Breast cancer in Western Australia: clinical practice and clinical guidelines

OBJECTIVES: To review changes in patterns of care for women with early invasive breast cancer in Western Australia from 1989 to 1999, and compare management with recommendations in the 1995 National Health and Medical Research Council guidelines. DESIGN AND SETTING: Population-based surveys of all cases listed in the Western Australian Cancer Registry and Western Australian Hospital Morbidity Data System. MAIN OUTCOME MEASURES: Congruence of care with guidelines. RESULTS: Data were available for 1649 women with early invasive breast cancer (categories pT1or pT2; pN0 or pN1; and M0). In 1999, 96% had a preoperative diagnosis by fine-needle aspiration or core biopsy (compared with 66% in 1989), with a synoptic pathology report on 95%. Breast-conserving surgery was used for 66% of women with mammographically detected tumours (v 35% in 1989) and 46% of those with clinically detected tumours (v 28% in 1989), with radiotherapy to the conserved breast in 90% of these cases (83% in 1989). Adjuvant chemotherapy was given to 92% of premenopausal women with node-positive disease and 63% with poor-prognosis node-negative tumours (v 78% and 14%, respectively, in 1989). Among postmenopausal women with receptor-positive tumours, tamoxifen was prescribed for 91% of those with positive nodes (85% in 1989) and 79% of those with negative nodes (30% in 1989). Among postmenopausal women with receptor-negative tumours, chemotherapy was prescribed for 70% with positive nodes (v 33%) and 58% with negative nodes (v none). CONCLUSIONS: Patterns of management of women with early invasive breast cancer in Western Australia during the 1990s changed significantly in all respects toward those recommended in the 1995 guidelines.     

Domestic violence and induced-abortion: report of three cases

Domestic violence not only violates women's rights, but is also associated with adverse consequences ranging from physical injury to psychological morbidity. Several studies have associated domestic violence with risk of having an induced-abortion. The following three cases indicate that domestic violence may not cause unwanted pregnancy, but may be the reason that leads victims to resort to abortion.     

Sarcoidosis: clinical presentation, immunopathogenesis, and therapeutics

Sarcoidosis is a multisystem granulomatous disorder that most often affects the lungs and may cause significant morbidity. Sarcoidosis can manifest as neurological disease, uveitis, blindness, end-stage pulmonary fibrosis, pulmonary hypertension, dysrhythmias, cardiomyopathy, hypercalcemia, and renal failure. Sarcoidosis persists as chronic disease in approximately one-third of those affected. Clinical pitfalls and misconceptions about the course of disease place this population at risk for delayed or inadequate care. While noncaseating granulomas are the histopathological hallmark of sarcoidosis, they also are nonspecific. No pathognomonic diagnostic test exists for sarcoidosis, so the diagnosis remains one of exclusion. While the etiology of sarcoidosis is still unknown, recent insights into its immunopathogenesis have moved investigators closer to finding more effective treatments. Corticosteroids remain the standard of care when treatment is indicated, despite their adverse effect profile. Clinical investigations of novel drugs and biological agents targeting mechanisms involving CD4 type 1 helper T cells may provide more effective, better tolerated therapies.     

Lung transplantation in Australia: barriers to translating new evidence into clinical practice

Evidence "beyond reasonable doubt" may never be achievable for low-volume drugs.     

Skin cancer in Geraldton, Western Australia: a survey of incidence and prevalence

A survey of the incidence and prevalence of non-melanocytic skin cancer in Geraldton, Western Australia, was undertaken in November 1987. All residents aged 40 to 64 years whose names were on the electoral roll on August 1, 1987 were invited to undergo a whole-body skin examination by a dermatologist. When a skin cancer was suspected, participants were referred for treatment to their usual medical practitioner. Subjects were asked to recall incident skin cancers over the preceding two years, and medical records were searched for confirmatory evidence. Histological confirmation of all lesions, both prevalent and incident, was sought and sections were obtained for a standardized review. The prevalence of confirmed non-melanocytic skin cancer in those aged 40 to 64 years was 7.0% in men and 4.7% in women. The prevalence of basal-cell carcinoma (BCC) was 6.5% in men and 4.5% in women while the prevalence of squamous-cell carcinoma (SCC) was 1.2% in men and 0.3% in women. The estimated incidence rate of non-melanocytic skin cancer in this age group was 1560 per 100,000 person-years. The estimated incidence rate of BCC in men was 1335 per 100,000 person-years, and in women 817 per 100,000, while in men the estimated incidence rate of SCC was 890 per 100,000 person-years, and in women it was 289 per 100,000 person-years.     

Cerebrospinal fluid rhinorrhea: an unusual presentation of domestic violence

The incidence of "battered woman syndrome" is increasing over the past few years affecting as many as one in every four families. Most of these cases present to the emergency room with mostly head and maxillofacial injuries. We are describing three cases of battered women with cerebrospinal fluid rhinorrhea as the only presenting symptom of domestic violence. The different etiologies, work up and treatment strategies are all discussed and reviewed.     

“早临床、多临床、反复临床”教学模式探索与实践

“早临床、多临床、反复临床”是21世纪世界高等医学教育改革的主流趋势。某高校立足现行医学教育模式存在的不足,从理论教学和实践教学两方面着手改革,构建适合我国实际的“早临床、多临床、反复临床”教学模式;并运用问卷调查和OSCE考试进行效果评定。评价结果表明该模式对促进医学生知识、能力和素质的全面发展具有较好的成效。