Measuring the quality of life (QoL) of women with breast cancer is an important aspect of measuring treatment success. In Croatia, no QoL studies have been carried out with a focus on patients after ...mastectomy. The aim of this study was to examine QoL 1 month and 1 year after mastectomy.
This cross-sectional single-center study of quality of life was conducted in 101 patients, 50 of whom had undergone a mastectomy 1 month prior, and 51 of whom had undergone a mastectomy 1 year prior. The study was conducted from July 2015 to June 2016. The questionnaires used in the study were developed by the European Organisation for Research and Treatment of Cancer (EORTC). The questionnaire EORTC QLQ-C30 assesses the QoL of cancer patients, and the questionnaire EORTC QLQ-BR23 is a disease-specific breast cancer module. A chi square test, Fisher's exact test, Kolmogorov-Smirnov test, Student's t-test and Mann-Whitney U test were performed in the statistical analysis using the statistical program SPSS (Inc. Released 2008. SPSS Statistics for Windows, Version 17.0. Chicago: SPSS Inc.).
Patients who had undergone a mastectomy a year earlier placed a higher value on their health state than did those who had undergone a mastectomy a month earlier. The most affected values of functional status on the EORTC QLQ-C30 scale were emotional functioning (37.5 95% CI 33.3-61.6) and sexual functioning (16.67 95% CI 0-33.3) 1 month and 1 year after mastectomy, respectively. The most affected symptoms on the EORTC QLQ-C30 scale were hair loss 66.67 95% CI 33.3-100) and fatigue 33.33 95% CI 24-44) 1 month and 1 year after mastectomy, respectively.
In our study, both functional and symptom scales were more affected in women 1 month after mastectomy. QoL was considerably improved in women 1 year after the surgery compared to 1 month after mastectomy. The results of this study could contribute to the public awareness of the QoL of breast cancer patients.
Postoperative cognitive decline following cardiac surgery is one of the frequently reported complications affecting postoperative outcome, characterized by impairment of memory or concentration. The ...aetiology is considered multifactorial and the research conducted so far has presented contradictory results. The proposed mechanisms to explain the cognitive decline associated with cardiac surgery include the neurotoxic accumulation of β-amyloid (Aβ) proteins similar to Alzheimer's disease. The comparison of coronary artery bypass grafting procedures concerning postoperative cognitive decline and plasmatic Aβ1-42 concentrations has not yet been conducted.
The research was designed as a controlled clinical study of patients with coronary artery disease undergoing surgical myocardial revascularization with or without the use of a cardiopulmonary bypass machine. All patients completed a battery of neuropsychological tests and plasmatic Aβ1-42 concentrations were collected.
The neuropsychological test results postoperatively were significantly worse in the cardiopulmonary bypass group and the patients had larger shifts in the Aβ1-42 preoperative and postoperative values than the group in which off-pump coronary artery bypass was performed.
The conducted research confirmed the earlier suspected association of plasmatic Aβ1-42 concentration to postoperative cognitive decline and the results further showed that there were less changes and lower concentrations in the off-pump coronary artery bypass group, which correlated to less neurocognitive decline. There is a lot of clinical contribution acquired by this research, not only in everyday decision making and using amyloid proteins as biomarkers, but also in the development and application of non-pharmacological and pharmacological neuroprotective strategies.
- A 45-year-old male patient was admitted to the emergency unit due to posterior stab wound of the neck. The knife was directed diagonally from the left to the right side of the neck in the ...dorsoventral axis. The patient was fully conscious upon admission with pain and paresthesia along the upper right extremity. The patient underwent computed tomography (CT) and CT angiography scan of the neck, which revealed the knife blade piercing the left sided neck muscles and through the intervertebral ligaments of the C IV/C V in direction to the contralateral internal carotid artery, vertebral artery and the C5 nerve root. The patient underwent an urgent surgery according to the radiographs. Electromyography was performed during the early postoperative care and revealed an acute lesion of the right-sided C5 nerve root. Postoperative follow-up magnetic resonance imaging revealed intact brachial plexus bundles at the site of injury. Symptoms of reduced muscle strength and limited range of motion of the upper right extremity prevailed. Penetrating neck injuries represent a rare entity of all trauma injuries. Meticulous preoperative radiographs revealed close proximity of the knife blade tip to the right-sided vertebral artery and common carotid artery. Limited abduction at the right shoulder during postoperative period correlated to the C5 nerve root injury.
