Trends in the incidence and survival of cancer in teenagers and young adults: regional analysis for South East England 1960-2002.

AIMS: This study aimed to describe trends in the incidence and survival of cancer in teenagers and young adults in South East England between 1960 and 2002, and the influence of socioeconomic status upon survival. MATERIALS AND METHODS: Data on 1788 patients aged 15-24 years were extracted from the Thames Cancer Registry, assigning each to a diagnostic group using the Birch and Marsden classification. Age-specific incidence rates in 5-year periods for the age groups 15-19 and 20-24 years were calculated for each diagnosis. Five-year relative survival estimates by diagnostic group were calculated for both age groups using 5-year periods of follow-up and non-overlapping years of diagnosis. To calculate overall survival estimates by socioeconomic group, the 10-year follow-up period 1993-2002 was used. RESULTS: Overall incidence rates were 162 per million person-years in 15-19 year olds and 261 in 20-24 year olds. We found a higher overall incidence in males, in 20-24 year olds and an increasing incidence over the last four decades, particularly in this age group. In both the 15-19 and 20-24 years age groups lymphomas were most common. The 5-year relative survival improved for all diagnostic groups, except bone tumours in the older age group, particularly for leukaemia and slightly more for the 20-24 than 15-19 years age group. Teenagers aged 15-19 years and living in more deprived areas had a significantly lower survival than those in more affluent areas. CONCLUSIONS: These findings confirm the increased incidence and improved outcome of cancer in teenagers and young adults. Future analyses should investigate trends in bone tumour survival across regions, survival by socioeconomic status and the influence of specialised care on further improvements in survival.

Best practice in primary care pathology: review 4.

This fourth best practice review examines four series of common primary care questions in laboratory medicine are examined in this review: (1) safety monitoring for three common drugs; (2) use of prostate-specific antigen; (3) investigation of vaginal discharge; and (4) investigation of subfertility. The review is presented in question-answer format, referenced for each question series. The recommendations represent a precis of the guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most of them are consensus based rather than evidence based. They will be updated periodically to take account of new information.

Microcirugía tubárica distal translaparoscópica: sus resultados / Translaparoscopic distal tubal micro surgery: its results

Introducción: La patología tubárica distal representa un 30 a 40 por ciento de la causas de disfunción reproductiva. Objetivos: Mostrar los resultados obtenidos con el tratamiento laparoscópico del factor tubárico distal en la paciente con esterilidad de origen tuboperitoneal. Material y Métodos: Desde el año 1996 se analizaron propectivamente pacientes sometidas a cirugía tubárica distal por laparoscopia, con esterilidad por factor tuboperitoneal. Se excluyeron del trabajo a la mujeres con baja reserva ovárica y aquellas parejas con factor masculino severo, pero se incluyeron casos de factor masculino en tratamiento médico o reproducción asistida de baja complejidad. Se realizó un seguimiento mínimo de 1 año. Resultados: Se estudiaron 123 pacientes operadas hasta marzo de 1999, con esterilidad primaria (n=84) o secundaria (n=39). Se realizaron fimbrioplastias (n=107) y salpingoneostomías (n=19). Se obtuvieron 47 embarazos (38.2 por ciento), y en 12 casos ya se verificó un segundo embarazo. La mayoría de los embarazos se obtuvieron en el primer año postoperatorio (74.5 por ciento)y en las pacientes menores de 34 años (76.6 por ciento). La tasa de embarazos ectópicos fue del 6.4 por ciento (3 casos, todos correspondientes a salpingostomías por hidrosálpinx) y la de abortos 23.4 por ciento (11 casos). En 76 casos se halló endometriosis que se trató laparoscópicamente y, en 48 casos (63.1 por ciento) con leuprolide adyuvante por 4-6 meses. De estas pacientes, 24 embarazaron, independientemente del uso adyuvante de leuprolide (p=0.8). Conclusiones: La laparoscopia operatoria permite hoy en día resolver la patología tubárica distal de una manera mínimamente invasiva, con resultados similares a la técnica convencional, en pacientes con factor tuboperitoneal (AU)

Microcirugía tubárica distal translaparoscópica: sus resultados / Translaparoscopic distal tubal micro surgery: its results

Introducción: La patología tubárica distal representa un 30 a 40 por ciento de la causas de disfunción reproductiva. Objetivos: Mostrar los resultados obtenidos con el tratamiento laparoscópico del factor tubárico distal en la paciente con esterilidad de origen tuboperitoneal. Material y Métodos: Desde el año 1996 se analizaron propectivamente pacientes sometidas a cirugía tubárica distal por laparoscopia, con esterilidad por factor tuboperitoneal. Se excluyeron del trabajo a la mujeres con baja reserva ovárica y aquellas parejas con factor masculino severo, pero se incluyeron casos de factor masculino en tratamiento médico o reproducción asistida de baja complejidad. Se realizó un seguimiento mínimo de 1 año. Resultados: Se estudiaron 123 pacientes operadas hasta marzo de 1999, con esterilidad primaria (n=84) o secundaria (n=39). Se realizaron fimbrioplastias (n=107) y salpingoneostomías (n=19). Se obtuvieron 47 embarazos (38.2 por ciento), y en 12 casos ya se verificó un segundo embarazo. La mayoría de los embarazos se obtuvieron en el primer año postoperatorio (74.5 por ciento)y en las pacientes menores de 34 años (76.6 por ciento). La tasa de embarazos ectópicos fue del 6.4 por ciento (3 casos, todos correspondientes a salpingostomías por hidrosálpinx) y la de abortos 23.4 por ciento (11 casos). En 76 casos se halló endometriosis que se trató laparoscópicamente y, en 48 casos (63.1 por ciento) con leuprolide adyuvante por 4-6 meses. De estas pacientes, 24 embarazaron, independientemente del uso adyuvante de leuprolide (p=0.8). Conclusiones: La laparoscopia operatoria permite hoy en día resolver la patología tubárica distal de una manera mínimamente invasiva, con resultados similares a la técnica convencional, en pacientes con factor tuboperitoneal

One thousand initiated cycles of in vitro fertilization in women > or = 40 years of age.

