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Background: Transcatheter arterial chemoembolisation (TACE) is the treatment of choice for intermediate stage hepatocellular carcinoma (HCC). Doxorubicin-loaded drug-eluting beads (DEB)-TACE is expected to improve the performance of conventional TACE (cTACE). The aim of this study was to compare DEB-TACE with cTACE in terms of time-to-tumour progression (TTP), adverse events (AEs), and 2-year survival. Methods: Patients were randomised one-to-one to undergo cTACE or DEB-TACE and followed-up for at least 2 years or until death. Transcatheter arterial chemoembolisation was repeated ‘on-demand'. Results: We enrolled 177 patients: 89 underwent DEB-TACE and 88 cTACE. The median number of procedures was 2 in each arm, and the in-hospital stay was 3 and 4 days, respectively (P=0.323). No differences were found in local and overall tumour response. The median TTP was 9 months in both arms. The AE incidence and severity did not differ between the arms, except for post-procedural pain, more frequent and severe after cTACE (P

The management of hepatic hemangioendothelioma (HHE) may be challenging. We aimed to review a large cohort of children who presented to our centers with symptomatic HHE in the last 16 years. We collected age at presentation, clinical features, histology, diagnostic process, management and outcome. Twenty seven patients (male/female 5/22), median age 13 days (1–1530) presented with hepatomegaly (24/27), cardiac failure (10/27), cutaneous hemangiomas (8/27), fever and anemia (6/27 each), vomiting (5/27), splenomegaly (4/27). The lesion was focal, multifocal, or diffuse in 9 patients of each group. The management included medical treatment (8/27), embolization (8/27), resection (3/27), observation (6/27), transplantation (2/27). After 16 months’ follow-up (30 days–11 years), 23/27 (85%) were alive. Diffuse lesions (4/4), cardiac failure (4/4), type II histology (4/4), age older than 6 months at diagnosis (3/4) predicted mortality (all p

Arterioportal fistulas (APFs) are uncommon vascular abnormalities with a heterogeneous etiology. In pediatric orthotopic liver transplantation (OLT), APFs are frequently iatrogenic, following percutaneous liver interventions. The aim of this study was to report the 10-year experience of a tertiary referral center for pediatric OLT in the interventional radiological (IR) and conservative management of acquired APFs. A retrospective search was performed to retrieve pediatric patients (&lt, 18 years old) with a diagnosis of APF at color Doppler ultrasound (CDUS) or computed tomography angiography (CTA) from 2010 to 2020. Criteria for IR treatment were the presence of hemodynamic alterations at CDUS (resistive index &lt, 0.5, portal flow reversal) or clinical manifestations (bleeding, portal hypertension). Conservatively managed patients served as a control population. Clinical and imaging follow-up was analyzed. Twenty-three pediatric patients (median age, 4 years, interquartile range = 11 years, 15 males) with 24 APFs were retrieved. Twenty patients were OLT recipients with acquired APFs (16 iatrogenic). Twelve out of twenty-three patients were managed conservatively. The remaining 11 underwent angiography with confirmation of a shunt in 10, who underwent a total of 16 embolization procedures (14 endovascular, 2 transhepatic). Technical success was reached in 12/16 (75%) procedures. Clinical success was achieved in 8/11 (73%) patients, three clinical failures resulted in one death and two OLTs. After a median follow-up time of 42 months (range 1–107), successfully treated patients showed an improvement in hemodynamic parameters at CDUS. Conservatively managed patients showed a stable persistence of the shunts in six cases, spontaneous resolution in four, reduction in one and mild shunt increase in one. In pediatric patients undergoing liver interventions, APFs should be investigated. Although asymptomatic in most cases, IR treatment of APFs should be considered whenever hemodynamic changes are found at CDUS.

