Biomedical subjects

G R Kerr

Publications and source records attributed to G R Kerr.

At least 19 recordsLinked to original sources

PubMed2006

Is routine chest radiography a useful test in the follow up of all adult patients with soft tissue sarcoma?

Following treatment for localized soft tissue sarcoma the risk of relapse is either locally or in the lungs. In Edinburgh patients are reviewed every 6 months with a chest X-ray (CXR). The radiation exposure over a 10 year follow up remains small, but it is unclear if all patients, irrespective of the initial grade of their primary tumour, require this. To determine the pick up rate of lung metastases by routine CXR over a 10 year period and to review the primary histology. Adult patients on routine follow up between 1994 and 2004 were identified and the notes of those with lung metastases reviewed. Data was collected on their initial histology, and date and method of diagnosis of lung metastases. 179 patients were under follow up. 24 (13%) developed lung metastases. For 2, notes were not found. 6 (27%) had metastases diagnosed by routine CXR, 9 (41%) had metastases diagnosed by non routine CXR and 7 (32%) had metastases diagnosed by CT. On review of histology none were grade 1, 4 (18%) were grade 2 and 18 (82%) were grade 3. 155 patients received. 6 monthly CXR for 10 years with no detection of lung metastases. Lung metastases occurred in a minority of patients (13%) and most (82%) occurred in patients with grade 3 tumours. No patients with grade 1 tumours developed lung metastases. Thus routine CXR may be appropriate on grade 3 tumours, but not on lower grade tumours where other risk factors are absent.

Adult↗

PubMed2005

Symptom control and quality of life in people with lung cancer: a randomised trial of two palliative radiotherapy fractionation schedules.

AIMS: To determine whether palliation of chest symptoms from a 10 Gy single fraction (regimen 1) was equivalent to that from 30 Gy in 10 fractions (regimen 2). MATERIALS AND METHODS: Patients with cytologically proven, symptomatic lung cancer not amenable to curative therapy, with performance status 0-3, were randomised to receive either 30 Gy in 10 fractions or a 10 Gy single fraction. Local symptoms were scored on a physician-assessed, five-point categorical scale and summed to produce a total symptom score (TSS). This, performance status, Hospital Anxiety and Depression (HAD) score and Spitzer's quality-of-life index were noted before treatment, at 1 month after treatment and every 2 months thereafter. Palliation was defined as an improvement of one point or more in the categorical scale. Equivalence was defined as less than 20% difference in the number achieving an improvement in the TSS. RESULTS: We randomised 149 patients and analysed 74 in each arm. According to the design criteria, palliation was equivalent between the two arms. TSS improved in 49 patients (77%) on regimen 1, and in 57 (92%) patients on regimen 2, a difference of 15% (95% confidence interval [CI] 3-28) in the proportion improving between the two regimens. A complete resolution of all symptoms was achieved in three (5%) on regimen 1, and in 14 (23%) patients on regimen 2 (P < 0.001), a difference in the proportion between the two regimens of 21% (95% CI 10-33). A significantly higher proportion of patients experienced palliation and complete resolution of chest pain and dyspnoea with regimen 2. No differences were observed in toxicity. The median survival was 22.7 weeks for regimen 1 and 28.3 weeks for regimen 2 (P = 0.197). CONCLUSIONS: Although this trial met the pre-determined criteria for equivalence between the two palliative regimens, significantly more patients achieved complete resolution of symptoms and palliation of chest pain and dyspnoea with the fractionated regimen.

Aged↗

PubMed2005

The management and outcome of patients with germ-cell tumours treated in the Edinburgh Cancer Centre between 1988 and 2002.

