Incidence of childhood cancer in Latin America and the Caribbean: coverage, patterns, and time trends / Incidencia del cáncer infantil en América Latina y el Caribe: cobertura de los registros, patrones y tendencias a lo largo del tiempo / Incidência de câncer infantil na América Latina e no Caribe: cobertura, padrões e tendências temporais

ABSTRACT Objective. To provide a comprehensive overview of geographical patterns (2001-2010) and time trends (1993-2012) of cancer incidence in children aged 0-19 years in Latin America and the Caribbean (LAC) and interpret the findings in the context of global patterns. Methods. Geographical variations in 2001-2010 and incidence trends over 1993-2012 in the population of LAC younger than 20 years were described using the database of the third volume of the International Incidence of Childhood Cancer study containing comparable data. Age-specific incidence per million person-years (ASR) was calculated for population subgroups and age-standardized (WSR) using the world standard population. Results. Overall, 36 744 unique cases were included in this study. In 2001-2010 the overall WSR in age 0-14 years was 132.6. The most frequent were leukemia (WSR 48.7), central nervous system neoplasms (WSR 23.0), and lymphoma (WSR 16.6). The overall ASR in age group 15-19 years was 152.3 with lymphoma ranking first (ASR 30.2). Incidence was higher in males than in females, and higher in South America than in Central America and the Caribbean. Compared with global data LAC incidence was lower overall, except for leukemia and lymphoma at age 0-14 years and the other and unspecified tumors at any age. Overall incidence at age 0-19 years increased by 1.0% per year (95% CI [0.6, 1.3]) over 1993-2012. The included registries covered 16% of population aged 0-14 years and 10% of population aged 15-19 years. Conclusions. The observed patterns provide a baseline to assess the status and evolution of childhood cancer occurrence in the region. Extended and sustained support of cancer registration is required to improve representativeness and timeliness of data for childhood cancer control in LAC.

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RESUMO Objetivo. Apresentar uma visão abrangente dos padrões geográficos (2001 a 2010) e das tendências temporais (1993 a 2012) da incidência de câncer em crianças e jovens de 0 a 19 anos na América Latina e no Caribe (ALC) e interpretar os resultados no contexto de padrões mundiais. Métodos. Foram descritas variações geográficas de 2001 a 2010 e tendências de incidência de 1993 a 2012 na população com menos de 20 anos da ALC usando informações comparáveis da base de dados do terceiro volume do estudo International Incidence of Childhood Cancer. Foram calculadas taxas de incidência específica por idade por milhão de pessoas-ano (ASR, na sigla em inglês) para subgrupos populacionais e taxas padronizadas por idade usando a população padrão mundial (WSR, na sigla em inglês). Resultados. No total, foram incluídos 36 744 casos únicos. No período de 2001 a 2010, a WSR para todos os tumores combinados na faixa etária de 0 a 14 anos foi de 132,6. Os diagnósticos mais frequentes foram leucemia (WSR de 48,7), neoplasias do sistema nervoso central (WSR de 23,0) e linfoma (WSR de 16,6). A ASR para todos os tumores combinados na faixa etária de 15 a 19 anos foi de 152,3, e a maior taxa foi a de linfoma (ASR de 30,2). A incidência foi maior no sexo masculino do que no sexo feminino e maior na América do Sul do que na América Central e no Caribe. De modo geral, em comparação com as estimativas mundiais, a incidência na ALC foi menor, exceto para leucemia e linfoma entre 0 e 14 anos e para outros tumores e tumores não especificados em qualquer idade. A taxa de incidência na faixa etária de 0 a 19 anos aumentou em 1,0% ao ano (IC de 95% [0,6, 1,3]) entre 1993 e 2012. Os registros incluídos cobriam 16% da população de 0 a 14 anos e 10% da população de 15 a 19 anos. Conclusões. Os padrões observados servem de referência para avaliar o status e a evolução da ocorrência de câncer infantil na região. É necessário garantir um apoio ampliado e consistente aos registros de câncer para aprimorar a representatividade e a disponibilidade das informações em tempo adequado para o controle do câncer infantil na ALC.

Ten-year radiological and clinical outcomes of capitolunate arthrodesis with scaphoid and triquetrum excision for advanced degenerative arthritis in the wrist: Single-center, retrospective case series with 10patients.

