Diagnostic Accuracy of Intraoperative Frozen Section in Ovarian Neoplasms: Experience in a Tertiary Oncology Centre.

Background Ovarian cancer is the second most common type of female genital tract malignancy. Treatment planning differs for benign, borderline and malignant subtypes of surface epithelial tumours and depends on accurate histopathological diagnosis. A pre-operative diagnosis of the nature of ovarian tumors is not always reliable. Frozen section is a valuable diagnostic tool in rapid intraoperative categorization of ovarian masses and thereby helps in planning the surgical management. Adequate management and treatment of ovarian carcinoma requires a complete surgical staging supported by frozen-section examination. To achieve this goal it is necessary to have a high level of accuracy. Objective To assess the accuracy of intra-operative frozen section in the diagnosis of various categories of ovarian neoplasm conducted in Rajiv Gandhi Cancer Institute and Research Centre. Method Intra-operative frozen sections for suspected ovarian neoplasm that underwent surgery as primary line of therapy at this institution were analyzed retrospectively from Jan. 2014 - Dec. 2015. The results of frozen section were compared with the final histopathology diagnosis on paraffin sections and the overall accuracy, sensitivity, specificity, positive and negative predictive values were determined. Result The study included 159 cases and the mean age of patients was 44.72±14.28 years (Range 19-75 years). The mean size of tumor was 12.5±5.9 cm. Sensitivity of frozen section for benign, borderline and malignant tumors was 98.53%, 73.33% and 94.74% respectively and the related specificities were 95.60%, 96.53% and 100% respectively. There were 150 concordant cases and 9 discordant cases. Overall diagnostic accuracy of frozen section was 94.33%. Conclusion Intra-operative frozen section diagnosis appeared to be an accurate and comparable technique for the histopathology diagnosis of ovarian tumors.

Mesial prefrontal cortex degeneration in amyotrophic lateral sclerosis: a high-field proton MR spectroscopy study.

BACKGROUND AND PURPOSE: Frontotemporal lobar degeneration is responsible for the cognitive abnormalities seen in patients with ALS. We sought to evaluate the in vivo neurochemical changes associated with this pathology indicative of neuronal loss and gliosis. MATERIALS AND METHODS: Twenty-four patients with ALS (2 with ALS-FTD) and 15 healthy controls were studied. High-field proton MR spectroscopy of the mesial prefrontal cortex was used to determine concentrations of NAA and mIns, markers of neuronal integrity and gliosis, respectively. Metabolite concentrations were correlated with cognitive tests (verbal fluency, ACE). RESULTS: NAA/mIns was decreased 17% (P =.002). Abnormalities were present to a lesser degree in the individual metabolites NAA (decreased 9%; P =.08) and mIns (increased 11%; P =.06) than the ratio of the 2 metabolites. These measures did not correlate significantly with verbal fluency or the ACE. CONCLUSIONS: Prefrontal lobe degeneration exists in patients with ALS as indicated by an abnormal mesial prefrontal cortex neurochemical profile. Further study is necessary to determine the potential utility of the NAA/mIns ratio as a biomarker for frontal lobe degeneration in ALS.

Effects of carbon dioxide and ozone treatments on the volatile composition and sensory quality of dry-cured ham.

Randomized complete block designs with 3 replications were utilized to evaluate the effects of carbon dioxide (CO(2)) (0% at 96 h, 60% at 48 h, and 60% at 96 h) and ozone (O(3)) (0 and 175 ppm for 48 h) on the volatile flavor compound concentrations in dry-cured ham. Minimal differences existed in the presence and concentration of aroma active compounds in both CO(2) and O(3) fumigated hams but phenols were slightly more prevalent (P < 0.05) in the CO(2) treatments and oxidation compounds were slightly elevated (P < 0.05) in the ozone treated samples when compared to the control. Triangle tests (n = 54 and 56) indicated that consumers could not discern (P > 0.75) between the control hams and the hams that were fumigated with CO(2) and O(3), respectively. This study revealed that there were minimal aroma/flavor differences among the ham treatments between 0 and 60% CO(2) for 96 h; and also between 0 and 175 ppm O(3).