AIMS: The aim of this retrospective analysis was to review the outcome of patients with germ-cell tumours treated in the Edinburgh Cancer Centre over the past 15 years, and to see whether there had been any changes over three 5-year cohorts. MATERIALS AND METHODS: Patients referred with gonadal and extra-gonadal primary germ-cell tumours, between 1988 and 2002, were identified from the departmental database, and survival by stage and prognostic group was analysed. RESULTS AND CONCLUSIONS: The proportion of patients with stage I seminoma has significantly increased. The good prognosis of patients with early stage disease is confirmed, with the outcome for some groups of patients being better than expected. There is a non-significant trend to improved results over the three 5-year cohorts. The outcome for patients with stage IV seminoma is worse than would be expected, but numbers are small. The poor prognosis of patients with non-seminomatous germ-cell tumours who fall into the International Germ Cell Consensus Classification (IGCCC) poor-prognostic group is confirmed. Failure of patients with metastatic non-seminomatous germ-cell tumours to achieve a complete response to initial therapy is shown to be a poor prognostic indicator.

Adolescent↗

PubMed2005

Testicular sex cord-stromal tumours: the Edinburgh experience 1988-2002, and a review of the literature.

AIMS: Sex cord-stromal tumours of the testis are uncommon tumours, accounting for around 5% of testicular neoplasms. Treatment is primarily surgical, with no adjuvant therapy of proven benefit. We present a single-centre experience over a period of 15 years. MATERIALS AND METHODS: From 1988 to 2002, 18 patients with a diagnosis of sex cord-stromal tumour were referred to our centre. A retrospective analysis of their case notes was made and a pathological review undertaken. RESULTS: Sixteen were Leydig-cell tumours and two were Sertoli cell. For the Leydig-cell tumours, the median age at presentation was 42 years, 50% presented with a testicular mass and 31% with gynaecomastia. Two patients followed a malignant course: one revealing disease dissemination at initial staging, and a second 12 months after potentially curative orchidectomy. Salvage retroperitoneal lymphadenectomy in the latter patient proved unsuccessful. Clinical outcome correlated strongly with the presence of adverse pathological features described previously in the literature. After a median follow-up of 46 months, two patients have developed progressive disease, and two patients have died, one of metastatic Leydig-cell tumour. No patient defined as being of low malignant potential on pathological examination has relapsed outside our review period of 2 years. CONCLUSION: We confirm the overall excellent prognosis for most of the patients with sex cord-stromal tumours of the testis. Compared with most previous reports, pathological features seem to predict with reasonable accuracy the risk of malignant behaviour, and can adequately inform the subsequent review policy.

Adult↗

PubMed2002

Radical radiotherapy and salvage cystectomy as the primary management of transitional cell carcinoma of the bladder. Results following the introduction of a CT planning technique.

The objective of this study was to review the results of our policy of primary radiotherapy (RT) and salvage cystectomy for transitional carcinoma (TCC) of the bladder in the light of changes in our radiotherapy planning procedure, in particular the introduction of CT planning. The case notes of 163 patients treated with radical radiotherapy using a CT planning technique were examined. The main endpoint for assessment was response at the time of the check cystoscopy 6 months after the completion of treatment. In addition survival was estimated by stage of disease and by response at the time of first cystoscopy. Patterns of relapse and time to relapse were analysed. All percentages quoted in the text use the initial 163 patients as the denominator. One hundred patients (61%) achieved a complete response. The complete response rate was significantly related to T stage at presentation being 90% for T1, 75% for T2, and 53% for T3 disease respectively. Of these patients 78 remain disease free in the bladder (47%). Twenty-two have relapsed in the bladder, of whom 5 have also relapsed at metastatic sites. Fifteen patients have relapsed outside the bladder whilst remaining disease free within the bladder. At the time of last follow up or death from other causes 63 of the 100 patients who had a complete response remained disease free with an intact bladder. There were 18 (11%) partial responders. Seven of these patients went on to have a cystectomy. Ten remain alive, 7 disease free, 4 with intact bladders. In 24 patients (15%) there was no response and these patients have all died, the median survival being 10 months. In 21 patients (13%) a postradiotherapy cystoscopy was not performed. In all but one patient, who was lost to follow up, this was because of progressive disease. The median survival of these 20 patients was 6 months. Of the 163 patients 35% are alive and well with an intact bladder. If patients dying from other causes are included then 42% were rendered disease free. Cause specific survival was significantly related to stage of disease at presentation with 5 year actuarial survival being 87%, 48% and 26%, for T1, T2 and T3 disease respectively. Survival was also related to response to treatment at 6 months with 5 year survival being 64%, and 52% for complete and partial responders respectively. Survival was extremely poor for non-responders with only 37.5% surviving 1 year and none 5 years. There was a highly significant relationship between response and the development of, and the time to developing metastatic disease. Of those who exhibited a response 21% developed metastatic disease compared to 78% of non-responders. Salvage cystectomy offers the possibility of cure in those who achieve a complete or partial response with 42% of such patients being rendered disease free. Results however are poor in those who did not respond with all patients dying of their disease. Response rates for all stages, and survival for stages T1 and T2 are much improved from those previously reported from this centre and compare favourably with other published series. These results confirm the place of radiotherapy and salvage cystectomy in the management of TCC of the bladder in selected patients. In about one-third of patients the desired outcome of curing the patient of their cancer with organ preservation is achieved. The prognostic significance of cystoscopic response at 6 months and stage at presentation is confirmed. The outcome for patients with early stage disease is excellent. The relationship between response and the development of metastatic disease would suggest that even if these patients had had a primary cystectomy they may have fared badly, a conclusion supported by the fact that these results are comparable with surgical series. This series supports the role of radiotherapy in the management of this disease and suggests that modern RT techniques including CT planning have had a beneficial effect on the results of radical radiotherapy.

