Evaluation of two different methods for vascular sampling by three-dimensional power Doppler angiography in solid and cystic-solid adnexal masses.

OBJECTIVE: To analyze two different methods for performing three-dimensional power Doppler angiography (3D-PDA) vascular sampling in solid and cystic-solid adnexal masses. METHODS: Twenty-one 3D-PDA volumes from 18 consecutive and unselected solid or cystic-solid adnexal masses (13 malignant and five benign) were analyzed. A single examiner (J. L. A.) acquired all the volumes according to a predetermined scanning protocol. Two different observers (one inexperienced and the other experienced) calculated 3D-PDA vascular indices (vascularization index (VI), flow index (FI) and vascularization flow index (VFI)) from solid tumor areas. First, manual sampling (Plane A, 15 degrees rotation-step) was performed, and 1 week later 5-cm(3) sphere sampling from the most vascularized area was carried out. The observers made a record of any difficulty that they encountered in delineating the solid areas of tumors or in distinguishing true tumor vessels from pre-existing vessels, the time spent performing each analysis was recorded and inter- and intraobserver reproducibility was evaluated for each method using intraclass correlation coefficients (ICC). RESULTS: In four (19.0%) of the 21 volumes sphere sampling could not be performed because it was not possible to obtain a sphere smaller than 5.5 cm(3). This happened in cases in which image zooming was used when acquiring the 3D volume. The inexperienced observer encountered more difficulty, but not significantly more, than the experienced observer when analyzing 3D-PDA volumes both by manual sampling (29% vs. 14% of cases) and 5-cm(3) sphere sampling (35% vs. 18% of cases). The mean time spent by the inexperienced observer was significantly greater (P < 0.001) than that spent by the experienced observer both for manual sampling (6.11 min vs. 1.85 min) and 5-cm(3) sphere sampling (2.93 min vs. 2.15 min). Contrary to the findings for the experienced observer, the inexperienced observer required less time to perform sphere sampling than they did manual sampling. Interobserver agreement was high for both methods: ICC for manual volume, 0.993; manual VI, 0.908; manual FI, 0.913; manual VFI, 0.914; sphere volume, 0.949; sphere VI, 0.954; sphere FI 0.850; and sphere VFI, 0.953. Intraobserver reproducibility was also high, with all ICCs above 0.99. CONCLUSIONS: Manual and 5-cm(3) sphere sampling are reproducible methods for 3D-PDA vascular sampling. Caution is required when image zoom is used at the time of acquiring the volume because this may prevent sphere sampling. Difficulties found in performing both manual and sphere sampling do not seem to significantly affect the reproducibility of Doppler index calculations.

Paying tuition and academic performance of students at the Zagreb University School of Medicine.

AIM: To assess whether the prospect of waiving tuition fees influences the academic performance of the students with the lowest admission test scores and consequent mandatory tuition. METHODS: We compared the 110 tuition-paying students with the students who did not have to pay tuition because they scored well on 1994-1997 admission tests to the Zagreb School of Medicine. We formed 3 control groups (high-, medium-, and low-ranked students on the admission test), each with the same number of students as the group of tuition-paying students. Students' performance was assessed after the first two academic years on the basis of their grades, number of tries to pass the same examination, the time needed to pass an examination after a course, and the number of repeated years. RESULTS: Of 110 tuition-paying students admitted to the School in the 1994-1997 period, 13 had their tuition permanently waived and were therefore excluded from the analysis. Tuition-paying students had an the average grade of 3.1 out of maximum 5, took each examination 1.7 times before passing it, needed more than five months to pass an examination, and repeated 1.5 years per student. Their performance parameters did not differ from those of the low-ranked group, but were significantly worse than of the medium-ranked and high-ranked groups. Students in the high-ranked group performed the best in all four parameters (the average grade was slightly above 4.0, they took each examination 1.2 times on average, needed less than 2 months to pass an examination, and repeated 0.3 years per student). CONCLUSION: The prospect of waiving tuition fees had no influence on students' performance. The students' rank on the admission test strongly correlates with their later academic success.

Curricular and extracurricular activities of medical students during war, Zagreb University School of Medicine, 1991-1995.

War, as a major human disaster, affects many aspects of life, including medical education. This report describes curricular and extracurricular activities of the students at the Zagreb University School of Medicine during the wars in Croatia and neighboring Bosnia and Herzegovina. Although condensed versions of the curricula were prepared in case of a major breakdown in civilian life, the school maintained the continuity and quality of its curriculum throughout the war. Students engaged in extracurricular activities related to medical aspects of the war, including organization of resuscitation and first aid courses, collecting medical documentation on war victims, humanitarian help to refugees, and peace-promoting activities. Some students joined mobile surgical teams on the battlefronts. After army service, most of them returned to the school and successfully continued with their studies. The school also accepted guest-students from other new states emerged from former Yugoslavia. The authors found that the students' engagement in extracurricular activities related to medicine was enormously beneficial both to the psychological well-being of the students and to the region's peace-building efforts.