Hepatology needs to enter the 21st Century ?

[Bali05]

http://ihlpress.com/pdf%20files/hepdart09_presentations/liver/5_afdal_HepDart%202009%20Afdhal.pdf

Thought this is a very interesting presentation not to miss that is why posted it again on its own.

Bali05

[Trinity4]

"hasn't come returned"  Now that's good English there Trin.   Geez

[Trinity4]

Yes Mike they did.  It showed no iron accumlation at the time of biopsy which was in the latter part of 07 and my ferritin level at the time was near 1000.  It was the Porphyria Cutanea Tarda that was causing the elevated ferritin which was resolved with phlebotomy but my hgb was 17 at the time which is high for a woman.  The biopsy also ruled out hemochromatosis.

Even though I didn't SVR, since phlebotomy and completing treatment, my hgb levels are normal and the PCT hasn't come returned.

[mike716]

Hi, Trin. Did the Mayo Clinic stain for iron on one of your biopsy slides? Is that how you found out there was iron accumulation in your liver? (Just want to get this straight.)

M.

[mike716]

Hi, Trish. Well, you´re right, of course, when you say that cirrhosis is not the only thing that it´s important to diagnose. The progression is equally or more important. I tried to make that point, but maybe failed. What I meant was that it´s all really about avoiding cirrhosis, the tests and treatment. While we just have fibrosis and not yet cirrhosis, we have intact livere function. Although I think I read that even fibrosis can cause liver cancer.

As for my criticisms of biopsy, my point was that, not only isn´t it reliable vis-a-vis the whole liver, but for rapid progressors waiting three years is too long. I have talked my hospital into doing me another biopsy 2 1/2 years after the first one, but that is unusual. And if it turns out that my fibrosis has progressed to F4, what good was the test? What we need is accurate staging of the whole liver (or a mean score for it obtained by sampling) that is not invasive. This we do not yet have. Fibroscan is not the answer. Neither are any of the other tests.

Personally, after having undergone most of the different tests, I believe that the answer will come from a form of FibroTC (see my images for FibroTC results using tomographic imagery) using not gamma (x-) rays but MRI. FibroTC is just an analysis of the data; but the data must be taken from the entire liver, as it has now been shown convincingly that HCV-caused fibrosis is not necessarily homogeneous throughout the liver.

Mike

[mike716]

Great links, especially the IHLPress one! Thanks.

FWIW, I had a very instructive experience with Fibroscan last year. It´s all detailed in my initial post at the thread "Fibroscan ad libidum; or, Who controls the controls?" (http://www.medhelp.org/posts/Hepatitis-C/Fibroscan-ad-libidum-or--Who-controls-the-controls-/show/1113657). I´m not blowing my own horn here, just trying to provide information.

My conclusion re Fibroscan was this: In the hands of an experienced operator with good technique (like using an ultrasound scan to position and trigger the Fibroscan pulse), it may be a good test for differentiating between early-stage fibrosis and cirrhosis. It is NOT a good way of following fibrosis progression from stage to stage (F0 - F4).

This is what most of the impartial reports say, and my experience bears them out.

(BTW, willing, can you tell me what the difference is between a percutaneous biopsy and a laparoscopic one, that is, which is better and why? I´ll be doing a new biopsy in about six months and have a choice.)

Mike

[Trish77]

That's a little caustic, don't ya think?

Pun intended.