Cortisol changes interact with the effects of a cognitive behavioural psychological preparation for surgery on 12-month outcomes for surgical heart patients

Previous studies offer contradictory evidence regarding the effects of cortisol changes on health outcomes for surgical heart patients. Increased cortisol and inflammation have been related to psychological stress while separate studies have found an inverse relation between cortisol and inflammation. Psychological preparations for surgery can reduce stress and improve outcomes and may interact with cortisol changes. Following from these relationships, we hypothesised that a preparation for surgery will interact with changes in cortisol to affect outcomes. Measures were the SF 36 General Health and Activities, medical visits and satisfaction. Eighty-five patients were randomly assigned to standard care plus a psychological preparation or standard care alone using a single-blind methodology. Data on psychological and biological functioning were collected at admission, 1 day prior and 5 days post-surgery, and 12-months after hospital discharge. General health and activities, and medical visits were related to the interaction of cortisol change and psychological preparation in support of the hypothesis. Patients were more satisfied in the preparation group than controls. Based on these findings, some outcomes from psychological preparations may be affected by changes in levels of cortisol. These results caution against a one-size-fits-all approach to psychological preparations.     

‘Use what God has given me’: Difference and disparity in breast reconstruction

African-American women are significantly less likely to undergo postmastectomy breast reconstruction compared to white women in the USA. These observed differences have been interpreted as evidence of a healthcare disparity. The current study examines breast reconstruction decision-making among African-American women, locating reconstruction decisions in a context of culture, racial inequality and biomedicalisation. Semi-structured interviews were conducted with 27 African-American women who underwent mastectomy for breast cancer to add patient-centred perspectives to existing conceptualisations of racial/ethnic differences in reconstruction. Participants were socio-demographically diverse, and resided in the New York metropolitan area. Data analysis was informed by grounded theory. Spiritually and culturally informed body ethics often guided surgery decisions. Participants expressed reservations about breast implants, preferring autologous procedures that use ‘what God has given’. For some, breast reconstruction restored a sense of normalcy after cancer; others challenged an imperative to reconstruct. Several participants redirected our focus on access to reconstruction toward access to alternatives, noting the low reimbursement for prostheses, or their unavailability in patients’ skin tones. We suggest that a framework of ‘stratified biomedicalization’ better addresses the complexities of race, class and gender that inform preference, access and recommendations for breast reconstruction, and focuses attention on access to high and low-tech interventions.     

Multiple timescales of body schema reorganization due to plastic surgery

Plastic surgery modifies the distribution of mass centers of a person’s body segments, changing his or her posture. The functional reorganization processes that lead subjects to re-integrate these body changes into a new stable body (posture) schema is poorly understood but current theories suggest the possible contribution of two components: a feedback mechanism that strongly depends on sensory input and an internal model that is relatively less dependent on sensory input and improves posture control, for example by compensating for delayed feedback. To assess the relative contributions of these two mechanisms during the functional reorganization of a posture scheme, we have conducted a longitudinal postural study in a population of healthy adults who were subject to breast plastic surgery to reduce or augment body weight. We measured participants’ orthostatic posture and ground reaction force immediately after, after 4 months, and 1 year after the surgery. To investigate the role of visual sensory information in the reorganization process we tested the participants with eyes open and closed. Our results indicate that participants find a new dynamical equilibrium within a few days. However, posture maintenance remains sub-optimal long after the center of masses and the resultant of ground reaction force stop changing; in some cases, for more than 4 months. Furthermore, the re-adaptation process is faster and more efficient in the eyes-open than in the eyes-closed condition. These results suggest that the reorganization involves different subsystems (responsible for the biomechanical changes, the re-calibration of feedback mechanisms, and the re-adaptation of internal models), which act at different timescales.     

