Safety of maternal testosterone therapy during breast feeding.

This article is an adaptation of an abstract/poster presentaton made at the 13th International Congress on Steroidal Hormones and Hormones and Cancer, Quebec City, Canada (September 2008), concerning the topic of breast feeding as a contraindication to testosterone therapy. The purpose of the presentation and this article is to provide a summary of the findings of a study that was conducted to evaluate maternal absorption of testosterone and its excretion into breast milk by using three methods of delivery: sublingual drops, vaginal cream, and pellet implant. Testosterone was measurable in maternal blood by all three methods of delivery. No significanat increase of testosterone was seen in breast milk when testosterone was delivered by vaginal cream, sublingual drops, or subcutaneous pellet implant. Testosterone was very low in infant blood at baseline and during testosterone therapy by pellet implant. There was no adverse clinical affects in the infant after seven months of continuous testosterone therapy to the mother by subcutaneous pellet implant. Testosterone delivered by sublingual drops, vaginal cream, and pellet implant was absorbed but not measurably excreted into breast milk. Testosterone, delivered by a 100-mg subcutaneous pellet implant, was effective in relieving symptoms of testosterone deficiency and therapy is safe for the breast-fed infant. Testosterone by pellet implant may be a safer and more physiologic alternative to psychotropic medications.

A welcome return to old values, but it is what is under the bonnet that counts.

I am pleased that nurses at Broomfield Hospital in Chelmsford, Essex are to return to wearing hats (news May 13). Welcoming the white bonnets that are being piloted, the hospital's deputy director of nursing, Catherine Morgan, says: 'We value the professionalism that a smart uniform portrays.'

Immunohistochemical analysis of the IL-6 family of cytokines and their receptors in benign, hyperplasic, and malignant human prostate.

Interleukin-6 (IL-6) and its receptor have been implicated in prostate cancer progression. Because other members of the IL-6 family such as leukaemia inhibitory factor (LIF) and oncostatin M (OSM) share gp130, the signal transduction subunit of their receptors, interpretation of the data without considering the expression of these cytokines and their specific receptor subunits could be misleading. The immunohistochemical pattern of the IL-6 family and their receptor subunits in normal prostate, benign prostatic hyperplasia (BPH), and prostatic carcinoma (PC) was investigated. In normal prostates, gp130 and OSMRalpha were detected exclusively in the stroma and LIFRbeta was very scarce. While IL-6 was scarcely immunolocalized to the basal cells of the epithelium, OSM was detected in the stroma and LIF in both the epithelium and the stroma. This suggests an autocrine role for this family of cytokines in the stroma of normal prostates. In BPH, gp130 and OSMRalpha were detected both in the epithelium and in the stroma, whereas LIFRbeta was localized only to the epithelium. IL-6 localized preferentially to the epithelium, OSM to the stroma, and LIF to both compartments. Therefore, in addition to the autocrine role in the stroma, IL-6 and OSM may play a paracrine role from the stroma to the epithelium in BPH. In PC, gp130 and OSMRalpha were detected both in the epithelium and in the stroma, increasing with rising Gleason grade, whereas LIFRbeta was localized exclusively to the epithelium of low Gleason grade carcinomas. IL-6, LIF, and OSM localized in all cell types, with immunostaining increasing with Gleason grade. These data suggest an autocrine role for these cytokines in the epithelial cells of PC. The distinct pattern of expression of LIFRbeta exclusively in low Gleason grade carcinomas makes LIFRbeta a candidate for malignancy diagnosis. The role of OSM mainly in high Gleason grade carcinomas makes OSM a putative target for prostate cancer therapy.