居家镇痛治疗对中晚期癌症患者生活质量的影响

目的探讨居家镇痛对中晚期癌症患者生活质量的影响。方法对57例中晚期癌症患者以定期上门探访、电话随访为主要服务形式执行规范的居家镇痛治疗。结果疼痛缓解率92．98％,居家镇痛治疗1个月后患者整体生活质量及各个功能评分显著高于居家镇痛治疗前（均P〈0．05）。结论居家镇痛治疗能显著提高大多数患者生活质量,减轻其躯体疼痛,为中晚期癌痛患者一种较好的治疗方式。     

居家镇痛治疗对中晚期癌症患者生活质量的影响

目的 探讨居家镇痛对中晚期癌症患者生活质量的影响.方法 对57例中晚期癌症患者以定期上门探访、电话随访为主要服务形式执行规范的居家镇痛治疗.结果 疼痛缓解率92.98%,居家镇痛治疗1个月后患者整体生活质量及各个功能评分显著高于居家镇痛治疗前(均P＜0.05).结论 居家镇痛治疗能显著提高大多数患者生活质量,减轻其躯体疼痛,为中晚期癌痛患者一种较好的治疗方式.     

Katheterinterventionelle Therapie bei Erwachsenen mit Herz- und Gef??missbildungen

Advances in cardiac surgery and pediatric cardiology have made it possible for most patients with congenital heart and vascular disease to reach adulthood. Surgical techniques can be seen alongside catheter interventions as competitive or complementary therapies. Hybrid procedures help to provide better recovery with reduced need for repeated treatments. Interventional therapies range from closure of shunts and inappropriate vessels, balloon dilatation, and stent implantation to transcatheter valve implantation. In some congenital heart defects, primary therapy currently consists of catheter intervention rather than surgery (e.g., atrial septal defects) in most patients. But also corrected or palliated heart defects can be treated interventionally in order to avoid repeated operations and enhance quality of life. The goal of this article is to provide an overview of the most important interventional techniques that are currently available in this field.     

Buddy Study: Partners for better health in adolescents with type 2 diabetes

AIM: To investigate whether assigning young, healthy and motivated lay volunteer partners("buddies") to adolescents with type 2 diabetes improves hemoglobin A1c(HbA 1c). METHODS: Adolescents with type 2 diabetes were randomized to partnering with a "buddy" or to conventional treatment. During the initial screening visit, which coincided with a routine outpatient diabetes clinic visit, patients with type 2 diabetes underwent a physical examination, detailed medical history, laboratory measurement of HbA 1c, and completed two questionnaires(Pediatric Quality of Life Inventory and Children's Depression Inventory) to assess their overall quality of life and the presence of depressive symptoms. Patients were then randomized to the intervention(the buddy system) or conventional treatment(standard care). All patients were scheduled to return for followup at 3- and 6-mo after their initial visit. Hb A1 c was determined at all visits(i.e., at screening and at the 3- and 6-mo follow-up visits) and quality of life and depressive symptoms were evaluated at the screening visit and were reassessed at the 6-mo visit. RESULTS: Ten adolescents, recruited from a pool of approximately 200 adolescents, enrolled over a twoyear time period, leading to premature termination of the study. In contrast, we easily recruited motivated lay volunteers. We found no change in HbA 1c from the initial to the 6-mo visit in either group, yet our small sample size limited systematic assessment of this outcome. Participants repeatedly missed clinic appointments, failed to conduct self-glucose-monitoring and rarely brought their glucometers to clinic visits. Total quality of life scores(72.6 ± 6.06) at screening were similar to previously reported scores in adolescents with type 2 diabetes(75.7 ± 15.0) and lower than scores reported in normal-weight(81.2 ± 0.9), overweight(83.5 ± 1.8), and obese youths without diabetes(78.5 ± 1.8) or in adolescents with type 1 diabetes(80.5 ± 13.1). Among adolescents who returned for their 6-mo visit, there were no differences in total quality of life scores(70.2 ± 9.18) between screening and follow-up.CONCLUSION: Our approach, effective in adults with type 2 diabetes, was unsuccessful among adolescents and emphasizes the need for innovative strategies for diabetes treatment in adolescent patients.     

