Oncological outcomes in an Australian cohort according to the new prostate cancer grading groupings.

BACKGROUND: A new 5-tiered grading grouping system has recently been endorsed for reporting of prostate cancer (PCa) grade to better reflect escalating risk of progression and cancer death. While several validations of the new grade groupings have been undertaken, most have involved centralised pathological review by specialist urological pathologists. METHODS: Participants included 4268 men with non-metastatic PCa diagnosed between 2006 and 2013 from the multi-institutional South Australia Prostate Cancer Clinical Outcomes Collaborative registry. PCa-specific survival and biochemical recurrence-free survival were compared across the five grade groups using multivariable competing risk regression. RESULTS: For the entire cohort, risk of PCa death increased with increasing grade groups (at biopsy) Adjusted subdistribution-hazard ratios [sHR] and 95% confidence intervals [95%CI] were: 2.2 (1.5-3.6); 2.5 (1.6-4.2); 4.1 (2.6-6.7) and 8.7 (4.5-14.0) for grade groups II (pattern 3 + 4), III (pattern 4 + 3), IV (total score 8) and V (total score 9-10) respectively, relative to grade group I (total score < =6). Clear gradients in risk of PCa death were observed for radical prostatectomy (RP), but were less clear for those who had radiotherapy (RT) with curative intent and those who were managed conservatively. Likewise, risk of biochemical recurrence increased across grade groups, with a strong and clear gradient for men undergoing RP [sHR (95%CI): 2.0 (1.4-2.8); 3.8 (2.9-5.9); 5.3 (3.5-8.0); 11.2 (6.5-19.2) for grade groups II, III, IV and V respectively, relative to grade group I], and a less clear gradient for men undergoing RT. CONCLUSION: In general, the new five-tiered grade groupings distinguished PCa survival and recurrence outcomes for men with PCa. The absence of a clear gradient for RT may be due to heterogeneity in this patient group.

Clinical characteristics and outcomes of bilateral breast cancer in an Australian cohort.

PURPOSE: Uncertainty remains about the impact of bilateral breast cancer. Characteristics and outcomes of unilateral and bilateral breast cancer were compared within an Australian multi-institutional cohort. METHODS: Demographic, tumour and treatment characteristics were compared among unilateral (n = 2336) and bilateral cases (52 synchronous, 35 metachronous) using descriptive analyses. Disease-specific outcomes were investigated using Cox regression modelling to adjust for prognostic and treatment factors. RESULTS: Factors associated with increased risk of bilateral breast cancer included lobular histology (p = 0.046), family history (p = 0.025) and metropolitan residence (p = 0.006). Mastectomy was more common for bilateral cases (p = 0.001) while radiotherapy was less common (p = 0.015). Index metachronous cases were less likely to receive hormonal therapy (p = 0.001). Five-year survivals for metachronous, synchronous and unilateral cases were 79%, 88% and 94%, respectively. Poorer outcomes remained after adjusting for prognostic factors [HR = 2.26, 1.21-4.21]. CONCLUSION: Our results confirm international findings indicating worse outcomes from bilateral compared with unilateral breast cancer.

Accuracy of clinical variables in the identification of radiographically proven constipation in children.

STUDY OBJECTIVE: To determine whether clinical variables accurately identify children with radiographically proven constipation. METHODS: Prospective, cross sectional case series of children 2-12 years of age with abdominal pain (AP) requiring radiographic evaluation. Constipation was defined radiographically as the presence of fecal material throughout the colon. The presence of other pathology was noted. The pediatric emergency department (ED) physicians recorded a comprehensive history and physical examination and a provisional diagnosis was made. Radiographs were initially interpreted by the pediatric ED attending physicians; the official interpretation was later provided by a single board certified pediatric radiologist who was blinded to the ED interpretation. A discriminant analysis was performed to identify variables that could best discriminate between patients with, and without, radiographically proven constipation. RESULTS: In total 251 patients were enrolled over a 12 month period. Four variables were noted to be more common in constipated patients: a history of normal or hard stools, absence of rebound tenderness, presence of tenderness in the left lower quadrant and stool in the rectal vault on exam. Stool present on rectal exam was the best discriminator between patients with and without constipation. The discriminant analysis model had a sensitivity of 77%, specificity of 35% and a negative predictive value of 55%. CONCLUSION: No clinical variable, either as a single variable or in a model, accurately identified patients with abdominal pain and radiographically proven constipation.

Use of fake tanning lotions in the South Australian population.

