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Biomedical subjects

G Giles

Publications and source records attributed to G Giles.

At least 37 records · Page 2Linked to original sources
PubMed1995

Breast and ovarian cancer incidence after infertility and in vitro fertilisation.

Concern has been expressed that exposure to fertility drugs might be associated with a risk of ovarian cancer. We have examined the incidence of breast and ovarian cancer in a cohort of 10,358 women referred for in-vitro fertilisation (IVF) treatment in Victoria, Australia, between 1978 and 1992. The "exposed" group (n = 5564) had had ovarian stimulation to induce multiple folliculogenesis and the "unexposed" group (n = 4794) had been referred for IVF but were untreated or had had "natural cycle" treatment without ovarian stimulation. Duration of follow-up ranged from 1 to 15 years. Cases of cancer were determined by record linkage with data from population-based cancer registries. 34 cases of invasive breast cancer and 6 of invasive ovarian cancer were observed. A comparison with the expected numbers, derived by applying age-standardised general population rates to the cohort gave standardised incidence ratios (SIR) for breast cancer of 0.89 (95% CI 0.55-1.46) in the exposed group and 0.98 (0.62-1.56) in the unexposed group, and for ovarian cancer SIRs were 1.70 (0.55-5.27) and 1.62 (0.52-5.02), respectively. Rates of all cancers were not significantly different from general population rates. The relative risk (RR) of cancer, adjusted for age and infertility type, was, in the treated group compared with the untreated group, 1.11 (95% CI 0.56-2.20) for breast cancer and 1.45 (0.28-7.55) for ovarian cancer. The risk of body of uterus cancer was increased in the exposed and unexposed groups combined (SIR 2.84 [1.18-6.81]). Women with unexplained infertility, independent of IVF exposure, had significantly increased risks of ovarian cancer (RR = 19.19 [2.23-165.0]) and body of uterus cancer (RR = 6.34 [1.06-38.0]) compared with women with known causes of infertility. This relatively short-term follow-up suggests that ovarian stimulation with IVF is not associated with an increased risk of breast cancer. Although there was no significantly increased risk of ovarian cancer after ovarian stimulation with IVF the small number of cases limits the conclusions that can be drawn. Longer-term follow-up of large cohorts of women who have been in IVF programmes will be necessary.

Adult↗
PubMed1995

Cervical cytology reported as negative and risk of adenocarcinoma of the cervix: no strong evidence of benefit.

The relationship between negative cervical cytology reports and risk of adenocarcinoma of the cervix was evaluated in a case-control study of 113 cases and 452 controls. All cases and controls had received at least two negative cytology reports. There was no significant difference between the cases and controls in the number of negative cytology reports or in history of cervical abnormality; while a test for trend in the time since last negative cytology report was significant (P < 0.001), the estimated benefit was very modest. Although the estimates of relative protection were higher in women aged less than 35 years than in women aged 35-69 years, this difference was not statistically significant. These results suggest that cervical screening as practised in the 1970s and 1980s was much less effective in preventing adenocarcinoma than squamous carcinoma of the cervix.

Adenocarcinoma↗
PubMed1995

Multiple primary melanomas: an analysis of cancer registry data from Victoria and New South Wales.

All primary invasive cutaneous malignant melanomas (CMM) diagnosed in Victoria and New South Wales from 1985 to 1989 were obtained from the population-based cancer registries. Altogether 14,590 people with first CMMs were followed for at least 2 years, during which time 496 multiple primary CMMs were identified. Of the study population, 3.4% developed a second primary CMM and 0.3% developed three or more. It was estimated that 4.5% of people would develop a second CMM within 5 years of the first and that the risk was higher in males, particularly in men aged over 70 years. With regard to metachronous primaries, only age and thickness of the first primary were significant predictors of the thickness of the second: older people tended to have thicker CMMs and second CMMs were generally thinner than the first. Body site concordance was higher than expected by chance, particularly for synchronous diagnoses. The high degree of site concordance of metachronous primaries lent support to the hypothesis that skin adjacent to the first CMM might have undergone a 'field effect', rendering it at increased susceptibility to malignancy.

Adolescent↗
PubMed1994

Cutaneous malignant melanoma in Australia, 1989.

