No abstract

Menstrual activity is dependent on a critical body weight and may, therefore, be modified by nutritional factors. Lower plasma levels of testosterone, androstenedione, dehydroepiandrosterone, and prolactin, and differences in gonadotrophin levels were found during the menstrual cycle in rural black South African versus white women. When premenopausal vegetarian South African black women were fed a Western diet, plasma testosterone and prolactin levels increased, while estradiol decreased and follicle-stimulative hormone increased. In postmenopausal black women a similar diet decreased plasma leutinizing and follicle-stimulating hormone and increased prolactin levels. Differences between white and black women eating their customary diets may be related to genetic factors and/or lifestyle and diet. However, a Western diet induced changes in hormonal activity in vegetarian black women. These changes in hormonal levels in black women were comparable to those found in women with menstrual irregularities. Further study is needed to determine whether the difference in hormonal activity during the menstrual cycle between vegetarian black and white women may in part explain the lower incidence of coronary heart disease and breast cancer in the former.

Advanced head and neck cancer thought to be incurable by irradiation or surgery alone or in combination was treated by intra-arterial chemotherapy and radiation therapy. Two series have been treated, the one using methotrexate and alkylating agents, and the other Velban alone. The one-year results of the second appear to be better. This line of investigation should be pursued further.

Fig. 575). Sections through this tumour showed a small focus of carcinoma, at an early stage of development. The story of this patient emphasizes the importance of keeping in touch with affected members even when they profess to be in good health, and illustrates the fact that malignant disease may arise in the absence of any symptoms due to the polyposis.Case 2.-The second patient was a boy, aged 17, marked by an arrow in the family pedigree (Fig. 576) in which 24 adult members are recorded. Nine of these 24 are known to have inherited polyposis and 5 have died from intestinal cancer.This family was first investigated by MI. Tom Rowntree in 1950, and the information available at that time was published (Rowntree, 1950), but in this earlier version of the family pedigree the patient now being reported was not included because at that time he had not been traced and his existence was unknown to us. We knew that his mother had died of rectal cancer at the age of 22, but only subsequently did we discover that she had had an illegitimate son who had been brought up by in-law relatives. This boy at the age of 17 began to have diarrhcea, which was investigated by barium meal, and polyposis coli was discovered. His doctor then referred him to this hospital, where the diagnosis was confirmed, and inquiry into his family connexions showed the linkage with the family previously investigated.When first examined at St. Mark's Hospital G. C. was 17 years of age. He appeared healthy and his only complaint was persistent diarrhoea for the last six weeks, unaccompanied by blood or excess of mucus. Sigmoidoscopic examination revealed large numbers of adenomatous polyps in the rectum, which were treated by fulguration in several sessions. Then the rectum having been cleared of polyps, colectomy and ileorectal anastomosis was carried out.The colon from this patient is illustrated in Fig. 577 and a close-up of one region in Fig. 578. It will be seen that the mucosa was thickly carpeted with rounded adenomatous tumours. In some regions more than thirty tumours were visible in a square inch. An estimate of the total number of tumours calculated from the average density and surface area gave a figure in excess of 5000. The histological picture was that of adenomas undergoing active epithelial proliferation but with no indication of malignancy. This second case illustrates the importance of keeping in touch with a O F T H E N I P P L E 48 1 GARDNER, E.