17 research outputs found
Breast Reconstruction after Mastectomy
Results of our analysis show as that breast reconstruction become a standard part of the care of female patients with breast cancer. We will analyse the factors that are important for the primary or secondary breast reconstruction after mastectomy, and also take a closer look on the most recent scientific advances on breast reconstruction and on the protocols regarding them. The breast is the most common site of cancer in Croatia women. Breast cancer is the first leading cause of cancer death among women today. The incidence of female breast cancer in Croatia estimates that approximately 2.200 news cases of female breast will be diagnosed every year. We retrospectively analysed data of 101 female patients undergoing reconstructive surgery for breast reconstruction after mastectomy at Division of Plastic Surgery and Burns, University Hospital Center Split and University Clinic of Plastic and Reconstructive Surgery, Innsbruck, Austria, between 1998 and 2008. For the purpose of outcome assessment, we performed the tree different type of questionnaire: (1) Personal/medical profile (Table 1), (2) Aesthetic assessment (Table 2), and (3) Psychosocial assessment (Table 3). The occurrence of main complications during breast reconstruction (partial necrosis of flap, hernia of donor site, pulmonary embolism, deep venous thrombosis, infection rate, hemathoma and seroma formation, and extrusion of expander/implant) during hospitalisation and follow up period until 6 post operatively were analysed with respect to use different type of reconstructive methods for breast reconstruction. The difference in complication between patients groups was evaluated by c2-test. The level of significance was set up at p=0.05. Mann-Whitney test was used to compare the time from mastectomy to breast reconstruction, due to asymmetrical data distribution. The three main variables of this study were to identify significant risk factors, asses the aesthetic outcome, and patient satisfaction with performed different methods for breast reconstruction (LD flap with or without tissue expander and implant, pedicle and free TRAM flaps, and expander /implants only. These variables determined the current guidelines for early and late breast reconstruction after mastectomy such as patient data, age and own decision, relation ship between reconstruction and radiotherapy, and chemotherapy, and finally about breast preserving operation. The result should confirm that breast reconstruction after mastectomy is justified, especially in young women, as well as how essential is team work involved in breast cancer operation and breast reconstruction after mastectomy
Current Trends in Breast Reduction
Results of our study describe the long term effects of reduction mammaplasty. Many women with excessively small or
large breasts have an altered personal self-image and often suffer from low self-esteem and other psychological stresses.
This procedure is designed to reduce and reshape large breasts, and since the size, shape, and symmetry of a womanās
breasts can have a profound effect on hermental and physical well-being it is important to observe the patientās long-term
outcome. Currently, breast reduction surgery is safe, effective and beneficial to the patient. In Croatia, reduction mammoplasty
is often excluded from the general health care plan. The distinction between Ā»reconstructiveĀ« versus Ā»cosmeticĀ«
breast surgery is very well defined by the American Society of Plastic Surgeons Board of Directors. Unfortunately, the
Croatian Health Society has yet to standardize such a distinction. There is an imperative need for evidence-based selection
criteria. We retrospectively analyzed data of 59 female patients suffering from symptomatic macromastia who underwent
reduction mammaplasty over a 16 year period (1995 until 2011). Our aim was to compare and contrast the various
techniques available for reduction mammaplasty and to determine, based on patient outcome and satisfaction, which
technique is most suited for each patient. The results of our study generally reinforce the observation that reduction
mammaplasty significantly provides improvements in health status, long-term quality of life, postsurgical breast appearance
and significantly decrease physical symptoms of pain. A number of 59 consecutive cases were initially treated
with the four different breast reduction techniques: inverted-T scat or Wisa pattern breast reduction, vertical reduction
mammaplasty, simplified vertical reduction mammaplasty, inferior pedicle and free nipple graft techniques. The average
clinical follow-up period was 6-months, and included 48 patients. The statistical analysis of the postoperative patient
complications revealed a significant positive relationship in regards to smoking. The majority of these complications
were wound related, with no significant relationship between patient complications and variables such as age,
BMI, ASA score, resection weight of breast parenchyma, nipple elevation, duration of surgery, and type of pedicle. The
higher number of complication correlated with a lower volume of parenchyma resection (rho=ā0.321). Overall satisfaction
with the new breast size (79%), appearance of the postoperative scars (87%), overall cosmetic outcome score (91%),
overall outcome (100%), psychosocial outcome (46%), sexual outcome (85%), physical outcome (88%), satisfaction with
preoperative information data (92%), and finally satisfaction with overall care process (96%) was calculated. As expected,
the physical symptoms disappeared or were minimized in 88% of patients. Each method of breast reduction has
its advantages and disadvantages. The surgeon should evaluate each patientās desires on the basis of her physical presentation.
