The Immunohistochemical Profile of Mammary Tissue in Women With Macromastia and Its Potential Clinical Implications

Macromastia is an excessive, rapid, or slow growth of breast tissue in 1 or both breasts. While macromastia represents a benign lesion, it may cause breast, shoulder, back, and neck pain, poor posture, infections, and loss of nipple sensation. The pathogenesis of macromastia or hypertrophy of mammary tissue remains poorly understood. The purpose of this study is to investigate the immunohistochemical expression of several hormone receptors that may potentially influence the growth of breast tissue in women with macromastia. Immunohistochemical studies performed on representative sections of breast tissue from 63 patients diagnosed with macromastia included estrogen receptor, progesterone receptor, androgen receptor (AR), prolactin receptor, growth hormone receptor, and vascular endothelial growth factor. The expression of each stain was evaluated separately in the glandular epithelium and adipose tissue and calculated as an H-score. We observed that AR expression in breast glandular and adipose tissue in women with macromastia was significantly lower than benign, nonhypertrophic breast tissue of a control group. Although the analyses were controlled for the age, the fact the mean age and hormonal status differed between the patients and the controls could have affected the results. Additional large studies will be required to further verify this finding and increase the knowledge about the etiology of this condition and then guide pharmacological treatment of juvenile and/or idiopathic gigantomastia.

Understanding Covid-19: Digit ratios and duration of oxygen therapy in hospitalized Covid-19 patients

BACKGROUND

Covid-19 severity shows a sex difference (males>females) and progressive hypoxia among the most seriously affected. Digit ratios are sexually dimorphic and may be negatively-related to prenatal (2nd-to-4th digits' ratio; 2D:4D) and pubertal (3rd-to-5th digits' ratio; 3D:5D) testosterone. Oxygen therapy is important in Covid-19 treatment and low 2D:4D is linked to efficient oxygen metabolism. We consider relationships between digit ratios and duration of oxygen treatment in hospitalized Covid-19 patients.

METHODS

Digit lengths were measured from photographs of the patient's hands. Age, Sex, BMI, vaccination status and number of days of O2 treatment, were recorded.

RESULTS

There were 100 (58 women) patients. Sex differences (males

CONCLUSION

We have found that high (feminized) 2D:4D of males and females is positively related to duration of oxygen therapy. This adds to the evidence for links between severity of Covid-19 and national and individual level variation in foetal androgen (as measured by 2D:4D). We discuss our finding in the light of the "low-androgen-driven COVID-19 pandemic theory".

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Key Words

• COVID-19
• Digit ratio
• Oxygen therapy

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MESH Headings

• Humans
• Male
• Female
• Androgens
• Fingers/anatomy & histology
• Digit Ratios
• COVID-19/therapy
• Pandemics
• COVID-19 Drug Treatment
• Sex Characteristics
• Oxygen/therapeutic use

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Affiliation(s)

Anna Kasielska-Trojan Plastic, Reconstructive and Aesthetic Surgery Clinic, Institute of Surgery, Medical University of Lodz, Lodz, Poland.
Maciej Jabłkowski Department of Infectious and Liver Diseases, Medical University of Lodz, Lodz, Poland
Jolanta Białkowska-Warzecha Department of Infectious and Liver Diseases, Medical University of Lodz, Lodz, Poland
Oliwia Kwaśniewska Medical University of Lodz, Lodz, Poland
Bogusław Antoszewski Plastic, Reconstructive and Aesthetic Surgery Clinic, Institute of Surgery, Medical University of Lodz, Lodz, Poland

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Do Intraoperative Platelet-Rich Plasma Injections Influence the Final Appearance of Vertical Scars after Breast Reduction? Spectrophotometric Analysis

Background: Platelet-rich plasma (PRP) has been shown to support wound healing and tissue regeneration due to its high concentration of growth factors and cytokines. This study aims to investigate the effect of intraoperative PRP injections on the final appearance of vertical scars after breast reduction, as well as to identify potential predictors of a scar's aesthetic assessment using spectrophotometric parameters. Methods: In this prospective, randomized trial, 82 scars from 41 women who underwent bilateral breast reduction with an inverted T pattern were analyzed. PRP or a placebo substance (0.9% sodium chloride solution) was injected intraoperatively into the edges of vertical wounds. Spectrophotometric measurements of scar pigmentation were performed 3 and 6 months after surgery; additionally, two independent observers evaluated the aesthetic appearance of scars based on photographs. Results: The results showed that the use of intraoperative PRP injections did not significantly influence the final appearance of vertical scars after breast reduction. Conclusions: We indicated spectrophotometric variables (b) in the early stages of wound healing (after 3 months) that can be predictors of the final scar's aesthetic outcome. This can be helpful in detecting scars that may need additional interventions to optimize the healing process.

The Problem of Diagnostic Criteria of Breast Implant Illness in Women After Breast Reconstruction: Review and Discussion of a Case

INTRODUCTION

There has been a rising trend in the use of silicone breast implants for breast reconstructions after breast cancer treatment, as well as in the aesthetic breast procedures. A cluster of non-specific symptoms related to the presence of silicone implant has been called breast implant illness (BII). However, there are no strict criteria of BII which would specifically define this term. The increasing interest in BII among patients and physicians urges verifying own cases of "on-demand" explantations.

MATERIAL AND METHODS

In this paper, we discussed a case of a patient with initial BII diagnosis, after breast reconstruction, and reviewed the literature on the BII symptoms and aetiology. A decision for aesthetic revision, not explantation, was made as the diagnosis of BII was questioned, and somatisation due to dissatisfaction with the aesthetic result of breast reconstruction was diagnosed.

RESULTS

Improving aesthetics by implant exchange and contralateral mastopexy caused a full recovery from patient's symptoms.

CONCLUSION

Based on our case, we point on the fact that BII diagnosis in patients after breast reconstruction is challenging. We suggest that while considering such a diagnosis and further proceedings, e.g. explantation, especially in patients after breast reconstruction, some exclusion criteria should be considered. Dissatisfaction with the result of the surgery can also lead to somatisation and the presence of real clinical symptoms, which should not be confused with the possible autoimmune reaction to silicone particles.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Digit ratio and the femoral circumflex artery perforator: A sex-dependent association between the vascular system of the thigh and prenatal sex hormones?

BACKGROUND

The anterolateral thigh flap (ALTF) is a type of free flap which is commonly used in reconstructive surgery procedures and is based on the perforator from femoral circumflex artery. Some authors found that the location of the perforator differs between sexes.

OBJECTIVE

To verify the influence of prenatal sex hormones (as measured by 2D:4D) on the morphology of the perforator of the descending branch of the femoral circumflex artery.

METHODS

88 participants (43 women) of a mean age of 28.5 years (SD 8.1 years) had the following measurements performed: height and weight; right and left-hand 2nd and 4th fingers' lengths; and distance from anterior superior iliac spine to the perforator from descending branch of lateral femoral circumflex artery related to the thigh length (right and left) (AP ratio).

RESULTS

Right 2D:4D and Dr-l (right minus left 2D:4D) were dimorphic, similarly to AP ratio (right and left), which in women was significantly higher than in men. A significant correlation was found between right and left 2D:4D and location of the perforator of the left thigh in men. The higher right and left 2D:4D (more feminine) the higher the left AP ratio (more feminine).

CONCLUSION

Our findings suggest that the location of perforator of femoral circumflex artery may be influenced by prenatal sex steroids such that low prenatal testosterone and high prenatal oestrogen are correlated to high AP (lower branching of the artery).