A rare case of thoracolumbar spondyloptosis after a severe polytraumatic event is presented. Spondyloptosis accounts for a minor proportion of all spine trauma cases and is usually accompanied by ...complete neurological deficit. A 48-year-old man suffered severe polytrauma after having been hit by a truck at the work place. Radiographic scanning revealed multiple traumatic injuries and spondyloptosis at the L1/L2 level in coronal plane. However, despite extensive injuries, ASIA score was estimated as D. The patient underwent urgent multidisciplinary surgery due to severe head injuries. The next surgery was performed to stabilize the thoracolumbar segment and to preserve neurological functions. The surgery included implantation of transpedicular titanium screws
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posterior approach. Good postoperative recovery was achieved during early postoperative rehabilitation at our Department, which was estimated as ASIA score D. In conclusion, prompt operative treatment to achieve neural integrity and early rehabilitation should be considered as the gold standard in such complicated injuries. Postoperative recovery largely depends on the quality of rehabilitation, which leads to improvement of patient self-care and normal social and psychological functions. In our case, the good preoperative neurological status of the patient also contributed to better postoperative outcome.
•Among numerous diseases which reduce the functional ability of the hand, aseptic necrosis of the lunate bone is a particularly significant one.•Depending on the anatomical variation of the ulnar ...bone, shortening of the radius may achieve pressure relief on lunatum.•Pressure distribution in the distal radiocarpal joint is vital for healing, and shortening of the radius relieves the pressure on the lunate bone.•The exact type of surgery and the amount of radial osteotomy depends on preoperative ulnar variant.
The aim of the research was to determine the smallest amount of loading on the lunate bone obtained by gradually shortening the radius in different ulnar variants as the potential treatment of Kienböck's disease.
The research was conducted on anatomic preparations of 20 upper extremities using only the distal part of the forearm and hand, placing them in exactly defined positions. A Fuji Prescale film was inserted in the open radiocarpal joint to measure pressure after compressing axially by changing the length of forearm in four stages by the gradual shortening of the radius.
The greatest reduction of average pressure on the lunatum achieved by shortening the radius depended on ulnar variant. In ulnar variant 0, the greatest reduction of average pressure on lunatum was achieved by shortening the radius for 3 mm (24% reduction). For ulnar variant −1, the greatest reduction of average pressure on lunatum was achieved by shortening the radius for 2 mm (37% reduction). For ulnar variants −2, −3 and +1, the greatest reduction of average pressure on lunatum was achieved by shortening the radius for 3 mm (5%, 75% and 9% respectively).
The pressure distribution in the distal radiocarpal joint is vital for healing, and shortening of the radius relieves the pressure on the lunate bone. The exact type of surgery and the amount of radial osteotomy depends on preoperative ulnar variant.
•Blunt abdominal trauma is the major cause of abdominal injury in children.•No clear guidelines exist for the initial management of blunt pancreatic trauma in children.•Most patients with pancreatic ...trauma can initially be treated non-operatively, while early surgical treatment may benefit patients with lesions of the main pancreatic duct.•ERCP offers both highly accurate diagnosis and potential treatment of ductal injuries.
Blunt abdominal trauma is the major cause of abdominal injury in children. No clear guidelines exist for the initial management of blunt pancreatic trauma in children. The aim of this study was to perform a systematic review and meta-analysis of initially non-operative versus initially operative treatment in children with blunt pancreatic injury.
Studies including children (<18 years) with blunt pancreatic injuries published in any language after year 1990 were included. Total of 849 studies were identified by searching PubMed, Scopus, CINAHL and Cochrane Database. After review, 42 studies met inclusion criteria and were included in this systematic review. There were 1754 patients, of whom 1095 were initially managed non-operatively (NOM), and 659 operatively (OM). Primary outcome was non-operative management success rate, and secondary outcomes were mortality, complications (including specifically pseudocysts and pancreatic fistulas), percent of patients and days on total parenteral nutrition (TPN), length of hospital stay and readmissions.
There was no difference in mortality between NOM and OM groups. The incidence of pseudocysts was significantly higher in NOM group compared to OM (P<0.001), especially for AAST grade III or higher (P<0.00001). Overall incidence of pancreatic fistulas was significantly lower for NOM group (p = 0.02) but no difference was observed for AAST grades III or higher (p = 0.49). There was no difference in the length of hospital stay (P = 0.31). Duration of total parenteral nutrition was not different for all AAST grades (P = 0.35), but was significantly shorter for OM group for AAST grades III and higher (p = 0.0001). There was no overall difference in readmissions (P = 0.94). Overall success rate of initial non-operative treatment was 87%.
Most patients with pancreatic trauma can initially be treated non-operatively, while early surgical treatment may benefit patients with lesions of the main pancreatic duct. ERCP offers both highly accurate diagnosis and potential treatment of ductal injuries.
Background
Pancreatic fistula after pancreaticoduodenectomy is one of the most severe complications with mortality rates as high as 45%, and the prediction of most severe form of fistula (grade C) is ...crucial for successful management of patients who are to undergo cephalic pancreatoduodenectomy. It has been found that the amount of abdominal fat may predict grade C postoperative pancreatic fistula. In this study, we analysed the value of retrorenal fat thickness in the prediction of grade C pancreatic fistula.
