Due to the demographic development osteopoorosis is an increasing serious medical and economical problem today in developed industrial countries including Czech republic. Fractures of the proximal femur in the elderly are one of the manifestations of the illness. Within the context of the pharmacological prevention we must consider carefully its contribution in comparison with costs of the fracture treatment in the hospital. This graduation theses deals with evaluation of expenses on the surgical treatment of these fractures and expenses on the pharmacological prevention using Fosamax. This comparison is made in economic situation in Czech republic in the end of the first decade of 21. century

Bakgrund: Bröstcancer är den vanligaste cancerformen hos kvinnor världen över vilket påverkar flertal varje år då överlevnadsprognosen förbättras. Den primära behandlingen vid bröstcancer består av kirurgi vilket kan innebära att antingen en del av bröstet eller att hela bröstet opereras bort. Syfte:Att beskriva kvinnors upplevelser efter kirurgisk behandling av bröstcancer. Metod:En litteraturöversikt med kvalitativ metod och induktiv ansats där 12 artiklar genomgick dataanalysen som gav tre kategorier: ”en förlorad identitet”, ”strävan efter normalitet” och ”stöd och förståelse”. Resultat:Kvinnor upplevde att något fattades från dem och känslan av en skild identitet framkom, även skada på feminitet och sexualitet. En längtan att få återgå till det liv som ansågs vara normalt uppkom varav rekonstruktion oftast upplevdes vara en nödvändighet för att bli återställd som person,  men några framförallt äldre kvinnor ansåg att upplevd hälsa var viktigare. Kvinnor upplevde även att stödet försvann för tidigt samtidigt som känslan av övergivenhet uppkom. Slutsats: Kvinnor som behandlats kirurgiskt för bröstcancer påverkas i olika grad och på flertal skilda plan. Upplevelsen är individuell och kan vara fluktuerande över tid. Stödgrupper är en viktig del varav nyttan är stor. Rekonstruktion är något som upplevelsen skiljer sig kring, vilket dels kan kopplas till ålder. / Background: Breast cancer is the most common form of cancer in women worldwide which effects multiple every year as the prognosis of survival improves. The primary treatment for breast cancer is surgery which can imply either a part of the breast or the whole breast gets removed.Aim: To describe women’s experiences after surgical treatment of breast cancer. Method: A literature review with qualitative method and a inductive approach  where 12 articles went throughthe data analysis that gave three categories: “a lost identity”, “the pursuit of normality” and “support and understanding”. Results:Women felt that something was taken from them and the feeling of a disconnected identity emerged, even damage to femininity and sexuality. A desire to return to the life that was considered to be normal emerged, of which reconstruction was most often perceived as a necessity for being restored as a person, but some especially older women felt that perceived health was more important. Women also felt that the support disappeared prematurely and the feeling of abandonment arose.Conclusion:Women who has been surgically treated for breast cancer are affected to varying degrees and in several different areas. The experience is individual and can be fluctuating over time. Support groups are an important part of which the benefit is substantial. Reconstruction is something where the experience differs, which can partly be linked to age.