Variability of anterolateral thigh flap perforator locations - clinical implications

<b><br>Introduction:</b> The anterolateral thigh flap is an example of a free flap widely applied for reconstruction of tissues within various areas of the body.</br> <b><br>Aim:</b> The aim of the study was to determine the most common locations of the ALT flap perforators in men and women as well as to clarify any potential differences in the location of the vessel in male vs. female subjects.</br> <b><br>Material and method:</b> In years 2021-2022, a study was conducted at the Plastic, Reconstructive, and Aesthetic Surgery Clinic in a group of 90 volunteers (45 women and 45 men, a total of 180 lower extremities) to determine the location of the anterolateral thigh flap perforator against the flap surface using a portable Doppler probe.</br> <b><br>Results:</b> Variable locations were revealed for the anterolateral thigh flap perforator within the study. In women, the perforator is located more distally from the anterior superior iliac spine, most frequently within the inferolateral quadrant, while being located closer to the anterior superior iliac spine, and most frequently within the superolateral quadrant, in men. No perforator was found in 3.3% of the examined limbs. No statistically significant differences were observed between the course of the perforators within the left and right lower limbs in individual patients.</br> <b><br>Conclusions:</b> The location of the ALT flap perforator is subject to sexual dimorphism, which facilitates the investigation area being narrowed down to the well-defined locations of its most frequent occurrence when planning anterolateral thigh flap reconstructive procedures.</br>.

Evaluation of outcomes of lower eyelid entropion and ectropion surgical repair

<b><br>Introduction:</b> The imbalance of external and internal forces acting on the lower eyelid can result in entropion and ectropion, both of which cause ocular irritation and loss of proper eye protection. Potential complications of untreated cases include recurrent inflammation of the conjunctiva and cornea, conjunctival neovascularization, corneal abrasion or perforation, and ultimately even loss of vision. Although various surgical techniques are used to address this problem, their long-term outcome and effectiveness are still under discussion. </br> <b><br>Aim:</b> To evaluate outcomes of surgery for entropion and ectropion, including a modified Wheeler's method for entropion correction.</br> <b><br>Methods:</b> A non-comparative study (prospective and retrospective groups) included 100 patients operated on in two university hospitals' plastic surgery departments for lower eyelid entropion or ectropion, following formal ethics approval. The prospective group included 50 patients assessed preoperatively and at 3 and 12 months postoperatively. The retrospective group was comprised of 50 patients (2012-2018), whose preoperative documentation and clinical examinations were analyzed. The main outcome measures were change between pre- and postoperative patient-reported symptoms (VAS scale), ectropion/entropion grading scale (EGS/EnGS), quality of life (WHOQOL-BREF), and occurrence of complications.</br> <b><br>Results:</b> The differences in the severity of all symptoms before and after surgery evaluated with the VAS scale were statistically significant in both groups (p <0.05). We observed 6 recurrences (12%) in the prospective group and 9 (18%) in the retrospective group, with minor complications. Very good functional and esthetic postoperative results were confirmed in 70% (79) of the whole group and in 13 patients (81.3%) treated with the modified Wheeler's method. In the prospective group, the Mann- Whitney U test for dependent variables revealed significant improvement in the somatic, psychological, and environmental domains, with no significant change in the social relationships domain.</br> <b><br>Conclusions:</b> The results following entropion/ectropion surgery prove the effectiveness of the methods used. Complementing them with the modified Wheeler's method brought an increase in the number of very good outcomes. Surgery of lower eyelid malposition contributed to reduced symptoms and improved quality of life. The rates of postoperative sequelae were low.</br>.

Skin cancer occurrence: single-center experiences from period 2020-2022

<b><br>Introduction:</b> Skin cancers constitute a group of medical disorders remaining a field of interest for surgeons and dermatologists. Currently, this group is typically divided into malignant melanoma (MM) and keratinocyte cancers (KC).</br> <b><br>Aim:</b> The aim of this study is to analyze the cases of skin cancers treated in the Department of Plastic, Reconstructive, and Aesthetic Surgery in Lodz (Poland) during the COVID-19 pandemic (from 2020 to 2022) and then compare the results with the ones from the pre-pandemic period (from 2017 to 2019).</br> <b><br>Material and methods:</b> An analysis of histopathological files from the period between 2020 and 2022 was performed. It was based on the following criteria: sex, age, type of skin cancer, subtype of basal cell carcinoma (BCC), location, and dimensions of the tumor. The study sample consisted of 225 patients presenting 241 cases of skin cancers. There were 74 men and 151 women, with the mean age being 71.7.</br> <b><br>Results:</b> The most common skin cancer was BCC (175 cases, 72.6%) followed by SCC (59 cases, 24.5%), melanoma (5 cases, 2.1%), and other (2 cases, 0.8% - angiosarcoma and sweat gland carcinoma).</br> <b><br>Conclusions:</b> A marked reduction in the number of skin cancers detected during the pandemic period was reported on. Delay in the surgical treatment of skin tumors does not seem to affect the size of the removed lesion. Some models predicting that tumors would be larger after the confinement period are not applicable in reality. However, further investigations with larger samples from multiple centers are needed to confirm these findings and to work out standards on how to deal with healthcare crises in the future.</br>.

Selected factors affecting the rate of reduction of body weight components during the first six months after bariatric surgery: A cohort study

<b><br>Aim:</b> To determine whether the rate of slimming following bariatric surgery depends on the sex, type of bariatric surgery, time elapsed since surgery or body weight components.</br> <b><br>Materials and methods:</b> The material is comprised of the results of three series of anthropometric measurements in 91 obese patients (before bariatric surgery, about 3 months after bariatric surgery and about 6 months afterwards). The inclusion criteria were patients of Polish origin admitted to the hospital from July 1, 2017 to January 31, 2019 for surgical treatment of obesity and written consent for the surgery and participation in the study. The measurements included body weight components assessed by bioelectrical impedance analysis.</br> <b><br>Results:</b> The reduction of all features was greater after SG than GB (p<0.0001), greater in the first quartile than in the second quartile after surgery (p<0.0001), and higher for fat mass than for other body weight components (p<0.0001). The sex of the patients, type of bariatric surgery, time elapsed since the operation, and type of body weight component constituted interactive modifiers of the rate of reduction.</br> <b><br>Conclusion:</b> After bariatric surgery, the reduction of fat mass was quicker in men than in women. SG and RYGB lead to a greater reduction of fat mass than GB. Among all three analyzed procedures, only for SG did the rate of body weight component reduction not decrease in the second quartile after surgery. This finding should be taken into account when creating an algorithm for treating a patient after bariatric surgery</br>.

Correlations between antimicrobial peptides and spectrophotometric skin color parameters in patients with basal cell carcinoma

BACKGROUND

Antimicrobial peptides (AMPs) are active molecules in the human innate immune system, that participate in host defense and regulate the inflammation process. Previous reports have confirmed that antimicrobial peptides play a critical role in carcinogenesis.

OBJECTIVE

The present study aimed to evaluate the correlations between plasma concentrations of AMPs and spectrophotometric parameters of skin color in patients with basal cell carcinoma and compare the results with those of healthy controls.

METHODS

The plasma concentrations of cathelicidin and beta-defensin-2 in 100 patients (50 with skin cancer and 50 healthy control subjects) were measured, and skin color parameters were tested using a DermaSpectrophotometer.

RESULTS

In patients with basal cell carcinoma, the concentrations of cathelicidin and beta-defensin-2 were significantly higher than those in healthy controls. In healthy control patients, when erythema increases, the levels of cathelicidin and beta-defensin-2 also increase. The direction of the relationship is opposite in people with basal cell carcinoma-the concentration of antimicrobial peptides decreases and the level of erythema increases.

CONCLUSION

A significantly higher level of plasma concentrations of cathelicidin and HBD-2 are correspondent to the presence of basal cell carcinoma. Skin cancer modifies the relationship between intensity of skin erythema and the levels of cathelicidin and HBD-2. This can be related to inadequate immunological response in patients with skin cancers. New direction of research may be pioneered in searching for cytokine or mast cells disorders.

