Aims The EURO-ENDO registry aimed to study the management and outcomes of patients with infective endocarditis (IE). Methods and results Prospective cohort of 3116 adult patients (2470 from Europe, 646 from non-ESC countries), admitted to 156 hospitals in 40 countries between January 2016 and March 2018 with a diagnosis of IE based on ESC 2015 diagnostic criteria. Clinical, biological, microbiological, and imaging [echocardiography, computed tomography (CT) scan, 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT)] data were collected. Infective endocarditis was native (NVE) in 1764 (56.6%) patients, prosthetic (PVIE) in 939 (30.1%), and device-related (CDRIE) in 308 (9.9%). Infective endocarditis was community-acquired in 2046 (65.66%) patients. Microorganisms involved were staphylococci in 1085 (44.1%) patients, oral streptococci in 304 (12.3%), enterococci in 390 (15.8%), and Streptococcus gallolyticus in 162 (6.6%). 18F-fluorodeoxyglucose positron emission tomography/computed tomography was performed in 518 (16.6%) patients and presented with cardiac uptake (major criterion) in 222 (42.9%) patients, with a better sensitivity in PVIE (66.8%) than in NVE (28.0%) and CDRIE (16.3%). Embolic events occurred in 20.6% of patients, and were significantly associated with tricuspid or pulmonary IE, presence of a vegetation and Staphylococcus aureus IE. According to ESC guidelines, cardiac surgery was indicated in 2160 (69.3%) patients, but finally performed in only 1596 (73.9%) of them. In-hospital death occurred in 532 (17.1%) patients and was more frequent in PVIE. Independent predictors of mortality were Charlson index, creatinine > 2 mg/dL, congestive heart failure, vegetation length > 10 mm, cerebral complications, abscess, and failure to undertake surgery when indicated. Conclusion Infective endocarditis is still a life-threatening disease with frequent lethal outcome despite profound changes in its clinical, microbiological, imaging, and therapeutic profiles.

There is an increasing clinical demand for HER2 analysis in breast cancer, especially since the release of trastuzumab. The authors assessed the ability of immunohistochemistry to detect HER2 overexpression in invasive mammary carcinomas (IMC) using five antibodies. Paraffin-embedded samples of 86 IMCs (T2N0) were used to compare the immunohistochemical overexpression of HER2 using two polyclonal antibodies (HercepTest [DAKO] and A0485 [DAKO]) and three monoclonal antibodies (CB11 from two different laboratories, Biogenex and Novocastra, and 4D5 [Genentech]). All immunostainings were scored according to the FDA-approved HercepTest recommendations. The HercepTest-positive cases were compared with gene amplification by FISH (Oncor Inform, Ventana). The HercepTest was positive in 31 of the 86 cases (36.1%). The DAKO antibody A0485 was positive in 25 of the 66 (37.8%). Monoclonal antibody 4D5 was positive in only 15 of the 86 cases (17.4%). There was almost total agreement in results between the two CB11 antibodies: 25 of the 86 positive cases (29.1%). All cases positive for CB11 or 4D5 were HercepTest positive. Most of the HercepTest 2+ cases were negative when using either monoclonal antibody. FISH was positive in 19 of the 20 HercepTest 3+ cases and negative in 5 HercepTest 2+ cases. Three CB11-2+ cases showed no amplification by FISH. In three FISH-positive cases the immunohistochemistry showed no overexpression by all antibodies used. These findings suggest that immunohistochemistry may be used reliably as a primary methodology for evaluating HER2; however, the use of polyclonal antibodies may not be adequate to assess HER2 overexpression. CB11, regardless of the manufacturer (Biogenex or Novocastra), showed better concordance with FISH (kappa=0.83) than did the polyclonal antibodies.

