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Objective: To evaluate the impact of standardized operative and peri-operative care on the outcome of liver transplantation in a single center series of 395 adult patients., Method and Material: Between February 1984 and December 31, 1998, 451 orthotopic liver transplantations were performed in 395 adult patients (> or = 15 years) at the University Hospitals St-Luc in Brussels. Morbidity and mortality of the periods 1984-1990 (Gr I--174 pat.) and 1991-1998 were compared (Gr II--221 pat.). During the second period anti-infectious chemotherapy and perioperative care were standardized and surgical technique changed from classical orthotopic liver transplantation with recipients' vena cava resection (and use of veno-venous bypass) towards liver implantation with preservation of the vena cava (without use of bypass). Immunosuppression was cyclosporine based from 1984 up to 1996 and tacrolimus based during the years 1997 and 1998. Immunosuppression was alleviated during the second period due to change from quadruple to triple and even double therapy and due to the introduction of low steroid dosing and of steroid withdrawal, once stable graft function was obtained. Indications for liver grafting were chronic liver disease (284 pat--71.9%), hepatobiliary tumor (52 pat--13.2%), acute liver failure (40 pat--10.1%) and metabolic disease (19 pat--4.8%). Regrafting was necessary because of graft dysfunction (21 pat), technical failure (12 pat), immunological failure (18 pat) and recurrent viral allograft disease (5 pat); three of these patients were regrafted at another institution. Follow-up was complete for all patients with a minimum of 9 months., Results: Actuarial 1, 5 and 10 years survival rates for the whole group were 77.9%, 65.7% and 58.3%. These survival rates were respectively 77.3%, 69.7%, 62.5% and 73.2%, 59.6% 51.4% for benign chronic liver disease and acute liver failure; those for malignant liver disease were 80.6%, 44.3% and 36.7%. Early (< 3 months) and late (> 3 months) posttransplant mortalities were. 14.4% (57 pat) and 21.2% (84 pat). Early mortality lowered from 20% in Gr I to 9.4% in Gr II (p < 0.02); this was due to a significant reduction during the second period of bacterial (99/174 pat.--56.9% vs 82/221 pat.--37.1%), fungal (14 pat.--8% vs 7 pat.--3.2%) and viral (87 pat.--50% vs 49 pat.--22.2%) infections (p < 0.05) as well as of perioperative bleeding (92 pat.--52.9% vs 39 pat.--17.6%--p < 0.001). Late mortality remained almost identical throughout the two periods as lethal outcome was mainly caused by recurrent allograft diseases, cardiovascular and tumor problems. Morbidity in these series was important considering that almost, half of the patients had a technical complication, mostly related to bleeding (131 pat--33.2%) and biliary problems (66 pat--16.7%). Retransplantation index was 1.1 (54 pat.--14%). Early retransplantation mortality was 24%; it lowered, although not yet significantly, during the second period (8/25 pat.--32% vs. 5/29 pat.--17.2%)., Conclusion: Despite a marked improvement of results, liver transplantation remains a major medical and surgical undertaking. Standardization of operative and perioperative care, less haemorraghic surgery and less aggressive immunosuppression are the keys for further improvement.

Intraductal papillary-mucinous tumours are rare epithelial tumours with all intermediate types occurring from papillary to mucin-hypersecreting forms. They affects generally old men and recurring pancreatitis is the main clinical feature. Endoscopic Retrograde Pancreatography is the best diagnostic method, showing large dilatation of the ducts and filling defects due to mucin's plugs or papillary tumour. IPMT are slow-growing and have low malignant potential; as to far, surgical resection is considered mandatory, however, better distinction between benign and malignant evolution will probably select cases in which conservative follow-up may be proposed.

The main aspects of hepatic chemoembolization are first described: principles, drugs and their vectors, various techniques and contra-indications. In the literature as in our own experience, most encouraging results are reported in metastases from endocrine tumors and hepatocellular carcinoma. Favourable results in the latter disease have been particularly emphasized by Japanese authors whose data are reported, as well as results in a personal series and in three controlled studies. Chemoembolization is now able to induce partial or complete responses. Nevertheless, unambiguous selection of responding patients cannot be stated yet, especially for hepatocellular carcinoma where an underlying chronic liver disease probably plays an important role in prognosis. Consequently, chemoembolization of malignant hepatic tumors must still be considered as a technique under evaluation.

As it appears from a review of the literature of the last decade, arteriography is important in the diagnosis and management of gastrointestinal haemorrhage but its role has to be evaluated by a multidisciplinary approach. In fact, the role of arteriography in upper gastrointestinal bleeding is often therapeutic, because diagnosis is often made by endoscopy. In lower gastrointestinal bleeding, arteriography is mainly diagnostic and its role in treatment remains limited. Controlled studies are necessary to compare transcatheter embolization with other treatments.