The impact of exposure to tobacco smoking and maternal trauma in fetal life on risk of migraine

Introduction

Prenatal period is the key time in human development. Many prenatal factors are well-known and increase the risk of developing diseases' after birth. Few studies indicated the link between the prenatal period and the prevalence of migraine in childhood and adolescence so far. We decided to broaden current knowledge and investigate whether the prenatal factors influence the prevalence of migraine in adulthood. The objective of this study is to provide evidence of relationship between in utero environment and risk of migraine.

Methods

In total 266 females (136 in the migraine group, 130 in the control group) and 80 males (35 in the migraine group, 45 in the control group), aged 18-65 participated in the study. The quality of prenatal environment was characterized on the basis of mother's and father's education, tobacco smoke exposure, alcohol consumption, and traumatic event during pregnancy, which are considered as prenatal factors and affect on fetal development.

Results

Migraine occurrence in adulthood was significantly associated with maternal tobacco smoking during pregnancy (OR 3.42, 95% CI 1.54-7.61, p = 0.036) and traumatic event during pregnancy (OR 2.27, 95% CI 1.24-4.13, p = 0.020).

Discussion

Our study suggests that the fetal programming effect of tobacco smoking exposure and maternal trauma is not limited to prenatal life and is suggested as having a role in adulthood. Our findings support evidence that migraine adulthood can be partly influenced by early life conditions.

The role of TGF-β and antimicrobial peptides in basal cell carcinoma: a systematic review

Introduction

Basal cell carcinoma (BCC) is the most common skin cancer in humans, occurring in more than 50% of Caucasians during their lifetime, with a frequency rate that is continually increasing.

Material and methods

We present a systematic review summarizing the role of transforming growth factor β (TGF-β), cathelicidin, and human β-defensins (HBDs) in the pathogenesis of BCC. The major online databases including PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Google Scholar were searched to extract studies regarding the levels of TGF-β, HBD, and cathelicidin in BCC.

Results

A total of 14 studies met the inclusion criteria and were included in this systematic review. There were 6 studies that included initially established levels of TGF-β in BCCs. A total of 87 BCCs were analysed, and a common result was that the TGF-β levels increase in the BCCs compared to the control groups. Analogously, 2 studies contained numerical data on HBD levels but with a different in methodology. The level of cathelicidin was established in 108 BCCs and was significantly higher in the BCC group than in the control group.

Conclusions

The presented review shows evidence that proteins like TGF-β, HBD, and cathelicidin play a role in developing BCC. Protein levels or their expression are elevated in patients with BCC. Furthermore, a critical review of the literature was presented and discussed, highlighting its shortcomings.

Digit ratio (2D:4D), laryngeal cancer and vocal fold leukoplakia

BACKGROUND

To date, there are no studies that have analyzed the possible influence of exposure to prenatal sex hormones on the risk of laryngeal cancer (LC) and premalignant laryngeal lesion-vocal fold leukoplakia (VFL). Digit ratio (2D:4D) is suggested to be a proxy of prenatal sex hormone exposure.

OBJECTIVE

To examine 2D:4D in patients with LC and clarify if it could add to the verified risk factors in estimating the overall risk of LC.

METHODS

511 subjects participated in the study. The study group included 269 patients: with LC (N = 114, 64 men) and VFL (N = 155, 116 men). Controls included 242 healthy individuals (66.40 ± 4.50 years (106 men)).

RESULTS

Predictive models estimating the risk of VFL and LC in women, based solely on predictors like smoking and alcohol consumption had a lower area under the ROC curve (AUC) than the model with left 2D:4D. AUC for the model estimating the likelihood of VFL increased from 0.83 to 0.85, and for LC from 0.76 to 0.79.

CONCLUSIONS

Low left 2D:4D may be associated with an increased risk of developing leukoplakia and laryngeal cancer in women. In the case of laryngeal cancer, left 2D:4D may serve as additional variable (to other known risk factors, such as smoking and/or alcohol consumption), which can improve cancer risk prediction.

Is Preoperative Asymmetry a Predictor of Postoperative Asymmetry in Patients Undergoing Breast Reduction?

Plastic surgeons aim to achieve symmetry in breast surgeries, which is the main determinant of chest aesthetics. The aim of this study was to verify if preoperative breast asymmetry is a predictor of postoperative asymmetry in women undergoing breast reduction. In this prospective study, we enrolled 71 women (the mean age 37 years, SD 10 years) with breast hypertrophy who underwent reduction mammaplasty. We collected clinical data including age, height, weight, weight of the resected tissues, and performed pre and postoperative photographic documentation. The following measurements of both breasts were analyzed: volumes (vol), nipple-sternal notch distance (A-sn), difference between nipples' levels (A-A'), nipple-midline distance (A-ml), difference between inframammary folds levels (IF-IF'), distance between inframammary fold and nipple (IF-A), distance between inframammary fold apex and midline (IF-ml). All measurements were performed preoperatively and 6 months after the surgery and asymmetries of all variables were calculated (asy-vol, A-A', asyA-sn, asyA-ml, IF-IF', asyIF-A, asyIF-ml). Postoperative asymmetry of breast volumes and nipples position was not associated with any of the analyzed clinical variables. Postoperative asymmetry of nipples' level was associated with preoperative asymmetry of IF-ml; however, logistic regression did not detect any preoperative measurement influencing postoperative volume and nipples' level asymmetry. Moreover, we found that preoperative asyIF-ml increased the risk of postoperative volume asymmetry, which is above the average (52 cc) (OR = 2.04). Postoperative breast asymmetry after breast reduction is not related neither to preoperative asymmetries nor clinical variables; however, asymmetry of inframammary fold apex to the midline may be the factor affecting postoperative volumetric asymmetry.

Breast Fluctuating Asymmetry in Women with Macromastia/Gigantomastia

BACKGROUND

A number of studies have reported breasts have high fluctuating asymmetry (FA:|Right-Left|), suggesting that they contain evolutionary and clinical information (e.g., high FA correlates with breast cancer risk). Here we focus on breast FA in women with a wide range of breast sizes, including participants with macromastia and/or gigantomastia.

MATERIAL AND METHODS

The sample included 65 women (mean age 33.97 ± 12.1 years). Thirty were randomly selected students and/or patients who regarded their breast size as small, normal or average and who had not undergone or intended to have any breast surgery. The remainder (n = 35) were qualified for breast reduction due to macromastia and/or gigantomastia. In all participants we measured/calculated weight, height and BMI, as well as took chest photographs. Breast volumes and nipple areola complex FAs were evaluated in a specifically-designed software.

RESULTS

Breast size significantly positively correlated with breast volume FA in all women (t = 5.17, p < 0.0001) and in women with macromastia/gigantomastia (t = 2.32, p = 0.027). All nipple location FAs correlated positively with breast size.

CONCLUSIONS

In women with different breast sizes, breast size correlates with FA calculated from breast volume and nipple location FAs. In women with macromastia and/or gigantomastia, breasts present higher FA than "normal" breasts. This observation may give a rationale for earlier and more frequent prophylactic breast imaging in women with macromastia and/or gigantomastia.

Right-left digit ratios, a novel form of asymmetry: Patterns of instability in children and relationships to platelet counts and hospitalization in adults with COVID-19

High right minus left (R-L) asymmetry of digit ratios has been reported to be linked to hospitalization for COVID-19. Here we examined the developmental patterns of this novel form of asymmetry in children and further explored their relationships to platelet counts and hospitalization for COVID-19 in adult patients. We considered ratios calculated from four digits (2D, 3D, 4D, 5D) in: (i) a sample of healthy participants aged 2 years to 18 years (n = 680, 340 males) and (ii) 96 adult patients (42 males) hospitalized for COVID-19 and 100 controls (53 males). The protocol for (ii) included a questionnaire and laboratory test results. In sample (i) of the six unsigned digit ratio asymmetries, those which included 5D had the highest mean asymmetry with the greatest between-individual variation and they were unstable over the age range of 2 years to 18 years. In sample (ii) patients showed higher asymmetries than controls in four ratios (2D:4D, 2D:5D, 3D:5D, 4D:5D) and a sum of asymmetries of the two independent ratios (2D:4D+3D:5D) correlated positively with platelet counts and hospitalization. Conclusion: Means and SDs of digit ratio asymmetry that include the 5th digit are high and age-unstable. Digit ratio asymmetry, particularly 5th digit ratio asymmetry and a composite measure of 2D:4D + 3D:5D asymmetry, may be positively linked to high platelet counts in COVID-19 patients and to an elevated risk of hospitalization.

