Colorectal cancer (CRC) has the second-highest tumor incidence and is a leading cause of death by cancer. Nearly 20% of patients with CRC will have metastases at the time of diagnosis, and more than 50% of patients with CRC develop metastatic disease during the course of their disease. A group of experts from the Spanish Society of Medical Oncology, the Spanish Association of Surgeons, the Spanish Society of Radiation Oncology, the Spanish Society of Vascular and Interventional Radiology, and the Spanish Society of Nuclear Medicine and Molecular Imaging met to discuss and provide a multidisciplinary consensus on the management of liver metastases in patients with CRC. The group defined the different scenarios in which the disease can present: fit or unfit patients with resectable liver metastases, patients with potential resectable liver metastases, and patients with unresectable liver metastases. Within each scenario, the different strategies and therapeutic approaches are discussed.

Background: Embolization is an established treatment for varicocele. Coils are most frequently used in the procedure. Liquid embolic and sclerosing agents seem to have a number of advantages over coils. Purpose: To report our experience and explain the technique of using N-2-butyl-cyanoacrylate (N2BCA) in varicocele treatment. Material and Methods: From January 2010 to July 2011, 42 gonadal veins in 41 consecutive patients (age range, 11–41 years; mean, 18 years) with a diagnosis of varicocele were treated with N2BCA as an embolic agent. The clinical diagnosis was confirmed by Doppler ultrasound in all patients. Institutional review board approval was obtained, and all the patients signed informed consent for this retrospective review. In all cases, a 4-F hydrophilic catheter was used to catheterize the distal portion of the gonadal vein through which N2BCA, emulsified with lipiodol, was injected. Results: The technical success was 100%. No complications or non-targeted embolizations were reported. Seven patients reported moderate post-embolization pain that required oral analgesic treatment for 7–10 days. After 12-month follow-up, all patients exhibited varicocele resolution in the Doppler ultrasound examination as well as relief of all previous symptoms. We have no fertility-related data for patients treated for this condition. Conclusion: N2BCA as an embolic agent is a therapeutic alternative for the endovascular treatment of varicocele. This technique is uncomplicated, inexpensive, efficient, and safe.

Hiccups is a reflex consisting of a sudden spasmodic contraction of the diaphragm causing shaking of the inspiratory muscles of the chest and abdomen, followed by the sudden closure of the glottis, which generates a characteristic noise of air being violently expelled from the lungs. The hiccup reflex consists of the afferent limb (phrenic nerve, vagus nerve, or thoracic sympathetic fibres), the central connection (not involving a specific centre), and the efferent limb (primarily the phrenic nerve). Depending on their duration, hiccups are classified as transient hiccups (episodes lasting seconds or minutes), persistent hiccups (longer than 48 hours), and recurrent hiccups (episodes of hiccups more lasting than transient and often with frequent repetition). In most bouts of transient hiccups the aetiology is unknown. In the case of persistent hiccups the most frequent causes are gastro-oesophageal diseases (Table 1).1 View this table: Table 1. Causes of persistent hiccups This article describes an unusual cause of persistent hiccups and considers some of the remedies that can be used for the condition. A 68-year-old man with a history of smoking (20 pack–years) and a left upper lobe lobectomy for tuberculosis 50 years ago, came to his primary care doctor following about 10 days of persistent hiccups, malaise, and costal and lumbar pain of mild intensity. A blood test was requested and omeprazole 20 mg daily was prescribed. The patient came back 6 days later to collect the blood test results, with symptoms persisting. The tests revealed slight leucocytosis, C-reactive protein elevation (14.29 mg/dL), erythrocyte sedimentation rate (84 mm/hr), total bilirubin (2.6 mg/dL), direct (0.7 mg/dL), indirect (1.9 mg/dL), and rheumatoid …