心理护理干预对骨折患者抑郁焦虑及生活质量的影响

目的：探讨心理护理干预对骨折患者抑郁焦虑及生活质量的影响。方法选择骨折患者60例作为研究对象,随机分为护理干预组和对照组,对照组给予常规护理,干预组在常规护理基础上给予心理护理干预,比较两组焦虑抑郁情况以及生活质量。结果两组护理后焦虑和抑郁评分均显著下降（P ＜0.01）,护理后,干预组焦虑抑郁评分显著低于对照组（P ＜0.01）。出院后1个月随访,干预组生活质量各维度得分显著高于对照组（P ＜0.01）。结论心理干预能够显著缓解骨折后患者的焦虑和抑郁情绪,从而提高患者的生活质量。     

Effects of a Combined Aerobic and Strength Training Program in Youth Patients with Acute Lymphoblastic Leukemia

Cure rates of youth with Acute Lymphoblastic Leukemia (ALL) have increased in the past decades, but survivor’s quality of life and physical fitness has become a growing concern. Although previous reports showed that resistance training is feasible and effective, we hypothesized that a more intense exercise program would also be feasible, but more beneficial than low- to moderate-intensity training programs. We aimed to examine the effects of an exercise program combining high-intensity resistance exercises and moderate-intensity aerobic exercises in young patients undergoing treatment for ALL. A quasi-experimental study was conducted. The patients (n = 6; 5-16 years of age) underwent a 12-week intra-hospital training program involving high-intensity strength exercises and aerobic exercise at 70% of the peak oxygen consumption. At baseline and after 12 weeks, we assessed sub-maximal strength (10 repetition-maximum), quality of life and possible adverse effects. A significant improvement was observed in the sub maximal strength for bench press (71%), lat pull down (50%), leg press (73%) and leg extension (64%) as a result of the training (p < 0.01). The parents’ evaluations of their children’s quality of life revealed an improvement in fatigue and general quality of life, but the children’s self-reported quality of life was not changed. No adverse effects occurred. A 12-week in-hospital training program including high-intensity resistance exercises promotes marked strength improvements in patients during the maintenance phase of the treatment for Acute Lymphoblastic Leukemia without side-effects. Parents’ evaluations of their children revealed an improvement in the quality of life.

Key points

• Patients with ALL present low muscle strength and poor quality of life.
• High-intensity resistance exercises combined with moderate-intensity aerobic exercise improved muscle strength and quality of life during the maintenance phase of ALL treatment.
• The exercise training program seemed to be tolerable and safe in ALL patients.

Key words: Acute lymphoblastic leukemia, child, strength training, pediatrics, quality of life     

下肢深静脉血栓形成患者非手术治疗后的近期生存质量研究

目的：观察下肢深静脉血栓形成（DVT）患者非手术治疗后的近期生存质量情况。方法：选取符合条件的50例下肢DVT患者,采用SF-36量表对入选患者治疗前与治疗后不同时间（1,2,3个月及4个月以上）的生理机能（PF）、生理职能（RP）、一般健康状况（GH）、情感职能（RE）、社会功能（SF）、躯体疼痛（BP）、精力（VT）及精神健康（MH）8个维度进行评分并比较。结果：患者在不同阶段的基线资料分布均衡可比,平均随访时间（3.82±1.84）个月,量表总Cronbach α系数为0.8652。患者在规范治疗前后的不同阶段8个维度评分差异均有统计学意义（均P<0.001）,治疗后不同阶段各维度评分明显高于治疗前,且随时间逐渐增高。治疗后各阶段间除PF在治疗后1个月与治疗后4个月以上的评分间差异有统计学意义（P=0.01）,所有维度评分的变化差异均无统计学意义（均P>0.05）。结论：下肢DVT患者经非手术治疗后近期生存质量明显好转并进入平台期,可恢复至健康人水平,患者生存质量的拐点出现的时间至少在治疗后4个月以上。

     

An assessment of health related quality of life using the child health and illness profile-adolescent edition in adolescents with chronic kidney disease due to underlying urological disorders

PURPOSE: We examined health related quality of life in adolescents with congenital urological disease causing kidney disease using a generic health related quality of life instrument. We then compared the results to those in adolescents with medical kidney disease and to population based norms. MATERIALS AND METHODS: The Child Health and Illness Profile-Adolescent Edition was administered to 113 patients 10 to 18 years old with chronic kidney disease. Mean domain and subdomain scores for adolescents with urological disease were compared to those of adolescents with medical kidney disease and to population based norms. RESULTS: The cohort included adolescents with an underlying diagnosis of congenital urological anomaly (37 patients) or other causes of kidney disease (76). Compared to adolescents with kidney disease caused by other factors, those with congenital urological disease scored statistically significantly better in the Child Health and Illness Profile-Adolescent Edition subdomain of Limitations of Activity (mean 22.3 [SD 2.5] vs 20.4 [SD 5.0], p = 0.04). Compared to population norms, adolescents with congenital disorders scored lower in the Disorders domain (mean 16.5, 95% CI 14.2 to 18.9) but better in the Risks domain (mean 25.9, 95% CI 25.1 to 26.6) and in the Home Safety and Health subdomain (mean 25.2, 95% CI 23.7 to 26.6). CONCLUSIONS: As assessed by the Child Health and Illness Profile-Adolescent Edition generic health status questionnaire, adolescents with kidney disease due to underlying congenital urological disease had fewer limitations of activity compared to those with underlying medical kidney disease. Except for low scores in the Disorders domain, children with underlying urological disease did not have significant impairments in any other domain compared to population based norms.     