Immunoexpression of Bmi-1, CK15, Bcl-2 in different types of basal cell carcinomas

INTRODUCTION

Basal cell carcinoma (BCC) occurs in aggressive and non-aggressive forms. The expression of immunohistochemical markers varies in different types of BCC.

AIM

Immunohistochemical analysis of selected proteins in BCCs.

MATERIAL AND METHODS

The immunohistochemical method was used to examine the immunoexpression of Bmi-1, CK15 and Bcl-2 in 56 cases of BCC divided into four groups.

RESULTS

Positive Bmi-1 staining 3-4+ level (nodular type) was seen in 91.3% of samples, 4+ (infiltrative) in 92.3%, 4+ (nodular/infiltrative) - 69.2%, 3+ - 30.8%, in BSC 3+ - 42.8%, and 28.6% each for 2+ and 4+. Low grade positivity (0-1+) in CK15 staining was present in 52.1% of nodular BCC, 46.2% - nodular/infiltrative, 92.3% - infiltrative, and 100% - BSC, but levels 2-3+ in nodular BCC in 47.8%, nodular/infiltrative BCC - 53.8%, infiltrative - 7.7%. Bcl-2 positivity (3-4+) was revealed in nodular BCC in 95.6%, (1-2+) in 100% of BSC, infiltrative and infiltrative/nodular BCC, but the lowest (0-1+) in 76.9% of nodular/infiltrative BCC, 71.4% of BSC, and in 38.4% of infiltrative BCC.

CONCLUSIONS

Positive Bmi-1 staining was the highest in the aggressive infiltrative subtype of BCCs, whereas the lowest in basosquamous cell carcinomas (BSC). Infiltrative BCC was characterized by a lower level of CK15 expression than nodular BCC and nodular/infiltrative BCC. Differentiation of Bcl-2 expression depended on the type of tumour; the highest level was found in nodular BCC, low grade in nodular/infiltrative and infiltrative BCCs, and BSC.

When Body Art Goes Awry-Severe Systemic Allergic Reaction to Red Ink Tattoo Requiring Surgical Treatment

The aim of this report is to present a case of a patient who developed unusual systemic hypersensitivity reaction to a red-pigmented tattoo and to discuss diagnostic difficulties in case of systemic reactions to tattoo ink. The patient reported erythroderma on his arms and chest accompanied by plaque elevation of red parts of his most recently performed forearm tattoo as his primary symptoms. His health condition entailed a prolonged topical and intravenous immunosuppressive therapy, which proved ineffective. Over a year after emergence of initial symptoms, he presented to the Plastic Surgery Clinic with generalized erythroderma, systemic lymphadenopathy, elevation and granuloma formation in red tattoos on his forearm and complaints of fatigue and inability to participate fully in work-related and social activities. The patient underwent six staged excisions with direct closures, flap plasties and full-thickness skin grafts. Following completion of each surgical resection, the patient's symptoms gradually subsided. We find this case illustrative of a clinical challenge that delayed hypersensitivity reactions to red tattoos may pose. Furthermore, we provide insights on management of hypersensitivity reactions. This report underlines the importance of social awareness of and public health approach to tattoo complications as key to successful prevention, identification and treatment of adverse reactions to tattoos.

100 years of Thorek method - is this technique of breast reduction still actual?

In 1922, Max Thorek described the method of breast reduction with the transfer of the nipple-areola complex as free grafts. Initially, this method met with quite a lot of criticism. Therefore, the search for solutions guaranteeing better aesthetic results of breast reduction have been evolved.The aim of the study is to present our own experiences related to the Thorek method of breast reduction in patients with gigantomastia and to consider whether this technique is still relevant in the 21st century.The study included women operated on for large breasts at the Plastic, Reconstructive and Aesthetic Surgery Clinic between 2012-2021. In the analysis 95 women aged 17 to 76 were involved.In the analyzed group of 95 women, 14 patients underwent breast reduction with transfer of the nipple-areola complex as a free graft (modified Thorek&apos;s method). In the remaining 81 cases, breast reduction was performed with the transfer of the nipple areola complex on the pedicle (upper-medial - 78, lower - 1, upper-lower - McKissock&apos;s method - 2).The usage of Thorek&apos;s method is still actual in a selected group of women. This technique seems to be the only safe one in patients with gigantomastia, with a high risk of nipple-areola complex necrosis related to the distance of nipple transfer, as well as after the end of the reproductive period. Its main disadvantages (tendency to breasts being too wide and flat, unpredictable nipple projection and nipple pigmentation) can be minimized by modification of the Thorek method or minimally invasive follow-up techniques.

The Influence of Faith and Religion on Family Interactions and Interest in Health Issues during the COVID-19 Pandemic—A Study among Polish Adolescents

Background: COVID-19 has dominated health, economic, and geopolitical issues for many months, but it also has great influence on individuals and families. The aim of this study was to verify whether the pandemic of COVID-19 changed religious practices and how religiosity moderated the influence of the pandemic on family interactions and attitudes towards health issues in adolescents. Methods: The study groups included 561 adolescent high school students (314 females and 247 males) from two kinds of high schools: public and Catholic. Results: Most Catholic school students have not changed their religious practices during the pandemic or just changed the form of attendance to TV or internet (59.7%). Moreover, 8.6% of them stopped the practices, in comparison with 12.9% of public school students, most of whom had not attended a mass before and during the pandemic. The results showed that in adolescents’ opinions the pandemic caused family relations to be stronger, however this effect was modified by religiosity. Conclusion: Attending Catholic school and being a practicing believer influenced some aspects of faith and family relations during the pandemic, but in most aspects, they did not influence attitudes toward health issues. The results of the study highlight the need to secure, especially for non-believing adolescents, family support during the pandemic, while in believers faith may provide such support.

The 2D:4D index is associated with the development of excess body weight in adults, but not with the rate of weight loss following bariatric surgery

2D:4D finger length ratio is a proxy of prenatal sex hormone exposure. Prenatal testosterone decreases and prenatal estrogens increase this index. In the current study we investigated whether the 2D:4D index, as a marker of the prenatal hormonal environment, is associated with the development of overweight and obesity in adults, and whether is it correlated with the rate of weight loss in patients after bariatric surgery. We tested 125 adults with obesity (BMI ≥ 30.0 kg/m²), 125 adults with overweight (BMI 25.0–29.9 kg/m²) and 153 persons with normal body weight (BMI < 25 kg/m²) of both sexes. We have found that the development of excessive body weight in men and women, and fat accumulation in the upper arms, thighs and lower legs in women with obesity (but not men) are associated with increased prenatal estrogen exposure. This relationship indicates a new area of activity in the field of obesity prevention. Moreover, it seems that the 2D:4D index (especially of the right hand) may be a useful factor in early prediction of the risk of developing excessive body weight in humans. The rate of weight loss after bariatric surgery is independent of prenatal exposure to sex hormones.

