Calidad de vida relacionada con la salud en personas con úlcera venosa / Health-related quality of life of people with venous ulcer / Qualidade de vida relacionada à saúde em pessoas com úlcera venosa

Introducción: la úlcera venosa es la heridade origen vascular que más se presentaen la población adulta; afecta la calidad de vida,por loque se requiereun abordajeinterdisciplinarioparala atenciónde las personas que la padecen. Objetivo:describir las variables clínicas y sociales que interfieren en la calidad de vida relacionada con la salud de un grupo deadultosconúlcera venosa.Métodos:estudio observacional de tipo cohorte; incluyó 80 personas evaluadas en tres clínicas de Medellín(Colombia), en quienes seaplicó elinstrumento de evaluaciónCharing Cross Venous Ulcer Questionnaire. Se describieron las variablessociodemográficas y la evolución de la calidad de vidahasta la cicatrización y se construyó un modelo de regresión logística para explicar las variables asociadas a tener lapeorcalidad de vida. Resultados:el 28,8%de los participantes obtuvieron 64 o más puntos, es decir, grado de afección alto durantela primera mediciónde la calidad de vida;en el 68,8%el puntaje fue63o menos, lo que significó afecciónmoderadaysolo el 2,4%tuvo baja afección.Laspeores puntuaciones se registraron enmujeres,participantes de mayor edad y quienes tenían mayor compromiso de la herida; la afección involucró las dimensiones Estado emocional, Estética, Función social y Actividades domésticas,aunque hubo evolución favorablede la calidad de vidamientrasiba cicatrizandola úlcera. Conclusiones:lacalidad de vida relacionada con la saludestá altamente afectada en las personasque tienen úlcera venosa, siendo más frecuente en quienes tienen dolor constante,heridas más grandes, de mayor tiempo de antigüedad y aquellos con mala percepción desusalud; por tanto,se requiere oportunamentela intervención profesional e interdisciplinaria en salud para el logro de la cicatrizacióny del bienestary para mejorar la calidad de vida.

ntroduction: Venous ulcers are the most common vascular injury in the adult population. They affect the quality of life, so people who suffer from venous ulcers require an interdisciplinary approach to their care. Objective: To describe clinical and social variables that affect the health-related quality of life of a group of adults with venous ulcers. Methods: Observational cohort study carried out with 80 people examined in three medical centers in Medellín (Colombia) and who were given the Charing Cross Venous Ulcer Questionnaire to answer. Sociodemographic variables and the quality-of-life evolution until scarring were described. A logistic regression model was built to explain the variables associated with having the poorest quality of life. Results:There were28.8% of the participants who scored 64 or more points on the first quality of life measurement, which indicates a highly affected quality of life; 68.8% scored 63 or less, indicating a moderately affected quality of life, while only 2.4% indicated a slightly affected quality of life. The worst scores were seen among women, older participants, and those with greater ulcer severity. The dimensions of emotional status, cosmesis, social interaction, and domestic activities were affected, although there was a favorable evolution of the quality of life while the ulcer was healing. Conclusions: Health-related quality of life is highly affected in people with venous ulcers and is more common in those with constant pain, larger and older sores, and those with poor health perceptions. Therefore, timely professional and interdisciplinary healthcare interventions are required to achieve wound healing and wellness and improve quality of life

Introdução:a úlcera venosa é a ferida de origem vascular que ocorre mais frequentemente na população adulta e afeta a qualidade de vida, por isso é necessária uma abordagem interdisciplinar para o cuidado das pessoas que a sofrem. Objetivo:descrever as variáveis clínicas e sociais que interferem na qualidade de vida relacionada à saúde de um grupo de adultos com úlcera venosa.Métodos:estudo de coorte observacional; incluíram-se 80 pessoas avaliadas em três clínicas em Medellín (Colômbia), nas quais foi aplicado o instrumento de avaliação Charing Cross Venous Ulcer Questionnaire. Descreveram-se as variáveis sociodemográficas e a evolução da qualidade de vida até a cicatrizaçãoe construiu-se um modelo de regressão logística para explicar as variáveis associadas à pior qualidade de vida.Resultados: 28,8% dos participantes obtiveram 64 ou mais pontos, ou seja, alto grau de condição na primeira mensuração da qualidade de vida; em 68,8% a pontuação foi de 63 ou menos, o que significa condição moderada e apenas 2,4% em condição baixa. As piores pontuações foram registradas em mulheres, participantes mais velhos e naqueles com maior complicação da ferida; a afecção,envolvia as dimensões Estado Emocional, Estética, Função Social e Atividades Domésticas, embora houvesse evolução favorável da qualidade de vida enquanto a úlcera cicatrizava. Conclusões:a qualidade de vida relacionada à saúde é altamente afetada em pessoas com úlcera venosa, sendo mais frequente naquelas com dor constante, feridasmaiores, mais antigas e com má percepção de saúde; portanto, é necessária intervenção oportuna profissional e interdisciplinar em saúde para alcançar a cicatrização e o bem-estar e melhorar a qualidade de vida

