Does oncoplastic breast-conserving surgery cause unnecessary additional evaluations?

OBJECTIVE: Patients who have undergone breast-conserving surgery may experience fear of recurrence. Post-operative granulation tissue and fat necrosis are common issues for these patients. As a result, additional examinations may increase, which can entail increased costs and stress for patients. In this study, if oncoplastic breast-conserving surgery causes additional imaging and unnecessary additional evaluations. PATIENTS AND METHODS: We retrospectively analyzed data from 432 patients who had undergone breast-conserving surgery in the same surgical unit between 2013 and 2017. We separated the patients into two main groups: Group 1 were those operated with conservative breast-conserving surgery, while Group 2 had operations using oncoplastic breast-conserving surgery techniques. The two groups were compared in terms of post-operative radiological examinations, suspected radiological findings, and biopsy needs. RESULTS: There were 203 patients in Group 1 and 229 in Group 2. The median follow-up time was 66 months (range 12-109). Additional mammography use was higher in the second group (p=0.003). However, the two groups had no statistical differences for additional imaging and biopsy needs in general (p=0.138). Sixty-two patients (14.3%) had biopsies with suspicious radiological findings (15.8% vs. 13.1%). Eight (12.8%) of these patients had malignant results. There were local recurrences in six patients, one in the first group and five in the second group (p=0.084). CONCLUSIONS: Oncoplastic breast-conserving surgery may increase post-operative mammography use. However, there is no statistical difference between the two groups for either additional imaging in total or in biopsy needs.

Sleep parameters associated with long-term outcome following subthalamic deep brain stimulation in Parkinson's disease.

INTRODUCTION: We aimed to investigate the effects of changes in sleep architecture on long-term clinical outcome in patients with Parkinson's disease (PD) who underwent deep brain stimulation of subthalamic nuclei (STN DBS). METHODS: We followed up eight PD patients before and three years after STN DBS surgery. In addition to clinical assessments, polysomnography (PSG) followed by multiple sleep latency tests was performed before and after STN DBS, while stimulator was ON and OFF. RESULTS: Subjective sleep latency was significantly decreased (P=0.033) and sleep duration was increased (P=0.041), as measured by Pittsburgh sleep quality index. Latency to REM sleep stage was shortened after surgery with STN DBS ON (P=0.002). Index of central type of abnormal respiratory events was significantly increased while stimulator was ON (P=0.034). Total number of major body movements was found to be increased when stimulator was turned OFF (P=0.012). Among PSG data obtained during STN DBS ON, it was observed that duration of N3 sleep was negatively correlated with UPDRS scores at 1st (P=0.038) and 3rd (P=0.045) post-operative years. Among PSG variables during STN DBS OFF, durations of N3 sleep (P=0.017) and REM sleep (P=0.041) were negatively correlated with UPDRS scores at post-operative 1st year. CONCLUSION: Disturbances in sleep architecture are associated with higher UPDRS scores and worse prognosis at 1st and 3rd post-operative years. Similar results obtained while stimulator was OFF at the end of 1st year support the presence of microlesion effect after STN DBS, which is probably not long lasting.

Reversible reduction of apparent diffusion coefficient values in bilateral internal capsules in transient hypoglycemia-induced hemiparesis.

A woman aged 68 years who experienced recurrent right hemiparesis caused by hypoglycemia was admitted to our hospital. When she was experiencing a low level of glucose, diffusion-weighted MR imaging showed the presence of hyperintensity lesions in the bilateral internal capsule. Diffusion-weighted MR imaging has been infrequently performed in patients with hypoglycemia. We report the reversible hyperintensity lesions on diffusion-weighted MR imaging in a hypoglycemic period in a patient with reversible hemiparesis. A reduction of apparent diffusion coefficient in a hypoglycemic period was clearly shown.