Vascular Endothelial Growth Factor Receptor 2 (VEGFR2) rs2071559 Gene Polymorphism and the Risk of Gliomas: A Systematic Review and Meta-Analysis.

BACKGROUND: A glioma is a form of tumor that is abundant in blood vessels. Vascular endothelial growth factor receptor (VEGFR) and its receptor 2 (VEGFR2) are important in the process of angiogenesis. The relationship between VEGFR2 rs2071559 and glioma development is currently uncertain. The present study aims to analyze the correlation between VEGFR2 rs2071559 gene polymorphism and the susceptibility to gliomas. METHODS: A thorough search was carried out in the Cochrane Library, Scopus, and Medline databases from inception until 20 February 2024 using a mix of pertinent keywords. We used random-effects models to examine the odds ratio (OR) and reported the results together with their respective 95% confidence intervals (CIs). RESULTS: A total of six studies were incorporated. The results of our meta-analysis indicated that all genetic models of VEGFR2 rs2071559 gene polymorphism, starting from dominant (OR 1.40; p < 0.00001), recessive (OR 1.52; p < 0.0001), CC genotype (OR 1.78; p < 0.00001), CT genotype (OR 1.30; p < 0.0001), and C allele (OR 1.41; p < 0.00001), were associated with a higher risk of developing gliomas. The subgroup analysis revealed a higher OR for studies with a sample size of ≥500, originated from Asia, with a mean age of ≥42.3 years, and a male prevalence of <57%. CONCLUSIONS: This study suggests that VEGFR2 rs2071559 gene polymorphism is associated with a higher risk of gliomas.

The role of nutrition-based index in predicting survival of breast cancer patients: A systematic review and meta-analysis.

Background: Prognostic nutritional index (PNI) and Controlling Nutritional Status (CONUT) are two model that incorporates the role of inflammation and nutrition factors to predict the progression of tumor. The primary objective of this investigation is to examine the ability of PNI and CONUT score for predicting the survival in breast cancer patients. Methods: A comprehensive search was conducted on the Cochrane Library, Scopus, Europe PMC, and Medline databases up until August 14th, 2023, utilizing a combination of relevant keywords. This review incorporates literature that examines the relationship between PNI, CONUT, and survival in breast cancer. We employed random-effect models to analyze the hazard ratio (HR) and present the outcomes together with their corresponding 95 % confidence intervals (CI). Results: A total of sixteen studies were incorporated. The results of our meta-analysis indicated that high PNI was associated with better overall survival (OS) (HR 0.38; 95%CI: 0.28-0.51, p < 0.00001, I2 = 32 %), but not disease-free survival (DFS) (HR 0.60; 95%CI: 0.33-1.10, p = 0.10, I2 = 78 %) than low PNI in breast cancer patients. Meta-analysis also indicated that high CONUT was associated with worse OS (HR 1.66; 95%CI: 1.21-2.28, p = 0.002, I2 = 78 %) and worse DFS (HR 2.09; 95%CI: 1.60-2.73, p < 0.00001, I2 = 41 %) in breast cancer patients. Conclusions: This study suggests the prognostic role of both PNI and CONUT score for predicting survival in breast cancer patients.

Warming Prior to Heel Stick: Blood Sample Quality and Infant Comfort-A Randomized Controlled Trial.

BACKGROUND: Capillary blood sampling (heel stick) in infants is commonly performed in neonatal care units. Before the procedure, warming the infant's heel is often a customary practice, but no consensus exists on the most effective heel-warming method. PURPOSE: To compare the effects of routinely used warming methods (glove, gel pack, or blanket) applied prior to heel stick on blood sample quality and infant's comfort. METHODS: This prospective, double-blind, randomized controlled trial conducted in the neonatal intensive care unit included infants (postmenstrual age of ≥28 + 0 weeks and ≤43 + 6 weeks) who were computer-randomized to 1 of 3 warming methods.The primary outcome was blood flow velocity at sampling. Secondary outcomes were hemolysis index, infant COMFORTneo score, and frequency of postprocedure skin injuries. In addition, irrespective of the warming method used, the correlation between heel skin temperature and postprocedure heel skin injury was analyzed. RESULTS: A total of 176 heel warmings were successfully randomized, and 173 were analyzed. Despite a significant difference in obtained heel skin temperature after warming between the 3 warming methods ( P = .001), no difference in blood flow velocity ( P = .91), hemolysis index ( P = .99), or COMFORTneo score ( P = .76) was found. Baseline skin temperatures above 37.0°C were associated with higher incidences of skin injury, and skin temperatures after warming were significantly higher in skin-injured heels ( P = .038). IMPLICATIONS FOR PRACTICE AND RESEARCH: All 3 warming methods had similar effects on blood sample quality and infant's comfort. However, excessive warming of the heel should be avoided to prevent skin injuries.

