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BREAST CHANGES IN FIBROCYSTIC DISEASE OF THE PANCREAS
1246 CŒLIAC DISEASE SIR,-I grateful to Dr. French for his letter last week in which he corrects a possible source of misunderstanding in my Charles West lecture, which appeared in your issue of Nov. 26. Dr. French quotes the last sentence of a paragraph concerning the value of faecal-fat estimations.Lest there be others who have also mistaken my meaning, I should like to make it clear that throughout the paragraph my remarks concerned the percentage estimation of fat in the dried stool, not the estimation of total fat excreted over any given period. WILFRID SHELDON. London, W.1. am
BREAST CHANGES IN FIBROCYSTIC DISEASE OF THE PANCREAS
SiR,—I read with interest Dr. Jolly’s appeal for information (Nov. 26). Some three years ago I noticed breast enlargement in two cases of fibrocystic disease during the second half of infancy. I wondered whether the breast might share in the fibrocystic change and discussed the matter with Dr. Reginald Lightwood, who doubted this possibility, pointing out that the breast was not a mucus-secreting gland. I have not since seen a case with enlargement of the breast, but I have arranged for microscopic examination of the unenlarged breast disc in two infants who died of fibrocystic disease in the first half of infancy. In each case the microscopic appearance was normal. Grimsargh, near
GORDON HESLING.
Preston.
AUREOMYCIN,
IMPROVED
NUTRITION, AND
GYNÆCOMASTIA
SiR,—The observation by my friend, Dr. Hugh Jolly (Nov. 26), that breast changes occur in children with fibrocystic disease of the pancreas gives me an opportunity’to play a card of low denomination which I have held in my hand for eighteen months. A man, aged 42 years, suffered from cor pulmonale secondary to bronchitis and emphysema. The pulmonary disorder was camplicated by recurring acute infections which were con-
by aureomycin therapy. He was discharged from hospital in December, 1953, taking prophylactic aureomycin 0-5 g. twice daily. His nutrition was much improved and he gained 8 lb. iri the three weeks after discharge. On March 8, 1954, the infection relapsed and he was readmitted to hospital. It was noticed that he had gynsecomastia, more apparent in the left breast than in the right. No aureomycin was given for eleven days after admission, and urinary endocrine assays were made during this period and later (see table). I did not at this time associate the gynaecomastia with aureomycin trolled
therapy, and a week’s further course of 2 g. daily was given. During this time the breasts enlarged and the patient complained of considerable discomfort (see figure). His weight increased from 7 st. 2 lb. to 7 st. 8 lb. during this fortnight, When the aureomycin was stopped the breasts ceased to irritate, but the pulmonary infection later relapsed and oxytetracycline therapy was instituted. Within two days the breasts were again irritable. Liver-function tests were normal throughout his stay in hospital. I concluded from these observations that both the
aureomycin and the oxytetracycline were factors in the production of the gyniscomastia. A probable hypothesis of pathogenesis is that the drugs interfered with either the production or the absorption of vitamin B, one of whose properties is the destruction of oestrogen in the body.1 It was remarkable how quickly the drugs produced irritation in the breasts. Since this experience I have not used these drugs in the prophylaxis of pulmonary infections in children. It is possible that improved nutrition, particularly enhanced absorption of protein, may be an additional factor in causation when mucoviscidosis is treated by pancreatic granules. In men who were incarcerated in
Japanese prison-camps gymecomastia occurred, occa. sionally during the phase of confinement (and testicular atrophy) but more often on release and during the early weeks of rapidly improving nutrition.2-J 1. Briskind, M. S., Briskind, G. R. Endocrinology, 1942, 31, 109. 2. Klatskin, G., Salter, W. T., Huin, F. D. Amer. J. med. Sci. 1947, 213, 19. 3. Salter, W. T., Klatskin, G., Hum, F. D. Ibid, p. 31. 4. Platt, S. S., Schulz, R. Z., Kunstadter, R. H. Bull. U.S. Army med. Dep. 1947, 7, 403.
