Application of anticancer agent embolism in Miles'' operation

A double-blind prospective study was done with 15 patients with anterior shoulder instability to determine the diagnostic efficacy of magnetic resonance (MR) imaging versus arthroscopy in the evaluation of chondral or osteochondral lesions of the humeral head. MR produced 6 true positives, 5 true negatives and 4 false negatives, and its accuracy and sensitivity were 60% and 87%, respectively, whereas arthroscopy gave 8 true positives, 5 true negatives and 2 false negatives, with a sensitivity of 80% and an accuracy of 87%. All lesions diagnosed with either method were regarded as positive by definition, with the result that the specificity was always 100%. The differences in diagnosis sprang from the false negatives. The 40% discrepancy between the two methods was probably due to our distinction in MR between intra- and extra-articular osteochondral lesions. In the first group (the 4 MR false negatives), there were three instances of first-degree intra-articular lesion and one diagnostic error (third-degree lesion). In the second (the 2 arthroscopy false negatives), the lesions were of the extra-articular type. It is thus advisable to employ both of these methods to ensure the correct diagnosis of a Hill-Sachs lesion, and hence the correct choice of treatment.     

Helicobacter eradication: an expensive Sisyphus task

BACKGROUND: The benefits of eradicating H. pylori infection vary about the antimicrobial regimen. In contrast, comparing many clinical studies the overall outcomes seem independent of the kind of treatment. Therapy depends on accurate diagnosis. Therefore, the observed differences and correspondences can be caused by not obviously but systematic influences using noninvasive diagnostic tests. METHOD: Simulations concerning noninvasive tests with variable specificity and sensitivity were performed. The results were compared to the hypothetical estimate that 1/3 of the population of Germany were H. pylori infected. This group should be traced and checked again after a treatment with 90% efficacy. RESULTS: In comparison to the a priori conditions most decisions according to noninvasive tests were not valid. Both sensitivity and specificity differ significantly from 100%, therefore the accuracy was low. The differences between true positives and true negatives were unpredictably accelerated if the inclusion criteria depend on the poor sensitivity of the first test. For the second test which is commonly used regarding its specificity, there is a change in the statistical behavior. As a result, the homogeneity that is true and false negatives and positives of the non-infected or infected groups differed considerably. One of the examples was a procedure using a test with 79% specificity and 85% sensitivity. If the prevalence of the infection was 33% the simulations demonstrated a therapeutic effect of about 76.5% instead of a priori efficacy of 90%. Under these conditions 14% of the population become false positive. Furthermore, the simulations revealed a second effect. Using the same test with low accuracy twice the investigator got the impression of superior therapeutic considerations. The misleading conclusion was caused by diminished sensitivity if the specificity remained constant. Thus, neither serological tests nor the 13C-breathtests can be assumed as validated methods for both to screen infected people and to check the treatment. Furthermore, the noninvasive tests are not useful for the determination of the prevalence of H. pylori infection. The influence of variable sensitivity and specificity of a diagnostic test on the outcome of a clinical trial can become a bias or can be used to manipulate the outcome. CONCLUSION: The effect of a therapeutic regimen depends on the prevalence of the H. pylori infection. Because it is difficult to separate true positives, in clinical trials the main effects and interactions can be improved under the conditions used in "experimental design". Some earlier results must be reevaluated because of the bias resulting from inadequate diagnostic tests.     

Task specificity and language effects in verification: Comments on "Development of the concept of truth functional negation."

