Cancer antigen 125 in ovarian cancer surveillance: a decision analysis model.

We used decision analysis techniques with Markov cohort modeling to examine the role of cancer antigen 125 (CA-125) in follow-up surveillance strategies among patients with advanced ovarian cancer. Utilities were derived from a societal perspective.Using quality-adjusted life years (QALYS) as the outcome variable, the value of CA-125 monitoring for asymptomatic women with ovarian cancer was found to be reduced as compared with a strategy that includes CA-125 testing. Decisions to include CA-125 in surveillance strategies for ovarian cancer patients should be made after discussion with full disclosure of the preference-sensitive nature of CA-125. The model demonstrates that preferences and perspective can influence decisions in cancer care.

Evidence for correlation of objective and subjective measures of nasal airflow in patients with common cold.

OBJECTIVES: To utilize posterior rhinomanometry and conductance, as units of measurement, to further investigate the relationship between subjective and objective measures of nasal airflow. DESIGN: A prospective, observational study. SETTING: Common Cold Research Centre. PARTICIPANTS: Sixty healthy volunteers from the staff and student population of Cardiff University with an upper respiratory tract infection. MAIN OUTCOMES MEASURES: To determine correlations between visual analogue scores (VAS) and posterior rhinomanometry for total, unilateral, high and low conductance groups. RESULTS: No correlation was found between total VAS and total conductance (r = 0.17, P = 0.10). A substantially significant correlation was found between unilateral VAS and unilateral conductance (rho = 0.50, P < 0.001). The unilateral VAS and conductance were highly correlated for the low total conductance group (rho = 0.61, P < 0.001). CONCLUSIONS: Posterior rhinomanometry allows actual measurement of the combined and unilateral conductance of nasal passages. The units of conductance, as opposed to resistance, allow totally obstructed nasal passages to be included in analysis. Visual analogue scores and conductance correlate strongly in unilateral measures for participants with a low total nasal conductance. Posterior rhinomanometry and units of conductance are recommended for future studies investigating the relationship between objective and subjective measures of nasal airflow.

Pseudomyxoma peritonei: a case series and review of the literature.

The purpose of this study was to use descriptive methodology to study the management of patients with pseudomyxoma peritonei (PMP) at the Princess Margaret Hospital. This is a case series of patients with a diagnosis of PMP treated between January 1, 1995 and December 31, 2001. A health record search using the morphology code for PMP was done and identified 70 patients. Additionally, an unrestricted Medline search was conducted between 1990 and 2002 for PMP. Eight cases of PMP were treated by the Gynecologic Oncology service at Princess Margaret Hospital during the study period. The patients ranged in age from 43 to 84 and presented with a pelvic mass and/or increasing abdominal girth. All but two patients underwent appendectomy as part of their surgery. Postoperative management was by gynecologic oncology for seven of eight patients. An appendiceal origin was confirmed for six patients and highly suspicious for one patient. The remaining patient underwent appendectomy, but it was not sufficiently sectioned for diagnosis. Chemotherapy was given to patients in a non-uniform fashion. Removal of mucinous tumors of the ovary should include appendectomy. Consultation from a general surgical oncologist should be sought where appendiceal origin is confirmed. Coding errors may occur in medical records at a frequency greater than is anticipated.

Prophylactic antibiotics for abdominal hysterectomy: indication for low-risk Canadian women.

OBJECTIVE: To determine whether prophylactic antibiotics decrease the risk of infectious morbidity after total abdominal hysterectomy (TAH) in women at low risk for infection. METHODS: An analysis of data from 1570 women undergoing planned TAH at 15 secondary and tertiary hospitals in Nova Scotia, Ontario, and Quebec, who agreed to participate in a centrally randomized controlled trial of vaginal antisepsis with povidone-iodine gel compared to no gel after the standard preoperative vaginal preparation with povidone-iodine solution. RESULTS: Prophylactic antibiotics were used in 993 of 1570 women (63%). Appropriately timed prophylactic antibiotics decreased infectious morbidity (odds ratio [OR], 0.65; 95% confidence interval [CI], 0.50-0.85; P < .002). After controlling for risk factors for infection and study centre, the protective effect was even more pronounced (adjusted OR, 0.51; 95% CI, 0.36-0.73). Prophylactic antibiotics were associated with decreases in abdominal wound infection (OR, 0.45; 95% CI, 0.30-0.66) and pelvic infection (OR, 0.49; 95% CI, 0.26-0.92). CONCLUSION: Women who did not receive prophylactic antibiotics had a higher surgical infection rate. Prophylactic antibiotics should be recommended for all women undergoing TAH.

Ovarian cancer patients and hormone replacement therapy: a systematic review.

OBJECTIVE: Although the majority of patients with ovarian cancer are menopausal, approximately one-third are premenopausal at the time of diagnosis. Little information is available concerning the impact of hormone replacement therapy (HRT) on the clinical outcomes of patients previously treated for ovarian cancer. The objective of this review is to determine whether there is any adverse impact on survival among women with ovarian cancer on HRT. METHODS: A protocol was developed in advance of commencement of this systematic review. It detailed the plan for the search strategy, selection criteria for studies, and methods for data collection and analysis. No limitation of study design was made, and the details of the search strategy are described in the text of the review. Two reviewers independently evaluated the eligibility of all studies and abstracted the data. RESULTS: One randomized trial and two observational studies are included. Due to methodological heterogeneity of the included studies, results have not been pooled in a meta-analysis. The randomized trial presented differences between the intervention and control groups on median overall survival (44 months vs. 34 months/HRT vs. No-HRT) and disease-free survival (34 months vs. 27 months/HRT vs. No-HRT) that were not significant. Similarly, there were nonsignificant differences in survival and recurrence rates in the two included cohort studies. CONCLUSIONS: This is a comprehensive systematic review of the evidence concerning HRT in ovarian cancer patients. Until more evidence becomes available, it appears that HRT is acceptable for patients with ovarian cancer as part of supportive and symptomatic therapy.

Phylloides tumor of the breast: a report of 14 cases.

The objective of this retrospective study is to determine the role of radiation therapy in the management of benign phylloides tumors. Fourteen patients with a diagnosis of benign phylloides tumor (PT) and registered at the Princess Margaret Hospital are included in the study. Definitive surgery consisted of either lumpectomy in seven patients or mastectomy in the other seven patients. One patient died of her disease, and the remaining patients had no evidence of disease at last follow-up (median 38.4 months). Among these 13 patients, 4 had at least one recurrence and the recurrence rate was higher for the group who underwent lumpectomy (43% compared with 28%). One patient was treated by lumpectomy and adjuvant radiation therapy, and had no subsequent recurrence (follow-up time 35.5 months). The role for radiation therapy in the management of this disease remains unclear.