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Aims: To analyze the main etiological factors and some clinical characteristics of patients with HCC at diagnosis and to compare them with those we described ten years ago. Methods: 179 patients were included in Group 1, while 132 patients were included in Group 2. For all patients age, sex, serum markers of hepatitis B and C viruses, alcohol consumption, serum alpha feto-protein (AFP) levels and the main liver function parameters at HCC diagnosis were recorded. Results: Mean age was 66.0 years for Group 1 and 69.0 for Group 2 (P=0.005). HCV was responsible for 80.3% of HCC cases in Group 2 versus 72% in Group 1 (P=0.005). HBV alone and co-infection of HCV+HBV decreased, but not significantly. In Group 1 only four patients had an underlying normal liver, while in Group 2 no patients showed an underlying normal liver (P=ns). HCC was more frequently associated with Child class A in Group 2 (P=0.0001), whereas in Group 1 it was more frequently associated with class C (P=0.0001). Staging of HCC correlated inversely when patients of Groups 1 and 2 were compared (Pb0.03). AFP serum levels were above normal in 72% of cases in Group 1 and in 41.5% in Group 2 (P=0.0001). Conclusion: This study shows that over the last decade a number of characteristics of patients with HCC in our region have changed, particularly age at onset of HCC, staging of underlying liver disease and staging of HCC.

Aim To evaluate the reliability of the bright liver (BL) echo pattern on ultrasound to detect histological steatosis in chronic cryptogenic hypertransaminasaemia (CCH) and hepatitis C virus (HCV)-related forms of hypertransaminasaemia. Materials and methods One hundred and fifty patients, 54 with CCH and 96 with HCV hypertransaminasaemia (76 genotype 1/2 and 20 genotype 3), were enrolled. Histological steatosis was measured as the percentage of hepatocytes involved. The reliability of the BL sign was estimated using the sensitivity, specificity, positive and negative predictive values. Results Histological steatosis was present in 102/150 patients (68%) divided into 59/96 (62%) in the HCV group and 43/54 (79.6%) in the CCH group (χ 2 =4.4; p =0.035). In a multivariate analysis, the variable associated with the BL echo pattern was steatosis percentage ( p =0.0018). Steatosis percentage was higher in CCH group than in the HCV genotype 1/2 and 3 groups ( p =0.02). The sensitivity of the BL echo pattern was 88% in the CCH group [confidence interval (CI) 95% 74–95] versus 61% (CI 95% 44–73) in the HCV genotype 1/2 group. The CI indicates that ultrasound can provide evidence for steatosis in a statistically significant way in the CCH versus HCV genotype 1/2 patients. In the genotype 3 group, the sensitivity was high (90%), but the limited number of cases limited the statistical significance due to the high CI. Conclusion In CCH the BL echo pattern has excellent reliability in diagnosing steatosis, better than in HCV hypertransaminasaemia because of the higher prevalence and extent of steatosis.

The aim of this study was to identify possible clinical, biochemical or instrumental markers which can predict in a non-invasive manner the presence of EV. One hundred and fifty-eight consecutive liver cirrhotic patients seen at our outpatient clinic were included in this study. The diagnosis of LC was done on liver biopsy findings or based on instru m e n t a l , clinical and serological data. Patients underwent EGE, ultra - sound of the upper abdomen, Doppler of the main splancnic vessels and the main parameters of liver function were tested. Liver cirrhosis was mostly correlated to hepatitis C virus and most patients were class A according to Child. At EGE, EV w e re absent in 41 patients, grade 1 in 86 patients, while 22 and 9 patients presented varices grade 2 and 3, re s p e c t i v e l y. When patients were divided according to the presence/absence of varices, statistically significant differences re g a rding pro t h rombin activity values (p

Transarterial chemoembolization (TACE) is included among the wide therapeutic tools for the treatment of hepatocellular carcinoma (HCC), tumour with high frequency and malignancy. The approach is invasive and, beyond the discomfort for the patient, it is charged by a number of side effects and complications. In this study we report the case of renal acute failure of hypovolemic origin, as a consequence of a TACE in a patient suffering from HCC, occurred after one week of intervention. The different possible mechanisms involved in the pathogenesis of this complication are discussed.