Breast reduction surgery increases the overall personal and social health; not only for the patient, but for their
family and friends as well. It is an imperative that every surgeon is aware of this, in order to provide the highest level of
care and quality to their patients
Necrotizing fasciitis: literature review of contemporary strategies for diagnosing and management with three case reports: torso, abdominal wall, upper and lower limbs
Necrotizing fasciitis (NF) is an uncommon soft tissue infection, usually caused by toxin-producing virulent bacteria. It is characterized by widespread fascial necrosis primarily caused by Streptococcus hemolyticus. Shortly after the onset of the disease, patients become colonized with their own aerobic and anaerobic microflora from the gastrointestinal and/or urogenital tracts. Early diagnosis with aggressive multidisciplinary treatment is mandatory. We describe three clinical cases with NF. The first is a 69 years old man with diabetes mellitus type II, who presented with NF on the posterior chest wall, shoulder and arm. He was admitted to the intensive care unit (ICU) with a clinical picture of severe sepsis. Outpatient treatment and early surgical debridement of the affected zones (inside 3 hours after admittance) and critical care therapy were performed. The second case is of a 63 years old paraplegic man with diabetes mellitus type I. Pressure sores and perineal abscesses progressed to Fournier's gangrene of the perineum and scrotum. He had NF of the anterior abdominal wall and the right thigh. Outpatient treatment and early surgical debridement of the affected zones (inside 6 hour after admittance) and critical care therapy were performed. The third patient was a 56 year old man who had NF of the anterior abdominal wall, flank and retroperitoneal space. He had an operation of the direct inguinal hernia, which was complicated with a bowel perforation and secondary peritonitis. After establishing the diagnosis of NF of the abdominal wall and retroperitoneal space (RS), he was transferred to the ICU. There he first received intensive care therapy, after which emergency surgical debridement of the abdominal wall, left colectomy, and extensive debridement of the RS were done (72 hours after operation of inquinal hernia). On average, 4 serial debridements were performed in each patient. The median of serial debridement in all three cases was four times. Other intensive care therapy with a combination of antibiotics and adjuvant hyperbaric oxygen therapy (HBOT) was applied during the treatment. After stabilization of soft tissue wounds and the formation of fresh granulation tissue, soft tissue defect were reconstructed using simple to complex reconstructive methods
ULOGA PSIHIJATRA U LIJEÄENJU OPEKLINSKIH TRAUMA
Psihijatrijski simptomi opÄenito se pojavljuju kao dio složenog sistemskog odgovora na opeklinsku ozljedu. PsiholoÅ”ko
i farmakoloÅ”ko lijeÄenje neophodno je za uspjeÅ”ni oporavak bolesnika ili barem za smanjenje psihijatrijskih
posttraumatskih posljedica. Treba imati na umu da je psiholoŔka adaptacija dugotrajan proces koji traje mjesecima pa i
godinama. Nužno je da opeklinski tim struÄnjaka uz procjenjivanje tjelesnog oporavka bolesnika, uporedo procjenjuje i
njegovo psihiÄko i afektivno stanje. Iako veÄina bolesnika može postiÄi zadovoljavajuÄu prilagodbu, mnogi se nastavljaju
boriti sa slikom o sebi, ljutnjom, bijesom, tugom, nesanicom, strahom, povlaÄenjem, bijegom od ranijih aktivnosti, Å”to
iziskuje nastavak psihoterapijskog i psihijatrijskog lijeÄenja. Psihijatrijsko bi lijeÄenje zahtijevalo i usvajanje odreÄenih
smjernica u lijeÄenju takvih bolesnika
Delivery of hypertrophic term newborns in Split Clinical Hospital Center
Cilj rada: Istražiti uÄestalost, naÄine i Äimbenike raÄanja hipertrofiÄne novoroÄenÄadi u Klinici za ženske bolesti i porode KBC-a Split tijekom 2008. i 2009. godine.