Vitamin D supplementation for improving sperm parameters in infertile men: A systematic review and meta-analysis of randomized clinical trials.

Objective: Vitamin D has been hypothesized to have a potential role in altering sperm motility and metabolism. However, experimental studies have demonstrated inconsistent results between vitamin D and sperm parameters. This study aims to investigate the role of vitamin D supplementation to improve sperm parameters in infertile men. Methods: This is a systematic review and meta-analysis study. We comprehensively conducted a search on ClinicalTrials.gov, IRCT.ir, Europe PMC, and PubMed and collected published studies on vitamin D supplementation and sperm parameters for infertile men. The risk of bias was assessed by using Risk of Bias version 2 (RoB v2) and the statistical analysis was performed by using Review Manager 5.4 software. Results: Five trials with a total of 648 infertile men were included. Our meta-analysis showed that supplementation with vitamin D may significantly improve total sperm motility [mean difference 4.96 (95% CI 0.38, 9.54), p = 0.03, I2 = 69%], progressive sperm motility [mean difference 4.14 (95% CI 0.25, 8.02), p = 0.04, I2 = 89%], and normal sperm morphology [mean difference 0.44 (95% CI 0.30, 0.57), p < 0.00001, I2 = 0%] better than placebo in infertile men. However, total sperm count (p = 0.15), sperm concentration (p = 0.82), and semen volume (p = 0.83) did not differ significantly between two groups. Conclusions: Vitamin D supplementation may improve sperm motility, progressive sperm motility, and morphology in infertile men. Vitamin D supplementation may be considered in managing male fertility issue.

Syringocystadenoma papilliferum in a 20-year-old adult: a case report and literature review.

Syringocystadenoma papilliferum is a rare, benign hamartomatous neoplasm of skin adnexal originating from pluripotent cells differentiating into either apocrine or eccrine sweat glands. It usually appears at birth, during infancy or puberty and commonly located at head and neck. This case report illustrates a rare occurrence at an atypical anatomical location and unusual onset. In this case report, we report a 20-year-old female with a chief complain of solitary pink-brown color fleshy plaque with soft-medium consistency on her left flank region since the last 7 months. She underwent complete surgical excision and histopathology examination, which confirmed the diagnosis as syringocystadenoma papilliferum without sign of malignancy, with main characteristics histologically include cystic invaginations from the epidermis lined by double layers of epithelial and myoepithelial cells. Despite having benign characteristics, rare transformations to malignancy have been reported. Therefore, complete surgical excision and histopathology examination should be done in suspicion of syringocystadenoma papilliferum.

Using artificial intelligence in a primary care setting to identify patients at risk for cancer: a risk prediction model based on routine laboratory tests.

OBJECTIVES: To evaluate the ability of an artificial intelligence (AI) model to predict the risk of cancer in patients referred from primary care based on routine blood tests. Results obtained with the AI model are compared to results based on logistic regression (LR). METHODS: An analytical profile consisting of 25 predefined routine laboratory blood tests was introduced to general practitioners (GPs) to be used for patients with non-specific symptoms, as an additional tool to identify individuals at increased risk of cancer. Consecutive analytical profiles ordered by GPs from November 29th 2011 until March 1st 2020 were included. AI and LR analysis were performed on data from 6,592 analytical profiles for their ability to detect cancer. Cohort I for model development included 5,224 analytical profiles ordered by GP's from November 29th 2011 until the December 31st 2018, while 1,368 analytical profiles included from January 1st 2019 until March 1st 2020 constituted the "out of time" validation test Cohort II. The main outcome measure was a cancer diagnosis within 90 days. RESULTS: The AI model based on routine laboratory blood tests can provide an easy-to use risk score to predict cancer within 90 days. Results obtained with the AI model were comparable to results from the LR model. In the internal validation Cohort IB, the AI model provided slightly better results than the LR analysis both in terms of the area under the receiver operating characteristics curve (AUC) and PPV, sensitivity/specificity while in the "out of time" validation test Cohort II, the obtained results were comparable. CONCLUSIONS: The AI risk score may be a valuable tool in the clinical decision-making. The score should be further validated to determine its applicability in other populations.