OBJECTIVE: To describe the characteristics of cutaneous malignant melanoma in Australians in 1989. DESIGN AND DATA: Descriptive analysis of all invasive melanomas reported to State or Territory cancer registries in 1989. MAIN OUTCOME MEASURES: The age, sex and State or Territory of residence of affected individuals, and the topography, morphology and thickness of the melanoma. RESULTS: The age-standardised incidence rates of melanoma were 30.2 and 23.9 per 100,000 males and females respectively; the highest rates were observed for the male trunk (11.7 per 100,000) and female lower limbs (8.8 per 100,000); the most commonly specified morphology was superficial spreading melanoma, followed by nodular melanoma and lentigo malignant melanoma. Fifty-two per cent of melanomas of known thickness were thinner than 0.76 mm, with females having proportionally more thin melanomas than males, and males having twice the rate of melanomas thicker than 3 mm. Melanoma rates in northern latitudes were approximately double those further south. CONCLUSIONS: Distinct patterns of melanoma incidence by latitude and body site confirm the role of sunlight exposure in melanoma aetiology. Females often have thinner melanomas than males, which is reflected in their better prognosis. People living closer to the equator more often have level 1 (in situ) and thin invasive melanoma, probably related to increased awareness of melanoma risk with decreasing latitude. The collection of melanoma data would be improved if pathologists' reports routinely included melanoma site, morphology, level and thickness. All registries should collect data on level 1 melanomas to help evaluate early melanoma detection programs and to continue surveillance of the Australian skin cancer epidemic.

Adolescent↗
PubMed1994

Metastases from squamous cell carcinoma of the skin in southern Australia.

BACKGROUND: The frequency with which squamous cell carcinoma (SCC) of the skin metastasizes is a matter of dispute. Studies from private practices have reported much lower rates than hospital-based surveys, and one school of thought is that SCCs which arise in sun-damaged skin have a low risk of metastasis. METHODS: A prospective study of out-patients with histologically confirmed SCC was undertaken in southern Australia, a region with a very high incidence of skin cancer. RESULTS: Between November 1988 and November 1989, 481 patients were entered into the study and 420 followed for at least 3 years. An SCC was the initial diagnosis for 73 patients, 3 were immunosuppressed and 2 had an SCC of the lip, leaving 68 immunocompetent patients with SCC of the skin. Metastatic SCC developed in 2 patients (5.8% adjusted for losses) within 3 years. The SCCs were small and arose in sun-damaged skin. CONCLUSION: Patients with SCC of the skin need a careful follow-up because of the risk of metastasis.

Adult↗
PubMed1994

The development of non-melanocytic skin cancers in people with a history of skin cancer.

OBJECTIVE: To determine the incidence of new skin cancer formation in people who have had skin cancer removed. STUDY DESIGN: A prospective study of Melbourne out-patients with histologically confirmed non-melanoma skin cancer (NMSC). All patients with NMSC seen by one author (D.C.) between November 1988 and November 1989 were entered into the study and reviewed regularly. New skin cancers were removed and recorded. RESULTS: Four hundred and eighty-one patients were entered and 420 followed for at least 3 years. New NMSC developed in 60% (adjusted for losses) by the end of 3 years. A multivariate analysis determined that the main risk factor for new NMSC formation was the number of previous skin cancers that a patient had. Those who had had multiple skin cancers (3 or more) were at significantly greater risk than those with less than 3. Age, sex and type of NMSC were not risk factors for new skin cancer formation. CONCLUSION: Patients with NMSC require long-term follow-up because of the risk of new skin cancer formation. Those with multiple NMSC need more careful follow-up, and possibly more frequent examinations, because they are at greater risk.

Adult↗
PubMed1993

Accuracy and survival benefit of cytological prediction of endometrial carcinoma on routine cervical smears.

Among 359 women who received a cytology report of endometrial malignancy from the Victorian Cytology Service during 1982-87, the positive predictive value for a later histological diagnosis of endometrial malignancy was 64%. The positive predictive value was significantly higher for the group of women in whom the cytopathologists made definite predictions of endometrial malignancy as compared to the group where the cytologic features were only suggestive of endometrial malignancy (75% vs. 50%, chi 2 = 23.4; p < 0.001). The sensitivity of cervical cytology performed within two years of the diagnosis of endometrial malignancy was 28%. The odds ratio of death from endometrial cancer among women where the cytology may have allowed for an early diagnosis in comparison to women where cytology did not hasten the diagnosis was 0.78 (95% confidence interval = 0.25-2.47; p > 0.05). We conclude that while cervical cytology can predict the presence of malignancy for a small proportion of women with endometrial cancer, there remains no evidence that a cervical cancer screening program will make a major impact on reducing the morbidity and mortality from endometrial cancer.