The purpose of the study was to compare the accuracy of FNAC, CNB, and combined biopsy according to tumor size of suspicious breast lesions.FNAC and CNB were performed in 264 patients with suspicious breast lesions from August, 1997 to August, 2002. The procedures were guided by ultrasound and performed in the same session by the same operator. The lesions were divided in four groups according to the tumor size in the histopathology report: lesions smaller than 1 cm, between 1 and 2 cm, between 2 and 5 cm, and lesions greater than 5 cm.The final surgical histopatology results identified 222 (84%) malignant cases and benign lesions summed 42 (16%). For lesions smaller than 1 cm, FNAC, CNB, and combined biopsy were equivalent for all parameters. For lesions between 1 and 2 cm, FNAC and CNB were equivalent. Combined biopsy showed higher absolute sensitivity (P ¼ 0.007) and lower inadequate rate (P ¼ 0.03) when compared to FNAC. However, when combined biopsy and CNB were compared, no difference were found. For lesions between 2 and 5 cm, CNB showed higher absolute sensitivity (P < 0.001) and lower inadequate rate (P < 0.007) when compared to FNAC. Combined biopsy showed higher sensitivity compared to FNAC and CNB alone (P < 0.05) in this group. For lesions greater than 5 cm, FNAC and CNB were equivalent for all parameters. Combined biopsy only showed higher absolute sensitivity (P ¼ 0.04) when compared with FNAC alone.The combination of FNAC and CNB can improve the diagnosis of suspicious breast lesions higher than 1 cm. However, for lesions smaller than 1 cm, our results showed no difference between FNAC, CNB, and combined biopsy, for these lesions any modality has technical limitations. Diagn. Cytopathol. Key Words: breast cancer; tumor size; fine-needle aspiration cytology; core biopsyThe role of fine-needle aspiration cytology (FNAC) and core needle biopsy (CNB) in establishing the diagnosis of breast disease has been clearly demonstrated. Several studies have compared FNAC and CNB 1-5 with heterogeneous results. It is difficult to decide from published studies which method is preferred. Results may be influenced by patient selection, incidence of breast carcinoma in the population, availability of follow-up data, duration of follow-up, differences in biopsy technique, operator expertise, and interpretation of the results.6,7 Many published series are from academic centers and not from a general hospital setting. Calculations for accuracy are made in different ways sometimes reflecting the clinical effectiveness of the procedure, sometimes only evaluating the laboratory performance. Comparisons between series can only be made after recalculation. 7This study compares the results of FNAC and CNB according to the tumor size taken from the same lesion by the same operator in one session under ultrasound guidance. Materials and MethodsFNAC and CNB were performed in 264 patients with suspicious breast lesions from

Introduction: HER-2/neu overexpression has been tested using immunohistochemistry as a reliable and cost-effective method to select patients with invasive mammary carcinomas (IMC) for trastuzumab treatment, but there is no consensus regarding the best antibody to be used. The aim of the present study was to test five different antibodies for determining the status of HER-2/neu overexpression in IMC. Material and methods: Sixty-six formalin-fixed, paraffin-embedded IMC were investigated by immunohistochemistry, using two polyclonal antibodies, HercepTest TM (Dako) and A0485 (Dako), and three monoclonal antibodies, the clone CB11, from both Novocastra Laboratories and from Biogenex, and the clone 4D5 (Genentech). All immunostainings were scored according to the guidelines for the HercepTest TM. Results: The A0485 was positive in 25 cases (37.9%). The HercepTest TM was positive in 14/66 cases (21.2%). Both CB11 antibodies yielded a positive reaction in the same nine patients (13.6%). The 4D5 was positive in only 4/66 cases (6.1%). All positive cases for CB11 or 4D5 were HercepTest TM positive. All cases positive for HercepTest TM were positive for A0485. Most of the HercepTest TM and A0485 2+ cases were negative when using the other antibodies. Discussion: There was a higher number of cases presenting HER-2/neu positivity with the

CONTEXT: Carney complex (CNC), a familial multiple neoplasm syndrome with dominant autosomal transmission, is characterized by tumors of the heart, skin, endocrine and peripheral nervous system, and also cutaneous lentiginosis. This is a rare syndrome and its main endocrine manifestation, primary pigmented nodular adrenal disease (PPNAD), is an uncommon cause of adrenocorticotropic hormone-independent Cushing's syndrome. CASE REPORT: We report the case of a 20-year-old patient with a history of weight gain, hirsutism, acne, secondary amenorrhea and facial lentiginosis. Following the diagnosing of CNC and PPNAD, the patient underwent laparoscopic bilateral adrenalectomy, and she evolved with decreasing hypercortisolism. Screening was also performed for other tumors related to this syndrome. The diagnostic criteria, screening and follow-up for patients and affected family members are discussed.