Intracranial myxoid angiomatoid fibrous histiocytoma with "classic" histology and EWSR1:CREM fusion providing insight for reconciliation with intracranial myxoid mesenchymal tumors.

Angiomatoid fibrous histiocytoma (AFH) is an uncommon soft tissue neoplasm that can exhibit diverse morphological features, including myxoid change. Rarely, the tumor occurs intracranially and poses considerable diagnostic challenges to neuropathologists. This is compounded by a recently coined entity, referred to as intracranial myxoid mesenchymal tumor (IMMT). These tumors show significant overlaps with intracranial myxoid AFH from clinicopathological and molecular genetic viewpoints. We described an unusual intracranial tumor in a 30-year-old man. The tumor exhibited "classic" histological features of myxoid AFH and EWSR1:CREM fusion, a relatively novel variant of EWSR1:CREB family fusion, first identified in IMMT. We also performed a comprehensive literature review comparing the clinicopathological features of intracranial AFHs and IMMTs. Peritumoral lymphoplasmacytic cuffing appears to be the only morphological finding that is consistently absent in reported cases of IMMT while being present in most intracranial AFHs. Otherwise, both tumors showed considerable overlaps in clinical, histological, and immunohistochemical features and have a common molecular genetic signature of EWSR1:CREB family fusion, including EWSR1:CREM fusion. Our case appeared to be the first described EWSR1:CREM-fused intracranial tumor to show prominent peritumoral lymphoplasmacytic cuffing and myxoid change in addition to most of the other "classic" morphologic features of AFH. As such, while the current literature appears to be lacking when it comes to defining intracranial myxoid AFH and IMMT as separate nosological entities, they likely represent a morphological spectrum of a common entity characterized by EWSR1 rearrangement, akin to solitary fibrous tumors and hemangiopericytomas with the signal transducer and activator of transcription 6 gene (STAT6) rearrangement.

The Multifaceted Appearance of Supratentorial Ependymoma with ZFTA-MAML2 Fusion.

Ependymomas are glial neoplasms with a wide morphological spectrum. The majority of supratentorial ependymomas are known to harbor ZFTA fusions, most commonly to RELA. We present an unusual case of a 9-year-old boy with a supratentorial ependymoma harboring a noncanonical ZFTA-MAML2 fusion. This case had unusual histomorphological features lacking typical findings of ependymoma and bearing resemblance to a primitive neoplasm with focal, previously undescribed myogenic differentiation. We discuss the diagnostic pitfalls in this case and briefly review the histological features of ependymoma with noncanonical gene fusions. Our report underscores the importance of molecular testing in such cases to arrive at the correct diagnosis. Supratentorial ependymomas with noncanonical fusions are rare, and more studies are necessary for better risk stratification and identification of potential treatment targets.

Clinicopathological associations and prognostic values of IDH1 gene mutation, MGMT gene promoter methylation, and PD-L1 expressions in high-grade glioma treated with standard treatment.

INTRODUCTION: the objective was to evaluate the impact of IDH1 R132H mutation, MGMT methylation and PD-L1 expression in high grade glioma that received standard therapy (surgery, radiation and chemotherapy) to overall survival (OS). METHODS: this is a retrospective study of 35 high grade glioma cases. Genotyping of IDH1 gene alteration on the mutation hotspot R132 (Sanger sequencing method with Applied Biosystems 3500 Genetic Analyzer), EZ DNA Methylation-Gold kit (Zymo Research) is used to study the methylation, Cell line BT549 (ATCC HTB-122) and HCT-116 (ATCC CCL-247) were used as unmethylated control and partially methylated control respectively. Anti-human PD-L1 antibody clone E1L3N®from Cell Signalling Technology (USA) and Rabbit XP®were used to see PDL-1 expression. RESULTS: anaplastic astrocytoma cases had more MGMT promoter methylation (50%) than glioblastoma multiforme (GBM) (20%), more IDH1 R132H mutation (42%) than GBM (4.3%). Immunohistochemistry tumor proportion score method (TPS) identified 17% and 8.7% were PD-L1 positive in AA and GBM groups, respectively. Cases with IDH1 R132H mutation and MGMT methylation still showed better OS although with high PD-L1 expression. CONCLUSION: IDH1 R132H mutation and MGMT methylation were good prognostic markers. High expression of PD-L1 apparently might not indicate poor overall survival in the presence of IDH1 R132 mutation and MGMT methylation.

