Highlights Retrospective clinical review of 167 patients with breast cancer bone metastases. Comprehensive study of clinical characteristics, prognostic factors, and survival. First study to assess outcomes associated with operative vs . nonoperative treatment. Utilizing surgical treatment involves a complex, personalized care decision.
The size of the median nerve may serve as a useful parameter to predict carpal tunnel syndrome (CTS) in a subset of patients. The purpose of this study was to evaluate magnetic resonance imagingebased measurements of median nerve cross-sectional area (CSA) to examine trends between patient subgroups and CSA that may assist in predicting the individuals who are most likely to develop CTS symptoms. Methods: A retrospective chart review of 1,273 wrist magnetic resonance images was performed, and the images were analyzed to evaluate the median nerve CSA at the level of the pisiform and the hook of hamate. The age, sex, height, weight, and body mass index (BMI) of the patients were collected from their medical records. Results: The median nerve size correlated with patient BMI. Additionally, patients with CTS had larger median nerves at the hook of hamate and pisiform than those without CTS. When subdividing patients on the basis of BMI, obese patients with CTS had larger median nerve CSA at the pisiform than those without CTS. Conclusions: This study demonstrated that increased BMI is associated with increased median nerve CSA at the hook of hamate and pisiform in patients with or without CTS. Additionally, patients with CTS had larger median nerve CSA than those without CTS. Measurements at these locations may help predict individuals who are likely to experience median nerve impingement. Type of study/level of evidence: Prognostic III.
The incidence of pneumothoraces with automated cardiopulmonary resuscitation (CPR) is unknown. Herein, we present 4 cases of pneumothoraces occurring in the setting of automated mechanical CPR (AM-CPR) in a 2-month period since incorporating mechanical devices into our resuscitation program. Two of the cases were in-hospital cardiac arrests, whereas the other 2 were out-of-hospital cardiac arrests. The Life-Stat 1008 device was utilized for AM-CPR in all cases. All cases demonstrated confirmed pneumothoraces on post-resuscitation imaging. Several factors may have contributed to the observed pneumothoraces. Two of the cases presented with obstructive lung disease, whereas the other 2 had underlying malignancy. Suboptimal positioning and failure to secure the included shoulder straps could have led to migration of the piston over the ribs. Further study is needed to determine the incidence of complications for all FDA-approved AM-CPR devices compared with manual chest compressions.
To evaluate adverse events (AEs) and disease outcomes after post-mastectomy radiotherapy (PMRT) using proton beam therapy (PBT). Materials/Methods: From 2011 to 2016, 125 patients with 129 treated chest walls (4 bilateral) were identified in the prospective multi-institutional Proton Collaborative Group (PCG) registry. AEs were prospectively recorded using CTCAE version 4.0. Acute AEs occurred within 6 months after start of PBT. Late AEs occurred or persisted beyond 6 months after start of PBT. Luminal A was defined as ER or PR-positive, HER2-normal, Ki-67 < 14%. Luminal B was defined as ER or PR-positive, HER2normal, Ki-67 14%. Luminal NOS was defined as ER or PR-positive, HER2-normal, Ki-67 not reported. Associations were assessed using Fisher's exact and Wilcoxon tests. Statistical analysis was performed using a data management and decision management software. Results: Median follow-up was 12 months (range 0-39). Median age at time of PBT was 52 (range 21-86). Median body mass index (BMI) was 27 (range 16-54). Histologic subtypes included: Luminal A or NOS 43%, Luminal B 26%, HER2-amplified 21%, and triple negative 10%. Most common clinical stage was cT2 40%, cN+ 67%, cM0 100%. All patients had mastectomy (20% bilateral) with 73% axillary lymph node dissection and 27% sentinel lymph node biopsy. Invasive margins were negative in 95%. Ductal carcinoma in situ (DCIS) margins were 2 mm in 86%. Systemic therapy was delivered in 94% with 84% receiving cyclophosphamide, 80% taxanes, 66% anthracyclines, 22% HER2-directed, and 16% platinum agents. Predominant regimen was doxorubicin, cyclophosphamide, and taxane (52%). Adjuvant endocrine therapy was used in 84%. Including chest wall boost, median total RT dose was 55.0 Gy Relative Biological Effectiveness (RBE) (range 43.2-70.4) in 1.8-2.0 Gy RBE fractions. RT fields included: chest wall 100%, axillary 96%, supraclavicular 99%, internal mammary 92%, chest wall boost 68%, and nodal boost 7%. Only 2% of patients did not complete the prescribed course due to pain/dermatitis, each reaching 50.4 Gy RBE before terminating RT during the chest wall boost. Maximum AE was grade 3 in 13% including acute grade 3 pain 8% and acute grade 3 dermatitis 8%. No patient had late AE > grade 2. Positive invasive margins and DCIS margins < 2 mm were associated with grade 3 pain (pZ0.02, pZ0.05). The patients with grade 3 pain who had positive invasive margins or DCIS margins < 2 mm all received chest wall boost and had median dose 60.4 Gy RBE. Patients with grade 3 dermatitis had higher median dose (60.4 Gy RBE vs 55.0 Gy RBE, pZ0.10). At last follow-up, local recurrence was 2%, distant metastasis 6%, and breast cancer death 3%. Conclusion: To our knowledge, this is the largest reported prospective cohort of PMRT using PBT. PMRT with comprehensive regional nodal irradiation using PBT was well-tolerated, with 13% acute grade 3 toxicities and no late grade 3 toxicities.
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