Effects of exercise training on bone remodeling, insulin-like growth factors, and bone mineral density in postmenopausal women with and without hormone replacement therapy.

The purpose of this study was to determine the effects of 12 months of weight bearing and resistance exercise on bone mineral density (BMD) and bone remodeling (bone formation and bone resorption) in 2 groups of postmenopausal women either with or without hormone replacement therapy (HRT). Secondary aims were to characterize the changes in insulin-like growth factors-1 and -2 (IGF-1 and -2) and IGF binding protein 3 (IGFBP3) in response to exercise training. Women who were 3-10 years postmenopausal (aged 40-65 years) were included in the study. Women in the HRT and no HRT groups were randomized into the exercise intervention, resulting in four groups: (1) women not taking HRT, not exercising; (2) those taking HRT, not exercising; (3) those exercising, not taking HRT; and (4) women exercising, taking HRT. The number of subjects per group after 1 year was 27, 21, 25, and 17, respectively. HRT increased BMD at most sites whereas the combination of exercise and HRT produced increases in BMD greater than either treatment alone. Exercise training alone resulted in modest site-specific increases in BMD. Bone remodeling was suppressed in the groups taking HRT regardless of exercise status. The bone remodeling response to exercise training in women not taking HRT was not significantly different from those not exercising. However, the direction of change suggests an elevation in bone remodeling in response to exercise training, a phenomenon usually associated with bone loss. No training-induced differences in IGF-1, IGF-2, IGF-l:IGF-2 (IGF-1 : IGF-2), and IGFBP3 were detected.

Case report: diabetic ketoacidosis in a patient with glucagonoma.

The development of diabetic ketoacidosis is an unusual complication of a glucagon-secreting pancreatic islet cell neoplasm, with only four reported cases in the literature. In this article, the authors report on a 46-year-old woman with a glucagonoma cosecreting pancreatic polypeptide, somatostatin, and serotonin diagnosed 8 months before the onset of diabetic ketoacidosis. She was treated with hydration, insulin, and octreotide, with improvement in her clinical course and a decrease in the glucagon, pancreatic polypeptide, and chromogranin A plasma levels. With the addition of weekly 5-FU, she has maintained a partial radiographic response and has had no further episodes of diabetic ketoacidosis for a 4.5-year period. Diabetic ketoacidosis can develop in the presence of a glucagonoma, and the pathophysiology remains unknown.

Epididymal cribriform hyperplasia. A variant of normal epididymal histology.

We describe a case of orchiectomy for testicular germ cell neoplasm with a peculiar associated cribriform hyperplasia of the epididymis. The process, which we have termed epididymal cribriform hyperplasia (ECH), is tantalizingly akin to patterns of cribriform ductal carcinoma in situ of the female breast and is characterized by complex arcades and cellular bridges spanning dilated epididymal lumina. The cells lining these interconnecting arches have hyperchromatic nuclei, but lack significant atypia or mitotic activity. A limited search of the Vanderbilt University Medical Center (Nashville, Tenn) surgical pathology files produced 30 cases with evaluable epididymis, 15 of which had some degree of ECH. The ECH occurred in a broad age range with a mean of 40 years. No association of ECH with testicular germ cell neoplasia, adenomatous hyperplasia of the rete testis, or parenchymal atrophy could be documented. We conclude that ECH is a seldom recognized variant of normal epididymal histologic appearance that may be present in up to half of epididymides.

Distribution of CA 19-9 in adenocarcinomas and transitional cell carcinomas. An immunohistochemical study of 527 cases.

To determine the distribution of CA 19-9 in adenocarcinomas and transitional cell carcinomas, formalin-fixed paraffin-embedded tissue from 527 cases of these tumors was studied using a monoclonal antibody to CA 19-9 and an avidin-biotin immunohistochemical technique. Positive reactivity was seen in some tumors of all types except hepatocellular carcinoma. Positive reactions were most common in pancreatic adenocarcinomas (94%), bile duct carcinomas (91%), and transitional cell carcinomas (76%). The majority of tumors from the ovary, endometrium, distal esophagus/stomach, and colon also showed positive staining. Immunoreactivity was seen in 25-29% of carcinomas of the lung, thyroid, and endocervix. Few positive reactions were seen in renal cell carcinomas (2%), prostatic adenocarcinomas (3%), and breast carcinomas (6%). It was concluded that CA 19-9 is frequently present in several types of adenocarcinoma and transitional cell carcinoma. Immunostaining for CA 19-9 may be helpful in excluding hepatocellular carcinoma, prostatic adenocarcinoma, and renal cell carcinoma in certain clinical settings.

Distribution of CA 125 in adenocarcinomas. An immunohistochemical study of 481 cases.

To determine the distribution of CA 125 in adenocarcinomas, formalin-fixed, paraffin-embedded tissue from 481 cases of adenocarcinoma from a variety of primary sites were studied using a monoclonal antibody to CA 125 (B27.1) and an avidin-biotin immunohistochemical technique. Positive reactivity was most common in adenocarcinomas of the endocervix, ovary, and endometrium (61% to 94%). However, relatively frequent positive reactions also were seen in adenocarcinomas of the pancreas (48%) and bile ducts (56%). Adenocarcinomas of the breast, lung, thyroid, distal esophagus/stomach, and liver (hepatocellular carcinoma) showed positive reactions in 7% to 20% of cases. Staining of rare tumor cells was seen in 2 of 45 colonic adenocarcinomas and in 1 of 61 prostatic adenocarcinomas. No reactivity was seen in the 54 renal cell carcinomas studied. Although CA 125 is most commonly present in gynecologic adenocarcinomas, it is also produced by some adenocarcinomas from many other sites. Immunostaining for CA 125 may be helpful in ruling out renal cell carcinoma in certain clinical settings.

The physician's obligation to treat AIDS patients.

Medicine's triumph over contagious disease through improved techniques of prevention and treatment in the decades before the appearance of the acquired immunodeficiency syndrome (AIDS) left physicians with little impetus to explore their feelings regarding the acceptance of personal risk in the course of patient care. The rapid expansion of the AIDS epidemic, however, has made it essential for every physician and medical student to confront this issue and determine whether he is willing to accept the minimal risks of transmission posed by the human immunodeficiency virus (HIV) to health care workers. This paper will present five arguments in support of the contention that the physician is obligated to treat all those who would benefit from his care, even when such care entails personal risk to himself. These arguments include the historical traditions of the profession, formal ethical codes, the dependent nature of the patient, the social contract, and medicine as a profession.