V. McLin: Portosystemic vascular shunts
We are talking to Prof. Valerie McLin of Geneva, Switzerland, where at the Hôpitaux universitaires de Genève she heads the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, about the clinically Protean — and thus as fascinating as they are challenging — disorders called portosystemic vascular shunts. Intrahepatic or extrahepatic, they all should be closed. But how are they to be recognized, assessed, and best closed? What resources are available to assist caregivers without specialized experience in offering their patients the best therapies for what certainly are uncommon problems? Beginning with diagnosis, which may come, for example, through discrepant results between two forms of newborn-infant screening for galactosemia, through evaluation for subtle neurocognitive dysfunction in the “over-tall” child doing poorly at school, or through oncologists’ efforts to sort out liver tumors, Prof. McLin lays out for us what one might see, how one might see it, and, having seen it, what to do about it. Furthermore, she encourages — in the best traditions of international co-operation that inform ESPGHAN — consultative referrals, whether of patient records only or of the patients themselves, to the scientific registry and dedicated support-and-treatment center that her team staff in Geneva. And of course there’s a website . . . get your paper and pencil ready to take down the details. This podcast will leave you resolved to understand more about hepatic malperfusion and its consequences and might, just might, let the puzzle-pieces for some of your more baffling patients fall into place for you.