Ausgehend von Ilija Trojanows Roman "Der Weltensammler" (2006) untersucht der vorliegende Beitrag die Wechselwirkung zwischen Kosmopolitismus und Übersetzungspraktiken am Fallbeispiel der exzentrischen Figur Sir Richard Francis Burtons (1821–1890). Ist Trojanows Burton-Figur ein kosmopolitischer Übersetzer? Wie soll man das titelgebende Epitheton interpretieren? Und inwiefern darf das Weltensammeln als ein zeitgemäßes Konzept gelten? Mit Hilfe philologischer Kriterien und übersetzungstheoretischer Überlegungen möchte der Beitrag einige fundierte, wenngleich nur vorläufige Antworten auf diese Fragen vorschlagen – nicht zuletzt mit einem Seitenblick auf museale Tendenzen der Gegenwart.

We aimed to evaluate the role of liver biopsy to predict subclinical biliary strictures (BS) and assess the impact of BS on long-term allograft dysfunction following liver transplantation in children (LT). We reviewed all liver biopsies performed from 2012-2018. Percutaneous transhepatic cholangiography (PTC) was performed in patients presenting cholangiolar proliferation on cytokeratin-7 stained sections. We performed 271 biopsies in 161 children (86% with a left lateral segment); 44/161 (27%) presented with diffuse or multifocal cholangiolar proliferation. Among them, a tight BS was confirmed in 38/44 (86%, 24% of total) and it was managed by balloon dilatation. Cholangiolar proliferation showed a positive predictive value (PPV) for BS of 86.4%. Levels of alkaline phosphatase >325 IU/L predicted BS (P = .007). Dilatation of intrahepatic bile ducts on ultrasound was found only in 44% of patients with BS. Following a median follow-up of 9.2 years, only 15/38 (39%) patients resolved the BS. In conclusion subclinical BS is very common and probably underdiagnosed in these patients. Histological evidence of cholangiolar proliferation detectable by cytokeratin-7 immunostain should be preferred to liver function tests and ultrasound to suspect BS. BS in this setting should be regarded as a main cause of long-term allograft dysfunction.

Radiology, both diagnostic and interventional, plays a key role in the management of diseases involving a native liver or a graft, contributing to the diagnosis, treatment, and follow-up of pediatric patients with liver diseases. The diagnostic radiology can provide indirect information on the staging and complications of chronic disease and the detection of benign and malignant focal liver lesions and can offer a detailed preoperative planning, revealing the vascular and biliary anatomy of the patient. It is important that radiologists are adequately prepared in the management of pediatric patient both for the specific knowledge and for the adequate interaction required by these patients. Children, often very young, have a low compliance during examinations, and if for CT, MRI, and interventional procedures anesthesia is provided, during the ultrasound they are awake and afraid. For this reason it is necessary to have adequate time to reassure them and make the environment comfortable with heated rooms and sonographic gel, to allow the examination be the most appropriate. The second important skill is “ad hoc” specialization, since children are not small adults. Furthermore, in pediatric liver transplantation centers, the presence of interventional radiology is fundamental, which allows less invasive approach in cases once considered of exclusive surgical relevance, such as biliary complications after transplantation. Nowadays, these cases can be treated by interventional radiologists with less risk, less pain, and faster recovery time, improving patient’s care and outcome.

Aim: The aim was to evaluate cost–effectiveness of yttrium-90 transarterial radioembolization (TARE) in comparison to sorafenib treatment. Patients & methods: A single-center, retrospective, observational study was performed, 166 patients with intermediate-/advanced-stage hepatocellular carcinoma were treated with sorafenib and 19 with TARE. The patients out of the sorafenib group matching the inclusion criteria for TARE, were reassigned to a subgroup SOR3. Results: Mean costs for SOR3 patients amounted to €27,992 per patient, instead for TARE treatment, mean expense per patient was €17,761 (p = 0.028). Overall survival was similar between the two groups, while midterm survival rates (p = 0.012) were significantly higher with TARE treatment. Conclusion: TARE causes significantly lower treatment costs than sorafenib with better outcome in midterm survival.