Risk of Migraine in Europeans with Low Melanin Levels—A Population Based Case-Control Study

Populations with a relatively low concentration of melanin, e.g., inhabitants of Europe, North America, and Australia, are the most vulnerable to the harmful effects of UV radiation. Individuals with fair phototype are at greatest risk of developing skin cancer. Several neurological studies present that light skin may modify the risk of Alzheimer’s and Parkinson’s diseases. However, the relationship between migraine and skin pigmentation has not been investigated yet. The objective of this study is to provide evidence of the relationship between skin pigmentation and migraine prevalence in adults. We examined a group of 148 adults (33 men, 115 women) with migraine and a control group of 107 adults (43 men, 64 women). Parameters of skin pigmentation (melanin index, erythema index, CIElab, and RGB scales) were measured using a DSM II Cortex Technology dermospectrophotometer. Risk of migraine in lightly pigmented adults was elevated. Individuals with a low melanin index had over 3-fold increased risk of migraine (women: OR 3.53, men: OR 3.73). Fair phototype, which results from lightly pigmented skin, was associated with migraine prevalence. Migraineurs should take extra care to protect their skin from the negative effects of solar radiation.

Digit ratios and their asymmetries as risk factors of developmental instability and hospitalization for COVID-19

COVID-19 presents with mild symptoms in the majority of patients but in a minority it progresses to acute illness and hospitalization. Here we consider whether markers for prenatal sex hormones and postnatal stressors on developmental instability, i.e. digit ratios and their directional and unsigned asymmetries, are predictive of hospitalization. We focus on six ratios: 2D:3D; 2D:4D; 2D:5D; 3D:4D; 3D:5D; 4D:5D and compare hospitalized patient and control means for right, and left ratios, directional asymmetries (right–left) and unsigned asymmetries [|(right–left)|]. There were 54 patients and 100 controls. We found (i) patients differed in their digit ratios from controls (patients > controls) in all three ratios that included 5D (2D:5D, 3D:5D and 4D:5D) with small to medium effect sizes (d = 0.3 to 0.64), (ii) they did not differ in their directional asymmetries, and (iii) patients had greater |(right–left)| asymmetry than controls for 2D:4D (d = .74) , and all ratios that included 5D; 2D:5D (d = 0.66), 3D:5D (d = .79), 4D:5D (d = 0.47). The Composite Asymmetry of the two largest effects (2D:4D + 3D:5D) gave a patient and control difference with effect size d = 1.04. All patient versus control differences were independent of sex. We conclude that digit ratio patterns differ between patients and controls and this was most evident in ratios that included 5D. Large |(right–left)| asymmetries in the patients are likely to be a marker for postnatal stressors resulting in developmental perturbations and for potential severity of COVID-19.

The Importance of Surgical Sex Reassignment in TheOpinion of Female-To-Male Transsexuals

&lt;br&gt;&lt;b&gt;Introduction:&lt;/b&gt; The term transsexualism determines people whose gender identity is contrary to their genetic sex and physical features. This condition leads to a discrepancy between the psychological gender preferred by transsexuals and their biological sex. Transsexuals experience a feeling of being incarcerated in a foreign body and therefore wish to alter their sex by hormone therapy and surgical treatment.&lt;/br&gt;&lt;br&gt;&lt;b&gt;Aim:&lt;/b&gt; The aim of this study is to describe the opinions of female-to-male transsexuals concerning sex reassignment surgery with selecting the most important stage.&lt;/br&gt;&lt;br&gt;&lt;b&gt;Method:&lt;/b&gt; The questionnaire studies were performed among a group of 82 female-to-male transsexuals with a mean age 25.2 years. Patients were at different stages of treatment. Results: More than 90% of the questionnaired transsexuals expect to complete their treatment with hope. For 86.6% of transsexuals, the most important stage in surgical treatment is the phalloplasty, the second panhysterectomy (70.7%), and the third breast reduction (69.5%).&lt;/br&gt;&lt;br&gt;&lt;b&gt;Conclusions:&lt;/b&gt; Phalloplasty is the most important stage in sex reassignment surgery in the opinion of transsexuals. Each stage of treatment improves the mental comfort of female-to-male transsexuals.&lt;/br&gt.

Coexistence of Thumb Aplasia and Cleft Lip and Alveolus with Aortopulmonary Window—A Tip for Prenatal Diagnostics for Rare Heart Anomalies

Multiple congenital anomaly syndromes pose a challenge to neonatologists, as many anomalies may indicate cryptogenic malformations or disorders. Aortopulmonary window (APW) is a very rare congenital heart disease (CHD) and causes many difficulties in prenatal diagnostics. In this report, we describe a case of a female patient with multiple rare congenital malformations: aortopulmonary window, right thumb aplasia, facial nerve palsy and cleft lip and alveolus. None of the malformations were diagnosed prenatally. A long-term follow-up (40 years) is presented. The presence of certain defects (thumb aplasia) may indicate the need for a careful fetal examination extended by a fetal ECHO performed in a reference center of prenatal cardiology. The coexistence or syndromic character of the presented malformations should be verified in future if more such cases are described.

Genetic Factors of Idiopathic Gigantomastia: Clinical Implications of Aromatase and Progesterone Receptor Polymorphisms

The role of estrogen, progesterone, their receptors and aromatase in the development of the breast is well documented. In this study we examined the association of genetic variants of progesterone receptor (PGR) and aromatase (CYP19A1) genes with gigantomastia risk. We conducted a case-control study among 124 women: 60 with gigantomastia and 64 controls. We examined the single nucleotide polymorphisms (SNPs) for CYP19A1 (rs749292 and rs7172156) and PGR (rs1042838). Our results showed that allele G in rs749292 (CYP19A1) increased the risk of gigantomastia, but not significantly (p = 0.09). There is a correlation between rs1042838 (PGR) and waist-to-hip ratio (WHR) in women with gigantomastia-AC genotype correlates with lower WHR and CC with higher WHR. There were no correlations between the onset of gigantomastia, the age of menarche and the length of the menstrual cycle, and rs1042838, rs749292 and rs7172156. We did not find differences in the SNP of PGR (rs1042838) between women with gigantomastia and controls. However, our findings showed more frequent G allele in CYP19A1 (rs749292) in women with gigantomastia.

Can Digit Ratio (2D:4D) Be Indicative of Predispositions to Autoimmune Thyroid Diseases in Women - Hashimoto Thyroiditis and Graves' Disease?

Hashimoto thyroiditis and Graves' disease are autoimmune thyroid diseases which occur much more frequently in women than in men. Estrogen receptors are found in the thyroid gland and can modulate the gland's function. Digit ratio (2D:4D) is thought to be a negative correlate of prenatal testosterone and a positive correlate of prenatal estrogen. This study aimed to examine a relationship between right and left 2D:4D in women with Hashimoto thyroiditis and Graves' disease. The cross-sectional study included 106 women with autoimmune thyroid disease: 73 women diagnosed with Hashimoto thyroiditis and 33 women with Graves' disease, together with 70 healthy women as controls. Second and fourth digit length, weight, height were measured directly, and 2D:4D and BMI were calculated. Compared to controls, right and left 2D:4D were significantly higher in women with Hashimoto thyroiditis and lower in women with Graves' disease, the effects were higher for right 2D:4D. The mean length of right 4D was significantly lower in the examined women with Hashimoto thyroiditis than in Graves' disease. Higher right and left 2D:4D in women with Hashimoto thyroiditis suggests that prenatal exposure to high levels of estrogens relative to testosterone may play a role in the development of this disease. Lower right and left 2D:4D in women with Graves' disease suggest a role of high prenatal androgens relative to estrogens in Graves' disease pathogenesis.

The role of oestrogen and progesterone receptors in gigantomastia

INTRODUCTION

Gigantomastia is a rare condition characterised by excessive breast growth. The pathophysiology of mammary enlargement varies depending on the type of gigantomastia: gestational, juvenile virginal, or idiopathic. The study aimed at examining the receptor status (oestrogen receptor α (ERα) and progesterone receptor (PR)) of breast tissue in adult women with juvenile or idiopathic gigantomastia.

