RESUMO
PURPOSE OF THE STUDY: The aim of this study was to evaluate the influence of obstructive sleep apnea (OSA) in children on maternal and paternal anxiety. PATIENTS AND METHODS: This prospective study was conducted from January 2013 until January 2016 in the Ear, Nose and Throat (ENT) Department at the University Hospital of Split, Croatia. The parents of 59 children with a median age of 5 years (range: 2-9) who were suffering from obstructive sleep apnea (OSA) due to adenotonsillar hypertrophy were enrolled into the study. All children were scheduled for adenoidectomy or adenotonsillectomy because of airway obstruction. In addition, their parents completed the 20-item State-Trait Anxiety Inventory-1 (STAI-1) and 20-item State-Trait Anxiety Inventory-2 (STAI-2) questionnaires before the operation and 30 days after the surgery when their children had considerable improvements in breathing during their sleep. The STAI is an instrument that quantifies both state (STAI-1) and trait (STAI-2) anxiety. State-Trait Anxiety Inventory-1 (state anxiety) is intended to measure transitory anxiety at a specific time (related to OSA symptoms in our study), whereas STAI-2 (trait anxiety) measures long-term anxiety. RESULTS: Overall, the study included 57 mothers and 53 fathers of 59 children diagnosed with OSA. The mean preoperative STAI-2 score of parents was 31.1⯱â¯7.5; for fathers it was 28.2⯱â¯6.3, and for mothers it was 33.7⯱â¯7.6. The STAI-1 and STAI-2 scores showed significant differences before and after the surgery according to gender. The mean score of mothers was 5.5 (95% CI: 2.8 to 8.1) higher than the mean score of fathers (tâ¯=â¯4.1, pâ¯<â¯0.001) on the STAI-2 scale. The mean score of mothers was 5.6 (95% CI: 0.48 to 0.7) higher than the mean score of fathers (tâ¯=â¯2.2; pâ¯=â¯0.032) on the preoperative STAI-1 scale. The mean score of mothers was 1.95 (95% CI: 0.35 to 3.6) higher than the mean score of fathers (tâ¯=â¯2.4; pâ¯=â¯0.017) on the postoperative STAI-1 scale. The mean score of mothers was 6.22 higher than the mean score of fathers (pâ¯=â¯0.029) on the preoperative STAI-1 scale, adjusted for the STAI-2 scale. The mean score of mothers was 1.8 higher than the mean score of fathers (pâ¯=â¯0.039) on the postoperative STAI-1 scale, adjusted for the STAI-2 scale. These data suggest that differences between the preoperative and postoperative STAI-1 score for mothers was the highest (51⯱â¯7) in children with severe OSA and the lowest (28⯱â¯14) in children with mild OSA (pâ¯<â¯0.001). The difference between the preoperative and postoperative STAI-1 score for fathers was the highest (48⯱â¯6.6) in children with severe OSA and the lowest (25⯱â¯10) in children with mild OSA. CONCLUSION: The results of our study suggest that obstructive sleep apnea in children is a disturbing symptom for parents and is associated with a significant level of anxiety that depends on OSA severity. After the surgical treatment of the children (adenoidectomy or adenotonsillectomy), the anxiety level of both parents decreased. We suggest that preoperative psychological intervention should be considered in selected cases for mothers and fathers of children with severe OSA in order to diminish the symptoms of anxiety that can compromise normal postoperative recovery in operated children.