Central nervous system neuroepithelial tumors with MN1-alteration: an individual patient data meta-analysis of 73 cases.

MN1 alteration characterizes a recently described group of neuroepithelial tumors with varied morphological features. In cIMPACT-NOW update 6, only those with astroblastoma morphology has been accepted as a newly recognized tumor type, whereas the rest of morphological variants are considered lesions sub-judice. We perform an individual patient data meta-analysis of MN1-altered neuroepithelial tumors comprising a total of 73 cases, in order to study the survival data and predictive markers for better diagnosis and management of this rare molecular entity. The 5- and 10-year progression-free survival are 38% and 0%, whereas the 5- and 10-year overall survival are 89% and 55%, respectively. Among all the morphological variants of MN1-altered tumor, astroblastoma morphology is significantly associated with an improved overall survival, emphasizing the importance of providing an integrated histologic and molecular diagnosis. Histological grading within the molecularly-defined MN1-altered astroblastoma remains controversial. In tumors with astroblastoma morphology, the odds of MN1-altered status among patients less than 15-year-old is 10.5 times that of those 15-year-old and older, and female of 9.4 times that of the male gender. Gross tumor resection appears as main treatment modality for better disease control based on observational data.

Quantification of Cell-Free HER-2 DNA in Plasma from Breast Cancer Patients: Sensitivity for Detection of Metastatic Recurrence and Gene Amplification.

The purpose of this study was to quantify the free-circulating plasma HER-2 DNA (cfHER-2 DNA) and to assess the ability of analysis to discriminate between patients with primary breast cancer and healthy controls in order to detect metastatic recurrence in comparison with serum HER-2 protein and also HER-2 gene amplification. The study population consisted of 100 patients with primary breast cancer and 50 healthy female donors. An additional 22 patients with metastases were subsequently included. cfHER-2 DNA was quantified with a quantitative PCR method together with a reference gene. RESULTS: Using a cut-off of 2.5 for the ratio of the cfHER-2 DNA/reference gene, three (of 15) tissue HER-2-positive patients had a ratio >2.5 prior to the detection of metastatic disease. In the post-metastatic/pre-chemotherapy setting, 11 (of 23) tissue HER-2-positive patients with metastases had a ratio >2.5. There was no difference between absolute preoperative cfHER-2 DNA values for patients with primary breast cancer and those for healthy controls. There was no difference between cfHER-2 DNA values taken within nine months of development of the metastatic disease and the levels in patients without metastases, but there was a significant difference in the corresponding serum HER-2 protein levels in the tissue HER-2-positive patient group. CONCLUSION: Amplified HER-2 DNA can be detected in plasma when using a ratio between cfHER-2 DNA and a reference gene. cfHER-2 DNA could not be used to discriminate between patients with primary breast cancer and healthy controls, and could not predict the development of metastatic disease.

Serum HER-2: sensitivity, specificity, and predictive values for detecting metastatic recurrence in breast cancer patients.

