QUALITY OF LIFE AND DEPRESSION AMONG FEMALE PATIENTS UNDERGOING SURGICAL TREATMENT FOR BREAST CANCER: A PROSPECTIVE STUDY

Background: Breast carcinoma is the most common malignant disease in women in the majority of developed countries. The development of depression as well as the quality of life (QoL) in these patients depends not only on the result of oncologic treatment, but on the cosmetic outcome as well. The primary aim of this prospective study was to investigate the changes in QoL and depressive symptoms among patients undergoing surgical treatment for breast cancer. Subjects and methods: We conducted a prospective study that included 100 female patients (mean age 60.26 years) who underwent surgical and oncological treatment for breast carcinoma at the University Hospital Center Zagreb, Croatia. The patients were photographed before and after treatment and were required to fill out a standardized quality of life questionairres QLQ – C30 and QLQ – BR23, Beck Depression Inventory (BDI) and a questionnaire on breast asymmetry. Results: Our results show that patients had significantly higher QoL levels compared with their pre-surgical results. Statistical trend of a lower degree of depression was also observed. A worse cosmetic outcome (i.e., postoperative assymetry) was associated with a lower QoL, but there was no association with depression. Depression was significantly related to the level of pain and lower financial status. Conclusion: QoL improved after surgical treatment of breast cancer and was dependant on postoperative asymmetry, whereas the findings for depressive symptoms remained less clear. Future research should investigate more factors that may contribute to the QoL and degree of depression in this patient population

Endoscopically Assisted Latissimus Dorsi Flap Harvesting and Breast Reconstruction in Young Female with Poland Syndrome

We will describe a second phase of breast reconstruction on a young girl suffering from Poland syndrome. She has the breast, pectoralis major and minor muscle aplasia on the right side. She has no other deformities. The best result is achieved by combining latissimus dorsi flap and a silicone implant, and even better aesthetic result is accomplished with endoscopically assisted latissimus dorsi harvesting. Purpose of this operation is to correct the chest asymmetry and to accomplish good aesthetic result

Reconstruction of a Soft Tissue Defect of the Back after Myelomeningocele Closure with Modified V-Y Plasty

Myelomeningocele is a congenital defect in vertebral arches with cystic dilatation of meninges and structural or functional abnormality of spinal cord or cauda equina. It is a form of spinal dysraphisam with overlying skin defect (spina bifida aperta). That condition is related to other clinical complications such as infection that can produce furthermore complications. To prevent rate of complications surgical treatment in first 24 h is strongly suggested. In this case report we describe a patient (infant) with congenital myelomeningocele who’s defect was treated surgically by the neurosurgeon. In operative procedure plastic surgeon was involved to cover the skin defect remaining after neurosurgical closure of spinal canal. Bilateral advancement local skin flaps were used in soft tissue defect closure. Review of the literature that refers to advancement local skin flaps was carried out

Combined Vacuum-Assisted Closure Treatment with Laparoscopic Mobilization of an Omental Flap and Meshed Skin Grafts for Reconstruction of Infected Sternotomy Wounds: Two Cases

In cardiac surgery, poststernotomy wounds are life threatening complications, with mortality up to 50%. We described two patients, who underwent coronary artery bypass grafting and postoperatively developed a deep sternal wound infection. Reconstruction was combined with vacuum-assisted closure treatment, laparoscopic mobilization of an omental flap and split thicknes skin grafts. The omental flap is a well-vascularized local flap with a large surface area and has excellent immunologic and angiogenic properties. Both patients recovered completely. In our opinion, vacuum-assisted closure treatment and laparoscopic mobilization of great omentum is suitable option for treating deep sternal wounds

Determination of an anatomical localization of umbilicus using mathematical model

