scholarly journals Estimation of quality of life after operative treatment for venous trophic ulcers of the lower extremities

2020 ◽  
Vol 87 (7-8) ◽  
pp. 33-37
Author(s):  
V. І. Liakhovskyi ◽  
R. М. Riabushko ◽  
А. V. Sydorenko
Keyword(s):  
Quality Of Life ◽  
Lower Extremities ◽  
Well Being ◽  
Operative Intervention ◽  
Group I ◽  
Subjective Estimation ◽  
Standard Set ◽  
Group Ii ◽  
Arteries And Veins

Objective. To study the patients’ quality of life after operative interventions, performed for venous trophic ulcers of the lower extremities. Маterials and methods. Analysis of data from 82 hospital cards of stationary patients was conducted. The patients were treated during 2010 - 2017 yrs in the Department of Vascular Surgery of Poltava Regional Clinical Hospital named after М. V. Sklifosovskyi for venous trophic ulcers of the lower extremities (Class С5 in accordance to Clinical-Etiological-Anatomical-Pathophysiological classification - СЕАР). The cause of trophic ulcers occurrence in all the patients was confirmed, using ultrasound duplex scanning of pelvic and the lower extremities arteries and veins. After conduction of certain conservative therapy the operative intervention, directed on elimination of the occurrence cause of trophic ulcers, was done. In all the patients the conduction of endovenous thermal ablations was not indicated, taking into account the anatomic peculiarities presented. Depending on the methods of operative interventions performed, the patients were distributed into two groups: Group I - 48 (58.5%) patients, surgical treatment of whom consisted of typical conventional open operative interventions, using a standard set of instruments, while Group II - 34 (41.5%) patients, to whom operative interventions were done, using elaborated own gadgets for the wounds edges opening, dissection and ligation of perforant and large subcutaneous veins, nontraumatic suturing of postoperative wounds. All operative interventions in the Group II patients were performed, using ultrasonographic support. In patients of both Groups a subjective estimation of quality of life was conducted, using questionnaire CIVIQ (Chronic Insufficiency Venous International Questions) for interviewing preoperatively and in 1, 3 and 6 mo postoperatively. Results. In accordance to data obtained, in patients of Group II the score in points of quality of life was higher, because in them the ulcers have healed faster, the pain sensation reduced, resulting in the psycho-emotional state improvement. Besides this, 29 (85.3%) patients of Group II have noted, that even while some symptoms persisted, their subjective signs reduced, leading to the well-being improvement. The conduction of treatment in accordance to own procedures proposed have promoted the raising of the quality of life score in patients, suffering trophic ulcers of the lower extremities. Conclusion. Application of gadgets of own elaboration during operative intervention on venous system of the lower extremities accelerates its performance and reduces traumaticity. This leads to reduction of the pain sensitivity intensity, raising of subjective estimation of quality of life in remote postoperative period.

scholarly journals ASSESSMENT OF QUALITY OF LIFE OF PATIENTS AFTER SURGERY MADE BY THE IN-HOUSE DEVICES AND METHODS

2020 ◽  
Vol 73 (12) ◽  
pp. 2664-2666
Author(s):  
Nataliia О. Riabushko ◽  
Roman М. Riabushko ◽  
Mykola М. Riabushko ◽  
Olena B. Riabushko
Keyword(s):  
Quality Of Life ◽  
Radiofrequency Ablation ◽  
Emotional State ◽  
Health Improvement ◽  
Group I ◽  
Apparent Reduction ◽  
Standard Set ◽  
Group Ii ◽  
Surgery Department