Assuntos
Tonsila Faríngea/patologia , Ansiedade/etiologia , Pai/psicologia , Mães/psicologia , Tonsila Palatina/patologia , Apneia Obstrutiva do Sono/psicologia , Adenoidectomia , Tonsila Faríngea/cirurgia , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Hipertrofia/complicações , Masculino , Pessoa de Meia-Idade , Tonsila Palatina/cirurgia , Período Pós-Operatório , Período Pré-Operatório , Estudos Prospectivos , Índice de Gravidade de Doença , Fatores Sexuais , Apneia Obstrutiva do Sono/etiologia , Inquéritos e Questionários , TonsilectomiaRESUMO
Results of this clinical study on surgical treatment of pressure ulcers at Department of Plastic, Reconstructive and Aesthetic Surgery, Dubrava University Hospital showed that there was no difference between the 2011-2016 and 2003-2008 periods, indicating continuation of good surgical treatment planning and appropriate postoperative care. Despite the smaller number of hospitalized patients in the 2011-2016 period (31 patients and 42 reconstructive procedures), the number of reconstructive procedure was similar to the recent 2003-2008 period (47 patients and 57 reconstructive procedures). The best results of reconstruction of sacral region pressure ulcer were achieved with fasciocutaneous and musculocutaneous flaps. Whenever possible, depending on the extent of the defect, musculocutaneous flaps should be preferred for reconstruction. It is especially suitable for pressure ulcer recurrence. For ischial region reconstruction, good results can be obtained by mobilizing the semimembranosus and/or semitendinosus in defect gap. For trochanteric region, the tensor fascia lata flap is a good choice. For maximal functional and reconstructive results, a multidisciplinary approach in pressure ulcer treatment has the leading role in the modern concept of wound healing. Surgical treatment should always include radical debridement, ostectomy and well planned defect reconstruction. Conservative treatment should be support to surgical treatment with a focus on patient health care and high hygiene measures. In recent years (2011-2016), the usage of better conservative treatment led to reduction of patient hospital stay and surgical treatment of pressure ulcer. Further 'wound care' nurses training in Croatia can lead the trend towards advanced practice nursing in pressure ulcer prevention and conservative treatment.
Assuntos
Desbridamento/métodos , Procedimentos de Cirurgia Plástica , Úlcera por Pressão , Higiene da Pele , Cirurgia Plástica , Adulto , Croácia/epidemiologia , Desbridamento/estatística & dados numéricos , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera por Pressão/epidemiologia , Úlcera por Pressão/cirurgia , Melhoria de Qualidade , Procedimentos de Cirurgia Plástica/métodos , Procedimentos de Cirurgia Plástica/estatística & dados numéricos , Procedimentos de Cirurgia Plástica/tendências , Recidiva , Higiene da Pele/métodos , Higiene da Pele/normas , Higiene da Pele/tendências , Cirurgia Plástica/métodos , Cirurgia Plástica/tendências , CicatrizaçãoRESUMO
BACKGROUND: Apert syndrome is a set of complex malformations of the first brachial arch, with manifestations on the skull, face, hands and feet. At the level of the hand, the following signs are always present: complex syndactyly of the second, third and fourth digits with distal bone fusion; simple syndactyly of the fifth digit; foreshortened thumb with radial clinodactily; and symphalangism excluding the fifth digit. METHODS: The digital separation of an Apert hand should begin at 9 months of age and should be completed by 2 to 4 years of age. Our simplified approach consists of early bilateral surgery on border digits followed by unilateral separation of middle syndactily combined with thumb and digit osteotomies and bone grafting as required. RESULTS: Between 1995 and 2010 seven patients with Apert syndrome underwent reconstructive surgery of the complex hand syndactyly. The main target in our surgical strategy involved early bilateral separation of border digits, which started between 1 and 2 years of age. The unilateral middle syndactyly mass division with osteotomy of the thumb and other digits and bone grafting (as required) was carried out in later surgeries, which are usually completed by 4 years of age. The evaluation of the results was performed based on the functional results of the hand, morbidity, flap necrosis, skin graft lysis, postoperative range of motion in the small joints, gross grasp, pincer grasp, scar appearance, contractures of digits, and aesthetic outcome. CONCLUSION: As intended, this study proves the need for a complex surgical approach as early as possible with low revision rate, and acceptable functional and aesthetic outcome.
Assuntos
Acrocefalossindactilia/diagnóstico , Acrocefalossindactilia/terapia , Procedimentos de Cirurgia Plástica/métodos , Transplante Ósseo , Feminino , Humanos , Lactente , Masculino , Osteotomia , Polegar/anormalidades , Polegar/cirurgiaRESUMO
Muscular echinococcosis accounts for 0.5% to 5.4% of all hydatid disease cases, with very little data on the incidence of muscular echinococcosis of the head and neck. We report a unique case of primary echinococcosis of the right sternocleidomastoid muscle in a 56-year-old man. Preoperative assessment by ultrasound and fine needle aspiration did not point to echinococcosis. We suspected the right diagnosis intraoperatively and confirmed it postoperatively by pathohistology and serologic tests. Echinococcosis of the liver and the lungs was also excluded postoperatively. Combination of operative treatment and postoperative albendazole herapy in two 28-day cycles one month apart resulted in complete regression of the disease. Echinococcosis should be considered as differential diagnosis of a multicystic mass in neck, particularly if it is of longstanding duration. Serologic tests for echinococcosis should be included in differential diagnostic procedures for each multicystic formation on the neck, especially in endemic areas.