Cilj: Izgled pupka je od ključnog značaja za ukupni estetski dojam prednje trbušnestijenke i kod muškaraca i žena. Do sada je objavljeno svega nekoliko matematičkih modela za predviđanje lokalizacije pupka. Cilj ove studije bio je razviti matematički model za predviđanje lokalizacije pupka kod mladih muškaraca i žena te kod sredovječnih žena. U nastavku, željeli smo razviti zajednički model upotrebljiv kod oba spola. U našim modelima koristili smo antropometrijske karakteristike poput indeksa tjelesne mase (BMI), opsega struka (WC), opsega bokova (HC), a kako bi nadogradili naše rezultate. ----- Metode: Za ovu studiju uključeno je 98 slučajno odabranih volontera, studenata s Medicinskog fakulteta u Zagrebu i 46 sredovječnih žena, kandidata za abdominoplastiku kao posebna ciljna skupina. Izmjerene su antropometrijske karakteristike i udaljenosti između pupka i specifičnih čvrstih točaka oko trbušne stijenke. Antropometrijske mjere bile su tjelesna masa (BW), tjelesna visina (BH), indeks tjelesne mase (BMI), opsezi struka i bokova (WC, HC) te omjer opsega struka i opsega bokova (WC/HC). Svi prikupljeni podaci bili su statistički obrađeni standardnim metodama. ----- Rezultati: Studija je izvela dvije regresijske jednadžbe kao najtočnije alate za predikciju lokalizacije pupka. Za žene, najtočnija predikcija lokalizacije pupka bila je bazirana na udaljenosti između pupka i linije koja spaja prednje hipohondrije, na temelju koje je izvedena sljedeća jednadžba: u-i-hy = tjelesna masa x 0.5799 + tjelesna visina x -0.5051 + BMI x 1.8230 + omjer opsega struka i bokova x -10.6364 + 89.6411. Za muškarce, najtočnija predikcija lokalizacije pupka bila je bazirana na udaljenosti između pupka i linije koja spaja spine ilijake anterior superior, na temelju koje je izvedena sljedeća jednadžba: u-i-is = dob x 0.2033 + tjelesna masa x 0.6445 + tjelesna visina x -0.5692 + BMI x -2.2802 + opseg struka x -0.0911 + 101.9408. ----- Zaključak: Zaključujemo da dob ispitanika i antropometrijske karakteristike uvelike istih utječu na lokalizaciju pupka na prednjem trbušnom zidu. Prirodna raznolikost u antropometrijskim mjerama između žena i muškaraca onemogućuje korištenje jedinstvenog matematičkog modela za predikciju lokalizacije pupka u oba spola zbog prevelike pogreške pa preporučujemo dva različita predikcijska modela kao najtočniju matematičku metodu za predviđanje lokalizacije pupka kod muškaraca i žena. Ovaj kvantitativni model preporučujemo kao pouzdanu metodu kod pozicioniranja pupka nakon rekonstruktivnih ili estetskih zahvata kojima je izvorna anatomska lokalizacija pupka kompromitirana.Aim: The umbilicus is an essential esthetic landmark on the abdominal wall in women and men. There are only few models published for predicting exact localization of the umbilicus. The aim of our study was to develop a mathematical model for predicting correct umbilical positioning in a sample of young women and men and in a sample of middle-aged women. In addition, we wanted to develop a predictive model applicable to both sexes. We applied our models with distinct anthropometric characteristics such as body mass index (BMI) and waist circumference (WC)/hip circumference (HC) to further expand our findings. ----- Methods: In this study, 98 Croatian women and men randomly selected from the University of Zagreb and 46 female patients awaiting abdominoplasty procedure at our institution were included. Anthropometric data and measurements between the umbilicus and fixed bony points around the anterior abdomen were collected. The data collected were body weight (BW), body height (BH), BMI, WC and HC, and waist-hip ratios. All collected data were subjected to standard statistical analyses. ----- Results: This study developed 2 different regressive equations for the most accurate prediction of exact umbilical localization. In women, the best prediction of the position of the umbilicus was based on the distance from the interanterior hypochondrium line to the umbilicus using the following regressive equation: u-i-hy = BM x 0.5799 + BH x -0.5051 + BMI x 1.8230 + WHR x -10.6364 + 89.6411. In men, the best prediction of the position of the umbilicus was based on the distance from the umbilicus to the interspinous line using the following regressive equation: u-i-is = age x 0.2033 + BW x 0.6445 + BH x -0.5692 + BMI x -2.2802 + WC x -0.0911 + 101.9408. ----- Conclusion: We found that age and anthropometric dimensions have a significant influence on the position of the umbilicus on the anterior abdominal wall. The naturally occurring anthropometric variations between women and men made the results of a unique predictive model for umbilical position inaccurate. We found that using 2 distinct predictive models, 1 for both subgroups of women and 1 for men, generated the most accurate predictive results. This quantitative tool should be applied to both women and men for the correct positioning of the umbilicus in reconstructive and esthetic procedures in which the original umbilical location is affected

