The "Central Tendency Bias" in the assessment of facial attractiveness in group-based and individual ratings-A survey-based study in 727 volunteers

BACKGROUND

The increasing number of esthetic procedures emphasizes the need for effective evaluation methods of outcomes. Current practices include the individual practitioners' judgment in conjunction with standardized scales, often relying on the comparison of before and after photographs. This study investigates whether comparative evaluations influence the perception of beauty and aims to enhance the accuracy of esthetic assessments in clinical and research settings.

OBJECTIVE

To compare the evaluation of attractiveness and gender characteristics of faces in group-based versus individual ratings.

METHODS

A sample of 727 volunteers (average age of 29.5 years) assessed 40 facial photographs (20 male, 20 female) for attractiveness, masculinity, and femininity using a 5-point Likert scale. Each face was digitally edited to display varying ratios in four lip-related proportions: vertical lip position, lip width, upper lip esthetics, and lower lip esthetics. Participants rated these images both in an image series (group-based) and individually.

RESULTS

Differences in the perception of the most attractive/masculine/feminine ratios for each lip proportion were found in both the group-based and individual ratings. Group ratings exhibited a significant central tendency bias, with a preference for more average outcomes compared with individual ratings, with an average difference of 0.50 versus 1.00. (p = 0.033) CONCLUSION: A central tendency bias was noted in evaluations of attractiveness, masculinity, and femininity in group-based image presentation, indicating a bias toward more "average" features. Conversely, individual assessments displayed a preference for more pronounced, "non-average" appearances, thereby possibly pointing toward a malleable "intrinsic esthetic blueprint" shaped by comparative context.

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".

Collapse

Key Words

• COVID-19
• Digit ratio
• Oxygen therapy

Collapse

MESH Headings

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

Collapse

Grants Collapse

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

Collapse

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>.

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.

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.

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.

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.

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.

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.

Body size measurements, digit ratio (2D:4D) and oestrogen and progesterone receptors' expressions in juvenile gigantomastia

Background Juvenile breast hypertrophy is characterised by massive enlargement of the breast in the peri-pubertal period. We aimed to analyse body size measurements (body mass index [BMI], waist-to-hip circumference ratio [WHR]), digit ratio (ratio of II and IV digits' length [2D:4D]) and oestrogen receptor (ER) alpha (ERα) and progesterone receptors (PRs) in the breast gland in women with juvenile gigantomastia. Methods The study involved 30 women (mean age 25.7 years) (mean age of onset - 14.8 years). ERα and PR expressions were detected immunohistochemically in breast gland samples. For comparison, 100 controls (50 women and 50 men) were included. Results BMI and WHR in women with gigantomastia were higher than in control women and the former had a higher WHR than expected for their BMI. 2D:4D in the examined women did not differ from that in control women. However, left 2D:4D was negatively related to the age of gigantomastia onset. There were no correlations between ER and PR expressions and the analysed body and digit ratios. Conclusions The lack of a relationship between 2D:4D and juvenile breast hypertrophy may suggest that foetal exposure to sex hormones may not be crucial in its aetiology. However, the link between high left 2D:4D and early development of gigantomastia suggests that prenatal sex hormones have a role in its development timing. High WHR, and particularly high WHR relative to BMI, may indicate that these women had at some stage of development higher circulating androgens, which may have been converted to oestrogens in breasts due to local aromatase activity. Verification of this hypothesis could allow consideration of the role of aromatase inhibitors in juvenile breast hypertrophy.

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.

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.

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.

Collagen type III and elastin genes polymorphism and the risk of nonsyndromic striae

BACKGROUND

Striae have been reported to be one of the most common skin lesions and a commonly encountered esthetic problem.

OBJECTIVES

The aim of this research was to examine elastin gene polymorphism (rs7787362, ELN) and collagen type III alpha 1 polymorphism (rs1800255, COL3A1) among polish woman population with SD in comparison with women without the lesions and to verify these polymorphisms as risk factors for SD.

METHODS

Seventy female students (35 with striae (the mean age 23.9 years, SD 1.2 years) and 35 without these lesions (22.9 years, SD 1.7 years)) were included in the study. The subjects were asked to fill out a questionnaire including questions concerning risk factors for SD and had a cheek swabbed for cells for DNA isolation.

