VALIDATION OF THE CROATIAN VERSION OF THE SURGICAL FEAR QUESTIONNAIRE (SFQ) IN ADULT PATIENTS WAITING FOR ELECTIVE SURGERY.

The Surgical Fear Questionnaire (SFQ) is an instrument for self-assessment of surgical fear and consists of two subscales, one assessing the fear of short-term consequences (SFQ-s) and another one of long-term consequences (SFQ-l) of surgery. The aim of this study was to test the Croatian version of the SFQ with regard to its psychometric properties. This prospective cohort study included patients who presented to the Department of Surgery for elective surgery in the inpatient setting at a tertiary health care facility in Croatia between April 1 and May 31, 2019. Data on 144 patients were suitable for data analysis. Data collection was performed in the afternoon before surgery using the Personal Information Form, Numerical Rating Scale self-report instruments (NRS), SFQ and Hospital Anxiety and Depression Scale (HADS) assessing sociodemographic factors, surgical fear via NRS and SFQ, expected pain and emotional state. The Cronbach alpha value as a statistical measure for reliability of psychometric tests for the SFQ-s subscale was 0.79, for SFQ-L subscale 0.84, and for total SFQ 0.81. The exploratory factor analysis (EFA) showed a two-factor structure. Significant correlations of the SFQ with the NRS and HADS-anxiety subscale were demonstrated. Our study demonstrated the Croatian version of the SFQ to have a high level of reliability and hence can be used as a self-report instrument for surgical fear with two subscales. Convergent validity of the SFQ with other self-report instruments is shown.

Current Surgical Methods in Local Rectal Excision.

Background: The treatment of rectal cancer has evolved with the advancement of surgical techniques. Less invasive approaches are becoming more accepted as the primary treatment method. Summary: Such methods as transanal excision, transanal endoscopic microsurgery, and transanal minimally invasive surgery can reduce morbidity and mortality rates. However, not all patients are suitable candidates for these procedures, and proper diagnostics are necessary to establish indications. Compared to total mesorectal excision, transanal excision techniques have been shown to have fewer complications and comorbidities while still being able to remove cancerous tissue entirely. Transanal excision is the simplest method, where the operator removes visible rectal lesions. The basic principle of transanal endoscopic microsurgery is to dilate the rectum mechanically and by air insufflation and then use special surgical instruments to remove suspicious lesions under the vision of a telescope. Transanal minimally invasive surgery combines transanal endoscopic microsurgery and single-incision laparoscopic surgery, making the hard-to-reach proximal rectum accessible to classic laparoscopic instruments. Key Message: Local excision techniques, when used as a monotherapy for treating patients with rectal cancer, have established themselves as a curative and less radical treatment for strictly selected patients with early rectal carcinoma, leading to improved quality of life. When combined with other modalities such as neoadjuvant chemoradiotherapy, total neoadjuvant therapy, and immunotherapy, transanal surgery can be offered to patients with locally advanced rectal cancer as part of the organ preservation strategy. This review will discuss the patient selection and technical aspects of transanal surgery, showcasing its current role in treating rectal carcinoma.

[Video-assisted extirpation of breast fibroadenoma with immediate bilateral breast augmentation--a case report]. / Videoasistirana ekstirpacija fibroadenoma dojke s neposrednim obostranim povecanjem dojki--prikaz bolesnice.

BACKGROUND: Since mid 1990s video-assisted breast surgery (VABS) has been developed in the treatment of benign and malignant breast diseases. According to studies that are conducted mainly in Japan, this tehnique is safe, easy to learn and his main advantage is excellent cosmetic results on postoperative appearance of breasts that cannot be achived with standard surgical procedures. OBJECTIVE: To present a first case of video assisted breast surgery in Croatia applied to treatment of breast fibroadenoma and immediate bilateral breast augmentation. CASE REPORT: A 39 year old female patient was admitted to our hospital for elective procedure of breast augmentation. On this occasion video assisted extirpation of fibroadenoma was performed through inframammary incision and followed by immediate bilateral breast augmentation. CONCLUSION: VABS is feasible, cosmetic effects are evident and the VABS deserves attention as a possible surgical option in breast surgery. However further experience on this field must be gained and it remains to evaluate this tehnique on the additional studies.

Sexual dimorphism of the extraorbital lacrimal glands in SF-1 knockout mice.

Sexual dimorphism (SD) represents all the differences between males and females of the same species. SD of the murine lacrimal gland and the major effect of testosterone on its formation are well documented. Steroidogenic factor-1 (SF-1, NR5a1) is a nuclear receptor essential for the fetal development of steroid hormones producing organs and SF-1 knockout mice (Sf-1 KO) are therefore born without gonads and adrenal glands. The aim of this study was to investigate whether SD in lacrimal glands is present in the absence of exposure to sex hormones during development. Lacrimal glands from adult Sf-1 KO male and female mice without hormonal exposure, and from males that were treated with testosterone propionate (TP) prior to sacrifice, were examined. After sacrifice, glandular tissue was processed using standard histological procedures. Paraffin sections were analysed by stereology and immunostained against the androgen receptor (AR). Our results showed that there were no statistically significant differences in the mean volumes of acini, connective tissue or ductal system between males, females, and males on TP. The same pertains to the mean length of the ducts in all three groups. In the absence of sex hormones, sex chromosomes proved to be insufficient in inducing sexual dimorphism in LG. However, nuclei of the acinar cells in males on TP were positive for AR, whereas in males without TP no expression of AR was detected. Administration of TP induced the expression of AR in the nuclei of acinar cells of males but did not affect the morphology of LG. We conclude that SD in the lacrimal gland is not present in Sf-1 KO mice and this suggests that sex hormones have a major role in the development of SD in the lacrimal gland.

Foetal Leydig cells and the neuroendocrine system.

It has been shown that adult human Leydig cells express a number of neuroendocrine markers, and, therefore, could be considered as a part of the neuroendocrine system in the adult. A limited number of studies have dealt with the dynamics of development of human foetal Leydig cells, whereas studies on their neuroendocrine nature are still extremely rare. Therefore, the aim of our study was to investigate the development of human foetal Leydig cells in different weeks of gestation (wg) and to check if these cells express certain markers characteristic of the diffuse neuroendocrine system (DNS). Qualitative, quantitative histological studies and immunohistochemical analyses of human foetal testicular tissue have been performed. According to our data, Leydig cells formed a dynamic population of cells within the interstitum of testes in the period between 15 and 36 wg. The total number of Leydig cells of human foetal testes changed through different stages of gestation by means of 'pulsatile' dynamics (most likely, by following the variable level of gonadotropins). At early stages of development (15-17 wg) immunohistochemical reactions for the expression of neuron specific enolase (NSE) were positive within sex cords and between them, in the interstitum. Pro-spermatogonia in the sex cords were positive, as well as elongated spindle-shaped cells of the interstitum (very likely, precursors of Leydig cells). During the later stages of development (28-36 wg), excluding the pro-spermatogonia, the interstitial Leydig cells were also positive. The results of the immunohistochemical analyses (the expression of NSE) confirmed the hypothesis that human foetal Leydig cells were of neuroendocrine nature.