Correlação entre a deflexão intrinsecoide, classificação clínica e parâmetros ecocardiográficos em cães com degeneração mixomatosa valvar mitral / Correlation between intrinsecoid deflection, clinical classification and echocardiographic parameters in dogs with degenerative mitral valve myxomatosis

A degeneração mixomatosa valvar mitral (DMVM) costuma ser diagnosticada pelo ecocardiograma, porém o eletrocardiograma (ECG) pode sugerir alterações específicas e auxiliar no diagnóstico e no tratamento. A deflexão intrinsecóide (DI) é uma medida simples do ECG, que representa o início da despolarização ventricular e pode indicar a presença de sobrecargas e hipertrofia no ventrículo esquerdo. O objetivo deste trabalho é comparar dados prévios sobre condição clínica e ecocardiograma de cães com endocardiose de mitral e o valor da deflexão intrinsecóide do ECG, para buscar uma relação de concordância. Foram selecionados os arquivos de 45 cães anteriormente atendidos na rotina clínica do HV-UPFR. A estatística mostrou diferença relevante nos grupos B1, B2 e C nas derivações D2, D3, aVF, rV, V2 e V4 (P<0,05), o que permitiu classificá-los de acordo com o tamanho da DI, e esse resultado correspondeu à classificação do consenso de endocardiose de mitral em cães nesses estágios. Concluiu-se que há um aumento gradativo no valor da DI à medida que a DMVM avança, principalmente nos estágios B1, B2 e C, associado à sobrecarga e à hipertrofia ventricular esquerda, portanto esse parâmetro pode ser usado na classificação da doença.(AU)

The mitral valve myxomatous degeneration (DMVM) is usually diagnosed by echocardiography, however, electrocardiogram (ECG) may suggest specific alterations and aid diagnosis and treatment. Intrinsicoid deflection (DI) is a simple ECG measure that represents the onset of ventricular depolarization and may indicate the presence of overload and hypertrophy in the left ventricle. The objective of this study is to compare previous data on clinical condition and echocardiogram of dogs with mitral endocardiosis and the value of the intrinsicoid deflection from ECG to obtain a concordance relation. The archives of 45 previously examined dogs in the clinical routine of HV-UFPR were selected. The statistic showed a significant difference in groups B1, B2 and C in leads D2, D3, aVF, rV, V2 and V4 (P< 0,05), which allowed to classify them according to the DI size, and this result corresponded to the consensus classification of mitral endocardiosis in dogs at these stages. It was concluded that there is a gradual increase in the value of DI as DMVM progresses, especially in stages B1, B2 and C, associated with left ventricular overload and hypertrophy, so this parameter can be used to classify the disease.(AU)

Physical activity, functional ability, and quality of life after breast cancer surgery.

This cross-sectional study aimed to assess the influence of different surgical treatment modalities on the level of physical activity, functional capacity, and quality of life of breast cancer survivors. One hundred eighty women aged 30-60 years old were selected and allocated to control group (CG, women without breast cancer, n = 45), breast-conserving surgery group (BCG, n = 45), mastectomy group (MG, n = 45), and breast reconstruction group (BRG, n = 45). Physical activity, functional capacity, and quality of life were assessed, respectively, using the following self-report questionnaires validated for use in Brazil: International Physical Activity Questionnaire (IPAQ), Stanford Health Assessment Questionnaire (HAQ-20), and Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). The groups were homogeneous relative to sociodemographic variables. The scores for physical activity (IPAQ) did not differ between CG and BRG, whereas they were better for CG than for BCG and MG (p = 0.0270). The results for functional capacity (HAQ-20) were better for CG than for MG (p = 0.0450), with no difference between the remaining groups. Differences were found for the SF-36 domains "physical functioning" (p < 0.01), "physical role functioning" (p < 0.001), "emotional role functioning" (p = 0.0174), and "general health" (p = 0.0307). CG and BRG differed significantly relative to the domains "physical role functioning" and "emotional role functioning" only. We concluded that patients who underwent breast reconstruction exhibited higher levels of physical activity and quality of life than patients subjected to mastectomy alone or breast-conserving surgery.

