Gynekomastie je definována jako benigní proliferace mužské prsní žlázy, během života se může objevit až u 40-65 % mužů. Pubertální gynekomastie je ve většině případů důsledkem hormonální nerovnováhy, většinou vzniká u Tannerova stadia 3-4, kdy testikulární objem dosahuje 8-10 ml, v průměrném věku 14 let. Později spontánně vymizí, nevyžaduje tak terapeutickou intervenci. Ve zbývajících případech je nutné vyloučit patologickou příčinu. Metodou první volby je konzervativní terapie, při neuspokojivém výsledku je ve vzácných případech indikováno operační řešení. Kazuistika popisuje případ adolescenta s gynekomastií neodpovídající na konzervativní léčbu. Možnost chirurgického řešení před dosažením osmnácti let věku tak představuje významný posun ve strategii léčby gynekomastie a umožňuje tak podstatně zlepšit kvalitu života dospívajících.

Gynecomastia is defined as benign proliferation of the breast tissu; it can occur in up to 40-65% of men during their lifetime. In most cases, pubertal gynecomastia is the result of hormonal imbalance, it usually occurs in Tanner stage 3-4, when the testicular volume reaches 8-10 ml, at an average age of 14 years. Later it disappears spontaneously, so it does not require therapeutic intervention. In the remaining cases, it is necessary to exclude a pathological cause. The method of first choice is conservative therapy, in case of unsatisfactory results, very rare an operative solution is indicated. The case report describes the case of an adolescent patient with gynecomastia unresponsive to conservative treatment. The possibility of a surgical solution before reaching eighteen years of age thus represents a significant shift in the strategy of gynecomastia treatment and thus enables a substantial improvement in the quality of life of adolescents.

• MeSH
• gynekomastie * diagnóza   etiologie   terapie   MeSH
• lidé MeSH
• mladiství MeSH
• mléčné žlázy lidské patologie   MeSH
• pohlavní hormony MeSH
• tamoxifen aplikace a dávkování   terapeutické užití   MeSH
• zákroky plastické chirurgie metody   MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

• Publikační typ
• abstrakt z konference MeSH

In women at high risk of developing breast cancer, bilateral prophylactic mastectomy (BPM) 1 significantly reduces the risk; simultaneously, breast reconstruction preserves body integrity. Given the complex and personal nature of such surgical procedures, patient assessment of satisfaction and health-related quality of life (HRQoL) 2 is essential in evaluation of surgical outcomes. With this review, we aim to organize the current knowledge on patient-reported outcomes (PROs) 3 in bilateral prophylactic surgery. Literature search was conducted using the databases Google Scholar, PubMed, and Web of Science to address the following questions, which can help clinicians and women undergoing the procedures navigate their healthcare decision-making process: How does BPM with reconstruction influence cancer-related distress? How does the surgery impact patient satisfaction and HRQoL? How do preoperative PROs differ from postoperative outcomes? Does the type of BPM and the type of reconstruction impact patient satisfaction and HRQoL? Furthermore, we summarize available patient-reported outcome measures (PROMs) 4 that can be administered to women undergoing BPM with reconstruction. In addition, we discuss possible future directions for PRO research in prophylactic breast surgery.

• MeSH
• hodnocení výsledků péče pacientem MeSH
• kvalita života MeSH
• lidé MeSH
• mamoplastika * metody   MeSH
• mastektomie metody   MeSH
• nádory prsu * prevence a kontrola   chirurgie   MeSH
• profylaktická mastektomie * metody   MeSH
• spokojenost pacientů MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

• MeSH
• biomedicínský výzkum * MeSH
• kurzy a stáže v nemocnici * MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Geografické názvy
• Spojené státy americké MeSH

