RESUMO
PIP: An analysis of 401 gynecologic deaths occurring at the Charity Hospital of Louisianna in New Orleans from April 1961 to January 1969 was compiled for comparison with a similar study (401 fatalities) conducted at the same medical facility in 194 (Miller). In the Miller series, the age factor displayed a gradual rise to 45 years followed by a gradual decline. In the 366 malignant cases collected in 1970, ages ranged from 13 (ovarian cancer) to 100 years plus, and 177 patients were under age 50. 40% of the earlier cases were benign and explain the earlier peak while the higher age peak for 1970 may be the result of the fact that women live longer and well into the age period in which malignancy is more likely to develop. Generally the women in the 1970 series, both clinically and statistically, were in fairly good condition; the poor or moribund status of some was chiefly caused by their malignant disease. Unlike the 1944 series, preoperative preparations were generally good, though in over half the cases, the patients were poor risks for any therapy. The earlier series displayed many complications, some of which were extremely serious and some of which were poorly handled, while peritonitis, pulmonary complications and embolus all showed significant decreases in the 1970 series. Cardiovascular and renal diseases, especially uremia (46 cases) were the most frequent causes of death after cancer. In the 1944 series, eight patients displayed or had a history of multiple malignant diseases; the 1970 series had 26 such cases. Carcinoma of the cervix was a major problem in both studies, accounting for 167 of the 247 deaths from malignant disease in the earlier study and for 209 out of 366 in the later investigation which also included 50 deaths from carcinoma of the endometrium. The age range in the 1970 series was from 23 to over 100 years, and less than half the patients sought medical advice within a year of developing symptoms. In the 1944 series, the delay was even longer. Only half the patients in the later series were first seen at a time when the stage of the disease was still favorable to cure. In both series, bleeding was the most frequent first symptom, but appears to have been disregarded as an inconvenience due to its painlessness by the patient or regarded as part of the menopausal pattern by physicians and thereby untested. The age range among 50 cases of endometrial cancer was from 31 to 82 years and the time lag between symptoms and admission was 0 to 13 years. The second largest number of fatalities in both series was from ovarian cancer. Among 59 1970 cases, the age range was from 13 to 72 years and the time lag reached six years in one case. Better surgical techniques, combined with irradiation and chemotherapy have improved treatment of this pelvic cancer since 1944, but generally significant improvement in the treatment of malignancies has yet to be achieved. In the 1970 series, outside physicians could be blamed for 17 of 366 deaths from malignant disease and the hospital staff for 47. Physicians should communicate the following facts: 1) any discharge and any kind of abnormal bleeding may indicate cancer and demands prompt testing; 2) all women over 30 years of age should have a pelvic twice yearly; 3) all women in this age group should also receive a biannual Pap test, which ideally should be given any time a woman has contact with a physician.^ieng