The aim of this study was to evaluate the long-term outcomes of capitolunate arthrodesis for treating advanced wrist osteoarthritis. The arthrodesis procedures were performed in three women and seven men having a mean age of 59years (range, 20-70). Eight of the patients were manual laborers. The dominant hand was operated on in seven patients. The osteoarthritis was attributed to scapholunate dissociation (SLAC) in six patients and scaphoid nonunion (SNAC) in four patients. The arthrodesis site was stabilized with two vertical compression screws. Patients were reviewed after an average follow-up of 122months (80-172). The clinical and radiological outcomes consisted of measuring pain on a visual analog scale (VAS), determining the QuickDASH and PRWE scores, the patients' satisfaction, the radiolunate and capitolunate angles, carpal height, radiolunate joint condition, and fusion of the arthrodesis site. The mean pain level was reduced from 5 to 1 (P<0.05). The range of motion improved by 20° in flexion-extension and 10° in radioulnar deviation, while strength improved by 8kg relative to the preoperative measurements (P<0.05). The QuickDASH was 15points (±12) and the PRWE was 20 (±32). Relative to the preoperative values, the radiolunate angle was reduced by 4.5° and the capitolunate angle by 6.5°. Carpal height was 6.5mm less on average (P<0.05). None of the patients had a nonunion or deterioration of the radiolunate joint. One patient developed Type II complex regional pain syndrome. The nine other patients were able to return to work. Capitolunate arthrodesis provided pain relief and good function in 9 of the 10patients in our case series. The results was maintained over time, both in terms of mobility and pain relief, which were clearly improved after the surgical treatment. We found no signs of deterioration of the radiolunate joint over 10years. There are very few published studies describing the long-term outcomes of this procedure. Our findings are consistent with those in the literature, which makes capitolunate arthrodesis with scaphoid and triquetrum excision a highly satisfactory and reliable technique in the long term for the treatment of advanced osteoarthritis in the wrist. LEVEL OF EVIDENCE: IV.

Radiographic evaluation of a novel horizontal dorsal intercarpal capsulodesis as a treatment of pre-arthritic scapholunate dissociation: a cadaver study.

Dorsal capsulodesis is an important part of the treatment of pre-arthritic scapholunate instability. We designed an experimental study using 14 fresh-frozen cadaver wrists to demonstrate the efficacy of a new horizontal dorsal intercarpal capsulodesis. We sectioned the scapholunate ligament to create a scapholunate dislocation. Several radiographic views, static and 'in stress', were recorded and we statistically compared the scapholunate interval before and after the section of the scapholunate ligament, and after the creation of the capsulodesis. The results showed a significant decrease of the scapholunate interval after the creation of the capsulodesis, especially in neutral and maximal ulnar deviation of the wrist. They also proved that our cadaveric model is reliable. This study demonstrated that this novel capsulodesis reduces the scapholunate interval in a cadaveric model.

[Gallstone disease post-radical gastrectomy for gastric adenocarcinoma at the National Institute of Neoplastic Diseases, January 1990 to December 2000]. / Litiasis vesícular post- gastrectomía radical por adenocarcinoma gástrico en el Instituto Nacional de Enfermedades Neoplásicas, enero 1990 a diciembre del 2000.

SUBJECT: To determinate the frecuency and the time of development of the gallbladder stones in gastrectomy post-operated patients with stomach adenocarcinoma at The National Cancer Institute in Lima, Peru. METHODS: In an observational, descriptive and retrospective case series design, 148 patiens' files who underwent gastrectomy for stomach adenocarcinoma in the National Cancer Institue of Lima during 1990 and 2000, have been reviewed looking for the development of gallbladder stones. RESULTS: A total de 148 patients were involved in this study. 29 of them (19.6%) develop gallbladder stones during the (x years of) follow up vs 119 (80.9%) . The mean age ot the 29 patients with gallbladder stones were 59.9 years ans 18 of them were female and 11 male.\The mean time of develop gallbladder stones was 3.1 years.According to the type of surgery, 14 patient wiht gallbladder stones underwent to subtotal gastrectomy and 15 to total gastrectomy. CONCLUSIONS: The frecuency of gallbladder stones post gastrectomy in this study was 19.6%. The mean time of the develop and diagnosis of litiasis was 3.1 years.To perform the colecistectomy at the same time of the gastrectomy could be an important decision in patients with high risk of gallstones and gallbladder cancer.We need furthermore studies to have conclusions about the risk factors.