Mechanical Aortic Valve Replacement in Children and Adolescents After Previous Repair of Congenital Heart Disease

Due to improved outcome after surgery for congenital heart defects, children, adolescents, and grown‐ups with congenital heart defects become an increasing population. In order to evaluate operative risk and early outcome after mechanical aortic valve replacement (AVR) in this population, we reviewed patients who underwent previous repair of congenital heart defects. Between July 2002 and November 2008, 15 (10 male and 5 female) consecutive patients (mean age 14.5 ± 10.5 years) underwent mechanical AVR. Hemodynamic indications for AVR were aortic stenosis in four (27%), aortic insufficiency in eight (53%), and mixed disease in three (20%) after previous repair of congenital heart defects. All patients had undergone one or more previous cardiovascular operations due to any congenital heart disease. Concomitant cardiac procedures were performed in all of them. In addition to AVR, in two patients, a mitral valve exchange was performed. One patient received a right ventricle‐pulmonary artery conduit replacement as concomitant procedure. The mean size of implanted valves was 23 mm (range 17–29 mm). There were neither early deaths nor late mortality until December 2008. Reoperations were necessary in five (33%) and included implantation of a permanent pacemaker due to complete atrioventricular block in two (15%), mitral valve replacement with a mechanical prosthesis due to moderate to severe mitral regurgitation in one (7%), aortocoronary bypass grafting due to stenosis of a coronary artery in one (7%), and in one (7%), a redo subaortic stenosis resection was performed because of a secondary subaortic stenosis. At the latest clinical evaluation, all patients were in good clinical condition without a pathological increased gradient across the aortic valve prosthesis or paravalvular leakage in echocardiography. Mechanical AVR has excellent results in patients after previous repair of congenital heart defects in childhood, even in combination with complex concomitant procedures. Previous operations do not significantly affect postoperative outcome.     

眼罩模拟联合过渡期护理干预在重睑手术患者中的应用效果

目的 观察对重睑手术患者应用眼罩模拟联合过渡期护理干预的效果。方法 选取2021年2月-2023年 2月于我院行重睑手术的76例患者为研究对象,随机分为对照组和观察组,每组38例。对照组给予常规护 理,观察组给予眼罩模拟联合过渡期护理干预,比较两组满意度、舒适度、生活质量、血压及心率水平。 结果 观察组满意度各项评分均高于对照组（P ＜0.05）;观察组干预后社会环境、生理、文化、心理评分 均高于对照组（P ＜0.05）;观察组生活质量各维度评分均高于对照组（P ＜0.05）;观察组术前、术中、 术后收缩压、舒张压均优于对照组（P＜0.05）;观察组术前、术中、术后心率均优于对照组（P＜0.05）。 结论 眼罩模拟联合过渡期护理干预在重睑手术患者中的应用效果确切,可提高患者的舒适度,改善其生 活质量,有利于提升护理满意度,减少患者血压及心率波动,值得临床应用。     

The Outcomes and Quality of Life of Patients with Achalasia after Peroral Endoscopic Myotomy in the Short-Term

Purpose: To assess the short-term efficacy and quality of life (QOL) of patients with achalasia after peroral endoscopic myotomy (POEM).Methods: Thirty-five achalasia patients underwent POEM from May 2013 to December 2013. The data on clinical evaluation and QOL before therapy, at 1 month and 6 months postoperation were collected and analyzed.Results: All the thirty-five patients underwent POEM successfully. By comparing the data of the preoperative with that of 1 month and 6 months after POEM respectively, we found that: mean Eckardt score decreased (6.83 vs 0.51, 6.83 vs 0.46, all P <0.05), esophagus diameter reduced (47.97 mm vs 32.00 mm, 47.97 mm vs 28.50 mm, all P <0.05), and esophageal manometry declined (29.5 mmHg vs 11.5 mmHg, 29.5 mmHg vs 10.3 mmHg, all P <0.05). Complications occurred in 14.3% (5/35) of the cases, and no recurrence was observed. At each time point, postoperative QOL scores were higher than those of preoperative (P <0.05).Conclusions: POEM is safe and effective for treating achalasia in the short-term, it can relieve clinic symptoms as well as improve patients’ QOL.     

