Fecal steroid excretion and degradation and breast cancer stage.

Evaluation of excretion and degradation of fecal steroids in 74 women with breast cancer in relation to stage, tumor size, and histopathologic nodal status revealed significant differences in relation to stage of disease and tumor size. The level of total fecal steroids (mean +/- SD in mg/g dry wt) in patients with Stage I disease was 40 + 20, Stage II = 56 +/- 32, and Stage III = 75 +/- 57 (P = 0.006). Secondary fecal steroids in women with Stage I disease were 26 +/- 16, Stage II = 40 +/- 27, and Stage III = 57 +/- 34 (P = 0.003). Fecal steroid excretion and degradation was significantly higher in women with larger tumors, whereas nodal status did not contribute to observed differences indicating that dissemination of disease did not influence the results. These differences were noted to be independent of obesity since similar patterns of fecal steroid excretion were noted within the subgroups of both lean and obese women. Increased levels of total fecal steroids and secondary compounds apparently contribute to tumor promotion and may reflect a potential for excess estrogen synthesis since intestinal bacteria have the ability to synthesize estradiol, estrone, and 3,17-methoxyestradiol from secondary steroids present in the colon.

Tissue immunoglobulins and early recurrence in Crohn's disease.

The early recurrence rates following surgical treatment of Crohn's disease are distressingly high. In clinical studies in which an attempt is made to correlate duration, severity and extent of disease, the prediction as to which patients are prone to have the disease recur was not successful. The immunoglobulin G value is elevated in the diseased portion and in 50 per cent of the normal appearing margins of resected intestine from patients with Crohn's disease. Half of the patients with immunoglobulin G values above 18 milligrams per gram of dry weight at the margins had recurrences at the suture line within three years. The immunoglobulin G concentrations do not correlate with steroid treatment, duration of symptoms, extent of disease, presence of epithelioid granulomas or previous recurrent disease. Immunoglobulin A and immunoglobulin M values are not helpful in predicting recurrences. Elevation of immunoglobulin G values at the resection margins appears to be a reliable indicator of early recurrence in patients with Crohn's disease.

Association between estrogen receptors and weight in women with breast cancer.

A significant association between body weight and estrogen receptor protein (ERP) was noted in 83 women with primary and metastatic breast cancer. Thirteen of 34 (54%) women with weight greater than 150 lb had low or absent receptor protein (less than 10 femtomoles/mg of cytoplasmic protein) compared to 15 of 59 (25%) women with weight less than 150 lb (P less than 0.025). The observed association was stronger in the group of 62 postmenopausal women (P less than 0.01). The findings suggest that the endocrine and metabolic milieu in women with increased weight favors autonomous growth of breast cancer, and adjuvant treatment in this group should be planned accordingly.

PIP: Body weight, as a parameter to be considered in the treatment of women with breast cancer, was studied to determine any association between it and estrogen receptor protein (ERP) content. ERP was determined in 83 women with primary or metastatic breast tumors. A strong association between ERP and body weight was noted among the 62 postmenopausal women with primary and metastatic tumors. 80% of those with weight equal to or less than 150 pounds had positive ERs, as opposed to only 43% of those of higher weight (P .01). A similar assocation was found among the 56 postmenopausal women with primary breast tumors. The corresponding percentages were 81 and 47 (P .01). There were 21 determinations of ERP among premenopausal women: 13 of 21 (61%) had positive ER as opposed to 42 of 62 (68%) in the postmenopausal group. In all 83 women combined, 11 of 24 overweight women had positive ERP determinations compared with 44 of 59 (75%) with lower weight (P .025).

Effects of clofibrate and of an estrogen-progestin combination on fasting biliary lipids and cholic acid kinetics in man.

PIP: The effects of clofibrate and of the combined administration of estrogen plus progestin on the concentration of fasting hepatic bile lipids and on pool sizes and turnover rates of cholic acid were studied. 8 women with normal serum lipids, 1 male with beta-lipoproteinemia, and 1 female with pre-beta-lipoproteinemia were studied after recovery from cholecystecomy. Hepatic bile was collected periodically as long as 4 1/2 months through a closed indwelling cystic duct catheter. Clofibrate lowered serum cholesterol by 15-25% in 3 of the normolipidemic patients. In a patient with hypertriglyceridemia, serum cholesterol fell from 306 to 171 and triglycerides from 520 to 179. Estrogen plus progestin produced a 7% rise in serum cholesterol in 1 patient. Biliary cholesterol increased during clofibrate (7 patients) and hormone (3 patients) administration while bile acid levels were decreased. Cholic acid kinetics in 3 patients showed decreased synthesis rates and pool sizes with both drugs. It is suggested that increased cholesterol saturation of bile during administration of a natural estrogen with progestin to cholecystectomized patients relects an increased propensity to cholesterol formation.^ieng

Serum bile acids in liver disease.

Serum bile acids have been measured in patients with a wide variety of liver diseases using a technique which separates the major individual conjugated and free bile acids. Total serum bile acids may be elevated up to 100 times the normal concentration in patients with liver disease and this increase consists largely of conjugated bile acids. The ratio of glycine-conjugated to taurine-conjugated bile salts is low in all types of liver disease and this is found particularly in the serum of patients with obstructive jaundice. There is a decrease in the ratio of trihydroxy:dihydroxy cholanic acid in patients with cirrhosis.