PURPOSE: The aim of this study was to determine the sensitivity, specificity, and predictive values of serum HER-2 for detecting metastatic recurrence in breast cancer patients. METHODS: In the period 2004-2009, serum HER-2 was measured in 1,348 patients with breast cancer: 837 during routine controls at the Oncology Department and 511 newly diagnosed. The patients with positive serum HER-2, all the newly diagnosed and 1/5 of the patients with negative serum HER-2 were followed with serum HER-2 measurements every 3-12 months using the ADVIA Centaur assay. Tissue HER-2 status was determined by IHC and FISH. Patients with a single serum HER-2 value above 15 µg/L were considered serum positive. Metastases were diagnosed according to the routine clinical methods using imaging/biopsy. RESULTS: Of the 862 patients included, 21 had unavailable medical records and were excluded. Patients with unknown tissue status (218), missing blood sample before recurrence (74), or presenting with primary metastatic disease (9) were also excluded. Blood samples before the detection of metastatic recurrence were available in 154 tissue HER-2-positive and in 386 tissue HER-2-negative patients. The sensitivity, specificity, positive and negative predictive values in tissue HER-2-positive patients with values above 15 µg/L were 69 % (95 % CI 53-80 %), 71 % (62-78), 47 % (35-59), and 86 % (77-91), respectively. Combining the cutoff value of 15 µg/L with a delta value of >100 % increase from individual baseline after primary therapy, or increasing the cutoff to 32 µg/L raises the specificity to 96 %, but lowers the sensitivity to 50 and 47 %, respectively. Preoperative serum HER-2 values were accessible in 69 tissue-positive patients, but no significant association was found with later development of metastases. The sensitivity, specificity, positive and negative predictive values in tissue HER-2-negative patients with values above 15 µg/L were 33 % (21-47), 77 % (73-82), 18 % (12-27), and 88 % (84-91), respectively. CONCLUSIONS: Monitoring tissue HER-2-positive breast cancer patients with serum HER-2 has a sufficient sensitivity to detect metastatic recurrence, while its use in monitoring of tissue HER-2-negative patients is unsatisfactory.

Serum HER-2 predicts response and resistance to trastuzumab treatment in breast cancer.

BACKGROUND: Serum HER2 (S-HER2) was approved in 2003 by the US Food and Drug Administration (FDA) for monitoring trastuzumab treatment in tissue HER2 positive breast cancer patients. Information of the value of S-HER2 is scarce. We hypothesised that S-HER2 would reflect the clinical effect of trastuzumab. METHODS: We followed 48 patients eligible for trastuzumab treatment for up to 6 years or until death. S-HER2 was measured on an ADVIA Centaur System and S-Trastuzumab was measured by an in-house developed fluorescent enzyme immunoassay system on the ImmunoCap 100. RESULTS: A decrease in S-HER2 of ≥ 20% was correlated to no progression in the disease in 20 out of 21 clinical courses (p<0.0001). An increase in S-HER2 of ≥ 20% was correlated to progression in the disease in 40 out of 44 clinical courses (p<0.0001). Patients with no recurrence after trastuzumab treatment (n=18) had a median S-HER2 concentration of 10.5 µg/L, whereas patients alive with recurrence (n=13) had a median S-HER2 of 20.1 µg/L (p=0.002). Patients who died prompted by recurrence (n=17) had a median S-HER2 of 232.4 µg/L at latest measurement before death (p=<0.0001) compared to patients without recurrence. In two patients with S-HER2 values above 1000 µg/L the concentrations of S-trastuzumab were measured below the target trough concentration in serum of 10 mg/L. CONCLUSIONS: Decreasing values of S-HER2 predicts response to treatment whereas increasing levels predict resistance. S-HER2 above 1000 µg/L warns that standard doses of trastuzumab may be insufficient as reflected by low concentrations of S-trastuzumab.

Sensitivity of CA 15-3, CEA and serum HER2 in the early detection of recurrence of breast cancer.

BACKGROUND: The aim of this project was to investigate the sensitivity of CA 15-3, CEA and HER2 in the early diagnosis of metastatic breast cancer. METHODS: Serial serum values of CA 15-3, CEA and HER2 were determined in 107 patients with recurrence after breast cancer. Fifteen of the patients had primary disseminated disease, nine patients only developed local recurrence during the follow-up period and the remaining 83 developed distant metastases. RESULTS: In the group of patients with distant metastatic disease (n=83), elevated serum levels of CA 15-3 (>32.4 U/mL), CEA (>2.5 µg/L for non-smokers and >10 µg/L for smokers) and HER2 (>15 µg/L) were found in 49.4%, 38.6% and 32.5%, respectively, at the time of diagnosis of recurrence. CA 15-3 was significantly better than HER2 (p=0.027). The most sensitive combination was obtained using CA 15-3/CEA (60.2%) or CA 15-3/HER2 (57.8%). Combining all three tumour markers raised the sensitivity to 63.9%. In the subgroup of patients with tissue HER2+ tumours, the sensitivity of HER2 increased to 55.6%. The best combination in this group was CEA/HER2 (66.7%). In the subgroup of patients with tissue HER2- tumours, CA 15-3 was significantly better. The best combination was CA 15-3/HER2 or CA 15-3/CEA with a sensitivity of 55.8% and 59.6%, respectively. CONCLUSIONS: The combination of several tumour markers enhances the sensitivity for detection of metastatic breast cancer. We recommend HER2 or the combination of CEA and HER2 in tissue HER2+ and CA 15-3 or the combination of CA 15-3 and CEA in tissue HER2-.