Subjective scar assessment scales in orthopaedic surgery and determinants of patient satisfaction: A systematic review of the literature / 中华创伤杂志(英文版)

PURPOSE@#Scar assessment tools can be utilized during the post-operative period to monitor scar progress. The primary aim of this systematic review was to evaluate current subjective scar assessment scales utilized in orthopaedic surgery. The secondary aim was to identify determinants of patients' satisfaction with their scars and evaluate current measurement scales.@*METHODS@#The preferred reporting items for systematic reviews and meta-analyses checklist was followed. Electronic databases, currently registered studies, conference proceedings and the reference lists of included studies were searched. There were no constraints based on language or publication status. A narrative synthesis provided a description and evaluation of scales utilized in orthopaedic surgery. Determinants of patient satisfaction were identified along with the scales used to measure satisfaction.@*RESULTS@#A total of 6059 records were screened in the initial search. Twenty-six articles satisfied the inclusion criteria, assessing 7130 patients. In the literature, six validated subjective scar scales were identified, including the Vancouver scar scale, patient and observer scar assessment scale, Manchester scar scale, Stony Brook scar evaluation scale, visual analogue scale, and Hollander wound evaluation scale. Studies utilizing these scales to evaluate scars following orthopaedic procedures did so successfully. These were total hip arthroplasty, total knee arthroplasty, and limb reconstruction. The scales demonstrated satisfactory validity. Functional outcomes such as restoration of movement ranked among patients' highest concerns. Scar cosmesis was found to be amongst patients' lowest priorities.@*CONCLUSIONS@#Subjective scar assessment scales identified in the literature were not designed specifically for orthopaedic surgery. However, these were able to appropriately assess scars in the studies identified in this review. Current evidence suggests the effect of scar cosmesis on patient satisfaction with orthopaedic procedures is limited.

Skin closure after ileostomy reversal: comparative study between conventional linear versus purse-string suturing

Background: Wound infection and scarring are relatively common complication after stoma reversal. Immediate skin closing by conventional linear closure technique is associated with varying percentage of wound infection ranging from 2 to 41%. Delayed skin closure is associated with prolonged healing time and poor scar cosmesis. In order to overcome these problems, an alternative method of skin closure during stoma reversal has been suggested. It involves taking purse-string subcuticular absorbable sutures to close the skin during Ileostomy reversal. Our study is a comparative study between conventional linear skin closure and this alternative form skin closure in stoma closure procedures for the assessment of surgical site infection and scar cosmesis.Methods: 40 patients were enrolled for the study, divided in two groups, one undergoing purse-string skin closing (n=20) and the other undergoing linear skin closure (n=20) during stoma reversal. All the data was analysed using IBM SPSS version 21.0 taking p value less than 0.05 was taken as level of significance.Results: Surgical site infections were seen in 3 out of 20 patients in whom purse-string skin closure was done, while it was 9 out of 20 patients in primary linear closure during stoma reversal group. Post-operative pain was found significantly lesser in purse-string group compared to linear closure group on same and first post-operative day. Scar cosmesis was assessed using patient and observer scar assessment scale and was observed better in purse-string group of patients.Conclusions: Purse-string skin closure is a better alternative surgical option to consider during stoma reversal surgeries as compared to conventional linear closure.