Aged↗

PubMed2001

Long-term survival in patients with non-small cell lung cancer treated with palliative radiotherapy.

The aim of palliative thoracic radiotherapy in patients with advanced non-small cell lung cancer (NSCLC) is to alleviate symptoms. This study was designed to determine whether any patients achieved long-term survival after this treatment. In Edinburgh, between 1974 and 1993, 4531 patients were treated with palliative radiotherapy for NSCLC, receiving ten fractions or fewer. We reviewed the case notes of the long-term survivors. Sixty-one (1.3%; 95% confidence interval (CI) 1.0-1.6) patients survived for more than 5 years; 43 (70%) had histological confirmation of cancer; 28 (46%) had stage Stage I or II, 28 (46%) Stage III and one Stage IV disease; 53 (87%) patients were treated with doses of 30-35 Gy in ten daily fractions, seven (12%) received 20 Gy in five daily fractions and one received a 10 Gy single fraction. Forty-two (69%) patients had a radiological complete response, 16 (26%) a partial response and the remainder stable disease. Clinically significant radiation pneumonitis occurred in one (2%) patient, radiation myelopathy in two (3%) and multiple rib fractures in one (2%). There did not appear to be an association between long-term survival and a radiosensitive phenotype. On univariate analysis, long-term survival was more frequent in patients receiving ten-fraction regimens than in those who underwent a shorter course of radiotherapy (chi 2 = 19.5, P < 0.001). Thirty-four (0.8%; 95% CI 0.6-1.0) patients were disease free at death or at last review (median 10 years; range 5-17). We conclude that palliative thoracic radiotherapy produces long-term survival in 1.3% and personal cure in up to 1% of patients with advanced NSCLC.

Aged↗

PubMed2001

Do "conditions contributing to the death" clarify the predictors of infant mortality in Texas?

Predictors of infant mortality are usually based on the underlying causes reported on infant death certificates. Death certificates also contain space for "Other significant conditions contributing to the death but not resulting in the underlying cause." We investigated whether these "contributing conditions" might clarify the predictors of infant death in Texas or interventions that might reduce deaths from the underlying causes. A "multiple cause of death" file converted the underlying causes and contributing conditions associated with each infant death in 1996 into International Classification of Diseases codes. We ranked the major underlying causes, the conditions contributing to those causes, the conditions contributing to all infant deaths, and the effect of combining the underlying causes with contributing conditions to determine the main predictors of infant mortality. We found that extreme immaturity was the most common condition, causing or contributing to 604 of the 2081 deaths in 1996. We conclude that the underlying causes provide a misleading perception of the major predictors of infant death in Texas; combining them with the conditions contributing to those deaths provides a clearer picture. Given the powerful predictive value of preterm birth for infant mortality, the limited current ability to prevent preterm birth, and the cost of its complications, expanded efforts to improve understanding of its causal processes and develop preventive strategies should be top national and state priorities.