MRI appearance of florid cystic endosalpingiosis of the uterus: a case report.

Endosalpingiosis is a non-neoplastic proliferation of ectopic tubal epithelium. It may be found incidentally or the patients may present with chronic pelvic pain. It may resemble a gynecologic malignancy on imaging findings and clinicians and radiologists should be aware of this benign entity to render a correct diagnosis and to avoid over-treatment. We report here the MR imaging appearance of a case of florid cystic endosalpingiosis.

Effects of phosphine and methyl bromide fumigation on the volatile flavor profile and sensory quality of dry cured ham.

In separate experiments, randomized complete block designs with three replications were utilized to evaluate the effects of phosphine (PH(3)) (0, 200 and 1000ppm for 48h) and methyl bromide (MB) (0, 4, 8, 16, and 32mg/L for 48h) fumigation concentration on the volatile flavor compound concentrations in dry cured ham. Minimal differences existed (P>0.05) in the presence and concentration of aroma active compounds in both PH(3) and MB fumigated hams but sulfur and oxidation compounds were more prevalent (P<0.05) in the fumigated treatments when compared to the control. As phosphine fumigation concentration increased, the residual concentration of phosphine also increased in the hams (P<0.05), but all samples contained levels that are lower than the legal limit of phosphine allowed in stored food products (0.01ppm) in the United States. A triangle test (n=56) indicated that consumers could not discriminate (P>0.75) between the control hams and those that were fumigated with PH(3). Minimal aroma/flavor differences existed among MB, PH3 and control hams, and dry cured ham that was fumigated with PH(3) was safe for consumption based on residual phosphine concentrations in the meat tissue.

Use of cluster analysis and preference mapping to evaluate consumer acceptability of choice and select bovine M. longissimus lumborum steaks cooked to various end-point temperatures.

Consumer research was conducted to evaluate the acceptability of choice and select steaks from the Longissimus lumborum that were cooked to varying degrees of doneness using demographic information, cluster analysis and descriptive analysis. On average, using data from approximately 155 panelists, no differences (P>0.05) existed in consumer acceptability among select and choice steaks, and all treatment means ranged between like slightly and like moderately (6-7) on the hedonic scale. Individual consumers were highly variable in their perception of acceptability and consumers were grouped into clusters (eight for select and seven for choice) based on their preference and liking of steaks. The largest consumer groups liked steaks from all treatments, but other groups preferred (P<0.05) steaks that were cooked to various end-point temperatures. Results revealed that consumers could be grouped together according to preference, liking and descriptive sensory attributes, (juiciness, tenderness, bloody, metallic, and roasted) to further understand consumer perception of steaks that were cooked to different end-point temperatures.

Sulfuryl fluoride fumigation effects on the safety, volatile composition, and sensory quality of dry cured ham.

A randomized complete block design with three replications was utilized to evaluate the effects (P<0.05) of various fumigation concentrations of sulfuryl fluoride (SF) (0, 12, 24, 36 and 72 mg/L) on the fluoride, sulfuryl fluoride, and volatile flavor compound concentrations in dry cured ham. Fluoride and SF concentrations increased (P<0.05) in dry cured hams as SF fumigation concentration increased, but all samples contained fluoride and SF concentrations below the legal limits of 20 and 0.01 ppm, respectively. Minimal differences existed (P>0.05) in the presence and concentration of aroma active compounds, but oxidation compounds were slightly more prevalent (P<0.05) in the 72 mg/ml treatment when compared to the control. A triangle test (n=54) indicated that consumers could not discern (P>0.75) between hams that were fumigated with SF at 0 and 36 mg/ml. This study revealed that there were minimal aroma/flavor differences among the ham treatments between 0 and 36 mg/ml, and that dry cured ham that was fumigated with SF was safe and met legal requirements for consumption.