Objetivo: Comparar os resultados cefalométricos obtidos com tratamentos compensatórios e tratamentos orto-cirúrgicos para pacientes que apresentam Classe III esquelética. Metodologia: Foram selecionadas de forma retrospectiva telerradiografias iniciais e finais de 97 pacientes Classe III esquelética. Os critérios de inclusão foram: dentição permanente completa até primeiros molares, relação molar de Classe III, ausência de extrações dentárias durante o tratamento, ausência de problemas periodontais severos, Wits menor que -2mm, telerradiografia em normalateral iniciais e finais, fotografias intra e extra-bucais iniciais e modelos de gesso iniciais. Os pacientes foram divididos em 3 grupos. Grupo C: pacientes que foram submetidos ao tratamento ortodôntico associado à cirurgia ortognática (uni ou bimaxilar) totalizando 30 pacientes (idade média inicial 25,07 [22,90-25,56]). Grupo R pacientes que foram submetidos ao tratamento ortodôntico compensatório usando a prescrição Roth totalizando 30 pacientes (idade média inicial 16,22 [15,68-23,90]). Grupo B pacientes que foram submetidos ao tratamento ortodôntico compensatório usando a prescrição Biofuncional para Classe III totalizando 37 pacientes (idade média inicial 19,97 [18,53–24,68]). A severidade da Classe III foi determinada pela relação posterior e dividida em ¼, ½, ¾ e completa. Todas as telerradiografias foram digitalizadas e seus traçados foram realizados pelo mesmo examinador no software Dolphin (Dolphin Imaging Versão 11.9). As variáveis estudadas foram divididas em grupos: Alterações Maxilares, Mandibulares, Maxilo-Mandibulares, Convexidade Facial, Padrão Facial, Posição dos dentes superiores, Posição dos dentes inferiores e Perfil Tegumentar. A análise estatística foi realizada utilizando o software SPSS, versão 18.0. [SPSS Inc. lançado 2009. PASW Statistics for Windows, Versão 18.0. Chicago: SPSS Inc.]. As variáveis contínuas simétricas foram expressas como média e erro padrão da média (± SEM) ou mediana e intervalo de confiança de 95% ([IC 95%]), definido pelo teste de Shapiro-Wilk. As variáveis categóricas foram descritas por frequências absolutas (n) e relativas (n%). Para comparação de meios entre grupos independentes, foi aplicada uma Análise de Variância Unidireccional (ANOVA) com teste post hoc de Tukey ou teste de Kruskal-Wallis com teste post hoc Dunn. Além disso, o teste de classificação assinado por Wilcoxon foi usado para dados emparelhados (por exemplo, medições pré e pós-tratamento). Por outro lado, as variáveis categóricas foram comparadas intragrupo pelo teste do Qui-Quadrado com análise residual ajustada padronizada. Todos os dados foram avaliados usando o SPSS, versão 18.0. O nível de significância foi fixado em 5%.Resultados: O grupo C apresentou uma severidade maior do 8 que os demais grupos tendo 73,3% dos pacientes com uma Classe III severa (3/4 e completa). Houve um avanço do ponto A (projeção da maxila) nos Grupos B e C e um recuo do mesmo no Grupo R. Já na mandíbula, apenas o Grupo C apresentou um recuo estatisticamente significativo. Os três grupos apresentaram uma melhora na relação Wits estatisticamente significativa. Contudo, apenas os grupos C e B apresentaram uma melhora significativa nas medidas ANB e NAP, mostrando que nestes grupos houve uma melhora no perfil dos pacientes. Em relação ao posicionamento dentário, o Grupo R apresentou uma vestibuloversão, extrusão e projeção dos incisivos superiores e uma linguoversão, retrusão e extrusão dos incisivos inferiores. Já o grupo Biofuncional apenas apresentou uma extrusão dos incisivos superiores e inferiores, sem alteração em relação à inclinação. O Grupo C apresentou uma descompensação com vestibuloversão dos incisivos inferiores e palatoversão dos incisivos superiores. Nos grupos C e B, os lábios superiores foram posicionados mais para anterior e os lábios inferiores mais para posterior, melhorando o perfil tegumentar. Já no grupo R, o lábio superior foi posicionado mais para posterior, deixando o perfil tegumentar mais côncavo. Conclusões: O grupo C e B apresentaram um avanço da maxila (Ponto A) semelhantes, enquanto que o Grupo R mostrou um recuo da mesma. Alterações mandibulares só ocorreram no grupo C. Houve uma melhora na convexidade facial e pefil tegumentar nos grupos C e B e houve uma piora no grupo R. O Grupo R apresentou maiores características de compensação dentária do que o grupo B, sendo que este último apresentou os melhores resultados quando opta-se pela camuflagem ortodôntica. Quando existe envolvimento de ambas as bases ósseas (maxila e mandíbula), o melhor tratamento é a associação de tratamento ortodôntico e cirurgia ortognática. Quando o envolvimento é apenas da maxila, o tratamento com a prescrição Biofuncional apresenta resultados semelhantes ao tratamento com