Protective effect of yerba mate intake on the cardiovascular system: a post hoc analysis study in postmenopausal women.

The prevalence of cardiovascular and metabolic diseases is increased in postmenopausal women, which contributes to the burden of illnesses in this period of life. Yerba mate (Ilex paraguariensis) is a native bush from Southern South America. Its leaves are rich in phenolic components, which may have antioxidant, vasodilating, hypocholesterolemic, and hypoglycemic proprieties. This post hoc analysis of the case-control study nested in the Obesity and Bone Fracture Cohort evaluated the consumption of yerba mate and the prevalence of hypertension, dyslipidemia, and coronary diseases in postmenopausal women. Ninety-five postmenopausal women were included in this analysis. A questionnaire was applied to evaluate the risk factors and diagnosis of cardiovascular diseases and consumption of yerba mate infusion. Student's t-test and chi-square test were used to assess significant differences between groups. The group that consumed more than 1 L/day of mate infusion had significantly fewer diagnoses of coronary disease, dyslipidemia, and hypertension (P<0.049, P<0.048, and P<0.016, respectively). Furthermore, the serum levels of glucose were lower in the group with a higher consumption of yerba mate infusion (P<0.013). The serum levels of total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglycerides were similar between the groups. This pragmatic study points out the benefits of yerba mate consumption for the cardiovascular and metabolic systems. The ingestion of more than 1 L/day of mate infusion was associated with fewer self-reported cardiovascular diseases and lower serum levels of glucose. Longitudinal studies are needed to evaluate the association between yerba mate infusion and reduction of cardiovascular diseases in postmenopausal women.

Influence of dressing application time after breast augmentation on cutaneous colonization: A randomized clinical trial.

Concepts regarding the best way to treat a surgical wound vary, in literature, ranging from no dressing use to dressing maintenance for 24 to 48 hours or until suture removal. This study aimed to evaluate the influence of the length of dressing maintenance after breast augmentation with implants on cutaneous colonization and surgical site infection. This is a two-arm, parallel group, randomized clinical trial. Eighty patients who were candidates for augmentation mammoplasty with silicone implants were randomly allocated to two groups, in which the dressing was removed on postoperative day 1 (group A, n = 40) or postoperative day 6 (group B, n = 40). Cutaneous colonization was examined by culturing samples collected before and after dressing removal. The criteria defined by the Centers for Disease Control and Prevention were used to assess surgical site infection. No significant difference regarding cutaneous colonization was observed between groups before dressing application. On postoperative day 6, significantly more bacterial growth was observed in group A (p = 0.01). No surgical site infection occurred. We concluded that maintaining the dressing for 6 days led to a lower cutaneous colonization but did not influence surgical site infection rates.

Náuseas y vómitos postoperatorios: incidencia, características y factores de riesgo. Estudio prospectivo de cohortes / Postoperative nausea and vomiting: Incidence, characteristics and risk factors - A prospective cohort study