Background & Aims: Portosystemic encephalopathy (PSE) is a major complication of trans-jugular intrahepatic porto-systemic shunt (TIPS) placement. Most devices are self-expandable polytetrafluoroethylene-covered stent grafts (PTFE-SGs) that are dilated to their nominal diameter (8 or 10 mm). We investigated whether PTFE-SGs dilated to a smaller caliber (under-dilated TIPS) reduce PSE yet maintain clinical and hemodynamic efficacy. We also studied whether under-dilated TIPS self-expand to nominal diameter over time. Methods: We performed a prospective, non-randomized study of 42 unselected patients with cirrhosis who received under-dilated TIPS (7 and 6 mm) and 53 patients who received PTFE-SGs of 8 mm or more (controls) at referral centers in Italy. After completion of this study, dilation to 6 mm became the standard and 47 patients were included in a validation study. All patients were followed for 6 months; Doppler ultrasonography was performed 2 weeks and 3 months after TIPS placement and every 6 months thereafter. Stability of PTFE-SG diameter was evaluated by computed tomography analysis of 226 patients with cirrhosis whose stent grafts increased to 6, 7, 8, 9, or 10 mm. The primary outcomes were incidence of at least 1 episode of PSE grade 2 or higher during follow up, incidence of recurrent variceal hemorrhage or ascites, incidence of shunt dysfunction requiring TIPS recanalization, and reduction in porto-caval pressure gradient. Results: PSE developed in a significantly lower proportion of patients with under-dilated TIPS (27%) than controls (54%) during the first year after the procedure (P =.015), but the proportions of patients with recurrent variceal hemorrhage or ascites did not differ significantly between groups. No TIPS occlusions were observed. These results were confirmed in the validation cohort. In an analysis of self-expansion of stent grafts, during a mean follow-up period of 252 days after placement, none of the PTFE-SGs self-expanded to the nominal diameter in hemodynamically relevant sites (such as portal and hepatic vein vascular walls). Conclusions: In prospective, non-randomized study of patients with cirrhosis, we found under-dilation of PTFE-SGs during TIPS placement to be feasible, associated with lower rates of PSE, and effective.

Transjugular intrahepatic portosystemic shunts (TIPS) are now routinely utilized for the treatment of the complications of cirrhosis-related portal hypertension: indeed TIPS has now a clear indication for active bleeding or to prevent rebleeding after failure of combined medical/ endoscopic procedures; it is also indicated for refractory ascites and, at some extent in refractory hydrothorax in cirrhotic patients and type II hepatorenal syndrome. The initial experience with TIPS was based on the use of bare stents (1,2). These stents were prone to allow intra- stent neointimal proliferation, with the direct consequence of a greater risk of stent dysfunction. The major drawbacks of TIPS are shunt dysfunction and hepatic encephalopathy (HE), reported up to 77% and 50% within the first year (3,4), respectively. The availability of expanded polytetrafluoroethylene (ePTFE)-covered stents has dramatically improved the long-term patency of TIPS but the HE incidence has remained relatively high, ranging from 35–45% at 1 year, even since the advent of covered stents (5,6) and can probably be reduced with a more careful selection of patients. The cost-effectiveness issue of adopting covered (most expensive) and bare stent has been frequently raised but has never been properly addressed. In their recent meta-analysis Qi X et al. (7) compare the outcome of covered versus bare stents for TIPS in cirrhotic patients with portal hypertension. The goals of the meta- analysis were to compare the outcome in term of shunt patency, overall survival and HE when using different stent

Objectives: Report of an unusual case of pancreatic fistula in a child. Background: Pancreatic diseases are relatively uncommon in the pediatric age group, with a rather heterogeneous clinical picture from generic abdominal distension to massive pleural effusion. Clinical Relevance: The amylase analysis of pleural liquid is crucial for the etiologic diagnosis of pancreatitis with internal pancreatic fistula. Magnetic resonance cholangiopancreatography may support the etiologic diagnosis of pancreatic pleural fistula in children. Management of internal pancreatic fistula is analyzed. Conclusion: Maintaining a high index of suspicion is essential for the etiologic diagnosis of pancreatic pleural fistula in children.