The aim: To estimate the patients’ quality of life after surgery made by the in-house devices and methods. Materials and methods: According to the peculiarities of surgical treatment, the set of instruments used and the methods of its application during surgery, all patients were assigned into two groups: group І (comparison group, or retrospective group) involved 48 (58.5%) patients who received treatment at the Vascular Surgery Department and had contraindications to endovascular laser and radiofrequency ablation, as evidenced by ultrasonographic color angioscanning (USCAS). These patients underwent typical phlebectomies, which were performed using a standard set of instruments; group ІІ (prospective) involved 34 (41.5%) patients treated in the Surgery Department. Patients of this group also had contraindications to endovenous laser and radiofrequency ablation, which was confirmed by USCAS data. Results: It has been found that following the six months after treatment, no patient in Group II and Group I measured the quality of life unsatisfactory. Satisfactory measures were made by 6 (12.5%) and 2 (5.9%) patients in Group I and Group II, respectively. Good scores of quality of life was established in 33 (68.75%) and 19 (55.9%) patients, respectively. Excellent scores were observed in patients of Group I (9 (18.75%)) and Group II (13 (38.2%)). In addition, in our survey, patients’ responses were divided into three categories: “Never”, “Rarely”, “Quite often”, “Very often”, “Constantly”. That is, with a negative outcome (incomplete disappearance of the symptom, its apparent reduction), we can observe the dynamics of positive changes. Conclusions: Patients of Group II had a higher rates of quality of life, because the process of ulcer healing was faster, pain was reducing, contributing to improvement of the patient’s psycho-emotional state. In addition, the examined 29 (85.3%) patients of Group II noted that even with the preservation of some symptoms, their subjective manifestations were reducing leading to health improvement. All this contributes to improving the quality of life of patients with trophic ulcers of the lower extremities, which were treated according to our methods.

scholarly journals Impact of adjuvant intrabladder therapy on quality of life in patients, suffering musculo-noninvasive cancer of the bladder

2020 ◽  
Vol 87 (7-8) ◽  
pp. 47-52
Author(s):  
F. І. Коstyev ◽  
О. V. Bondar ◽  
R. S. Chystiakov ◽  
V. V. Lysenko
Keyword(s):  
Quality Of Life ◽  
Well Being ◽  
Social Adaptation ◽  
Bcg Vaccine ◽  
Hyperthermic Chemotherapy ◽  
Group I ◽  
Cancer Of The Bladder ◽  
Group Ii ◽  
Eortc Qlq

Objective. Comparative estimation of quality of life in patients with a high-risk musculo-noninvasive cancer of the bladder was accomplished while conduction of adjuvant intrabladder hyperthermic chemotherapy and immunotherapy with BCG vaccine. Маterials and methods. Depending on kind of treatment, the patients were distributed into two groups: Group I - 44 patients, to whom adjuvant intrabladder immunotherapy with BCG vaccine was applied, and Group II - 41 patients, to whom intrabladder chemotherapy was conducted, using the system for local hyperthermy Combat BRS. Results. The data from the patients interviewed, using EORTC QLQ-30 questionnaires, confirmed better quality of life in patients of Group II, who obtained intrabladder hyperthermic chemotherapy, peculiarly in accordance to indices of physical status, social adaptation and intoxication. In accordance to data of the patients’ interviewed with the help of FACT-BL questionnaire, also better results were obtained in patients of Group II in accordance to the social and functional well-being status, the urination quality and values of indices of the «Cancer of the Bladder» scale. Conclusion. Higher quality of life was noted in patients of Group II, who obtained intrabladder hyperthermic chemotherapy. The lower quality of life in patients of Group I, who obtained immunotherapy with BCG vaccine, was connected with multiple side effects and enhanced toxicity of this therapy, accordingly.

scholarly journals Impact of hemodialysis on the wellbeing of chronic kidney diseases patients: a pre-post analysis

2020 ◽  
Vol 27 (1) ◽  
Author(s):  
Um-e-Kalsoom ◽  
Sabiha Khan ◽  
Israr Ahmad
Keyword(s):  
Quality Of Life ◽  
Social Support ◽  
Perceived Social Support ◽  
Kidney Diseases ◽  
Chronic Kidney Diseases ◽  
Group I ◽  
Significant Difference ◽  
Group Ii ◽  
The Impact