Litiasis vesícular post-gastrectomía radical por adenocarcinoma gástrico en el Instituto Nacional de Enfermedades Neoplásicas, enero 1990 a diciembre del 2000 / Gallstone disease post-radical gastrectomy for gastric adenocarcinoma at the National Institute of Neoplastic Diseases, January 1990 to December 2000

OBJETIVO: Determinar la frecuencia de litiasis vesicular en pacientes post-operados con gastrectomía por adenocarcinoma gástrico, determinar el tiempo de aparición de litiasis vesicular en pacientes gastrectomizados por Adenocarcinoma Gástrico. MÉTODOS: Se realizo un estudio observacional, descriptivo retrospectivo. Se revisó un total de 148 historias clínicas de pacientes sometidos a gastrectomía por adenocarcinoma gástrico en el Instituto Nacional de Enfermedades Neoplásicas en el periodo de 1990 al 2000. RESULTADOS: De los 148 casos de pacientes post gastrectomizados por adenocarcinoma gástrico que fueron enrolados, 29(19.6 por ciento) presentaron litiasis vesicular versus 119(80.9 por ciento) que no presentaron litiasis vesicular como complicación post gastrectomía. La media de edad de 29 pacientes con litiasis vesicular post gastrectomía por adenocarcinoma gástrico fue de 59.9años (min. 39años máx.74años). La distribución de la litiasis vesicular en relación al sexo fue, femenino 18(62.1 por ciento) casos y masculino 11(37.9 por ciento) casos. La media del tiempo de aparición de la litiasis vesicular post gastrectomía fue de 3.1 años, para el sexo masculino 2.7años y para el sexo femenino de 3.3 años. Según el tipo de cirugía se presento litiasis vesicular en 14 pacientes que fueron sometidos a Gastrectomía Subtotal Distal y a 15 pacientes a los que se les practicó Gastrectomía Total. CONCLUSIONES: la Frecuencia de litiasis vesicular post gastrectomía fue de 19.6 por ciento. El periodo de aparición de colelitiasis fue de 3.1 años. La colecistectomía podría ser una toma de decisión importante en pacientes con alto riesgo de litiasis y cáncer vesicular post gastrectomía. El presente trabajo de investigación invita a realizar otros estudios de tipo cohorte en el cual se determine el factor de riesgo principal para la aparición de esta complicación.

SUBJECT: To determinate the frecuency and the time of development of the gallbladder stones in gastrectomy post-operated patients with stomach adenocarcinoma at The National Cancer Institute in Lima, Peru. METHODS: In an observational, descriptive and retrospective case series design, 148 patiens' files who underwent gastrectomy for stomach adenocarcinoma in the National Cancer Institue of Lima during 1990 and 2000, have been reviewed looking for the development of gallbladder stones. RESULTS: A total de 148 patients were involved in this study. 29 of them (19.6 percent) develop gallbladder stones during the (x years of) follow up vs 119(80.9 percent). The mean age ot the 29 patients with gallbladder stones were 59.9 years ans 18 of them were female and 11 male./The mean time of develop gallbladder stones was 3.1 years. According to the type of surgery, 14 patient wiht gallbladder stones underwent to subtotal gastrectomy and 15 to total gastrectomy. CONCLUSIONS The frecuency of gallbladder stones post gastrectomy in this study was 19.6 percent. The mean time of the develop and diagnosis of litiasis was 3.1 years. To perform the colecistectomy at the same time of the gastrectomy could be an important decision in patients with high risk of gallstones and gallbladder cancer. We need furthermore studies to have conclusions about the risk factors.

[Factors associated with fecal incontinence after childbirth. Prospective study in 525 women]. / Facteurs liés à l'incontinence anale du post-partum. Etude prospective chez 525 femmes.