Case report. MR appearance of cervical donovanosis mimicking carcinoma of the cervix.

Donovanosis is an acquired sexually transmitted disease predominantly affecting the external genitalia. The cervix is an uncommon site of involvement, and can clinically mimic carcinoma of the cervix. The imaging (MR) appearance of donovanosis has not been described previously in the literature. We report a case wherein the MR appearance of cervical donovanosis is indistinguishable from carcinoma of the cervix.

Relationship between cariogenic diet and dental caries as evaluated from a 5-day diet diary in 4-12 year-old children.

A preliminary study was conducted on 50 children in the age group of 4-12 years, who were divided into two groups on the basis of decayed, missing and filled teeth (DMFT) i.e. Group A (1-3) and Group B (> 3). A 5-day diet diary was evaluated and Sweet Score, Total Sugar Exposure, At Meal Sugar Exposures and Between Meal Sugar Exposure were calculated. There was statistically significant difference between the two groups in relation to Sweet Score and Total sugar Exposures. Between Meal Sugar Exposure and At Meal sugar exposure did not differ significantly.

Direct costs of emergency medical care: a diagnosis-based case-mix classification system.

STUDY OBJECTIVE: To develop a diagnosis-based case mix classification system for emergency department patient visits based on direct costs of care designed for an outpatient setting. DESIGN: Prospective provider time study with collection of financial data from each hospital's accounts receivable system and medical information, including discharge diagnosis, from hospital medical records. SETTING: Three community hospital EDs in Los Angeles County during selected times in 1984. MEASUREMENTS AND MAIN RESULTS: Only direct costs of care were included: health care provider time, ED management and clerical personnel excluding registration, nonlabor ED expense including supplies, and ancillary hospital services. Indirect costs for hospitals and physicians, including depreciation and amortization, debt service, utilities, malpractice insurance, administration, billing, registration, and medical records were not included. Costs were derived by valuing provider time based on a formula using annual income or salary and fringe benefits, productivity and direct care factors, and using hospital direct cost to charge ratios. Physician costs were based on a national study of emergency physician income and excluded practice costs. Patients were classified into one of 216 emergency department groups (EDGs) on the basis of the discharge diagnosis, patient disposition, age, and the presence of a limited number of physician procedures. Total mean direct costs ranged from $23 for follow-up visit to $936 for trauma, admitted, with critical care procedure. The mean total direct costs for the 16,771 nonadmitted patients was $69. Of this, 34% was for ED costs, 45% was for ancillary service costs, and 21% was for physician costs. The mean total direct costs for the 1,955 admitted patients was $259. Of this, 23% was for ED costs, 63% was for ancillary service costs, and 14% was for physician costs. Laboratory and radiographic services accounted for approximately 85% of all ancillary service costs and 38% of total direct costs for nonadmitted patients versus 80% of ancillary service costs and 51% of total direct costs for admitted patients. CONCLUSION: We have developed a diagnosis-based case mix classification system for ED patient visits based on direct costs of care designed for an outpatient setting which, unlike diagnosis-related groups, includes the measurement of time-based cost for physician and nonphysician services. This classification system helps to define direct costs of hospital and physician emergency services by type of patient.

Case-mix classification for emergency departments.

This study developed a patient classification system for hospital emergency departments. Conducted at three Los Angeles area community hospitals, data collection included coding and abstracting medical records information, patient billing information detailing each patient's utilization of hospital services, and patient-specific provider time measuring each provider's time spent in direct patient care activities. A 20,000 patient sample was derived containing clinical and resource use variables, including physician, emergency department, and ancillary service direct costs. Patient visits were classified into 216 homogeneous groups, or patient clusters, using four types of variables: diagnoses, disposition, age, and physician procedures. The Emergency Department Groups (EDGs) appear to represent a clinically coherent system for classifying emergency department visits; moreover, the groups were found to explain 63% of the overall variance in resource use (total direct cost) suggesting that the EDGs may offer a useful tool for hospital cost control and reimbursement reform.