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.

Specific brainstem and cortico-spinal reflex abnormalities in coexisting essential tremor and Parkinson's disease (ET-PD).

OBJECTIVE: We aimed to analyze functional changes at brainstem and spinal levels in essential tremor (ET), Parkinson's disease (PD) and coexisting essential tremor and Parkinson's disease (ET-PD). PATIENTS AND METHOD: Age- and gender-matched patients with tremor (15 ET, 7 ET with resting tremor, 25 ET-PD and 10 PD) and 12 healthy subjects were enrolled in the study. Diagnosis was established according to standardized clinical criteria. Electrophysiological studies included blink reflex (BR), auditory startle reaction (ASR) and long latency reflex (LLR). RESULTS: Blink reflex was normal and similar in all groups. Probability of ASR was significantly lower in ET-PD group whereas it was similar to healthy subjects in ET and PD (P<0.001). LLR was recorded during voluntary activity in all three groups. LLR II was more common in ET, PD and ET-PD groups. LLR III was far more common in the PD group (n=3, 13.6% in ET; n=4, 16.0% in ET-PD and n=7, 46.7% in PD; p=0.037). CONCLUSIONS: Despite the integrity of BR pathways, ASR and LLR show distinctive abnormalities in ET-PD. In our opinion, our electrophysiological findings support the hypothesis that ET-PD is a distinct entity.

A comparison of some of the cardiovascular risk factors in vegetarian and omnivorous Turkish females.

BACKGROUND: Elevated serum total homocysteine (tHcy) is associated with an increased risk of cardiovascular disease. Homocysteine levels may be influenced by dietary habits. The aim of the present study was to determine the effects of a vegetarian diet on some of the cardiovascular risk factors in Turkish females. METHOD: The study was conducted on 26 vegetarian and 26 omnivore females. Serum tHcy, folate, vitamin B(12) and lipids were determined and dietary data were assessed using a 4-day food intake record at two time points. RESULTS: Compared with omnivores, vegetarians had higher plasma tHcy, 10.8 +/- 3.72 versus 12.6 +/- 5.97, (P < 0.05) and folate (P < 0.05) levels. The prevalence of hyperhomocysteinaemia was higher in vegetarians than in omnivores (34.6% versus 12.0%). In addition, serum vitamin B(12) levels were lower in vegetarians than in omnivores (P < 0.05). In vegetarians, significant inverse correlation was found between tHcy and serum vitamin B(12) levels (r = -0.969, P = 0.001). CONCLUSION: The higher prevalence of mild hyperhomocysteinaemia in vegetarians indicated a diminished protective effect of vegetarian nutrition in cardiovascular disease prevention.

Phenytoin-induced parkinsonism.

This report presents a 30-year-old man who developed subacute phenytoin-induced cerebellar ataxia and parkinsonism that resolved after discontinuation of the phenytoin treatment. Phenytoin was started for seizure prophylaxis in another health institution where he was referred for bilateral intracerebral orbitofrontal haemorrhage due to a head trauma. To our knowledge, there has been only one other case report describing phenytoin-induced parkinsonism, which was also reversible. The issue of the development of parkinsonism due to the phenytoin toxicity in the case of bilateral orbitofrontal lesion is addressed.

Hemifacial spasm and posterior auricular muscle.

We aimed to investigate to which extent posterior auricular muscle (PAM) was affected and whether it contributed to the reflex activity in hemifacial spasm (HFS) patients. 19 HFS patients' spasm activities were recorded from facial muscles. Spasm activity of PAM was recorded synchronously on the symptomatic side in all patients. Lateral spread of blink reflex to orbicularis oris and PAMs were recorded in all but two patients. Botulinum toxin was applied to the PAM with the 14 patients presenting tinnitus, "clicking" or a "ticking" sound on the sane side and other positive auricular symptoms. After treatment, there was symptomatic improvement in 9 of 14 patients. The patients presenting with auricular symptoms and showing spasm activity in their PAMs can be thought as a candidate for botulinum toxin treatment scheme.