ortodontia e cirurgia. A prescrição Biofuncional apresenta resultados de camuflagem melhores do que a prescrição Roth em todas as situações. / Objective: To compare cephalometric results obtained with compensatory treatments and ortho-surgical treatments for patients with skeletal Class III. Methods: Initial and final cephalograms of 97 skeletal Class III patients were retrospectively selected. Inclusion criteria were: complete permanent dentition until first molars, Class III molar relationship, absence of dental extractions during treatment, absence of severe periodontal problems, Wits less than -2mm, teleradiography at initial and final, intra and extra photographs and initial gypsum models. Patients were divided into 3 groups. Group C: patients who underwent orthodontic treatment associated with orthognathic surgery (uni or bimaxillary) totaling 30 patients (initial mean age 25,07 [22,90-25,56]). Group R patients who underwent compensatory orthodontic treatment using the Roth prescription totaling 30 patients (initial mean age 16,22 [15,68-23,90]). Group B patients who underwent compensatory orthodontic treatment using the Biofunctional prescription for Class III totaling 37 patients (Initial mean age 19,97 [18,53-24,68]). The severity of Class III was determined by the posterior relationship and divided into ¼, ½, ¾ and complete. All cephalograms were digitized and their tracings were performed by the same examiner in Dolphin software (Dolphin Imaging Version 11.9). The variables studied were divided into groups: Maxillary, Mandibular, Maxillo-Mandibular, Facial Convexity, Facial Pattern, Upper Teeth Position, Lower Teeth Position and Tegumentary Profile. Statistical analysis was performed using SPSS software, version 18.0. [SPSS Inc. released 2009. PASW Statistics for Windows, Version 18.0. Chicago: SPSS Inc.]. The symmetric continuous variables were expressed as mean and standard error of the mean (± SEM) or median and 95% confidence interval ([95% CI]), defined by the Shapiro-Wilk test. Categorical variables were described by absolute (n) and relative (n%) frequencies. For comparison of means between independent groups, a Univirectional Variance Analysis (ANOVA) was applied with Tukey post hoc test or Kruskal-Wallis test with Dunn post hoc test. In addition, the Wilcoxon-signed classification test was used for paired data (for example, pre- and post-treatment measurements). On the other hand, the categorical variables were compared intra-group by the chi-square test with standardized adjusted residual analysis. All data were evaluated using SPSS, version 18.0. The level of significance was set at 5%. Results: Group C had a higher severity than the other groups, with 73,3% of patients with a severe Class III (3/4 and complete). There was a progression of point A (projection of the maxilla) in Groups B and C and a retreat of the same in Group R. In the mandible, only Group C presented a statistically significant 10 decrease. The three groups showed a statistically significant improvement in the Wits ratio. However, only groups C and B showed a significant improvement in ANB and NAP measurements, showing that in these groups there was an improvement in the patients' profile. Regarding tooth positioning, Group R presented vestibuloversion, extrusion and projection of the upper incisors and a linguoversion, retrusion and extrusion of the lower incisors. On the other hand, the Biofunctional group presented only an extrusion of the upper and lower incisors, with no change in relation to the inclination. Group C presented a decompensation with vestibuloversion of the lower incisors and palatoversion of the upper incisors. In groups C and B, the upper lips were positioned more anteriorly and the lower lips more posteriorly, improving the tegumentary profile. In the Roth group, the upper lip was positioned posteriorly, leaving the tegmental profile more concave. Conclusions: Group C and B presented similar maxillary advancement (Point A), while Group R showed a decrease of the same. Mandibular changes occurred only in group C. There was an improvement in facial convexity and tegumentary skin in groups C and B and there was worsening in group R. Group R presented higher tooth compensation characteristics than group B, and the latter presented the best results when opted for orthodontic camouflage. When there is involvement of both bone bases (maxilla and mandible), the best treatment is the association of orthodontic treatment and orthognathic surgery. When the involvement is only of the maxilla, the treatment with the prescription Biofuncional presents results similar to the treatment with orthodontics and surgery. The Biofunctional prescription presents better camouflage results than the Roth prescription in all situations.