Uses the sentence-picture comparison procedures in K. J. Kim's (see record 1985-25108-001) experiment and Korean-speaking children's exposure to the English language to explain Kim's findings that true negatives are more difficult than false negatives for both English- and Korean-speaking children but that Korean-speaking children perform extremely poorly on true negative statements. The discrepancy between these findings and the present author's (see record 1984-14618-001) finding that verifying true negatives over false negatives is greater among Korean- than English-speaking children is considered. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intraepithelial carcinoma of the cervix uteri. 1) Cytologic detection in gynecologic practice. Our exerience with 15,000 smears

The best results in screening for subclinical cancer of the cervix are given by cytological studies. The authors in reviewing their experience in this method of screening studied the result of 15,000 smears which gave a diagnosis of 37 cases of intra-epithelial carcinoma of the cervix, which means 1 case of carcinoma in situ diagnosed in every 400 smears. Although the technique is very simple it has to be carried out according to strict criteria at the time of taking the smear, of fixing it immediately and of staining it. There is a group of patients who are at high risk about the age of forty, when there is a marked influence due to parity. But only a systematic policy will bring about diagnosis of pre-invasive carcinoma in cases where the cervix is clinically healthy. The cytology is usually characteristic, though the diagnosis may be difficult during pregnancy, or when hormone contraception is being used or when there is a trichomonas infection present. This explains why we find false positives in 0.03 per cent of cases in this study and false negatives in 0.03 per cent of cases. Their rarity means that the method is 99.94 per cent reliable. Finally, the cervical smear gives an opportunity for studying the vaginal microbial flora as well as the cyto-hormonal state.     

Use of the computed tomographic whole body scanner to stage and follow patients with advanced ovarian carcinoma

Advanced ovarian carcinoma continues to be a difficult tumor to evaluate noninvasively. Recent developments in chemotherapy have enhanced response rates in this disease, thus improving the likelihood of tumor regression. Computed Tomography (CT) allows the noninvasive estimation of tumor extent in patients with ovarian carcinoma. Seventeen patients with epithelial ovarian carcinoma had 22 whole body CT scans performed either just prior to or following laparotomy. For determination of tumor involvement, when the CT was positive, a high pathologic correlation was found at liver, ascitic, peritoneal, mesenteric, and omental sites (sensitivity). When the cT was negative, high pathologic correlation was found at ascitic and mesenteric sites (specificity). Lower and negative correlation at other disease sites is attributed to difficulty of CT detection of small (1 cm) tumor nodules on visceral surfaces. Eighteen patients with advanced ovarian carcinoma were followed prospectively during treatment with repetitive CT scans. CT results were compared with physical examination, other radiologic studies, and clinical status. In 83% (15/18) of patients and 88% (59/67) of CT scans performed, CT was found to contribute useful management information. Clinical decisions were made on the basis of CT alone in 43% (29/67) of scans performed. These data suggest that CT scanning is very useful in the staging and follow-up of patients with ovarian carcinoma and can replace other radiologic procedures, but it is not completely accurate and needs to be correlated with physical examination and in cases without tumors visible with CT, with laparotomy.     

Biodistribution of charged F(ab')2 photoimmunoconjugates in a xenograft model of ovarian cancer

The effect of charge modification of photoimmunoconjugates (PICs) on their biodistribution in a xenograft model of ovarian cancer was investigated. Chlorin(e6)c(e6) was attached site specifically to the F(ab')2 fragment of the murine monoclonal antibody OC125, directed against human ovarian cancer cells, via poly-1-lysine linkers carrying cationic or anionic charges. Preservation of immunoreactivity was checked by enzyme-linked immunosorbent assay (ELISA). PICs were radiolabelled with 125I and compared with non-specific rabbit IgG PICs after intraperitoneal (i.p.) injection into nude mice. Samples were taken from normal organs and tumour at 3 h and 24 h. Tumour to normal 125I ratios showed that the cationic OC125F(ab')2 PIC had the highest tumour selectivity. Ratios for c(e6) were uniformly higher than for 125I, indicating that c(e6) became separated from 125I. OC125F(ab')2 gave highest tissue values of 125I, followed by cationic OC125F(ab')2 PIC; other species were much lower. The amounts of c(e6) delivered per gram of tumour were much higher for cationic OC125F(ab')2 PIC than for other species. The results indicate that cationic charge stimulates the endocytosis and lysosomal degradation of the OC125F(ab')2-pl-c(e6) that has bound to the i.p. tumour. Positively charged PICs may have applications in the i.p. photoimmunotherapy of minimal residual ovarian cancer.     

