Autopsy examination is considered to be an essential element for medical auditing and teaching. Despite the significant progress in diagnostic procedures, autopsy has not always confirmed the clinical diagnosis. In the present study, we compared the diagnosis recorded on medical charts with reports of 96 autopsies performed at the University Teaching Hospital of the Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil, between 1975 and 1982, and of 156 autopsies performed at the same institution between 1992 and 1996. The clinical diagnosis of the basic cause of death was confirmed at autopsy in 77% of cases. The percent confirmation fell to 60% when the immediate terminal cause of death was considered, and in 25% of cases, the terminal cause was only diagnosed at autopsy. The discrepancies between clinical and autopsy diagnosis were even larger for secondary diagnoses: 50% of them were not suspected upon clinical diagnosis. Among them, we emphasize the diagnosis of venous thromboses (83%), pulmonary embolisms (80%), bronchopneumonias (46%) and neoplasias (38%). Iatrogenic injuries were very frequent, and approximately 90% of them were not described in clinical reports. Our results suggest that highly sensitive and specific diagnostic tests are necessary but cannot substitute the clinical practice for the elaboration of correct diagnoses.

Sudden-onset bilateral deafness as a clinical manifestation of hyperleukocytosis in chronic myeloid leukemia (CML) is a rare occurrence. We found only 27 clinical descriptions in 16 published papers. In this work, the authors present a review on deafness in CML and describe a new case with prominent hyperleukocytosis, where the neurological findings suggest slowing of the circulation through small blood vessels in the brainstem as the cause of deafness. The evolution was good after treatment. To our knowledge, this is the second case documented with electrical auditory brainstem-evoked potentials and the first with magnetic resonance imaging.

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Background: The incidence rates of breast cancer in developed countries increased between 1980 and 1990 due to use of breast cancer screening and lifestyle changes. Since 2000, however, breast cancer incidence has decreased in these areas, which is possibly attributed to less exposure to hormone replacement therapy. Since 1990, the United States, United Kingdom, and France have reported a reduction in breast cancer related deaths, mainly due to improved early detection and more effective therapies. Data considering the trend of incidence and mortality rates in Brazil are scarce. Herein, we have evaluated these trends in a population-based cancer registry. Methods: We have collected the data from annual rates of breast cancer incidence (BCI) and mortality from breast cancer (MBC) in a population-based cancer registry in Jau (Sao Paulo State, Brazil) and joinpoint regression analysis was used to evaluate the incidence and mortality trends. Annual average percentage change (AAPC) was estimated and increase or decrease in rates was considered when AAPC was statistically significant (p value less than 0.05), otherwise it was considerable stable. Results: BCI and MBC rates are exposed in Table 1 and 2, respectively. Table 1. BCI in Jau-SP, from 2000 to 2009.YearNumber of casesBCI (/100,000 women)20003160.9720012944.6520024367.4520033857.6520043143.8820053957.2320062739.2020073744.0320083946.6220093839.33 AAPC for BCI was -3.02% (p = 0.1226) and for MBC was -9,77% (p = 0.0082). Conclusion: This data from a population-based cancer registry demonstrates that in Jau (Sao Paulo, Brazil), from 2000 to 2009, BCI was stable and MBC has decreased. Table 2. MBC in Jau-SP, from 2000 to 2009.YearBreast Cancer Related DeathsMBC (/100,000 women)20001320.3620010915.4720021219.8620031216.5620040813.652005067.9520061318.6220070911.312008078.382009076.96 Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-06-24.

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e20711 Background: Breast cancer is the leading cause of cancer in women in Brazil and in the western world. Despite the high incidence of breast cancer in elderly women, there is no solid information regarding the real impact of the adjuvant systemic therapy in this population, considering the underrepresentation of patients with 65 years of age or older in cancer-treatment trials. Moreover, elderly patients may face some difficulties to receive adequate adjuvant systemic treatment in the routine clinical practice. Methods: Two hundred fifty eight patients with 65 years of age or older at the time of diagnosis of operable breast cancer and treated in our Institution from February 2000 to December 2005 were retrospectively studied. Clinical and pathological data were recorded as well as the type of adjuvant systemic therapy: hormonal therapy (HT), chemotherapy (CT) or both. We evaluated the disease free survival and overall survival and compared the results between the group of patients treated with HT only and the group of patients treated with both HT and CT. Results: Ninety five (37.5%) patients were stage I, 150 (58.1%) were stage II and 6 (2.3%) were stage III, while 5 (1.9%) patients were diagnosed with DCIS. Ductal carcinoma was the most frequent histological type (81%) and grade II were reported in the majority of patients (47.3%). Mostly of patients were hormonal sensible (74.4% were ER+ and 64% were PR+) and HER 2 negative (81.8%). One hundred seventy eight (69%) patients received any kind of adjuvant HT while 91 (35.3%) received any kind of adjuvant CT. There was no statistical difference between patients treated with HT when compared with the group of patients treat with HT and CT, regarding disease free survival and overall survival. However, a higher rate of high risk patients were observed in the group treated with both HT and CT. Conclusions: Despite the age, a considerable part of this elderly breast cancer patient's population has received adjuvant systemic treatment. Benefits from HT and/or CT may be considered in this group of patients. No significant financial relationships to disclose.