Intraoperative radiotherapy with electrons as partial breast irradiation in limited stage breast cancer: Early term clinical and cosmetic outcomes

Purpose: We aimed to report the experience of intraoperative electron radiation therapy (IOERT) with Mobetron (Intraop Medical Incorporated, Santa Clara, CA, USA) as a partial breast irradiation (PBI) for patients with early-stage breast cancer and explanation of IOERT application and present early clinical and cosmetic result. Materials and Methods: Between November 2012 and February 2014, in Ankara Oncology Hospital, Radiation Oncology Clinic, was performed IOERT as a PBI with a single dose of 21 Gy for 21selected patients. Median tumor size was 1.5 cm (range, 0.6–2.8 cm). Median treatment duration was 2.04 min (range, 1.26–2.44 min). According to final pathology, two patients were found to have close margin and mastectomy was applied. Three cases (two were N1 mic and one case had perineural invasion and tumor size was >2 cm) received whole breast irradiation. Results: Median follow-up time was 3 years (range, 26–42 months). One patient died because of nonbreast cancer reason, all of the other patients (except one) alive without disease. There was no Grade 3 or 4 toxicities related to the IOERT. Good or excellent cosmesis was revealed 79% (15/19) and 95% (18/19), by physician and patient, respectively. Conclusion: IOERT, for patients with early-stage breast cancer as a part of breast-conserving treatment, offer patients better cosmetic results with less skin toxicity and increases comfort of patients by shortening duration of treatment time

Laparoscopic versus conventional open appendicectomy: a prospective comparative analytical study in a tertiary care set up

Background: Present study outlines the outcomes of laparoscopic appendicectomy compared to open conventional appendicectomy in a tertiary care set up with aim to validate advantages and shortcomings of both procedures.Methods: A series of 80 cases above 18 years of age with clinical diagnosis of appendicitis having Alvarado score of seven and above were studied prospectively under the two groups after proper written consent: Open appendectomy-40 cases, Laparoscopic appendectomy-40 cases. Both groups were compared on grounds of intra-operative complications, additional diagnostic potential, operative time, postoperative analgesia, post-operative complications, length of hospital stay, subjective cosmesis, and return to routine normal activities. Values obtained were statistically analyzed.Results: The median operative time in Laparoscopic Appendicectomy was 58.22 minutes (range 32.68-85.46 min) as compared to open procedure which took 43.65 minutes (30.36-65.48min) (P<0.05). Conversion to open procedure was done in 10% (n=4) of laparoscopic cases. Mean value of postoperative pain by visual analogue scale was low in Laparoscopic Appendicectomy (LA) compared to Open Appendicectomy (OA) (P<0.05). Mean post-operative stay (3.2±0.34 days versus 2.3±0.24 days) and surgical site infection was recorded in 10 patients (25%) in OA group and 5 (13.9%) in LA group (P<0.05).Conclusions: It can be concluded that laparoscopic surgery is safe with greater diagnostic potential for additional pathologies and better Subjective cosmesis . But all these merits were at the price of longer operating time and a specialized set up needed for laparoscopy.

Flap Reconstruction Options And Outcomes For Carcinoma Lip - Our Experience

Aim The aim of this study was to review and describe techniques for the reconstruction of defects after resection of lip squamous cell carcinoma with emphasis on cosmetic and functional outcome. Patients and Methods A review of techniques and selected case presentations using different flap designs for the reconstruction of perioral defects following resection of squamous cell carcinoma in 25 patients out of 128 cases of head and neck malignancies was performed in period of 2017-2018 in Regional Cancer Centre,Govt Coimbatore medical college hospital. The Abbe estlander ,Nasolabial flap,Karapandzic flaps5 deltopectoral ,PMMF flap were used for lip defects. Results All reconstructed patients had acceptable functional results and healed without complication. Seven tumors were located in upper lip, Eight tumors in lower lip and Ten tumors in the angle of mouth. The lip defects were easily closed with the Karapandzic flaps, Abbe estlander ,nasolabial ,deltopectoral flap, forehead flap. While cosmesis was acceptable in all cases, the commissure was the most difficult region to reconstruct with a esthetic appearance and functional outcome. There were no flap failures.Oral competence was noted to be better in Karapandzic flaps, Abbe estlander flap,Nasolabial flap than deltopectoral/ forehead flap. Conclusion The Karapandzic,nasolabial and Abbe estlander flaps provide a easy and useful method to reconstruct perioral defects following resection for oral cancer.

Giant Cell Granuloma of the Maxilla: A Rare Case Report.

