Risk awareness on uterine cancer among Australian women.

Uterine cancer is the most common invasive gynaecological cancer in Australia. Early detection is a key predictive factor achieved by increasing public awareness and participation in screening. This observational study measures awareness of gynaecological malignancies, particularly uterine, among women in two rural areas of New South Wales, Australia. Patients presenting to gynaecology clinics in January to March 2014 were invited to complete a structured questionnaire. Women with a history of cancer and incomplete questionnaires were excluded. Of the 382 patients invited to participate, 329 (86%) responded with complete feedback. Most respondents were younger than than 50 years (66%) and married with at least 2 children (74%). The majority (94%) of participants had no awareness of uterine cancer and many (46%) were unable to identify common risk factors including obesity, diabetes and hypertension. The ability to identify risk factors was correlated to age, marital status and obesity. The study identifies poor awareness on uterine malignancies in two typical areas of rural Australia. Although external validity is limited by sociological factors, poor awareness of uterine cancer among rural patients in this study represents a valid public health concern. It is imperative to improve awareness of uterine cancer and available screening programs to facilitate early detection and cure.

Can the use of quality assurance tools reduce the impact of surgical complications on the well-being of obstetricians and gynaecologists in Australia and New Zealand?

BACKGROUND: While adverse events primarily affect the patient, surgeons involved can also experience considerable distress. AIMS: The aim of the survey was to assess the impact of complications on the day-to-day life, work and health of Australian and New Zealand obstetricians and gynaecologists and to evaluate existing support systems and coping strategies. METHODS: A 43-question survey on self-assessment, quality assurance (QA) tools, impact of complications on individuals' health and relationships, and support available was emailed to fellows, trainees, subspecialists and subspecialty trainees of the Royal Australian and New Zealand College of Obstetrics and Gynaecology (RANZCOG). We collected 606 responses from a target population of 2296 (response rate 26.3%). RESULTS: When complications occur, sleep was affected of 80%, family and social relationships of 55% and physical health of 48% of respondents. The major sources of support were from colleagues (83%), family (82%) and medical defence organisations (73%), with professional bodies perceived as providing least support. Nearly 80% of respondents felt the need to talk to someone they trust during times of complications. Overall, 100% of respondents used at least one QA tool (62% used two, 26% three and 9% four QA strategies). There were significant differences between respondent groups in use of the QA tools. CONCLUSIONS: Surgical complications have a significant impact on the well-being of Australian and New Zealand obstetricians and gynaecologists. Existing support comes from colleagues and family, but structured, unbiased support for surgeons from a professional source is urgently warranted.

Normal live births after intracytoplasmic sperm injection in a man with the rare condition of Eagle-Barrett syndrome (prune-belly syndrome).

OBJECTIVE: To report the first live births of male infants resulting from intracytoplasmic sperm injection (ICSI) using spermatozoa from a man with Eagle-Barrett syndrome (EBS). DESIGN: Case report. SETTING: Assisted conception unit within a private hospital. PATIENT(S): An infertile couple. INTERVENTIONS: An infertile couple received repeated treatment with ICSI. MAIN OUTCOME MEASURE(S): Clinical pregnancy and a normal live birth. RESULT(S): In 2008, after microinjection of ten oocytes, the transfer of a single expanded blastocyst led to the premature birth of a morphologically normal male infant at 18 weeks' gestation. This outcome followed preterm rupture of membranes and possible cervical incompetence. In 2009, after microinjection of six oocytes, transfer of a single 5-cell embryo led to a singleton pregnancy, with emergency cervical cerclage being performed at 21 weeks. A healthy male infant was born at 30 weeks, with no evidence of EBS, by lower-segment cesarean section for breech presentation and premature labor. In 2012, after elective laparoscopic placement of cervical suture, microinjection of ten oocytes and transfer of a single 4-cell embryo led to a singleton pregnancy with a healthy male infant, with no evidence of EBS, being born by cesarean section at 38 weeks. CONCLUSION(S): This report suggests that EBS is not transmitted to male offspring via ICSI.

The value of serum CA125 for the development of virtual follow-up strategies for patients with epithelial ovarian cancer: a retrospective study.

BACKGROUND: Serum CA125 is routinely used in the follow up of ovarian cancer. The objective of the present study was to evaluate the usefulness of CA125 in the detection of ovarian cancer recurrence. METHODS: This retrospective case study was carried out at a tertiary gynaecological cancer centre in Australia. Patients with all cell types of epithelial ovarian cancer (EOC) treated between 2003 and2010 were considered eligible. We excluded patients whose aim of treatment was palliative, had no follow-up, had no pre-operative CA125 reading or had pre-operative CA125 levels < 35 U/mL. After primary treatment, patients were followed up as per guidelines suggested by National Comprehensive Cancer Network (NCCN). We recorded if symptoms, findings from physical examination, imaging or serum CA125 levels led to the diagnosis of recurrence. An increase in CA125 levels to twice the postoperative nadir was considered as "doubling" at any time during follow up. RESULTS: Analysis is based on 56 patients who completed primary treatment and who presented for a total of 274 follow-up episodes. Of those, 29 patients (52%) developed a recurrence within the follow up period. Recurrence was diagnosed by CA125 alone in 14 of 29 patients (48%). CA125 was not elevated in 7 patients (24%) who recurred. Doubling of CA125 from nadir was observed in 27/29 patients. Of those 27 patients the doubling from nadir occurred within the normal range of 35 U/ml in 3 cases and outside the normal range in 24 cases. Multivariate analysis suggests that doubling of serum CA125 (OR 5.10, p 0.036) and nadir CA125 > 10 U/ml (OR 2.86, p 0.01) remained the only independent factors to predict ovarian cancer recurrence. CONCLUSIONS: The present paper proposes the validation of a novel CA125 algorithm aiming to detect recurrent EOC. These data may allow us to investigate novel ways of follow up that do not require a patient's physical attendance at a clinic (virtual follow-up).