Liver transplantation in children with hepatocellular carcinoma. Do Milan criteria apply to pediatric patients?

HCC constitutes 25-30% of primary malignant liver tumors in children. Conventional surgical excision is not possible in more than 50% of patients. LTx has recently become an important therapeutic option for adults and children with primary liver tumors. The aim of this study was a retrospective analysis of the clinical and pathological data of children with HCC treated with LTx in relation to Milan criteria assessed at diagnosis and then immediately before transplantation, in comparison with a group of patients treated conventionally. Between 1990 and 2007 we have treated 21 children diagnosed with HCC. Patients were divided into two groups: group I, 10 children treated conventionally and group II, 11 children treated with LTx regardless of previous therapy. The outcome of our patients treated conventionally with resection and chemotherapy is very poor--the disease-free survival rate is 30%. In contrast, despite that only 3 children having fulfilled adult Milan criteria, early clinical results of LTx are much superior. Total hepatectomy followed by LTx is the main treatment option for the majority of children with HCC. Decisions on the type of surgical treatment is made individually, but very early in the course of treatment.

Letter to the editor. A case of inborn choroid plexus carcinoma.

This is a short comment on the article by Balaji et al. "CT and MR Imaging in Choroid Plexus Carcinoma. Report of Two Cases" (The Neuroradiology Journal 2006, 19: 330-333).

[Prenatal diagnosis of a brain tumour--an example of diagnostic and therapeutical algorithm].

The authors describe their cooperation in the diagnosis and treatment of a newborn with malignant brain tumour (rare case of carcinoma of the choroid plexus) recognised by means of prenatal sonography and magnetic resonance. The case history is an example of modern algorithm of diagnostic and therapeutic procedures in perinatal medicine and the necessary multicentre collaboration.

Middle aortic syndrome treated by stent implantation.

OBJECTIVES: To determine outcome of stent implantation in patients with middle aortic syndrome. DESIGN: Prospective study, case series. SETTING: A tertiary paediatric cardiology centre in a children's hospital. PATIENTS: Five patients, aged 4 to 17 years (mean 11.4 years), with upper limb hypertension due to middle aortic syndrome. INTERVENTION: Stents were implanted in the mid/lower thoracic/upper abdominal aorta. MAIN OUTCOME MEASURE: Satisfactory deployment of stents and blood pressure control. RESULTS: In all patients, angiocardiography showed long segment stenosis in the mid or lower thoracic/upper abdominal aorta. The pressure gradient was between 40 and 90 mm Hg (mean 63.2 mm Hg). Seven Palmaz stents were implanted. Immediately after implantation, the gradient decreased to between 0 and 35 mm Hg (mean 13.6 mm Hg). Angiography showed a satisfactory result with widely patent stents in all. In one patient, thrombosis of the stent occurred six days after implantation. This was successfully treated with infusion of alteplase, further balloon dilatation, and implantation of a second stent overlapping the first, both dilated to 10 mm diameter. One patient had elective redilatation of the stent six months after implantation, with further reduction of the gradient from 35 mm Hg to 10 mm Hg. At the latest follow up between three and 20 months (mean 12.2 months) after stent implantation, in four patients blood pressure was better controlled with antihypertensive drugs. One patient was normotensive without drugs. Computed tomography showed no aneurysm formation in the region of the stents. CONCLUSIONS: Stent implantation is a preferable alternative to surgery in the treatment of patients with middle aortic syndrome and merits further evaluation.

[Preliminary results of the treatment of occlusive hydrocephalus in children by endoscopic techniques]. / Wstepne wyniki leczenia wodoglowia obturacyjnego u dzieci przy zastosowaniu techniki endoskopowej.

The group of 20 patients with the preliminary diagnosis of occlusive hydrocephalus were treated by neuroendoscopic technique. Ten ventriculocystocisternostomies in cases with third ventricle arachnoid cysts accompanied by hydrocephalus, 9 ventriculostomies, and 1 ventriculostomy with fenestration of posterior fossa cystic lesion were performed. It was proven that the neuroendoscopic procedures were effective in 17 cases (85%) in the 10 months mean follow-up period of the study group. With no mortality, transient surgical complications were observed in 5 cases (25%). In 3 cases, inefficacy of the method was caused by false preoperative evaluation, and inappropriate surgical technique.

[Craniopharyngioma in childhood. Significance of the extent of surgical resection and adjuvant megavoltage irradiation for event: free survival]. / Czaszkogardlaki wieku dzieciecego. Wplyw rozleglosci resekcji chirurgicznej oraz radioterapii na czas przezycia wolny od wznowy guza.

A series of 81 children with craniopharyngiomas is presented. All patients were operated on between 1981 and 1992. According to the applied treatment the presented group was divided into three distinct categories. 28 patients underwent what was considered by the surgeon to be total excision of their tumour, 27 bad partial excision, in the rest 26 children partial excision of the tumour was followed by local rtgtherapy. The impact on the outcome, the statistically estimated probability of event-free survival, following different type of applied treatment was the main aim of this study. The 5- and 10-year actuarial recurrence free survival rate were 78% and 52% respectively, for total removal group, versus 46% and 28% for partial removal, and 49% and 18% for partial removal followed by megavoltage irradiation. The study show a statistically significant advantage for radial surgical removal of childhood craniopharyngioma in event free survival. It is emphasized that total resection using modern diagnostic and surgical methods is the mainstay for childhood carniopharyngioma. Nearly 87% of pediatric craniopharyngiomas can be totally resected.