Giant cell granuloma (GCG) is an uncommon bony lesion in the head and neck region, most commonly affecting the maxilla and mandible and has a female predilection. The clinical behaviour of central GCG ranges from a slowly growing asymptomatic swelling to an aggressive lesion. The clinical, radiological, histological features and management of an aggressive GCG of maxilla in a five-month-old male child are described and discussed here. The emphasis lies that surgery is the traditional and still the most accepted treatment for GCG. Le Fort I osteotomy has been advocated as one of the access osteotomy for the surgical management of aggressive and extensive GCG involving the maxilla.

Oral approaches for benign lesions- a novel approach.

Introduction -Cosmetically acceptable surgical results are the demand of this modern era. Aesthetic facial look has lots of impact on financial, social and personnel life. Material and Methods- A total of twenty cases were studied in the Department of ENT at Hind Institute of Medical Sciences (HIMS), Barabanki, Uttar Pradesh. FNAC, USG and CECT were done and only benign lesions were selected which could be approached intraorally. Results-There were 20 patients aged between fifteen years to sixty years. There were ten cases of submandibular swellings, four cases of sebaceous cyst, three cases of lipoma and two cases of parapharyngeal space swelling and one case of plunging ranula. The mean operation time of the IOA group was significantly longer than that of the TCA group, but decreased gradually with surgical experience. The mean hospital stay of the IOA group was significantly shorter than that of the TCA group. Conclusions-The innovative surgical approaches were studied and meticulous, cosmetically acceptable results which were highly appreciated by the patients and their attendants were achieved. The stay in the hospital and complication rates were also quite low in intraoral approach than conventional external approach. Hence, intraoral approaches should be used for benign lesions which are amenable to surgery.

A Case Study of Delayed Primary Suturing in Facial Injuries Following Animal Bites.

Aims: To evaluate the role of delayed primary suturing in prevention of sepsis and achieving better cosmetic appearance in animal bite injuries over the head and neck areas. Study Design: Prospective observational study. Place and Duration of Study: Department of Otorhinolaryngology at Govt. Medical College, Nanded, Maharasthra, (India) from a period of Jan 2009 to Dec 2013. Methodology: A prospective observational study of 70 cases of patients presented to us in the form of injury to head and neck area by animal bites. In all patients we followed the standard norm for delayed primary closure in form of: • Thorough wound toileting • Equine Rabies Immunoglobulin at the site of wound in all patients • Anti-Rabies vaccination • Daily dressing • Delayed primary suturing after 10 days All patients were routinely followed up and assessed for wound sepsis, cosmesis and function. Results: Among the animal bites, dog bite injuries were found to be most common facial injuries followed by swine and cat. In our study group of 70 patients which was dominated by males from second decade onwards showed a faint line of demarcation in sex distribution in children. Cosmetic outcome on comparing our study of delayed primary closure with Paschos NK et al. study healing by secondary intention, delayed primary suturing exhibited significantly better result with the mean score of (1.50) for VSS compared to healing by secondary intention group with mean score of (3.05) for VSS was recorded (p= 0.000) (95% CI 0.1516-0.1494). Conclusion: Delayed primary closure exhibited improved cosmetic appearance when compared with healing by secondary intention.

Three Port Versus Standard Four Port Laparoscopic Cholecystectomy- A Prospective Study.

The current study was undertaken to compare the safety, efficacy, cosmesis, cost effectiveness, complication rates and incidence of conversions. In a period of one year 200 patients with symptomatic GB stone disease were randomly divided into group A (100 patients) for three port technique and group B (100 patients) for standard four port technique. The outcomes were assessed based on duration of surgery, complication rates, postoperative pain, cosmesis, hospital stay and conversion rates.The mean operative time was compared and found to be less in group A. Intraoperative and postoperative complications was similar in both groups. The postoperative pain was less in group A. The mean hospital stay was less in group A (1.27 days) than group B (1.95 days).Better cosmetic results and patient satisfaction was observed in group A. 5 patients of group A required fourth port and 3 patients of group B required conversion to open cholecystectomy. The three port technique is a safe and feasible method in hands of an experienced laparoscopic surgeon. Thus it can be recommended as a safe alternative to conventional four ports laparoscopic Cholecystectomy.