Are language-acquisition strategies universal?

Tested a universality hypothesis of language acquisition that states that the order of acquisition of verifying 4 types of statements is true affirmatives (e.g., "You are a child"), false affirmatives (e.g., "You are a baby"), false negatives (e.g., You aren't a child"), and true negatives (e.g., "You aren't a baby"). 18 English- and 18 Japanese-speaking 3- or 4-yr-olds were asked to verify these statements. Consistent with the hypothesis, English-speaking Ss found true negatives most difficult, but contrary to the hypotheses, Japanese speakers found false negatives most difficult. A theory of cross-linguistic language acquisition is proposed that deals with the interaction of universal and unique aspects of the child's basic psychological mechanism across the 2 languages. A statement-verification model for Japanese is also presented. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation on non invasive diagnostic tests for the second look in epithelial ovarian cancer

OBJECTIVE: To determine the usefulness of diagnostic tests performed before a second look laparotomy in patients with epithelial ovarian cancer. STUDY DESIGN: Thirty-three patients with epithelial ovarian cancer attended at Fundación Jiménez Díaz from 1984 to 1995 were studied. All patients initially underwent cyto-reducing surgery, followed by at least six platinum-based chemotherapy cycles. Prior to second look laparotomy all patients were evaluated by computerized tomography (CT) of the pelvis and abdomen, CA-125, pelvic-abdominal echography and gynecologic examination. To evaluate sensitivity, specificity, positive predictive value and negative predictive value for each test contingency tables were used. RESULTS: Eleven out of the 33 second look patients (33%) had histologic or cytologic evidence of disease. Six out of the eleven positive second look had a positive CT prior to second look (sensitivity of 55%). CT showed lack of disease in 21 out of the 22 negative second look cases (specificity 95%). Positive and negative predictive values of the test were 86% and 81%, respectively. Nine cases out of the 28 who had a CA-125 obtained had a positive second look. Four out of these nine patients had an increased CA-125 value (sensitivity 44%, specificity 95%, positive predictive value 80% and negative predictive value 78%). Sensitivity, specificity, positive predictive value and negative predictive value of physical examination and echography were 36%, 100%, 100%, 76% and 27%, 95%, 75%, 72%, respectively. On the other hand, sensitivity, specificity, positive predictive value and negative predictive value of all tests taken together were 64%, 91%, 78% and 83%, with a rate of false-negative results of 17% and a rate of false-positive results of 22%. CONCLUSION: Pelvic-abdominal computerized tomography, CA-125, pelvic-abdominal echography and gynecologic examination can be an alternative to second look laparotomy for the diagnosis of persistence or recurrence of the disease in patients with epithelial ovarian cancer.     

Magnesium isotopic abundance measurement in humans: comparison of two mass spectrometric methods

OBJECTIVE: A population of children having bilateral moderate to profound hearing impairment was investigated to find out the number who passed (false negatives) and who failed (true positives) a screening test based on the auditory brain stem response (ABR). DESIGN: This study of the ABR is a parallel report to Lutman, Davis, Fortnum, and Wood (1997), where the transient evoked otoacoustic emission was examined on a similar but not identical population of at-risk neonates. Hearing screening was undertaken in at-risk neonates (targeted screening) at seven hospitals in the UK using the Nottingham ABR Screener. During the period from January 1988 to December 1993, a total of 6983 neonates had been tested. Assessment of audiological records from the participating centers ascertained that 201 children born between January 1988 and December 1993 had hearing threshold levels in both ears of 50 dB or more, averaged over the speech frequencies 0.5, 1, 2, and 4 kHz. Of these, 51 had completed the ABR screening test. Examination of the ABR records, which included both machine and visual scoring, indicated whether they had passed or failed the screening test. RESULTS: Forty-six of the 51 hearing impaired babies failed the neonatal ABR screen either on one or both ears (five false negatives), and 42 failed the test on both ears (nine false negatives). This resulted in field sensitivities of 90% and 82%, respectively. Two cases of suspected progressive hearing loss have been included in the numbers of false negative results. The percentage of babies passing the screen on both ears and subsequently having normal hearing (specificity) is typically 93%. CONCLUSIONS: Neonatal hearing screening in an at-risk population using a highly automated ABR test is a viable and effective tool for identification of hearing impairment. Although the field sensitivity of the test is high, it is unable to identify all babies with a criterion level of hearing loss. There are a number of possible explanations as to the origin of false negative results: configuration of the pure-tone audiogram, a progressive hearing loss, acquired sensorineural or conductive loss, retrocochlear deafness, or an incorrect interpretation of the screening test. Passing a neonatal screening test, therefore, does not exclude the possibility of subsequent hearing impairment and highlights the need for further surveillance.     

