Resultados post operatorios de genitoplastia feminizante en hiperplasia adrenal congénita / Post operative results of feminizant genitoplasty in congenital adrenal hyperplasia

Resultados post operatorios de dos pacientes con diagnóstico de hiperplasia adrenal congénita por deficiencia de 21 hidroxilasa a quienes se les realizó genitoplastia feminizante. Se presentan 2 casos clínicos de pacientes con diagnóstico de hiperplasia adrenal congenital en el periodo neonatal a quienes se les realizó genitoplastia feminizante, utilizando la técnica de Fortunoff, modificada por Allen. De la primera paciente se muestran los resultados del post operatorio inmediato y a los 7 meses. De la segunda paciente mostramos igualmente los resultados del post operatorio inmediato, al año y en el inicio de la pubertad. Las dos pacientes muestran excelentes resultados cosméticos, que les han permitido un adecuado desarrollo. La genitoplastia feminizante debe ser realizada por cirujanos urólogos, especialmente entrenados en este tipo de patologías, para asegurar los mejores resultados estéticos y funcionales, ofreciéndole a la paciente un adecuado desarrollo físico y psicológico

Trends in the terminal care of cancer patients: South Australia, 1981-1990.

BACKGROUND: The increasing numbers of cancer patients, the high costs of terminal care, and the development of palliative care services have led to a growing interest in patterns of terminal cancer care. These patterns are relevant to the formulation and evaluation of health services policy. AIMS: To investigate trends in the place of death of South Australian cancer patients between 1981 and 1990, and to examine associations of socio-demographic and clinical variables with the place of death. METHODS: Data relating to 2715 deaths attributed to cancer in 1990 were extracted from the Central Cancer Registry. To assess trends, these data were directly standardised to the age-sex distribution of cancer deaths in 1981 and 1985 which were investigated in a previous study. Unconditional logistic regression was used to investigate predictors of place of death. RESULTS: The proportion of deaths which occurred in major metropolitan public hospitals decreased from 40% in 1981 to 28% in 1990. Conversely, the proportion which occurred in hospice units increased from 5% to 20% over the same period. There was a decline in the proportion of deaths which occurred in private hospitals, but there was no significant change in the proportion which occurred in country hospitals or nursing homes. The proportion of deaths at home remained around 14%. Associated with place of death were age, sex, type of malignancy, survival time from diagnosis to death, Aboriginality, and area of residence. Further research to assess the clinical appropriateness of terminal care patterns is suggested.

Interstate differences in incidence and mortality from melanoma. A re-examination of the latitudinal gradient.

OBJECTIVE: To investigate the patterns of cutaneous malignant melanoma (CMM) mortality in Australia. DESIGN: A descriptive analysis of melanoma incidence and mortality in Australia supplemented by a case series analysis of melanoma survival. Melanoma mortality rates were based on tabulations supplied by the Australian Bureau of Statistics for the years 1969-1989. Melanoma incidence rates were based on State cancer registry records for the years 1977-1990. The case series survival analysis was based on detailed individual records from the population-based cancer registries in Tasmania and South Australia. MAIN OUTCOME MEASURES: The level of and rise in melanoma mortality rates during 1969-1989 in Australia; the five-year survival rates for Tasmanian and South Australian cases; and male:female incidence ratios related to latitude. RESULTS: We found annual increases in melanoma mortality rates of 2.5% in men (P < 0.0001) and 1.1% in women (P < 0.0001) for all Australia. The five-year survival rates (with 95% confidence intervals [CI]) were: 67% (59%-75%) for Tasmanian men; 79% (76%-83%) for South Australian men; 80% (74%-86%) for Tasmanian women and 88% (86%-91%) for South Australian women. A change in the male:female incidence ratio with latitude was also found--women have significantly higher incidence rates at higher latitudes, but similar rates to men at lower latitudes. CONCLUSIONS: The age standardised mortality from CMM for the period 1969 to 1989 shows little variation by State for women, despite a considerable range in latitude. CMM mortality in men is increasing at a faster rate than that in women. Between 1982 and 1987 the male:female incidence ratio in high latitudes in the Southern Hemisphere showed an excess of cases in women, a finding which we believe has not been reported before.

