BACKGROUND Hepatic encephalopathy(HE)is a complication of liver cirrhosis and can result in neuropsychological and neuromuscular dysfunctions in patients.Rifaximin,an antibiotic,has been reported to decrease the occur...BACKGROUND Hepatic encephalopathy(HE)is a complication of liver cirrhosis and can result in neuropsychological and neuromuscular dysfunctions in patients.Rifaximin,an antibiotic,has been reported to decrease the occurrence of overt HE and also improve cognitive function in studies from Europe and the United States of America.There is not enough evidence of the relationship between the long-term use of rifaximin and its clinical effects in the Japanese.AIM To determine the clinical effects of long-term rifaximin therapy in decompensated liver cirrhosis patients,with overt HE or hyperammonemia.METHODS In this single-center retrospective observational cohort study,we reviewed the data of 38 patients who had taken rifaximin at the dose of 1200 mg/d for more than 24 wk.The primary outcome measured was the efficacy of long-term rifaximin use,and secondary outcome measured was the safety of its long-term use as determined by its influence on portosystemic shunts as well as Escherichia coli-related infections.Moreover,we compared the prognosis between the rifaximin group and control cases,matched for hepatic elasticity assessed by magnetic resonance ela-stography,age,and Child-Pugh classification.RESULTS Of the 38 patients included in the study,12(31.6%)had overt HE,27(71.1%)had complications of esophageal varices,and 9(23.7%)had hepatocellular carcinoma(HCC).The control group was matched for age,Child-Pugh classification,liver stiffness,and presence of HCC.The median of serum ammonia level before treatment was 104μg/dL(59-297),and 2 wk after treatment,it significantly decreased to 85μg/dL(34-153)(P=0.002).A significantly low value of 80.5μg/dL(44-150)was maintained 24 wk after treatment.The long-term use of rifaximin did not cause a decline in liver function.Diarrhea occurred in 2 patients,who improved with the administration of probiotics,and there were no cases of aborted rifaximin therapy owing to adverse events.In patients with Child C,the survival was short,but there was no significant difference compared with that of the control group.CONCLUSION Rifaximin therapy improves overt HE.The long-term use of rifaximin in the Japanese is effective and safe.展开更多
Background: Miriplatin is a slow-release, lipophilic platinum complex, developed to produce a superior antitumor effect for hepatocellular carcinoma (HCC). However, the miriplatin suspension is highly viscous and can ...Background: Miriplatin is a slow-release, lipophilic platinum complex, developed to produce a superior antitumor effect for hepatocellular carcinoma (HCC). However, the miriplatin suspension is highly viscous and can form an embolism in the hepatic artery, which can result in insufficient antitumor effect. Thus, reducing the viscosity of the suspension compound by combining it with the less-viscous cisplatin suspension might reduce or even prevent vessel embolism, while providing the quick-release effects of cisplatin. Purpose: To compare the outcomes of therapy using miriplatin plus cisplatin and cisplatin monotherapy in transcatheter arterial chemoembolization (TACE) for HCC. Methods: We retrospectively evaluated a total of 87 patients with Barcelona Clinic Liver Cancer (BCLC) stage A or B HCC who received conventional TACE using a combination of platinum agents (cisplatin and miriplatin) (n = 50) or cisplatin alone (n = 37) for the first time from September 2006 to December 2012. Short term therapeutic effect was measured by dynamic computed tomography 1 - 3 months after TACE, in reference to the modified Response Evaluation Criteria in Solid Tumors. Treatment-related adverse effects were graded by the National Cancer Institute Common Terminology Criteria (ver. 4.0). 1-, 3-, and 5-year survival rates were calculated. Subgroup analyses were performed by Child-Pugh classification and BCLC criteria. Results: Median duration of follow-up was 35 months (range 7 - 90). Median overall survival was 38 months. Patients who had combination therapy had better 1-, 3-, and 5-year survival rates: 100%, 56.7%, and 26.2%, respectively, compared to monotherapy: 100%, 42.1%, and 9.0%, respectively (p = 0.034). No serious complication or treatment-related mortality was observed in both groups. Conclusion: TACE using miriplatin plus cisplatin was related to a prolonged survival, with comparable adverse effects of TACE using cisplatin alone.展开更多
