Recent trends in infant mortality rates and proportions of low-birth-weight live births in Canada

OBJECTIVE: To identify spatial patterns of changes in infant mortality rates and proportions of low-birth-weight live births observed in 1994. SETTING: Canada. SUBJECTS: Live births and infant deaths in Canada between 1987 and 1994. Data for Newfoundland were unavailable for 1987 through 1990. OUTCOME MEASURES: Annual infant mortality rates (crude and after excluding live newborns weighing less than 500 g); proportion of live births by low-birth-weight category (500-2499 g). RESULTS: Nova Scotia, New Brunswick, Quebec and Manitoba had lower crude and adjusted infant mortality rates in 1994 than in 1993. Newfoundland, Saskatchewan, Alberta and British Columbia had higher rates in 1994 than in 1993. The crude rate in Ontario was lower, and the adjusted rate higher, in 1994 than in 1993. A downward trend in the proportion of low-birth-weight live births was observed in Quebec (chi(2) for trend = 29.2, p < 0.01). Conversely, an upward trend was observed in Ontario (chi(2) for trend = 241.3, p < 0.01). However, the increase may have been due to data errors, especially in 1993 and 1994, involving truncation of ounces in 2 digits to 1 digit (e.g., 5 pounds 10 ounces became 5 pounds 1 ounce). CONCLUSIONS: Although the marginal increases in infant mortality observed in several provinces could be the result of random variation, future trends should be closely monitored. The proportion of low-birth-weight live births in Canada (excluding Ontario) appears to be stable, with Quebec showing significant reductions. The errors in data for Ontario need to be corrected before trends can be estimated for that province and for Canada as a whole.     

Involved field radiation, fractionated total body irradiation, high dose cyclophosphamide, and autologous bone marrow transplantation in the treatment of malignant lymphomas

We report the results of intensive therapy and autologous bone marrow transplantation (BMT) in 23 patients with malignant lymphoma (eight Hodgkin's disease and 15 non-Hodgkin's lymphoma) who failed primary therapy. All patients had evidence of disease prior to transplant therapy: 10 had never achieved a complete remission and 13 were in relapse. The preparative regimen included involved field radiation followed by fractionated total body irradiation and high dose cyclophosphamide. A complete remission was achieved in 15 patients, 11 of whom continue in unmaintained complete remission from 27 to 72 months after BMT (median follow-up of 52 months). Of the remaining patients, five did not achieve a complete remission and three died of early toxicity. The event-free survival of the entire group is 47%. Disease status at the time of BMT was significantly correlated with patient outcome. The event-free survival of 13 patients in whom there was no objective evidence of tumor growth on conventional dose therapy was 77% compared with only 10% in patients with tumors progressing on conventional dose therapy (p less than 0.002). All six patients transplanted in untreated relapse continue in unmaintained remission, suggesting that debulking chemotherapy may not be necessary before BMT. Alternative approaches are needed in patients whose tumors progress on conventional dose therapy.     

Perioperative complications following sagittal split osteotomy of the mandible.

INTRODUCTION: The aim of this study was to review complications in a series of 1264 consecutive patients who were operated in a single centre during a 20-year-period. MATERIAL AND METHODS: Complications were documented, their incidences calculated and compared with data from the literature. RESULTS: In 35 patients (2.8%) infection developed requiring extraoral incision and drainage; in 27 patients (2.1%) the inferior alveolar nerve was inadvertently cut; 18 patients (1.4%) had to undergo re-operation due to bending or fracture of osteosynthesis material; 15 patients (1.2%) suffered from bleeding complications; in 12 patients (0.9%) an unfavourable split occurred. In 8 patients (0.6%) foreign bodies were left in situ; in 7 patients a partial weakness of the facial nerve occurred, which was permanent in 1 patient. Six patients (0.5%) with a significantly higher age than average (mean: 33.6 years in comparison with 23.1 years) developed non-union at the site of osteotomy, and the mandible had to be bone grafted. Two patients (0.2%) developed osteomyelitis, and in one patient airway problems led to a need for tracheostomy (0.1%). CONCLUSION: Although some of these complications of bilateral sagittal split with osteotomy carry severe limitations in health related quality of life, it remains an overall safe procedure, demanding, however, comprehensive informed consent. Good knowledge of technical reasons for these complications should help to reduce their incidence.