Supervivencia tras el tratamiento de metástasis cerebral, única, tardía en una paciente afectada de cáncer de ovario / Survival after treatment for late, isolated, cerebral metastasis from ovarian cancer

La incidencia de las metástasis cerebrales en el cáncer de ovario es baja. Presentamos el caso de una paciente de 48 años con carcinoma serosopapilar de ovario bilateral. Se decide quimioterapia neoadyuvante, cirugía citorreductora de rescate y radioterapia pelviana, por ser subóptima la cirugía. A los 9 años presenta una recidiva pleural que se resuelve con 6 ciclos de carbotaxol. A los 11 años presenta una metástasis cerebral de 8 cm, que se extirpa, y se administra tratamiento complementario con radioterapia holocraneal y boost sobre el lecho quirúrgico. Actualmente, la paciente está asintomática y sin secuelas. En pacientes con metástasis cerebral única, la cirugía, seguida de radioterapia y quimioterapia sistémica, ofrece los mejores resultados

Central nervous system metastases from ovarian carcinoma are uncommon. We present the case of a 48-year-old woman with a bilateral serous papillary ovarian carcinoma. She received neoadjuvant chemotherapy and underwent suboptimal cytoreductive surgery and pelvic irradiation. Nine years later she had a pleural relapse of the disease and was treated with six cycles of carbotaxol. Eleven years after the initial diagnosis she presented an 8 cm brain metastasis and underwent resection followed by whole-brain radiotherapy with a boost on the tumor bed. The patient is currently asymptomatic and shows no sequels. In patients with an isolated brain metastasis, surgery followed by radiotherapy and systemic chemotherapy offers the best results

Visual analysis of antepartum fetal heart rate tracings: inter- and intra-observer agreement and impact of knowledge of neonatal outcome.

OBJECTIVE: To evaluate the inter- and intra-observer agreement of visual analysis of fetal heart rate tracing and to evaluate the bias introduced by knowledge of perinatal outcome in this interpretation. METHODS: One hundred tracings were independently analyzed by four observers. In a second study period, two observers re-analysed the 100 tracings in order to evaluate intra-observer agreement. The other two observers re-analyzed the tracings, which were labelled with fictitious perinatal outcome to evaluate the impact of this information on reliability. Agreement was analyzed by means of the proportion of agreement for qualitative parameters and the inter- and intra-class correlation coefficient for quantitative data. RESULTS: Poor agreement was found for quantitative variability, low variability category and number of decelerations. Moderate agreement was observed for baseline, normal variability category and number of accelerations. Fetal heart rate variability and number of accelerations and decelerations were found to be significantly influenced by clinical information of perinatal outcome. Biased observers showed lower reliability than unbiased ones. CONCLUSION: Visual assessment of fetal heart rate tracings is unreliable due to low rates of agreement between and within observers. Only qualitative classification such as normal baseline and normal variability showed good agreement. Knowledge of clinical information introduces subjectivity to the visual analysis, leading to a negative impact on reliability.