Beaucoup de progrès restent à réaliser dans la compréhension de la physiopathologie ainsi que dans la prise en charge thérapeutique de lépilepsie. De nombreux patients restent réfractaires au traitement médical et sont susceptibles dêtre de bons candidats à un traitement chirurgical. Lapport de nouvelles techniques dimagerie est une avancée importante dans la définition des crises et dans la localisation du foyer épileptogène et a permis daméliorer le résultat du traitement chirurgical par une meilleure sélection des candidats. La première partie de notre travail est une introduction générale où sont principalement exposées les techniques actuelles dexploration de lépilepsie ainsi que les résultats à long terme du traitement chirurgical chez 399 patients souffrant dépilepsie réfractaire, de manière à préciser le rôle de la chirurgie ainsi que les facteurs pouvant influencer le résultat postopératoire. La prise en charge des crises dépilepsie réfractaire dont le foyer épileptique se localise au niveau de zone fonctionnelle reste difficile et controversée. Il existe des arguments historiques et physiologiques justifiant une exérèse chirurgicale du foyer au niveau de zones fonctionnelles telles que le cortex sensitivomoteur mais il nexiste pourtant pas dans la littérature moderne de série qui permette dévaluer lefficacité de ce traitement et de le comparer avec dautres techniques chirurgicales comme par exemple les transsections sous- piales multiples. Dans la deuxième partie de ce travail, nous présentons une série de cinq patients provenant de la série des 399 patients exposée dans la première partie de notre travail, qui ont tous bénéficié dune résection corticale au niveau du cortex sensitivomoteur. Nous montrons que la difficulté du traitement de ces patients nest pas tant le geste chirurgical mais la définition et la localisation exacte du foyer épileptogène. Nous démontrons également que la mise au point exhaustive et précise de cette pathologie, en utilisant les méthodes dinvestigation décrites dans la première partie, permet de sélectionner les candidats de manière optimale avec des résultats postopératoires satisfaisants. La physiopathologie des crises dépilepsie est encore mal définie. Le mécanisme le plus souvent évoqué est un déséquilibre synaptique entre les afférences excitatrices et inhibitrices, une anomalie des canaux ioniques membranaires ou encore un trouble du métabolisme neuronal ou glial au niveau dun foyer où les neurones présentent une activité anormale. Une des questions primordiales à éclaircir est de savoir si cest le neurone qui est hyperexcitable, le réseau neuronal présent au sein du foyer ou les deux. Les structures gliales formées par les astrocytes et les oligodendrocytes jouent-elles un rôle accessoire ou primordial dans ce phénomène ? En dehors du rôle que pourraient jouer les connexions synaptiques dans le phénomène épileptique, les jcs semblent être importantes dans le mécanisme physiopatholgique des crises. Elles pourraient favoriser la synchronisation de lactivité épileptique ainsi que la propagation de celle-ci vers les régions cérébrales avoisinantes. La troisième partie de notre travail explore le rôle que pourrait jouer les jcs dans le phénomène épileptique. Les épilepsies mésiotemporales associées à une sclérose hippocampique sont les épilepsies dont le traitement chirurgical est le plus fréquemment proposé lorsque les crises deviennent réfractaires au traitement médical. Lobtention de tissu est dès lors aisée ce qui nous a permis détudier lexpression des jcs au niveau de tissus hippocampiques provenant de patients épileptiques et de la comparer avec celle déterminée au niveau dhippocampes provenant de patients non épileptiques et obtenus postmortem. Notre objectif est de savoir si cette éventuelle contribution au phénomène épileptique est liée à une augmentation de lexpression des jcs au niveau des tissus épileptiques et, si oui au niveau de quels types cellulaires (neurones, astrocytes) et de quelles régions de lhippocampe (gyrus dentelé, CA1 à CA4, subiculum)