Health-related quality of life in children with flexible flatfeet: a cross-sectional study

Purpose

The effect of paediatric flexible flatfeet (PFF) on health-related quality of life (HRQOL) has not been investigated. In this prospective cross-sectional study, the HRQOL of children with PFF was compared to those with typically developing feet (TDF) using two validated measures. We hypothesised that reduced HRQOL would be observed in children with PFF. The reliability of parents’ perceptions of their child’s symptoms was also investigated.

Methods

48 children with PFF and 47 with TDF between the ages of 8 and 15 completed The Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) and Pediatric Quality of Life Inventory (PedsQL™ 4.0). Proxy questionnaires were also completed. Reliability of parent and child questionnaire scores was assessed using the intraclass correlation coefficient (ICC) and Student’s t test. Differences between HRQOL between PFF and TDF were assessed using the Student’s t test.

Results

ICCs overall demonstrated good reliability between parent and child questionnaire domain scores. There was a tendency for parents to overestimate the impairment of the child in the PFF group. PFF children demonstrated clinically significant decreased HRQOL than TDF children. This was most marked in the physical domain scores.

Conclusion

Although parents may overestimate their child’s impairment, children with PFF still have significantly impaired HRQOL when compared to TDF children. The impairment can be as severe, or worse, than published HRQOL for acutely and chronically unwell children. As such, PFF cannot be regarded as just a benign normal variant. The management of PFF should involve consideration of the symptom profile and HRQOL.

Level of evidence:

II.

Electronic supplementary material

The online version of this article (doi:10.1007/s11832-014-0621-0) contains supplementary material, which is available to authorized users.     

Do Parents’ Exercise Habits Predict 13–18-Year-Old Adolescents’ Involvement in Sport?

This study examined links between parents’ exercise habits and adolescents’ participation in sports activities, considering the aspects of gender and age. It was hypothesized that regular exercise by both parents would be related to children’s involvement in sport regardless of their gender and age. Moreover, it was hypothesized that children’s sports activities would be more strongly related to their father’s exercise activities. The study also examined the links between parents’ exercise habits and children’s motivation for sports. It was hypothesized that competition motives would be more important for children whose parents exercised regularly. The research sample included 2335 students from the seventh (n = 857), ninth (n = 960) and eleventh (n = 518) grades of various Lithuanian schools. The study used a questionnaire survey method, which revealed the links between parents’ exercise habits and their children’s participation in sport. Assessment of data for girls and boys showed that daughters’ participation in sport could be predicted by both their fathers’ and mothers’ exercise habits, but sons’ sports activities could be predicted only by the regular physical activities of their fathers. The assessment of children’s sporting activities according to age revealed links between parental exercising and the engagement of older (15–16 years old), but not younger adolescents (13–14 years old). Analysis of sports motivation showed that competition motives were more important for boys than for girls. Fitness, well-being and appearance motives were more important for older adolescents (15–18 years old), while competition motives were more important for younger adolescents (13–14 years old). Research revealed the relationship between children’s sport motives and fathers’ exercise habits, while examination of mothers’ exercise revealed no difference.

Key points

• Parental exercising significantly predicts adolescents’ engagement in sport. Daughter’s engagement in sport is related to both parents whereas son’s involvement in sport is related only to father’s exercise habits.
• Regular exercising of both mother and father predicts 13 - 14-year-old adolescents’ engagement in sport. However, mother exercising is not related to older adolescents’ involvement in sport.
• Research revealed the relation of adolescents’ sport motives and father’s exercising, and no differences were established depending on mother’s exercise habits.