Cause of Death↗

PubMed1999

Searching for preventable causes of child mortality in Texas: trends in the major causes from 1987 through 1996.

We ranked the underlying causes of child deaths in Texas from 1989 through 1991 for the groups aged 1 through 4, 5 through 9, 10 through 14, and 15 through 19 years. External causes (injuries) accounted for 66% of child deaths, and 5 accounted for at least 100 deaths each: motor vehicle accidents, homicide, suicide, drowning, and burns. Of the deaths that had potential for primary prevention, more than 95% involved accidents, suicide, and homicide. Of the smaller number of deaths that had potential for secondary prevention, treatment of infectious conditions had the greatest potential. From 1987 through 1996, child deaths from all causes averaged 2498 per year. Natural causes averaged 871 per year; external causes averaged 1627 per year. Among the external causes, annual averages for accidents were 1089 deaths; for motor vehicle accidents, 703; for homicide, 334; and for suicide, 187. We used linear regression analyses to estimate trends in deaths and mortality rates. The only categories that experienced an increased number of deaths, despite a 12% increase in the population, were deaths from all causes in the adolescent age groups; from natural causes in all but the group aged 1 through 4 years; from external causes in the adolescent age groups; from suicide in all but the group aged 1 through 4 years; and from homicide in all age groups. The increased number of deaths was often lower than the increase in the population, resulting in lower mortality rates. The only mortality rates that increased were those from all causes in the group aged 15 through 19 years; from natural causes, in both adolescent age groups; from suicide, in the group aged 10 through 14 years; and from homicide, in all but the group aged 5 through 9 years. These trends suggest that primary prevention of child deaths in Texas should focus on external causes, particularly motor vehicle accidents, homicides, and suicides.

Adolescent↗

PubMed1999

Factors associated with fetal mortality in the triethnic population in texas, 1993 through 1995.

We examined the underlying causes of fetal deaths reported for 1993 through 1995 in relation to the mother's ethnicity, reproductive history, and medical factors listed on birth and fetal death certificates. The overall fetal mortality rate (FMR) was 6.3 per 1000 live births plus fetal deaths, and 5.6, 5.9, and 9.8 per 1000, respectively in pregnancies of white, hispanic, and black women. Preterm birth (low birth weight) was a major predictor (or consequence) of fetal death, and extremes of maternal age, increased parity, and plural pregnancies were also associated with increased FMRs, especially in black women. The underlying causes reported on fetal death certificates were complications of the placenta, cord, and membranes (36%); ill-defined conditions arising in the perinatal period (23%); fetus affected by maternal complications of pregnancy (10%); fetus affected by maternal conditions unrelated to pregnancy (6%); and short gestation and unspecified low birth weight (5%); 14% of fetal deaths were associated with congenital abnormalities. Factors reported most frequently were premature rupture of the membranes, disorders of amniotic fluid volume, pregnancy-associated hypertension, diabetes, anemia, previous preterm or small-for-gestational-age births, incompetent cervix, chronic hypertension, and sexually transmitted diseases. More than 40% of fetal deaths were not associated with any medical risk factor. FMRs associated with maternal anemia, cardiac disease, pregnancy-associated hypertension, eclampsia, and previous birth weighing more than 4 kg were at least 1.5 times higher in pregnancies of black women than in the other 2 ethnic groups. The underlying causes of fetal death provide few targets for their primary prevention; preventive efforts might better be directed to the closer surveillance and care of pregnant women with demographic, reproductive, and medical factors associated with increased risk.

Ethnicity↗

PubMed1998

Similar decreases in local tumor control are calculated for treatment protraction and for interruptions in the radiotherapy of carcinoma of the larynx in four centers.