Background: Bone metastases occur in most patients with advanced hormone-refractory prostate cancer causing pain, pathologic fractures, and spinal cord compression. Few studies specifically address surgical treatment of metastatic spinal cord compression (MSCC) in prostate cancer. Criteria for identifying patients who may benefit from surgery are poorly defined. Most of the current knowledge regarding tumor biology in prostate cancer is based on studies of primary tumors or soft tissue metastases. The mechanisms regulating growth of bone metastases are not fully established. Aims: a) to evaluate outcome after surgery for MSCC in prostate cancer and to identify prognostic factors for survival and functional recovery; b) to evaluate current practice for referral of prostate cancer patients with MSCC; c) to analyze expression of androgen receptor (AR), cell proliferation, apoptosis, and prostate-specific antigen (PSA) in bone metastases with regard to survival after surgery for complications of bone metastases. Patients and Methods: We retrospectively evaluated the hospital records of 68 consecutive patients operated for metastatic spinal cord compression. Tumor tissue from bone metastases was obtained on spinal surgery (54 patients), fracture surgery (4 patients) and biopsy (2 patients), and analyzed by immunohistochemistry. Results: Study I: Mortality and complication rate after surgery was high. Patients with hormone-naïve disease and those with hormone-refractory disease with good performance status and without visceral metastases had more favorable survival. The ability to walk after surgery was related to better survival. Study II: A new score for prognosis of survival after surgery for spinal cord compression includes: hormone status of prostate cancer, Karnofsky performance status, evidence of visceral metastasis, and preoperative serum PSA. The score is simple, tumor specific, and easy to apply in clinical practice. Study III: Our results suggest that delays in diagnosis and treatment may have negative impact on functional outcome. Pretreatment ability to walk, hormone status of prostate cancer, and time from loss of ambulation influenced neurological recovery after surgery for spinal cord compression. Study IV: High nuclear AR immunostaining in bone metastases and high preoperative serum PSA were associated with a poor outcome after metastasis surgery in patients with hormone-refractory prostate cancer. Short-term effect of castration therapy disclosed that nuclear AR immunostaining was decreased and apoptosis was increased, but cell proliferation remained largely unaffected. Conclusion:  Prostate cancer patients with metastatic spinal cord compression represent a heterogeneous group. We identified prognostic factors for survival and functional outcome, which may help clinicians in making decisions about treatment. Our results also implicate the need for development of local and regional guidelines for treatment of patients with spinal cord compression, as well as the importance of information to patients at risk.

No description available.

Ovarian torsion is a rare children’s acute abdominal disease which is difficult to diagnose and there is no consensus among scientists how to treat it. This is the first scientific research in Lithuania which analyses causes, optimal diagnostic criteria, the strategy, methods of surgical treatment and follow-up results of ovarian torsion in children. This is the largest research of the follow-up results of the conservative surgical treatment in the world. It was identified during the research that as many as 54.7% of the causes of ovarian torsion were congenital anatomical. In the case of 45.3% of the patients ovarian torsion was caused by pathological derivatives. In patients before menarche there were statistically significantly more mature teratomas (p=0.03). No specific symptoms of ovarian torsion in children were identified. Prior to the surgery, ultrasonography showed that the twisted ovary was on average 21.48 (17.06) times larger than the healthy ovary. Leukocytosis and ovarian blood flow disorders were statistically significantly more common in the case of ovarectomy. None of the girls who underwent detorsion with the ovary left