Predicting the duration of poststroke dysphagia is important to guide therapeutic decisions. Guidelines recommend nasogastric tube (NGT) feeding if swallowing impairment persists for 7 days or longer and percutaneous endoscopic gastrostomy (PEG) placement if dysphagia does not recover within 30 days, but, to our knowledge, a systematic prediction method does not exist. OBJECTIVE To develop and validate a prognostic model predicting swallowing recovery and the need for enteral tube feeding. DESIGN, SETTING, AND PARTICIPANTS We enrolled participants with consecutive admissions for acute ischemic stroke and initially severe dysphagia in a prospective single-center derivation (2011-2014) and a multicenter validation (July 2015-March 2018) cohort study in 5 tertiary stroke referral centers in Switzerland. EXPOSURES Severely impaired oral intake at admission (Functional Oral Intake Scale score <5). MAIN OUTCOMES AND MEASURES Recovery of oral intake (primary end point, Functional Oral Intake Scale Ն5) or return to prestroke diet (secondary end point) measured 7 (indication for NGT feeding) and 30 (indication for PEG feeding) days after stroke. RESULTS In total, 279 participants (131 women [47.0%]; median age, 77 years [interquartile range, 67-84 years]) were enrolled (153 [54.8%] in the derivation study; 126 [45.2%] in the validation cohort). Overall, 64% (95% CI, 59-71) participants failed to recover functional oral intake within 7 days and 30% (95% CI, 24-37) within 30 days. Prolonged swallowing recovery was independently associated with poor outcomes after stroke. The final prognostic model, the Predictive Swallowing Score, included 5 variables: age, stroke severity on admission, lesion location, initial risk of aspiration, and initial impairment of oral intake. Predictive Swallowing Score prediction estimates ranged from 5% (score, 0) to 96% (score, 10) for a persistent impairment of oral intake on day 7 and from 2% to 62% on day 30. Model performance in the validation cohort showed a discrimination (C statistic) of 0.84 (95% CI, 0.76-0.91; P < .001) for predicting the recovery of oral intake on day 7 and 0.77 (95% CI, 0.67-0.87; P < .001) on day 30, and a discrimination for a return to prestroke diet of 0.94 (day 7; 95% CI, 0.87-1.00; P < .001) and 0.71 (day 30; 95% CI, 0.61-0.82; P < .001). Calibration plots showed high agreement between the predicted and observed outcomes. CONCLUSIONS AND RELEVANCE The Predictive Swallowing Score, available as a smartphone application, is an easily applied prognostic instrument that reliably predicts swallowing recovery. It will support decision making for NGT or PEG insertion after ischemic stroke and is a step toward personalized medicine.

To evaluate the efficiency of pleurodesis (PD) in the management of symptomatic malignant pleural effusion (PE) in breast cancer, we reviewed 46 patients undergoing 49 PDs. When radiotherapy was part of the initial treatment, 41% of PEs were ipsilateral to the primary, if not, 85% of PEs were ipsilateral (P < 0.0075). Six percent of patients presented dyspneic with exertion, 32% during daily routine; 61% at rest. All except 1 were improved after PD; 74% had no dyspnea, 23% had exertional dyspnea. PD relieved chest pain in 4 and cough in 5 patients. With 31 Talc/Iodine PDs, 2 mortalities and 2 minor complications occurred. Of 17 tetracycline PDs, 1 was complicated by bronchopleural fistula and 1 failed. 1 Mustine PD was uncomplicated. Survival at 6, 12, and 24 months was 58%, 40%, and 13%, respectively. Primary local radiotherapy may prevent ipsilateral PE. Talc/Iodine and tetracycline PD reliably provide relief from the distressing symptoms of malignant PE.

Distribution électronique Cairn.info pour L'Harmattan. © L'Harmattan. Tous droits réservés pour tous pays.La reproduction ou représentation de cet article, notamment par photocopie, n'est autorisée que dans les limites des conditions générales d'utilisation du site ou, le cas échéant, des conditions générales de la licence souscrite par votre établissement. Toute autre reproduction ou représentation, en tout ou partie, sous quelque forme et de quelque manière que ce soit, est interdite sauf accord préalable et écrit de l'éditeur, en dehors des cas prévus par la législation en vigueur en France. Il est précisé que son stockage dans une base de données est également interdit.

Oxygen affinity of haemoglobin modulates cerebral blood flow in premature infants: a study with the non-invasive Xe-133 method. Acta Paediatr Scand Suppl 360: 26, 1989. Low cerebral blood flow (CBF) is thought to cause ischaemic brain lesions in premature infants, but a normal outcome has also been observed. Low oxygen affinity of haemoglobin and high arterial oxygen content, independently, reduce CBF under normal, physiological conditions. Transfusions lower the amount of fetal haemoglobin [HbF] and therefore the oxygen affinity of premature babies. In 47 premature babies (range of gestational age 25-34 weeks, birthweight 740-1370 g), CBF was measured with the i.v. Xenon 133 method on days 1, 3 and 7. The relative amount of fetal

Between 1985 and 1991, we randomly assigned 77 women over the age of 70 years with stage I-3a breast cancer to undergo a modified radical mastectomy or tumour excision followed by tamoxifen. Median follow-up was 45 months. Patients treated by tumour excision and tamoxifen had a significantly better survival (P = 0.04). The disease-free survival of the tumour excision and tamoxifen group was close to significantly better (P = 0.10). Only two patients in the tamoxifen group required an axillary dissection on follow-up for progressive nodal enlargement. Two patients underwent a local mastectomy for locally recurrent disease. We conclude that tumour excision followed by continuous tamoxifen is an acceptable, safe alternative to a modified radical mastectomy in patients over 70 years of age.