Methods
A total of 140 patients who underwent pancreaticoduodenectomy were retrospectively analysed. Retrorenal fat thickness and intra‐abdominal fat, expressed as total fat area, visceral fat area and subcutaneous fat area, were determined from computed tomography slices using the known range of attenuation values (−190 to −30). Blood loss, operating time, pancreatic texture and main pancreatic duct diameter as well as body mass index were also analysed.
Results
Retrorenal fat thickness (P = 0.0004), duct diameter (P = 0.0008), subcutaneous fat area (P = 0.023) and total fat area (P = 0.014) were found to be significant predictors of grade C pancreatic fistula.
Conclusion
Although retrorenal fat tissue thickness may seem robust, it is a simple measure that can be used to predict the most severe grade of pancreatic fistula after pancreaticoduodenectomy.
Prediction of the most severe form of postoperative pancreatic fistula is crucial for successful management of patients who are to undergo cephalic pancreatoduodenectomy. Measurement of retrorenal fat tissue thickness is a simple measure that may help to predict the most severe grade of pancreatic fistula after pancreaticoduodenectomy.
Postoperative pancreatic fistula (POPF) is one of the most severe complications after cephalic pancreaticoduodenectomy, with mortality as high as 30%. Risk scores may help predict the risk of POPF. ...Multiple external validations substantially improve generalized clinical acceptability of a scoring system.
The aim of this study was to externally validate previously described fistula risk score in the prediction of clinically relevant POPF.
All patients who underwent pancreaticoduodenectomy for any indication during a 5-year period were prospectively analyzed. A total of 132 patients were analyzed.
Of the 132 patients, 44 (33.3%) developed pancreatic fistula, including 12.9% biochemical leaks, 7.6% grade B fistula, and 12.9% grade C fistula. Cut-off point of 4.5 was determined to best separate patients who developed clinically relevant POPF with area under curve of 78% (p = .00003). Sensitivity and specificity for the prediction of clinically relevant POPF with the cut-off value of 4.5 was 70.4 and 74.3%, respectively. Positive predictive value with cut-off value 4.5 was 57.8%, and negative predictive value was 83.4%.
Fistula risk score identified low risk patients with false negative rate of 16.6%. Further external validation studies on large cohorts of patients and with wide case-mix may enable additional refinements of the score model.
Specific personality traits may predispose individuals to various forms of addictive behaviors. This study aimed to investigate the association between personality traits of university students and ...Internet addiction (IA). A sample of 1051 university students was recruited from the largest university in Eastern Croatia. A structured anonymous questionnaire that included questions regarding students’ sociodemographic information and Internet usage patterns, the Young Internet Addiction Test and Big Five Inventory served as a research tool. The study revealed that 1.0% of the studied sample expressed severe IA while 24.6% of study participants expressed some signs of addiction. The IA was detected in 576 (80.0%) students who used the Internet mainly for social networking, in 30 (78.9%) students who mainly used it for online gaming, and in 153 (52.2%) students who mainly used it for university assignments (p < 0.001). Higher neuroticism, higher extraversion, and higher openness to new experiences were connected with IA in general (p < 0.001). Higher neuroticism, higher extraversion, and higher openness to new experiences were significantly associated with addictive behavior during social networking (p < 0.001). Higher extraversion and higher openness to new experiences were significantly associated with addictive behavior during Internet usage for university assignments (p = 0.025), while there were no significant associations between specific personality traits and addictive behavior during online gaming (p = 0.059). Personality traits must be taken into account while developing programs and implementing interventions for preventing IA in the university student population.
During the past several decades there has been a substantial increase in the incidence of malignant melanoma worldwide. The highest incidences were reported in New Zealand and Australia. In Europe ...the northern countries generally have a higher incidence. The aim of this retrospective study was to provide the incidence and mortality for all patients with malignant melanoma diagnosed in Osijek-Baranya County, Eastern Croatia, during 2000-2008. In the past 30 years in the Republic of Croatia the incidence of melanoma increased by 337%. During the period of 2000-2006 in Osijek-Baranja County, the incidence of melanoma increased by 13%. The incidence of melanoma increases with age, but in past decades melanoma is more often diagnosed in people aged 25-40. The mortality between 2000 and 2008 increased by 18%. The incidence of melanoma generally increases equally in men and women. The most common localization of skin melanoma in males was trunk and in females the lower extremities. Presently, in Osijek-Baranya County melanoma is 15th on the list of malignant tumors and represent 2% of all malignant tumors. In New Zealand, Australia and European northern countries mortality is reduced, as result of earlier diagnosis and education of risk groups. Unfortunately, in Osijek-Baranya County, in a comparison with these countries, the mortality is higher although incidence is the same or lower.
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