MATERIAL AND METHODS

The study involved 70 women who underwent breast reduction due to juvenile or idiopathic gigantomastia. Control breast specimens were obtained from 18 female cadavers. ERα and PR expressions were detected immunohistochemically in breast gland samples.

RESULTS

Categorised and uncategorised ERα and PR expression did not differ between women with gigantomastia and control women. It was found that in both groups weak (0-30%) ERα and PR expression was the most common. Analysis of categorised data also did not reveal any significant correlations between ERα or PR and the women's age: for the whole group: p = 0.795 (ERα), p = 0.207 (PR), for women with gigantomastia: p = 0.934 (ERα), p = 0.43 (PR), and for control women: p = 0.638 (ERα), p = 0.805 (PR).

CONCLUSIONS

Gigantomastia is not caused by increased expression of ERα and PR. Analysing abnormal sensitivity of these receptors to hormones may be crucial in establishing the increased risk of breast cancer in women with gigantomastia.

The Assessment of Nipple Areola Complex Sensation with Semmes-Weinstein Monofilaments-Normative Values and Its Covariates

Objective: To establish normative data for nipple-areola complex (NAC) sensibility examined with Semmes-Weinstein monofilament test (SWMT) and two-point discrimination (TPD) in women with varying breast sizes, including women with gigantomastia. We also aimed to identify clinical variables influencing NAC sensation. Methods: A total of 320 breasts in 160 Caucasian women (mean age 33.6 years, SD 11 years) were examined (including 50 hypertrophic breasts). NACs sensation was examined using Semmes-Weinstein monofilaments (SWM) and the Weber Two-Point Discrimination Test. Results: The nipple appeared to be the most sensitive part of NAC. In normal-sized breasts, sensation thresholds (SWM) correlated with: age, BMI, history of births, breast size and ptosis (for all locations), breastfeeding history (for nipple and upper areola) and areola diameter (for all locations apart from the nipple). Regression analysis showed that age, cup size and suprasternal notch-to-nipple distance are risk factors for diminished NAC sensation. Sensation thresholds in all NAC locations of hypertrophic breasts were significantly higher compared to normal-sized breasts, while TPD tests did not differ between the groups. Conclusions: We provided normative values of NAC sensation (tactile threshold and TPD) for different NAC areas. Our investigation indicated that SWM are useful diagnostic tools when the following factors are considered while examining NAC sensation: location (nipple vs. areola), age, breast size, suprasternal notch-to-nipple distance, history of births and breastfeeding. Hypertrophic breasts presented significantly higher sensation thresholds for all NAC locations. The report may serve as a reference data for further investigations regarding NAC sensation after different breast surgeries.

Prenatal oestrogen-testosterone balance as a risk factor of migraine in adults

BACKGROUND

Migraine is a common neurological disease with extremely debilitating, but fully reversible symptoms. Women suffer from migraine more often than men. It was assumed that fluctuation of oestrogen level during menstrual cycle is one of many factors responsible for more frequent migraine attacks. The second-to-fourth digit ratio (2D:4D) is considered as an indicator of prenatal sex steroids. Balance of prenatal androgens (testosterone) and oestrogen has been studied in numerous diseases that are affected by hormones. However, the relationship between migraine and the sex steroids balance in prenatal development is still unexplained. The aim of this paper is to provide an evidence of relationship between prenatal oestrogen and testosterone exposure following 2D:4D digit ratio, and migraine prevalence in adults.

METHODS

We examined a group of 151 adults (33 males, 118 females) with migraine and a control group of 111 adults (45 males, 66 females). 2D:4D digit ratio of both hands was measured using sliding Vernier calliper.

RESULTS

Significant differences were found in the right hand. Female migraineurs had lower value of 2D:4D ratio than the control group and the right 2D:4D was lower than left 2D:4D (Δ2D:4D), suggesting prenatal testosterone dominance. The opposite relationship was observed in males. Male migraineurs had higher value of 2D:4D ratio and Δ2D:4D was greater than the control group, suggesting prenatal oestrogen dominance.

CONCLUSIONS

Our results suggest that depending on sex, different proportion of prenatal sex steroids might be a risk factor of migraine in adults. Women with migraine were presumably exposed in prenatal life to higher testosterone levels relative to oestrogen, while men with migraine were probably exposed in prenatal life to higher levels of oestrogen relative to testosterone.

BreastIdea Volume Estimator: A New Tool for Breast Volume Estimation-Presentation and Validation for Women

Breast volume assessment is crucial in a breast surgeon's clinical practice. The aim of this study was to present and validate a new Web application, BreastIdea Volume Estimator, a module for breast estimation of the already validated BreastIdea application. Forty breasts in 20 women were scanned using a three-dimensional scanner. They were then photographed in nonstandardized conditions, and volume estimations were calculated using BreastIdea Volume Estimator. Accuracy in addition to relative and absolute reliability of BreastIdea Volume Estimator measurements were investigated. In addition, breast volume differences were analyzed. Breast volume estimation using BreastIdea Volume Estimator yielded satisfactory accuracy and presented precision of the level of clinical measures. The mean absolute difference for both observers was 4.33 ± 3.79 cc and 6.78 ± 4.66 cc, which correspond to 1.87 ± 1.89 percent and 2.75 ± 2.05 percent errors of measurement. Similar relations were found for measurements of breast volume differences. BreastIdea Volume Estimator is a clinically oriented, reliable tool for breast volume evaluation. It provides results of appropriate accuracy regardless of chest abnormality and photograph standardization.

Clinical picture and treatment of cutaneous lesions in patients with neurofibromatosis type 1

INTRODUCTION

The most common type of neurofibromatosis is Recklinghausen disease (NF-1). A major feature of NF1 is the development of localized cutaneous neurofibromas. Such types of lesions are manifested in > 99% of adults with NF1 and are responsible for major negative effects on quality of life.

AIM

To present the clinical picture of patients with NF-1 and to report authors' own observations related to their surgical treatment.

MATERIAL AND METHODS

A retrospective study aiming to present a group of patients with Recklinghausen disease was planned. The study was carried out in 39 patients with NF-1.

RESULTS

All patients had cutaneous neurofibromas localized in different parts of the body. The three most frequent localizations were the abdomen, back, and face. Surgical treatment was performed in 31 patients. All patients had discomfort due to the presence of cutaneous nodules especially because their visibility and multiplicity.

CONCLUSIONS

Due to the polymorphism of the clinical picture and unpredictable course of the disease, there is no one standard of treatment of patients with Recklinghausen disease. Excision of tumours in the early stage of their development gives better functional and aesthetic results.

Frequency of various craniofacial clefts observed in a single center during a period of 34 years

BACKGROUND

Orofacial clefts are the most common congenital anomalies of the head and neck.

AIM

The aim of this paper is to present own group of patients with different types of isolated orofacial clefts.

MATERIAL AND METHOD

A retrospective study presenting patients with different facial clefts was carried out in the group of 473 patients born in the city of Lodz.

RESULTS

In the whole group there were: 434 patients with cleft lip and/or palate, 28 with nose clefts and 11 with rare facial clefts classified according to Tessier categorization.

CONCLUSION

In our group, the majority of cases comprised of typical cleft lip and/or palate. Nose clefts are not always a part of craniofacial clefts, but isolated nose clefts can occur and can be observed as midline defects or ala nasi anomaly. A simple system may be adequate for surgical repair, with the more detailed classification schemes important for further understanding of the disease.

Neurofibromatosis type 1 - social aspects of functioning and public attitude

The neurofibromatosis type 1 (NF-1) is the most common phacomatosis. Its clinical picture is variable and the course of the disease is progressive.

AIM

The aim of this paper is to present social aspects of living with neurofibromatosis type 1.