Abstract Background Hemodialysis may have serious psychological impact upon patients suffering from chronic kidney diseases. The aim of the present study is to investigate the impact of hemodialysis on the wellbeing of individuals with chronic kidney diseases (CKD). Result A sample consists of (N = 100) CKD patients referred from neurology ward of Leady Reading Hospital Peshawar. Data was collected from both male (50%) and female (50%) in 2017. Participants were divided into two groups on the basis of pre-set criteria. In group I, individuals with 4–5 stage of CKD referred first time for dialysis treatment were recruited. Group II comprised of CKD patients with 1–3 stage. Demographic data sheet, Pakistan Anxiety and Depression, WHO Quality of Life scale, and Perceived Social support scale (PSS) were used to test the hypotheses. Paired sample t test was use to see the difference between pre- and post-analysis of depression, anxiety, QOL, and PSS in group I (experimental group). Results suggests significant difference on depression (p > .001), anxiety (p > .001), and QOL (p > .001), while no significant difference was reported on perceived social support (p <.673). Findings also indicate no significant difference between group I and group II on QOL depression, anxiety, and PSS. Conclusion The findings concluded that patients under hemodialysis treatment suffered from depression, anxiety, and poor quality of life.

scholarly journals Quality of life in young and middle age adult temporomandibular disorders patients and asymptomatic subjects: a systematic review and meta-analysis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Lucas Bozzetti Pigozzi ◽  
Duziene Denardini Pereira ◽  
Marcos Pascoal Pattussi ◽  
Carmen Moret-Tatay ◽  
Tatiana Quarti Irigaray ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Diagnostic Criteria ◽  
Latin American ◽  
Temporomandibular Disorders ◽  
Meta Analysis ◽  
Group I ◽  
Axis I ◽  
Group Ii

Abstract Aims To compare the difference in the quality of life between temporomandibular disorders (TMD) patients and non-TMD subjects diagnosed with the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) or the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Methods Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica database (EMBASE) and Latin American and Caribbean Health Sciences Literature (LILACS) databases were searched in studies published in English and Portuguese. The search was performed by two independent reviewers in duplicate. A manual search and the gray literature were also included. The inclusion criteria were clinical studies that used the RDC/TMD axis I and quality of life with standard questionnaires in young and middle-aged adult population (18–55 years). The data were analyzed quantitatively by combining the results in a meta-analysis using forest plots. The measure of effect used was the standardized mean difference (SMD) in depression levels. The Newcastle–Ottawa Scale (NOS) was used to evaluate the quality of the studies. The publication bias was assessed by funnel plots. The initial search included 806 articles without duplications. Results Twenty-four articles were included in the final systematic review. Of these, 9 were included in the meta-analysis, where it was shown a statistically significant in all axis I groups: (a) global TMD—groups I, II and III combined, N = 3829, SMD (95% CI) = 1.06 (0.65–1.51), p = 0.000; (b) group I—muscle disorders, N = 3,056, SMD (95% CI) = 0.82 (0.45–1.18), p = 0.000; (c) group II—disc displacements, N = 3,184, SMD (95% CI) = 0.59 (0.26–0.91), p = 0.000; and (d) group III—arthralgia/arthritis/arthrosis, N = 2781, SMD (95% CI) = 0.98 (0.59–1.36), p = 0.000. When compared to controls. Conclusions Quality of life is affected in all axis I TMD patients, especially in groups I and III with higher pain intensity and disability as compared to group II.

scholarly journals Comparitive evaluation of different concentrations of alcohol in ultrasound guided coeliac plexus neurolysis for pain relief in upper abdominal malignancies

2021 ◽  
Vol 8 (4) ◽  
pp. 492-500
Author(s):  
Manish Kumar Singh ◽  
Pragya Verma ◽  
Sarita Singh ◽  
Gyan P Singh ◽  
Hemlata Verma
Keyword(s):  
Quality Of Life ◽  
Morphine Consumption ◽  
Rescue Analgesia ◽  
Vas Score ◽  
Group I ◽  
Significant Difference ◽  
The Mean ◽  
Group Ii ◽  
Upper Abdominal

