Role of the internet in communication between patient and surgeon before rhinoplasty.

Our aim was to assess the use of the internet for patients considering rhinoplasty, to identify the influence of the medical information acquired, and to review favourable and adverse aspects of the acquired knowledge online. A prospective study was conducted on 106 patients listed for post-traumatic or aesthetic rhinoplasty. We surveyed 18 questions to evaluate demographic and sociological data, and the importance of the information acquired from the internet. Respondents searched online for description of operations, contact with other patients, and with the surgeon, and for preoperative and postoperative pictures. Patients who were considering aesthetic rhinoplasty were given medical information by a third party or from the internet, and those who were having post-traumatic corrections were usually referred by their general practitioner. We conclude that the internet is an important source of medical information about rhinoplasty for patients, but it does not contain enough data. It plays an essential part, particularly for those patients having the operation for aesthetic reasons, in contrast to those having post-traumatic correction. Reviewing and certifying the plastic surgical websites would validate certified services. Independent, direct contact with the doctor helps patients to obtain more accurate, personalized knowledge. In addition, surgeons should support patients by giving them a list of verified websites, which would contribute to increased doctor-patient communication.

Individual and ethnic aspects of preoperative planning for posttraumatic rhinoplasty.

The aim of this study was to compare the aesthetic results of post traumatic rhinoplasty among Europeans with populations of healthy Caucasians described in earlier reports, and to collate correct parameters of nasal shape in healthy representatives of both sexes and various races for improvement in aesthetic results of surgery. 3-D scanning of the face was performed in 54 patients after posttraumatic septorhinoplasty. Analysis of 3D model was based on two indices of the nasal proportions and four angles of the region from 18 anthropological points. Parameters of the nasal shape in addition to gender were compared to average values of healthy Caucasian population, described before. Normal characteristics of the nose among individuals of three races from previous studies were also compared to one another. In females, mean height and width of the nose as well as length of both nostrils was smaller. Neither were there any significant differences in width of the nostrils and length of the nasal pyramid nor nasal prominence. Nasal proportions were similar in both sexes. Some of the nasal angles differed in addition to gender. Posttraumatic rhinoplasty resulted in correct shape of the nose similar to the healthy Caucasian population. The aesthetic nose differ among healthy individuals of the three races analysed. While preoperative planning is important, knowledge of the normal values of parameters characterising shape in both genders is equally important as the individual differences in relation to the whole face.

The internet as a source of information for patients prior to rhinoplasty.

OBJECTIVES: To determine the prevalence of Internet use by patients considering rhinoplasty and to identify the impact of such information on their decisions. METHODS: Prospective analysis of the impact of information received via the Internet by patients considering rhinoplasty on their decision-making prior to surgery. Eighty six patients, scheduled for post-traumatic or aesthetic rhinoplasty, received a questionnaire, consisting of 19 questions, which sought to evaluate their perception of the importance of the Internet information to them and also collected relevant demographic and sociological data. RESULTS: Respondents searched online for descriptions of medical procedures, information about how to contact other patients, pre- and post-operative pictures and making contact with a doctor. Patients considering aesthetic rhinoplasty received medical information from a third party or via the Internet. Individuals requiring post-traumatic surgical treatment were usually referred by family doctor. CONCLUSION: Patients planning nasal aesthetic surgery form their opinions after consulting friends and searching the Internet, which can act as an important medical assistance.

Angiogenesis markers quantification in breast cancer and their correlation with clinicopathological prognostic variables.

Tumoural angiogenesis is essential for the growth and spread of breast cancer cells. Therefore the aim of this study was to assess the diagnostic performance of angiogenesis markers in tumours and there reflecting levels in serum of breast cancer patients. Angiogenin, Ang2, fibroblast growth factor basic, intercellular adhesion molecule (ICAM)-1, keratinocyte growth factor (KGF), platelet-derived growth factor-BB, and VEGF-A were measured using a FASTQuant angiogenic growth factor multiplex protein assay. We observed that breast cancer tumours exhibited high levels of PDGF-BB, bFGF and VEGF, and extremely high levels of TIMP-1 and Ang-2, whereas in serum we found significantly higher levels of Ang-2, PDGF-BB, bFGF, ICAM-1 and VEGF in patients with breast cancer compared to the benign breast diseases patients. Moreover, some of these angiogenesis markers evaluated in tumour and serum of breast cancer patients exhibited association with standard clinical parameters, ER status as well as MVD of tumours. Angiogenesis markers play important roles in tumour growth, invasion and metastasis. Our results suggest that analysis of angiogenesis markers in tumour and serum of breast cancer patients using multiplex protein assay can improve diagnosis and prognosis in this diseases.

