Chemical ablation of stellate ganglion for head and neck cancer pain.

We present a case of patient with orofacial cancer having pain on one side of face affecting her ability to speak, chew, swallow and sleep leading to emotional and behavioral deterioration. A diagnostic stellate ganglion block was performed followed by chemical neurolysis using phenol under ultrasound guidance, to prevent complications due to inadvertent spread of drug. Her pain scores decreased drastically, she was able to chew and swallow. Weighing the risk of permanent Horner's syndrome or motor paralysis with benefit of improvement in basic functioning of debilitated patients chemical neurolysis of stellate ganglion can be performed with advanced imaging modalities.

Stellate ganglion blockade-techniques and modalities.

Stellate ganglion block (SGB) is utilized in the diagnosis and management of various vascular disorders and sympathetically mediated pain in upper extremity, head and neck. The stellate ganglion lies medial to the scalene muscles, lateral to longus coli muscle, esophagus, trachea and recurrent laryngeal nerve, anterior to C7 transverse process and prevertebral fascia, superior to the subclavian artery and posterior to vertebral vessels. Consequently, inadvertent placement of the needle tip into these soft tissues and vessels occur with blind technique. Henceforth, various interventional modalities are being used for SGB, these have been reviewed in this paper. Various techniques of SGB have been described, and vary from the use of standard blind technique to the use of fluoroscopy, computerized tomography, magnetic resonance imaging, and radio nucleotide tracers. However, these techniques may not be practical in a clinical setting, insofar as they are time consuming, costly, and may involve radiation exposure. The use of fluoroscopy does not visualize the blood vessels close to the stellate ganglion. Ultrasounds are the alternative. They help in visualization of soft tissues to prevent complications and help in deposition of drug subfascially, under direct visual control.

Early complication risks of legal abortions, Canada, 1975-1980.

PIP: In Canada, about 3% of the women obtaining legal abortions were reported to have experienced 1 or more early complications(s) of abortion. This and other findings in this paper are based on a study of about 352,000 therapeutic abortions performed on women in Canada during 1975-80. The abortion complication rate declined by 25% from a rate of 3.2/l00 in 1975 to under 2.4 in 1980. The abortion complication rate was highest for women under age 20 (4.1), being 1.5 times the complication rate for women ages 20-24 and twice the complication rate for those 25-29. The risk of early complications of abortion increased with the gestation period. For women obtaining abortions at 13 weeks or beyond, the risk of early complication(s) was 10 times greater than the risk for women obtaining abortions under 13 weeks gestation. The abortion complication rates were considerably lower for instrumental evacuation procedures than for instillation procedures. The abortion complication rates for various procedures were: menstrual extraction 0.4; suction dilatation and curettage (D and C), 0.8; surgical D and C, 1.7; hysterotomy, 9.1; saline 22.4; prostaglandin, 29.0; and urea, 30.9. (author's)^ieng

A perspective on Canadian teenage births, 1992-94: older men and younger women?

This article uses vital statistics relating to births by Canadian mothers between 1992 and 1994 to examine the distribution of age of father by age of mother at the birth of the child. Over 77% of births to teenage mothers involved males who were older than the mother. At the time of birth of the child, the mean difference between age of the teenage mother and the father was 4.1 years, compared with a mean of 2.6 years for all mothers and fathers. For mothers below the age of 18 years, 37% of partners were within 2 years of the woman's age, 39% were 3 to 5 years older, and 24% were six or more years older. Family planning and sex education programs directed at the prevention of teenage pregnancy, especially if these programs are given in the elementary or high school system, would not necessarily reach older males, who make up the majority of partners in teenage pregnancies.

Therapeutic abortions, Canada, 1970-1988.