The South Australian Cancer Registry: a means of assessing cancer incidence, mortality and case survival.

In 1977, a Cancer Control and Surveillance Unit was established by the South Australian government. The infrastructure of the Unit was the State's Cancer Registry which was established simultaneously. By 1990, approximately 70,000 invasive cancer cases had been notified to the Registry for a population which had increased from 1,287,550 in 1977 to 1,400,000. In 1990, 2940 cancers were notified in males and 2640 in females. The leading sites in males were the prostate, lung, colon and melanoma of the skin, while in females they were the breast, colon, melanoma of the skin and lung. An increase in age-standardised incidence rates for all cancer sites combined has been documented for the 1977-1990 period. The magnitude of the increase was 7% in males and 12% in females. Meanwhile, there were 1544 male cancer deaths and 1203 female cancer deaths in 1990. Amongst males, age-standardised mortality rates tended to decline in the 1980's, due largely to a reducing age-standardised incidence of lung cancer. By comparison, an increased lung cancer incidence in females contributed to an overall increase of 6% in the age-standardised mortality rate for cancers of all sites combined in this sex during the life of the Registry. During the period 1977-1990 there was a 55% increase in the number of new invasive cancers in males and females combined. Most of this increase can be attributed to the ageing of the South Australian population and to a much lesser degree to population growth. During the same period there was a concomitant increase in 43% in the number of deaths where the underlying cause of death was cancer. Case survival rates are found to be very similar in South Australia to those reported for the United States, with about 51% of cases surviving their cancers 5 years after diagnosis. 5-year survival rates for the diagnostic period, 1983-1990, were generally better than for 1977-1982. The evidence for improved survival was strongest for cancers of the oesophagus, colon, cervix, prostate and testes, and for low-grade and medium-grade lymphomas and chronic myeloid leukaemias. When case survival rates were calculated for childhood tumours, significant improvements were found for acute lymphatic leukaemias and non-Hodgkin lymphomas for the diagnostic period, 1983-1990, when compared with 1977-1982.

Case-survival rates for infiltrating ductal carcinomas by category of hospital at diagnosis in South Australia.

OBJECTIVE: To determine whether case-survival rates for infiltrating ductal carcinomas diagnosed in South Australia during 1980-1986 have varied by hospital of attendance at diagnosis. A null hypothesis was tested. DESIGN: All 2589 cases notified to the State Cancer Registry were included. The date of censoring for survival analyses was June 30, 1989. Multivariate analyses were undertaken adjusting for age at diagnosis, diameter of tumour, and extent of nodal involvement. RESULTS: After adjusting for differences in age, diameter and nodal status, there was not a significant difference in case outcome between large public hospitals, large private hospitals and smaller hospitals (P greater than 0.05). CONCLUSIONS: Although protocols for treatment of breast cancer are in a transitional phase and differences exist, case-survival rates have not shown a substantial variation by hospital of attendance at diagnosis.

Infiltrating ductal carcinoma of the breast in South Australia. Implications of trends in tumour diameter, nodal status and case-survival rates for cancer control.

The SA Central Cancer Registry gained sufficient information from routine pathology reports to record both the diameter and the nodal status for approximately half the infiltrating ductal carcinomas of the breast that were diagnosed in that State between 1980 and 1986. Of these, 27% of cancers had diameters of less than 2.0 cm at diagnosis and a similar proportion measured 4.0 cm or more. Almost half (48% of cancers) showed evidence of axillary nodal metastasis. Although the over-all variation in diameters by socioeconomic status did not approach statistical significance, lesions tended to be smaller in cases from the upper than the middle or lower socioeconomic areas of Adelaide. There also was evidence of earlier diagnosis during a breast self-examination campaign, but only a marginal increase in case-survival rates that readily was attributable to chance. A relatively poor case-survival rate applied in non-metropolitan areas, especially among older women, after adjusting for the available information on the stage of disease at diagnosis. A more limited access to treatment services may have been responsible. It will be important in a State-wide mammographic screening programme to provide for ready access by women in non-metropolitan areas to both screening and follow-up treatment services.