Delayed two-stage breast reconstruction with implants: The authors' recent experience.

BACKGROUND: Presently, breast cancer detection is delayed in Poland and, thus, the only other option for patients is amputation and breast reconstruction (immediate or delayed). Reconstructive methods are based on using the patient's own tissue (pedicled or free myocutaneous flaps) or implants (a tissue expander, which is later exchanged for a prosthesis or an expandable implant). OBJECTIVE: To evaluate the aesthetic results of a delayed two-stage breast reconstruction with the use of implants (expander and prosthesis) in patients who have previously undergone cancer-related mastectomy. METHODS: From 2006 to 2009, 54 patients (34 to 65 years of age) underwent reconstruction at least one year after their mastectomy and adjuvant chemotherapy; three women also received x-ray therapy. All women underwent a two-stage treatment with a tissue expander, which was later exchanged for a prosthesis. RESULTS: Outcomes of the surgery (evaluated by the physician and the patient at least six months after all stages of reconstruction) were found to be very good in 42 patients and good in 12 patients. After amputation and x-ray therapy in two cases, a fistula developed, which necessitated implant removal. CONCLUSIONS: After amputation, breast reconstruction with implants (expander and prosthesis) provides good aesthetic results. The method is mildly burdening to the patient and does not cause severe scarring. Symmetrization of the second breast is often recommended; however, the cost is not covered by the national health system. In principle, earlier x-ray therapy disqualifies the application of implants. Dividing reconstruction into two stages (expander and prosthesis) allows for possible correction of prosthesis placement.

[Hypertrophy of labia minora--pathomorphology and surgical treatment]. / Przerost warg sromowych mniejszych--patomorfologia i leczenie chirurgiczne.

BACKGROUND: Hypertrophy of labia minora is a variant of normal anatomy. The enlargement can be unilateral or bilateral and is sometimes asymmetric. Hypertrophy of the labia minora may be attributed to mechanical irritation and endocrine diseases. Labia minora longer than 5 cm is a functional and aesthetic problem for many women. Surgical treatment is performed at the request of the patient and based on surgical reduction of labia minora. AIM: The goal of this paper is to present our own experiences in labia minora reduction. MATERIAL AND METHODS: Twenty-one patients with labia minora hypertrophy aged from 18 to 35, were operated. Hypertrophy was bilateral in all cases but asymmetrical in 5. We have observed that labia majora were smaller than normally and even after labioplasty did not contact in the midline. We performed elliptical resection of the protuberant segment of the hypertrophic labium. RESULTS: We obtained good aesthetic and functional results. All patients were fully satisfied with the outcome. CONCLUSIONS: Hypertrophy of labia minora is not a pathologic condition but rather a variant of normal anatomy. Indication of the operation is psychical and functional discomfort. Elliptical resection of the protuberant tissue is a safe method of treatment.

Tattooing and body piercing--what motivates you to do it?

BACKGROUND: Body ornamentation is becoming more and more popular, especially among young people. AIMS: To establish the sociodemographic characteristics of people with tattoos or body piercing and to analyze the motivations for body ornamentation. METHODS: The questionnaire studies were undertaken in Lodz--one of the largest cities in Poland. The data was collected from a group of 968 people, 476 of whom had a piercing and 492 a permanent tattoo. RESULTS: Statistical analysis revealed that in the group of people with a tattoo, 36.8% were female and 63.2% were male. Contrary proportions were noted among people with a piercing: 78.8% female and 21.2% male. CONCLUSIONS: Body piercing is significantly more popular among women while tattooing is more popular in men. Among adolescents, body piercing is performed considerably earlier than tattooing. The main reasons for body ornamenting in the Polish population are the desire to enhance one's individuality and the need to increase sexual attractiveness.

[Female-to-male transsexual's stereotype among university men and women on the basis of semantic differential]. / Stereotyp transseksualisty typu kobieta-meiczyzna wsród studentów uczelni wyzszych na podstawie dyferencjalu semantycznego.