OBJECTIVE: To determine the prevalence of fecal incontinence after childbirth and to identify the risk factors. METHODS: This was a prospective observational study with a consecutive inclusion of 525 women who delivered over a three months period. Women were questioned about their fecal continence four days and six weeks after delivery. RESULTS: The incidence of fecal incontinence four days and six weeks after childbirth was respectively 8.8% and 3.3%. The risk factors for fecal incontinence at 4 days after childbirth were instrumental delivery by forceps (adjusted odds ratio 8.64, 95% confidence interval 3.55-21.0, p < 0.001) and unassisted delivery at home (adjusted OR 8.06, 95% CI 1.30-50.0, p = 0.025). Independent risk factors for the presence of fecal incontinence 6 weeks later were: instrumental forceps delivery (adjusted OR 10.8, 95% CI 2.82-41.3, p = 0.001), unassisted delivery at home (adjusted OR 50.0, 95% CI 3.09-802, p = 0.006), bi-parietal diameter of the newborn > 93 mm (adjusted OR 4.56, 95% CI 1.46-14.1, p = 0.009) and maternal age >30 years (adjusted OR 4.60, 95% CI 1.11-19.1, p = 0.036). CONCLUSION: Fecal incontinence is common after childbirth and its prevalence is predominantly associated with instrumental delivery, unassisted delivery at home, bi-parietal diameter of the newborn and maternal age.

[Gastric cancer invading the muscularis propia]. / Cáncer Gástrico con invasión hasta la muscular propia.

OBJECTIVE: Determine the clinical features and the survival of patients with gastric cancer invading the muscularis propia. MATERIAL AND METHODS: We reviewed the clinical records of the patients with gastric cancer invading the muscularis propia, that had undergone surgical treatment at the National Cancer Institute (INEN) between 1950 and 1999. We considered age, sex, location of the tumor, regional lymph node metastases (N), distant metastases (M), TNM stage and survival. RESULTS: 202 patients had gastric cancer invading the muscularis propia, the mean age was 60.03 years, 105 (52%) were females, in 69% the neoplasm was in the antrum and in 22% in the body. We found regional lymph node metastases in 48% and distant metastases in 1%; 52.1% was in the IB TNM stage and 3.1% in the IV. The five year survival rate using Kaplan Meier was 66%, patients with N0, N1, N2 and N3 had 78%, 70%, 25% and 0% respectively.

[Total gastrectomy for gastric cancer in patients over 70 years old]. / Gastrectomía total por cáncer gástrico en pacientes mayores de 70 años.

OBJECTIVE: To determine if the morbidity and postoperative mortality after a full gastrectomy for gastric cancer performed on patients of more than 70 years of age were different from those of younger patients. MATERIAL AND METHODS: Between 1980 and 1999, a total of 411 gastrectomies for gastric adenocarcinoma were performed at the Institute of Cancer Diseases (INEN). Of these, 87 were inpatients older than 70 years of age (elderly group) and 92 were inpatients between 50 and 59 years of age (young group). The clinical record of both groups were studied and the clinical-pathological features, morbidity and postoperative mortality, staying time in hospital and survival rate were compared. RESULTS: There was no significant difference between the two groups regarding clinical-pathological features except in the TNM stage. In the elderly group 23.0% had stage IV and 43.5% in the young group (p=0.007). The average operating time in the elderly group was shorter than in the young group (5.5 hours versus 6.0 hours, p=0.015). The morbidity for the elderly group was 29.9% and that of the young group was 34.8%, whereas the postoperative mortality for the elderly and young groups was 4.6% and 2.2%, respectively. Pneumonia was the most frequent postoperative complication (14.8%) and the primary cause of postoperative death in the elderly group. Time in hospital and survival were similar between both groups. CONCLUSIONS: The morbidity and postoperative mortality after a full gastrectomy for cancer of the stomach in the elderly is no different from those found in younger patients.

[Mechanical versus manual suture in the jejunal esophageal anastomosis after total gastrectomy in gastric cancer]. / Sutura mecánica versus sutura manual en la anastomosis esófago yeyunal después de gastrectomía total por cáncer gástrico.

AIM: To compare the leakage rate of esophagojejunal anastomosis performed with stapler or hand sutures. MATERIAL AND METHODS: We studied a series of 367 patients who underwent total gastrectomy for gastric cancer at the Instituto de Enfermedades Neoplásicas (Lima-Peru) from 1986 to 1999. RESULTS: In 197 patients esophagojejunal anastomosis was performed with stapler and in 170 with manual sutures. There were no differences between both groups with regard to age, TNM stage, operating time and hospital stay. There were 8 anastomotic leakage (4.1%) in the stapler group and 4 (2.4%) in the hand sutures group (p> 0.05). Of these 12 cases, 2 patients (16%) died of causes directly related to the leak of the esophagojejunal anastomosis. CONCLUSION: There were no statistical differences in the rate of leakage of the esophagojejunal anastomosis performed with stapler or hand sutures, thus both techniques should be accepted as standard procedures.