Liver-directed therapies in metastatic colorectal cancer.

Colorectal cancer (CRC) is a major health concern in the United States (US) with over 140,000 new cases diagnosed in 2012. The most common site for CRC metastases is the liver. Hepatic resection is the treatment of choice for colorectal liver metastases (CLM), with a 5-year survival rate ranging from 35% to 58%. Unfortunately, only about 20% of patients are eligible for resection. There are a number of options for extending resection to more advanced patients including systemic chemotherapy, portal vein embolization (PVE), two stage hepatectomy, ablation and hepatic artery infusion (HAI). There are few phase III trials comparing these treatment modalities, and choosing the right treatment is patient dependent. Treating hepatic metastases requires a multidisciplinary approach and knowledge of all treatment options as there continues to be advances in management of CLM. If a patient can undergo a treatment modality in order to increase their potential for future resection this should be the primary goal. If the patient is still deemed unresectable then treatments that lengthen disease-free and overall-survival should be pursued. These include chemotherapy, ablation, HAI, chemoembolization, radioembolization (RE) and stereotactic radiotherapy.

Symptomatic cholelithiasis and functional disorders of the biliary tract.

Symptomatic cholelithiasis and functional disorders of the biliary tract present with similar signs and symptoms. The functional disorders of the biliary tract include functional gallbladder disorder, dyskinesia, and the sphincter of Oddi disorders. Although the diagnosis and treatment of symptomatic cholelithiasis are relatively straightforward, the diagnosis and treatment of functional disorders can be much more challenging. Many aspects of the diagnosis and treatment of functional disorders are in need of further study. This article discusses uncomplicated gallstone disease and the functional disorders of the biliary tract to emphasize and update the essential components of diagnosis and management.

Methamphetamine-induced paralytic ileus.

Methamphetamine abuse has become a significant problem in the United States with recent surveys reporting that nearly 10 million Americans have tried methamphetamine at least once. Methamphetamine is a stimulant drug that causes the release of monoamine neurotransmitters. Among its most deleterious effects are its ability to produce tachycardia, hypertension, and ischemia. However, it also has the potential to cause clinically significant effects outside of the cardiovascular system although a case of paralytic ileus caused by methamphetamine use has not been described before in the literature. Described is a case in which a patient presented with chest and abdominal pain after methamphetamine use. The patient was ultimately diagnosed with a methamphetamine-induced paralytic ileus.