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A modern approach to breast cancer treatment after mastectomy includes immediate breast reconstruction (performed simultaneously with the mastectomy). The understanding of factors that influence women's decisions and appreciation of their satisfaction is as important as the knowledge of medical efficiency of the selected treatment. The influence of women's age on opinion making for immediate breast reconstruction was researched in a monocentric prospective study (N = 102). Methods included questionnaires, interviews and medical documentation reviews. Women comply breast reconstruction with silicone implants and autologous tissue equally. Analyzing age distribution it is evident that women age 35-50 and older than 65 would agree to reconstruction with silicone implants more often. This can be explained by the fact that younger women expect to have better shaped breasts after reconstruction then prior to the same, while older women tend to avoid breast reconstruction using muscle flaps because they are more demanding and also require longer hospitalization.

Chronic pain is the most serious long-term complication after groin hernia repair. The aim of this preliminary research was to assess the quality of life before and after standard tension-free mesh repair and new method of tension-free inguinal hernia repair using anterior rectus sheath. Total of 62 patients were evaluated. Anterior rectus sheath method was performed in 29 patients and in 33 patients standard mesh repair was used (Lichtenstein repair). Quality of life was assessed before and after the surgery using short-form SF-36 questionnaire (QualityMetric Inc.), adjusted for Croatian language. There were statistically significant improvements in bodily pain and general health scores in both groups. Patients operated using mesh technique also demonstrated statistically significant improvements in social functioning and emotional role. Similarly, patients in whom inguinal hernia was repaired using anterior rectus sheath had significantly better postoperative scores for physical functioning and role physical scores. Quality of life assessment demonstrated good ability to differentiate between several independent aspects of quality of life. Anterior rectus sheath repair significantly improved quality of life and was shown to be similar to mesh repair in the aspect of physical functioning.

Objective: To explore the way the doctor-patient communication process may be improved by adopting the patients' conversational style in the development of written materials for surgical patients., Methods: Written information prepared by doctors, specialists in abdominal surgery, was tested for comprehension on patients undergoing cholecystectomy, using the standard Cloze test procedure. At the same time, the patients were asked to describe in their own words all they knew about their illness and the treatment. The collected 150 patient narratives were analyzed, and a typical narrative for each educational level was selected based on average SMOG score, word count and sentence length. The patient-worded information was then tested for comprehension on new patients, selected from primary health care, using the same Cloze procedure as with doctor-developed information. Patient profile of best lay communicators was defined using also sociodemographic characteristics, and reported information seeking and decision making preferences., Results: Only 50% of patients completed Cloze test, of which over 40% showed poor comprehension. Analysis of transcribed narratives collected from 150 patients showed increasing complexity of style by educational level (average SMOG score 7, 8, and 9; sentence length 11, 13, and 15 words; for low, medium, and high educational level, respectively). Cloze tests based on typical narratives, and tested on primary care patients, indicated to the style best understood by all. Dominant characteristics of patients producing a narrative of similar style to the best-understood narrative were observed: medium educational level, women over 60, urban workers, interviewed after surgery, informed by specialist at ultrasound, knowledge about illness from 1 to 10 years, learned most about illness from lay people, those who wanted more information in both oral and written form, and preferred active role in decision making., Conclusion: Analysis of patient profiles with typical narratives that were best understood by other patients shows where to look for lay experts in doctor-patient communication., Practice Implications: Obtained findings indicate to the importance of patient participation in developing informed consent information, and to the possible method for improving comprehension of educational patient materials in general.

Acute appendicitis is a common surgical condition that requires prompt diagnosis. Besides modern imaging techniques, scoring systems, based on clinical signs and symptoms and routine laboratory assessments, have been used as a diagnostic aid. However, differences in sensitivities and specificities were observed if the scores were applied to various populations and clinical settings. The purpose of this paper is to assess validity of three scores (modified Alvarado score, Ohmann score and Eskelinen score) for diagnosis of acute appendicitis in women. 126 female patients admitted for suspicion of acute appendicitis in a tertiary hospital emergency department were analyzed prospectively. Modified Alvarado score, Ohmann score and Eskelinen score were calculated at admission and compared to final diagnosis. All patients with modified Alvarado score 7 or more had acute appendicitis (100% specificity) and it can be used to determine the need for immediate appendectomy. Values of Ohmann score greater than 6 resulted in 0.9% rate of overlooked appendicitis. Besides obvious educational role, scores may help to determine the group of patients who require immediate appendectomy, therefore expediting treatment and avoid unnecessary observation or more lengthy diagnostic procedures that require highly educated and skilled senior staff: No single score may be used alone to dictate or decline surgery. Different cut-off points may also be considered for different subpopulations.

