bacterial peritonitis (SBP), liver abscess, and cholecystitis; and 4 (5.7%) had other infections. Bacterial cultures of blood were prepared from 73 of the 325 patients (22.5%), and were positive in 22 of the 73 patients (30.1%). Of these 22 culture-positive patients, 11 had sepsis, 6 had IVH infection, 2 had liver abscess, 1 had cholecystitis, 1 had pneumonia, and 1 had decubitus ulcer. Gram-positive bacterial strains were detected most frequently, in 16 of the 24 strains isolated. Univariate analysis revealed significant differences between the groups with and without infectious complications with regard to hepatitis B virus infection, Child-Pugh classification, ascites, esophageal varices, survival rate, total-bilirubin (T-Bil), albumin (Alb), lactate dehydrogenase (LDH), total cholesterol (T-chol), and prothrombin time (PT). On multivariate analysis, the Alb level was selected as a significant independent factor contributing to the development of infections. CONCLUSIONS: Patients with advanced cirrhosis with low Alb levels should be carefully treated, and the administration of broad spectrum antibiotics covering gram-positive bacteria needs to be considered in the treatment of infections.

Age Distribution↗

PubMed2002

Analysis of background factors influencing long-term prognosis of patients with chronic hepatitis C treated with interferon.

OBJECTIVE: Interferon (IFN) therapy has been used as antiviral therapy for chronic hepatitis C (CH-C); however, complete response to the therapy is observed in only about 30% of patients in Japan. Background factors involved in the responsiveness to IFN therapy, and progression to liver cirrhosis (LC) and hepatocellular carcinoma (HCC) after IFN therapy have not yet been sufficiently investigated. METHODS: One hundred twenty-one patients with CH-C who received IFN therapy at Showa University Hospital between 1984 and 1999 were analyzed. RESULTS: At 6 months after the termination of IFN therapy, 53 patients achieved a complete response, 11 patients incomplete response, and 57 patients no response. During a mean follow-up of 52.7 months, 12 patients progressed to LC, and 10 patients developed HCC. Multivariate analysis showed that significant independent factors involved in progression to LC were platelet count and the efficacy of IFN therapy. The significant independent factor involved in the development of HCC was platelet count. The factor involved in the therapeutic effect at 6 months after the termination of IFN administration was the serum hepatitis C virus (HCV) RNA levels before IFN therapy. CONCLUSION: Patients with high HCV RNA levels and low platelet counts should be considered to be at high risk of progressing to LC and developing of HCC and should be carefully followed after IFN therapy using ultrasonography, CT scan and MRI.

Adult↗

PubMedDate not supplied

Efficacy and safety of prednisolone in patients with autoimmune hepatitis.

A retrospective cohort study involving 29 Japanese patients with autoimmune hepatitis (AIH) was performed to clarify factors that predict the efficacy of prednisolone and the occurrence of various serious adverse effects. Independent predictors were identified by logistic analysis and with use of the Cox proportional hazard model. Responses to prednisolone were noted in 28 patients, who were classified into the complete remission group (52%) or the relapse group (48%). Multivariate analysis identified alanine aminotransferase, alkaline phosphatase, and immoglobulin G levels as independent predictors of relapse. The adverse effects most frequently observed were diabetes mellitus (37.9%), psychiatric/ neurologic symptoms (34.5%), and circulatory symptoms (34.5%). Predictive factors included lactate dehydrogenase, albumin, and fasting blood glucose levels for diabetes mellitus, alkaline phosphatase and C-reactive protein for psychiatric/ neurologic symptoms, and autoimmune hepatitis score and lactate dehydrogenase for circulatory symptoms. Selection of an optimal treatment method for individual patients may be possible after the risks of relapse and adverse effects have been estimated.

Asian People↗