PURPOSE: Data on patients with cancer of the larynx are analyzed using statistical models to estimate the effect of gaps in the treatment time on the local control of the tumor. METHODS AND MATERIALS: Patients from four centers, Edinburgh, Glasgow, Manchester, and Toronto, with carcinoma of the larynx and treated by radiotherapy were followed up and the disease-free period recorded. In all centers the end point was control of the primary tumor after irradiation alone. The local control rates at > or = 2 years, Pc, were analyzed by log linear models, and Cox proportional hazard models were used to model the disease-free period. RESULTS: T stage, nodal involvement, and site of the tumor were important determinants of the disease-free interval, as was the radiation schedule used. Elongation of the treatment time by 1 day, or a gap of 1 day, was associated with a decrease in Pc of 0.68% per day for Pc = 0.80, with a 95% confidence interval of (0.28, 1.08)%. An increase of 5 days was associated with a 3.5% reduction in Pc from 0.80 to 0.77. At Pc = 0.60 an increase of 5 days was associated with an 7.9% decrease in Pc. The time factor in the Linear Quadratic model, gamma/alpha, was estimated as 0.89 Gy/day, 95% confidence interval (0.35, 1.43) Gy/day. CONCLUSIONS: Any gaps (public holidays are the majority) in the treatment schedule have the same deleterious effect on the disease free period as an increase in the prescribed treatment time. For a schedule, where dose and fraction number are specified, any gap in treatment is potentially damaging.

Carcinoma↗

PubMed1997

Pain relief and quality of life following radiotherapy for bone metastases: a randomised trial of two fractionation schedules.

BACKGROUND: The optimum dose and fractionation schedule for the palliative irradiation of painful bone metastases is controversial. PURPOSE: To compare the efficacy, side-effects and effect on quality of life of two commonly used radiotherapy schedules in the management of painful bone metastases. MATERIALS AND METHODS: In a prospective trial, 280 patients were randomised to receive either a single 10 Gy treatment or a course of 22.5 Gy in five daily fractions for the relief of localised metastatic bone pain. RESULTS: Response rates have been calculated from 240 assessable treated sites of pain. The overall response rates were 83.7% (single treatment) and 89.2% (five fractions). The complete response rates were 38.8% (single treatment) and 42.3% (five fractions). The median duration of pain control was 13.5 weeks (single treatment) and 14.0 weeks (five fractions). None of these differences was statistically significant. There were no differences between the groups in the effect of treatment on a variety of quality of life parameters. CONCLUSIONS: It is concluded that a single 10 Gy treatment is as effective as a course of 22.5 Gy in five fractions in the management of painful bone metastases.

Bone Neoplasms↗

PubMed1997

Searching for preventable causes of infant mortality in Texas.

Texas' health objectives include reducing the infant mortality rate from 8.1 per 1000 live births in 1990 to no more than 7 per 1000 by the year 2000. To help target potentially preventable causes of infant mortality, we examined the underlying cause of each of the 2545 infant deaths that occurred in Texas during 1990. Potential existed for primary prevention of the underlying cause of at least some of 778 infant deaths and for secondary prevention by treating the underlying causes of 1127. The following appear to be the most promising targets and strategies for prevention: causes of neonatal mortality by improving the clinical care of high-risk newborns; sudden infant death syndrome by having infants sleep in the supine position; respiratory complications of preterm birth by preventive and therapeutic surfactant; death from bacterial infections by optimal antibiotic therapy; injuries and accidents by optimal parental supervision; preterm birth and adverse pregnancy outcomes by optimal prenatal, obstetric, and neonatal care; and neural tube defects by adequate paraconceptual folic acid.

Cause of Death↗

PubMed1996

Adverse effect of treatment gaps in the outcome of radiotherapy for laryngeal cancer.

BACKGROUND AND PURPOSE: A correlation has been demonstrated between unplanned prolongation of radiotherapy and increased local relapse. This review was performed to assess the importance of overall time on the outcome of curative radiotherapy of larynx cancer. MATERIALS AND METHODS: Retrospective analysis was performed of 383 patients with laryngeal cancer managed by elective radiotherapy between 1976-1988 in the Department of Clinical Oncology, University of Edinburgh, Western General Hospital, Edinburgh All cancers were confirmed histologically to be squamous cell carcinomas. All subjects received radiotherapy in 20 daily fractions (except Saturdays and Sundays), employing individual beam direction techniques and computer dose distribution calculations. Main outcome measures were complete resolution of the cancer in the irradiated volume; local relapse; survival and cause-specific survival rates. RESULTS: Radiotherapy was completed without any unplanned interruption (28 +/- 2 days) in 230/383 (60%) of patients. A statistically significant two-fold increase in local relapse rates was observed when treatment was given in 31 days or more. There also was a statistically significant four-fold increase in laryngeal cancer deaths when the treatment time exceeded 30 days. CONCLUSIONS: In patients with laryngeal cancer, accelerated repopulation of cancer cells probably occurs after the start of radiotherapy. When the overall treatment time is 4 weeks or less, gaps at weekends are not detrimental. However, long holiday periods or gaps in treatment longer than 4 days increase the risk of laryngeal cancer relapse and cancer-related mortality. Significant gaps in treatment should be avoided. If treatment has to be prolonged, additional radiation dose should be prescribed to compensate for increased tumour cell proliferation.

