No clastogenic activity of a senna extract in the mouse micronucleus assay.

In previous studies, an analytically well-defined senna extract, commonly used as a laxative, gave positive responses in vitro in the Ames test and in the CHO assay. Therefore, the objective of this study was to investigate the genotoxic activity of the same senna extract in an in vivo genotoxicity assay by means of the generally acknowledged MNT. After administration of an oral dose of 2000 mg senna extract/kg to NMRI mice of both genders, which is equivalent to 119 mg potential rhein/kg, 5.74 mg potential aloeemodin/kg and 0. 28 mg potential emodin/kg, there were no elevated levels of micronuclei in bone marrow cells. Kinetic studies were performed in parallel to demonstrate target organ availability. Highest concentrations in the plasma were reached after 1 h with 3.4 microg rhein/ml and 0.065 microg aloeemodin/ml. In all cases, emodin was below the limit of quantification. From the results, the in vitro clastogenic activity of the senna extract could not be confirmed in the mouse micronucleus assay. Together with further negative in vivo genotoxicity studies with anthranoids, the conclusion can be drawn that there is no indication so far demonstrating a genotoxic risk for patients taking senna laxatives.

Prifinium bromide - a new antispasmodic.

A new antispasmodic, prifinium bromide (Riabal; Intal Ethicals) has been evaluated clinically and found to be most effective in the therapy of spastic and inco-ordinated lesions of the oesophagus.

Standard oesophageal tests and practice.

The specific diagnosis and institution of correct therapy for patients with oesophageal symptoms are only possible after full, sophisticated investigation. This article describes the standard oesophageal tests employed.

Diabetes and oesophageal dysfunction.

Cineradiographic and manometric studies of oesophageal function were carried out in four different groups of patients (those suspected of having oesophageal disease, with and without symptoms; and in two groups of diabetes, with and without diabetic neuropathy). All groups were found to have abnormal oesophageal function, and this was not commoner in those with diabetic neuropathy.

Augmented histamine test in the treatment of symptomatic hiatal hernia.

The augmented histamine test was performed in 150 cases of oesophageal hiatal hernia with and without duodenal ulcers and the results have been analysed. There was no significant difference in the result compared with normals. In addition there is no correlation between the acid secretion and either symptoms or size of the hernia. The pathogenesis of heartburn is briefly discussed.

The surgical gastro-intestinal motility clinic: The history of oesophagology at Groote Schuur Hospital.

The growth of the Surgical Gastro-intestinal Motility Clinic at Groote Schuur Hospital is described. This especially depicts the history of oesophagology in the Cape. Details of the work performed are discussed.

Oesophageal bleeding from aortoesophageal fistula due to aortic aneurysm.

From pathology data it appears that aortic aneurysm may be the commonest cause of aorto-oesophageal fistula (AOF), but this entity is rarely diagnosed clinically. We report 6 patients, seen during a 5-year period, with aneurysms which initially caused chest pain and minor oesophageal bleeding. The diagnosis of AOF was made before death in only 1 case; surgery was not attempted. This patient and 4 others died when rupture into the oesophageal lumen or wall caused exsanguinating haemorrhage. The 6th patient, who died after prostatectomy without a major haemorrhage, had oesophageal fibrosis localized at the aneurysm; this type of lesion occurs in the development of a fistula. The therapeutic ideal is to forestall fatal rupture by prompt diagnosis and immediate surgery when mild oesophageal bleeding gives warning of fistula formation.

Contraction pattern variations in oesophagography.

In recent literature a pattern of transient transverse folds seen in oesophagography has been described as a new variant. It is suggested, however, that the pattern is part of a spectrum of oesophageal contractions that occurs with or without specific lesions, and that it is created by contraction of the transverse oblique muscles of the oesophagus.

Intramural rupture of the oesophagus.

Two cases of intramural rupture of the oesophagus are described. In both cases the diagnosis was made endoscopically and confirmed radiologically. Both patients were successfully managed conservatively but were later found to have disordered oesophageal motility. The clinical presentation of severe retrosternal chest pain followed by haematemesis and then dysphagia is stressed, and the diagnostic features on barium swallow examination and endoscopy are described. It is suggested that the diagnosis should be made on clinical presentation and barium swallow, and that the possible hazards of endoscopy in the acute stage should be avoided.

Carcinoma of the thoraco-abdominal oesophagus.

A new approach in the management of carcinoma of the thoraco-abdominal oesophagus, by means of pre-operative chemotherapy, in the form of Methotrexate and irradiation, followed by a one-stage resection, using a thoracic/abdominal approach, is described. This resulted in a marked tumour regression without leading to difficulty with operative management.

A prospective controlled trial of sclerotherapy in the long term management of patients after esophageal variceal bleeding.

The preliminary results of the first 25 months of a prospective randomized controlled clinical trial, designed to compare repeated injection sclerotherapy with conservative medical management in the long term treatment of all patients shown to have previously bled from esophageal varices, are presented in detail. To date, 31 patients have been randomized, 15 in the chronic injection group and 16 in the control medical management group. In addition, five patients excluded for geographic reasons have been injected out of trial. Ethanolamine oleate has been injected into the varices, using a modified rigid esophagoscope under general anesthesia. The preliminary results have been encouraging. It has been possible to eradicate esophageal varices in the chronic injection group and, once the varices had been eradicated, no patient had recurrence of variceal bleeding. On the other hand, recurrent variceal bleeds have remained a continuing problem in a number of the patients in the control study. A longer follow-up period will be required to assess both the quantitative and the qualitative aspects of survival and to determine how long esophageal varices will remain eradicated as well as how frequently repeated injections will be required.