Outcomes of high-risk breast lesions diagnosed using image-guided core needle biopsy: results from a multicenter retrospective study

PURPOSEThe clinical management of high-risk lesions using image-guided biopsy is challenging. This study aimed to evaluate the rates at which such lesions were upgraded to malignancy and identify possible predictive factors for upgrading high-risk lesions.METHODSThis retrospective multicenter analysis included 1.343 patients diagnosed with high-risk lesions using an image-guided core needle or vacuum-assisted biopsy (VAB). Only patients managed using an excisional biopsy or with at least one year of documented radiological follow-up were included. For each, the Breast Imaging Reporting and Data System (BI-RADS) category, number of samples, needle thickness, and lesion size were correlated with malignancy upgrade rates in different histologic subtypes. Pearson’s chi-squared test, the Fisher–Freeman–Halton test, and Fisher’s exact test were used for the statistical analyses.RESULTSThe overall upgrade rate was 20.6%, with the highest rates in the subtypes of intraductal papilloma (IP) with atypia (44.7%; 55/123), followed by atypical ductal hyperplasia (ADH) (38.4%; 144/375), lobular neoplasia (LN) (12.7%; 7/55), papilloma without atypia (9.4%; 58/611), flat epithelial atypia (FEA) (8.7%; 10/114), and radial scars (RSs) (4.6%; 3/65). There was a significant relationship between the upgrade rate and BI-RADS category, number of samples, and lesion size Lesion size was the most predictive factor for an upgrade in all subtypes.CONCLUSIONADH and atypical IP showed considerable upgrade rates to malignancy, requiring surgical excision. The LN, IP without atypia, pure FEA, and RS subtypes showed lower malignancy rates when the BI-RADS category was lower and in smaller lesions that had been adequately sampled using VAB. After being discussed in a multidisciplinary meeting, these cases could be managed with follow-up instead of excision

The effect of lumbar traction on clinic and functional status of patients diagnosed with subacute lumbar disc herniation

Lomber disk hernisi, dejenere diskin lomber spinal sinir kökünü sıkıştırması ile ortaya çıkan bel ve bacak ağrısı ile karakterize klinik tablodur. Çalışmanın amacı subakut lomber disk hernisi tanısı konan hastalarda fizik tedavi yöntemlerinden biri olan traksiyonun; ağrı, klinik, fonksiyonel durum ve yaşam kalitesi üzerine olan etkilerini araştırmaktır. Çalışmaya subakut lomber disk hernisi tanısı almış 61 hasta alındı. Olgular rastgele olarak iki gruba ayrıldı. Birinci gruba vücut ağrırlığının %35-50 kuvvetinde, 2. gruba vücut ağırlığının %10-20'si olacak kuvvette ?intermittant traksiyon? uygulandı. Tüm hastalara egzersiz programı ve bel ağrısından korunmak için önlemler konusunda eğitim verildi. Tedavi etkinliği paravertebral kas spazmı, el-parmak zemin mesafesi, lateral fleksiyon, lomber modifiye Schober, düz bacak kaldırma testi, visüel analog skala, short-form 36, Oswestry Bel Ağrısı Özürlülük ve Roland-Morris Fonksiyonel Değerlendirme formları ile tedavi öncesi, tedavi sonrası ve bir ay sonra değerlendirildi. Çalışmanın sonunda klinik parametreler, ağrı, Oswestry Bel Ağrısı Özürlülük, Roland-Morris Fonksiyonel Değerlendirme sonuçları ve Short-Form 36 değerlendirmelerinde her iki grupta iyileşme görülürken bu değişimler açısından gruplar arasında istatistiksel olarak fark bulunmadı. Sonuç olarak, lomber disk hernisinde vücut ağırlığının %35-50'sinin çekildiği traksiyon uygulamasının, vücut ağırlığının %10-20'siyle çekilen plasebo uygulamasından üstünlüğü gösterilemedi. İki gruptaki iyileşmenin; disk hernilerinin yaklaşık %50'sinin yapılan tedaviye bağlı olmaksızın birkaç haftada doğal seyri sonucu iyileşmesine, traksiyon dışında diğer konservatif tedaviler ve egzersiz programına da bağlı olabileceği kanaatindeyiz. Anahtar kelimeler: Subakut lomber disk hernisi, traksiyon, fonksiyonel durumLumbar disc herniation is a clinical entity characterized with lumbar and leg pain caused by the compression of spinal nerve root by the degenerated lumbar disc. This study?s aim was to investigate the effects of traction as a physical treatment method for the patients diagnosed with subacute lumbar disc herniation on pain, clinic status, functional status and life quality. Sixty-one patients diagnosed with subacute lumbar disc herniation were involved in the study. The patients were randomly divided into two groups. First group was gone through an intermittant traction with a force of their body weight?s 35-50%, and second group with a force of their body weight?s 10-20%. An exercise program was given to all patients and all patients were informed about precautions to protect themselves from lumbar pain. Treatment efficacy was assessed before the treatment, after the treatment and after a month later with the parameters of paravertebral muscle spasm, hand-finger floor distance, lateral flexion, lumbar modified Schober, straight leg raise test, visual analog scale, short form 36, Oswestry Lumbar Pain Disability and Roland-Morris Functional Evaluation forms. At the end of the study, improvements in both groups were observed in clinical parameters, such as Oswestry Lumbar Pain Disability, Roland Morris Functional Questionnaire results and short form 36 evaluations while there was no statistically significant difference between the groups. As a result, traction with a body weight?s 35-50% could not be showed to be superior to the placebo practice of traction with a body weight?s 10-20% in lumbar disc herniation. We were convinced that apart from the treatment itself, the improvement in both groups could be due to the improvement that can be seen in natural outcome of 50% of the disc herniations within a few weeks. This improvement could also be related to conservative treatments and exercise program except for the traction. Key words: Subacute lumbar disc herniation, traction, functional status