AIM: The aim of this study is to determine female-to-male transsexual's (FtM) stereotypes created in female and male university students and comparing them in the analysed groups. METHOD: 300 university students (from the Technical University of Lódz, University of Lódz, Medical University of Lódz) received a questionnaire with 10 pairs of the opposite meaning adjectives (good-bad, weak-strong, fast-slow, ugly-pretty, fat-thin, suppressed-loud, clever-stupid, light-heavy, active-passive, kind-cruel) related to a notion 'female -to-male transsexual' and placed on the extremes of the 7-point scales. The respondents also described each adjective as positive, negative or neutral. RESULTS: For most of the adjectives' pairs (fast-slow, ugly-pretty, fat-thin, suppressed-loud, clever-stupid, light-heavy and, in men's answers also good-bad and kind-cruel) the students placed FtM transsexual in the middle of the scales (the median was 4). Women significantly more often than men placed FtM transsexual closer to the adjectives "good", "pretty" and "kind", also they assessed the FtM transsexual more often as being "clever". CONCLUSIONS: 1. The Female-to-male transsexual is not perceived stereotypically among university students. 2. Men created more negative female-to-male transsexuals' image than women.

[Acceptance of transsexualism among university students from Lódz]. / Akceptacja transseksualizmu wsród studentów lódzkich uczelni wyzszych.

UNLABELLED: Transsexualism is one of the gender identity disorders where psychological sex is opposed to anatomical sex. This disorder leads to a discrepancy between the preferred social gender and the biological sex. AIM: The aim of this research is to compare knowledge and attitude toward transsexualism in student's opinion, coming from three universities in Lódz. METHOD: The questionnaire study was performed in the group of 300 students from three universities in Lódz: Technical University of Lódz, University of Lódz, Medical University of Lódz. The questionnaire contained 30 questions related to respondent's sex, birthplace, knowledge about definition and aetiology of transsexualism and also rights which students would grant to transsexuals. RESULTS: The right definition of transsexualism was pointed by 64% of students from Medical University, 57% from Technical University and 40% from University of Lódz. The right to surgical sex change for transsexuals would be granted by 87% of students from the Medical University, 69% from the University of Lódz and 40% from the Technical University. Majority of medical students (90%) and respectively 78% and 57% from the University of Lódz and Technical University would accept a transsexual as his/her co-worker. CONCLUSIONS: Student's knowledge about transsexualism is similar and does not differ from a foreign student's knowledge. Students from natural science studies (medicine and biology) are the most tolerant towards transsexuals.

Complications after body piercing in patient suffering from type 1 diabetes mellitus.

BACKGROUND: Body piercing has been a well-known practice of body ornamentation. Nowadays, it is believed to involve from 6.5% to 50% of the population. Complications after body piercing procedures are variable. OBJECTIVE: The aim of this report is to present complications after body piercing in a patient suffering from type 1 diabetes mellitus. METHODS: A twenty-four-year-old woman came to our plastic surgery outpatient clinic complaining of penetration of earring clips to her earlobes. This caused inflammation and continuous decubitus ulcers on the posterior surfaces of both earlobes. CONCLUSION: On the basis of observations of the described patient, it can be concluded that unregulated diabetes is a contraindication to body piercing procedures.

[Developmental disturbances of medial part of face of patients with bilateral cleft lip and palate with special consideration of a nose]. / Zaburzenia rozwojowe srodkowego odcinka twarzy u chorych z obustronnym rozszczepem wargi i podniebienia ze szczególnym uwzglednieniem nosa.

