Ann Acad Med Singap
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Ovarian cancer is predominantly a disease of postmenopausal women which presents at a late stage and has an overall 5-year survival of less than 30%. If detected at stage I, survival is dramatically increased and this would suggest that screening for ovarian cancer may reduce mortality. However, the inaccessibility of the ovaries and the absence of a confirmed premalignant condition make screening for preclinical disease difficult. ⋯ Multimodal screening using tumour markers and ultrasound in combination gives high sensitivity and specificity and is also the most cost-effective potential screening strategy. The sensitivity and specificity of these techniques are sufficient to warrant large-scale clinical trials of ovarian cancer screening. Three such trials are currently underway and, in due course, will establish whether any screening strategy will ultimately reduce mortality from ovarian cancer.
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Despite advances in antimicrobial therapy and medical support, septic shock remains a leading cause of death. Emerging adjunctive therapy for septic shock can be divided into those directed against bacterial components, those directed against host-derived inflammatory-mediators and those designed to limit tissue damage. ⋯ Therapies against endotoxin, tumour necrosis factor, interleukin-1 and platelet activating factor did not reduce mortality. Future effective therapies will probably use combination of agents depending upon the nature of the infection and the type of patient.