The role of media and peer influences in Australian women's attitudes towards cosmetic surgery

The study aimed to examine the influence of media and peers on attitudes towards cosmetic surgery using a sociocultural framework. A sample of 351 Australian women aged 18–69 years completed measures of media exposure, friend conversations, internalisation of appearance ideals, appearance comparison, body dissatisfaction, and attitudes towards cosmetic surgery. Correlational analysis showed that almost all media and friend variables were significantly correlated with positive attitudes towards cosmetic surgery. A structural equation model based on the sociocultural model showed a good level of fit to the data. The effects of media exposure and friend conversations on body dissatisfaction and attitudes towards cosmetic surgery were mediated by internalisation. We concluded that media exposure and friend conversations affected attitudes towards cosmetic surgery both directly and indirectly. Our results contribute to the understanding of the sociocultural mechanisms underlying women's motivations for cosmetic surgery.     

A comparison of risk factors for women seeking labiaplasty compared to those not seeking labiaplasty

Little is known about the factors associated with the desire for labiaplasty. We compared 55 women seeking labiaplasty with 70 women in a comparison group who were not seeking labiaplasty. Measures administered included the Perception of Appearance and Competency Related Teasing Scale, Childhood Trauma Questionnaire, Disgust Scale Revised, and the Genital Appearance Satisfaction scale with open-ended questions about their genitalia. Approximately a third of the labiaplasty group recalled specific negative comments in the past towards their labia, a proportion significantly greater than the three per cent in the comparison group. Participants reporting genital teasing also showed higher Genital Appearance Satisfaction scores than those who were not teased. However, women seeking labiaplasty were, compared to the comparison group, no more likely to have a history of neglect or abuse during childhood. There was no difference between the groups on disgust sensitivity or the perception of being teased in the past about their competence or appearance in general.     

自体脂肪移植的临床应用

脂肪移植手术便于操作、创伤小、恢复快、效果好,备受整形外科医师青睐。随着技术的进步,自体脂肪移植应用范围不断扩展,其应用于整形美容外科的各个方面,用于修复各种原因造成的软组织缺损。脂肪移植手术过程包括脂肪的获取、脂肪的处理以及脂肪移植,已经是一项成熟的技术。但是,脂肪移植手术仍有很多的未知区域,比如脂肪成活机制,影响脂肪成活率的因素等,现对脂肪移植的应用作一综述。     

手术治疗在晚期乳腺癌中的应用价值

乳腺癌已经成为女性最常见的恶性肿瘤。虽然乳腺癌的早期诊断和治疗水平已经得到了很大水平的提高,但是仍有相当一部分患者在诊断时就已经存在远处转移,或者在术后出现局部复发以及远处转移。对于手术治疗在这些晚期乳腺癌患者中的作用,目前还存在很大的争议。本文对相关内容进行了探讨,认为晚期乳腺癌的治疗需要多学科协作的综合治疗,不应该忽视手术这个重要的治疗手段,从而使晚期的患者也能获得长期生存甚至治愈的机会。     

胃肠道手术术后并发韦尼克脑病临床分析

探讨胃肠道手术术后并发韦尼克（Wernicke）脑病的临床特点、患病机制及诊断和治疗方法。回顾性分析我院2006年~2010年胃肠道手术术后并发Wernieke脑病的临床资料。结果5例经补充维生素B1症状迅速消失,1例因获得诊断较迟,共济失调改善效果差,1例死亡。因此,Wernicke脑病临床表现极不典型,对于禁食时间...     

早期胃癌的治疗

目前,早期胃癌（early gastric cancer,EGC）的治疗仍以开放性手术治疗为主,其预后明显优于进展期胃癌。近年来,随着对EGC浸润与转移规律的深入认识和新技术的应用,其治疗中微创外科的应用更为广泛和合理,并重视患者术后的生活质量。本文结合国内外的研究进展,深入探讨EGC的治疗方法及应用指征,特别是微创外...     

河南省50家医院手术安全核查的实施与思考

为了解河南省手术安全核查的实施情况,采用卫生部统一设计的调查问卷对河南省18市50家医院进行调查。结果显示,被调查50家医院对手术安全核查的重要性认识基本到位,但对于手术核查的具体方式有待进一步规范,建议各级医疗机构加强手术安全核查制度的落实与监管,以保障患者安全。