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At present, there is no standard treatment for cholangiocarcinoma, a fatal cancer of the biliary tree. New therapies for cholangiocarcinoma are difficult to evaluate because treatment endpoints are ill-defined. This viewpoint explains why the current endpoints are problematic and proposes a new quantitative system for assessing disease progression.
Hepcidin is the iron-regulatory hormone that links innate immunity and iron metabolism. Normally, a regulatory feedback loop with circulatory iron controls hepatic hepcidin production. Inflammatory stimuli upregulate hepcidin production, which can lead to anemia. Anemia downregulates hepcidin production. Human disorders associated with inappropriate hepcidin levels include anemia of inflammation and hereditary hemochromatosis.
At present there is no cure for chronic pancreatitis—a progressive condition that culminates in the destruction of the pancreas. Recent advances in genetic and immunologic research have spawned new insights into the mechanisms underlying chronic pancreatitis, and new models are helping us understand associated risk factors and etiologies.
The etiology and pathogenesis of ulcerative colitis remain unclear, but evidence is accumulating that both genetics and the environment are important. Although diagnosis remains based on well-established clinical, endoscopic and histologic criteria, recent advances in the detection of fecal and serologic markers and the use of wireless capsule endoscopy promise to aid diagnosis.
At present, there is no uniformly effective treatment for recurrentClostridium difficile-associated disease. Tapering and pulsing antibiotics after a 10-day standard course can decrease the recurrence of disease, as can adjunct use of the probiotic Saccharomyces boulardii. Restoration of normal colonic flora might be another treatment option, and new treatment approaches being developed include a vaccine.
This article highlights the case of a 74-year-old Caucasian female who presented with jaundice, clay-colored stools, diarrhea, and fatigue of 3 months' duration, accompanied by a weight loss of 6.8 kg. The results of initial investigations were interpreted as primary sclerosing cholangitis, but futher investigation revealed lytic and and blastic bone lesions. A sacral bone biopsy established the diagnosis of systemic mastocytosis.
