Validation and comparison of Breast Graded Prognostic Assessment scores in patients with breast cancer and brain metastases

Validation and comparison of Breast Graded Prognostic Assessment scores in patients with breast cancer and brain metastases (AU)

Validation and comparison of Breast Graded Prognostic Assessment scores in patients with breast cancer and brain metastases.

PURPOSE: Brain metastases (BM) occur in 15-35% of patients with metastatic breast cancer, conferring poor prognosis and impairing quality of life. Clinical scores have been developed to classify patients according to their prognosis. We aimed to check the utility of the Breast Graded Prognostic Assessment (B-GPA) and its modified version (mB-GPA) and compare them in routine clinical practice. METHODS: This is an ambispective study including all patients with breast cancer BM treated in a single cancer comprehensive center. We analyzed the overall survival (OS) from BM diagnosis until death. The Kaplan-Meier method and Cox proportional hazard regression model were used in the analyses. ROC curves were performed to compare both scores. RESULTS: We included 169 patients; median age was 50 years. HER2-positive and triple negative patients were 33.7% and 20.7%, respectively. At the last follow-up, 90% of the patients had died. Median OS was 12 months (95% confidence interval 8.0-16.0 months). OS was worse in patients with > 3 BM and in patients with triple negative subtype. CONCLUSIONS: In our series, we confirm that B-GPA and mB-GPA scores correlated with prognosis. ROC curves showed that B-GPA and mB-GPA have similar prognostic capabilities, slightly in favor of mB-GPA.

[Clinical assessment of pediatric patients with Waddel's triad]. / Evaluación clínica del paciente pediátrico con tríada de Waddell.

INTRODUCTION: Waddell's triad represents an emergency for pediatric patients due to the high incidence of injuries associated with the femur fracture. OBJECTIVE: To clinically assess, upon presentation, the femur fracture associated with the head trauma, chest and/or abdominal trauma in the pediatric patients and its course during the hospital stay. MATERIAL AND METHODS: Prospective, observational study analyzing the cases that had clinical, imaging and picture records to assess the presence of associated injuries as well as their course during the hospital stay. RESULTS: A total of 21 patients were included; 13 boys and 8 girls, ages 3-14 years; weight upon admission was 12-30 kg, the Pediatric Trauma Score range was 1-9 points; 9.6% sustained open fractures; 15 cases had femoral fracture associated with musculoskeletal injuries; the most frequent finding related with head trauma was brain edema. Sixty-two percent of those with thoracic or abdominal trauma warranted a surgical procedure; 18 patients required mechanical ventilation; several methods were used to treat the femur fractures. CONCLUSIONS: The polytraumatized patients need multidisciplinary care. There is a high percentage of musculoskeletal and non-orthopedic associated injuries in Waddell's triad. The Pediatric Trauma Score is a good indicator of the severity of the patient's condition.

[Mediastinoscopy: technical aspects and current indications]. / Mediastinoscopia: aspectos técnicos e indicações atuais.

Mediastinoscopy is an useful tool for mediastinal exploration with minimal surgical trauma. The anatomical and Technical basis of this procedure are simple and safe, and can be adapted to specific purposes. Surgical intervention is performed under general anesthesia and is carried out direct visual inspection. Mediastinoscopy is a diagnostic routine procedure in lung cancer staging and mediastinal adenopathy investigation. Since Carlens described the method of cervical mediastinoscopy, other authors developed new techniques, in order to improve and extend the range of mediatinal exploration. The mediastinoscope and the other tools used to perform the classic mediastinoscopy can also be used to perform pleuroscopy and even the transmediastinal esophagectomy.