Patients' subjective assessment as a decisive predictor of malignancy in pelvic masses: results of a multicentric, prospective pelvic mass study

OBJECTIVE

The prognosis for ovarian cancer patients remains poor. A key to maximizing survival rates is early detection and treatment. This requires an accurate prediction of malignancy. Our study seeks to improve the accuracy of prediction by focusing on early subjective assessment of malignancy. We therefore investigated the assessment of patients themselves in comparison to the assessment of physicians.

METHODS

One thousand three hundred and thirty patients participated in a prospective and multicenter study in six hospitals in Berlin. Using univariate analysis and multivariate logistic regression models, we measured the accuracy of the early subjective assessment in comparison to the final histological outcome. Moreover, we investigated factors related to the assessment of patients and physicians.

RESULTS

The patients' assessment of malignancy is remarkably accurate. With a positive predictive value of 58%, the majority of patients correctly assessed a pelvic mass as malignant. With more information available, physicians achieved only a slightly more accurate prediction of 63%.

CONCLUSIONS

For the first time, our study considered subjective factors in the diagnostic process of pelvic masses. This paper demonstrates that the patients' personal assessment should be taken seriously as it can provide a significant contribution to earlier diagnosis and thus improved therapy and overall prognosis.

Styrene-Butadiene Rubber Filled with Fluorinated Carbon Black: Part II. Effect of Curative Level

The cure and tensile properties of sulfur vulcanized styrene-butadiene rubber filled with a conventional furnace black or a fluorinated black have been determined. Compositions with the fluorinated black and normal curative levels exhibit retarded cure compared to corresponding ones with the furnace black. This is due to a reaction between the sulfenamide accelerator and the fluorinated black. Notwithstanding, a fluoro-filled composition with no curatives substantially crosslinks when molded at 150°C. Thus, fluoro-black filled specimens have competing effects toward crosslinking. On the one hand, crosslinking is inhibited by reaction with the accelerator, while, on the other hand, the fluoro-black itself can cause crosslinking.

And donor makes three

A growing number of infertile women are being implanted with embryos conceived from their husband's sperm and eggs donated by other women. Though some clinics report a success rate of one in three, such adopt-an-embryo procedures pose legal, ethical and emotional problems.

Last rights. In sickness and in health, more people are taking life's biggest decision away from doctors and into their own hands

When dying is all that awaits them, more and more people are choosing certain death now rather than uncertain life on medical support systems. But the decision seldom comes easy, as a Newsweek reporter discovers during three weeks with the doctors, nurses, patients and families in an intensive-care ward. A best-selling guide to suicide fires debate over when it is right to let life go--and who should make that choice when the patient no longer can.

Effect of eye patching on the overnight corneal swelling response with rigid contact lenses

In this study, 23 subjects wore a rigid extended wear (EW) lens overnight with a light pressure patch covering the eye while 19 subjects wore the same type of lens without patching. Corneal thickness measurements taken immediately upon awakening showed no significant difference in corneal swelling between the two groups. This result indicates that light pressure patching does not significantly affect the overnight corneal swelling found with rigid EW lenses, and it suggests that lagophthalmos during contact lens wear does not contribute significantly to the oxygen reaching the cornea during the closed-eye phase of overnight swelling studies.

Production of estradiol by each ovary during the estrous cycle of cows

The objective of our experiment was to examine changes in serum concentrations of estradiol in each utero-ovarian vein before, during and after gonadotropin surges. Four cows were given prostaglandin F2 alpha (PGF2 alpha) during diestrus and three cows were allowed to cycle spontaneously. All cows had a cannula in each utero-ovarian vein and in one jugular vein. Most cows had two transient rises in estradiol, primarily coming from a single ovary, preceding and after luteinizing hormone (LH) surges. The first rise in estradiol began after luteal regression and was sustained from 48 h before a pre-ovulatory LH surge to the end of the LH surge. The second rise in estradiol was sustained from 72 to 168 h after the end of an LH surge. To determine how rapidly asymmetrical production of estradiol began during luteolysis, several cows were injected with PGF2 alpha during the luteal phase. Blood samples were taken from a jugular and both utero-ovarian veins at hourly intervals before and after PGF2 alpha. Asymmetrical production of estradiol began within 3 h after an injection of PGF2 alpha. We concluded: (1) that a single ovary was responsible for the sustained increases in concentration of estradiol that occur during proestrus to estrus and early diestrus in cows and (2) that cows may have at least one follicle capable of producing estradiol during most days of an estrous cycle, thus little delay in selection of which follicle eventually ovulates occurs after luteal regression.