Epidemiological features of melanoma in South Australia: implications for cancer control.

South Australian Cancer Registry data for 1977-1987 show an increase in the recorded incidence of invasive malignant melanomas of the skin of approximately 54% in men and 33% in women. However, the abrupt nature of this increase after a relatively stable incidence level in 1977-1981, the absence of any evidence yet of an increase in mortality after this increase in incidence, and the trend towards thinner lesions are consistent with the conclusion that earlier diagnosis has had an influence. Case-survival rates were higher in 1982-1987 compared with 1977-1981. The thickness of lesions at diagnosis was less for women, younger patients and patients from more affluent areas; parallel trends were found in case-survival rates. After adjusting for tumour thickness and the level of invasion at diagnosis, trends in survival by sociodemographic features were not apparent. The implications of these and related findings for cancer control programmes are discussed.

Cervical cancer in South Australia: trends in incidence, mortality and case survival.

Approximately 90% of cervical cancers are considered preventable through regular screening and the treatment of precursor lesions, but fewer than 20% of South Australian women were found to have been screened in 1984. Data from the State Cancer Registry have shown an increase in cervical cancer incidence of approximately 80% in women under 50 years of age in the 9-year period to 1986, but a decrease of about 25% in older women. Mortality data have shown similar patterns by age, although the increase in younger women tended to extend to an older age. Case survival was unchanged between the diagnostic periods 1977-1981 and 1982-1987 and there was little change in the proportion of cases that were adenocarcinomas.

Cancer incidence among migrant populations in South Australia.

South Australian Cancer Registry data for 1977-1986 have been used to compare the incidence of cancer for overseas-born populations and for the State as a whole. British and Irish migrants were found to have a higher incidence of all cancer sites combined, largely because of elevations in the incidence of cancers of the lung, stomach and female breast, whereas southern-European migrants showed a lower incidence of cancer, mostly as a result of low incidence rates for cancers of the colon, prostate, lung (women only), melanoma and female breast. Differences in incidence also were evident by country of birth for cancers of the buccal cavity, oropharynx, nasopharynx, oesophagus, liver, larynx, pleura, testes, uterine body, bladder and kidney, and various lymphohaematopoietic cancers. The aetiological implications of these findings, particularly in relation to environmental and life-style factors, are considered.

The use of State and hospital-based cancer-registry data to describe the epidemiological and clinical characteristics of laryngeal cancer in South Australia.

State and hospital-based cancer registries can be complementary sources for data that describe the general epidemiological and clinical features of cancers in specific populations. This has been illustrated with data on laryngeal cancer from registries in South Australia. The data were sufficiently detailed to indicate: trends in incidence by calendar year, age, sex, place of residence and country of birth; the distribution of cases by the subsite of the tumour, the histological type and grade, and the pretreatment clinical stage of the cancer at diagnosis; the complaints of patients at presentation; the modes of treatment by the stage of the cancer; and case-survival rates, both over all and as related to the subsite of the tumour, the sex and the stage of disease. Data also were available to indicate the increased risks of disease that were associated with tobacco smoking and alcohol consumption. The findings broadly are consistent with the results of previous epidemiological studies and show the utility of the combined use of state and hospital registry data to describe the general features of cancers in local populations.

Cancer case-survival rates for South Australia: a comparison with US rates and a preliminary investigation of time trends.

Five-year relative case-survival rates for all cancers collectively are similar in South Australia (49%) and the United States (50%). This suggests that outcomes of cancer treatment do not vary appreciably between the two populations. There is an indication of higher survival rates in South Australia for melanoma, Hodgkin's disease, multiple myeloma and gastric cancer, but lower survival rates for cancers of the thyroid, corpus uteri, prostate, colon, kidney and lung. The differences in point estimates of the rates were most conspicuous for Hodgkin's disease, multiple myeloma and prostatic cancer. The reasons for a cautious interpretation of these findings are discussed and some possible explanations are suggested. South Australian data point to an upward trend in survival rates between the diagnostic periods 1977-1980 and 1981-1985 for patients with Hodgkin's disease, diffuse large-cell lymphomas, melanomas and cancers of the prostate and rectum.

