Transient elastography (TE) has received increasing attention as a means to evaluate disease progression in chronic liver disease patients. In this study, we assessed the value of TE for the prediction of fibrosis stage in a cohort of pediatric patients with nonalcoholic steatohepatitis. Furthermore, TE interobserver agreement was evaluated. TE was performed in 52 consecutive biopsy-proven nonalcoholic steatohepatitis patients (32 males, 20 females, age 13.6 ؎ 2.44 years). The area under the receiver operating characteristic curves for the prediction of "any" (>1), significant (>2), or advanced fibrosis (>3) were 0.977, 0.992, and 1, respectively. Calculation of multilevel likelihood ratios showed that TE values <5, <7, and <9 kPa, suggest the presence of "any" fibrosis, significant fibrosis, and advanced fibrosis, respectively. TE values between 5 and 7 kPa predict a fibrosis stage of 1, but with some degree of uncertainty. TE values between 7 and 9 kPa predict fibrosis stages 1 or 2, but cannot discriminate between these two stages. TE values of at least 9 kPa are associated with the presence of advanced fibrosis. The intraclass correlation coefficient for absolute agreement was 0.961. Conclusion: TE is an accurate and reproducible methodology to identify pediatric subjects without fibrosis or significant fibrosis, or with advanced fibrosis. In patients in which likelihood ratios are not optimal to provide a reliable indication of the disease stage, liver biopsy should be considered when clinically indicated. (HEPATOLOGY 2008;48:442-448.) N onalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the metabolic syndrome, a cluster of abnormalities related to insulin resistance, which is frequently associated with obesity. Given the strong association of NAFLD with increased body mass index (BMI) and the considerable increase in the prevalence of overweight among children and adolescents, 1 NAFLD represents an emerging clinical problem affecting a substantial proportion of these subjects (2.6%-9.8%), 2-3 especially in the presence of obesity. 4 The high prevalence of NAFLD, and the likelihood of evolution to cirrhosis and its complications warrant increased attention toward this disorder. 5-9 Disease progression depends on the presence of hepatocellular damage, inflammation and fibrogenesis which define a pathological entity called nonalcoholic steatohepatitis (NASH).Currently, histopathological analysis of liver tissue represents the only means to assess fibrosis in NAFLD. 10 In the past decade, major efforts have been directed at identifying noninvasive methods for the assessment of liver fibrosis in different chronic liver diseases (CLD) including NAFLD. 11 These efforts assume a particular relevance in the pediatric setting, where the use of liver biopsy is perceived as bearing higher risks and is less acceptable than in adults.A noninvasive medical device based on transient elastography (TE) (Fibroscan; Echosens, Paris, France) has

Single-lead, VVIR ENDO pacing had higher efficiency and safety than EPI, and it might be the best choice for PM implantation in infants. However, because of small patient numbers and lack of longer FU, these findings should be treated with caution.

Objective Obesity in childhood is associated with an inflammatory state in adipose tissue and liver, which elevates risk for diabetes and liver disease. No prior study has examined associations between pathologies occurring in adipose tissue and liver to identify elements of tissue damage associated with type 2 diabetes risk. This study sought to determine if inflammation and fibrosis in abdominal subcutaneous adipose tissue (SAT) in obese/overweight children (BMI-z 2.3±0.76) was related to the extent of observed liver disease or type 2 diabetes risk. Design & Methods Biopsy samples of abdominal (SAT) and liver were simultaneously collected from 33 Italian children (mean BMI 28.1±5.1 kg/m2 and mean age 11.6±2.2 years) with confirmed NAFLD. Histology and immunohistochemistry were conducted on biopsies to assess inflammation and fibrosis in adipose tissue and fibrosis and inflammation in liver. Results Presence vs. absence of crown like structures (CLS) in SAT was significantly related to liver fibrosis scores (1.7±0.7 vs. 1.2±0.7, p=0.04) independent of BMI. SAT fibrosis was significantly correlated with a lower disposition index (r=−0.48, p=0.006). No other adipose measures were associated with liver disease parameters. Conclusion Markers of subcutaneous WAT inflammation are associated with greater extent of liver fibrosis independent of obesity and SAT fibrosis may contribute to diabetes risk through reduced insulin secretion.

Interventional radiology technique is now well established and widely used in the adult population. Through minimally invasive procedures, it increasingly replaces surgical interventions that involve higher percentages of invasiveness and, consequently, of morbidity and mortality. For these advantageous reasons, interventional radiology in recent years has spread to the paediatric age as well. The aim of this study was to review the literature on the development, use and perspectives of these procedures in the paediatric musculoskeletal field. Several topics are covered: osteomuscle neoplastic malignant and benign pathologies treated with invasive diagnostic and/or therapeutic procedures such as radiofrequency ablation in the osteoid osteoma; invasive and non-invasive procedures in vascular malformations; treatment of aneurysmal bone cysts; and role of interventional radiology in paediatric inflammatory and rheumatic inflammations. The positive results that have been generated with interventional radiology procedures in the paediatric field highly encourage both the development of new ad hoc materials, obviously adapted to young patients, as well as the improvement of such techniques, in consideration of the fact that childrens' pathologies do not always correspond to those of adults. In conclusion, as these interventional procedures have proven to be less invasive, with lower morbidity and mortality rates as well, they are becoming a viable and valid alternative to surgery in the paediatric population. MUSCULOSKELETAL MALIGNANT TUMOURSOsteosarcoma, Ewing sarcoma and rhabdomyosarcoma are the most common musculoskeletal tumours of childhood and adolescence.

shunt is routinely kept inflated for several hours after sclerosant administration to prevent systemic embolization. We opted to perform coil embolization of the main draining vein after administration of the sclerosant in lieu of leaving the occlusion balloon in place for several hours.