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.

Effects of home exercises on motor performance in patients with Parkinson's disease.

OBJECTIVE: To investigate the effect of home exercises on the motor performance of patients with Parkinson's disease. DESIGN: A prospective blinded study with allocation of patients into their groups by alternate weeks. SETTING: A University Hospital neurology and physiotherapy department. SUBJECTS: Recruited from a movement disorders outpatient clinic of Cerrahpasa School of Medicine diagnosed with Parkinson's disease, classified as Hoehn and Yahr Grades I, II and III. INTERVENTIONS: Patients who fulfilled the inclusion criteria were recruited to the study. Each patient was evaluated at the end of first and second month after the baseline evaluation. Patients were divided into two groups. Those in the first and third week were put in the exercise group and second and fourth week in the control group. Patients in the exercise group (n = 15) were given a schedule of exercises to undertake at home; the others (n = 15) did not receive this instruction. MEASURES: Ten- and 20-m walking test, first pace length, pace number in 10 m, walking around a chair, Nine Hole Peg Board (NHPB) test. RESULTS: Following the home exercise programme, patients in the exercise group showed improvement in walking 10 and 20 m, time elapsed to complete walking around a chair and length of the first pace length, and in the motor performance of both hands (p < 0.001). CONCLUSIONS: A home-based rehabilitation programme for patients with Parkinson's disease helped to improve motor performance compared to patients who did not take advantage of a regular, professionally designed exercise programme.

The influence of age in peripheral facial palsy on brainstem reflex excitability.

BACKGROUND: Neuronal plasticity is expected to be different at different ages and adaptive changes developing after peripheral facial palsy (PFP) may provide a clue in this respect. AIMS: To investigate the difference in the reorganization developing after facial nerve damage between patients who developed PFP at childhood-youth and middle-old age. PATIENTS AND METHODS: Twenty-two patients were divided into two groups according to the age-at-onset of PFP; young (PFP 1), and elderly (PFP 2). Two age-matched control groups (C 1 and C 2) comprised of 32 healthy subjects were included in the study. The latency, R(2) area, and recovery of the R(2) area of the blink reflex were investigated. STATISTICAL ANALYSIS: ANOVA and Bonferroni tests were used. RESULTS: The R(2) areas were significantly greater on the intact side of the PFP 1 group as compared to that in the control group ( P =0.012). The recovery of R2 component was significantly enhanced on the symptomatic (P = 0.027), and intact (P = 0.041) sides in PFP 1 as compared to that in the C 2 group at the stimulus interval of 600 ms. Significant enhanced recovery was noted at 200 ms stimulus interval on the symptomatic side of the two PFP groups (PFP 1, P = 0.05 and PFP 2, P = 0.025) and on the intact side of the PFP 1 group (P =0.035) as compared to that in the control groups. CONCLUSION: Young age-at-onset of PFP is associated with more prominent excitability changes developing at the neuronal and interneuronal level.

Reliability and validity of the Geriatric Depression Scale in depression in Parkinson's disease.

The objective of this study was to investigate reliability and validity of the self rated 30 item Geriatric Depression Scale (GDS) in screening and diagnosis of depression in Parkinson's disease (PD). The study sample comprised 109 non-demented patients with PD admitted to the movement disorders outpatient unit. The reference diagnosis of depression was made according to DSM-IV criteria. Discriminant validity and internal consistency of the total scale were studied. Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated for different cutoff scores. Receiver operating characteristics (ROC) analysis was also carried out. The sample comprised 56 patients with and 53 without depression. In the discriminant validity analysis, the mean total GDS score of subjects with depression was significantly higher compared with those without depression. The Cronbach's alpha score was 0.92 and the split half correlation coefficient 0.91. The cutoff score of 13/14 provided the highest sum of sensitivity and specificity level. The sensitivity of this cutoff score was 0.78 and specificity 0.85, while PPV was 0.84 and NPV 0.79. The area under the curve value in the ROC analysis was 0.891. Sensitivity and specificity analysis showed that cutoff scores of 8/9 or 9/10 could be useful for screening and 14/15 or 15/16 for diagnostic purposes. This study showed that the 30 item GDS, with its high discriminant validity, internal consistency, and reasonably clear cutoff scores, could be a useful screening or diagnostic self rated depression scale in patients with PD.