OBJECTIVE: To evaluate the results of IVF in women > or = 40 years of age using their own oocytes. DESIGN: Retrospective study. SETTING: Wolfson and Royal Masonic in vitro fertilization units, London, United Kingdom. PATIENT(S): A total of 1,087 IVF cycles were started in women > or = 40 years of age. INTERVENTION(S): Medical records of patient outcomes were reviewed. MAIN OUTCOME MEASURE(S): Clinical pregnancy, miscarriage, and delivery rates. RESULT(S): Of the 1,087 cycles started in 471 women > or = 40 years of age, 842 reached oocyte retrieval (77.5%) and 702 had embryos transferred (64.6%). The pregnancy rate (PR) was significantly lower in women > or = 40 years of age than in a control group of women <40 years of age (11.3% versus 28.2%). It decreased sharply in women >42 years of age, and no women >45 years of age had a child. Women > or = 40 years of age were more likely to miscarry (27% versus 12.7%). When only one embryo was available for transfer, the PR was 3.3%. When >2 embryos were available for transfer, the PR was similar whether 2 or 3 embryos were replaced. No triplet pregnancy occurred. Women > or = 40 years of age achieved a cumulative PR of 30% after three cycles with a cumulative "take home baby" rate of 21%. CONCLUSION(S): In vitro fertilization is a reasonable treatment for women <45 years of age using their own gametes. Those with a "good response" in their first attempt may be encouraged to complete three cycles with an acceptable chance of conception.

Effect of salpingectomy on ovarian response to superovulation in an in vitro fertilization-embryo transfer program.

OBJECTIVE: To investigate the effect of salpingectomy on the response of each ovary in patients undergoing an IVF-ET treatment cycle and to compare the results with those of patients who had not had surgery and were undergoing IVF-ET during the same period. DESIGN: A prospective study. SETTING: Tertiary referral academic IVF unit. PATIENT(S): Twenty-nine ET cycles were evaluated in 29 patients who previously had undergone unilateral salpingectomy because of ectopic pregnancy (study group). Seventy-three patients with unexplained or male factor infertility served as controls. INTERVENTION(S): Ovulation induction and IVF-ET. MAIN OUTCOME MEASURE(S): In the study group, mean ovarian volume, number of follicles, and number of oocytes recovered from each ovary were assessed and compared. The overall results, cycle characteristics, and pregnancy rates of the two groups were compared. RESULT(S): Among the patients who had undergone salpingectomy, significantly fewer follicles developed and consequently fewer oocytes were retrieved from the ovary on the operated side (4.4 versus 8.2 follicles and 3.8 versus 6.0 oocytes). There were no differences in the total numbers of follicles and oocytes recovered from both ovaries, the cycle characteristics, or the pregnancy rates between study and control groups. CONCLUSION(S): Salpingectomy has no detrimental effect on the total ovarian performance during IVF-ET treatment or on the outcome of IVF-ET. However, the ipsilateral ovary could be adversely affected. This could be detrimental in selected patients undergoing IVF-ET, in whom the second ovary already is compromised or missing.

Predictive value of the results of a first in-vitro fertilization cycle on the outcome of subsequent cycles.

This study examines the relationship between the first cycle of in-vitro fertilization (IVF) and subsequent cycles. The results of all IVF cycles conducted at The Hammersmith Hospital or The Royal Masonic Hospital between 1988 and 1995 were studied including those cycles where egg recovery was abandoned due to poor ovarian response. All patients underwent a standardized treatment protocol. Of those women who achieved a clinical pregnancy during their first IVF attempt, 33% achieved a pregnancy during their second cycle, statistically significantly different from the 24% of patients conceiving during a second cycle who had failed to conceive during their first. 36% of those who achieved a biochemical pregnancy in their first cycle became pregnant in their second. Age was an important factor in the success of IVF treatment, with pregnancy rates of 48% in the 20-25 year age group falling to 8% in those aged > or =41 years. Cumulative pregnancy rates were 26% after one cycle, increasing to 43% after two cycles and reached 80% after seven cycles. A previous pregnancy significantly improved a couple's probability of conception in a later IVF cycle. Overall pregnancy rates per cycle were constant for the first three attempts. Cumulative pregnancy rates continued to rise to 72% after six cycles. Thus the more cycles a couple undergo (up to six) the greater their chance of a pregnancy.

Right or left ovary--which one is better?

This study tests the hypothesis that there is a different response after gonadotrophin-releasing hormone and human menopausal gonadotrophins (GnRH/HMG) stimulation for in-vitro fertilization (IVF) in patients with either a right or left ovary. A total of 56 cycles in 44 women after left oophorectomy (group A) was compared with 42 cycles in 29 women following right oophorectomy (group B). Tubal disease was the sole cause of infertility in all cases. The two groups were similar in age. There was no difference in total amount or days of HMG required for ovulation induction, peak oestradiol concentrations, number of oocytes retrieved and fertilization rate. The pregnancy rate was identical in the two groups (20.0 and 20.9% respectively). Our results indicate that with GnRH/HMG ovulation induction protocol for IVF there is no predilection of one ovary over the other.