OBJECTIVE: To explore the relationship between the use of fake tanning lotions and repeated sunburn among South Australian adults, with a view to informing the Anti-Cancer Foundation of South Australia's (ACFSA) policy on fake tanning products. STUDY DESIGN: Population survey. PARTICIPANTS: 2005 South Australians aged 18 years or older, selected randomly from the electronic White Pages. MAIN OUTCOME MEASURES: Self-reported use of fake tanning lotions in the past 12 months; frequency of sunburn over summer; and various sun-protective behaviours. RESULTS: 2,005 of the 2,536 eligible participants (79%) were surveyed by telephone. Fake tan use was most prevalent among women (15.9%), people aged 18-24 years (15.4%), and people with household incomes above $40 000 per year (11.9%). Fake tan users were more likely than non-users to use sunscreens (81.3% v 56.5%; P < 0.001), but less likely to take other precautions such as wearing hats (40.9% v 51.0%; P = 0.04) and protective clothing (22.3% v 34.1%; P = 0.005). They were also more likely to report having been burnt more than once over summer (26.2% v 16.5%; P = 0.025). Multivariate analysis indicates a statistically significant association between fake tan use and repeated sunburn (odds ratio, 2.07; 95% confidence interval, 1.17-3.69), which was independent of age, sex, skin type and sun-protection practices. CONCLUSION: Users of fake tanning products may be at greater risk of repeated sunburn. The ACFSA sees no justification at this stage for altering its present policy position of not actively promoting the use of fake tanning lotions as a means of reducing sunburn.

Small bowel perforation: an unusual presentation for child abuse.

Hollow viscus perforation due to inflicted blunt abdominal injury is uncommon. Diagnosis is frequently delayed because of inaccurate or absent history, nonspecific or delayed physical findings or both, and laboratory tests with low sensitivity. Computed tomographic scanning of the abdomen is the best diagnostic test available. A high index of suspicion is essential to diagnose visceral perforation early, as significant morbidity and mortality results from diagnostic delay.

Congenital diaphragmatic hernia with gastric volvulus presenting as an acute tension gastrothorax.

This report describes a 3-month-old infant with acute severe respiratory distress in whom a diagnosis of congenital diaphragmatic hernia with tension gastrothorax and gastric volvulus was made. A review of the pathophysiology, clinical presentation, differential diagnosis, diagnostic evaluation, and treatment of congenital diaphragmatic hernia is presented.

Human N-acetylgalactosamine-4-sulphatase: protein maturation and isolation of genomic clones.

N-Acetylgalactosamine-4-sulphatase (EC 3.1.6.1, G4S) is composed of a 57 kDa species in human liver that dissociates into 43 kDa and 8 kDa subunits under reducing conditions and, when deficient, causes the lysosomal storage disorder, mucopolysaccharidosis type VI. We isolated genomic clones containing the G4S first exon, including the leader peptide and the amino terminus of the 43 kDa polypeptide. Amino-terminal amino acid sequences of the 43 kDa and 8 kDa subunits indicated that the 8 kDa component is linked to the 43 kDa polypeptide by a single disulphide bond, does not contain the mannose-6-phosphate lysosomal targeting signal and is at the carboxyl terminus of G4S.

Human alpha-L-fucosidase: complete coding sequence from cDNA clones.

The human lysosomal storage disorder fucosidosis results from the deficiency of alpha-L-fucosidase, a lysosomal enzyme essential for the catabolism of oligosaccharides containing alpha-L-fucosides. cDNA clones coding for human alpha-L-fucosidase have been isolated from lambda gt10 and lambda gt11 cDNA libraries derived from human liver, placenta and colon. Compilation of cDNA sequences results in a nucleotide sequence of 2053 base pairs encoding alpha-L-fucosidase. The sequence contains an open reading frame of 461 amino acids beginning with the first in-frame methionine and includes 439 amino acids which comprise the mature protein in addition to a hydrophobic signal peptide sequence of 22 amino acids.

Chromosomal localization of ARSB, the gene for human N-acetylgalactosamine-4-sulphatase.

A deficiency of N-acetylgalactosamine-4-sulphatase (G4S, gene symbol ARSB), results in the accumulation of undegraded substrate and the lysosomal storage disorder, Maroteaux-Lamy syndrome (mucopolysaccharidosis type VI). In situ hybridization using an 3H-labelled human G4S genomic DNA fragment to human metaphase chromosomes localized ARSB to chromosome 5q13-5q14. This location is consistent with, an refines, previous chromosomal assignments based on the expression of human G4S in somatic cell hybrids.