Key words: Physical activity, sports participation, family association, sports motivation     

Malformations in adult cases in Egypt

The pathologic patterns as an indication for cardiac surgery in adults with congenital heart diseases and subsequently the surgical techniques have changed greatly in the last decade. The presence of fully equipped pediatric cardiac units helped in early surgical repair in many lesions. However, this service is not always readily available in many parts of the world with the effect of seeing patients with congenital heart diseases latter on during their life needing intervention. Also, older surgical concepts (like considering a trileaflet mitral valve as normal) resulted in the presentation of a subgroup of patients who needed re-intervention latter during adulthood. Surgeons are also faced with the residual effects of putting in different kinds of prosthetic valves or homografts that degenerates or the child overgrows and need to be dealt with latter during the child life. Although the interventional transcatheter techniques helped in the closure of small atrial septal defects, patent ducti, pulmonary arteriovenous fistulas, and dilatation of coarctations, it helped in the emergence of a new pathologic entities like failed or complicated transcatheter closure or dilatations. As a result of competition with the cardiologists, minimal access cardiac surgery emerged. Upper and lower partial ministernotomies and right thoracotomy and fast-track congenital heart operation in some lesions had effectively decreased pain and discomfort, shortened the recovery period, and improved the cosmetic result.     

Medical predictors for long-term behavioral and emotional outcomes in children and adolescents after invasive treatment of congenital heart disease

Background

The aim of the study was to test the following: (1) the predictive value of medical variables for long-term parent-reported behavioral and emotional problems in children and adolescents who underwent invasive treatment of congenital heart disease in infancy and (2) the relationship between parental psychological distress and parental reports on problems in children.

Methods

The Child Behavior Checklist was used to investigate to what extent behavioral and emotional problems in 7- to 17-year-old children with congenital heart disease can be predicted by the following: (1) medical history, (2) therapeutic intervention and direct postinterventional course, (3) long-term medical course, (4) present contact with physicians, and (5) present medical status. The General Health Questionnaire was used to assess parental distress (especially anxiety).

Results

Higher Child Behavior Checklist total problems scores were predicted by cardiac medication before therapeutic intervention. Palliative intervention (Rashkind procedure) before therapeutic intervention was associated with more favorable scores on total problems and externalizing. Long-term maternal distress was significantly related to parent-reported problems in children.

Conclusion

Long-term behavioral and emotional outcomes are only marginally predicted by medical variables. In counseling of children with congenital heart disease and their parents, attention should be paid to long-term maternal distress that has an influence on parent-reported problems in children.     

Levels of exhaled nitric oxide before and after surgical and transcatheter device closure of atrial septal defects in children

OBJECTIVES: We have shown that exhaled nitric oxide levels decrease after surgical closure of congenital left-to-right cardiac shunts. It remains unclear whether the change in exhaled nitric oxide levels reflects endothelial injury caused by the use of cardiopulmonary bypass or the decrease in pulmonary blood flow attendant on shunt closure. Transcatheter atrial septal defect closure permits shunt closure without the use of cardiopulmonary bypass. Therefore we compared changes in exhaled nitric oxide levels after surgical and transcatheter device closure of atrial septal defects. METHODS: We enrolled sequentially 30 children undergoing atrial septal defect closure. Fifteen patients (age range, 0.4-16 years; median age, 6.5 years) underwent surgical atrial septal defect closure with cardiopulmonary bypass, and 15 patients (age range, 4-17 years; median age, 8.4 years) had device closure of the atrial septal defect in the catheterization laboratory. We measured nitric oxide levels in end-tidal expiratory gas with a rapid-response chemiluminescent analyzer before and after atrial septal defect closure. RESULTS: After surgical repair of the atrial septal defect, exhaled nitric oxide decreased by 21%, from 10.9 +/- 4.4 to 8.4 +/- 3.3 ppb (P <.005), whereas after transcatheter defect closure, exhaled nitric oxide increased by 23%, from 7.6 +/- 2.6 to 9.3 +/- 3.7 ppb (P <.005). Hemoglobin levels in patients undergoing surgical intervention were significantly lower (P =.0001) postoperatively. CONCLUSIONS: We confirmed that exhaled nitric oxide, despite a fall in hemoglobin, decreases after surgical closure of atrial septal defects. In contrast, exhaled nitric oxide levels increase after transcatheter closure. Exhaled nitric oxide levels may reflect bypass-induced endothelial cell injury and are independent of changes in pulmonary blood flow.     