Public perception of "scarless" laparoendoscopic single-site surgery in gynecology

OBJECTIVE: To investigate the public perception of laparoendoscopic single-site surgery (LESS) according to the age group. METHODS: An anonymous questionnaire about the desire for cosmesis and the preference for LESS in treatment of benign gynecologic diseases was provided to healthy volunteers (n=102). The survey participants were divided into two age groups (young women 40 years). The desire for cosmesis was assessed using a validated scale, Body Image Scale. RESULTS: All of the participants completed the questionnaire. The Body Image Scale scores were not different between the two age groups (11.5+/-3.5 vs. 11.8+/-4.0, P=0.656). The most common fear of surgery was the risk of complications in both age groups (69% in the young age group and 65% in the middle-aged group). Unless the operative risk increased, most of the participants (61% to 67%) in both age groups preferred LESS. Their choice was influenced by reduced scarring (43% to 61%), more safety (20% to 39%), reduced postoperative pain (8% to 10%), and new technology (4% to 6%). CONCLUSION: Based on these results, there was no difference in the desire for cosmesis and perception of LESS according to the age. Therefore, physicians should discuss and consider LESS even in middle-aged women.

Result and outcome of shorter fractionation schedule for post-operative cancer breast patients.

Background: The purpose of this prospective study is to determine the effectiveness and cosmetic outcome of shorter fractionated radiotherapy in post-operative invasive breast cancer patients. Methods: Between July 2009 and June 2011, 216 post-operative cancer breast patients were treated with this regimen on cobalt60. The chest wall and supraclavicular area were treated using a tangential parallel pair, & direct supraclavicular portal with wedges as necessary, to a dose of 40 Gy / 15 fractions (study group) (133 cGy for tangential and 266 cGy for supraclavicular field each). (Control Group received 50 Gy / 25#) No additional boost was given. The median duration of follow-up surviving patients are 3 years. Results: From July 2009 to July 2011 (2 years), 216 histopathologically proven cases of Invasive ductal carcinoma of Breast were included in this study. All patients with early and locally advanced stage breast cancer were treated with hypofractionated and conventional schedule of radiotherapy. At baseline 80.19% in the study and 75.45% of patients in the control group were being rated as excellent or good. At 2 years, the percentages of patients with an excellent or good cosmetic outcome were 75.80% in the study and 73% in the control group. Grade II skin reactions were more in control (60%) as compared to study group (49%). A radiation schedule delivering 40 Gy / 15 # seems to offer control rates of locoregional tumour relapse & late adverse effects at least as favourable as the standard schedule of 50 Gy / 25#. Conclusion: Shorter fractionation schedule is very much effective in preventing recurrent breast cancer and it provides a high level of patient satisfaction as well as reduce money and overall treatment time. Its shorter duration offers the added advantage of a more efficient use of resources and greater patient convenience.

Minimally invasive strabismus surgery versus paralimbal approach: A randomized, parallel design study is minimally invasive strabismus surgery worth the effort.

Introduction: Minimal access surgery is common in all fields of medicine. We compared a new minimally invasive strabismus surgery (MISS) approach with a standard paralimbal strabismus surgery (SPSS) approach in terms of post‑operative course. Materials and Methods: This parallel design study was done on 28 eyes of 14 patients, in which one eye was randomized to MISS and the other to SPSS. MISS was performed by giving two conjunctival incisions parallel to the horizontal rectus muscles; performing recession or resection below the conjunctival strip so obtained. We compared post‑operative redness, congestion, chemosis, foreign body sensation (FBS), and drop intolerance (DI) on a graded scale of 0 to 3 on post‑operative day 1, at 2‑3 weeks, and 6 weeks. In addition, all scores were added to obtain a total inflammatory score (TIS). Statistical Analysis: Inflammatory scores were analyzed using Wilcoxon’s signed rank test. Results: On the first post‑operative day, only FBS (P = 0.01) and TIS (P = 0.04) showed significant difference favoring MISS. At 2‑3 weeks, redness (P = 0.04), congestion (P = 0.04), FBS (P = 0.02), and TIS (P = 0.04) were significantly less in MISS eye. At 6 weeks, only redness (P = 0.04) and TIS (P = 0.05) were significantly less. Conclusion: MISS is more comfortable in the immediate post‑operative period and provides better cosmesis in the intermediate period.