Somatosensory evoked blink response in hemifacial spasm and peripheral facial palsy.

Somatosensory blink response (SBR) is produced by electrical stimulation of peripheral nerves or skin areas remote from the face. We investigated the presence of SBR in cases with hemifacial spasm (HFS) and peripheral facial palsy (PFP). Fifty-seven cases of HFS, 54 cases of PFP and 39 normal subjects were included in the study. A routine blink reflex study was performed in all subjects. Supramaximal stimulation of the median nerve was given ipsilateral to the either spasm or paralytic side for SBR. Recordings were made at the orbicularis oculi (o.oc) bilaterally and ipsilaterally at the orbicularis oris (o.or) muscles. SBR was elicited in 12 of 39 control subject. Twenty four of 48 HFS cases were SBR positive. Twelve of them had o.or response. An SBR was elicited at the ipsilateral o.oc in 35 of 46 patients with PFP with synkinesia. Twenty-six patients had an SBR at the ipsilateral o.or. In the 13 patients with PFP without synkinesia only 3 people had an SBR. SBR positivity was seen more often in PFP with synkinesia than in cases with HFS. SBR if positive spreads to the lower part of the face in most of cases with HFS and PFP with synkinesia.

Sleep and sleepiness in patients with Parkinson's disease before and after dopaminergic treatment.

Sleep disturbances and daytime sleepiness are well-known phenomena in Parkinson's disease (PD). Fifteen previously untreated PD patients underwent clinical evaluation, subjective sleep evaluation and polysomnographic evaluation (PSG) before and after a treatment period of mean 8+/-3.1 months with dopaminergic drugs. Both mean Unified Parkinson's Disease Rating Scale (UPDRS) total score and mean subset III of the UPDRS were significantly improved with dopaminergic treatment. PSG revealed that administration of dopaminergic drugs resulted in significant increase in mean percentage of stages 1 and 2. The mean Epworth Sleepiness Scale (ESS) score was significantly increased and mean Multiple Sleep Latency Test (MSLT) score was significantly decreased after dopaminergic treatment indicating subjective and objective daytime sleepiness. The differences in MSLT scores were best explained by a higher dose of L-dopa, whereas other variables such as disease duration, treatment duration, Hoehn and Yahr stage, sleep efficiency index or dopamine agonists did not increase the significance. In contrast, any of the variables appeared to explain ESS score variability. This study demonstrates that daytime sleepiness is not present in untreated patients but emerges later during dopaminergic treatment. Total daily L-dopa dose is predictive of objective daytime sleepiness. Furthermore, subjective assessment of sleepiness may cause underestimation of the severity of daytime sleepiness.

Stuttering may be a type of action dystonia.

We observed abnormal involuntary movements, involving principally the facial and neck muscles, in 23 patients with stuttering. These movements were similar to involuntary movements seen in distinct dystonic syndromes. There was a history of stuttering in the first degree relatives of six patients. The association of stuttering with degenerative neurologic disorders and focal brain lesions, cerebral blood flow changes in patients with developmental stuttering, its occurrence as a side effect of centrally acting drugs, induction and alleviation of stuttering by mechanical perturbation, or by electrical stimulation of the thalamus, a strong genetic predisposition with male preponderance, and the statistically significant occurrence of stuttering in the family history of patients with idiopathic torsion dystonia suggest an organic basis for developmental stuttering. These findings and the reported similarities between the involuntary movements associated with stuttering and dystonic involuntary movements support the hypothesis that stuttering is a form of segmental or focal action dystonia.