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.

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.

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.

Repeat abortions in Canada, 1975-1993.

In Canada, 20% of women who obtained an abortion between 1975 and 1993 had had at least one previous abortion. An analysis of data on 1.2 million abortions shows that the proportion of abortion patients undergoing repeat procedures increased from 9% to 29% over the 19-year period. The proportion was above average (22-28% for all years combined) among women who were in common-law marriages, those aged 25-39 and those who had previously had children. In 1993, 27 women per 1,000 who had ever had an abortion underwent another one, while 13 women per 1,000 who had never had an abortion obtained their first one; among teenagers, the repeat rate was four times the rate of first abortions (81 per 1,000 vs. 19 per 1,000). During the study period, the repeat rate rose sharply among women younger than 25 but fell among those aged 30 and older. In 1993, fewer than 2% of abortions were obtained by women who had had three or more previous procedures, suggesting that abortion is not widely used as a primary method of birth control.

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.

Declining cesarean section rates: a continuing trend?

Since the mid-1980s, cesarean section rates in Canada have declined. By 1993, 18 of every 100 deliveries were by cesarean section, compared with close to 20 per 100 in 1987. As well, in 1993, 9 of every 100 deliveries were primary cesareans, down from a high of almost 11 per 100 in the mid-1980s. And the repeat cesarean section rate fell from 39 per 100 cesareans in the mid-1980s to 34 in 1993. A major factor in the downtum of cesarean section rates has been a steady increase in vaginal births after cesarean section (VBACs). From 1979 to 1993, the rate rose more than tenfold from 3 to 33 per 100 women who previously had a cesarean section. This trend toward VBAC deliveries was apparent among women in all age groups. Within Canada, there are large provincial differences in cesarean section and VBAC rates. In 1993, cesarean rates ranged from 15 per 100 deliveries in Manitoba to 22 in New Brunswick. VBAC rates ranged from 16 per 100 previous cesarean sections in New Brunswick and Newfoundland to 42 in Alberta. This article traces trends in cesarean section and VBAC rates in Canada and the provinces from 1979 to 1993. The data are based on individual patient admission/separation records of general and allied hospitals, that are submitted to Statistics Canada.

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.

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.

Multiple births: trends and patterns in Canada, 1974-1990.

This paper examines Canadian trends and patterns in multiple births in relation to total confinements, singleton births, maternal age, parity, gestational age and birth weight using vital statistics from 1974 to 1990. Multiple-birth rates in Canada increased from 912.8 to 1,058.9 per 100,000 confinements between 1974 and 1990. The increase is especially noticeable for women over 30. The rate of triplet and higher-order births increased from 8.3 to 21.7 per 100,000 confinements between 1974 and 1990. The proportion of multiple-birth babies that were pre-term (< 37 weeks gestation period) increased from 32.8% in 1974 to 45.8% in 1990. Factors associated with the increase in multiple births may include the use of assisted pregnancy techniques, and the fact that women aged 30 and older, who are at higher risk of a multiple birth, and who postponed their child bearing, have increased their fertility. The sharp increase in multiple-birth rates has implications for maternal and child health and health care costs.