Antecedentes. El objetivo de este estudio fue identificar los factores de riesgo y determinar la incidencia de náuseas y vómitos postoperatorios en una cohorte de pacientes en un hospital terciario universitario. Métodos. Estudio de cohortes prospectivo realizado en una Unidad de Recuperación Postanestésica durante un período de 3 semanas. Ciento cincuenta y siete pacientes adultos sometidos a cirugía programada no-cardiaca y no-intracraneal fueron elegibles para el estudio. Fueron analizados datos de los pacientes y de las características perioperatorias. La Escala de intensidad de náuseas y vómitos postoperatorios y la Escala analógica visual de náuseas se aplicaron para medir náuseas y vómitos postoperatorios a las 6 y a las 24h después de la cirugía. Fue efectuado un análisis descriptivo, y para las comparaciones se aplicaron el test de Mann-Whitney, el test exacto de Fisher o el test Chi-cuadrado. Asimismo se aplicó un análisis de regresión logística binaria univariante y multivariante con el cálculo de odds ratio (OR) y su intervalo de confianza del 95% (IC 95%). Resultados. De los 157 pacientes, 39 (25%) tuvieron náuseas y vómitos postoperatorios a las 6h y 54 (34%) a las 24h. Entre los pacientes que experimentaron náuseas y vómitos postoperatorios, en 6 (15%) estos eran clínicamente significativos (Escala de intensidad de náuseas y vómitos postoperatorios>50) a las 6h y en 9 (23%) a las 24h. La mayoría de los pacientes tuvieron náuseas clasificadas como leves a las 6 (57%) y 24 (56%) h. A las 6h, 3 pacientes (10%) tuvieron náuseas clasificadas como severas, y a las 24h, 5 (9%) pacientes. La mediana y el rango intercuartil para la Escala analógica visual de náuseas fue 40 (20-60) a las 6h y 50 (20-60) a las 24h. Seis pacientes (14%) a las 6h y 7 (18%) a las 24h tuvieron una puntuación en la Escala analógica visual de náuseas>75. Los pacientes con un valor>50 en la Escala de intensidad de náuseas y vómitos postoperatorios tuvieron una mayor puntuación en la Escala analógica visual de náuseas a las 6 (75 frente a 30, p<0,05) y 24 (70 frente a 40, p<0,05) h. El análisis univariado identificó los siguientes factores de riesgo para náuseas y vómitos postoperatorios: puntuación Apfel>2 (OR 3,2; IC 95% 1,6-6,4; p=0,001), antecedentes de náuseas y vómitos postoperatorios (OR 2,9; IC 95% 1,3-6,5; p=0,009) y el sexo femenino (OR 2,7; IC 95% 1,4-5,4; p=0,005). En el análisis multivariado fueron factores de riesgo los antecedentes de náuseas y vómitos postoperatorios (OR ajustada 2,5; IC 95% 1,1-5,7; p=0,030) y el sexo femenino (OR ajustada OR 2,4; IC 95% 1,2-4,9; p=0,015). Conclusión. La mayoría de los pacientes no tuvieron náuseas y vómitos postoperatorios clínicamente significativos. Aquellos que presentaron una puntuación>50 en la Escala de intensidad de náuseas y vómitos postoperatorios tuvieron una mayor puntuación en la Escala analógica visual de náuseas. La historia anterior de náuseas y vómitos postoperatorios y el sexo femenino fueran considerados factores de riesgo independientes para náuseas y vómitos postoperatorios (AU)

