Anaerobic liver abscesses as initial presentation of silent colonic cancer.

BACKGROUND: Rarely, multiple liver abscesses caused by anaerobic organisms are the presenting form of unsuspected colonic cancer in the absence of liver metastases. CASE OUTLINE: A 68-year-old man was admitted with abdominal pain, fever and chills. Imaging scans and repeated cytology yielded a diagnosis of multiple liver abscesses. Pus cultures grew Peptostreptococcus anaerobius, Bacteroides melaninogenicus and Peptostreptococcus spp. A search for the underlying cause led to the discovery of an adenocarcinoma of the sigmoid colon. After a 12-month postoperative follow-up, the patient is free of hepatic metastases. DISCUSSION: Anaerobic liver abscesses should always alert the clinician to possible silent colonic carcinoma.

[The neurobiology of sleep: Cajal and present-day neuroscience]. / Neurobiología del sueño: Ramón y Cajal y la neurociencia actual.

AIMS: We briefly describe the most significant findings obtained recently concerning the sleep-waking cycle in comparison to the studies conducted by Cajal on the same subject. DEVELOPMENT: This paper includes a short biographical sketch of Santiago Ramón y Cajal, with special emphasis on his importance within the framework of neuroscience. Cajal represents the decisive turning point in neurobiological studies, with the discovery of the synapse and his law of dynamic polarization. We conduct a short survey of the current knowledge about the phases of sleep and oneiric phenomena, based on their anatomo-physiological foundations. We present a summary of the history of the subject and analyze the contributions made by Cajal to this field, i.e. his study of the associative cortices, which are essential in memory processes and related to the mechanisms governing the sleep-waking cycle. For Cajal the fine anatomy of the thalamus must be considered in relation to the specificity of its connections an idea that is still completely valid today. He did not observe any projections of the thalamic reticular nucleus towards the cerebral cortex, a fact that has been corroborated using modern-day techniques. He spoke of the involvement of neuroglia in the attentional and sleep processes, which is so, although not quite in the way Cajal thought. He considered the production of dreams to be based on intimate neural mechanisms, which is still so. He also studied other brain structures related with the regulation of the sleep waking cycle, although avoiding any specific mention of the mechanisms controlling such a cycle. Furthermore, he conducted self-observation studies with a high degree of insight. CONCLUSIONS: Cajal studied the phenomena of attention and sleep in an objective manner and contributed a number of significant interpretations, some of which are now somewhat outdated while others are still wholly valid today.

Efficacy and tolerability of pantoprazole versus ranitidine in the treatment of reflux esophagitis and the influence of Helicobacter pylori infection on healing rate.

Patients with reflux esophagitis (grade II or III, Savary-Miller, intention-to-treat, n=256, age range 19-82 years) were randomly assigned to a double-blind, double-dummy treatment with either pantoprazole 40 mg once daily or ranitidine 150 mg twice daily. After 4 weeks, each patient was clinically and endoscopically assessed. Failure to heal required a further 4 weeks of treatment and a new evaluation thereafter. After 4 weeks, healing of lesions was confirmed in 63% (69 out of 109) of patients receiving pantoprazole and in 22% (25 out of 113) receiving ranitidine (P < 0.001, per protocol population). After 8 weeks, the cumulative healing rates were 88% and 46%, respectively (P < 0.001). Complete freedom from esophagitis-related symptoms (acid eructation, heartburn, pain while swallowing) was greater in the pantoprazole than in ranitidine group after 2 and 4 weeks (74% vs. 47%; 87% vs. 52%, respectively, P < 0.001). After 4 weeks, the healing rate was 76% in Helicobacter pylori (Hp)-positive vs. 45% in Hp-negative patients treated with pantoprazole (P < 0.01). The Hp status did not influence healing rates in patients treated with ranitidine. The most frequent adverse events in the pantoprazole group were diarrhea and somnolence (2-3% of patients), and in the ranitidine group, headache, diarrhea, dizziness, increase of liver enzymes and pruritus (2-4% of patients). In conclusion, pantoprazole was more effective than ranitidine in the healing rate and relief from reflux esophagitis-associated symptoms, and Hp infection was associated with higher healing rate during therapy with pantoprazole but not with ranitidine.

Very-low dose antacid in treatment of duodenal ulcer. Comparison with cimetidine.

Antacid (AA) in a very low dose (88 mmol/day) was compared to the standard 800-mg dose of cimetidine in healing duodenal ulcers. The influence of sex, age, symptom duration at entry, night pain, smoking, coffee consumption, and alcohol on ulcer healing was studied. The antacid was given in two different schedules: group I--20 ml 1 hr after breakfast and at bedtime; group II--10 ml 1 hr after breakfast and lunch and 20 ml at bedtime. Cimetidine (group III) was given in two divided doses: 400 mg 1 hr after breakfast and 400 mg at bedtime. Endoscopic control was performed after four weeks and, if necessary, after eight weeks of treatment. The healing rate after four weeks of treatment was, respectively, for groups I, II, and III, 45.5%, 55.8%, and 69.4% (group I = group II, and group III different from groups I and II). After eight weeks of treatment the healing rate was 61.5%, 80.8%, and 88.0% for groups I, II, and III, respectively (group II = group III, and group I different from groups II and III). Except for group I, smoking did not influence healing rate. Age, sex, symptoms at entry, night pain, and coffee consumption did not influence the treatment results. The authors concluded that the very low dose of magaldrate (88 mmol/day), when administered in three divided doses (10 ml after breakfast and lunch and 20 ml at bedtime) for eight weeks was as effective as 800 mg of cimetidine (400 mg twice a day) in healing duodenal ulcer.