Ovarian cancer: comparison of findings with perfluorocarbon-enhanced MR imaging, In-111-CYT-103 immunoscintigraphy, and CT

PURPOSE: To determine the accuracy of breath-hold gadolinium- and perflubron-enhanced magnetic resonance (MR) imaging, immunoscintigraphy with indium-111-CYT-103 (planar and single photon emission computed tomography [CT]), and contrast material-enhanced CT for the detection of ovarian cancer prior to laparotomy. MATERIALS AND METHODS: Sixteen patients with primary (n = 3) or treated (n = 13) ovarian cancer underwent imaging of the abdomen and pelvis with each modality. All images were reviewed prospectively for tumor location, and results were compared with findings at surgery. RESULTS: With CT or MR imaging, tumor was detected in 11 of 13 (85%) patients compared with 11 of 12 patients (92%) with immunoscintigraphy. Per patient accuracy for CT was 81% compared with 75% for MR imaging and 86% for immunoscintigraphy. For detection of individual sites of tumor, the sensitivity of MR imaging was highest (81%) compared with CT (51%, P < .001) and immunoscintigraphy (50%, P < .01). The combination of MR imaging and immunoscintigraphy depicted 89% of sites of tumor involvement confirmed at laparotomy. CONCLUSION: MR imaging and immunoscintigraphy show promise for the evaluation of patients with ovarian cancer.     

Implications of differences in elevations of K-corrected and non-K-corrected MMPI T scores.

Presents evidence from the literature that Minnesota Multiphasic Personality Inventory (MMPI) T scores for K-corrected scales tend to be higher than T scores of the same group of persons for corresponding non-K-corrected scales. This seems to be the case not only for psychiatric patients but also for medical patients and normal individuals. The principal implications are that when indexes of pathology are based on the usual cut scores for both K- and non-K-corrected scales, (a) diagnostic decisions based on K-corrected scores may result in more false positives and fewer false negatives than may diagnostic decisions based on non-K-corrected scores, and (b) which type of scale (K-corrected vs non-K-corrected) results in the higher proportion of correct diagnoses in a mixed group should depend in a predictable way on the ratio of normal to abnormal Ss in the group. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spiral CT angiography and surgical correlations in the evaluation of intracranial aneurysms

