Transjugular portosystemic shunts in pediatric patients awaiting liver transplantation.

Three pediatric patients from 6 to 11 years of age awaiting liver transplantation for end stage liver disease underwent transjugular intrahepatic portosystemic shunt (TIPS) placement for control of variceal bleeding. Two of the three procedures were performed emergently after endoscopic sclerotherapy failed to stop active bleeding. One procedure was performed electively after multiple prior bleeding episodes. The shunts were created from the middle or left hepatic vein to the left portal vein, and none of the subsequent transplant surgeries was complicated by the presence of the stents. No major or minor complications were related to TIPS placement. Two patients underwent concomitant variceal embolization. Bleeding was successfully controlled in each patient. We conclude that TIPS placement in children is technically feasible, does not complicate subsequent surgery, and is useful treating acute variceal hemorrhage in pediatric patients awaiting liver transplantation.

Rehabilitation medicine approach to Charcot-Marie-Tooth disease.

Hereditary motor sensory neuropathies (HSMN) encompass a wide range of related neuromuscular disorders. Electrodiagnostic studies are a powerful tool in differentiating between the different types. Timely rehabilitative treatment of the deformities may result in significant functional improvement and delay or obviate need for future surgery. This article outlines types of HSMN, focusing on the electrodiagnosis and treatment of each.

Hepatocellular carcinoma: CT appearance after percutaneous ethanol ablation therapy. Work in progress.

Nine patients with biopsy-proved hepatocellular carcinoma underwent percutaneous ethanol ablation therapy (PEAT) with computed tomographic (CT) guidance. Twenty-five ablation sessions were performed in nine lesions ranging in size from 1.8 to 6.5 cm. Repeat biopsy was performed in seven of those nine lesions between 1 and 2 months after completion of therapy. CT scans obtained immediately after ablation demonstrated a necrotic area equal in size to the target lesion in five patients; four of those five patients have had negative findings at biopsy and are free of known disease. None of the patients with CT evidence of limited necrosis are currently free of disease. Peripheral nodularity was demonstrated after ablation in three patients at CT; none are free of disease. All four patients in whom there was no peripheral nodularity are free of known disease. Thus, CT evidence of necrosis and lack of nodularity immediately after PEAT are suggestive of absence of disease.

Stent deformation and intimal hyperplasia complicating treatment of a post-carotid endarterectomy intimal flap with a Palmaz stent.

We report a case of common carotid artery Palmaz stent placement for treatment of an intimal flap after surgical endarterectomy. Despite technical success with an excellent immediate result, a significant stenosis detected by duplex sonographic examination developed at 10 months. This stenosis, the result of stent compression and intimal hyperplasia, illustrates the previously theoretic risk associated with placement of the balloon-expandable stent in a compressible site such as the cervical carotid artery. In addition, we demonstrate that significant intimal hyperplasia may occur after carotid artery stent placement, potentially limiting long-term patency.