Određivanje anatomske lokalizacije pupka uz pomoć matematičkoga modela [Determination of an anatomical localization of umbilicus using mathematical model]

Aim: The umbilicus is an essential esthetic landmark on the abdominal wall in women and men. There are only few models published for predicting exact localization of the umbilicus. The aim of our study was to develop a mathematical model for predicting correct umbilical positioning in a sample of young women and men and in a sample of middle-aged women. In addition, we wanted to develop a predictive model applicable to both sexes. We applied our models with distinct anthropometric characteristics such as body mass index (BMI) and waist circumference (WC)/hip circumference (HC) to further expand our findings. ----- Methods: In this study, 98 Croatian women and men randomly selected from the University of Zagreb and 46 female patients awaiting abdominoplasty procedure at our institution were included. Anthropometric data and measurements between the umbilicus and fixed bony points around the anterior abdomen were collected. The data collected were body weight (BW), body height (BH), BMI, WC and HC, and waist-hip ratios. All collected data were subjected to standard statistical analyses. ----- Results: This study developed 2 different regressive equations for the most accurate prediction of exact umbilical localization. In women, the best prediction of the position of the umbilicus was based on the distance from the interanterior hypochondrium line to the umbilicus using the following regressive equation: u-i-hy = BM x 0.5799 + BH x -0.5051 + BMI x 1.8230 + WHR x -10.6364 + 89.6411. In men, the best prediction of the position of the umbilicus was based on the distance from the umbilicus to the interspinous line using the following regressive equation: u-i-is = age x 0.2033 + BW x 0.6445 + BH x -0.5692 + BMI x -2.2802 + WC x -0.0911 + 101.9408. ----- Conclusion: We found that age and anthropometric dimensions have a significant influence on the position of the umbilicus on the anterior abdominal wall. The naturally occurring anthropometric variations between women and men made the results of a unique predictive model for umbilical position inaccurate. We found that using 2 distinct predictive models, 1 for both subgroups of women and 1 for men, generated the most accurate predictive results. This quantitative tool should be applied to both women and men for the correct positioning of the umbilicus in reconstructive and esthetic procedures in which the original umbilical location is affected

Determination of an anatomical localization of umbilicus using mathematical model