UNLABELLED: Cleft is a developmental malformation, which is defined as a partial or complete lack of anatomic tissues continuity in typical areas of disorders in embryological face development. The reasons for cleft formation are not completely recognised but many hypotheses indicate both environmental and genetic factors as possible sources. The list of the cleft types is the following: cleft lip, cleft lip and alveolus, isolated cleft palate, cleft lip, alveolus and palate, and combined clefts. The malformation may occur unilateral or bilateral. According to World Health Organization cleft lip and palate is classified in the first ten of the most common developmental disorders, however the bilateral form of pathology is the least popular one. MATERIAL AND METHODS: The aim of the study is the anthropometric measurement of a nose of children and adolescents with bilateral cleft lip, alveolus and palate in comparison with data gathered as a result of healthy people measurements. The research was conducted on 26 patients with the malformation: 12 girls and 14 boys at the age range between 7 and 18. The measurements were taken with the use of small bow and slide compasses. For the purpose of the statistical analysis we used formula for standardisation. Both, the arithmetic average and the standard deviation were estimated on the basis of research done on 30 healthy people of same sex and at proper age. Intersexual comparison of these values with the use of t-Student test was done. In order to distinguish homologues features in respect to the comparative group, one-way ANOVA and test post hoc (Duncan) were used. RESULTS: Malformation was mainly reflected in increased width the base of the nose (sbal-sbal), width of nose (al-al) and its small prominence (sn-prn). Increase in head height values together with underdevelopment in sagittal plane was also observable. The increase of upper face height (n-sto) was recognized as stronger in case of females than males with the same malformation. The middle part of face was characterized by increase of height measurements together with sagittal plane underdevelopment. CONCLUSIONS: It was stated that the patients with bilateral cleft lip, alveolus and palate tended to have flat and wide nose.

Are body piercing and tattooing safe fashions?

The trend to ornamenting the human body by piercings and tattoos which is observed all over the world is becoming more and more popular. The aim of this research was to compare the frequency of complications occurring after piercing and tattooing and to analyze the conditions under which the procedures were performed. The research was based on the results of questionnaire studies performed in a group of 824 people (57.8% women and 42.2% men) aged 14-52. The data were compared by the fraction difference statistic test. The procedure was performed in professional establishments for 93.1% of people with piercings and 78.8% with tattoos. The difference between these fractions is statistically significant (p < 0.05). Complications were noted in 45.6% of people with piercings and 31.25% with tattoos. This difference is also statistically significant (p < 0.05). The people questioned with piercings noted mainly local infections, bleeding and tissue tearing, while subjects with tattoos mentioned pruritus and/or bleeding. We conclude that body piercing is connected with a higher risk of more serious complications than tattooing. There is a social awareness of this so piercing procedures are more often done in professional establishments.

[Binder's syndrome--symptoms and treatment]. / Zespól Bindera--objawy i leczenie.

INTRODUCTION: The flat dorsum and short septum of the nose, enlarged nasal angle, small naso-labial angle, maxillary micrognathism, and augmented upper lip, what makes the concave midface profile are the symptoms of Binder syndrome (maxillonasal displasia). The treatment consists of nasal and maxillary correction followed by orthodontic rehabilitation. MATERIAL AND METHODS: Five cases affected with Binder syndrome (age: 5-20 years old) were observed. Two patients were surgically treated in age 14 and 20-year-old. Nose correction was performed--elongation of skin nasal septum and bone graft to dorsum. Three patients need the orthodontic treatment of occlusal class III. There was no indication to corrective osteotomy of maxilla. RESULTS: Five year long-term result after surgical nose correction is excellent. CONCLUSIONS: The treatment schedule in Binder syndrome depends on the progress of the symptoms in the face occlusion. Surgical treatment can be limited only to reconstruction of the nasal dorsum and apex or additionally maxillary advancement. Grafting to the osteo-chondral scafold of the nose can be carry out from 14-year-old, and osteotomy of the nose or maxilla should be planned after 18-year-old. Every patient affected with maxillonasal displasia requires consultation and orthodontic treatment.

[Congenital lesions of the external nose]. / Wrodzone guzki nosa zewnetrznego.

Congenital lesions of the external nose appear during embryologic development. Their usual location is midline nasal area. The most common are dermoid cyst, glioma, encephalocele and meningocele. The histopatology confirms dermoid cyst in 60%. Diagnosis is based mainly on clinical examination of the patient. Computer tomography and magnetic resonance are useful to reveal the pathway of intracranial herniation or presence of associated anomalies of the cranial bones. A complete surgical removal of the lesion is the only effective treatment. In Plastic Surgery Clinic in Lodz, 20 patients 2-20 years old were operated between the years 1973-2004. Treatment consisted of simple surgical excision of the nasal lesion. The dermoid cyst was diagnosed in 55%. In 3 cases, where herniations were observed, a preparation and simple ligature was performed. The results of all operations were satisfactory. Congenital lesion of the external nose should be considered as dermoid cyst, glioma, encephalocele or meningocele. Complete excision is very important. Deformations of the nose after surgery are to be corrected after the facial skull growth process ends.

[The occurrence of the cleft lip and/or palate in cleft-twins]. / Wystepowanie rozszczepów wargi i/lub podniebienia u blizniat.