We investigated the accuracy of spiral computed tomography angiography (CTA) in the detection and study of intracranial aneurysms by comparing CTA with selective angiograms and surgical findings. Twenty-six patients (9 men and 17 women; mean age 53.1 +/- 1.8 years) with suspected intracranial aneurysms were submitted to CTA (1- to 2-mm slices, pitch 1:1, 24 s, RI = 1) after a conventional CT examination showing subarachnoid hemorrhage (SAH) in 19 cases and during neuroradiological investigations performed for other reasons in 7 cases. One hundred twenty to 150 ml iodate contrast agent (0.3-0.4 gI/ml) were injected intravenously at 5 ml/s rate and with 12- to 25-s delay calculated with a preliminary test bolus. Three-dimensional shaded surface display (3D SSD) and maximum intensity projection (MIP) reconstructions were obtained from axial images. Then, within 48 h, all patients were submitted to digital subtraction angiography (DSA), with separate assessment of CTA and DSA findings. Twenty-two aneurysms shown by CTA were confirmed at DSA and surgery (true positives), whereas the vascular lesion was not confirmed at DSA in 2 cases (false positives). The presence of intracranial aneurysms was excluded at both CTA and subsequent DSA in 7 cases (true negatives) and there were no false negatives; sensitivity was 100 %, specificity 77.8 %, and diagnostic accuracy 93.5 %. Computed tomography angiography aneurysm location was confirmed at surgery in all cases, with very high accuracy in assessing the presence of an aneurysm neck (100 %). Computed tomography angiography accurately depicted the aneurysm shape in 20 of 22 cases, but failed to depict its multilobed nature in 2 cases. The mean aneurysm diameter calculated at CTA was 0.99 +/- 0.12 cm vs 1.09 +/- 0.11 cm at surgery (p < 0.01). The present results suggest that the high sensitivity of CTA, if confirmed by further studies, might help in avoiding having to resort to arteriography after negative CTA in SAH patients.     

Relationship of preoperative serum CA-125 to survival in epithelial ovarian carcinoma

BACKGROUND: Epithelial carcinoma of the ovary has the highest death rate of any gynecologic malignancy in the developed world. The antigen CA-125 has been used over the past decade as a tumor marker for epithelial ovarian cancer and other cancers of coelomic epithelium. The object of this study was to see if the degree of elevation of preoperative CA-125 was related to length of survival in patients with epithelial ovarian carcinoma. METHODS: Eighty-two consecutive patients diagnosed with epithelial ovarian carcinoma were evaluated for their initial preoperative CA-125 level, time to recurrence, length of survival and level of primary debulking as well as International Federation of Gynecologists and Obstetricians stage, grade and histology. Ovarian tumors of low malignant potential were not included in the study. All patients had their initial surgery performed by one surgeon. RESULTS: Decreased length of survival was related to the degree of elevation of CA-125 prior to initial exploratory laparotomy (P = .047). The mean initial CA-125 for patients surviving five years or more (15 patients) was 899 U/mL, with an SD of +/- 1,880 U/mL, while the CA-125 for patients surviving less than five years (67 patients) was 1,978 U/mL, with an SD of +/- 1,852 U/mL (P = .02). Increased stage of disease at initial laparotomy showed a relationship to increased CA-125 (P < .0001). CONCLUSION: In epithelial ovarian carcinoma, high preoperative serum levels of CA-125 predict decreased length of survival.     

Percentages of cervical cytologic diagnoses as a quality assurance method

OBJECTIVE: To demonstrate empirically that the efficiency of rescreening to discover false negative cytologic diagnoses is greatly enhanced by prospectively stratifying accessions according to risk level. STUDY DESIGN: We stratified accessions from 11 clinical sources and established the rate of diagnoses according to three categories: (1) "within normal limits"/"benign cellular changes" (WNL/BCC), (2) "atypical squamous/glandular cells of undetermined significance" (ASCUS/AGCUS) and (3) "squamous intraepithelial lesion/invasive carcinoma" (SIL/CA). We then prospectively rescreened all negative smears from sources with rates of positive diagnoses (ASCUS/AGCUS and SIL/CA) in excess of 20% and 5% of negative smears from sources with rates of positive diagnoses < 20%. We compared the detection rates of false negatives on rescreening target groups with random rescreening of 10% of all negative smears. RESULTS: The rates of SIL/CA, ASCUS/AGCUS and WNL/BCC varied from 0 to 43%, 4% to 14% and 46% to 94%, respectively. Rescreening 10% of all negative smears revealed a false negative fraction of 3%; rescreening target groups revealed a false negative fraction of 5.9%. CONCLUSION: The yield of prospectively detected false negative diagnoses was significantly increased by targeting high-risk accession groups. When cytology laboratories serve diverse populations, stratifying accessions by risk to permit increased sampling from the proportionately higher risk categories is a simple and effective device to maximize the yield and benefit from rescreening.     

