Melatonin influences Fos expression in the rat suprachiasmatic.

Administration of the pineal hormone melatonin to rats induces expression of Fos, the protein product of the c-fos proto-oncogene, in the suprachiasmatic nucleus (SCN), the putative biological clock of mammals. Expression of the Fos protein is dependent on circadian phase: injections in the late subjective night (circadian time (CT) 22) induce Fos expression in cells within the ventral SCN whereas injections during the subjective day are ineffective. Since melatonin injections in the late subjective day have previously been shown to phase advance circadian rhythms, these results indicate that phase-advances of the circadian system can occur without increased expression of Fos protein in the SCN, at least at levels detectable by immunohistochemistry. In support of in situ hybridization histochemical evidence obtained previously, immunocytochemical data from vehicle-injected control rats suggest that the Fos protein undergoes an endogenous fluctuation with peak levels in the SCN occurring during the subjective night. These observations indicate that melatonin can affect immediate early gene expression within the SCN.

Treatment of reflux oesophagitis with a carbenoxolone/antacid/alginate preparation. A double-blind controlled trial.

Twenty-nine patients were treated with a carbenoxolone/antacid/alginate preparation (Pyrogastrone) and 30 with antacid/alginate alone four times each day for 8 weeks, in a double-blind study, to ascertain the value of carbenoxolone in the treatment of patients with endoscopically confirmed reflux oesophagitis. Symptom review every 2 weeks and endoscopic findings every 4 weeks were converted to a 6-point grading system to facilitate statistical comparison, using a stochastic model for predicting the rate of change in grades during treatment. Carbenoxolone-treated patients showed an 82% improvement in symptom grades over 8 weeks and improved 50% faster (P less than 0.01) than did control patients, who showed a 63% improvement. Endoscopic improvement was not significantly different in the first 4 weeks, although healing was better maintained in carbenoxolone-treated patients during the second 4 weeks (P less than 0.05). At the low doses used (5 X 20 mg daily) no significant side effects of carbenoxolone were encountered. Pyrogastrone should be considered as a therapeutic alternative in patients who fail to respond to routine management with antacids.

Gastric candidiasis.

A male, aged 60 with rheumatoid arthritis which was treated with prednisone, developed a severe symptomatic stomal gastritis at the site of a previous Polya partial gastrectomy. The endoscopic appearance of the lesion was similar to that of Candida infection, which is more frequently seen in the oesophagus. Candida albicans was cultured from biopsy specimens, and prompt resolution of the lesion and the patient's symptoms occurred with orally administered antifungal therapy. Primary gastric candidiasis should be considered in compromised patients with symptoms of infection of the upper part of gastrointestinal tract.

Evaluation of carbenoxolone sodium in the treatment of duodenal ulcer.

A double blind trial involving 21 patients on carbenoxolone and 23 patients on placebo was conducted under endoscopic control to assess the healing of duodenal ulcers over a period of 6 weeks. The two groups were adequately matched with the exception that larger ulcers predominated in the carbenoxolone group. Relief of symptoms showed poor correlation with ulcer healing. Fourteen of the 21 patients in the carbenoxolone group and 7 of the 23 in the placebo group showed endoscopic evidence of complete healing. The result is highly significant (P less than 0.016) and confirms the therapeutic efficacy of carbenoxolone sodium positioned-release capsules in the treatment of duodenal ulcers. Side effects of carbenoxolone therapy in the form of weight gain, rise in diastolic blood pressure and hypokalaemia were observed, but with adequate monitoring and appropriate countermeasures, no patient suffered any ill effects.

Chronic erosive (verrucous) gastritis. A study of 108 patients.

Chronic erosive gastritis (C.E.G.) is a gastric mucosal lesionwith characteristic radiological and endoscopic appearances. Pyloric gland hyperplasia is seen on histological examination of biopsy specimens. C.E.G. is uncommonly reported in the English literature. In reviewing 3,800 upper gastro-intestinal endoscopies from 1971--1976, 108 patients were diagnosed as having typical features of chronic erosive gastritis, an incidence of 2.8%. There was a significant association with duodenal ulceration and an overall male predominance. The lesion can also co-exist with gastric ulceration and has been observed as an incidental finding in patients examined urgently for upper gastro-intestinal bleeding. In this context C.E.G. should be distinguished from acute mucosal erosions. Symptoms may relate to the accompanying peptic ulceration, although dyspepsia epigastric pain, fullness and nausea may possibly occur with C.E.G. alone.

Evaluation of a new fibre colonoscope the Olympus TCF-2L.

Experience with the new Olympus twin channel TCF-2L colonoscope is presented. Based on 60 examinations including 25 polypectomies it is concluded that the instrument when compared with other colonoscopes is easier to handle and its advancement within the colon is faster, smoother and therefore less disagreeable to the patient. The proximal colon is easier to reach than previously experienced. Polypectomy and retrieving of polyps can efficiently be undertaken. This instrument will undoubtedly further enhance the usefulness and therapeutic value of fibre colonoscopy.

Review of five cases of early gastric carcinoma.

Five cases of early gastric carcinoma (EGC) were seen in 12 months. The clinical features did not provide guide-lines to diagnosis, which depends on air contrast barium studies, endoscopic recognition of early malignancy, adequate biopsies, and their interpretation. Malignancy was present in an average of 60% of the biopsies taken. The most common type of lesion was IIc. The superficial nature of the malignancy was predicted at endoscopy in four cases but was unsuspected in one case which was considered to be advanced carcinoma until the resected specimen was throughly examined microscopically. The excellent prognosis of EGC was discussed. Only conservative surgery need be performed if the superficial nature of the lesion is recognized before operation.

Gastrointestinal endoscopic polypectomy.

Recent advances in the field of gastroenterological endoscopy have now embraced endoscopic polypectomy. Experiences at the Royal North Shore Hospital over a period of one year include 42 colonic and three gastric polypectomies. Rectal bleeding was the main presenting feature in the patients with colonic polyps. All colonic polyps were situated between the sigmoid and transverse colon. Eighteen polyps were under 1 cm in size, 15 between 1 and 2 cm and nine over 2 cm. There was one carcinoma detected in each of these groups. No significant complications were encountered with any of these patients. The high yield of malignancy, none of which could be suspected on clinical or radiological grounds, more than justifies the introduction of this endoscopic procedure which will offer considerable saving from both the point of view of economic factors and personal discomfort.