Purpose High mortality and a limited performance of valvular surgery are typical features of infective endocarditis (IE) in octogenarians, even though surgical treatment is a major determinant of a successful outcome in IE. Methods Data from the prospective multicentre ESC EORP EURO-ENDO registry were used to assess the prognostic role of valvular surgery depending on age. Results As compared to < 80 yo patients, ≥ 80 yo had lower rates of theoretical indication for valvular surgery (49.1% vs. 60.3%, p < 0.001), of surgery performed (37.0% vs. 75.5%, p < 0.001), and a higher in-hospital (25.9% vs. 15.8%, p < 0.001) and 1-year mortality (41.3% vs. 22.2%, p < 0.001). By multivariable analysis, age per se was not predictive of 1-year mortality, but lack of surgical procedures when indicated was strongly predictive ). By propensity analysis, 304 ≥ 80 yo were matched to 608 < 80 yo patients. Propensity analysis confirmed the lower rate of indication for valvular surgery (51.3% vs. 57.2%, p = 0.031) and of surgery performed (35.3% vs. 68.4%, p < 0.0001) in ≥ 80 yo. Overall mortality remained higher in ≥ 80 yo (in-hospital: HR 1.50[1.06-2.13], p = 0.0210; 1-yr: HR 1.58[1.21-2.05], p = 0.0006), but was not different from that of < 80 yo among those who had surgery (in-hospital: 19.7% vs. 20.0%, p = 0.4236; 1-year: 27.3% vs. 25.5%, p = 0.7176). Conclusion Although mortality rates are consistently higher in ≥ 80 yo patients than in < 80 yo patients in the general population, mortality of surgery in ≥ 80 yo is similar to < 80 yo after matching patients. These results confirm the importance of a better recognition of surgical indication and of an increased performance of surgery in ≥ 80 yo patients.

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RESUMO -Racional -A esofagite induzida por drogas pode ser decorrente do contato prolongado do medicamento com a mucosa ou de alterações das condições locais da mucosa esofágica. O uso de alendronato de sódio, um inibidor da reabsorção óssea utilizado na prevenção e tratamento da osteoporose, tem sido recentemente citado como causa de lesões no trato gastrointestinal superior. Objetivo -Descrever os achados clínicos, endoscópicos e histopatológicos de pacientes com esofagite ulcerativa associada ao uso de alendronato de sódio. Pacientes -Quatro pacientes do sexo feminino e um do sexo masculino, em tratamento de osteoporose com alendronato de sódio, submetidos a endoscopia digestiva alta seguida de biopsia esofágica. Resultados -Os pacientes apresentavam idade entre 64 e 84 anos e sintomatologia dispéptica após um período de 2 a 12 meses de uso de alendronato de sódio. A endoscopia digestiva mostrou área de mucosa friável, com erosão e/ou ulceração recobertas por fibrina, localizadas no terço distal do esôfago. O exame histopatológico mostrou esofagite ulcerativa caracterizada por material necrofibrinopurulento e tecido de granulação, além de material amarelado e refringente à luz polarizada. Os pacientes evoluíram com remissão completa dos sintomas após suspensão da droga. Conclusões -As lesões esofágicas associadas ao uso de alendronato de sódio não são freqüentes e parecem estar relacionadas ao uso incorreto da medicação. Os endoscopistas e patologistas devem ficar atentos à possibilidade do uso de alendronato de sódio diante do diagnóstico de úlceras esofágicas em pacientes idosos, principalmente do sexo feminino. Esta identificação implicaria em melhor tratamento dos pacientes.DESCRITORES -Esofagite, induzida quimicamente. Alendronato, efeitos adversos.