Materijali i metode: U istraživanje su ukljuÄene sve rodilje koje su u razdoblju od 2008. do 2009. godine rodile hipertrofiÄnu novoroÄenÄad (n = 792). Iz istraživanja su iskljuÄene viÅ”eplodne trudnoÄe, te mrtvoroÄena i malformirana novoroÄenÄad. Kontrolnu skupinu Äine sljedeÄa dva poroÄaja terminske eutrofiÄne voroÄenÄadi u promatranom razdoblju. Podaci su prikupljeni popisnom metodom iz pisanih raÄaonskih protokola Klinike za ženske bolesti i porode KBC-a Split.
Rezultati: U promatranom dvogodiÅ”njem razdoblju roÄeno je 8,76% hipertrofiÄne novoroÄenÄadi.
Carskim rezom roÄeno je 18,3% hipertrofiÄne novoroÄenÄadi i 15,1% eutrofiÄne novoroÄenÄadi (P = 0,072).
Majke hipertrofiÄne novoroÄenÄadi su ÄeÅ”Äe raÄale uz pomoÄ epiziotomije (P = 0,002). HipertrofiÄna novoroÄenÄad imala su statistiÄki znaÄajno veÄu (22,9%) prosjeÄnu poroÄajnu težinu (P < 0,001), za 4,9% veÄu duljinu (P < 0,001), te za 6,3% viÅ”i ponderalni indeks u odnosu na eutrofiÄnu novoroÄenÄad (P < 0,001). UÄestalost gestacijskog dijabetesa melitusa bila je statistiÄki znaÄajno veÄa u majki hipertrofiÄne novoroÄenÄadi (P = 0,031).
ZakljuÄak: Fetalna hipertrofija je stanje poveÄanog perinatalnog rizika. Ultrazvukom prepoznat ubrzani fetalni rast može usmjeriti naÄin daljnjega nadzora trudnoÄe, a neposredno prije poroda pomoÄi u izboru naÄina raÄanja i voÄenja poroÄaja.Aim: To investigate the frequency, mode of delivery and perinatal factors of hypertrophic term newborns at the Department of Gynaecology and Obstetrics, Split University Hospital in a two year period (2008- 2009).
Methods: The study included all parturient women who gave birth to hypertrophic term infants between 2008 and 2009 (n = 792). Multiple pregnancies, stillborns and malformed newborns were excluded from the study. The control group consisted of two term births of eutrophic newborns following each delivery from the study group. Clinical data were gathered from the birth protocol of the Department of Gynaecology and Obstetrics, Split University Hospital.
Results: In the analysed period 8.76% newborns were hypertrophic. Caesarean section was performed in 18.3% hypertrophic and 15.1% eutrophic newborns (P = 0.072). An episiotomy was preformed more
frequently in women with hypertrophic newborns (P = 0.002). Hypertrophic newborns had 22.9% significantly higher average birth weight (P < 0.001), 4.9% average higher length (P < 0.001) and 6.3% higher average ponderal index (P < 0,001). The frequency of gestational diabetes mellitus was significantly higher in women with hypertrophic newborns (P = 0.031).Conclusion: Fetal hypertrophy is a state of increased perinatal risk. Ultrasound detected accelerated fetal growth can help in directing a way of further pregnancy monitoring, and immediately before delivery in selection of birth mode and conduction of delivery
Preterm births at the Department of gynecology and obstetrics, University hospital Split
Cilj: Prikazati odlike prijevremenih poroÄaja i nedonoÅ”Äadi iz jednoplodovih trudnoÄa.