Protective effect of intense pulsed light on fibroblast injury induced by UVA Ⅰ / 中华医学美学美容杂志

Objective To study the protective effects of intense pulse light (IPL) on the injury of normal human skin fibroblasts (FB) induced by ultraviolet A (UVA Ⅰ ) in vitro and to explore its possible mechanism. Methods The human skin fibroblasts were isolated and cultured, and then irradiated by UVA Ⅰ (9 J/cm2) and IPL (15 J/cm2), respectively. The proliferative ability of the cells were detected by CCK-8. Cell cycle was detected by flow cytometry, and cylin D1 and CDK2 protein expression levels were detected by Western blot. Results Different doses of UVA Ⅰ irradiation caused certain damages of cultured fibroblasts. With the increasing of of UVA Ⅰ dose, cell proliferation was decreased. Cells went to death at the exposure to 11 J/cm2 UVA Ⅰ , while the proliferative activity did not change much at 7 J/cm2 UVA Ⅰ . Cells were treated with UVA Ⅰ for other 2 days, then with IPL irradiation for other 2days, showing clear stimulating to the cell proliferation as compared with the cells that received UVA Ⅰ treatment only. Flow cytometry results showed that an increase of cell proliferating index, and cell cycle protein cyclin D1 and CDK2 expression levels were also upregulated after IPL irradiation.Conclusion UVA Ⅰ irradiation may cause cell damage as showed by cell growth index, cyclin D1 and CDK2 expression, and this injury could be protected partly by IPL treatment. The intense pulsed light may regulate the expression of cyclin proteins that may promote normal fibroblast proliferation, which could be one of the mechanisms of IPL skin rejuvenation.

Endoscopic Removal of Parathyroid Tumors via an Unilateral Axillo-Breast Approach / 대한이비인후과학회지

Since Gagner introduced the first endoscopic parathyroidectomy in 1996, various approaches for endoscopic thyroidectomy & parathyroidectomy have been proposed. We have recently developed an unilateral axillo-breast approach for endoscopic thyroid surgery without gas insufflation. Through our experiences of more than 100 cases of endoscopic thyroidectomy, we have recently performed the endoscopic removal of parathyroid tumors. Case 1 was diagnosed as parathyroid adenoma, and we could not exclude the possibility of a thymic cyst, bronchogenic cyst, or brachial cleft cyst before the operation in Case 2. The final pathologic diagnosis of case 2 was a parathyroid cyst. To our knowledge, this is the first report of endoscopic removal of parathyroid tumor by an ENT surgeon in this country. This report suggests that endoscopic removal of parathyroid tumor or paratracheal mass via unilateral axillo-breast approach without gas insufflation could be a valid option for selective patients with major concern of cosmesis.

Cosmetic Results of Conservative Treatment for Early Breast Cancer / 대한방사선종양학회지

PURPOSE: This study was performed to evaluate the cosmetic outcome of conservative treatment for early breast cancer and to analyze the factors influencing cosmetic outcome. MATERIALS AND METHODS: From February 1992 through January 1997, 120 patients with early breast cancer were treated with conservative surgery and postoperative radiotherapy. The types of conservative surgery were quadrantectomy and axillary node dissection for 108 patients (90%) and lumpectomy or excisional biopsy for 10 patients (8.3%). Forty six patients (38%) received adjuvant chemotherapy (CMF or CAF). Cosmetic result evaluation was carried out between 16 and 74 months (median, 33 months) after surgery. The cosmetic results were classified into four categories, i.e., excellent, good, fair, and poor. The appearances of the patients' breasts were also analyzed for symmetry using the differences in distances from the sternal notch to right and left nipples. A logistic regression analysis was performed to identify independent variables influencing the cosmetic outcome. RESULTS: Cosmetic score was excellent or good in 76% (91/120), fair in 19% (23/120) and poor in 5% (6/ 120) of the patients. Univariate analysis showed that tumor size (T1 versus T2) (p=0.04), axillary node status (N0 versus N1) (p=0.0002), extent of surgery (quadrantectomy versus lumpectomy or excisional biopsy) (p=0.02), axillary node irradiation (p=0.0005) and chemotherapy (p=0.0001) affected cosmetic score. Multivariate analysis revealed that extent of surgery (p=0.04) and chemotherapy (p=0.0002) were significant factors. For breast symmetry, univariate analysis confirmed exactly the same factors as above. Multivariate analysis revealed that tumor size (p=0.003) and lymph node status (p=0.007) affected breast symmetry. CONCLUSION: Conservative surgery and postoperative radiotherapy resulted in excellent or good cosmetic outcome in a large portion of the patients. Better cosmetic results were achieved generally in the group of patients with smaller tumor size, without axillary node metastasis and treated with less extensive surgery without chemotherapy.