Effects of intracerebroventricular administration of beta-funaltrexamine on DAMGO-stimulated [35S]GTP-gamma-S binding in rat brain sections

In a retrospective study, a total of 120 ovarian cancer patients were paired in terms of staging, grading, patent age, and operative and cytostatic therapy. Half of the patients underwent radioimmunoscintigraphy for diagnostic purposes. From the point of view of possible adjuvant immunological therapy, we investigated to what extent patients with treated ovarian cancer benefit from the application of OC 125 in terms of survival time. In our study we have been able to show that at favorable stages (FIGO II) the patient benefitted more from a radioimmunoscintigraphy than at prognostically unfavorable stages (FIGO IV). Even within FIGO stage III we have been able to show, thanks to the large number of cases, that patients with an NED situation benefitted significantly more form radioimmunoscintigraphy in terms of survival than those with residual tumors. Throughout FIGO stage III, patients with radioimmunoscintigraphy showed significantly superior 5-year survival rates (p < 0.05) than those without radioimmunoscintigraphy. These data would appear to justify prospective studies to establish to what extent ovarian cancer patients benefit from an adjuvant application of OC 125 in terms of the 5-years survival rate and the relapse-free interval.     

Extraovarian peritoneal serous papillary carcinoma: studies of clinical and pathological features

OBJECTIVE: To study the clinicopathological features of extraovarian peritoneal serous papillary carcinoma (EPSPC). METHODS: The clinical pictures and pathological characteristics of 10 cases of EPSPC admitted to our hospital from 1980 through 1994 were studied retrospectively. Meanwhile, control studies were performed for 5 cases of ovarian serous papillary carcinoma and 4 cases of malignant peritoneal methothelioma. RESULTS: The ages of the 10 patients were between 44 and 77. The bilateral overies and fallopian tubes were all normal. The histomorphology as examined by photomicroscope and ultrastructural electromicroscope, the histochemistry determined by periodic acid-schiff (PAS) and Alcian blue stain and the immuno-histochemistry detected by carcinoembryonic antigen (CEA), AE1 and AE3 monoclonal antibody assays all revealed no difference between EPSPC and ovarian serous papillary carcinoma. The same is true for those between EPSPC and malignant methothelioma of peritonium except that the Alcian blue stain result would turned to be negative from positive after digesting with hyaluronidase and the micro-villi are longer for malignant peritoneal methothelioma as compared with EPSPC. CONCLUSIONS: The pathohistogenicity of EPSPC is not from ovaries but the methothelium of peritoneum, so called the secondary Müllarian system.     

Purification and characterization of the CA 125 tumor-associated antigen from human ascites

CA 125 is an antigenic determinant associated with epithelial ovarian carcinomas, which is recognized by a monoclonal antibody, OC 125. The biochemical structure, the immunological characteristics and the physiological function of CA 125 are unknown, principally because the molecule expressing it has not been purified to homogeneity. In the present study, we developed a single, one-step method for purifying CA 125 by column affinity chromatography, using the OC 125 antibody as immobilized ligand. The column proved to be highly specific for the purification of CA 125 from human ascites (HA). The antigen that eluted from the column has a specific activity of 6,240 +/- 120 U of CA 125/mg protein, the specific activity in the initial HA samples being 100 +/- 12 U/mg protein. The purified, immunoreactive CA 125 (IR-CA 125) was shown to be proteinaceous in nature. SDS-polyacrylamide gel electrophoresis (SDS-PAGE) and gel filtration characterization showed that the purified antigen exists as a high molecular weight (MW) complex, of up to 1.5 million daltons, which could be dissociated under strong denaturing conditions, giving rise to moieties with an apparent MW of 205 and 55 kD. IR-CA 125 was also associated with a lower MW protein, with an apparent MW of 10-15 kD. The 205-kD MW protein was immunoreactive CA 125, as measured by immunoradiometric assay after being electroeluted from the polyacrylamide gel. Furthermore, when the affinity-purified antigen was subjected to SDS-PAGE, followed by immunoblotting, the lane which was reactive with the iodinated OC 125 antibody gave rise to a band with a molecular mass of 205 kD. Our results suggest that, on an analytical scale, the affinity column is useful for the purification of CA 125. The purified antigen is being used to investigate the possible role of CA 125 in the growth, development and physiological characteristics of human ovarian carcinomas in in vitro studies.     