A total of 66,251 therapeutic abortions were performed in hospitals in Canada in 1988, an increase of 4.1% from the 63,662 performed in 1987. The abortion rate per 1,000 women 15-44 years was 10.6% in 1988, up from 10.2% in 1987. The number of therapeutic abortions performed annually peaked at 66,319 in 1982. The abortion rate peaked at 11.6% in 1979. Looking at marital status at the time of abortion in 1988, 67% of the women were single, 22% were married and 11% were widowed, divorced, separated, or living common law. About 22% of the women were under 20 years of age, 54.4% were between 20-29 years, 21.5% were between 30-39 years and 2.2% were over 39 years of age. At the time of pregnancy termination, the gestation period was under 13 weeks for 89.6% of abortion cases. The gestation period was 13 weeks or more for 10.4% of abortion cases. The trend towards abortions performed in the early stages of pregnancy may be one of the reasons for a 50% drop in the abortion complication rate to 1.6% of abortions in 1988 from 3.2% of abortions in 1975.

Trends in birth and fertility rates, Canada, 1921-1987.

This paper examines Canadian birth data from 1921 to 1987. Generally, birth and fertility rates have been declining since the baby boom of the 1940s and 1950s. Since 1972, Canada's total fertility rate has remained below the replacement level of 2.1, paralleling trends in the United States and other Western countries. From 1971 to 1987, the median age of mothers increased by two years for all births, and about three years each for first and second births. Changes in rates by province and by age are also examined.

Therapeutic abortions, Canada, 1987.

A total of 63,662 therapeutic abortions were performed in hospitals in Canada in 1987, an increase of 0.2% from the 63,508 performed in 1986. The abortion rate per 1,000 women 15-44 years was 10.2 in 1987, as it had been in 1986. Looking at marital status at the time of abortion, 67.3% of women were single, 21.8% married and the remaining 10.9% were separated, divorced, widowed or living common-law. About 22% of the women were under 20 years of age, 54.3% were between 20-29 years, 21.3% were from 30 to 39 years and 2.4% were over 39 years of age. At time of pregnancy termination, the gestation period was under 13 weeks for 88.5% of abortion cases, 13 to 16 weeks for 8% of cases, and over 16 weeks for 3.5% of cases.

Births and birth rates, Canada, 1988.

PIP: The number of recorded live births in Canada increased 1.9% between 1987-1988 for a total of 376,795. In fact, the annual number rose 9.7% from 1973-1988 (1973=343,000). Yet the crude birth rate (CBR) in 1988 was basically comparable to that of 1987 (14.5 and 14.4 respectively). Between 1961-1972, the CBR fell from 26.1-15.9 which equaled a 39% decrease. It hovered around the mid 15s between 1973-1979 then continued downward. Between 1980-1988, the CBR dropped an additional 6.4%. Alberta had the highest CBR (17.5) among the provinces while Quebec had the lowest CBR (13). Quebec experienced the greatest increase in the CBR (2.4%) between 1987-1988 whereas Ontario and BRitish Columbia the lowest (0.7%). Newfoundland, Saskatchewan, and Alberta experienced decreases in the CBR (3.6%, 1.2%, and 1.1% respectively). The territories had much higher CBRs than the provinces (the Yukon=20.1 and the Northwest Territories=30). The CBRs for the Yukon and the Northwest Territories increased 2.6% and 2% respectively between 1987-1988. The total fertility rate (TFR) stood at 1.7 in 1988 which was up slightly from 1987 (1.6) both of which were considerably below replacement level. Indeed TFR had remained below replacement fertility since 1972. Between 1971-1988, TFR fell 22.7%. Among the provinces, Quebec had the lowest TFR (1.5) and Saskatchewan the highest (2.1). Newfoundland did not have TFR data unavailable. The TFR for the Yukon matched that of Saskatchewan. It stood at a high of 3.2 for the Northwest Territories.^ieng

Demographic trends of marriages in Canada: 1921-1990.

This paper mainly describes levels and trends of marriages and rates and its relationship with demographic and social conditions in Canada from 1921 to 1990. In Canada, the propensity to marry was much higher in the 1960s and early 1970s than in the 1980s. A similar tendency was observed for a few years prior to, and at the beginning of, World War II and a couple of years after. The number of marriages peaked at an all time high of 200,470 in 1972 with a rate of 44.3 per 1,000 unmarried population aged 15-59. By 1986 the number of marriages had declined by 12.4% and the rate by 33.2%, but both the number of marriages and the rate increased marginally in the following three years. Since 1921 the average age at marriage has increased by 3.6 years for brides and 1.7 years for grooms. The proportion of marriages by previously divorced persons increased sharply after 1968. The changes in marriage rates in Canada parallel those exhibited in the United States and other developed countries in the western hemisphere.