Factores de riesgo asociados en menores de 5 años hospitalizados con infección respiratoria aguda baja por virus respiratorios en el Hospital de Emergencias Pediátricas 2011-2012 / Associated risk factors in children less than 5 years hospitalized with acute lower respiratory infection by respiratory viruses in the Hospital of Pediatric Emergency 2011-2012

La IRA baja viral es un problema de salud pública. El VSR causa 33,8 millones de nuevos episodios en menores de 5 años; 3,4 millones son graves que requiere ingreso hospitalario; 66,000 a 199,000 mueren presentándose el 99 por ciento en países en desarrollo; pero la incidencia y mortalidad es variable. En nuestro País existen pocos estudios al respecto, por lo que se plantea el estudio para determinar los factores de riesgo asociados en menores de 5 años hospitalizados con IRA baja por virus respiratorios en el Hospital de Emergencias Pediátricas entre abril del 2011 hasta marzo del 2012. El estudio es analítico, no experimental de corte transversal, realizado en 165 pacientes. El 45.5 por ciento de muestras fueron positivas, predominando el sexo masculino (57.33 por ciento). El VSR es frecuente en menores de 24 meses (69.33 por ciento), seguido del metaneumovirus (12 por ciento), presentándose durante todo el año con picos en otoño (49.33 por ciento) y primavera (9.3 por ciento) respectivamente; encontrándose la atelectasia como complicación frecuente. El promedio de hospitalización fue 5.35 días. En el 12.12 por ciento de los pacientes se usaron antibióticos, lo que demuestra la diferenciación clínica y el uso racional de los mismos. El peso y edad gestacional al nacimiento, grado de inmunización y nutrición, lactancia materna, contacto previo con personas resfriadas, antecedente de síndrome obstructivo bronquial recurrente e hiperreactividad bronquial no fueron características predisponentes para adquirir la enfermedad viral. La implementación de técnicas de diagnóstico viro lógico rápido, estandarización de criterios diagnósticos y manejo es fundamental para iniciar terapias pertinentes, disminuir la hospitalización y reducir los costos.

The viral ALRI is a public health problem. RSV causes 33.8 million new episodes in children under 5 years, 3.4 million are severe requiring hospitalization; 66.000 to 199.000 die presenting 99 per cent in developing countries, but the incidence and mortality varies. In our country there are few studies on the subject, making focuses on the study to determine the associated risk factors in children under 5 years of age hospitalized with ALRI by respiratory viruses in the Hospital's Emergency Department from April 2011 to March 2012. The study is analytical, cross-sectional nonexperimental involving 165 patients. 45.5 per cent of samples were positive, predominantly male (57.33 per cent). RSV is common in children under 24 months (69.33 per cent), followed by metapneumovirus (12 per cent), occurring throughout the year with peaks in autumn (49.33 per cent) and spring (9.3 per cent) respectively as atelectasis finding frequent complication. The average hospital stay was 5.35 days. In 12.12 per cent of patients antibiotics were used, demonstrating the clinical differentiation and their rational use. The weight and gestational age at birth, degree of immunization and nutrition, breastfeeding, previous contact with people with colds, history of recurrent bronchial obstructive syndrome and bronchial hyperreactivity were not predisposing characteristics to acquire viral disease. The implementation of rapid viral diagnosis techniques, standardization of diagnostic criteria and management is essential to start appropriate therapy, reduce hospitalization and reduce costs.

Serum HER-2 concentrations for monitoring women with breast cancer in a routine oncology setting.

