678 BREAST SIZE IN BREAST-CANCER PATIENTS AND CONTROLS

fragility and promote14the degradative enzymes. 13

release of bone

Department of Medical Microbiology, University of Bari, Bari, Italy

(collagenolytic)

D. FUMAROLA

PROPHYLACTIC CO-TRIMOXAZOLE IN LEUKÆMIA

SIR,-Dr Enno and colleagues (Aug. 19, p. 395) report

Oestrone is the dominating oestrogen in postmenopausal and has been suggested as being implicated in breastcancer aetiology. Oestrone is accounted for almost exclusively by peripheral aromatisation of androgenic precursors after the menopause, adipose tissue probably playing a major role in this oestrogen production. We did find a higher mean serum concentration of both oestrone and its major precursor (androstenedione) in 122 postmenopausal women with breast cancer than in their age-matched controls (unpublished). There was, however, no correlation between the serum levels of these hormones and weight or any index of overweight, thus contradicting a quantitative influence of adipose tissue on the serum levels. women

Department of Surgery, University Hospital, S-750 14 Uppsala, Sweden

HANS-OLOV ADAMI ÅKE RIMSTEN

BONE DISEASE AFTER JEJUNOILEAL BYPASS

SIR,-Stimulated by Dr Compston and her colleagues’ conclusion (July 1, p. 1) about the mechanisms involved in the bone disease associated with the intestinal bypass procedure for obesity, I should like to indicate another possible pathogenetic factor. Experimental studies and clinical observations have demonstrated that: (1) The blind loop resulting from the intestinal bypass procedure becomes heavily colonised with Enterobactenacese, mostly Escherichia coli and Bacteroides spp. 12 (2) Enterobacterial endotoxms may gain entrance to the systemic circulation as a consequence of the compromised clearing and detoxifying functions of the liver after intestinal bypass operations.3-6 (3) Bones of adult rats became progressively osteopenic 1-5 weeks after jejunoileal bypass or resection.’7 (4) Enterobacterial endotoxins can inhibit bone formations and mobilise radiocalcium in labelled mineral and matrix from fetal rat bone in vitro.9 (5) Endotoxms have been implicated in the bone resorption associated with peridontal disease. 10-12

suggestion of Simmonds et al.’ that a "resorptive factor", perhaps an endotoxin or endotoxin like substance produced in and released from the occluded intestinal segment, may lead or contribute to the bone lysosomal These data support the

1. Mezey, E., Potter, J. J., Rent, K. Clin. Res. 1974, 22, 694. 2. O’Leary, J. P., Maher, J. W., Hollenbëck, J. I. Gastroenterology,

1974, 66,

859.

Wands, J. R., La Mont, J. T., Mann, E., Isselbacher, K. J. New. Engl. J. Med. 1976, 294, 121. 4. Moake, J. L., Kageker, W. V., Cimo, P. L., Blakely, R. W., Rossen, R. D., Haesse, W. Ann. intern. Med. 1977, 86, 576. 5. Hollenbëck, J. I., O’Leary, J. P., Maher, J. W., Woodward, E. R. J. surg. Res. 1975, 18, 83. 6. Gans, H., Facs, D., Wendell, G. ibid. 1976, 21, 415. 7. Simmons, D. J., Hyland, G., Lesker, P. A., Cohen, M., Stein, T., Wise, L. Surgery, 1975, 78, 460. 8. Norton, L. A., Proffit, W. R., Moore, R. R. Nature, 1969, 221, 469. 9. Hausmann, E., Raisz, L. G., Miller, W. A. Science, 1970, 168, 862. 10. Aleo, J. J., DeRenzis, F. A., Farber, P. A. J. Periodont. 1974, 45, 672. 11. Hausmann, E., Wenfeld, N., Miller, W. A. Calcif. Tissue Res. 1972, 9, 272. 12. Johnson, D. A., Behling, U. H., Lai, C. H., Listgarten, M., Spcranoky, S., 3.

Nowotny A

Infect. Immun. 1978, 19, 246

use

of co-trimoxazole

on

prevent infection in acute leukxmia ; patients given these drugs in combination with nonabsorbable antibiotics (FRACON)1 had fewer infections than those given FRACON alone. The hazards of routine antimicrobial prophylaxis in hospital include infections with microorganisms that are primarily resistant to these drugs (e.g., cotrimoxazole and Pseudomonas aeruginosa), infections with microorganisms that become resistant to these drugs, and development of resistance in the hospital flora during prolonged use of a prophylactic routine. Presumably the reported series was too small and the duration of the regimen too short for such hazards to be encountered. However, we are concerned, especially in view of the last two of the above-mentioned hazards, about the use of a valuable drug combination for roiltine prophylaxis. The infection-rate in the FRACON group was remarkably high (15 out of 16 patients, 94%) compared with an earlier report1 suggesting a 52% infection-rate for patients on FRACON. In the Hammersmith Hospital series 57% of patients given FRACON and co-trimoxazole had infections. In our series of 26 patients given partial antibiotic decontamination2 only 7 (27%) became infected, and if, like Enno et al., we exclude patients infected at the time of presentation this figure falls to 15% (2 out of 13) (unpublished). The mean duration of extreme granulocytopenia (

Bone disease after jejunoileal bypass.

678 BREAST SIZE IN BREAST-CANCER PATIENTS AND CONTROLS fragility and promote14the degradative enzymes. 13 release of bone Department of Medical Mic...
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