Fuller Albright. His concept of postmenopausal osteoporosis and what came of it

Fifty years ago Albright contributed the following to understanding osteoporosis: (1) He recognized it as a deficiency of formation, not of mineralization of bone matrix; (2) he observed that 40 of 42 patients with osteoporosis before age 65 were women past menopause or young women postoophorectomy; (3) he concluded that estrogen stimulates osteoblasts (a conclusion later challenged); (4) he demonstrated by metabolic balance studies that estrogen causes a positive calcium balance in postmenopausal osteoporosis; (5) he introduced periodic progesterone to prevent or treat endometrial hyperplasia from prolonged estrogen therapy; and (6) he showed that long-term therapy arrested vertebral damage and height loss in postmenopausal osteoporosis and prevented them if started early. Since Albright's time, more sensitive methods of assessing bone density have replaced conventional roentgenograms. Some large scale trials of estrogen have indicated increased bone density and fewer fractures. Unopposed estrogen increases risk of endometrial cancer and decreases mortality from other cancers, myocardial infarction, stroke, and osteoporosis. Trials of calcitonin, diphosphonates, fluoride, vitamin D, and high calcium intake have not proved more effective than estrogen.

Clinical significance of antibodies to ovarian antigens; association with cancer of the genito-urinary tract

Serum from 491 patients with cancer and from 151 patients of comparable age without recognized cancer was tested by indirect immunofluorescence for antibodies to ovarian antigens. Circulating antibody to the cytoplasm of rabbit ova was found in from 19 to 47% of patients with cancer of the ovary, endometrium, kidney, bladder or testis, or with lymphoma, and in only 3-3% of control patients. Antibodies to thecacell antigens were not more common in patients with cancer than in other patients, but within the group of cancer patients, such antibodies were, in all but one case, associated with cancer of the genito-urinary tract or with lymphoma. The anti-theca-cell antibodies observed produced a staining pattern indistinguishable from that obtained with the serum of patients with Addison's disease but were not, in the cancer patients, associated with antibodies to adrenal tissue. Tests for antibody to the cytoplasm of ova were more frequently positive in patients with progressive cancers than in patients successfully treated by surgery or radiation, and were seen in patients in whom cancer had recurred following removal of the organ of origin. These findings suggest that the antigen or antigens that evoke antibody to the cytoplasm of ova arise from tumour cells rather than from damage to normal tissue by surgery, tumour invasion or radiation.

Circulating antibody to renal collecting ducts in patients with hepatoma or renal-cell carcinoma

An anti-kidney antibody was demonstrated by the indirect immunofluorescence method in the serum of patients with primary tumours of the liver or kidney. The distribution of fluorescence in rabbit kidney was consistent with that of antibody to collecting ducts. The anti-collecting duct antibody (anti-CDA) could be absorbed from serum by normal adult rabbit or human kidney tissue and by one of three specimens of renal-cell carcinoma tissue. Anti-CDA differed from anti-mitochondrial antibodies and from anti-liver/kidney microsomal antibody in the pattern of fluorescent staining obtained with rabbit kidney. Two-hundred sera from patients with cancer and other diseases and forty-three from healthy hospital personnel were tested for anti-CDA. Eleven of the twenty-five positive sera were from patients with primary cancer of the liver or urinary tract, and all but six of the remainder were from patients with tumours involving the liver or with liver disorders that may be associated with nodular hyperplasia or tumour.

Klinefelter's syndrome, a clinical and cytogenetic study in twenty-four cases

Clinical and cytogenetic studies were made of twenty four patients with Klinefelter's syndrome in order to determine the somatic consequences of X chromosomal overdosage and its effect on the incidence of metabolic and degenerative diseases. Salient features of the group were tall stature, obesity, a high incidence of diabetes mellitus, hyperlipemia, hypercholesterolemia, gall bladder disease, chronic pulmonary infection, peptic ulcer, varicose veins, laboratory indices of hypothyroidism and a disordered personality. There was a striking absence of hypertension, myocardial infarction and rheumatoid arthritis and no case of hyperthyroidism, thyroiditis or gout. Family histories revealed a high incidence of diabetes mellitus in close relatives.

Thus the second X chromosome, although it is sequestered in adult life appears to have profound metabolic as well as morphological effects.

Gonadal dysgenesis and ulcerative colitis. A case report with clinical, cytogenetic, and post-mortem studies

Images