MATERIALS AND METHODS

We examined 17 patients with NF-1 in the age between 22 to 61 years. In the group there were 11 women and 6 men. A special questionnaire was prepared for the study; it included questions concerning learning problems, difficulties in finding job, problems with getting into relationships and social reaction to NF-1.

RESULTS

More than 20% of patients had learning problems and worse marks than other students. Most of respondents did not have problems with making social relationships and difficulties in finding job. However more than 70% of patients thinks that they are different and they were harmed by the nature. Almost 1/3 of respondents do not recognize themselves as good life partner.

CONCLUSIONS

Neurofibromatosis type 1 decreases the self-confidence and self-esteem in patients with NF-1. The knowledge of this disease and its character is still poor in social audience. The patients' awareness of disease inheritance is high and their will to have children is small.

Digit ratio (2D:4D) in women and men with lung cancer

A prenatal sex steroid environment of high prenatal testosterone and low prenatal oestrogen inhibits lung development and may predispose individuals to be vulnerable to lung disease in later life. Therefore, the aim of this report was to investigate whether there is an association between right and left 2D:4D (biomarker of prenatal sex steroids exposure) and primary lung cancer in women and men. Also, we considered the relationship between right–left 2D:4D (Δ2D:4D, a negative correlate of high prenatal testosterone and low prenatal oestrogen) and the age of lung cancer diagnosis. The study included 109 patients (61 men) with lung cancer and 197 controls (78 men). In the study we found that: (i) women with lung cancer have lower 2D:4D compared to controls (the effect was independent of smoking), (ii) among women with cancer, age at diagnosis was positively related to 2D:4D, i.e. women with masculinized 2D:4D present earlier with the cancer than women with feminized 2D:4D, (iii) among men with lung cancer, those with the most aggressive form (small-cell lung cancer) had masculinized (low) Δ2D:4D compared to those with the less aggressive form (non-small cell lung cancer). The data suggests that masculinized right 2D:4D and Δ2D:4D are associated with a predisposition to lung cancer and/or the more aggressive forms of lung cancer.

Satisfaction from surgical treatment and its influence on the wellbeing of patients with Recklinghausen disease - preliminary report

&lt;b&gt;Background:&lt;/b&gt; Neurofibromatosis type 1 (NF-1) is one of the most common autosomal dominant disorders. Multiple benign dermal neurofibromas, café au lait spots, axillary and inguinal freckling are the hallmarks of NF-1. &lt;br&gt;&lt;b&gt;Aim:&lt;/b&gt; The aim of this paper is to verify if surgical treatment performed in patients with NF-1 is satisfactory to them and to describe demographic factors characteristic for patients with Recklinghausen disease. &lt;br&gt;&lt;b&gt;Methods: &lt;/b&gt;A special questionnaire was prepared for the study, which contained 45 questions. Seventeen patients with neurofibromatosis type 1 agreed to fill in the questionnaire aged from 22 to 61 years. &lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; Surgical treatment in patients was started between 6 and 45 years of age. All patients declared their will to continue surgical treatment. After treatment patients felt more comfortable, more self-confident and sociable. The first symptoms of neurofibromatosis were seen at about 13 years of life in most patients. All women who gave birth noticed progression of the disease during pregnancy. &lt;br&gt;&lt;b&gt;Conclusions: &lt;/b&gt;Performed surgical treatment raises life comfort and increases self-confidence in patients with neurofibromatosis type 1. Due to visible skin changes in neurofibromas it is worth referring patients to Plastic Surgery Departments. Doctors dealing with patients with NF-1 should inform them about the potential heredity of the disease and that puberty and pregnancy intensify the process of skin neurofibroma development.

Second to fourth digit ratio (2D:4D) in women with carpal tunnel syndrome

BACKGROUND

Carpal tunnel syndrome (CTS), a median nerve compressive neuropathy at the wrist, is the most common entrapment nerve disorder. Sex is an important risk factor of CTS as this condition is to five times more common in women than in men (sex-hormone dependent). There are no studies concerning 2D:4D (biomarker of prenatal sex steroids exposure) in patients with CTS.

AIM

Here we consider the relationship between 2D:4D and CTS in women.

STUDY DESIGN AND METHODS

The study involved 90 female participants (40 with a severe CTS (the mean age - 52.78 yrs., SD 11.44) and 50 control women (the mean age - 47.2 yrs., SD 8.23)). Anthropometric measurements were performed and the following indices were calculated: BMI, WHR and right and left 2D:4D.

RESULTS

A stepwise logistic regression model showed that higher WHR and lower right 2D:4D increase the risk of CTS in women (AUC = 0.8865).

CONCLUSIONS

These associations may suggest a role for prenatal and post-natal sex-hormones in CTS development, i.e. in the context of oestrogen receptor activation (number and/or sensitivity) and the pattern of fat distribution. Further studies examining the role of hormonal influence in this disorder may help to plan prophylaxis of CTS (e.g. early HRT).

A New Tool for Breast Anthropometric Measurements: Presentation and Validation for Women and Men

Introduction

Anthropometric measurements of breasts are crucial for planning surgical procedures; however, there are no practical solutions for their quick, digital performance. The aim of the study was to present and validate a self-designed web application BreastIdea (BI) designed for indirect breast anthropometry.

Methods

Ten male and 10 female volunteers had their chests measured directly according to the routine clinical practice. Then their chests were photographed in non-standardised conditions. Corresponding measurements were performed using BI. Accuracy and both relative and absolute reliability of BI measurements were investigated.

Results

Breast assessments using BI yielded highly accurate results and presented near-perfect precision when compared to direct anthropometric measurements of the breast. Indirect anthropometry eliminates the necessity to trace the body’s curves, which usually introduces a bias to linear measurements.

Conclusion

BI web application is a reliable tool for indirect breast measurements in a clinical setting, providing accurate results regardless of chest pathology and photograph standardisation.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Autologous fat transfer for facial recontouring in Parry-Romberg syndrome

BACKGROUND

Parry-Romberg syndrome (PRS) is a rare condition involving self-limited progressive facial hemiatrophy.

AIMS

To analyze esthetic results of fat graft used for correcting soft-tissues atrophy in PRS patients, in the aspect of volume restoration and skin rejuvenation, to present our experience in redefining facial contours in PRS and modification of fat graft accusation technique (based on Coleman's technique).

PATIENTS/METHODS

A prospective evaluation study was designed to analyze esthetic results (contour and skin condition), complications, and subjective satisfaction of eight patients with PRS treated with fat graft.

RESULTS

All patients underwent two (n = 6) or three (n = 2) procedures in 3 months intervals (the mean 3.7 months). No major postoperative complications were observed. The authors evaluated their esthetic results concerning face contour and symmetry as good (in four patients) and very good (in four patients). Subjective assessment showed high patients' satisfaction with the final result of face contouring (the mean VAS [0-5]-4.75).

CONCLUSIONS

Our experience shows that fat grafting in patients with PRS is safe and gives satisfactory results in the aspect of volume restoration and skin quality improvement. Modified technique of graft preparation (112 g for 3 minutes) enables to obtain less dense fat graft, which is more appropriate in case of PRS patients with thin atrophic skin.

Sublay or onlay incisional hernia repair along with abdominoplasty: which is better? Long-term results

PURPOSE

Estimation and comparison of results after incisional hernia repair (IHR) modo onlay or sublay with abdominoplasty in patients who lost the weight following Roux-en-Y Gastric Bypass (RYGB). Analysis and comparison of changes in quality of life (QL) of these patients prior to RYGB, before and after simultaneous IHR and abdominoplasty.

METHODS

Clinical analysis involved 40 patients with abdominal disfigurement (following RYGB and massive weight loss) after one-time IHR sublay method with abdominoplasty-group 1 or IHR onlay method with abdominoplasty-group 2. We evaluated postoperative results and long-term QL changes (DAS24, SF-36 scales).