Effects of comorbid anxiety disorders on the course of bipolar disorder-I

WOS: 000369972000009PubMed: 25765438Background and aims: Although comorbid anxiety disorders (AD) are quite frequent in bipolar disorders (BD), data on how this comorbidity affects BD are limited. In the present study, we aimed to investigate the frequency of comorbid AD in Turkish patients with bipolar disorder-I (BD-I) and the effects of comorbid AD on the course of BD-I. Methods: 114 patients with BD-I were included in the study. All patients were diagnosed by a psychiatrist. The patients were divided into two groups as BD-I patients with lifetime comorbid AD (BDI-CAD) or those without comorbid AD (BDI). Results: 37 (32.46%) patients had one or more comorbid lifetime AD. The numbers of admissions to the outpatient clinic within calendar year 2013 (P = 0.014), the number of lifetime mood episodes (P = 0.019) and the duration of BD (P = 0.007) were higher in the BDI-CAD group compared with the BDI group. There was a strong relationship between the duration of the disorder and the number of episodes (r = 0.583, P < 0.001). Partial correlation analyses showed that the number of admission to the outpatient clinic correlated significantly with the frequency of episodes (P = 0.007, r = 0.282). Conclusion : We found that the patients with BDI-CAD use the healthcare system more frequently than the BDI patients. This suggests that AD comorbidity may have a negative influence on the course of BD-I and it is a factor that should be considered in the clinical follow-up

Strok tipi komplikasyonların rehabilitasyon sonuçlarıyla ilişkisi

Amaç: Çeşitli etyolojik nedenli hemiparezisi olan olgular tedavi öncesi ve sonrası incelenerek fonksiyonel geri dönüşüm oranları, motor gelişimleri, oluşan komplikasyonlar ve bunlar üzerinde etkisi olabilecek faktörler araştırıldı. Hastalar ve Yöntemler: Rehabilitasyona alınan 82 hasta (52 erkek; ort. yaş 57.06±15.43; dağılım 8-82 ve 30 kadın; ort. yaş 56.17±14.41; dağılım 18-78) retrospektif olarak değerlendirildi. Olguların yaş, cinsiyet, tutulan taraf, etyolojik neden, mental durum, lisan özelliği, rehabilitasyona başlayana kadar geçen süre, giriş ve taburcu öncesi Brunnstrom değerleri, Ashworth indeksleri, fonksiyonel ambulasyon evreleri (FAE), Barthel indeksleri (Bİ), takip süresince ortaya çıkan komplikasyonlar ve hastanede toplam yatış süreleri kaydedildi. Bulgular: Tüm hastaların hastaneden çıkış öncesi Brunnstrom değerleri, Bİ ve FAE'leri hastaneye yatışlarına göre anlamlı düzeyde farklıydı. Rehabilitasyona başlayana kadar geçen süre ile tedavi sonrası değişim oranı arasında negatif korelasyon vardı. Hastanede yatış süresi ile skorlardaki değişim oranının pozitif korelasyon gösterdiği görüldü. Takip sırasında gelişen enfeksiyonların Bİ ve FAE'deki değişimi olumsuz etkilediği saptandı. Sonuç: Çalışmamızın bulguları hemiparezik olguların fonksiyonel durumlarının rehabilitasyonla olumlu yönde etkilendiğini, bu değişimin etyolojik nedenlerle ilişkisiz olduğunu ve komplikasyonların tedavi sonuçlarını etkilemediğini göstermektedir.Objectives: We examined cases of hemiparesis with various aetiological reasons, before and after treatment in order to analyse the factors which may affect functional recovery rates, motor development and complications. Patients and Methods: Eighty-two patients (52 males; mean age 57.06&plusmn;15.43; range 8-82 and 30 females; mean age 56.17&plusmn;14.41; range 18-78) were retrospectively evaluated. Patient characteristics including age, gender, side of hemiparesis, type of stroke, mental condition, speech ability, the onset to rehabilitation admission interval, Brunnstrom values, the Ashworth index, the Functional Ambulation Categories (FAC), Barthel index (BI) on admission and before discharge from the hospital, complications and length of inpatient stay were recorded. Results: There were significant differences between admission and discharge Brunnstrom values, BI and FAC's in all the patients. There was a negative correlation between the onset to rehabilitation admission interval and the rate of change after treatment. A positive correlation was observed between the length of inpatient stay and the rate of change in the scores. It was determined that infections negatively affected the changes in BI and FAC's after treatment. Conclusions: Our results suggest that the functional outcome of hemiparetic patients was positively affected by rehabilitation, and that the aetiological reasons and complications did not affect the results of the treatment

