Therapy Insight: Parenteral Estrogen treatment for Prostate Cancer—a new dawn for an old therapy

Oral estrogens were the treatment of choice for carcinoma of the prostate for over four decades, but were abandoned because of an excess of cardiovascular and thromboembolic toxicity. It is now recognized that most of this toxicity is related to the first pass portal circulation, which upregulates the hepatic metabolism of hormones, lipids and coagulation proteins. Most of this toxicity can be avoided by parenteral (intramuscular or transdermal) estrogen administration, which avoids hepatic enzyme induction. It also seems that a short-term but modest increase in cardiovascular morbidity (but not mortality) is compensated for by a long-term cardioprotective benefit, which accrues progressively as vascular remodeling develops over time. Parenteral estrogen therapy has the advantage of giving protection against the effects of andropause (similar to the female menopause), which are induced by conventional androgen suppression and include osteoporotic fracture, hot flashes, asthenia and cognitive dysfunction. In addition, parenteral estrogen therapy is significantly cheaper than contemporary endocrine therapy, with substantive economic implications for health providers

Estudo comparativo do diagnóstico de câncer pulmonar entre tomografia computadorizada e broncoscopia Comparative study between computed tomography and bronchoscopy in the diagnosis of lung cancer

OBJETIVO: Analisar a tomografia computadorizada e a broncoscopia no diagnóstico do câncer pulmonar e verificar a eficácia destas técnicas perante a presença desta doença. Os parâmetros idade, gênero, hábitos tabágicos, tipos histológicos, estadiamento e terapêutica foram, igualmente, analisados. MATERIAIS E MÉTODOS: Foram analisados 70 pacientes do Serviço de Pneumologia do Hospital Distrital da Figueira da Foz, Coimbra, Portugal, que realizaram ambas as técnicas em estudo, tendo-se confirmado ou não a presença de câncer pulmonar. RESULTADOS: Diagnosticaram-se 37 tumores pulmonares, 23 casos no gênero masculino e 14 no feminino. Histologicamente, 40,54% eram adenocarcinomas, seguido do carcinoma escamoso (32,43% dos casos) e do carcinoma de pequenas células (18,92%). O estadiamento mostrou 6,70% no estádio IB, 23,30% no estádio IIIA comparativamente ao IIIB com 36,70%, encontrando-se 33,30% dos doentes no estádio IV. A quimioterapia isolada foi efetuada em 75,7% dos doentes. A sensibilidade da broncoscopia foi de 83,8%, a especificidade, de 81,8%, e a precisão, de 82,8%. A sensibilidade da tomografia computadorizada foi de 81,1%, a especificidade, de 63,6%, e a precisão, de 72,8%. CONCLUSÃO: Os resultados da broncoscopia confirmaram a sua importância no diagnóstico do câncer pulmonar, pela dependência deste no exame anatomopatológico do tecido ou células, obtido por várias técnicas de biópsia. A tomografia computadorizada apresentou boa sensibilidade, de 81,1%, contudo, a sua especificidade, de apenas 63,6%, resulta do número de falso-positivos (36,4%).<br>OBJECTIVE: To analyze the role of computed tomography and bronchoscopy in the diagnosis of lung cancer, evaluating the effectiveness of these techniques in the presence of this disease. Parameters such as age, gender, smoking habits, histological types, staging and treatment were also analyzed. MATERIALS AND METHODS: The sample of the present study included 70 patients assisted at the Department of Pneumology of Hospital Distrital da Figueira da Foz, Coimbra, Portugal, who were submitted to both diagnostic methods, namely, computed tomography and bronchoscopy, to confirm the presence or the absence of lung cancer. RESULTS: Thirty-seven patients (23 men and 14 women) were diagnosed with lung cancer. Histologically 40.54% were adenocarcinoma, followed by squamous carcinoma (32.43% cases) and small-cell lung cancer (18.92%). Staging showed 6.70% stage IB disease, 23.30% stage IIIA and 36.70% stage IIIB, and 33.30% stage IV. Chemotherapy alone was the first treatment of choice for 75.7% of patients. Bronchoscopy sensitivity was 83.8%, specificity 81.8%, and accuracy 82.8%. Computed tomography sensitivity was 81.1%, specificity 63.6%, and accuracy 72.8%. CONCLUSION: Bronchoscopy results corroborated the relevance of the method in the diagnosis of lung cancer, considering its dependence on the anatomopathological study of tissue or cells obtained through different biopsy techniques. Computed tomography presented good sensitivity (81.1%), however the specificity of only 63.6% is related to the rate of false-positive results (36.4%)

The Mantle Section of Neoproterozoic Ophiolites from the Pan-African Belt, Eastern Desert, Egypt: Tectonomagmatic Evolution, Metamorphism, and Mineralization

The Eastern Desert (ED) Neoproterozoic ophiolites are tectonically important elements of the Arabian–Nubian Shield. Although affected by various degrees of dismemberment, metamorphism, and alteration, almost all of the diagnostic Penrose-type ophiolite components can be found, namely, lower units of serpentinized peridotite tectonite and cumulate ultramafics and upper units of layered and isotropic gabbros, plagiogranites, sheeted dykes and pillow lavas. The contacts between the lower unit (mantle section) and the upper unit (crustal section) were originally magmatic, but in all cases are now disrupted by tectonism. The mantle sections of the ED ophiolites are exposed as folded thrust sheets bearing important and distinctive lithologies of serpentinized peridotites of harzburgite and dunite protoliths with occasional podiform chromitites. The ED ophiolites show a spatial and temporal association with suture zones that indicate fossil subduction zone locations. Multiple episodes of regional metamorphism mostly reached greenschist facies with less common amphibolite facies localities. CO₂-metasomatism resulted in the development of talc–carbonate, listvenite, magnesite, and other carbonate-bearing meta-ultramafic rocks. Geochemical data from the ED serpentinites, despite some confounding effects of hydration and alteration, resemble modern oceanic peridotites. The ED serpentinites show high LOI (≤20 wt%); Mg# mostly higher than 0.89; enrichment of Ni, Cr, and Co; depletion of Al₂O₃ and CaO; and nearly flat, depleted, and unfractionated chondrite-normalized REE patterns. The modal abundance of clinopyroxene is very low if it is present at all. Chromian spinel survived metamorphism and is widely used as the most reliable petrogenetic and geotectonic indicator in the ED ophiolite mantle sections. The high-Cr# (mostly ~0.7) and low-TiO₂ (mostly ≤ 0.1 wt%) characters of chromian spinel indicate a high degree of partial melt extraction (≥30%), which is commonly associated with fore-arc settings and equilibration with boninite-like or high-Mg tholeiite melts. Based on the general petrological characteristics, the ED ophiolitic chromitites are largely similar to Phanerozoic examples that have been attributed to melt–peridotite interaction and subsequent melt mixing in fore-arc settings. The comparison between the ED Neoproterozoic mantle peridotites and Phanerozoic equivalents indicates considerable similarity in tectonomagmatic processes and does not support any major changes in the geothermal regime of subduction zones on Earth since the Neoproterozoic era. The mantle sections of ED ophiolites are worthy targets for mining and exploration, hosting a variety of ores (chromite, gold, and iron/nickel laterites) and industrial minerals (talc, asbestos, and serpentine)