Bacteriologic characteristics of pilonidal disease of the sacrococcygeal region were assessed in two groups of patients: patients with disease recurrence (group A), and patients who first ever presented for surgical treatment (group B). The frequency of anaerobic colonization was studied. Bacterial colonization is frequently present in patients with pilonidal disease of the sacrococcygeal region. Samples of the skin over the sacrococcygeal sinus showed the presence of bacterial colonization in 78% and 70% of group A and group B patients, respectively. Analysis of sinus fluid samples revealed the presence of bacteria in 88% of group A patients and 78% of group B patients. Anaerobic colonization in the content of pilonidal sinus was found in approximately 2/3 (64%) group A patients and about a half (52%) group B patients. Considerable bacterial colonization was also recorded in skin swab samples, i.e. in 48% of group A patients and 38% of group B patients. Anaerobic bacteria were rarely detected in pure cultures (in group A 6% skin swab, and 20% of sinus fluid samples, and in group B, 4% of skin swab and 12% of sinus fluid samples). Anaerobes were mostly detected in combined cultures (42% of skin swab and 44% of sinus fluid samples from group A, 32% of skin swab and 40% of sinus fluid samples from group B). Surgical methods to considerably reduce the conditions for anaerobic bacterial colonization of the wound should be the methods of choice in the management of pilonidal disease of the sacrococcygeal region.

Results of the surgical treatment of the pilonidal disease of the sacrococcygeal region in correlation with anaerobic infection are analyzed. Fifty patients with the disease recurrence (group A) and fifty patients presenting for operative treatment for the first time (group B) were observed. Twenty-five patients from group B were operated on by the method of limited excision and wound healing by open granulation and the other half were operated on by the method of excision and primary suture. The material for bacteriologic examination was obtained during the operative procedure. All patients underwent control examination at twelve months after the surgery. Recurrence was found in three (6%) group A patients and two (8%) group B patients operated on by the method of excision and open wound healing. Perioperative bacteriologic analysis showed anaerobic colonization in all study patients. Among the patients operated on by the method of excision and primary suture, recurrence was recorded in six (24%) cases. Bacteriologic analysis pointed to anaerobic colonization in five, and to aerobic colonization in only one patient. The significantly lower recurrence rates recorded with the method of limited excision and wound healing open granulation, were explained by favorable conditions for healing in such a wound (reduced conditions for anaerobic infection) compared to wound healing after excision and primary suture.

The aim of the study was to investigate reliability of Ranson's prognostic factors in our 43 patients with acute pancreatitis during a ten year period (1984-1993). Based on the retrospective analysis and Ranson's prognostic factors, the patients were divided into groups and severe form of pancreatitis. The patients with less than 3 prognostic factors were classified into the mild form group. The patients who had 3 or more Ranson's factors were considered as having the severe form of the disease. Sixty percent of the patients with severe form of the disease survived. All the patients who died (2 females and 7 males) had more than 6 Ranson's prognostic factors and died within 15 days from admission to hospital. Of the patients who died, eight had been operated on for multiorgan injury. None of the patients with mild form of the disease died. The prognosis of the outcome of pancreatitis with severe complications and of death mode, on the basis of Ranson's factors, was found to be more certain when more factors were present.

The aim of the study was to evaluate surgical methods used in the treatment of gastric outlet obstruction. From 1983 till 1994, 151 patients were surgically treated for gastric outlet stenosis at the Dubrava University Hospital. There were 120 males and 31 females, mean age 54.13 +/- 13.07 years. The treatment was evaluated by a modified Visick index. The most commonly surgical method used was Billroth I gastric resection. Postoperative complications developed in 8% of the patients, while early postoperative mortality was 2%. The authors compiled data on the postoperative course for 46 patients, 20 of whom were examined gastroscopically and radiologically. One recurrence which required reoperation was verified. Ninety-four percent of these patients were evaluated as Visick I and II. Billroth I gastric resection yields good results in treating gastric outlet obstruction, but postoperative complications and early postoperative mortality of 2% make it less suitable than proximal selective vagotomy with dilatation or duodenoplasty.

A 71-year-old woman with a syncope and carotid body tumor is described. On palpation of the tumor on the left side of the neck, the patient felt vertiginous and has a syncope, while ECG showed an asystolic pause of 7.6 s. The tumor was completely surgically removed. After the surgery, massage of the left side of the neck provoked neither sinus bradycardia nor asystole, and the pacing electrode was removed. Temporary pacemaker is recommended in patients with syncope caused by carotid body tumor for the safe performance of diagnostic and surgical procedures. This report describes the successful operation of carotid body tumor as a rare cause of syncope. The patient feels well one year after the surgery.

Using biomechanical principles, the qualitative occurrences in the wound were quantified. On the basis of the empirical knowledge that the wound, from its inception to healing, is warmer than its surroundings, we presumed that there was a certain regularity in the course of temperature values of the wound during primary healing. For measuring the temperature of the wound and its surroundings an electric thermometer of the ELLAB type was used. First, the temperature of the skin in the epigastric region in 30 healthy examinees, who were due to undergo a gall-bladder concrements operation was determined. The temperatures were measured within a traced dotted network. After the operation, in the same examinees, the temperatures were registered proximal to the wound and in its closer surroundings throughout the first eight post-operative days. Statistically evaluated the results showed that the temperature of the wound and of its surroundings, measured after operation, was higher than prior to operation. The temperature of the wound gradually rises up to the third post-operative day, and then gradually falls from the fourth post-operative day. This course of temperature is explained in part by the biological occurrences in the wound. The inflammatory reaction as a consequence of damage to the tissue is responsible for the initial increase of wound temperature. It lasts a limited time and has a limited intensity. This could be proved by histological preparations of the wound. The persistence of increased temperature after the third post-operative day is a sign of disturbed healing and predicts infection and secondary healing.(ABSTRACT TRUNCATED AT 250 WORDS)