Background. Postoperative nausea and vomiting are a common complication after surgery. The objective of the study was to identify risk factors, and to determine the incidence of postoperative nausea and vomiting in a cohort of patients in a tertiary university hospital. Methods. Prospective cohort study was conducted in a Post Anesthetic Care Unit during a period of 3 weeks. One hundred and fifty-seven adult patients subjected to scheduled non-cardiac and non-intracranial surgery were eligible for the study. Patient perioperative characteristics data were analyzed. The postoperative nausea and vomiting intensity scale and nausea visual analog scale were applied to measure postoperative nausea and vomiting at 6h and 24h after surgery. Descriptive analysis was performed and the Mann-Whitney U, Fisher's exact, or Chi-square tests were applied. A univariate and multivariate logistic binary regressions with calculation of odds ratio (OR) and its 95% confidence interval (95% CI) were performed. Results. Thirty-nine (25%) patients and 54 (34%) patients had postoperative nausea and vomiting at 6h and 24h, respectively. Of the patients who experienced postoperative nausea and vomiting, 6 (15%) had clinically significant postoperative nausea and vomiting (postoperative nausea and vomiting intensity scale>50) at 6h and 9 (23%) at 24h. The majority of patients classified nausea as mild at 6h (57%) and 24h (56%). At 6h, 3 (10%) patients classified nausea as severe, and at 24h 5 (9%) patients reported the same. The median and interquartile ranges for nausea visual analog scale were 40 (20-60) at 6h and 50 (20-60) at 24h. Six patients (14%) at 6h, and 7 (18%) at 24h had a nausea visual analog scale score >75. Patients with postoperative nausea and vomiting intensity scale > 50 had higher scores in the nausea visual analog scale at 6h (75 versus 30, P<.05) and 24h (70 versus 40, P<.05). The univariate analysis identified risk factors for postoperative nausea and vomiting: Apfel score>2 (OR 3.2, 95% CI 1.6-6.4, P=.001), previous history of postoperative nausea and vomiting (OR 2.9 95% CI 1.3-6.5, P=.009) and female patients (OR 2.7, 95% CI 1.4-5.4, P=.005). In the multivariate analysis previous history of postoperative nausea and vomiting (adjusted OR 2.5, 95% CI 1.1-5.7, P=.030) and female gender (adjusted OR 2.4, 95% CI 1.2-4.9, P=.015) were considered as independent risk factors for postoperative nausea and vomiting. Conclusion. Most of the patients do not have clinically significant postoperative nausea and vomiting. The patients who presented with postoperative nausea and vomiting intensity scale>50 had higher scores in the nausea visual analog scale. Independent risk factors for postoperative nausea and vomiting were previous history of postoperative nausea and vomiting and being female (AU)

Postoperative nausea and vomiting: incidence, characteristics and risk factors--a prospective cohort study.

BACKGROUND: Postoperative nausea and vomiting are a common complication after surgery. The objective of the study was to identify risk factors, and to determine the incidence of postoperative nausea and vomiting in a cohort of patients in a tertiary university hospital. METHODS: Prospective cohort study was conducted in a Post Anesthetic Care Unit during a period of 3 weeks. One hundred and fifty-seven adult patients subjected to scheduled non-cardiac and non-intracranial surgery were eligible for the study. Patient perioperative characteristics data were analyzed. The postoperative nausea and vomiting intensity scale and nausea visual analog scale were applied to measure postoperative nausea and vomiting at 6h and 24h after surgery. Descriptive analysis was performed and the Mann-Whitney U, Fisher's exact, or Chi-square tests were applied. A univariate and multivariate logistic binary regressions with calculation of odds ratio (OR) and its 95% confidence interval (95% CI) were performed. RESULTS: Thirty-nine (25%) patients and 54 (34%) patients had postoperative nausea and vomiting at 6h and 24h, respectively. Of the patients who experienced postoperative nausea and vomiting, 6 (15%) had clinically significant postoperative nausea and vomiting (postoperative nausea and vomiting intensity scale>50) at 6h and 9 (23%) at 24h. The majority of patients classified nausea as mild at 6h (57%) and 24h (56%). At 6h, 3 (10%) patients classified nausea as severe, and at 24h 5 (9%) patients reported the same. The median and interquartile ranges for nausea visual analog scale were 40 (20-60) at 6h and 50 (20-60) at 24h. Six patients (14%) at 6h, and 7 (18%) at 24h had a nausea visual analog scale score>75. Patients with postoperative nausea and vomiting intensity scale>50 had higher scores in the nausea visual analog scale at 6h (75 versus 30, P<.05) and 24h (70 versus 40, P<.05). The univariate analysis identified risk factors for postoperative nausea and vomiting: Apfel score>2 (OR 3.2, 95% CI 1.6-6.4, P=.001), previous history of postoperative nausea and vomiting (OR 2.9 95% CI 1.3-6.5, P=.009) and female patients (OR 2.7, 95% CI 1.4-5.4, P=.005). In the multivariate analysis previous history of postoperative nausea and vomiting (adjusted OR 2.5, 95% CI 1.1-5.7, P=.030) and female gender (adjusted OR 2.4, 95% CI 1.2-4.9, P=.015) were considered as independent risk factors for postoperative nausea and vomiting. CONCLUSION: Most of the patients do not have clinically significant postoperative nausea and vomiting. The patients who presented with postoperative nausea and vomiting intensity scale>50 had higher scores in the nausea visual analog scale. Independent risk factors for postoperative nausea and vomiting were previous history of postoperative nausea and vomiting and being female.