体肺动脉侧支血管堵闭术在紫绀型先天性心脏病围术期的应用

目的评价经皮体肺动脉侧支血管堵闭术在伴有右室流出道或肺动脉梗阻的紫绀型先天性心脏病病儿围手术期应用的效果。方法2005年5月至2006年6月,共11例紫绀型先天性心脏病病儿分别选用弹簧圈和血管塞行经皮体-肺侧支血管堵闭术,7例于外科矫治手术前行侧支血管的堵闭,4例于术后进行介入治疗。结果共堵闭侧支血管19条;6例堵闭单条、5例同时堵闭多条侧支。术后造影显示14条侧支（74％）分流基本消失,5条（26％）大部分堵闭。结论在外科手术前或术后反复心、肺功能不全的病儿,进行体肺侧支血管的堵闭治疗是安全、有效的,有利于渡过围手术期,提高手术成功率,改善手术效果。     

Application of modified sequential organ failure assessment score in children after cardiac surgery

OBJECTIVE: To evaluate the usefulness of the modified sequential organ failure assessment (m/SOFA) score for assessing morbidity and mortality in pediatric patients after cardiac surgery. DESIGN: Analysis of a prospectively collected database. SETTING: Pediatric intensive care unit of a university-affiliated hospital. PARTICIPANTS: Consecutive pediatric patients (n = 142) undergoing cardiac surgery. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The m/SOFA score, consisting of 5 organ scores (maximum score of 20 points), was calculated on admission (initial) and at 12 and 36 hours postoperatively. An initial score of >5 points with an unchanged or upward postoperative trend predicted a higher postoperative mortality and a greater need for intensive care intervention. In neonates, sustained higher score >10 points predicted an outcome of death with a sensitivity of 100% and a specificity of 87%. Given the higher mortality related to immature organ function and a greater complexity of heart defects, the application of the m/SOFA score, a less invasive and simple way to assess organ damage, is especially suitable in neonates. The m/SOFA score would be more appropriately assessed according to the congenital heart defect or surgical procedure because the types of cardiac defect after the surgical repair affect each organ score measurement. CONCLUSION: Application of the m/SOFA score in the early postoperative period, which reflects cumulative perioperative organ damage, would provide some direction to eventual outcomes of morbidity and mortality in patients with congenital heart defects undergoing surgery.     

Quality of life outcomes after pedicled TRAM flap delayed breast reconstruction.

OBJECTIVES: To evaluate the impact of TRAM flap delayed breast reconstruction on health related quality of life in patients who had undergone mastectomy. METHODS: Twenty-five patients following mastectomy were selected consecutively from the Plastic Surgery/Mastology Units of two university hospitals. All subjects underwent breast reconstruction with the use of pedicled TRAM flap. The patients' health related quality of life was assessed by a validated instrument, the SF-36 Health Survey Questionnaire. This was applied preoperatively and postoperatively at 3, 6 and 12-months follow-up. A group of 20 women with mastectomies who have not undergone breast reconstruction was used as a control. To assess patients' satisfaction with breast reconstruction we used Alderman's modified general satisfaction subscale. RESULTS: There was a progressive improvement in all dimensions of the SF-36, and this was statistically significant for seven of the eight dimensions. The scores were significantly higher on 'role emotional' and 'mental health' at 3 months postoperatively, on 'health perception' and 'role physical' at month 6 and on 'physical function', 'pain', health perception and 'social function' at postoperative month 12. Despite the increase in scores, no significant changes in 'vitality' were found. There was no significant preoperative difference between the control group and studied patients, and the control group's scores were significantly lower in all dimensions when compared to postoperative month 12, except on 'physical function'. The level of patients' satisfaction with the TRAM flap breast reconstruction was high. CONCLUSIONS: The data of this study suggest that delayed breast reconstruction with the use of the pedicled TRAM flap provides an improvement in health related quality of life of patients who have undergone mastectomy.     

Terms of agreement between the Austrian Society of Cardiology and the Austrian Society of Thoracic and Cardiovascular Surgery on transcatheter heart valve interventions*

BACKGROUND: Due to the increasing volume of transcatheter heart valve interventions, we place on record the terms of the agreement reached between the Austrian Society of Cardiology (?KG) and the Austrian Society of Thoracic and Cardiovascular Surgery (?GTHC) regarding these procedures as follows. METHODS: The paper is based on the guidelines of the European societies, a review of the PubMed literature, as well as information from the medical industry. RESULTS: Currently, transcatheter-based aortic and pulmonary implantation are performed as well as transcatheter-based procedures for mitral valve insufficiency. In all cases the indication should be decided jointly by the cardiologist and the cardiac surgeon. Furthermore, these procedures should only be performed in centres where both specialists are available on site. Only patients with either congenital or acquired heart valve disease who are at very high risk of morbidity and mortality with medical or standard surgical therapy should undergo transcatheter heart valve intervention. CONCLUSIONS: According to current literature, recommendations for transcatheter heart valve interventions are only based on level of Evidence C (Consensus of Expert Opinion).