Cilj: Izgled pupka je od ključnog značaja za ukupni estetski dojam prednje trbušnestijenke i kod muškaraca i žena. Do sada je objavljeno svega nekoliko matematičkih modela za predviđanje lokalizacije pupka. Cilj ove studije bio je razviti matematički model za predviđanje lokalizacije pupka kod mladih muškaraca i žena te kod sredovječnih žena. U nastavku, željeli smo razviti zajednički model upotrebljiv kod oba spola. U našim modelima koristili smo antropometrijske karakteristike poput indeksa tjelesne mase (BMI), opsega struka (WC), opsega bokova (HC), a kako bi nadogradili naše rezultate. ----- Metode: Za ovu studiju uključeno je 98 slučajno odabranih volontera, studenata s Medicinskog fakulteta u Zagrebu i 46 sredovječnih žena, kandidata za abdominoplastiku kao posebna ciljna skupina. Izmjerene su antropometrijske karakteristike i udaljenosti između pupka i specifičnih čvrstih točaka oko trbušne stijenke. Antropometrijske mjere bile su tjelesna masa (BW), tjelesna visina (BH), indeks tjelesne mase (BMI), opsezi struka i bokova (WC, HC) te omjer opsega struka i opsega bokova (WC/HC). Svi prikupljeni podaci bili su statistički obrađeni standardnim metodama. ----- Rezultati: Studija je izvela dvije regresijske jednadžbe kao najtočnije alate za predikciju lokalizacije pupka. Za žene, najtočnija predikcija lokalizacije pupka bila je bazirana na udaljenosti između pupka i linije koja spaja prednje hipohondrije, na temelju koje je izvedena sljedeća jednadžba: u-i-hy = tjelesna masa x 0.5799 + tjelesna visina x -0.5051 + BMI x 1.8230 + omjer opsega struka i bokova x -10.6364 + 89.6411. Za muškarce, najtočnija predikcija lokalizacije pupka bila je bazirana na udaljenosti između pupka i linije koja spaja spine ilijake anterior superior, na temelju koje je izvedena sljedeća jednadžba: u-i-is = dob x 0.2033 + tjelesna masa x 0.6445 + tjelesna visina x -0.5692 + BMI x -2.2802 + opseg struka x -0.0911 + 101.9408. ----- Zaključak: Zaključujemo da dob ispitanika i antropometrijske karakteristike uvelike istih utječu na lokalizaciju pupka na prednjem trbušnom zidu. Prirodna raznolikost u antropometrijskim mjerama između žena i muškaraca onemogućuje korištenje jedinstvenog matematičkog modela za predikciju lokalizacije pupka u oba spola zbog prevelike pogreške pa preporučujemo dva različita predikcijska modela kao najtočniju matematičku metodu za predviđanje lokalizacije pupka kod muškaraca i žena. Ovaj kvantitativni model preporučujemo kao pouzdanu metodu kod pozicioniranja pupka nakon rekonstruktivnih ili estetskih zahvata kojima je izvorna anatomska lokalizacija pupka kompromitirana.Aim: The umbilicus is an essential esthetic landmark on the abdominal wall in women and men. There are only few models published for predicting exact localization of the umbilicus. The aim of our study was to develop a mathematical model for predicting correct umbilical positioning in a sample of young women and men and in a sample of middle-aged women. In addition, we wanted to develop a predictive model applicable to both sexes. We applied our models with distinct anthropometric characteristics such as body mass index (BMI) and waist circumference (WC)/hip circumference (HC) to further expand our findings. ----- Methods: In this study, 98 Croatian women and men randomly selected from the University of Zagreb and 46 female patients awaiting abdominoplasty procedure at our institution were included. Anthropometric data and measurements between the umbilicus and fixed bony points around the anterior abdomen were collected. The data collected were body weight (BW), body height (BH), BMI, WC and HC, and waist-hip ratios. All collected data were subjected to standard statistical analyses. ----- Results: This study developed 2 different regressive equations for the most accurate prediction of exact umbilical localization. In women, the best prediction of the position of the umbilicus was based on the distance from the interanterior hypochondrium line to the umbilicus using the following regressive equation: u-i-hy = BM x 0.5799 + BH x -0.5051 + BMI x 1.8230 + WHR x -10.6364 + 89.6411. In men, the best prediction of the position of the umbilicus was based on the distance from the umbilicus to the interspinous line using the following regressive equation: u-i-is = age x 0.2033 + BW x 0.6445 + BH x -0.5692 + BMI x -2.2802 + WC x -0.0911 + 101.9408. ----- Conclusion: We found that age and anthropometric dimensions have a significant influence on the position of the umbilicus on the anterior abdominal wall. The naturally occurring anthropometric variations between women and men made the results of a unique predictive model for umbilical position inaccurate. We found that using 2 distinct predictive models, 1 for both subgroups of women and 1 for men, generated the most accurate predictive results. This quantitative tool should be applied to both women and men for the correct positioning of the umbilicus in reconstructive and esthetic procedures in which the original umbilical location is affected

Determination of an anatomical localization of umbilicus using mathematical model

