Jelena Nikolic

Psychosocial characteristics and motivational factors in woman seeking cosmetic breast augmentation surgery

BACKGROUND/AIMnThere are various opinions regarding the factors motivating women to undergo breast augmentation. The aim of this study was to estimate motivation for augmentation mammaplasty (AM), self-esteem and body image perception in breast augmentation patients.nnnMETHODSnThis prospective study involved AM patients operated in the Clinical Center of Vojvodina during a 3-year period. A total of 45 patients responded to our package of questionnaires designed to assess motivation for surgery, self-esteem level and body image perception. Those patients were compared to the control group of women who did not want to change their breast size, and who were similar in their age, social status and education level. Our package of questionnaires included a general questionnaire, Photographic Figure Rating Scale (PFRS) and Rosenbergs Self-Esteem Scale.nnnRESULTSnDifferences in marital status, educational level, habitation and employment status were statistically insignificant, but there was a significantly lower body mass index (BMI) in the operated women. Considering motives for surgery, a few factors were distinguished: desire to feel more feminine (82.2%), confident (75.5%) and attractive (73.3%), to feel less shy with men (64.4%), to improve their sex life (46.5%), teasing history (42.2%) and easier to find a partner (11.1%) and job (2.2%). Both groups demonstrated a high self-esteem level, but in the the AM group results were lower than in the control group. The mean current self-rating by the PFRS in the group AM was lower than in the control group (4.28 +/- 1.3 vs 5.12 +/- 1.23, respectively) and this coincided with lower BMI in the AM group. The women in the AM group had chosen significantly smaller body size as maximally attractive, and had chosen a narrower attractive body size range than the women in the control group. CONCLUSION. Preoperative evaluation of patients motives for surgery can help surgeons to exclude woman with unrealistic expectations and different psychological problems.

Varicella complications: Is it time to consider a routine varicella vaccination?

BACKGROUND/AIMnVaricella is a common and benign disease of childhood. Complications are rare, but in some patients, even without risk factors, severe, life treathening complications could be seen. The aim of this study was to establish the type and frequency of varicella complications among hospitalised patients over an 8-year period.nnnMETHODSnThis retrospective analysis included medical charts of the patients hospitalised in the Infectious Disease Clinic, Belgrade, Serbia, from 2001-2008 (4.85% of all registered patients with varicella in Belgrade, 2001-2008). Among hospitalised patients dermografic characteristics were analysed: hospitalisation lenght, presence and type of complications, presence of immunocompromising conditions and outcome of the disease. The diagnosis of varicella was made on clinical grounds, and in persons >40 years, with negative epidemiological data of contacts, serological confirmation (ELISA VZV IgM/IgG BioRad) and avidity of IgG antibodies were done to exclude the possibility of disseminated herpes zoster.nnnRESULTSnA total of 474 patient were hospitalised over an 8-year period. The age of patients was from 5 months to 75 years (mean 22.4 +/- 16.1, median 23.5 years). The majority of patients were adults (n=279; 58.9%) and 195 (41.1%) patients were < or =15 years old. Complications were found in 321/474 (67.7%) patients. The registered complications were: varicella pneumonia (n=198; 41.38%), bacterial skin infections (n=40; 8.4%), cerebelitis (n=28; 5.9%), bacterial respiratory infection (n=21; 4.4%), viral meningitis (n=10; 2.31%), encephalitis (n=9; 1.9%), thrombocytopenia (n=2; 0.4%); 11 (2.3%) patients had more than one complication, among them were sepsis, myopericarditis and retinal hemorrhages. When complications were analysed according to the age, there were no statistical significance, but when type of complication was analysed statistical significance was found (p < 0.05). In adults, pneumonia was the most common complication: 173/279 (62%), followed by skin infections (2.9%), bacterial respiratory infections (2.2%), and more than one complication (2.3%). Pneumonia was more common in adults than in children (7:1). In children skin infections were the most common complications (16.4%), followed by cerebelitis (13.3%), viral pneumonia (12.8%), bacterial respiratory infections (7.7%), encephalitis (3.6%), and more than one complication (4.1%). Neuroinfections were more common in children than in adults (6:1), as well as bacterial skin infections (4:1). Two patients died (0.4%).nnnCONCLUSIONnThere was no difference in the incidence of varicella complication in children and adults, but the type of complication differed. In children the most common complications were skin and neurological infections, while in adults it was varicella pneumonia. These data provide a baseline for estimating the burden of varicella in Belgrade and support the inclusion of varicella vaccine in childhood immunisation program in Serbia.