Carcinoma, Squamous Cell↗

PubMed1996

External beam and intraluminal radiotherapy for locally advanced bile duct cancer: role and tolerability.

BACKGROUND AND PURPOSE: Cholangiocarcinoma is rare but carries a poor prognosis. Radiotherapy has been used either as an adjuvant treatment following surgical resection of tumour or for palliation. The purpose of this study was to assess the feasibility and morbidity of accelerated external beam radiotherapy with or without intraluminal radiotherapy in the treatment of locally advanced bile duct cancer. MATERIALS AND METHODS: Thirty eight patients were treated. Surgical procedures performed prior to radiotherapy were extended hepatectomy (3), hepaticojejunostomy with tumour resection (6), palliative biliary-enteric bypass (6), biopsy (4), Whipple's procedure (1), gastrojejunostomy (1) and cholecystectomy (1). Twenty patients received external beam radiotherapy (ERT). Six patients received one Phase of ERT and 12 received two Phases, separated by a 2-week gap. Dose per Phase was 22.5 Gy in 10 twice daily fractions. After 1989, dose per Phase was increased to 27.5 Gy. One patient received Phase I ERT (30.0 Gy) using conventional fractionation and one patient received an uninterrupted, conventionally fractionate course of treatment (50.0 Gy). Fourteen patients received both ERT and intraluminal radiotherapy (IRT) using iridium-192 (192Ir) wire passed through a percutaneous, transhepatic catheter (median dose, ERT 23.8 Gy + IRT 40.0 Gy). In addition, four patients received IRT alone (median dose 45.0 Gy at 1 cm radius). Patients were followed for at least 42 months. RESULTS: Median overall survival was 15 months. Overall survival for the whole group at 1,2 and 3 years was 59.6%, 32.5% and 16.2%. Thirty four patients died of disease. Radiotherapy caused acute toxicity in seven patients. According to RTOG/EORTC criteria toxicity was Grade 1 in four cases, Grade 2 in two cases and Grade 3 in one case. Two patients developed gastrointestinal bleeding as a late complication of radiotherapy. CONCLUSIONS: Accelerated external beam radiotherapy with or without intraluminal radiotherapy is feasible and associated with acceptable toxicity when used in the management of advance cholangiocarcinoma.

Bile Duct Neoplasms↗

PubMed1995

Radical radiotherapy for localized adenocarcinoma of the prostate. A report of 191 cases.

OBJECTIVE: To assess the results of radiotherapy in the treatment of localized prostate cancer. End points for assessment were survival, local control, development of metastases, and the toxicity of therapy. MATERIALS AND METHODS: The case notes of 191 patients who were treated with radical radiotherapy between 1982 and 1992 were reviewed. The pathology of 130 patients was reviewed by a single pathologist. A multivariate analysis was performed to identify significant prognostic factors with regard to survival and relapse. RESULTS: One-hundred and eighty-two patients were assessable. The minimum length of follow-up was one year (median = 40 months). The actuarial cause-specific 5 and 10 year survival rates were 63% and 35% respectively. Local progression occurred in 41% of patients with 37% developing metastases. Multivariate statistical analysis demonstrated that T stage and Gleason Score were significant predictors for survival. Late complications were usually mild, with only 4% developing serious bladder toxicity. CONCLUSION: Radical radiotherapy has a role in the curative treatment of prostate cancer. Survival is significantly related to T stage at the time of presentation, and to the Gleason Score of the tumour. Survival in this series was not as good as the best surgical series, but it is still not clear which patients should receive radiotherapy and which surgery as their primary management.