Patients suffering from advanced upper abdominal malignancies have pain as predominant symptom affects their quality of life and survival. USG guided coeliac plexus neurolysis become benevolence in these patients on part of their pain management and quality of life improvement. To compare the efficacy of USG guided coeliac plexus neurolysis for pain relief in upper abdominal malignancies by using different concentration of alcohol (50% vs 75%).This Prospective, comparative, randomised double blinded study was conducted during Sep 2019 – Aug 2020 at our tertiary care centre. Total 60 cases were taken as per following inclusion and exclusion criteria and randomly divided into 2 groups i.e. 30 each group, we compare Visual Analogue Scale (VAS) score, quality of life (QOL) and need of rescue analgesia profile between the groups to know the efficacy of USG guided coeliac plexus block. In our study, we observed that the baseline mean VAS score in group I was 8.26±0.78 while in group II was 8.03±0.76. No significant difference was found in mean VAS score at this time between the groups (p=0.24). The baseline mean QOL score in group-I was 77.46±3.40 while for the cases of group II the mean QOL score was 77.36±3.33. No significant difference was found in mean QOL score at baseline between the groups (p=0.90). The baseline mean morphine consumption in group-I was 113.33±39.24 mg while for the cases of group-II the mean morphine consumption was 120.33±38.37mg. No significant difference was found in mean morphine consumption at this time between the groups (p=0.48).Both groups having 50% alcohol and 75% alcohol decreases the VAS score from baseline in patients having upper abdominal malignancies along with QOL and dosages of rescue analgesia whereas no significant difference in VAS score in patients of both groups.

scholarly journals Disorders of social functioning and quality of life in patients with gastroesophageal reflux disease while combined with undifferentiated connective tissue dysplasia

2020 ◽  
Vol 3 (1) ◽  
pp. 11-16
Author(s):  
Iryna Romash
Keyword(s):  
Quality Of Life ◽  
Gastroesophageal Reflux Disease ◽  
Connective Tissue ◽  
Gastroesophageal Reflux ◽  
Social Functioning ◽  
Reflux Disease ◽  
Control Group ◽  
Group I ◽  
Group Ii

Introduction. It has been scientifically confirmed that the risk of developing gastroesophageal reflux disease (GERD) increases especially with generalized or regional disruption of connective tissue structure, which is widespread among the population. Patients with such comorbid pathology may have a wide range of symptoms that may go beyond the general symptoms of heartburn and regurgitation. The symptoms and complications of GERD affect general health, daily and social functioning, physical and emotional activity. It also affects the quality of life (QoL) associated with health through frequent breaks during sleep, work and social activities. Purpose. study the dynamics of the level of quality of life and social functioning in patients with gastroesophageal reflux disease in combination with the syndrome of undifferentiated connective tissue dysplasia. Methodology. A total of 120 patients were included in the study: 65 men and 55 women: in 75 of them (Group II) GERD occurred on the background of UCTD, in 45 (Group I) as an independent disease. The control group consisted of 12 healthy individuals. The study was comprehensive. The Medical Outcomes Study 36-Item Short-Form Health Status (SF-36),the Gastrointestinal Symptom Rating Scale (GSRS) and the scale of "Personal and social performance" (PSP) -  were used to study patients in detail. Results and Discussion. Analyzing the results obtained on the basis of the GSRS questionnaire (Table 1), in patients with GERD on the background of UCTD, compared with patients of group I and the control group, there is a significant increase in three and four from the five scales. QoL in patients of Group II on the scale "Abdominal pain" were 14.3 ± 0.4 points, in Group I - 5.6 ± 1.3 points, in the Control Group - 2.4 ± 0.8 points, on the scale "Reflux syndrome": 13.7 ± 0.9, 10.5 ± 1.3 and 3.1 ± 0.9, respectively. "Dyspeptic syndrome" - 15.3 ± 0.4 points in Group II, 12.2 ± 0.6- in Group I and 6.1 ± 0.3- in the control group. "Constipation syndrome" 9.5 ± 0.8, 5.6 ± 1.03 and 5.7 ± 0.4, respectively (p <0,05). Conclusions: In this research we investigated the effect of comorbid pathology on QoL in patients with GERD, which developed against the background of UCTD. The results confirm that patients with such combined pathology have a lower level of quality of life and social functioning, and the tactics of treatment of such patients should take into account these changes

scholarly journals Effectiveness of pharmacopuncture by “alloplant” biomaterial in complex therapy of knee joint osteoarthritis

2020 ◽  
Vol 19 (1) ◽  
pp. 45-49
Author(s):  
Ruslan K. Urazbakhtin ◽  
Raushaniya N. Kildebekova ◽  
Lira T. Gilmutdinova ◽  
Vadim T. Kaybyshev ◽  
Ravil Sh. Mirkhaydarov ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Drug Therapy ◽  
Knee Joint ◽  
Well Being ◽  
Biologically Active ◽  
Basic Drug ◽  
Group Iii ◽  
Group I ◽  
Immunological Mechanisms