UNLABELLED: Twin pregnancies are associated with an increased risk of congenital malformation, illness and higher incidence of newborns during labour. They are noticed to have been more frequent in Poland in recent years. Based on the hospital records we reviewed the most common facial anomaly in twins--the cleft lip and palate. The frequency of this malformation occurrence in Poland is 1:502 in newborns. The etiopathogenesis of this malformation, in 17-20%, results from genetic factors. Researches on the occurrence of cleft lip and palate in twins strongly confirm the heredity of the malformation. THE AIM OF THE STUDY: The analysis of the occurrence frequency of the cleft lip and/or palate in cleft-twins was the main objective in our study. MATERIAL AND METHODS: In the study of 21 sets of cleft-twins, 6 of them were monozygotic and 15 were dizygotic. It was assessed on the basis of data that was received from parents, same-sex twins and physical likeness. Twin-siblings who had cleft anomalies, always had cleft lip and palate or an isolated cleft palate. RESULTS: The outcome showed that twins were not a subject to increased or decreased risk of cleft anomalies. Moreover, clefts did not increase the risk of twin-siblings labour. The hypothesis that a monozygotic twin pregnancy is a factor of increased risk of cleft anomaly was not confirmed. Presented data can be used in genetic counseling. In all likelihood, in the nearest future there will be chances for working out the cleft prophylaxis. CONCLUSION: Twin pregnancy does not changes risk of cleft anomaly and its occurrence does not increase of twin-siblings labor.

[Facial developmental irregularities of the face- in children with Binder's syndrome with regard to indirect angular measurements]. / Nieprawidlowosci rozwojowe twarzy u dzieci z zespolem Bindera w swietle posrednich pomiarów katowych.

UNLABELLED: Binder's syndrome is a disorder characterised by the underdevelopment of maxilla and nose. PURPOSE: The paper presents an attempt to analyse the developmental irregularities, described by angular features in patients with the syndrome. PATIENTS AND METHODS: The research was performed on 4 children aged 5-12 with maxillonasal dysplasia. Before orthodontic and surgical treatment standardised photographs of the head -- anterior and lateral (right and left) were taken. Seven angular measurements were taken on the standardised lateral photographs. The same measurements were made in the group of 30 girls and 60 boys aged 5-12 years. THE RESULTS of measurements were normalized into means and standard deviation of analogous features for normal persons in groups of sex and age, then every angle of the face was counted. From all angular features, three (fronto-nasal angle, inclination of upper lip angle and inclination of chin angle) were characterised by higher means in children with maxillonasal dysplasia. The most favourable mean of normalised value referred to the fronto-nasal angle and was 2.9. CONCLUSIONS: On the basis of this analysis it was affirmed that people with Binder's syndrome are characterised by a flat nose and strong inclination of upper lip and chin, resulting in characteristic concave facial profile. The most visible malformations of the face concern the inclination of the nose. The smallest deviation is localised in the area of the nose and lips.

[Familial cleft lip with or without coexisting cleft palate]. / Dziedziczenie rozszczepów wargi i/lub podniebienia.

Etiopatology of clefts has not been explained yet. It is assumed that the cause of this defect is complex and heterogeneous. Genes which induce the incidence of cleft have not been detected too but clinical observations indicate a familial predisposition. At the Plastic Surgery Clinic of the Lódz Medical Academy, on years 1972-2001, 3180 children with cleft lip or/and palate were being treated. The group under examination consisted of 540 children with positive family histories. Two genetic groups were confirmed and each of them with a different risk of the reoccurrence of the defect. The first group--cleft lip and palate, the second group--an isolated cleft palate. A correlation between the type of cleft and a child's sex and its cleft affected parent was found. Among children of mothers with cleft lip there were 60% of boys and only 15% of girls with the same type of cleft. In mothers with cleft lip and palate the same type of cleft has been detected in 70% of boys and 18% girls. Similar results were obtained when affected fathers were taken into account. However, in case of mothers and fathers who were affected with isolated cleft palate there were significantly more girls than boys who had cleft palate. An in-depth study of cleft inheritance mechanisms will make in the future a more precise prediction of the occurrence of the defect in consecutive generations possible. Perhaps, the chance to work out cleft preventions will emerge and the gathered data will be taken advantage of in genetic counselling.