文摘BACKGROUND Hepatic encephalopathy(HE)is a complication of liver cirrhosis and can result in neuropsychological and neuromuscular dysfunctions in patients.Rifaximin,an antibiotic,has been reported to decrease the occurrence of overt HE and also improve cognitive function in studies from Europe and the United States of America.There is not enough evidence of the relationship between the long-term use of rifaximin and its clinical effects in the Japanese.AIM To determine the clinical effects of long-term rifaximin therapy in decompensated liver cirrhosis patients,with overt HE or hyperammonemia.METHODS In this single-center retrospective observational cohort study,we reviewed the data of 38 patients who had taken rifaximin at the dose of 1200 mg/d for more than 24 wk.The primary outcome measured was the efficacy of long-term rifaximin use,and secondary outcome measured was the safety of its long-term use as determined by its influence on portosystemic shunts as well as Escherichia coli-related infections.Moreover,we compared the prognosis between the rifaximin group and control cases,matched for hepatic elasticity assessed by magnetic resonance ela-stography,age,and Child-Pugh classification.RESULTS Of the 38 patients included in the study,12(31.6%)had overt HE,27(71.1%)had complications of esophageal varices,and 9(23.7%)had hepatocellular carcinoma(HCC).The control group was matched for age,Child-Pugh classification,liver stiffness,and presence of HCC.The median of serum ammonia level before treatment was 104μg/dL(59-297),and 2 wk after treatment,it significantly decreased to 85μg/dL(34-153)(P=0.002).A significantly low value of 80.5μg/dL(44-150)was maintained 24 wk after treatment.The long-term use of rifaximin did not cause a decline in liver function.Diarrhea occurred in 2 patients,who improved with the administration of probiotics,and there were no cases of aborted rifaximin therapy owing to adverse events.In patients with Child C,the survival was short,but there was no significant difference compared with that of the control group.CONCLUSION Rifaximin therapy improves overt HE.The long-term use of rifaximin in the Japanese is effective and safe.
文摘Background: Miriplatin is a slow-release, lipophilic platinum complex, developed to produce a superior antitumor effect for hepatocellular carcinoma (HCC). However, the miriplatin suspension is highly viscous and can form an embolism in the hepatic artery, which can result in insufficient antitumor effect. Thus, reducing the viscosity of the suspension compound by combining it with the less-viscous cisplatin suspension might reduce or even prevent vessel embolism, while providing the quick-release effects of cisplatin. Purpose: To compare the outcomes of therapy using miriplatin plus cisplatin and cisplatin monotherapy in transcatheter arterial chemoembolization (TACE) for HCC. Methods: We retrospectively evaluated a total of 87 patients with Barcelona Clinic Liver Cancer (BCLC) stage A or B HCC who received conventional TACE using a combination of platinum agents (cisplatin and miriplatin) (n = 50) or cisplatin alone (n = 37) for the first time from September 2006 to December 2012. Short term therapeutic effect was measured by dynamic computed tomography 1 - 3 months after TACE, in reference to the modified Response Evaluation Criteria in Solid Tumors. Treatment-related adverse effects were graded by the National Cancer Institute Common Terminology Criteria (ver. 4.0). 1-, 3-, and 5-year survival rates were calculated. Subgroup analyses were performed by Child-Pugh classification and BCLC criteria. Results: Median duration of follow-up was 35 months (range 7 - 90). Median overall survival was 38 months. Patients who had combination therapy had better 1-, 3-, and 5-year survival rates: 100%, 56.7%, and 26.2%, respectively, compared to monotherapy: 100%, 42.1%, and 9.0%, respectively (p = 0.034). No serious complication or treatment-related mortality was observed in both groups. Conclusion: TACE using miriplatin plus cisplatin was related to a prolonged survival, with comparable adverse effects of TACE using cisplatin alone.