in the abdominal cavity had thromboembolism or peritonitis; no malignant tumour was detected in any girl. According to the histopathological findings, no necrosis was detected in 14 (82.35%) removed ovaries, therefore they could be salvaged. Normal ovarian anatomy and folliculogenesis were retained in 95.24% of girls and women who were... [to full text] / Kiaušidžių užsisukimas – reta ūminė vaikų pilvo organų liga, kurios diagnostika sudėtinga, o dėl gydymo mokslininkai vis dar nesutaria. Tai pirmasis Lietuvoje mokslinis tyrimas, analizuojantis vaikų kiaušidžių užsisukimo priežastis, optimalius diagnostikos kriterijus, chirurginio gydymo taktiką ir metodus bei atokiuosius rezultatus. Šis atokiųjų konservatyvaus chirurginio gydymo rezultatų tyrimas yra didžiausias pasaulyje. Darbe nustatyta, kad 54,7 % kiaušidės užsisukimo priežasčių buvo įgimtos anatominės; 45,3 % ligonių kiaušidė užsisuko dėl patologinių darinių. Ligonėms iki menarchės statistiškai patikimai dažniau rasta brandžių teratomų (p=0,03). Specifinių vaikų kiaušidės užsisukimo simptomų ir požymių nenustatyta. Iki operacijos, tiriant echoskopu, užsisukusi kiaušidė buvo didesnė nei sveikoji vidutiniškai 21,48 (17,06) karto. Leukocitozė ir kiaušidės kraujotakos sutrikimai statistiškai patikimai dažnesni mergaitėms, kurioms kiaušidė pašalinta. Nė vienai mergaitei, kuriai kiaušidė buvo atsukta ir palikta pilvo ertmėje, nebuvo trombembolijos ir peritonito, nė vienai nerasta piktybinio naviko. Remiantis patologijos histologijos tyrimais, nustatyta, kad 14-oje (82,35 %) pašalintų kiaušidžių nekrozės ir patologinių darinių nebuvo, todėl jos galėjo būti išsaugotos. Patikrintų 95,24 % mergaičių ir moterų atsuktos kiaušidės anatomija ir folikulogenezė išliko normali.

Kiaušidžių užsisukimas – reta ūminė vaikų pilvo organų liga, kurios diagnostika sudėtinga, o dėl gydymo mokslininkai vis dar nesutaria. Tai pirmasis Lietuvoje mokslinis tyrimas, analizuojantis vaikų kiaušidžių užsisukimo priežastis, optimalius diagnostikos kriterijus, chirurginio gydymo taktiką ir metodus bei atokiuosius rezultatus. Šis atokiųjų konservatyvaus chirurginio gydymo rezultatų tyrimas yra didžiausias pasaulyje. Darbe nustatyta, kad 54,7 % kiaušidės užsisukimo priežasčių buvo įgimtos anatominės; 45,3 % ligonių kiaušidė užsisuko dėl patologinių darinių. Ligonėms iki menarchės statistiškai patikimai dažniau rasta brandžių teratomų (p=0,03). Specifinių vaikų kiaušidės užsisukimo simptomų ir požymių nenustatyta. Iki operacijos, tiriant echoskopu, užsisukusi kiaušidė buvo didesnė nei sveikoji vidutiniškai 21,48 (17,06) karto. Leukocitozė ir kiaušidės kraujotakos sutrikimai statistiškai patikimai dažnesni mergaitėms, kurioms kiaušidė pašalinta. Nė vienai mergaitei, kuriai kiaušidė buvo atsukta ir palikta pilvo ertmėje, nebuvo trombembolijos ir peritonito, nė vienai nerasta piktybinio naviko. Remiantis patologijos histologijos tyrimais, nustatyta, kad 14-oje (82,35 %) pašalintų kiaušidžių nekrozės ir patologinių darinių nebuvo, todėl jos galėjo būti išsaugotos. Patikrintų 95,24 % mergaičių ir moterų atsuktos kiaušidės anatomija ir folikulogenezė išliko normali. / Ovarian torsion is a rare children’s acute abdominal disease which is difficult to diagnose and there is no consensus among scientists how to treat it. This is the first scientific research in Lithuania which analyses causes, optimal diagnostic criteria, the strategy, methods of surgical treatment and follow-up results of ovarian torsion in children. This is the largest research of the follow-up results of the conservative surgical treatment in the world. It was identified during the research that as many as 54.7% of the causes of ovarian torsion were congenital anatomical. In the case of 45.3% of the patients ovarian torsion was caused by pathological derivatives. In patients before menarche there were statistically significantly more mature teratomas (p=0.03). No specific symptoms of ovarian torsion in children were identified. Prior to the surgery, ultrasonography showed that the twisted ovary was on average 21.48 (17.06) times larger than the healthy ovary. Leukocytosis and ovarian blood flow disorders were statistically significantly more common in the case of ovarectomy. None of the girls who underwent detorsion with the ovary left in the abdominal cavity had thromboembolism or peritonitis; no malignant tumour was detected in any girl. According to the histopathological findings, no necrosis was detected in 14 (82.35%) removed ovaries, therefore they could be salvaged. Normal ovarian anatomy and folliculogenesis were retained in 95.24% of girls and women who were... [to full text]