RESULTS

Analysis of polymorphisms of elastin gene (rs7787362) and COL3A1 gene (rs1800255) showed that women with SD and without these lesions did not differ in these aspects. Polymorphism rs7787362 was also analyzed in relation to SD in different locations, and showed no differences.

CONCLUSION

In conclusion, we found that there are some clinical factors that reduced the risk of SD: history of intended weight loss, negative family history of SD, and lower BMI. Gene polymorphisms analysis in patients with SD may help to establish the etiology of these lesions and to target the therapy. Analysis of polymorphisms of elastin gene (rs7787362) did not show differences in allele distribution between women with and without SD. Polymorphisms of COL3A1 gene (rs1800255) also did not differ between the examined groups.

Comparison of objective and subjective evaluation of breast symmetrization results in patients with Poland syndrome

Introduction: There are many methods of analyzing the appearance of the breasts, but most of them are based on the patient’s subjective assessment or on the opinion of a specialist panel. Anthropometric measurements enable objective breast evaluation. The aim of the study was to compare the objective and subjective evaluation of aesthetic results of breast symmetrization in patients with Poland syndrome. Material and methods: The analysis of the results of the treatment was performed in 7 patients treated surgically due to unilateral breast underdevelopment in Poland syndrome. In the postoperative assessment, the following features were considered: 1 - breast volume, symmetry of: 2 – nipple areola-complexes (NAC), 3 - inframammary folds (IMF), 4 – upper poles (UP). The subjective assessment performed by the patient included each of the listed features and the overall satisfaction with the results of symmetrization on the 10-point Likert scale. Then, objective metric breast analysis was performed. Results: Overall assessment of postoperative breast asymmetry (mean 8.1) indicates a high level of patients’ satisfaction with breasts symmetrization. An objective analysis showed that the average breasts’ difference in volume was about 36 cc and the difference in NAC location was about 1.2 cm. Conclusion: 3D imaging is helpful in planning breast symmetrization procedures, especially in breast prostheses’ selection. Combination of this method with clinical experience results in good postoperative effects.

Do body build and composition influence striae distensae occurrence and visibility in women?

BACKGROUND

Striae have been reported to be one of the most common skin changes and a commonly encountered esthetic problem.

OBJECTIVES

To analyze risk factors of striae not associated with pregnancy and verify if body build and composition influence striae distensae (SD) occurrence and visibility.

METHODS

Eighty female students (40 with striae (the mean age 23.9 years, SD 2.05 years) and 40 without these lesions (24.7 years, SD 6.2 years)) were included in the study. The subjects were asked to fill out a questionnaire including questions concerning risk factors of SD. Body build and composition were examined using Tanita SC-331S Body Composition Analyzer.

RESULTS

Women without striae more often reported a history of intended weight loss (P < .0001), less frequently had a history of contraceptives intake (P < .001) and more often their family history of striae was negative or unknown (P = .01). Multivariate analysis including body build and composition parameters indicated BMI as risk factor of SD (P = .021; OR =1.155, 95% CI 1.006; 1.325).

CONCLUSIONS

History of contraceptives intake and a family history of striae are risk factors of SD occurrence, while weight loss can reduce the risk of these lesions. BMI appeared to be the risk factor of striae visibility, especially in abdomen, but not on the buttocks. Further clinical researches are needed to examine the pathophysiology of this condition and to inform patients about the possibility to reduce the risk of striae occurrence.

Gender-related risk factors for perioperative stroke after carotid endarterectomy in symptomatic patients

BACKGROUND

Carotid endarterectomy (CEA) is a surgical procedure used in ischemic brain stroke prevention in patients with symptomatic and asymptomatic severe carotid artery stenosis.

OBJECTIVES

This study compares perioperative stroke or death rate after carotid endarterectomy (CEA) in male and female patients, and determines risk factors for perioperative incidents in women and men.

MATERIAL AND METHODS

The outcome of surgical treatment of 269 consecutive symptomatic patients (181 men and 88 women) treated from January 2004 to August 2008 in the Department of Vascular, General and Oncologic Surgery was analyzed.