BACKGROUND: Lymphedema is a common adverse consequence of breast cancer therapy, while still relatively little is known about its pathophysiology. Several treatment options emerged over the past decades, and among them, vascularized lymph node transfer (VLNT) seems to be particularly promising. Animal models are indispensable to improve our understanding of the underlying processes surrounding the transplantation of a vascularized lymph node. This review aimed to systematically evaluate animal models of VLNT and compare their advantages and disadvantages. MATERIALS AND METHODS: A systematic review of literature in the Scopus, Web of Science, and Ovid MEDLINE databases was conducted according to the PRISMA guidelines to identify all studies on animal models used for the research of VLNT. The algorithm used in search of articles was "Vascularized Lymph Node Transfer" AND "Model". Articles were manually verified for relevance to the topic. The resulting models were assessed for their suitability for VLNT research. RESULTS: The literature search yielded a total of 233 studies after duplicates removal. Of those, 217 were excluded based on title and abstract review. Another study was excluded after reviewing the full-text article leaving 15 eligible studies to be included in this review article. CONCLUSIONS: Rats were found to be the most dominantly used animal model in the VLNT research, although other models had their benefits. The main areas of study were the functionality of VLNT within or without a preinduced lymphedema, its response to ischemia, and clarification of lymphatic pathways reestablishment following VLNT.

• MeSH
• krysa rodu rattus MeSH
• lidé MeSH
• lymfatické cévy * chirurgie   MeSH
• lymfatické uzliny MeSH
• lymfedém * etiologie   MeSH
• modely u zvířat MeSH
• nádory prsu * MeSH
• zvířata MeSH
• Check Tag
• krysa rodu rattus MeSH
• lidé MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH
• systematický přehled MeSH

BACKGROUND: Breast reconstructive surgery is often a multistage process. The aim was to understand which factors might increase the number of follow-up surgeries and the length of time required to complete the reconstruction process. METHODS: A cross-sectional analysis was performed. Clinical data of 110 patients who underwent delayed postmastectomy breast reconstruction with a 5-year examination period were reviewed retrospectively. Impact of clinical risk factors, oncological therapy, and reconstruction approach on the number of surgeries and the length of required time was analyzed. Mann-Whitney U test and Kruskal-Wallis rank sum test were used. RESULTS: In patients undergoing perioperative hormone therapy, an average of 2.9 surgeries and length of 20.2 months were required compared to 2.3 surgeries and 14.0 months in patients without hormone therapy (P = 0.003; P = 0.005). Previous abdominal surgery was associated with an increased number of breast reconstruction stages of 3.1 per patient (P = 0.056) and a longer reconstruction time of 23.0 months (P = 0.050). Patients undergoing nipple reconstruction or implant revision required an increased number of surgeries (P < 0.001; P = 0.012) and a longer reconstruction time (P = 0.002; P < 0.001). Contralateral breast surgery and flap revision were associated only with an increased number of surgeries (P < 0.001; P < 0.001). CONCLUSION: Perioperative hormone therapy was associated with a significantly higher number of surgeries and duration of time required to complete the reconstruction process. The highest increase in the number of surgeries was in patients with flap revision including anastomosis revision and necrectomy. 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 .

• MeSH
• estetika MeSH
• lidé MeSH
• mamoplastika * škodlivé účinky   metody   MeSH
• mastektomie metody   MeSH
• nádory prsu * etiologie   chirurgie   MeSH
• následné studie MeSH
• průřezové studie MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Patient-reported outcome measures (PROMs) have become an integral part of the evaluation of reconstruction surgery outcomes. However, there are limitations in current PROMs when it comes to the assessment of well-being during inpatient stay, patient perception of health, relationship with partner, and vitality (i.e., mood and ability to work and pursue hobbies, carry out daily tasks, and sleep) following breast reconstructive surgery. The aim was to develop a novel set of measures to compare patient satisfaction and health-related quality of life following different types of postmastectomy breast reconstruction. METHODS: A novel questionnaire was created and refined through cognitive interviews with patients and expert feedback. A field test study was conducted, including patients who had undergone delayed postmastectomy breast reconstruction with implant, autologous tissue, or combination of implant and autologous tissue. Based on the results, confirmatory factor analysis and examination of reliability of the questionnaire were conducted. Results of patient responses were analyzed using Chi-square test, Kruskal-Wallis test, and Mann-Whitney U test. RESULTS: Confirmatory factor analysis showed good model fit, and Cronbach's alpha indicated high internal consistency of the questionnaire. Besides that, patients with combination reconstruction reported significantly lower vitality than patients with implant and autologous reconstruction (p = 0.048). CONCLUSIONS: This novel questionnaire expands the current knowledge base of postmastectomy breast reconstruction PROMs. Results of the field test study showed that combination reconstruction was associated with lower patient vitality than other reconstruction types. 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 .