Background. Osteoarthritis is characterized by a decrease in the quality of life, which is currently considered as the main measure of well-being of an individual and a criterion for the effectiveness of treatment and rehabilitation measures. Modern research emphasizes the need for an integrated approach to the treatment of osteoarthritis, which should include pharmacological and non-drug methods of treatment. Aim. The purpose of the study was to evaluate the effectiveness of pharmacopuncture administration of Alloplant biomaterial by patients with osteoarthritis of the knee joint from the standpoint of influencing the immunological mechanisms of the disease. Methods. The randomization methodology was divided into 3 groups, comparable in terms of clinical and functional characteristics. Group I patients (n = 39) have standard basic drug therapy according to the federal clinical guidelines Osteoarthritis approved by the Association of Rheumatologists of Russia (2013), with additions from 2016; in patients of group II (n = 39), in addition to drug therapy, dispersed Alloplant biomaterial was used according to the original method; group III patients (n = 39) against the background of basic drug therapy are additionally prescribed a combination of dispersed Alloplant biomaterial at biologically active points and magnetic therapy with a pulsed magnetic field. Results. Against the background of the treatment of patients with osteoarthritis using pharmacopuncture with Alloplant biomaterial and magnetotherapy, there was a positive dynamics in clinical data with a significant decrease in pain intensity when walking and at rest, stiffness, with the restoration of immune status parameters and an improvement in the quality of life in the field of physical and psychological health . A more pronounced and lasting positive dynamics was observed in patients of group III against the background of the combined effects of pharmacopuncture with Alloplant biomaterial and magnetotherapy. Conclusion. The Alloplant biomaterial has a positive effect in the treatment of patients with stage III osteoarthritis according to the KellgrenLawrens classification. The similarity of the mechanism of action with drugs with a structurally modifying effect on cartilage allows us to recommend pharmacopuncture with Alloplant biomaterial for widespread use in the treatment of osteoarthritis.

scholarly journals Compressive Stockings After Hindfoot and Ankle Surgery

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0023
Author(s):  
Florian Grubhofer ◽  
Stephan Wirth
Keyword(s):  
Quality Of Life ◽  
Clinical Results ◽  
Control Group ◽  
End Points ◽  
High Compliance ◽  
Group I ◽  
Sf 36 ◽  
Ankle Surgery ◽  
Group Ii

Category: Hindfoot Introduction/Purpose: Swelling and pain are common after foot and ankle procedures. We hypothesized that compressive stockings (CS) treatment after hindfoot surgery would positively influence patient outcomes. Methods: We undertook this randomized controlled trial in 87 consecutive patients to analyze the clinical effect of CS after hindfoot and ankle surgery and evaluate CS-wearing compliance using sensors that were implanted into CS. Ankle swelling, pain status, quality of life (SF-36 score), and the American Orthopaedic Foot & Ankle Score (AOFAS) were set as the primary end points. The CS wearing time in hours and percentage were investigated as the secondary end points. All participants with CS (group I) were informed about the implanted sensor after the CS were taken off. A subgroup analysis of group I was performed to detect differences between patients with high vs low compliance. Results: At 12 weeks, the results of ankle swelling (mean 234 mm in group I and 232 mm in group II), pain in the visual analog scale (1.7 group I vs 1.9 in group II), the SF-36 score (38 points in group I vs 30 points in group II), and the AOFAS score (a mean of 76 points in both groups) showed no statistical differences between the 2 groups. The mean wearing time was 136 (range, 0-470) hours, which corresponds to a compliance rate of 65%. Sixteen participants had high compliance (>80%, >170 hours), and 21 patients had low or noncompliance. The clinical results of patients with high wearing compliance were not significantly better compared to the results of patients with low compliance. Conclusion: CS therapy after ankle and hindfoot surgery was associated with a low wearing compliance and did not influence ankle swelling, function, pain, and the quality of life compared to the control group. Furthermore, the clinical results of patients with high compliance were not better compared to the results of patients with low or noncompliance wearing behavior.