Dysplastic nevus: A risk factor of developing skin melanoma clinical and epidemiological study with retrospective review of literature

Dysplastic nevus is a risk factor for developing skin melanoma. The aim was to analyze patients with both skin melanoma and dysplastic nevi. A 10-year retrospective analysis (1999-2009) was conducted at the Department for Plastic and Reconstructive Surgery, Clinical Centre Vojvodina. During the observed time interval, of 482 patients treated for skin melanoma, 165 (34.2%) had also dysplastic nevi. Melanoma developed more often de novo (67.9%) and 32.1% by malignant alteration. The most dominant type of melanoma was nodular one (70.3%), the most frequent depth being 3.1-4mm (40.6%). The highest incidence of melanoma (32.1%) was in patients aged from 51 to 60 years. The 5- and 10-year survival rates were 72.7% and 50.3%, respectively. Our results correspond to those found in literature except for the fact that the majority of diagnosed melanomas were of nodular type with worse prognosis.

Specificities of hand trauma in agriculture

BACKGROUND/AIMnHand injuries in agriculture are characterized by massive destruction of all tissues, frequent amputations of finger, hand and often the whole extremity. These injuries are mutilant and can cause death. The aim of this paper was to show the specificities of hand injuries in agriculture in regard to hand injuries of other etiology.nnnMETHODSnWe analyzed patients that were treated in the Departement for Plastic and Reconstructive Surgery, Clinical Center Vojvodina, during a five-year period (2003-2007) because of hand injuries.nnnRESULTSnIn a five-year period there were 366 patients hospitalized because of hand injuries, out of whom 36 injuries were related to agricultural machinery use. In both groups the number of patients trended to increased, with male gender being dominant. Most of the patients were young or middle-aged men. In agricultural injuries most of the patients were in the group of 41-50-year old (30%), while in the other group, the patients were younger (21-30-year old). Hand injuries in agriculture resulted in finger amputation in 92%, while in the other group that number was much smaller (13%). Skin defect reconstruction in agricultural injuries required complex methods of skin grafting or skin flaps in more than 71%, while this was necessary in only 10% of other hand injuries.nnnCONCLUSIONnHand injuries in agriculture are very mutilant and often result in conquassation and finger amputation. A possibility to preserve tissue damaged in this way is very limited, and skin closer usually requires complex methods.

Plantar fibromatosis and Dupuytren’s contracture in an adolescent

BACKGROUNDnFibromatosis represents a wide group of benign, locally proliferative disorders of fibroblasts. Dupuytrens disease is a benign proliferative disease of palmar aponeurosis which usually affects adults between 40 and 60 years of age. Ledderhoses disease or plantar fibromatosis is plantar equivalent of Dupuytens disease most often affecting middle-aged and older men, usually bilateral, represented with painless nodule in the medial division of plantar fascia.nnnCASE REPORTnWe presented a 19-year old adolescent that turned to a plastic surgeon complaining to his small finger contracture. He noticed palmar thickening with nodule over the metacarpophalangeal joint of small finger of his right hand when he was 16 years old. A year later a finger started to band. During physical checkup we noticed plantar nodule that also had his father and grandmother. Magnetic resonance and tumor biopsy confirmed a suspicion on plantar fibromatosis - Ledderhoses disease. Clinical exam of the hand clearly led to a conclusion that the patient had Dupuytrens contracture with pretendinous cord over the small finger flexor tendons and lack of extension of proximal interphalangeal (PIP) joint. On the extensor side of the PIP joints there were Garrods nodes. The patient refused surgical treatment of plantar tumor, but agreed to surgical correction of finger contracture.nnnCONCLUSIONnDespite the fact that Dupuytrens disease and plantar fibromatosis are diseases of adults, the possibility of conjoint appearance of these forms of fibromatosis in adolescent period of life should be kept in mind especially in patients with strong genetic predisposition.