Breast reconstruction as an integral part of breast carcinoma therapy (a self-present final report of a research project IGA MZ CR)

This comparative prospective study elucidates whether breast reconstruction that is not associated with systemic oncological treatment may trigger a tumour relapse, and if there is any difference between the evaluated reconstruction methods, a simple procedure using an implant versus a TRAM flap, on this hypothetical influence. The study group of 95 patients suffered from stage I-II of breast carcinoma. As regards the available reconstruction procedures, the study group was divided into two subgroups, the first using an implant (n1 = 33) and the second using a TRAM flap (n2 = 62). All oncological problems manifesting during the subsequent 12 months were considered as a response to the reconstruction. The oncological course was compared with two control groups. The first control group (k1 = 82) corresponded to the study group in terms of tumour stage (I-II), average age, time of initial diagnosis, type of primary surgery, i.e. mastectomy with axilla exenteration, and subsequent oncological treatment. The second control group (k2 = 19,625) was based on the National Oncology Register data. It was formed from all patients with breast carcinoma stage I-II from 1985-1994. The disease development in terms of the relative number of relapses and deaths was compared to the number of healthy and living patients, respectively, in the preceding year. The working hypothesis of late breast reconstruction (i.e. not associated with oncological treatment) being a possible trigger effect on the subsequent course of breast cancer has not been confirmed. No statistically significant differences at the 5% significance level were found between individual reconstruction methods and control groups in terms of the number of local relapses and survival length.

[Psychological and social stress in children with cleft lip and palate]

The authors analyzed representative data on the increase of inborn developmental defects in Czechoslovakia; in 1970-1980 the increment was + 50%. Inborn developmental defects are studied from the psychiatric aspect as a stimulus causing a reaction of the family to the breakdown of their parenteral expectations of a healthy child and the problem of continuation of the family. The reaction of the mothers is usually post-partum depression and impaired development of attachment to the child. The handicapped child is stressed by operations, rehabilitation, the awareness of his own insufficiency and problems of parenteral attitudes. The authors investigated the family-history, development of the health status of the children, social status of the children and personality of mother and child.

PRINCIPAL FINDINGS

children with cleft lip and palate suffer from social stigmatization and specific disorders of self-evaluation. In these children problems associated with adaptation in the child community, manifestations of depression, low self-esteem, impaired ego identity and a tendency of a negative attitude to the world were recorded. These phenomena increase with the severity of the damage and the visibility of the defect. If the mother bagatellizes or refutes the defect to achieve social desirability, the psychic position of the child is even worse. Approximately half the mothers and children expressed the need of special psychological care of problems associated with the defect. Actual areas are defined on which the need of care is focused in different stages of the family life cycle. The authors discuss the need of a realist attitude and acceptance of the defect in the interest of satisfactory adaptation, and the possibility of the paeditrician to assist families.

[Psychological and social problems in families with children with congenital defects]

The authors investigated a group of 109 mothers whose children with a cleft (dg. 749) were up to the age of 13-15 years in the care of the Clinic of Plastic Surgery. The cleft served as a model situation for investigation of the parents' reaction, in particular the mother's reaction, to the birth of the child with a developmental defect. The main findings: three quarters of the mothers described the birth of a damaged child as a psychic shock followed by a series of neurotic symptoms. Some mothers suffered from reactive depression which was not diagnosed and therefore not treated. It was confirmed that the poor mental condition of the mother persist in the majority of the investigated group to the time of the child's adolescence and has a marked effect on its mental prosperity. Latent or manifest negative attitudes of the parents cause mental handicapping phenomena in the children (impaired self-esteem, impaired sexual identification etc.). Aggravating factors are stigmatizing manifestations from the environment of the family and child community, which affect some three quarters of mothers and children. The authors discuss suitable forms of medical and counseling care which after delivery and later would help to reduce the psychic trauma of the parents and promote adequate somatic and mental development of the child.