Bone regeneration in mandible defect with autograft bone and cell suspension from bone marrow in rabbits / Regeneração óssea em defeitos mandibulares com auto-enxerto ósseo e suspensão celular da medula óssea em coelhos

The objective of this study was to investigate the bone regeneration of a "gold standard" (autograft) from iliac crest associated with cellular therapy in rabbits. A bone defect was created with 10x5x5mm in 28 rabbit mandibles. The control group animals (n=14) were repaired with autograft of iliac crest and the experimental group animals (n=14) received iliac crest autograft in association with mononuclear cells from the bone marrow of the femur. Weekly radiographs were taken of the surgery region and histological analyses was performed in seven animals in each group at 15 days and in seven animals of each group at 30 days after the surgery. A gradual increase of bone density was observed and the experimental animals presented the bone bridge in 85.7 percent (6/7) of the cases, while only 42.8 percent (3/7) of the animals in the control group presented this structure 28 days after the surgery. The histopathological parameters analyzed did not show any statistical difference between the control and experimental group in 15 and 30 days of analysis. The results suggest that the mononuclear cells from the marrow bone can better support the autograft regeneration in mandible defects in rabbits.

Avaliou-se a regeneração óssea de auto-enxerto, considerado "padrão ouro" da crista ilíaca associado à terapia celular da medula óssea em coelhos. Foi criado um defeito ósseo de 10x5x5mm na mandíbula de 28 coelhos, distribuídos em grupo-controle com, 14 animais, reparados com auto-enxerto de crista ilíaca, e grupo experimental com, 14 animais, em que o auto-enxerto foi associado a células mononucleares da medula óssea autógena do fêmur. Foram realizadas radiografias semanais da região operada e análise histológica em sete animais de cada grupo aos 15 e em sete de cada grupo aos 30 dias do pós-operatório. Houve aumento gradativo da densidade óssea, e 85,7 por cento (6/7) dos animais do grupo experimental e 42,8 por cento (3/7) do grupo-controle apresentaram formação de ponte óssea 28 dias após a cirurgia. Na análise histopatológica aos 15 dias, os enxertos foram facilmente visualizados e a atividade das células fagocitárias foi intensa. Já aos 30 dias, a visualização foi mais difícil e, quando possível, apenas um resquício foi visualizado. Os resultados sugerem que a adição de células mononucleares da medula óssea favorece a regeneração do auto-enxerto em defeitos mandibulares de coelhos.

Evolution of reports of randomised clinical trials in plastic surgery.

Well-designed, well-conducted and well-reported randomised clinical trials (RCTs) can significantly impact medical care, by contributing to a strong evidence base from which clinical guidelines can be derived. In a previous study, we assessed the quality of reports of RCTs in plastic surgery published from 1966 to 2003. The aim of the present study was to verify what have changed over the last years. RCTs in plastic surgery published from 2004 to 2008 were identified through electronic searches, and classified according to their allocation concealment. Trials with allocation concealment appropriately described were evaluated as to their quality. Two independent reviewers performed the evaluations, using two tools: the Delphi List and the Jadad's quality scale. From 3840 identified studies, 96 were selected for classification according to allocation concealment; 28 (29%) of them appropriately described allocation concealment. From 1966 to 2003, 34 (17%) RCTs appropriately described allocation concealment (χ2=22.98, p<0.000). In the evaluation of the 28 RCTs by the Delphi List, the agreement coefficient between raters (kw) was 0.46 (z=7.24, p<0.000). Groups were similar at baseline in 96.4% of these trials, and this was the only item of the Delphi List, which significantly improved when compared with the period from 1966 to 2003 (χ2=18.53, p<0.000). When evaluated by Jadad's criteria, 14% of the RCTs were scored two points or less and thus considered of low quality (kw=0.72, z=8.57, p<0.001). From 1966 to 2003, 59% of RCTs were scored two points or less (χ2=17.07, p<0.004). We concluded that the quality of reports of RCTs in plastic surgery (as measured by the Jadad's criteria and only one component of the nine components of the Delphi List) significantly increased over the last years.

