Patches giving oestrogen through the skin could be an easy and safe alternative to hormone therapies used to treat prostate cancer.

The Cancer Research UK funded study found that oestrogen patches, usually used to treat menopause symptoms in women, reduced levels of testosterone in men to a similar extent as the current hormone treatment, LHRHa injections.

Many prostate cancers need the male hormone testosterone to grow. Using drugs to reduce testosterone in advanced stages of the disease can shrink the tumour or slow growth.

In the 1960s this was done by using oestrogen tablets, but this caused heart and blood clotting side effects for some men. Now, LHRHa injections are the main treatment for reducing testosterone but these may also cause serious side effects including hot flushes, osteoporosis, bone fractures and diabetes.

The trial was run by researchers from Imperial College London and the Medical Research Council Clinical Trials Unit with clinicians at Imperial College Healthcare NHS Trust.

They compared LHRHa injections to oestrogen patches in 254 men with locally advanced prostate cancer or prostate cancer that had spread, in order to test the benefits and side effects from the patches.

The results showed that patches appeared to suppress testosterone levels to a similar extent as LHRHa injections. After 12 months, the researchers also found that those having the LHRHa treatment had higher blood glucose and cholesterol levels, which can increase the risk of heart disease, compared to men treated with patches. The patches did not cause the same degree of heart and blood clotting problems caused by oestrogen tablets.

The initial trial has now been extended to study the long-term effectiveness and side effects of oestrogen patches in a larger group of 660 men.

Dr Ruth Langley, a study author from the Medical Research Council Clinical Trials Unit, said: ‘These promising new findings suggest that we might be able to use oestrogen patches or an oestrogen gel to treat prostate cancer without significantly increasing the risk of heart disease and stroke. We think the reason oral oestrogen causes these side effects is because the oestrogen reaches the liver in high concentrations straight from the stomach, whereas if the oestrogen can be absorbed through the skin, the effect on the liver is avoided.’

Professor Paul Abel, from the Department of Surgery and Cancer at Imperial College London and an honorary consultant in urology at Imperial College Healthcare, said: ‘The next step is to test if the oestrogen patches are as effective at stopping the growth of prostate cancer as the current hormone treatments. We

It appears that sugar really may help the medicine go down – studies suggest a few drops can comfort babies who are having their jabs. The Cochrane team reviewed 14 studies involving more than 1,500 infants going for routine childhood immunisations or a heel-prick blood test.
Babies given a sugary solution to suck as they were about to be injected cried far less than those given water. While sugar may pacify, it is unclear if it also relieves pain.
Experts say more research is needed to explore this.
A small study published a couple of years ago in The Lancet medical journal looked at the responses of 44 infants given either sugar or water as they had a heel-prick blood test. The sugar did not appear to make a difference to pain – all babies similarly grimaced and had comparable electrical activity measured with EEG readings in areas of the brain that process pain.
The lead researcher in the Cochrane review, Dr Manal Kassab of the Jordan University of Science and Technology in Irib, Jordan, said: ‘Giving babies something sweet to taste before injections may stop them from crying for as long.
‘Although we can’t confidently say that sugary solutions reduce needle pain, these results do look promising.’
Dr David Elliman of the Royal College of Paediatrics and Child Health said sugar solution was not used routinely in practice.
‘Generally, doctors recommend that the mother holds the baby and comforts it while they have their immunisation. If she is breastfeeding still, she might want to breastfeed her baby at the same time.
‘With older children we try to distract them. If you do the usual holding and comforting, I’m not sure how much sucrose would add.
‘What we do know is that using a shorter needle tends to be more painful, even though this might seem counterintuitive. That’s because the injections need to go into the muscle.’
By the time a child has reached its second birthday it should have had around 10 different injections to protect against various infectious diseases, including measles, mumps and rubella. BBC

