Sergio M. Crespo

Non-invasive assessment of liver fibrosis using magnetic resonance elastography in liver transplant recipients with hepatitis C

Liver biopsy has been the reference standard when evaluating fibrosis due to recurrent hepatitis after liver transplantation. Magnetic resonance elastography estimates liver stiffness, correlating to fibrosis.

Continuing Medical Education Questions: January 2010

A. Questionnaires have less sensitivity then biochemical test in screening for alcohol abuse. B. Th e CAGE questionnaire was developed for outpatients and focuses on short-term drinking behaviors. C. Th e AUDIT screen has a higher sensitivity and specifi city than shorter screening instruments. D. Screening for alcohol abuse/dependence is not important in the clinical setting. 3. Which one of the following statements is true regarding the treatment of alcoholic liver disease?

The long term use of covered metal stents in managing malignant biliary obstruction. Are we changing outcomes

Endoscopic placement of indwelling biliary stents has become he standard of care for palliation of jaundice in patientswith unreectable obstructing malignant tumours. The use of plastic stents PS) has been hampered by early occlusion requiring replacement very 3months, stentmigration and placement difficulty for stents arger than 10F through standard side-viewing therapeutic duoenoscopes. As a result of the deficiencies of PS, a self-expanding etal stent (SEMS) was developed in the hope of prolonging stent atency and reducing the need for repeat intervention. Since the allstent (Boston Scientific, Watertown, MA) was introduced in 990, SEMS placement has become the treatment of choice for nresectable,malignant, biliary obstruction in patients expected to urvive longer than 3 months. Initial randomised studies comparng SEMSwithPSdemonstrated longer patency rates anddecreased ates of cholangitis [1–3]. However, obtaining proper positioning s challenging due to expected foreshortening of the stent. Migraion is occasionally an issue, as is tissue ingrowth through the open esh of the SEMS, tumour overgrowth of the end of the prostheis and deposition of debris. A number of studies have observed 9–40% Wallstents’ occlusion rates [2,3]. As a result, new SEMS enerations have been developed with variations in diameters (6o 10-mm varieties), the use of nitinol, conformation and size of he wire opening, delivery system improvements with elimination f foreshortening, mechanisms of expansion and the addition of a lastic coating of the wire mesh.