Where patients with cancer die in South Australia.

In a sample of 1582 deaths among South Australian patients with cancer (795 deaths in 1981 and 787 deaths in 1985), 67% of deaths occurred in a hospital, 9% of deaths in a hospice, 10% of deaths in a nursing home, and 14% of deaths in a private residence. More patients died in a hospice or nursing home in 1985 than in 1981, and fewer died in a hospital. With increasing age, fewer patients died in a hospital and more in a nursing home. Compared with men, women were less likely to die at a private residence and more likely to die in a nursing home. A greater proportion of men with a living wife died at a private residence than was so among single or widowed men. However, conjugal status was not associated with the place of death of women. Patients who lived in the more affluent metropolitan suburbs tended more to die at a private residence than did those from poorer suburbs or country areas. Patients with haematological malignancies died in major metropolitan public hospitals more frequently than did patients with other tumours. Possible explanations are given for these findings.

Melanoma case survival rates in South Australia by histological type, thickness and level of tumour at diagnosis.

Data from the South Australian Cancer Registry on malignant melanoma of the skin showed that case survival rates were higher for lentigo maligna melanomas and superficial spreading lesions than for nodular and other histological classifications. Lower case survival rates applied to the thicker melanomas and those at a more invasive level at diagnosis. After adjusting for differences in thickness and level in this study, no statistically significant differences were apparent between case survival rates for the nodular lesions and the lentigo maligna and superficial spreading melanomas.

Promotion of breast self-examination in South Australia. A short-term evaluation.

In early October 1982, a campaign was launched in South Australia to encourage women to practice breast self-examination. A study of data from the State Cancer Registry was conducted to determine the impact of the campaign on the detection rate, the patient-survival rate and the extent of the tumour at the time of diagnosis. In the three months after the launch, 30% more cancer cases were detected than expected from the numbers presenting during similar periods in previous years. The increase was 53% for women under 50 years of age and 21% for older subjects. There is an indication that tumours diagnosed in the three months after the launch of the campaign were diagnosed earlier than those presenting in corresponding periods in earlier years. The proportion of cases with four or more affected nodes at diagnosis was substantially reduced. The slight differences in tumour diameter and one-year patient survival were also consistent with earlier diagnosis.

Determinants of case survival for cancers of the lung, colon, breast and cervix in South Australia.

Survival rates for cancers of the lung, colon and female breast, and for invasive lesions of the cervix have been analysed according to age, place of residence, country of birth, socioeconomic status, and where applicable, by sex and histological type and were found to be negatively related to age. For patients with cancers of the colon and cervix, survival rates were lower in country residents than in those of metropolitan Adelaide. Low socioeconomic status was associated with a lower survival rate for patients with colonic cancers and female breast cancers; a similar trend was suggested for those with cancers of the cervix. Higher survival rates were found for patients with squamous cell carcinomas and adenocarcinomas of the lung, and mucinous tumours of the breast. Higher survival rates for patients with breast tumours were associated with small tumour size at diagnosis. In some overseas-born populations, survival rates for patients with lung cancers and cervical cancers were higher than those in the Australian-born population. This warrants further investigation.

Infiltrating ductal carcinoma of the breast in South Australia. Sizes of primary lesions and histological evidence of axillary nodal metastases.

There are few data available at the community level in Australia to indicate the stages of breast cancers at diagnosis, and whether there is a trend towards earlier detection. Therefore, the tumour diameters and extent of axillary nodal metastases in 434 cases of infiltrating ductal carcinoma, which were reported to the South Australian Central Cancer Registry during a three-year period, were analysed. Approximately 27% of tumours were 1.9 cm or less in diameter, about 48% were in the 2.0 cm to 3.9 cm range, and 25% had a diameter of 4.0 cm or greater. Almost half of the patients (48%) had axillary nodal metastases. The extent of nodal involvement was positively related to size of the primary lesion both in women under 50 years of age and in older women. It is intended that this information will be used in future analyses to discover trends over time in tumour size and nodal involvement at diagnosis.