Despite receiving blood thinners and other clot prevention treatment, some patients still develop potentially lethal blood clots in the first month after their operations anyway, especially if they developed a surgical-site infection while in the hospital, according to results of a study at Johns Hopkins.
The research found that patients who experience a surgical-site infection after their abdominal surgery are four times more likely than infection-free patients to develop a deep-vein thrombosis (DVT) in the legs, or its more deadly cousin, a pulmonary embolism (PE) in the lungs. While only 4 percent of patients developed a DVT, 92 percent of those who did had received prophylaxis that previous research has shown is the best practice for prevention.
‘We need heightened awareness about the potential for venous thromboembolism (VTE) in patients with surgical-site infections,’ says study leader Susan L. Gearhart, M.D., an associate professor of surgery at the Johns Hopkins University School of Medicine. ‘We need to think beyond the prophylaxis we are already giving these patients. We need to think smarter.’
Nearly all surgical patients at The Johns Hopkins Hospital are routinely given proven treatments to prevent VTEs, usually the regular administration of low-dose blood thinners and the use of compression devices to keep blood flowing in the legs. Typically the treatments cease when people are discharged from the hospital.
Gearhart notes that much work in hospitals has gone into ensuring compliance with prophylaxis measures, including automated checklists to remind health care workers of their importance. VTEs are considered a form of preventable harm, and the Centers for Medicare & Medicaid Services may penalise hospitals where patients develop clots after some orthopedic procedures. But this new study shows that even when hospitals comply with prevention guidelines, VTEs can still occur.
For their study, Gearhart and her colleagues reviewed the records of 615 adults who underwent colorectal surgery at The Johns Hopkins Hospital between July 2009 and July 2011. Twenty-five (4.1 percent) developed VTE. Among patients who experienced a VTE, 92 percent had been given risk-appropriate VTE prophylaxis.
What was even more interesting to Gearhart, she says, was that 14 of the 25 patients with VTE (56 percent) also developed postoperative infections compared with 168 patients (28.5 percent) without VTE. The infectious complications in nine of the 14 patients (64.3 percent) occurred prior to or on the same day as the VTE. She says she had never before seen a link between infections and VTE in surgical patients.
One theory for the apparent link is that an increase of inflammatory protein molecules that accompanies an infection affects the functioning of platelets in the blood, which could increase the risk of thrombosis. Platelets are the sticky cells that facilitate clot formation in the blood.
Gearhart says it may be time to conduct more intense monitoring of colorectal surgery patients who develop surgical-site infections, and consider frequent screening for clots in those with infections. Such screening can be done with ultrasound equipment. She also suggests such patients be kept on blood thinners for 30 days after surgery regardless of when they are discharged. Johns Hopkins Medicine

In one of the largest observational studies of its kind, researchers report that a combination of chemotherapy and radiation followed by surgery in patients with stage 3 non-small cell lung cancer improves survival.

Patients who had chemoradiation therapy followed by surgery had twice the five-year survival rate of those who had only chemoradiation, says Dr. Matthew Koshy, a radiation oncologist at the University of Illinois Hospital & Health Sciences System and lead author of the study.

The study looked at various treatment strategies in an effort to identify the best option for overall survival. The researchers used the National Cancer Database to identify 11,242 adult patients ages 19 and older who were treated for stage 3 non-small cell lung cancer between 1998 and 2004.

Treatment strategies used against this form of lung cancer include chemoradiation therapy; chemoradiation followed by surgery; and surgery followed by chemoradiation.

‘The role of chemoradiation therapy followed by surgery is somewhat controversial, because previous clinical studies have not shown a clear survival benefit,’ said Koshy, who noted that the practice of using chemotherapy and radiation to reduce the extent of cancer prior to surgery was begun in an effort to improve poor survival rates in this group of patients.
Dr. Matthew Koshy, radiation oncologist, University of Illinois Hospital & Health Sciences System

The new study found that five-year overall survival was 34 percent for patients who received chemoradiation therapy followed by surgery to remove a lobe of the lung, 20 percent for patients who had the surgery followed by the adjuvant therapy, and 13 percent for patients who received chemoradiation therapy but no surgery.

The researchers say that additional prospective studies are needed to confirm the benefit of chemoradiation prior to surgery and define the standard of care for patients with stage 3 non-small cell lung cancer.

‘The main message to patients,’ Koshy said, ‘is to seek care from a multidisciplinary group of physicians that includes a thoracic surgeon, medical oncologist and radiation oncologist who can work together to determine the most appropriate initial treatment strategy.’ The University of Illinois Hospital & Health Sciences System