Three-dimensional scaffolds as a model system for neural and endothelial 'in vitro' culture.

Biomaterials based on the hydrophobic homopolymer poly(ethyl acrylate), PEA, and its copolymers with hydroxyethyl acrylate, p(EA-co-HEA) and methacrylic acid, p(EA-co-MAAc) were prepared as polymeric scaffolds with interconnected pores of 90 microns and tested in vitro as culture substrates and compared for their impact on the differentiation of neural stem cells (NSC) obtained from the subventricular zone (SVZ) of postnatal rats and human endothelial cells (HUVEC). Immunocytochemical staining assay for specific markers show that p(EA-co-MAAc) scaffolds were suitable substrates to promote cell attachment and differentiation of adult NSC and HUVEC cells.

Radiologia do intestino delgado de cães por meio da técnica de duplo-contraste / Small bowel double-contrast study in dogs

Radiographic exams still the main form to evaluate small bowel in all its extension, and when surveyprojections are not diagnostic, barium series are used although its sensibility can be imitated by filledoverlapped loops, difficulting detailed mucosa visualization. The objective of this study was to adjust anexam technique with intestinal double-contrast, based on techniques used in the human medicine, whichresulted satisfactorily in the demonstration of the mucosal surface in the 30 dogs submitted to the exam.The double-contrast in the lumen was achieved by a combination of a positive contrast medium,recovering the mucosal surface, and a negative filling the lumen. Ambient air and carboximethylcelullosewere the negative contrast medium tested and both were radiographicaly similar.

Genome-wide partial correlation analysis of Escherichia coli microarray data.

Transcriptional control is an essential regulatory mechanism employed by bacteria. Much about transcriptional regulation remains to be discovered, even for the most widely studied bacterium, Escherichia coli. In the present study, we made a genome-wide low-order partial correlation analysis of E. coli microarray data with the purpose of recovering regulatory interactions from transcriptome data. As a result, we produced whole genome transcription factor regulation and co-regulation graphs using the predicted interactions, and we demonstrated how they can be used to investigate regulation and biological function. We concluded that partial correlation analysis can be employed as a method to predict putative regulatory interactions from expression data, as a complementary approach to transcription factor binding site tools and other tools designed to detect co-regulated genes.

Genome-wide partial correlation analysis of Escherichia coli microarray data

Transcriptional control is an essential regulatory mechanism employed by bacteria. Much about transcriptional regulation remains to be discovered, even for the most widely studied bacterium, Escherichia coli. In the present study, we made a genome-wide low-order partial correlation analysis of E. coli microarray data with the purpose of recovering regulatory interactions from transcriptome data. As a result, we produced whole genome transcription factor regulation and co-regulation graphs using the predicted interactions, and we demonstrated how they can be used to investigate regulation and biological function. We concluded that partial correlation analysis can be employed as a method to predict putative regulatory interactions from expression data, as a complementary approach to transcription factor binding site tools and other tools designed to detect co-regulated genes.