scholarly journals Quality of Life in Cured Patients with Differentiated Thyroid Carcinoma

2008 ◽  
Vol 93 (1) ◽  
pp. 200-203 ◽  
Author(s):  
Hendrieke C. Hoftijzer ◽  
Karen A. Heemstra ◽  
Eleonora P. M. Corssmit ◽  
Agatha A. van der Klaauw ◽  
Johannes A. Romijn ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Thyroid Carcinoma ◽  
Short Form ◽  
Differentiated Thyroid Carcinoma ◽  
Life Assessment ◽  
Control Group ◽  
Group I ◽  
Group Ii ◽  
The Impact

Abstract Objective: This study was performed to evaluate the impact of cured differentiated thyroid carcinoma (DTC) on quality of life. Previous studies on quality of life in patients with DTC were hampered by small patient numbers or limited quality-of-life parameters or were uncontrolled. Design: This was a cross-sectional case-control study. Method: We assessed quality of life in 153 cured DTC patients with a median duration of cure of 6.34 yr (range 0.3–41.8) and studied the contribution of disease-specific, biochemical, and social variables, focusing on the degree of TSH suppression. Four validated health-related questionnaires were used (Short Form-36, Multidimensional Fatigue Index-20, Hospital Anxiety and Depression Scale, and Somatoform Disorder Questionnaire), including multiple aspects of physical, psychological, and social functioning. Patients were compared with 113 controls selected by patients themselves (control group I) and 336 pooled age- and gender-matched controls from other Leiden quality-of-life studies (control group II). Results: Patients had significantly decreased quality of life in 11 of 16 subscales when compared with control group I. In comparison with control group II, decreased scores in 13 of 16 items were observed. An important independent predictor for quality of life was duration of cure. Quality-of-life parameters were not influenced by serum TSH levels both measured at the time of quality-of-life assessment and measured over time since initial therapy. Conclusions: Patients cured for DTC have impaired quality of life, independently of TSH level. Quality-of-life parameters were inversely affected by duration of cure and consequently may be restored after prolonged follow-up.

scholarly journals Impaired quality of life of patients with acromegaly: control of GH/IGF-I excess improves psychological subscale appearance

2008 ◽  
Vol 158 (3) ◽  
pp. 305-310 ◽  
Author(s):  
Maria P Matta ◽  
Elisabeth Couture ◽  
Laurent Cazals ◽  
Delphine Vezzosi ◽  
Antoine Bennet ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Medical Treatment ◽  
Positive Impact ◽  
Group I ◽  
Igf I ◽  
Group Ii ◽  
Psychological Scales ◽  
Control Criteria ◽  
Design And Methods

IntroductionAcromegaly, a chronic disease caused by GH/IGF-I excess, has a major impact on quality of life (QoL).ObjectiveTo evaluate QoL of acromegalic patients in relation to control status of the disease.Design and methodsSingle center observational study including 93 patients with acromegaly recruited to complete QoL questionnaire (AcroQol). QoL was evaluated at least 3 months after surgery and/or medical treatment. Patients were divided into two groups: controlled (I) and uncontrolled (II) according to the latest consensus acromegaly ‘control’ criteria and further subdivided into four subgroups according to the previous pituitary adenoma surgery (Ib and IIb) or without surgery (Ia and IIa).ResultsMean GH (0.81±0.47 ng/ml) and IGF-I (195±71 ng/ml) values in group I were significantly lower than in group II (GH, 7.01±12.05 ng/ml and IGF-I, 513±316 ng/ml; P<0.001). There was no difference in total AcroQol score, physical, or psychological scales between groups I and II. However, when adjusted to age and disease duration since diagnosis, patients of group I (63±20%) showed an improved psychological subscale appearance than those of group II (58±17%; P=0.035). In group II, IGF-I level was lower after surgery (IIa=588±353, IIb=410±225 ng/ml; P<0.038), and psychological subscale appearance was significantly better in subgroup IIb (64.9±18.1%) than in subgroup IIa who had medical treatment (53.9±14.3%; P=0.009).ConclusionQoL is severely impaired in acromegalic patients. Control of GH/IGF-I excess by surgery or medical treatment seems to have a positive impact on psychological subscale appearance.

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