Endometrial Neoplasms↗
PubMed1993

Atypical and malignant meningiomas: importance of micronecrosis as a prognostic indicator.

Twenty-eight patients with a diagnosis of either atypical or malignant meningioma, according to the World Health Organisation (WHO) classification, were followed up to relate histopathological features with times to recurrence and death. Five year disease-free survival was 41% with a median disease free survival of 27 months. Micronecrosis was the only histopathological feature associated with increased risk of recurrence (rate ratio, 3.73: 95% confidence interval 1.03-13.6). At 36 months, 32% of patients with micronecrosis were alive compared with 71% of patients without micronecrosis. Brain invasion was not associated with disease-free survival. After recurrence, median survival was 7 months and was not correlated with any histopathological feature. The prevalence of micronecrosis was estimated from random samples of benign, atypical and malignant meningiomas to be 8%, 42% and 71% respectively. The relevance of these findings and the current WHO classification is discussed.

Adult↗
PubMed1993

Primary tumors of the brain, cranial nerves and cranial meninges in Victoria, Australia, 1982-1990: patterns of incidence and survival.

This report presents for the first time a detailed analysis of the distribution of primary brain tumors in a population in Australia. Data on 3,575 cases of benign and malignant tumors of the brain, cranial nerves and cranial meninges diagnosed among residents of the state of Victoria from 1982 to 1990 are used to calculate incidence rates and survival by histologic type, age and sex and to compare incidence of birthplace, socioeconomic status and year of diagnosis. No sharp decline in incidence rates is seen among those over age 60 and only small increases in incidence over the 9-year period have been observed. The overall incidence rates, distributions by histologic type, and patterns of excess incidence among those born in Southern and Eastern Europe and the Middle East are similar to observations in other geographic areas. No clear trend relating incidence and socioeconomic status is observed. Survival after brain tumor diagnosis is better among women then men (52 vs. 37% survive 5 years); this difference is attributable to the greater frequency among men of the more aggressive tumor types. The most striking male over female excess is for medulloblastoma, a type that occurs predominantly in the pediatric age group. This excess coupled with the fact that this tumor occurs at a much younger age in males may suggest the presence of a genetic predisposition in some patients with this disease.

Adolescent↗
PubMed1991

Socioeconomic status and cancer mortality and incidence in Melbourne.

Data were obtained for all deaths registered between 1979-1983, and for all new cancers recorded at the Victorian Cancer Registry between 1982-1983, in residents of Melbourne. A socioeconomic status (SES) measure had been produced for each local government area (LGA) by principal components analysis of sociodemographic variables recorded at the 1981 census. A SES score from 1 to 10 was assigned to each death and cancer. Population data from the census were similarly scored. Age standardised rates for all cause mortality, for mortality from all causes other than cancer and for both incidence and mortality of total cancers, cancer of the stomach, colon, rectum, lung, female breast, cervix, uterus, prostate and bladder, and for melanoma, lymphoma and leukaemia were analysed as a function of SES decile using weighted linear regression. Despite the limited number of years of data and the misclassification of the SES score, analyses showed there were inequitable distributions of mortality, and of some major cancers, across social strata in Melbourne during the early 1980s. The incidences of cancer of the breast, colon, prostate and melanoma were all positively associated with SES, while the incidences of cancer of the stomach, lung and cervix demonstrated negative SES gradients. For cancers where incidence showed a significant SES gradient there was a similar SES gradient with mortality. These patterns are consistent with the literature and implicate SES differences in education and access to services. Implications for health policy are discussed.

Adult↗
PubMed1990

Cervical cancers diagnosed after negative results on cervical cytology: perspective in the 1980s.