URINARY ENDOCRINE ASSAYS
The normal levels of cestrogen excretion for levels have any significance, I do not know.
men are
usually said to
range from 20 to 100 i.u. per
day. Whether the fluctuation or the low
BREAST CHANGES IN FIBROCYSTIC DISEASE OF THE PANCREAS
SiR,—I read with interest Dr. Jolly’s appeal for information (Nov. 26). Some three years ago I noticed breast enlargement in two cases of fibrocystic disease during the second half of infancy. I wondered whether the breast might share in the fibrocystic change and discussed the matter with Dr. Reginald Lightwood, who doubted this possibility, pointing out that the breast was not a mucus-secreting gland. I have not since seen a case with enlargement of the breast, but I have arranged for microscopic examination of the unenlarged breast disc in two infants who died of fibrocystic disease in the first half of infancy. In each case the microscopic appearance was normal. Grimsargh, near
GORDON HESLING.
Preston.
AUREOMYCIN,
IMPROVED
NUTRITION, AND
GYNÆCOMASTIA
SiR,—The observation by my friend, Dr. Hugh Jolly (Nov. 26), that breast changes occur in children with fibrocystic disease of the pancreas gives me an opportunity’to play a card of low denomination which I have held in my hand for eighteen months. A man, aged 42 years, suffered from cor pulmonale secondary to bronchitis and emphysema. The pulmonary disorder was camplicated by recurring acute infections which were con-
by aureomycin therapy. He was discharged from hospital in December, 1953, taking prophylactic aureomycin 0-5 g. twice daily. His nutrition was much improved and he gained 8 lb. iri the three weeks after discharge. On March 8, 1954, the infection relapsed and he was readmitted to hospital. It was noticed that he had gynsecomastia, more apparent in the left breast than in the right. No aureomycin was given for eleven days after admission, and urinary endocrine assays were made during this period and later (see table). I did not at this time associate the gynaecomastia with aureomycin trolled
therapy, and a week’s further course of 2 g. daily was given. During this time the breasts enlarged and the patient complained of considerable discomfort (see figure). His weight increased from 7 st. 2 lb. to 7 st. 8 lb. during this fortnight, When the aureomycin was stopped the breasts ceased to irritate, but the pulmonary infection later relapsed and oxytetracycline therapy was instituted. Within two days the breasts were again irritable. Liver-function tests were normal throughout his stay in hospital. I concluded from these observations that both the
aureomycin and the oxytetracycline were factors in the production of the gyniscomastia. A probable hypothesis of pathogenesis is that the drugs interfered with either the production or the absorption of vitamin B, one of whose properties is the destruction of oestrogen in the body.1 It was remarkable how quickly the drugs produced irritation in the breasts. Since this experience I have not used these drugs in the prophylaxis of pulmonary infections in children. It is possible that improved nutrition, particularly enhanced absorption of protein, may be an additional factor in causation when mucoviscidosis is treated by pancreatic granules. In men who were incarcerated in
Japanese prison-camps gymecomastia occurred, occa. sionally during the phase of confinement (and testicular atrophy) but more often on release and during the early weeks of rapidly improving nutrition.2-J 1. Briskind, M. S., Briskind, G. R. Endocrinology, 1942, 31, 109. 2. Klatskin, G., Salter, W. T., Huin, F. D. Amer. J. med. Sci. 1947, 213, 19. 3. Salter, W. T., Klatskin, G., Hum, F. D. Ibid, p. 31. 4. Platt, S. S., Schulz, R. Z., Kunstadter, R. H. Bull. U.S. Army med. Dep. 1947, 7, 403.
URINARY ENDOCRINE ASSAYS
The normal levels of cestrogen excretion for levels have any significance, I do not know.
men are
usually said to
range from 20 to 100 i.u. per
day. Whether the fluctuation or the low