Background: Nonmalignant portal vein thrombosis is a significant event in the course of cirrhosis that can contraindicate liver transplantation and even impact survival after the surgical procedure. Risk factors are not completely known or validated and are still debated. Aim: To identify in patients with cirrhosis the risk factors for portal vein thrombosis that are assessable in clinical practice. Methods: Between January 2014 and February 2017, 108 outpatients with cirrhosis and no portal vein thrombosis (78% Child A) were enrolled. Doppler ultrasound was performed every 3 or 6 months, for a median follow up of 19 months. Results: Portal vein thrombosis developed in 11 patients. Nonselective beta-blockade (hazard ratio [HR] 10.56; 95% confidence interval [CI]: 1.35-82.73; P = 0.025),and medium or large-sized oesophageal varices (HR 5.67; 95% CI: 1.49-21.63; P = 0.011) at baseline were associated with portal vein thrombosis development.Although heart rate (P < 0.001) and portal blood flow velocity at baseline (P = 0.005) were significantly reduced by nonselective beta-blockers, they were not related to portal vein thrombosis development. Conclusions:Our findings confirm an association between portal vein thrombosis development and oesophageal varices at baseline, but suggest that the association could be explained by exposure to nonselective beta-blockers, independently from effects on heart rate and portal blood flow velocity. The mechanisms that explain portal vein thrombosis development in patients on nonselective beta-blockers require elucidation in order to optimise targeting of nonselective beta-blockade in patients with cirrhosis.Authors' complete affiliations are listed in Appendix section.

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An adenomyoma of the uterus is a nodular tumor-like mass of benign endometrial glands, endometrioid stroma and smooth muscle tissue. Extra-uterine adenomyoma is an extremely rare tumor. The majority of the cases described was from ovary and located in the pelvis. We present a case of a 70 years old woman with clinical and radiological suspicious of disseminated malignancy. In the abdominal wall, a 5-cm nodule of larger dimension detected by computed tomography-scan was biopsied for accessibility reasons. The morphological and immunohistochemical features of the biopsy led us to propose the diagnosis of an extrauterine adenomyoma. This article reports the 22 nd case of extrauterine adenomyoma, a rare and poorly understood tumor that could be imagiologically and clinically indistinguishable from a metastasis.

The multifactorial origin of anterior knee pain in patellofemoral joint disorders leads to a demanding diagnostic process. Patellofemoral misalignment is pointed out as one of the main causes of anterior knee pain. The main anatomical risk factors of patellofemoral instability addressed in the literature are trochlear dysplasia, abnormal patellar height, and excessive tibial tubercle–trochlear groove distance. Diagnostic imaging of the patellofemoral joint has a fundamental role in assessing these predisposing factors of instability. Extensive work is found in the literature regarding the assessment of patellofemoral instability, encompassing several metrics to quantify its severity. Nevertheless, this process is not well established and standardized, resulting in some variability and inconsistencies. The significant amount of scattered information regarding the patellofemoral indices to assess the instability has led to this issue. This review was conducted to collect all this information and describe the main insights of each patellofemoral index presented in the literature. Five distinct categories were created to organize the patellofemoral instability indices: trochlear dysplasia, patellar height, patellar lateralization, patellar tilt, and tibial tubercle lateralization.

Hepatocellular carcinoma (HCC) is one of the most common tumors worldwide and one of the fastest growing causes of cancer-related mortality, being mostly diagnosed in patients with cirrhosis. Despite the recent efforts regarding an earlier diagnosis, the majority of patients are at advanced stages at first presentation, when the potential for institution of curative strategies is scarce. This tumor is remarkable because it occurs mostly superimposed on chronic liver diseases, which entails the need to take special attention to liver function preservation and hepatotoxicity prevention when choosing a specific therapy. Major changes had occurred in the management of HCC in the last decade. The decision-making process must be based on an accurate staging of the patient, using the Barcelona Clinic Liver Cancer (BCLC) staging system, updated knowledge of the new therapeutic options, their contraindications and the potential local or systemic complications. The authors start from 4 clinical different scenarios, in order to objectively discuss the therapeutic options available and the decision-making-process based on the staging system.