Bakgrund: Bröstcancer är den mest förekommande cancersjukdomen bland kvinnor världen över. Den vanligaste behandlingen mot sjukdomen är kirurgi, vilken innefattar mastektomi där hela bröstvävnaden tas bort eller lumpektomi där endast en del av bröstvävnaden avlägsnas. Det kirurgiska ingreppet kan medföra negativa konsekvenser för kvinnorna ur ett fysiskt, emotionellt och socialt perspektiv. Det kan även påverka kvinnors kroppsuppfattning samt hur kvinnorna ser på sig själva.  Syfte: Att belysa kvinnors kroppsuppfattning efter kirurgisk behandling där hela eller delar av bröstet tas bort till följd av bröstcancer.  Metod: En litteraturöversikt innehållande 12 kvalitativa artiklar som belyser kvinnors kroppsuppfattning efter genomförd kirurgisk behandling. Samtliga inkluderade artiklar kvalitetsgranskades, söktes igenom efter likheter samt skillnader och sammanställdes sedan iform av subkategorier och huvudkategorier i resultatet.  Resultat: Åtta olika subkategorier framkom: känsel, attack mot kroppsuppfattningen, identitet och feminitet, attraktion, minskad kvinnlighet, yttre fasad, normer och ideal och rädsla. Dessa föll in under de tre huvudkategorierna: kvinnans kroppsuppfattning i relation till jaget, till andra och den sociala omgivningen. Slutsats: Kvinnorna upplevde en negativt förändrad kroppsuppfattning sompåverkade identiteten samt feminiteten. Utöver kirurgins inverkan på kvinnan själv påvisades även att kvinnans relationer till närstående samt den sociala omgivningen hade påverkats till följd av den upplevda förändrade kroppen. Klinisk relevans: Denna litteraturöversikt kan leda till en ökad medvetenhet och förståelse av kvinnors kroppsuppfattning efter kirurgisk behandling hos sjuksköterskor. Detta kan i sin tur leda till att kvinnorna upplever bättre stöd och omvårdnad efter genomförd kirurgi efter bröstcancer. / Background: Breast cancer is the most occurring cancer form among women worldwide. The most common treatment of breast cancer is surgical treatment, which involves mastectomy where the whole breast tissue is removed or lumpectomy where only a part of the breast tissue is removed. The surgical operation can imply negative consequences for the woman in a physical, emotional and social perspective. It can also affect women´s body image as well as how they look upon themselves. Aim: To describe women’s body image after surgical treatment following breast cancer. Method: A literature review of 12 qualitative articles that illustrate woman’s body image after completed surgical treatment. All articles where assessed regarding quality and was profoundly searched through for similarities and differences, which compiled into subcategories and main categories presented in the results. Result: Eight different subcategories were found: feeling, an attack against the body image, identity and femininity, attraction, decreased femininity, the external facade, social norms and ideals and fear. These were divided into the three main categories: the woman’s body image in relation to myself, others and the social surroundings. Conclusion: The women experienced a negative change in their body image that influenced their identity and femininity. In addition to the impact of the surgery on the woman herself, the result also showed an impact on the relationships to people those who are close to them as well as the interactions within the society. Clinical Implication: This literature review can lead to an increased awareness and understanding of women’s body image after surgical treatment amongst nurses. In turn this can further lead to women feeling better support and care after surgical treatment following breast cancer.