Teenage pregnancy in Canada, 1975-1987.

PIP: Fertility, pregnancy outcomes, and regional variation trends during 1975 and 1987 for Canada is given using data from the registry of live births and information from therapeutic abortions. Teenage pregnancy rate has been defined s the numbers of pregnancy/1000 females between the age of 15-19 at the time of pregnancy. It was observed that the number and rate of teenage pregnancy had declined by 24% during this period. The average decline was greatest in the period 1981 to 1987. However, older teenagers (18-19 years) contributed 63% of the 36,694 pregnancies and 58% of the 13,501 induced abortions in 1987. Also, the average annual fertility rate for older teenagers was 3 times greater than younger teenagers during the 1975-1987 period. In general, teenage pregnancy rates were highest in the Western province. However, both abortion and teenage pregnancy rates were lower in Canada than in the US. Internationally, the Canadian teenage pregnancy rate was closest to Norway, lower than England, Wales, and Czechoslovakia and considerably lower than in the US. The decline in teenage fertility rate can be primarily explained by the increased age in women at 1st birth. Although data is limited, it is speculated that the availability and accessibility to contraceptives, knowledge and sexual behavior are significant factors that contributed to the decline in observed pregnancy rates.^ieng

Teenage pregnancies, Canada, 1975-1989.

There were 19,000 fewer teenage pregnancies in 1989 than the 58,600 in 1975. The teenage pregnancy rate (pregnancies per 1,000 women aged 15-19) declined 17.4% to 44.1 in 1989 from 53.4 in 1975. For 13 of the 15 years under study, both the numbers and rates of teenage pregnancies decreased year after year. Of teenage pregnancies in 1989, 58% resulted in live births, 36% in therapeutic abortions and 6% in other pregnancy terminations including stillbirths. The annual pregnancy rates for younger teenagers (15-17) were about 60% lower than the rates for older teenagers (18-19). In 1989, the teenage pregnancy rates for Prince Edward Island, New Brunswick and Quebec were lower than the national rate, while rates for Nova Scotia, Ontario and the four western provinces were higher.

Pregnancy outcomes.

Live births, induced abortions, and miscarriages/stillbirths are usually examined separately. This article combines the three outcomes to focus on pregnancy in Canada from 1974 to 1992. An estimated 525,100 pregnancies ended in Canada during 1992. While this was a substantial increase from 438,300 in 1974, the pregnancy rate in 1992-77 pregnancies per 1,000 women aged 15 to 44-was actually lower than in 1974, when it had been 85 per 1,000. As the pregnancy rate declined, there was a shift in outcomes. The share of pregnancies that ended in live births fell from 79% to 76%, and the proportion ending in miscarriages/stillbirths went from 9% to 5%. A growing proportion of pregnancies ended in abortions: 19% in 1992, compared with 12% in 1974. Trends in pregnancies varied with the age of the women. Pregnancy rates rose among those in their thirties, but dropped at all other ages. Consequently, older women accounted for a larger share of pregnancies at the end of the period than they had at the beginning. Pregnancy outcomes also differed depending on the women's age. The proportion that ended in an abortion was relatively high among women under age 25 and age 40 and over. Throughout the 1974-1992 period, the proportion of pregnancies ending in miscarriages or stillbirths fell among women of all ages.

Patterns and change in Canadian fertility 1971-1988: first births after age 30.

An analysis of Canada's changing pattern of births during the period 1971-1988 suggests that the tempo and timing of fertility has changed. Between 1971 and 1988, the number and rates of first births to women in their 30s increased rapidly, and rates for women younger than 25 declined. The rate of first births (first births per 1,000 women) for women 30-34 increased from 11.5 in 1971 to 17.1 in 1981 and to 22.3 in 1988--a 94% increase over the 17 years. The rate for women 35-39 also rose from 3.0 in 1971 to 3.6 in 1981 and 5.9 in 1988--a 97% increase occurring mostly in the 1980s.