• MeSH
• estetika MeSH
• hodnocení výsledků péče pacientem MeSH
• kohortové studie MeSH
• kvalita života MeSH
• lidé MeSH
• mamoplastika * metody   MeSH
• mastektomie metody   MeSH
• nádory prsu * chirurgie   MeSH
• reprodukovatelnost výsledků MeSH
• retrospektivní studie MeSH
• spokojenost pacientů MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: The rate of reparative osteogenesis controls when an implant is sufficiently stable as to allow functional loading. Using a mini pig model, the rate of reparative osteogenesis in two types of implant sites for example, an osteotomy versus a fresh extraction socket were compared. METHODS: Eight adult mini pigs were used for the study. In phase I, three premolars were extracted on one side of the oral cavity; 12 weeks later, in phase II, osteotomies were produced in healed extraction sites, and contralateral premolars were extracted. Animals were sacrificed 1, 5, and 12 weeks after phase II. Bone repair and remodeling were evaluated using quantitative micro-computed tomographic imaging, histology, and histochemical assays coupled with quantitative dynamic histomorphometry. RESULTS: One week after surgery, extraction sockets and osteotomy sites exhibited similar patterns of new bone deposition. Five weeks after surgery, mineral apposition rates (MARs) were elevated at the injury sites relative to intact bone. Twelve weeks after surgery, the density of new bone in both injury sites was equivalent to intact bone but quantitative dynamic histomorphometry and cellular activity assays demonstrated bone remodeling was still underway. CONCLUSIONS: The mechanisms and rates of reparative osteogenesis were equivalent between fresh extraction sockets and osteotomies. The volume of new bone required to fill a socket, however, was significantly greater than the volume required to fill an osteotomy. These data provide a framework for estimating the rate of reparative osteogenesis and the time to loading of implants placed in healed sites versus fresh extraction sockets.

• MeSH
• endoseální implantace zubů metody   MeSH
• extrakce zubů metody   MeSH
• miniaturní prasata MeSH
• prasata MeSH
• premolár chirurgie   MeSH
• remodelace kosti MeSH
• zubní implantáty * MeSH
• zubní lůžko * diagnostické zobrazování   chirurgie   MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Úvod: Vaskularizovaný transfer lymfatických uzlin (vascularized lymph node transfer – VLNT) představuje již relativně zavedenou mikrochirurgickou techniku v léčbě lymfedému. Její užití je vhodné zejména u pokročilých stádií lymfedému, kdy již není lymfovenózní anastomóza (LVA) indikována pro pokročilou sklerotizaci lymfatických cév. Pokud je transfer uzlin prováděn izolovaně bez kožního ostrovu, jsou možnosti pooperačního monitoringu omezené. Cílem studie bylo vyhodnocení užití vysokofrekvenčního ultrazvuku s barevným dopplerem k monitoringu stopkovaných lymfatických laloků. Metody: Celkem 15 laloků bylo elevováno na stopce a. et v. thoracica lateralis u potkanů kmene Wistar. Axilární svazek byl šetřen pro zachování mobility a komfortu zvířat. Vzorek byl rovnoměrně rozdělen do 3 následujících skupin: skupina A, arteriální ischemie; skupina B, žilní okluze; skupina C, zdravá skupina. Výsledky: Ultrazvukové snímky a trojrozměrné rekonstrukce z dopplerovského ultrazvuku poskytly potřebné informace o morfologii laloků a o případných patologických změnách. Překvapivě jsme nalezli žilní průtok u skupiny A. Toto zjištění podporuje teorii pumpy a koncept venózního VLNT. Závěr: Použití trojrozměrného barevného ultrazvukového doppleru je efektivní metodou pro monitoring lymfatických laloků bez kožního ostrovu. Trojrozměrná rekonstrukce usnadňuje vizualizaci morfologie laloku a případnou detekci patologie. Tuto metodu není těžké si osvojit. Námi použité vybavení bylo uživatelsky přívětivé i v nezkušených rukách rezidenta a nálezy je možné kdykoli analyzovat zpětně, je-li to třeba. Použití trojrozměrné rekonstrukce stírá problémy spojené se subjektivním hodnocením v monitoringu VLNT.