RESULTS

Perioperative stroke-death rate (within 30 days after the surgery) in women was 6.8% (6/88) and 3.3% (6/181) in men (p > 0.05). In the female group, none of the analyzed risk factors were associated with a higher risk of periprocedural incident, while in men, only hypercholesterolemia was a significant predictor of perioperative stroke (TC > 240 vs 240 vs 200-240: OR = 6.59; 95% CI: 1.12-38.97; p = 0.0375).

CONCLUSIONS

In men, hypercholesterolemia significantly increased the risk of perioperative stroke or death, while in females, none of the analyzed factors were determined as the predictors of the incident. The fact that plaque type VI by AHA was significantly more frequent in women and men more frequently were suffering from ischemic heart disease and peripheral artery occlusive disease appeared not to influence the outcome of CEA.

Are animal-related injuries in rural areas a social problem? A survey from Poland

OBJECTIVE

The aim of this study was to analyze the mechanisms of animal-related injuries in Polish rural areas, and to evaluate the effects of such injuries on subjects' health and social life.

MATERIAL AND METHODS

Data concerning animal-related injuries were collected from 102 patients (45 females and 57 males, mean age 45.01±11.4 years) on the basis of a questionnaire. The study was conducted in the rural area of central Poland. Moreover, to assess the severity of injuries to the head and neck region, the Facial Injury Severity Scale (FISS) was applied.

RESULTS

The most commonly affected body areas are the upper and lower limbs, which explains the fact that most subjects do not recognize the injury-related deformity as an aesthetic defect.Statistical correlations were observed in several aspects, amongst others: - women were significantly more likely than men to consider undergoing surgical procedures to eliminate/reduce post-traumatic deformities and scars (p<0.05); - injury-related deterioration in appearance resulted in limitations of patients' social life (p<0.0001).

Digit ratio (2D:4D) and postoperative pain perception

BACKGROUNDS

It has not been established whether sex differences in pain perception are influenced by prenatal sex hormones. Digit ratio as an indicator of prenatal hormone exposure can be used as a simple measure of the influence of prenatal hormones on pain sensitivity or perception in adulthood.

OBJECTIVE

The aim of this study was to determine a correlation between the 2D:4D ratio and pain perception in the postoperative period after rhinoplasty.

METHOD

A prospective cohort study of 100 patients (50 women of the mean age of 30.74±8.09years and 50 men of the mean age of 30.98±10.86years) who underwent posttraumatic rhinoplasty due to the nose trauma in Plastic, Reconstructive and Aesthetic Surgery Clinic. The following measurements were taken the day before a surgery: body height, waist and hip circumference, II and IV digits' lengths and body weight. All subjects filled in a questionnaire including 0-10-point VAS scales to assess postoperative pain 1h after an operation (AO), 6h AO, 12h AO, 24h AO and 48h AO.

RESULTS

Women with low 2D:4D reported significantly more pain 1h after an operation than women with high 2D:4D. Similar correlation was observed for low 2D:4D in women 48h AO. In men, low 2D:4D was associated with lower postoperative pain 12h AO (p=0.029).

CONCLUSION

In conclusion, we showed that low 2D:4D in women was associated with high postoperative pain, and low right 2D:4D in men was associated with low postoperative pain. This may suggest that intrauterine estrogen exposure makes women more resistant to pain.

Photographic Documentation in Plastic Surgeon's Practice

The aim of the study was to analyze practices of clinical photographic documentation management among plastic surgeons in Poland as well as to gain their opinion about the characteristics of "ideal" software for images archiving.

MATERIAL AND METHODS

The on-line survey link was send (via e-mail) to all members of Polish Society of Plastic, Reconstructive and Aesthetic Surgery. From 187 members, 86 subjects (47.5%, 54 men and 32 women, of the mean age 40.8 years ± 10.6 years) filled in the on-line questionnaire, which constitutes a representative sample of plastic surgeons practicing in Poland.

RESULTS

The study showed that only 7% of plastic surgeons use IT applications dedicated to archiving photographs. Instead, more than half of them store photos in ordered folders on computers. The majority of respondents (89.3%) are interested in using a dedicated computer application to archive photographic documentation. The most important features, which an application of this type should have are (265 answers): quick search (26%), easy to use (24%), quick data entry (22%), data security (15%), an ability to print selected data (7%), availability only to authorized employees of the unit (5%).