OBJECTIVES: To assess the magnitude of the problem of interval cancers of the cervix (those that are diagnosed within a short time after negative screening test results) in the 1980s, to compare the nature of interval cancers in younger women with that in older women, and, by reviewing negative cervical smears, to determine the proportion of interval cancers that might represent the development of malignancy anew compared with the proportion that might be associated with difficulties in sampling or errors in reporting. DESIGN: An audit of the interval cases of cervical cancer that had been diagnosed within 36 months of a smear having been reported as negative by the Victorian Cytology Gynaecological Service among women registered with cervical cancer during 1982-6. SETTING: The Victorian Cytology Gynaecological Service, a free public sector cytology laboratory in Victoria, Australia. SUBJECTS: 138 Women, all of whom had had cervical cancer diagnosed during the 36 months after having had a negative cervical smear. Subjects were divided into two age groups: younger women, aged less than 35; older women, aged 35-69. INTERVENTIONS: Negative slides were reviewed for evidence of optimal sampling and for the presence of cellular abnormalities that had been missed at the time of the original reporting. MAIN OUTCOME MEASURES: The number of interval cases of cancer of the cervix registered during 1982-6. The proportion of interval cases occurring in younger women and the proportion occurring in older women. Division of women into three risk categories based on clinical history and screening history that broadly corresponded to the probability that a diagnosis of cervical cancer might be expected during the 36 months after the issuing of a negative smear report. RESULTS: 138 Of 1044 (13.2%) women who had been registered with cervical cancer during 1982-6 had had one or more negative smears during the 36 months preceding the diagnosis of cancer. Interval cancers comprised a larger proportion of registrations of cervical cancer in women aged less than 35 years than in women aged 35-69 (21.1% v 11.0%, p less than 0.01). Women with interval cancer who had had at least three negative smears during the 10 years before the diagnosis of cancer were commoner in the younger age group than in the older age group (7.0% v 2.5%, p less than 0.01). When, however, the number of observed cases of squamous cell carcinoma was related to the number of expected cases in the absence of screening, no significant difference was found between the two age groups (6.8% v 4.8%, p greater than 0.10). The rate of diagnosis of interval cancer per 100,000 negative tests was lower among younger women than among older women (10/100,000 v 16/100,000). Review of the negative slides showed that 11.9% were again considered to be negative with an optimal sample having been obtained as evidenced by the presence of endocervical cells or metaplastic cells, or both. CONCLUSIONS: Interval cancers might comprise a larger proportion of all registered cases of cervical cancer among younger women owing to the larger proportion of such cancers being prevented in this age group. Among women with interval cancer review of the negative slides showed that most were accounted for by suboptimal sampling or by errors of reporting.

Adult↗
PubMed1990

Volunteer participation in feeding residents: training and supervision in a long-term care facility.

The increasing number of residents in long-term care facilities who require full and partial assistance during meals has created a need for volunteer support to enhance the quality of life for residents. The correlation between dependence in eating and the existence of swallowing disorders and the risk of aspiration in persons with swallowing disorders suggests that training must be given to volunteers who feed residents. A formalized program for volunteer training and supervision was implemented at Coler Memorial Hospital, a long-term care facility. The program's development and benefits are outlined. Implementation of this program resulted in better training of volunteers, increased socialization, communication, and safety for patients during meals.

Adult↗
PubMed1989

Effects of propylthiouracil and methimazole on splanchnic hemodynamics in awake and unrestrained rats.

The treatment of alcoholic liver disease with propylthiouracil is based on its effect of suppressing the ethanol-induced increase in hepatic oxygen consumption. It has been postulated that liver necrosis ensues when the increase in oxygen demand by the liver exceeds oxygen delivery to this organ. Data are now presented which show that propylthiouracil also increases portal blood flow in awake, unrestrained rats. Liver blood flow was determined using the labeled microsphere technique in rats at various intervals (0.25, 0.5, 1.0, 3.0, 6.0 and 24 hr) after oral propylthiouracil (50 mg per kg). Administration of propylthiouracil (dose range: 6.25 to 100.0 mg per kg) produced a dose-dependent increase in portal blood flow when given either orally or intraarterially. Maximal flows were obtained with 50 mg per kg (controls = 37.8 +/- 1.5, oral propylthiouracil = 50.7 +/- 2.2 ml.kg-1.min-1). This increase in portal blood flow was accompanied by a decrease in preportal vascular resistance (controls = 2.61 +/- 0.16; propylthiouracil, 50 mg per kg = 1.79 +/- 0.09 mmHg per ml.kg-1.min-1). These effects were correlated with the plasma concentrations of propylthiouracil (r = 0.67, n = 68, p less than or equal to 0.001). The effect of oral propylthiouracil (50 mg per kg) on portal blood flow started at 0.5 hr and lasted for 6 hr after administration, whereas total liver blood flow was increased for 3 hr. Oral propylthiouracil (50 mg per kg) for 5 days resulted in a 53% increase in thyroid weight, an 85% reduction in 125I thyroid uptake and a 74% decrease in serum thyroxine concentration.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