BACKGROUND: The purpose of this study was to determine the positive predictive value (PPV) of positive serum human epidermal growth factor receptor-2 (HER-2) for monitoring women with breast cancer following diagnosis and treatment in a routine clinical setting. METHODS: Serum HER-2 was measured in 1348 patients with breast cancer: 837 during routine oncology clinic visits and 511 following new diagnosis. All patients with positive serum HER-2, 1/5 of negative patients from the oncology clinic, and all the newly diagnosed were followed; a total of 862 patients. Serum HER-2 was measured using the Bayer ADVIA Centaur assay. Tissue HER-2 was determined using immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH). IHC +3 or IHC +2 and FISH>2.0 were positive. Patients were considered to have positive serum HER-2 when at least two values were >15 ng/mL. Recurrence, progression and regression were diagnosed according to usual clinical practice. Serum HER-2 concentrations did not contribute to diagnostic decision-making or selection of treatment. RESULTS: From January 2004 to January 2009, 149 patients were found to have positive serum HER-2. Of these, 35 were tissue HER-2 positive at surgery, 69 tissue-negative and 45 were not determined. Fifty-five of 149 that were serum HER-2 positive (37%, 95% CI: 29-45) had metastases. Among the 35 tissue-positive patients, 25 had recurrence in the form of metastases and there was good correlation between recurrence/progression and increase in serum HER-2 (p<0.0003). There was also a high correlation between effect of treatment and decline in serum HER-2 (p<0.0003). Of the 69 tissue-negative patients, 29 had recurrence in the form of metastases, and there was good correlation with serum HER-2 levels (p<0.000004). In this routine application of serum HER-2, the PPV for metastases recurrence detection in both tissue-positive and tissue-negative was 54 of 104 (52%, 95% CI: 42%-62%), in tissue-positive 25 of 35 (71%, 95% CI: 54%-85%), in tissue-negative 29 of 69 (42%, 95% CI: 30%-54%). The lead time of increases in serum HER-2 before recurrence could be determined in ten tissue-positive patients was 3-24 months (mean 11.3 months), when compared to standard clinical imaging methods. CONCLUSIONS: Serum HER-2 is a useful marker for the detection of recurrence of breast cancer and for monitoring the effect of treatment, especially in tissue HER-2 positive patients.

Condutas no trauma penetrante da artéria axilar / Procedures for penetrating trauma of axillary artery

Este artigo tem como objetivo analisar o trauma penetrante da artéria axilar e discutir as diferentes condutas realizadas na fase aguda, com ênfase no diagnóstico e no tratamento. São relatados três casos de pacientes com trauma penetrante da artéria axilar causado por ferimento por arma de fogo atendidos no Pronto-Socorro do Hospital das Clínicas da Universidade Estadual de Campinas no primeiro semestre de 2002. O primeiro caso recebeu diagnóstico de pseudo-aneurisma, o qual foi tratado por via endovascular. O segundo caso apresentava trombose da artéria axilar e lesão do plexo braquial, mas com índice pressórico braquial/braquial igual a 0,6, sendo adotada apenas conduta conservadora. O terceiro caso apresentava isquemia aguda no membro superior direito e necessitou de cirurgia de urgência. A reconstruçaõ arterial foi realizada com enxerto de veia safena. Todos os pacientes evoluíram satisfatoriamente durante o seguimento. Conclui-se que o tratamento das lesões vasculares traumáticas da artéria axilar deve ser individualizado, com análise das possibilidades aplicáveis em cada paciente.

Avaliação da quimioterapia adjuvante com o esquema CMF no câncer da mama estádio I e II, sem receptor de estrógeno / Adjuvant CMF in breast cancer stage I and II, negative estrogen receptor

Com o objetivo de avaliar os resultados obtidos com o esquema quimioterápico adjuvante CMF nas sobrevidas total e livre de doença de pacientes com carcinoma de mama estádios I e II, e avaliar o seu impacto na freqüência e local de recidivas e de óbitos, foram analisados os prontuários de um total de 190 pacientes, sendo 130 tratadas com seis ciclos de CMF adjuvante e 60 sem receber tratamento quimioterápico, entre janeiro de 1980 a agosto de 1991 e com seguimento clínico até dezembro de 1996. Os resultados mostraram que este procedimento não promoveu aumento significativo nas sobrevidas total e livre de doença, considerando-se tanto os estádios I e IIa. Quanto aos locais mais freqüentes de metástases, o sítio ósseo superou os demais, independentemente do tratamento ou estádio da doença.