PIP: Researchers analyzed 1971-1988 data from the Canadian Centre for Health Information to observe patterns and trends in fertility for 30 year old women in Canada, especially in terms of 1st births. In 1971, the rate of 1st births stood at 11.5/1000 for women 30-34 years old, by 1981 and 1988, it rose to 17.1 and 22.3 respectively. This equalled a 94% increase over the 17 years. Further the increase in 1st births for 35-39 year old women was 97% (3%, 3.6%, and 5.9% respectively). Overall, between 1971-1988, the percentage of single women increased more (by 32.5%) than that of all women (by 29.6%), especially 30-34 year old single women (by 174.2%). The rate of 1st births to 30-34 year old single women increased 7 fold between 1974-1988 (2.8-23.1) while the rate of 1st births to 30-34 year old married women only increased 1-2 fold (14.6-23.4%). For all 30-39 year old single women, the total number of 1st births increased 19 fold (240-4,769). 1st births rose each year for Prince Edward Island, Nova Scotia, and New Brunswick between 1972-1988. In Quebec, they also increased annually, except for 1976-1977 when they fell only slightly. In the Western provinces, the territories (the Yukon and Northwest Territories), and Ontario, 1st births peaked during 1980-1982 followed by small decreases thereafter. The 1985 1st birth rate for 30-34 year old women in Canada (20.3) compared favorably to that of Scotland (19.4), Sweden (20.4), and France (20.6). These shifts in the timing and speed of fertility affect demographic, epidemiologic, and social policy. For example, policy makers must consider that population growth potential is lower if more women wait to after age 30 to have their 1st birth than if more younger women do. Further this shift from younger to older ages of 1st births may result in an increase in the health risks associated with late childbearing.

Teenage pregnancies, 1974 to 1994.

OBJECTIVES: This article provides an overview of trends from 1974 to 1994 in pregnancies among women aged 15 to 19. DATA SOURCES: Vital statistics, abortion data, and hospital morbidity files maintained by Statistics Canada were used to develop estimated of pregnancies, live births, abortions, and stillbirths/miscarriages. ANALYTICAL TECHNIQUES: Rates of pregnancy, live birth, abortion and stillbirth/miscarriage are based on the female population aged 15 to 19. MAIN RESULTS: In 1994, there were an estimated 46,800 teenage pregnancies. This marked the continuation of an almost steady rise from 1987, when the number was 39,300. As well, there has been an increase in the percentage of teenage pregnancies ending in an abortion.

Marital status and abortion.

OBJECTIVES: This article examines the marital status of women who obtained abortions between 1974 and 1994, with particular attention to those who were married or in common-law relationships. DATA SOURCES: The data come from Statistics Canada's publications on abortions, in-patient hospital morbidity data, and reports from the United States. ANALYTICAL TECHNIQUES: Crude and age-standardized abortion rates from 1974 to 1994 were calculated by marital status. MAIN RESULTS: While abortion rates were highest for single women, those who were married (including common-law and separated) accounted for over one-quarter of all abortions performed in 1994. Since 1974, the age-standardized abortion rate per 1,000 married women aged 15 to 44 almost doubled from 6.6 to 11.2. For most of these women, it was their first abortion, and the majority had taken at least one pregnancy to term.

Second trimester abortions: trends and medical complications.

As a proportion of total abortions, those performed in the second trimester declined from 21% in 1974 to 10% in 1991. Second trimester (13 to 24 weeks) abortions were more frequent among women who were single, under age 20, and without prior deliveries or abortions. The stage of pregnancy at which an abortion was performed and the method used were associated with the risk of medical complications. Complication rates increased directly with the period of gestation. The complication rate for second trimester abortions was 13 times higher than that of first trimester abortions (under 13 weeks). The lowest complication rates were found among abortions performed using surgical D&C and suction D&C. The procedures primarily used for abortions at 16 or more weeks' gestation (i.e. the administration of prostaglandin, urea or saline) were associated with higher complication rates.