The level of urokinase-type plasminogen activator receptor is increased in serum of ovarian cancer patients

Ascites and serum of patients with ovarian carcinoma contain a soluble form of urokinase-type plasminogen activator receptor (uPAR). We now report that pro-uPA-Sepharose-purified uPAR from ascites of patients with ovarian carcinoma is the full-length molecule missing the glycosyl-phosphatidylinositol anchor, as determined by its amino acid composition. We next examined the significance of determining serum soluble uPAR (suPAR) levels in ovarian cancer patients using a specific ELISA and compared the results with serum concentrations of CA-125, an established diagnostic marker. Serum from pre- and postoperative ovarian cancer patients was assayed for suPAR and CA-125. The majority of the patients with ovarian cancer had enhanced preoperative serum levels of suPAR compared with healthy controls, but suPAR concentrations decreased after operation. Although uPAR was associated with most ovarian carcinomas, it appeared to be a less specific indicator for ovarian cancer than CA-125. On the other hand, suPAR was more specific for other types of solid tumors. Moreover, we have observed some cases of ovarian cancer that showed increase of suPAR but not of CA-125. The prognostic significance of serum suPAR assay for survival of ovarian carcinoma patients was evaluated using Cox's proportional hazards analysis. Our preliminary data show that high preoperative levels of suPAR were associated with worse survival of the patients, whereas CA-125 had no prognostic implications. This is the first report evaluating the assay of serum suPAR levels in ovarian cancer and analyzing its value as a tumor or prognostic marker.     

Effect of Saccharomyces boulardii against experimental oral infection with Salmonella typhimurium and Shigella flexneri in conventional and gnotobiotic mice

OBJECTIVE: To compare serum CA 125 assays with computed tomography (CT) and transvaginal ultrasound (TVUS) for early detection of disease recurrence in patients with ovarian cancer. METHODS: Sixty-two patients with non-mucinous epithelial ovarian cancer who had positive CA 125 levels (> 35 U/ml) were studied. We performed a retrospective review to determine the usefulness of serum CA 125 measurements. Setting the cut-off limit at either 35 U/ml or 16 U/ml, the accuracy of CA 125 measurements was compared with that of CT scanning, TVUS and operative findings at second-look laparotomy (SLL) in the early detection of recurrent tumors. RESULTS: Compared with SLL, both the specificity and the positive predictive value of CA 125 measurements were 100% at 16 and 35 U/ml. The sensitivity and the negative predictive value were 30.8 and 71.9%, respectively, below 35 U/ml and 53.8 and 79.3%, respectively, below 16 U/ml. The false-negative rate of CT was 36.1%. When the cut-off limit was reduced from 35 to 16 U/ml, 57.1% of patients considered to be in remission were reclassified as having persistent disease. A complete response confirmed by CT did not represent remission: CA 125 levels were 7.5-fold higher at the time of re-evaluation by CT. TVUS also lagged behind CA 125 assays in detecting disease recurrence. The sensitivity of ultrasound appeared to be lower than that of CT because it failed to detect extrapelvic lesions. CONCLUSION: A screening threshold (cut-off level) of 16 U/ml for CA 125 should be used to detect recurrent serous ovarian adenocarcinoma. Although ultrasound is a convenient method of detecting intrapelvic lesions, and has cost benefit, CT is necessary to detect extrapelvic recurrence. Neither CT nor ultrasound are more accurate than serial CA 125 assays in detecting disease recurrence.