Cilj: Izgled pupka je od ključnog značaja za ukupni estetski dojam prednje trbušnestijenke i kod muškaraca i žena. Do sada je objavljeno svega nekoliko matematičkih modela za predviđanje lokalizacije pupka. Cilj ove studije bio je razviti matematički model za predviđanje lokalizacije pupka kod mladih muškaraca i žena te kod sredovječnih žena. U nastavku, željeli smo razviti zajednički model upotrebljiv kod oba spola. U našim modelima koristili smo antropometrijske karakteristike poput indeksa tjelesne mase (BMI), opsega struka (WC), opsega bokova (HC), a kako bi nadogradili naše rezultate. ----- Metode: Za ovu studiju uključeno je 98 slučajno odabranih volontera, studenata s Medicinskog fakulteta u Zagrebu i 46 sredovječnih žena, kandidata za abdominoplastiku kao posebna ciljna skupina. Izmjerene su antropometrijske karakteristike i udaljenosti između pupka i specifičnih čvrstih točaka oko trbušne stijenke. Antropometrijske mjere bile su tjelesna masa (BW), tjelesna visina (BH), indeks tjelesne mase (BMI), opsezi struka i bokova (WC, HC) te omjer opsega struka i opsega bokova (WC/HC). Svi prikupljeni podaci bili su statistički obrađeni standardnim metodama. ----- Rezultati: Studija je izvela dvije regresijske jednadžbe kao najtočnije alate za predikciju lokalizacije pupka. Za žene, najtočnija predikcija lokalizacije pupka bila je bazirana na udaljenosti između pupka i linije koja spaja prednje hipohondrije, na temelju koje je izvedena sljedeća jednadžba: u-i-hy = tjelesna masa x 0.5799 + tjelesna visina x -0.5051 + BMI x 1.8230 + omjer opsega struka i bokova x -10.6364 + 89.6411. Za muškarce, najtočnija predikcija lokalizacije pupka bila je bazirana na udaljenosti između pupka i linije koja spaja spine ilijake anterior superior, na temelju koje je izvedena sljedeća jednadžba: u-i-is = dob x 0.2033 + tjelesna masa x 0.6445 + tjelesna visina x -0.5692 + BMI x -2.2802 + opseg struka x -0.0911 + 101.9408. ----- Zaključak: Zaključujemo da dob ispitanika i antropometrijske karakteristike uvelike istih utječu na lokalizaciju pupka na prednjem trbušnom zidu. Prirodna raznolikost u antropometrijskim mjerama između žena i muškaraca onemogućuje korištenje jedinstvenog matematičkog modela za predikciju lokalizacije pupka u oba spola zbog prevelike pogreške pa preporučujemo dva različita predikcijska modela kao najtočniju matematičku metodu za predviđanje lokalizacije pupka kod muškaraca i žena. Ovaj kvantitativni model preporučujemo kao pouzdanu metodu kod pozicioniranja pupka nakon rekonstruktivnih ili estetskih zahvata kojima je izvorna anatomska lokalizacija pupka kompromitirana.Aim: The umbilicus is an essential esthetic landmark on the abdominal wall in women and men. There are only few models published for predicting exact localization of the umbilicus. The aim of our study was to develop a mathematical model for predicting correct umbilical positioning in a sample of young women and men and in a sample of middle-aged women. In addition, we wanted to develop a predictive model applicable to both sexes. We applied our models with distinct anthropometric characteristics such as body mass index (BMI) and waist circumference (WC)/hip circumference (HC) to further expand our findings. ----- Methods: In this study, 98 Croatian women and men randomly selected from the University of Zagreb and 46 female patients awaiting abdominoplasty procedure at our institution were included. Anthropometric data and measurements between the umbilicus and fixed bony points around the anterior abdomen were collected. The data collected were body weight (BW), body height (BH), BMI, WC and HC, and waist-hip ratios. All collected data were subjected to standard statistical analyses. ----- Results: This study developed 2 different regressive equations for the most accurate prediction of exact umbilical localization. In women, the best prediction of the position of the umbilicus was based on the distance from the interanterior hypochondrium line to the umbilicus using the following regressive equation: u-i-hy = BM x 0.5799 + BH x -0.5051 + BMI x 1.8230 + WHR x -10.6364 + 89.6411. In men, the best prediction of the position of the umbilicus was based on the distance from the umbilicus to the interspinous line using the following regressive equation: u-i-is = age x 0.2033 + BW x 0.6445 + BH x -0.5692 + BMI x -2.2802 + WC x -0.0911 + 101.9408. ----- Conclusion: We found that age and anthropometric dimensions have a significant influence on the position of the umbilicus on the anterior abdominal wall. The naturally occurring anthropometric variations between women and men made the results of a unique predictive model for umbilical position inaccurate. We found that using 2 distinct predictive models, 1 for both subgroups of women and 1 for men, generated the most accurate predictive results. This quantitative tool should be applied to both women and men for the correct positioning of the umbilicus in reconstructive and esthetic procedures in which the original umbilical location is affected

Combined vacuum-assisted closure treatment with laparoscopic mobilization of an omental flap and meshed skin grafts for reconstruction of infected sternotomy wounds: two cases [Vakum potpomognuto liječenje i laparoskopski mobilizacija velikog omentuma u liječenju teških infekcija rana prsne kosti: prikaz dva slučaja]

In cardiac surgery, poststernotomy wounds are life threatening complications, with mortality up to 50%. We described two patients, who underwent coronary artery bypass grafting and postoperatively developed a deep sternal wound infection. Reconstruction was combined with vacuum-assisted closure treatment, laparoscopic mobilization of an omental flap and split thicknes skin grafts. The omental flap is a well-vascularized local flap with a large surface area and has excellent immunologic and angiogenic properties. Both patients recovered completely. In our opinion, vacuum-assisted closure treatment and laparoscopic mobilization of great omentum is suitable option for treating deep sternal wounds