Efficiency of Magnetic Field Treatment on Pressure Sores in Bedridden Patients

Objective: Pressure sores are an important source of complications in patients who are immobilized and bedridden. We aimed to investigate the efficiency of magnetic field treatment in pressure sores. Material and Methods: This was a randomized, double blind controlled design study. 20 patients in the study group received magneto-therapy, once a day for 30 minutes and with 150G, keeping to the BTL09 magnetotherapy device’s program. In the control group, 20 patients received the dressing only once a day. The surface areas of the pressure sores were evaluated at the onset of the treatment (1st day), and on the 7th and 15th days.Results: When within group comparisons were conducted, a significant difference was observed between the 1st and 7th day, 7th and 15th day, and 1st and 15th day measures in both the groups in terms of the scar area. The average healing time for the treatment group was 10.80±4.06 (6-20) days, and the average healing time for the control group was 18.85±9.75 (5-32) days. There was a statistically significant difference between the two groups (z=-2.114, p=0.034). Also, there was a significant difference in the scar area between the two groups in the 15th day measure (z=-3.818, p=0.000).Conclusion: The healing process of the tissue can be accelerated.with the use of magnetotherapy in the treatment of pressure sores of stage II and III

The effect of temperament on the treatment adherence of bipolar disorder type I

WOS: 000370961500003PubMed: 26207348Background and aims: Treatment adherence is one of the most important factors that may determine treatment response in patients with bipolar disorders (BD). Many factors have been described to be associated with treatment adherence in BD. Temperament that can influence the course of BD will have an impact on treatment adherence. The aim of this study is to investigate temperament effect on treatment adherence in euthymic patients with BD-I. Methods: Eighty patients with BD-I participated in the study. A psychiatrist used the Structured Clinical Interview for DSM-IV Axis-I Disorders to determine the diagnosis and co-morbidities. Hamilton Depression and Young Mania Rating Scale were used to detect the remission. We used the Temperament Evaluation of Memphis, Pisa, Paris, San Diego Autoquestionnaire and the 4-item Morisky Medication Adherence Scale to evaluate temperament and treatment adherence, respectively. The study group was divided into two groups as "treatment adherent" and "treatment non-adherent". Results: The cyclothymic and anxious temperament scores of the treatment non-adherent patients with BD-I were significantly higher than those of the treatment adherent group (p < 0.001, p = 0.006, respectively). Multiple linear regression analysis determined that cyclothymic temperament predicted treatment non-adherence (p = 0.009). Conclusion: It should be kept in mind that BD-I patients with cyclothymic temperament may be treatment non-adherent and future studies should explore whether temperament characteristics deteriorate BD-I course by disrupting treatment adherence

The Association of Vitamin D with Cognitive Functions: Cross-Sectional Study in Young Adult Women

Objective: The objective of this study was to examine the association between 25-hydroxyvitamin D [25(OH)D] and cognitive function in younger women. Materials and Methods: One hundred four women aged 18 to 65 years were recruited in the study. The demographic data were recorded and the Standardized Mini Mental State Examination (SMMSE) was administered. Patients were divided into three groups; 25(OH)D level <20 ng/mL regarded as vitamin D deficiency, 20-29 ng/mL as vitamin D insufficiency, ≥30 ng/mL as normal. Results: There was no statistically significant relationship between SMMSE scores and serum 25(OH)D levels. Conclusion: We found no evidence of associations between lower 25(OH)D levels and cognitive functions in younger women