Gene networks as a tool to understand transcriptional regulation

Gene regulatory networks, or simply gene networks (GNs), have shown to be a promising approach that the bioinformatics community has been developing for studying regulatory mechanisms in biological systems. GNs are built from the genome-wide high-throughput gene expression data that are often available from DNA microarray experiments. Conceptually, GNs are (un)directed graphs, where the nodes correspond to the genes and a link between a pair of genes denotes a regulatory interaction that occurs at transcriptional level. In the present study, we had two objectives: 1) to develop a framework for GN reconstruction based on a Bayesian network model that captures direct interactions between genes through nonparametric regression with B-splines, and 2) to demonstrate the potential of GNs in the analysis of expression data of a real biological system, the yeast pheromone response pathway. Our framework also included a number of search schemes to learn the network. We present an intuitive notion of GN theory as well as the detailed mathematical foundations of the model. A comprehensive analysis of the consistency of the model when tested with biological data was done through the analysis of the GNs inferred for the yeast pheromone pathway. Our results agree fairly well with what was expected based on the literature, and we developed some hypotheses about this system. Using this analysis, we intended to provide a guide on how GNs can be effectively used to study transcriptional regulation. We also discussed the limitations of GNs and the future direction of network analysis for genomic data. The software is available upon request.

Comparação entre o método de referência e a análise eletrônica na determinação da contagem de células somáticas do leite bovino / Comparison between standard method and electronic analyses for measurement of the bovine milk somatic cell count

Avaliou-se a metodologia eletrônica de determinação da contagem de células somáticas por citometria de fluxo, utilizando-se 48 amostras individuais de leite de vaca da raça Holandesa e cinco amostras de leite de conjunto. A contagem média de células somáticas das amostras individuais foi de 353.000 cel/ml (5,55log cel/ml) usando-se metodologia de referência e 328.000 cel/ml (5,52log cel/ml) usando-se o contador eletrônico. Para amostras de tanque, as médias foram 382.000 cel/ml (5,58log cel/ml) e 329.000 cel/ml (5,52log cel/ml) de CCS, respectivamente, para análise feita por microscopia direta e pelo equipamento eletrônico. Não houve diferença (P>0,05) entre os valores obtidos nas análises realizadas pelo método de referência e pelo analisador eletrônico rápido. Foi avaliada a qualidade das amostras-padrão de origem americana e canadense, por meio da contagem de células somáticas, pelo método de microscopia direta. Os resultados foram comparados aos valores declarados no laudo de análise das amostras, emitidos pelo laboratório fornecedor das amostras-padrão.

Quality of life outcomes after pedicled TRAM flap delayed breast reconstruction.

OBJECTIVES: To evaluate the impact of TRAM flap delayed breast reconstruction on health related quality of life in patients who had undergone mastectomy. METHODS: Twenty-five patients following mastectomy were selected consecutively from the Plastic Surgery/Mastology Units of two university hospitals. All subjects underwent breast reconstruction with the use of pedicled TRAM flap. The patients' health related quality of life was assessed by a validated instrument, the SF-36 Health Survey Questionnaire. This was applied preoperatively and postoperatively at 3, 6 and 12-months follow-up. A group of 20 women with mastectomies who have not undergone breast reconstruction was used as a control. To assess patients' satisfaction with breast reconstruction we used Alderman's modified general satisfaction subscale. RESULTS: There was a progressive improvement in all dimensions of the SF-36, and this was statistically significant for seven of the eight dimensions. The scores were significantly higher on 'role emotional' and 'mental health' at 3 months postoperatively, on 'health perception' and 'role physical' at month 6 and on 'physical function', 'pain', health perception and 'social function' at postoperative month 12. Despite the increase in scores, no significant changes in 'vitality' were found. There was no significant preoperative difference between the control group and studied patients, and the control group's scores were significantly lower in all dimensions when compared to postoperative month 12, except on 'physical function'. The level of patients' satisfaction with the TRAM flap breast reconstruction was high. CONCLUSIONS: The data of this study suggest that delayed breast reconstruction with the use of the pedicled TRAM flap provides an improvement in health related quality of life of patients who have undergone mastectomy.