Actuarial Analysis↗

PubMed1995

Radiotherapy for stages I and II testicular seminoma: results and morbidity in 238 patients.

We have undertaken a retrospective analysis of 238 patients with Stages I and II seminoma of the testis treated with radiotherapy in Edinburgh between 1974 and 1989. There were five deaths from seminoma. Cause-specific survival for the whole group at 2 and 5 years was 99.2% and 98.1%, respectively. Cause-specific survival at 2 and 5 years by stage (Royal Marsden staging classification) was: Stage I, 99.5% and 98.7% and Stage II, 98.1% and 96.1%. Fourteen (5.9%) patients relapsed (one after treatment for his second testicular seminoma). Eight were given successful salvage treatment, five died of seminoma and one died of intercurrent disease. 13 (5.5%) patients developed World Health Organisation (WHO) grade 3 gastrointestinal or haematological toxicity and two developed grade 4 gastrointestinal toxicity as a result of abdominal radiotherapy. 22 patients (9.2%) developed problems ascribed to late morbidity of abdominal radiotherapy including 18 with peptic ulcer disease. Contralateral testicular tumours occurred in seven (2.9%) patients and five (2.1%) patients developed malignancies at other sites.

Adolescent↗

PubMed1995

Ethnic differences in causes of infant mortality: Texas births, 1989 through 1991.

The mortality rate of African-American infants in Texas is about twice those of Anglo and Hispanic infants, due at least partly to their increased risk of preterm and low-weight birth. We examined the underlying causes of infant deaths from 1989 through 1991 for specific causes that accounted for the racial difference and for those that were associated with those adverse pregnancy outcomes. The overall infant mortality rate was 8.27 per 1000 live births (6.80 for Anglo, 7.72 for Hispanic, and 15.32 for African-American infants). About 37% of all infant deaths (but 48% of African-American deaths) were associated with adverse pregnancy outcomes; excluding these deaths reduced the overall rate to 5.20 per 1000 (4.59 for Anglo, 5.03 for Hispanic, and 8.05 for African-American infants). Accordingly, reducing adverse pregnancy outcomes in African-American women will reduce but not resolve the discrepancy in racial infant mortality rates. Infant mortality rates for 30 of the top 59 causes of death were at least 1.5 times higher in African-American than in Anglo and Hispanic infants, while a comparable excess in Hispanic infants was noted only for anencephaly; Anglo infants did not have an excessive mortality rate for any of the 59 causes. Reduction of the racial infant mortality rate discrepancy in Texas will require clarification and correction of factors that place pregnancies of African-American women at increased risk for adverse pregnancy outcomes and those that place their infants at increased risk for death from a wide range of causes.

Adult↗

PubMed1995

Proportional differences in births and infant mortality rates among the triethnic population in Texas from 1984 through 1986.

Birth at preterm gestation and/or with low birth weight is a major predictor of the infant mortality rate, which is twice as high in African-American as in Anglo and Hispanic infants in Texas. This study examined the relative proportions of Anglo, African-American, and Hispanic births that occurred in Texas at specific gestational ages and birth weights, and the neonatal, postneonatal, and infant mortality rates associated with those births. African-American infants showed a systematic tendency to be born at earlier gestational ages and with lower birth weights than did Anglo infants, while Hispanic-Anglo differences were limited to a small excess of preterm but not low weight Hispanic births. Preterm and low-birth-weight African-American infants had neonatal and infant mortality rates that were lower than those of Anglo infants, but that benefit was inadequate to compensate for the greater proportion of African-American births that were at risk. No consistent difference could be identified between Hispanic and Anglo infant mortality rates. We conclude that the birth weight and gestational age predictors of infant mortality reflect the combined effects of two ethnic-specific factors: the mortality rates at specific birth weights and gestational ages, and the proportions of births that are at risk. The biological and/or sociological causes for these ethnic differences in pregnancy outcomes and mortality risk need to be identified if the mortality rate of African-American infants in Texas is to be reduced.

Black or African American↗