CONCLUSIONS

Cooperation of health care providers with informatics may lead to the conceptualization of a program fulfilling the requirements of specific medical groups. On the basis of the questionnaire study we have collected the data necessary to create the concept of the unique software that would be useful for clinical practice of plastic surgeons as well for other specialists dealing with photographic documentation.

Skin color parameters and Fitzpatrick phototypes in estimating the risk of skin cancer: A case-control study in the Polish population

BACKGROUND

Light skin pigmentation is a known risk factor for skin cancer.

OBJECTIVE

Skin color parameters and Fitzpatrick phototypes were evaluated in terms of their usefulness in predicting the risk of skin cancer.

METHODS

A case-control study involved 133 individuals with skin cancer (100 with basal cell carcinoma, 21 with squamous cell carcinoma, 12 with melanoma) and 156 healthy individuals. All of them had skin phototype determined and spectrophotometric skin color measurements were done on the inner surfaces of their arms and on the buttock. Using those data, prediction models were built and subjected to 17-fold stratified cross-validation.

RESULTS

A model, based on skin phototypes, was characterized by area under the receiver operating characteristic curve = 0.576 and exhibited a lower predictive power than the models, which were mostly based on spectrophotometric variables describing pigmentation levels. The best predictors of skin cancer were R coordinate of RGB color space (area under the receiver operating characteristic curve 0.687) and melanin index (area under the receiver operating characteristic curve 0.683) for skin on the buttock.

LIMITATIONS

A small number of patients were studied. Models were not externally validated.

CONCLUSIONS

Skin color parameters are more accurate predictors of skin cancer occurrence than skin phototypes. Spectrophotometry is a quick, easy, and affordable method offering relatively good predictive power.

[Helicopter emergency medical services for patients with cerebral stroke]

OBJECTIVES

The aim of this cross-sectional study was to analyze transport by helicopter emergency medical services (HEMS) in cases of ischemic cerebral stroke in Poland in 2011 and 2012. We assessed the role of the HEMS in reducing prehospital times and analyzed changes in patients' status during transport.

MATERIAL AND METHODS

Retrospective study of all missions flown by the Polish HEMS to attend stroke patients over the 2-year period. The following data were collected for each mission and patient: time from activation of the HEMS until arrival at the scene, time spent at the scene; and scores on the National Advisory Committee for Aeronautics scale, the Revised Trauma Scale (ETR), and the Glasgow Coma Scale (ECG) at the scene and on transfer of the patient to the hospital or ambulance.

RESULTS

A total of 1191 patients were analyzed. The mean (SD) ETR and ECG scores on the scene were 11.1 (1.36) and 11.8 (3.39), respectively. After HEMS transport the means were 11.0 (1.5) and 11.7 (3.5). In-flight transport did not affect the patient's condition, but more time spent at the scene was associated with significantly lower scores on the scales.

CONCLUSION

Helicopter transport of these patients is safe and ensures their transfer to the nearest hospital or ambulance within the treatment time window. Time spent on care at the scene of the emergency should probably be as short as possible.

Can digit ratio (2D:4D) studies be helpful in explaining the aetiology of idiopathic gynecomastia?

BACKGROUND

Aetiology of idiopathic form of gynecomastia is unknown and it has not been established if it is related to factors present at the prenatal period or if it is caused by yet unidentified environmental conditions.

OBJECTIVE

The aim of this study is to compare digit ratio (2D:4D) in men with idiopathic gynecomastia and unaffected male and female controls from the general population.

METHODS

The study involved 250 subjects (50 men with idiopathic gynecomastia, 100 control men and 100 control women). Eight measurements were taken: body height, waist and hip circumferences, II and IV digits' lengths (right and left), and body weight, and 4 indices were calculated: BMI, WHR, and 2D:4D for the right and left hand.