RESULTS

We noted abnormal wound healing (2), pneumonia (3) and dysesthesia (3) in patients from group 1, and abnormal wound healing (2), seroma (2), pneumonia (2), and dysesthesia (4) in group 2. Quality of life was improved in the functional, esthetic and psychological aspects.

CONCLUSIONS

One stage incisional hernia repair by onlay as well as sublay method with abdominoplasty are safe surgical methods improving the functioning of patients after major weight loss following RYGB. Sublay hernia repair and abdominoplasty was connected with longer time of the: operation, drainage, analgesic agents use, time to mobilization and to full oral diet than the onlay method. Significant improvement of the quality of life was noted after every subsequent step of surgical treatment in both groups. Reduction of the risk of BMI re-growth after bariatric surgery is related to the need for constant, specialized care for these patients at every stage of follow-up after bariatric surgery.

Is There a Rationale behind Pharmacotherapy in Idiopathic Gynecomastia?

BACKGROUND/AIMS

The aim of this research was to analyze digit ratio in relation to estrogen receptor (ER) and progesterone receptor (PR) expression and to verify digit ratio (2D: 4D) as a marker of ER and PR overexpression in the male breast.

METHODS

This study included 35 patients who underwent breast reduction due to the idiopathic form of gynecomastia. The average age of the studied individuals was 25.7 years (SD = 7.8). ER and PR expression was detected in breasts, and digit ratios were calculated in patients with idiopathic gynecomastia.

RESULTS

ER expression did not correlate with the right (p = 0.51) and left 2D: 4D (p = 0.97). Also, there was no correlation between PR expression and 2D: 4D. A lack of correlation between these variables may result from the fact that the analyzed group of men with idiopathic gynecomastia was small in number, but at the same time, it appeared to be homogenous in these aspects (positive ER and/or PR expression and high digit ratio).

CONCLUSION

High digit ratio in men with gynecomastia may tend to be a marker of overexpression of ER and PR. This may justify an early use of tamoxifen in men with gynecomastia and a high digit ratio.

One stage onlay hernia repair with abdominoplasty in patients following gastric bypass surgery

PURPOSE

1. Evaluation of results after one-time incisional hernia repair (IHR) modo on-lay and abdominoplasty (Ab-pl) in patients after loss of weight following previous Roux-en-Y Gastric Bypass – RYGB. 2. Analysis of differences in quality of life (QL) changes in bariatric patients before RYGB, as well as before and after abdominal contouring operation.tion.

MATERIAL AND METHODS

Clinical analysis involved 20 patients with abdominal disfigurement (following RYGB, and massive weight loss) who underwent one-time IHR using on-lay method together with abdominoplasty. We estimated postoperative results, as well as changes in QL, before RYGB and before and after abdominal contouring procedure (based on DAS 24 and SF-36 scales) in comparison with stage before surgeries.

RESULTS

Complications - abnormal wound healing (infection, local necrosis) and pneumonia were found in two persons, seroma in two cases, whereas dysesthesia in four patients. We confirmed QL improvement in all aspects after each stage of treatment.

CONCLUSIONS

1. One-stage on-lay hernia repair and abdominoplasty is a safe method improving the functioning of patients. 2. All stages of bariatric treatment resulted in gradual improvement of the quality of life. 3. High BMI in patients before onlay incisional hernia repair with abdominoplasty increases the risk of complications, which is connected with longer hospital stay.

Degloving lower leg injury - the importance of additional treatment: negative pressure and hyperbaric oxygen therapy

Degloving injury poses a severe therapeutic challenge concerning both trauma and plastic surgery. The injury involves separation of skin and subcutaneous tissue from fascia and muscles. Treatment is often long-lasting and brings unsatisfying results due to the extent of damage, risk of infection and massive blood loss. In this article, we present the management and therapeutic outcomes of a patient admitted due to the degloving injury of the lower extremity caused by workplace accident. We described the complexity of treatment including surgical intervention as well as additional treatment, which combined brought good esthetic outcome.

Do skin and hair pigmentation in prepubertal and early pubertal stages correlate with 2D:4D?

OBJECTIVES

In most human populations women are less pigmented than men. However, before puberty, boys tend to have lighter skin than girls. Previous research has shown that skin pigmentation in European women is negatively correlated with digit ratio (2D:4D). Therefore, it has been hypothesized that skin pigmentation in females is partially controlled by prenatal hormones. The aim of this study was to examine the correlation between 2D:4D and pigmentation in girls and boys in the prepubertal or early pubertal stages of ontogenesis.

METHODS

The study group consisted of 598 Polish children (275 boys), aged 6.5-10.5 years. All underwent spectrophotometric measurements of skin and hair melanin index (SMI and HMI) and had the second and the fourth finger on both hands measured directly.

RESULTS

SMI (in girls) and HMI (in girls and boys) were positively correlated with age but 2D:4D was not. We regressed SMI and HMI on age and used the residuals as a measure of age-independent pigmentation. In girls, positive correlations were found between resSMI and 2D:4D for the right hand, but there was no correlation with left 2D:4D. In boys, resSMI did not correlate with 2D:4D. The resHMI was not related to 2D:4D in girls or boys.

CONCLUSION

Skin pigmentation in prepubertal or early pubertal girls is related to 2D:4D such that high 2D:4D is associated with higher pigmentation. This relationship may be mediated by the individual rate of sexual maturation.

External auditory meatus and/or conchal bowl reconstruction with postauricular island flap in patients with Basal Cell Carcinoma or Squamous Cell Carcinoma

Aims. Presenting our clinical experience with the postauricular island flap (pif) and estimation of the results following partial external auditory canal (eac) and/or auricular conchal bowl reconstructions with the pif in patients after carcinoma resections. Methods. We have analyzed postoperative results of 19 patients after auricular conchal bowl (11), or auricular conchal bowl and eac (8) reconstructions with pif, following malignant tumor resections, between 2000-2015. The patients were followed-up and evaluated in respect of early and long-term results after surgical treatment considering plastic surgeon’s and patient’s opinion. Results. The cancers were completely excised in all patients, and there were no recurrences within at least 2 years of follow-up. The observed complications after reconstructions comprised venous congestion in five cases (26.3 %), pinning of the operated ear in four patients (21 %), prominent earlobe in three (15.8 %), and eac constriction in three cases (15.8 %). Postoperative result was very good in all cases (both in the opinion of plastic surgeon and patients), except patients with pinning of the operated ear, prominent earlobe (moderately satisfied). Conclusions 1. Combined operations involving postauricular island flap reconstructions after partial (external auditory meatus and/or auricular conchal bowl) resections allowed for complete removal of malignant tumors with no evidence of recurrence, and also preservation of proper conchal shape in the reconstructed ear. 2. Retroauricular approach in cases with cancer involvement of the external auditory meatus allowed for proper visualization and estimation of lesions extent, as well as adequate surgical access.

Distribution of lip and/or palate clefts types among children form Lodz during years 1981-2015

Introduction. Cleft lip and/or palate are the most common face malformations. Clinical picture of these anomalies is very variable. Cleft can include only lip and/or alveolus, palate or all of these structures can be clefted. Aim. The aim of this paper is to present all particular types of clefts, their relationship to sex and body side in the group of children from Lodz during the years 1981-2015. Material and method. The study group included 434 patients with facial clefts (218 males and 216 females) in the age between 4 weeks to 18 years. Results. In the analyzed group there were 181 palate clefts (41.7%), 156 lip and palate clefts (36%) and 97 lip clefts (22.3%). Detailed analysis of clefts types showed that isolated palate clefts are definitely more frequent in females than males (112 vs 69), while lip and palate clefts in boys than girls (96 vs. 60). Conclusions. During 35 years in children form Lodz the most common type of anomaly were palate clefts, followed by lip and palate clefts and the less frequent were lip clefts. Palate clefts are more common in girls, while lip and palate clefts in boys. Left-sided clefts are two times more common than right clefts.