Metode: Podaci za dvogodiÅ”nje razdoblje (2008. ā 2009.) prikupljeni su popisnom metodom
iz pisanih raÄaoniÄkih protokola Klinike za ženske bolesti i porode KBC-a Split. UkljuÄene
su sve rodilje s prijevremeno roÄenom novoroÄenÄadi u ispitivanom razdoblju. Iz istraživanja
su iskljuÄene viÅ”eplodove trudnoÄe, mrtvoroÄena i malformirana novoroÄenÄad. Rezultati: Od
ukupno 9 042 roÄena novoroÄenÄeta u Klinici za ženske bolesti i porode KBC-a Split tijekom
dvogodiÅ”njeg razdoblja kao nedonoÅ”Äad je roÄeno 436 (4,8 %). Carskim rezom roÄena su 144
(33 %) nedonoÅ”Äeta. Udio hipotrofiÄne (11,6 % vs. 9,2 %; P = 0,113) i hipertrofiÄne (7,3 % vs.
8,4 %; P = 0,438) novoroÄenÄadi nije se razlikovao izmeÄu nedonoÅ”Äadi i terminske novoroÄenÄadi.
Ponderalni indeks nedonoÅ”Äadi bio je manji u odnosu na terminsku novoroÄenÄad
(2,45 g/cm3 vs. 2,68 g/cm3; P < 0,001). Niska APGAR ocjena je trinaest puta ÄeÅ”Äa (27,5 % vs.
2,1 %) u skupini nedonoÅ”Äadi (P < 0,001). ZakljuÄak: UÄestalost raÄanja nedonoÅ”Äadi u Klinici
ulazi u prosjek razvijenih zemalja svijeta, poroÄaji nedonoÅ”Äadi povezani su s veÄom uÄestalosti
carskog reza te nema razlike u uÄestalosti hipotrofije i hipertrofije nedonoÅ”Äadi u odnosu
na terminsku novoroÄenÄad. Kod nedonoÅ”Äadi je ponderalni indeks u prosjeku niži.Aim: This paper presents characteristics of preterm births and preterm infants from
singleton pregnancies. Methods: The data refer to a 2-year period (2008-2009) and were collected
from the birth protocol of the Department of Gynecology and Obstetrics, University
Hospital Split. The study included all mothers with prematurely born infants. Multiple pregnancies,
stillborn and malformed newborns were excluded from the study. Results: During the
research period, 436 (4.8 %) of all infants (n = 9042) were born as preterm newborns. The
caesarean section was performed on 144 (33 %) premature infants. The rate of hypothrophic
(11.6 % vs. 9.2 %; P = 0.113) and hypertrophic (7,3 % vs. 8.4 %; P = 0.438) infants did not differ
in preterm and term neonates. Ponderal index of preterm infants was lower (2.45 g/cm3 vs.
2.68 g/cm3; P < 0.001). Low APGAR score is thirteen times more frequent in the study group
(27.5 % vs. 2.1 %; P < 0.001). Conclusion: The frequency of preterm birth in the Department is
within the statistical average of developed countries. Preterm births are associated with higher
rate of caesarean section with no difference in the frequency of occurrence of fetal hypotrophy
and hypertrophy. In premature infants, ponderal index is significantly lower
Smjernice za rano prepoznavanje, dijagnostiku i terapiju neurogene orofaringealne disfagije [Guidelines for early detection, diagnostics and therapy of neurogenic oropharyngeal dysphagia]
Guidelines for the early detection, diagnostics and therapy of neurogenic oropharyngeal dysphagia have been made as a result of collaboration of clinicians of different backgrounds who are dealing with patients with neurogenic oropharyngeal dysphagia (NOD). These guidelines have been written by the representatives of the Croatian Society of Clinical Nutrition, Croatian Medical Association, Croatian Neurological Society, Croatian Medical Association, Croatian Society of Gastroenterology and Croatian Society of Nutritionists and Dietitians. The aim of these guidelines is to raise the awareness about NOD that is encountered in acute and chronic neurological diseases, especially in patients with stroke, extrapyramidal diseases, neuromuscular and demyelinisation diseases and dementia. We provide a detailed description of diagnostics of dysphagia, and we recommend the establishment of a multidisciplinary team for dysphagia involving neurologists, internists, speech therapists, dietitians, pharmacists and nurses with special competences for the management of NOD. An educated team member conducts diagnostics and rehabilitation in accordance with the validated tools, classifications and categorizations shown in these guidelines to allow a systematic and consistent treatment. The guidelines also provide detailed algorithms for introducing nutritional support ā from the application of modified texture foods, proper hydration to artificial nutrition (enteral and parenteral nutrition)