RESULTS

2D:4D in men with gynecomastia ([median (I-III quartiles)]: 1.03 (1.01-1.04) for right hand and 1.03 (1.01-1.03) for left hand) was significantly different than the ratio in control men [0.97 (0.95-0.99)] for right and left hand) (p<0.0001) and similar to the ratio found in control women [1.02 (1-1.03)] for right and left hand) (p=1). Men with gynecomastia were characterized with higher values of the following variables: weight, waist and hip circumferences, BMI and WHR. Their body height was significantly greater than in women (p<0.0001) but similar to the values observed in control men (p=0.2687).

CONCLUSION

The findings presented in this study may influence the aetiology-related classification of gynecomastia and justify introducing the new group: "gynecomastia related to the prenatal sex hormones disturbances".

Analysis of complications after blood components’ transfusions

Complications after blood components still constitute an important clinical problem and serve as limitation of liberal-transfusion strategy.

The aim of the study was to present the 5-year incidence of early blood transfusions complications and to assess their relation to the type of the transfused blood components.

Material and methods. 58,505 transfusions of blood components performed in the years 2006-2010 were retrospectively analyzed. Data concerning the amount of the transfused blood components and the numbers of adverse transfusion reactions reported to the Regional Blood Donation and Treatment Center (RBDTC) was collected.

Results. 95 adverse transfusion reactions were reportedto RBDTC 0.16% of alldonations (95/58 505) - 58 after PRBC transfusions, 28 after platelet concentrate transfusions and 9 after FFP transfusion. Febrile nonhemolytic and allergic reactions constitute respectively 36.8% and 30.5% of all complications.

Conclusion. Nonhemolyticand allergic reactions are the most common complications of blood components transfusion and they are more common after platelet concentrate transfusions in comparison to PRBC and FFP donations.

Dermatoscopy as a Helpful Tool in Plastic Surgeon’s Practice – A Preliminary Study

The aim of the study was to examine the utility of dermatoscopy in plastic surgeons’ practice in pigmented and non-pigmented skin lesions management.

Material and methods. The examined group consisted of 68 patients with 132 lesions (50 women and 18 men) aged from 12 to 75 years (the mean: 47.2 years ± 16.9 years), who underwent dermatoscopy. Dermatoscopic photographs were analysed according to the ABCD and 7-point scales and then, a further treatment (surgical excision, electro resection or regular follow-up and observations) was planned.

Results. The mean score of all lesions according to ABCD scale was 2.34 while in 7-point scale it was 0.62. In male and female groups the number of lesions and their ABCD and 7-point scale scores were similar (p>0.05). Histopathological examination revealed that all excised lesions were benign (compound melanocytic nevi) which corresponded with dermatoscopic evaluation.

Conclusions. Dermatoscopy seems to be helpful in surgeons’ dealing with skin lesions practise and in many cases it enables to choose less invasive technique of lesions’ removal (electro resection), which gives better aesthetic results.

Neurologic and functional long-term outcome after carotid endarterectomy

BACKGROUND

The aim of this research was to assess the neurologic status of patients a year after endarterectomy with the use of National Institutes of Health Stroke Scale (NIHSS) and the degree of disability using the modified Rankin Scale (mRS) and to examine the patients' subjective evaluation of their health.

METHODS

One hundred two patients with symptomatic internal carotid artery stenosis who underwent endarterectomy and attended a 1-year follow-up examination were enrolled in the study. The material comprised 72 (70.6%) men and 30 (29.4%) women. Before the surgery, the patients' neurologic status was assessed according to the NIHSS, and their functional status was rated with the mRS. Additionally, the patients were asked to assess their life quality on a 10-point Likert scale.

RESULTS

The mean NIHSS score before the operation was 2.76 points (SD 2.47), whereas a year after it was 2.05 points (SD 1.84) (P < .0001). The NIHSS scores that improved significantly a year after endarterectomy were level of consciousness-questions and commands, motor leg, and sensory (P < .05).

CONCLUSIONS

The patients' neurologic status assessed with the NIHSS improved significantly 1 year after carotid endarterectomy mostly because of the improvement in their verbal and motor communication ability, physical condition and agility, and reduction in sensory disturbances. The observed changes in the neurologic status were reflected in the functional status and subjective life quality assessment, which appeared to be significantly better a year after the surgical treatment.