Aesthetic outcome following breast-conserving surgery assessed by three evaluation modalities in relation to health-related quality of life.

BACKGROUND: The aim of this study was to compare the agreement between three different methods for evaluation of aesthetic outcome following breast-conserving surgery and adjuvant radiotherapy: a patient questionnaire, panel evaluation of photographs and the software BCCT.core. A further aim was to examine how these modalities predict health-related quality of life as measured by the validated Breast-Q™ questionnaire. METHODS: At 1-year follow-up after breast-conserving surgery, patients completed a study-specific questionnaire. Postoperative photographs were evaluated using the software BCCT.core. A panel of three healthcare professionals assessed preoperative and postoperative photographs. Agreement between methods was assessed using Spearman's correlation coefficients (rs ). The Breast-Q™ questionnaire was sent to study participants. The ability of the different evaluation methods to predict Q-scores for the health-related quality-of-life (HRQoL) domains satisfaction with breasts and psychosocial well-being was investigated using receiver operating characteristic (ROC) curves. RESULTS: A total of 532 patients undergoing breast-conserving surgery were examined before surgery. At 1-year follow-up, 334 patients completed the study-specific questionnaire. Postoperative photographs from 310 patients were evaluated using BCCT.core. The panel of healthcare professionals assessed photographs from 215 patients. Agreement between the different evaluation modalities was poor. The strongest agreement was noted between the panel evaluation for symmetry and BCCT.core results (rs = 0·59, P < 0·001). The Breast-Q™ questionnaire was returned by 348 patients. Patient satisfaction ratings at 1-year follow-up best predicted long-term HRQoL measured using the Breast-Q score, both in terms of satisfaction with breasts (area under the curve (AUC) 0·80, P < 0·001) and psychosocial well-being (AUC 0·73, P < 0·001). CONCLUSION: There is currently no ideal method for evaluating aesthetic outcome after breast-conserving surgery and adjuvant radiotherapy. These results emphasize the use of patient-related outcome measures.

Abnormal ductus venosus pulsatility index in the absence of concurrent umbilical vein pulsations does not indicate worsening fetal condition.

OBJECTIVE: Recordings of blood flow velocity waveforms in the ductus venosus (DV) and umbilical vein (UV) are routinely used in order to predict fetal condition in high-risk pregnancies. The aim of this study was to investigate the relationship between pathological blood flow in the two vessels and perinatal outcome. METHODS: High-risk pregnancies (n = 11 863) admitted from 1993 to 2011 for blood-flow examination, including recordings of DV pulsatility index for veins (DV-PIV) and UV pulsations, were included. The results were related to perinatal outcome, using the last Doppler examination prior to delivery in the analysis. RESULTS: Abnormal DV-PIV was observed in 3.9% of cases, intra-abdominal UV pulsations in 1.3% and pulsations in the cord in 0.7%. As expected, the rate of UV pulsations increased with increasing DV-PIV Z-score. Fetuses with a pathological DV-PIV, but without UV pulsations, showed fewer signs of compromise. This was also true for cases with a DV-PIV ≥ 4 SDs above the mean (53.7% had steady flow in the UV). In contrast, the occurrence of UV pulsations seemed to be an indicator of fetal compromise, regardless of level of DV-PIV. CONCLUSIONS: Abnormal fetal venous blood velocity is related to adverse outcome in high-risk pregnancies. However, abnormal DV-PIV is not a reliable indicator of fetal compromise unless UV pulsations are concurrently present, and should not be regarded an indication for emergency delivery.

Prophylactic treatment with an aerosolized corticosteroid liposome in a porcine model of early ARDS induced by endotoxaemia.

The effects of prophylactic treatment with an aerosolized corticosteroid liposome (CSL) in high dose were evaluated in a porcine model of early Adult Respiratory Distress Syndrome (ARDS) induced by endotoxaemia. Intermittent positive pressure ventilated (IPPV) pigs under chlormethiazole anaesthesia were infused with E. coli endotoxin (18 micrograms.kg-1.h-1) over 4 h. Eight animals served as controls and were pretreated with aerosolized placebo liposomes, either 15 min or 2 h, before start of the endotoxin infusion. Eight animals were pretreated with CSL in aerosolized form 15 min before start of endotoxin, and eight animals were pretreated 2 h before start of endotoxin. Pretreatment with CSL, both 15 min and 2 h before endotoxin, modified and partly counteracted the late endotoxin-induced impairment in expiratory resistance (EXPres), dynamic compliance (Cdyn) and mean pulmonary artery pressure (MPAP). The administration of CSL did not seem to have a restrictive influence on the endogenous cortisol production estimated by repeated measurements of serum cortisol levels. These results indicate that CSL, administered prophylactically in an aerosolized form to the lung, might be valuable as a modulator without systemic side effects in regard to some of the endotoxin-induced pulmonary impairments seen in this experimental model of early ARDS.