Search

In search of open minds and shared consent - Information, treatment options and postoperative care from the patient's perspective Abstract. This paper addresses knowledge gaps which are prone to handicap the ongoing communication process between medical / care personnel and patients of breast cancer, due to everyday routine and presumed lack of time. The respective qualitative studies do point to divergent expectations with regards to medical consultations and indicate that patients' satisfaction with therapeutic measures, which were decided in advance, might be improved. Three exemplary aspects of doctor-patient communication are then looked at closer: first the variety of treatment options offered, second the risk of expressing unconscious bias regarding patients' physical appearance and identity, and third the increasingly acknowledged desire of breast cancer patients to consult (… additionally, not alternatively) with other patients that are, or were previously affected by breast cancer and confronted with the decisions this condition entails.

Purpose: Indications for nipple-sparing mastectomy (NSM) have broadened to include the risk reducing setting and locally advanced tumors, which resulted in a dramatic increase in the use of NSM. The Oncoplastic Breast Consortium consensus conference on NSM and immediate reconstruction was held to address a variety of questions in clinical practice and research based on published evidence and expert panel opinion., Methods: The panel consisted of 44 breast surgeons from 14 countries across four continents with a background in gynecology, general or reconstructive surgery and a practice dedicated to breast cancer, as well as a patient advocate. Panelists presented evidence summaries relating to each topic for debate during the in-person consensus conference. The iterative process in question development, voting, and wording of the recommendations followed the modified Delphi methodology., Results: Consensus recommendations were reached in 35, majority recommendations in 24, and no recommendations in the remaining 12 questions. The panel acknowledged the need for standardization of various aspects of NSM and immediate reconstruction. It endorsed several oncological contraindications to the preservation of the skin and nipple. Furthermore, it recommended inclusion of patients in prospective registries and routine assessment of patient-reported outcomes. Considerable heterogeneity in breast reconstruction practice became obvious during the conference., Conclusions: In case of conflicting or missing evidence to guide treatment, the consensus conference revealed substantial disagreement in expert panel opinion, which, among others, supports the need for a randomized trial to evaluate the safest and most efficacious reconstruction techniques.

Aural haematomas occur commonly in dogs in which predisposing factors include trauma to the pinna, a history of violent head shaking, and acute or chronic otitis externa. Treatment usually involves invasive surgery performed under general anaesthesia but these techniques can create wounds requiring intensive aftercare. Furthermore, certain breeds of dog and/or older animals are often at greater risk due to complications arising from the use of anaesthetics. Therefore, a need exists for a less invasive procedure which can be performed easily in general practice and with minimal reliance on anaesthetics. Fibrin sealants fulfil these criteria and have been used successfully to treat aural haematomas in humans. This is the first known report on the use of fibrin sealant to treat a canine aural haematoma. In the present case, the haematoma recurred shortly after removal of the protective collar, and was subsequently treated by conventional surgery. Possible reasons for initial success of the fibrin sealant and then later recurrence of the haematoma (e.g. premature removal of the collar) are discussed.

We studied the effects of amounts of colostrum consumed on intestinal morphology and proliferation and digestive enzyme activities in neonatal calves. Group GrCmax calves were fed colostrum from the first milking undiluted on d 1-3 and diluted with 25, 50, 75 and 75 parts of a milk replacer on d 4-7. Group GrC1-3 calves were fed colostrum from milkings 1-6 up to d 3 and then a milk replacer up to d 7. Group GrF1-3 calves were fed a milk-based formula (containing only traces of growth factors and hormones) up to d 3 and then a milk replacer up to d 7. Calves were killed on d 8. Differences in feeding affected villus sizes and villus height/crypt depth ratios in the duodenum (GrCmax > GrC1-3), villus areas and villus height/crypt depth ratios in the jejunum (GrC1-3 > GrF1-3) and crypt depths in the colon (GrF1-3 > GrC1-3). Furthermore, different feeding protocols affected the proliferation rates of epithelial cells in the duodenum (GrC1-3 > GrCmax; GrC1-3 > GrF1-3) and the jejunum (GrF1-3 > GrC1-3; based on Ki-67 labeling). Lipase activities in the pancreas were influenced by colostrum feeding (GrC(max) > GrC(1-3)). Colostrum intake differentially affected intestinal epithelial surface and proliferation and enzyme activities. Feeding high amounts of first colostrum seemed to enhance the survival of mature mucosal epithelial cells in selected parts of the small intestine, whereas the lack of colostrum seemed to decrease epithelial growth.