RESUMO
Background/Aim: Immediate and delayed breast reconstruction remains a controversial topic. Apart from the clinical outcomes that have to be considered, there is a discrepancy of opinions regarding the potential differences in quality of life. It is essential to clarify this issue, in order to contribute to the reconstruction of the decision-making process. The aim of the study was to investigate potential differences in quality of life between immediate and delayed breast reconstruction patients. Materials and Methods: A systematic review of the literature was carried out, searching for case-control studies that have comparatively examined the effects of delayed and immediate reconstruction on quality of life. A literature search was carried out using the Medline, Scopus and Web of Science databases. The quality of the studies was evaluated using the STROBE checklist for case-control studies. Results: Three studies were found showing that immediate reconstruction led to benefits for the quality of life of patients, while one study showed the opposite. A relevant study revealed no statistically significant differences between the two groups, while another study, showed that immediate reconstruction entailed short-term benefits to quality of life. Four of the studies had debatable methodological approaches. Conclusion: The inconsistent study findings cannot lead to any reliable conclusions regarding differences between immediate and delayed reconstruction in quality of life. It is possible that the results vary due to the time point that the comparisons made. Future research to this direction is warranted.
RESUMO
PURPOSE: Several factors have been related to long-term survival after open abdominal aortic aneurysm (AAA) repair. The effect of carotid stenosis on outcome has not yet been examined. We performed an open prospective study to evaluate the prognostic significance of carotid stenosis on long-term survival of patients who had undergone elective operative repair of AAA. METHODS: Two hundred eight patients who underwent elective open AAA repair in our department between March 1987 and December 2001 were included in the study. All patients were evaluated preoperatively with color duplex ultrasound (US) scanning of the carotid arteries, and were followed up with clinical examination and carotid duplex US scanning 1 month after the operation and every 6 months thereafter. Median duration of follow-up was 50 months (range, 5-181 months). Cardiovascular morbidity and mortality, as well as all causes of mortality, were recorded and analyzed with regard to traditional risk factors and carotid US findings. RESULTS: Twenty-seven fatal and 46 nonfatal cardiovascular events were recorded. Both univariate and multivariate analysis showed that carotid stenosis 50% or greater and echolucent plaque were significantly associated with cardiovascular mortality and morbidity. Carotid stenosis was a stronger predictor of cardiovascular death than was ankle/brachial index. Age, hypercholesterolemia, coronary artery disease, and diabetes mellitus were also associated with higher mortality and morbidity from cardiovascular causes. CONCLUSION: Patients electively operated on for AAA repair and with stenosis 50% or greater and echolucent plaque at duplex US scanning are at significantly increased risk for cardiovascular mortality and morbidity. Carotid US can therefore be used to select a subgroup of patients with AAA who might benefit from medical intervention, including antiplatelet and lipid-lowering agents.