INTRODUÇÃO: as fraturas transtrocanterianas do fêmur são muito frequentes nos idosos, e seu tratamento é eminentemente cirúrgico. Na grande maioria dos casos há a consolidação da fratura, mas os pacientes parecem não evoluir satisfatoriamente do ponto de vista clínico. O objetivo deste estudo é avaliar a qualidade da marcha de pacientes que foram submetidos ao tratamento cirúrgico por uma técnica de fratura transtrocanteriana instável. MATERIAL E MÉTODOS: participaram deste estudo 24 pacientes operados por fratura transtrocanteriana instável do fêmur com utilização do DHS. Os pacientes foram acompanhados prospectivamente, e foi avaliada a qualidade da marcha de pós-operatório e comparada com a de antes da cirurgia, segundo o escore de Robinson. RESULTADOS: no período pré-operatório, 14 pacientes (58,3%) eram do grupo I segundo o escore de marcha de Robinson; 4 (16,7%), do grupo II; 3 (12,5%), do grupo III; 1 (4,2%), do grupo IV; e 2 (8,3%), do grupo V. Todas as fraturas evoluíram para a consolidação, e a taxa de mortalidade foi de 25%. Todos os pacientes foram encaminhados para o mesmo protocolo de reabilitação, e após um período médio de 9,69 meses, 28,6% dos pacientes apresentavam-se no grupo I do escore de Robinson; 23,8%, no grupo II; 4,8%, no grupo III; 23,8%, no grupo IV; e 19% estavam no grupo V. Esses dados mostram que, apesar da alta taxa de consolidação das fraturas, não houve melhora sequer na manutenção da qualidade da marcha dos pacientes, sendo estatisticamente significante (p= 0,003). CONCLUSÕES: as fraturas transtrocanterianas instáveis do fêmur podem ser tratadas com o DHS, apresentando uma alta taxa de consolidação. Entretanto, parecem não evoluir bem do ponto de vista funcional. Esses achados deveriam ser confirmados por outros estudos com maior número de pacientes e avaliando outro tipo de implante. / INTRODUCTION: transtrochanteric fractures of the femur are very frequent in elderly patients, and its treatment is mainly surgical. In most cases the fracture can be consolidated, but patients seem not to have a satisfactory clinical evolution. The objective of this study is to evaluate gait quality of patients who have been submitted to surgical treatment with a technique of unstable transtrochanteric fracture. MATHERIAL AND METHODS: This study evaluated 24 patients who had been operated for unstable transtrochanteric fracture of the femur with the use of DHS. The patients were prospectively followed up, and the postoperative gait quality was evaluated and compared to preoperative gait using Robinson score. RESULTS: In preoperative period, 14 (58.3%) patients belonged to Group I according to Robinson score, 4 (16.7%) belonged to Group II, 3 (12.5%) belonged to Group III, 1 (4.2%) belonged to Group IV, and 2 (8.3%) belonged to Group V. All the fracture evolved to consolidation, and the mortality rate was 25%. All the patients were referred to the same rehabilitation protocol, and after an average period of 9.69 months, 28.6% were in Group I of Robinson score, 23.8% were in Group II, 4.8% in Group III, 23.8% in Group IV, and 19% in Group V. These data show that, despite the high rate of fracture consolidation, there was no improvement even in the maintenance of the patients’ gait quality, being it statistically significant (p= 0.003). CONCLUSIONS: Unstable transtrochanteric fractures of the femur can be treated with DHS, presenting a high consolidation rate. However, they seem not to evolve functionally. These findings should be confirmed by other studies with a higher number of patients who also use another type of implant.