Background: Vascularized lymph node transfer (VLNT) is a relatively well-established microsurgical treatment for lymphedema that is especially beneficial for advanced cases in which lymphovenous anastomosis is not indicated due to lymphatic vessel sclerosis. When VLNT is performed without a skin paddle, such as a buried flap, the possibilities for postoperative monitoring are limited. The aim of our study was to evaluate the use of ultra-high-frequency color Doppler ultrasound with 3D reconstruction in a pedicled axillary lymph node flap. Methods: Flaps were elevated in 15 Wistar rats based on the lateral thoracic vessels. We preserved the axillary vessels to maintain the rats’ mobility and comfort. The rats were divided into three groups as follows: Group A, arterial ischemia; group B, venous occlusion; and group C, healthy. Results: Ultrasound and color Doppler scan images revealed clear information on flap morphology changes and pathology if it was present. Surprisingly, we detected venous flow in group A rats, supporting the pump theory and venous lymph node flap concept. Conclusion: We conclude that 3D color Doppler ultrasound is an effective method for monitoring buried lymph node flaps. 3D reconstruction makes it easier to visualize the flap anatomy and detect pathology if it is present. Moreover, the learning curve for the technique is short. Our setup is user-friendly even in the inexperienced hands of a surgical resident, and images can be reevaluated at any time if necessary. The use of 3D reconstruction removes the complications associated with observer-dependent monitoring of VLNT.

• MeSH
• chirurgické laloky transplantace   MeSH
• lymfatické cévy chirurgie   diagnostické zobrazování   MeSH
• lymfatické uzliny * diagnostické zobrazování   transplantace   MeSH
• lymfedém terapie   MeSH
• mikrochirurgie metody   MeSH
• modely u zvířat MeSH
• potkani Wistar MeSH
• ultrasonografie dopplerovská barevná * metody   MeSH
• výzkum MeSH
• zobrazování trojrozměrné MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH
• Publikační typ
• práce podpořená grantem MeSH

The disconnect between preclinical and clinical results underscores the imperative for establishing good animal models, then gleaning all available data on efficacy, safety, and potential toxicities associated with a device or drug. Mini pigs are a commonly used animal model for testing orthopedic and dental devices because their skeletons are large enough to accommodate human-sized implants. The challenge comes with the analyses of their hard tissues: current methods are time-consuming, destructive, and largely limited to histological observations made from the analysis of very few tissue sections. We developed and employed cryo-based methods that preserved the microarchitecture and the cellular/molecular integrity of mini pig hard tissues, then demonstrated that the results of these histological, histochemical, immunohistochemical, and dynamic histomorphometric analyses e.g., mineral apposition rates were comparable with similar data from preclinical rodent models. Thus, the ability to assess static and dynamic bone states increases the translational value of mini pig and other large animal model studies. In sum, this method represents logical means to minimize the number of animals in a study while simultaneously maximizing the amount of information collected from each specimen.

• MeSH
• fyziologická kalcifikace MeSH
• kryoprezervace metody   MeSH
• kryoultramikrotomie metody   MeSH
• lebka cytologie   MeSH
• miniaturní prasata MeSH
• odběr biologického vzorku metody   MeSH
• polyethylenglykoly MeSH
• prasata MeSH
• remodelace kosti MeSH
• sacharosa MeSH
• sodná sůl karboxymethylcelulosy MeSH
• zvířata MeSH
• Check Tag
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH