Pertuzumab, trastuzumab and taxane-based treatment for visceral organ metastatic, trastuzumab-naïve breast cancer: real-life practice outcomes.

PURPOSE: In this study, we aimed to describe the real-life practice outcomes of pertuzumab-trastuzumab-taxane (PTT) combination in visceral organ metastatic, trastuzumab-naive breast cancer (BC) patients. METHODS: This study was conducted by Turkish Oncology Group and included 317 patients' data from 36 centers. RESULTS: Median age was 51 (22-82). Median PFS was 28.5 months, while median OS was 40.3 months. Patients with brain metastases (n: 13, 4.1%) had worse PFS (16.8 m vs. 28.5 m; p = 0.002) and OS (26.7 m vs. 40.3 m; p = 0.009). Patients older than 65 years of age (n: 42, 13.2%) had significantly lower OS results (19.8 m vs. 40.3 m; p = 0.01). Two hundred sixty-eight patients (86.7%) received docetaxel while 37 patients (11.7%) received paclitaxel. PFS and OS were similar between taxane groups. In eight patients (2.5%), 5-40% ejection fraction decrement from baseline was detected without any clinical sign of heart failure. CONCLUSIONS: Our RLP trial included only visceral metastatic, trastuzumab-naïve BC patients including cases with brain involvement who received PTT combination in the first-line treatment. Regardless of negative prognostic characteristics, our results are in parallel with pivotal trial. Further strategies for brain metastasis should be developed to improve outcomes despite encouraging results with PTT treatment. Taxane selection can be personalized and endocrine maintenance may further improve outcomes after taxanes were discontinued. To our knowledge, this is the largest scale real-life clinical practice study of pertuzumab-trastuzumab-taxane therapy to date.

EEG and the linear skull fractures.

The EEGs of 111 children under the age of 16, and 21 adults after a head injury with a linear skull fracture were reviewed. From our results it can be concluded that linear skull fractures do not add any significant abnormality or any variation to what is stated for EEGs of minimal to mild concussions.

Gender differences in polysomnographic findings in Turkish patients with obstructive sleep apnea syndrome.

In this study, we evaluated the gender differences in body mass index (BMI), age and their effects on apnea-hypopnea index during total sleep time (AHI(TST)) in the Turkish population who were diagnosed with obstructive sleep apnea syndrome (OSAS) and compared them with data from the literature. A computerized database of 244 Turkish patients (194 males, 50 females) who had undergone overnight polysomnography (PSG) and diagnosed with OSAS at Bayindir Hospital sleep laboratory between October 2004 and January 2007 was reviewed. The male:female ratio of the patients was 3.88:1. Male patients were significantly younger compared to females (48.87 +/- 10.82 vs 52.94 +/- 12.14 years, respectively, P = 0.003). The BMI and AHI(TST) were similar in male and female patients (BMI = 29.52 +/- 4.63 vs 31.17 +/- 6.08 kg/m2, respectively, P = 0.083) (AHI(TST) = 27.45 +/- 22.97 vs 24.77 +/- 23.83, respectively, P = 0.149). For the male and female groups, AHI(TST) increased as BMI increased (P = 0.03, 0.04). The median values of AHI(TST) in male group, for the normal, overweight and obese + pathological obese groups were 12.45, 20.20 and 23.50, respectively, whereas the median values of AHI(TST) in female group were 11.10, 10.95 and 26.20, respectively. In the normal and obese + pathological obese groups, there was no statistically significant difference according to gender, whereas in the overweight group, male patients had significantly higher AHI(TST) (P = 0.02). There was no statistically significant difference between the male and female patients regarding the severity of OSAS (P = 0.358). However, there was a male tendency to moderate and severe OSAS in the normal and overweight BMI groups. In Turkish patients with OSAS, there was no gender difference in BMI and AHI(TST) and female patients were significantly older than the males. The OSAS was diagnosed in men nearly four times more often than in women.

Multiple plasma cell granuloma of the central nervous system: a unique case with brain and spinal cord involvement. Case report and review of literature.

STUDY DESIGN: Single subject (male, 34 years-of-age) case report. OBJECTIVES: To describe a unique case of plasma cell granuloma (PCG) with simultaneous brain and spinal cord involvement. SETTING: Private hospital, capital city, Turkey. METHODS: The patient presented with headache and paraplega. T2 weighted MR images showed multiple hyperintense cerebral, cerebellar, brainstem and spinal cord lesions that enhanced homogeneously with contrast medium. The patient was operated on, and the two intramedullary spinal cord lesions at T11 and T12 were totally excised. RESULTS: After 3 months of an intense physiotherapy programme the patient was able to walk with help. CONCLUSION: We report for the first time, the occurrence of multiple, simultaneous brain and intramedullary spinal cord plasma cell granulomas.