Cosmetic Result and Post-Operative Pain Reduction according to the Antepubic Location of Trocar Insertion in a Laparoscopic Appendectomy

BACKGROUND: Laparoscopic surgery was first applied in appendectomies. However, the use of laparoscopic surgery has become more popular in other operation than appendectomies such as cholecystectomies and herniorrhaphies. Many surgeons have abandoned the laparoscopic appendectomy because they think the procedure is tedious and has no advantage over the simple open appendectomy. However, the incisional scar is an unavoidable sequela of an open appendectomy, and post-operative pain is bothersome in many cases. METHODS: We carried out laparoscopic appendectomies in 49 consecutive patients by using antepubic trocar insertion to achieve maximum cosmetic effect and to minimize the post-operative pain. Fifteen patients (control group) underwent laparoscopic appendectomies with conventional trocar sites 2~3 cm above the symphysis pubis. Thirty-four patients (studied group) received a newly designed operation using an incision site on the symphysis pubis to maximize the cosmetic effect. We made a short subcutaneous tunnel from antepubic incision to facilitate the intra-abdominal dissection. RESULTS: When we compare the post-operative results, there was no difference between the two groups with respect to operation time, post-operative pain, post-operative hospital stay, or complications. CONCLUSIONS: A greater of the proportion patients who received the newly designed operation were satisfied with the cosmetic result.

Surgical treatment of mammary hyperplasia / 中国普通外科杂志

Objective To explore the significance and methods of surgical treatment of mammary hyperplasia. Methods Patients with mammary hyperplasia were treated by different operative procedures,and cosmetic operations were performed synchronously on some selected patients. Results 523 cases were treated by surgery. All cases were diagnosed as mammary hyperplasia on the pathological examination and were in good condition postoperatively. The results of synchronous cosmetic operation were satisfactory . Conclusions The surgical treatment of mammary hyperplasia should be done if the efficacy was not satisfatory after the therapy combined traditional chinese medicine with western medicine . The operative indications must be defined carefully.

Improvement of Cosmesis in the Surgical Treatment of Cleft Hand / 대한정형외과학회잡지

Being a rare disease entity, there have been few references about the cleft hand in Korea. We evaluated the postoperative cosmetic results of 17 cleft hands in 14 patients, who were treated surgically at the Department of Orthopedic Surgery of Seoul National University Hospital, from 1982 to 1993. Among 14 patients, 8 were males. Bilateral cleft hands were in five patients and unilateral in 9. Three of five patients who had bilateral cleft hands, were treated surgically on both hands. Remaining two patients had an operation on one hand which affected more severely. Average age at the time of operation was 2 years and 5 months(5 months-10years). Average duration of follow-up was 34 months(1 year 1 month-7years 5 months). By Lange's classification, typical patterns were 16 hands and atypical pattern one. By Flatt's classification, there were 8 hands of I b, 7 I c, 1 I a, 1 II. One patient had family history whose father had both cleft hands and feet. Congenital anomalies other than cleft hand were associated in 10 of 14 patients. Two patients had 3 associated anomalies, 4 patients 2, and 4 patients one. Syndactyly was the most common associated anomaly of affected cleft hand. Central cleft was closed by Snow-Littler technique in 4 hands(24%), Barsky method in 12(71%) and others in 1(6%). Metacarpal bone was treated by intermetacarpal ligament reconstruction in 1 hand(6%), excision only 7(41%), transfer of 2(rd) metacarpal to 3(rd) metacarpal base after excision 5(29%), and 2(rd) metacarpal corrective osteotomy 3(18%). Complications were in 2 hands; one wound dehiesence of cleft, and one partial necrosis of skin. The cosmetic results of surgical treatment were graded into good, fair or poor by the parents-Good ; when parents were satisfied with the result, Fair; improved cosmesis but not satisfied, and Poor; no improvement after surgery. Good was in 16 hands and fair in one.