Aesthetic outcome and oncological safety of nipple-areola complex replantation after mastectomy and immediate breast reconstruction

Immediate breast reconstruction (IBR) has become an established procedure for women necessitating mastectomy. Traditionally, the nipple-areola complex (NAC) is resected during this procedure. The NAC, in turn, is a principal factor determining aesthetic outcome after breast reconstruction, and due to its particular texture and shape, a natural-looking NAC can barely be reconstructed with other tissues. The aim of this study was to assess the oncological safety as well as morbidity and aesthetic outcome after replantation of the NAC some days after IBR. Retrospective analysis of 85 patients receiving 88 mastectomies and IBR between 1998 and 2007 was conducted. NAC (n=29) or the nipple alone (n=23) were replanted 7 days (median, range 2-10 days) after IBR in 49 patients, provided the subareolar tissue was histologically negative for tumour infiltration. Local recurrence rate was assessed after 49 months (median, range 6-120 months). Aesthetic outcome was evaluated by clinical assessment during routine follow-up at least 12 months after the last intervention. Malignant involvement of the subareolar tissue was found in eight cases (9.1%). Patients qualifying for NAC replantation were in stage 0 in 29%, stage I in 15%, stage IIa in 31%, stage IIb in 17% and stage III in 8%. Total or partial necrosis occurred in 69% and 26% if the entire NAC or only the nipple were replanted, respectively (P<0.01). Depigmentation was seen in 52% and corrective surgery was done in 11 out of 52 NAC or nipple replantations. Local recurrence and isolated regional lymph node metastasis were observed in one single case each. Another 5.8% of the patients showed distant metastases. We conclude that the replantation of the NAC in IBR is oncologically safe, provided the subareolar tissue is free of tumour. However, the long-term aesthetic outcome of NAC replantation is not satisfying, which advocates replanting the nipple alone.

Appraising and selecting conservation measures to mitigate desertification and land degradation based on stakeholder participation and global best practices

Most desertification research focuses on degradation assessments without putting sufficient emphasis on prevention and mitigation strategies, although the concept of Sustainable Land Management (SLM) is increasingly being acknowledged. A variety of already applied conservation measures exist at the local level, but they are not adequately recognised, evaluated and shared, either by land users, technicians, researchers, or policy makers. Likewise, collaboration between research and implementation is often insufficient. The aim of this paper is to present a new methodology for a participatory process of appraising and selecting desertification mitigation strategies, and to present first experiences from its application in the EU-funded DESIRE project. The methodology combines a collective learning and decision approach with the use of evaluated global best practices. In three parts, it moves through a concise process, starting with identifying land degradation and locally applied solutions in a stakeholder workshop, leading to assessing local solutions with a standardised evaluation tool, and ending with jointly selecting promising strategies for implementation with the help of a decision support tool. The methodology is currently being applied in 16 study sites. Preliminary analysis from the application of the first part of the methodology shows that the initial stakeholder workshop results in a good basis for stakeholder cooperation, and in promising land conservation practices for further assessment. Study site research teams appreciated the valuable results, as burning issues and promising options emerged from joint reflection. The methodology is suitable to initiate mutual learning among different stakeholder groups and to integrate local and scientific knowledge.

Combined effect of soil bund with biological soil and water conservation measures in the northwestern Ethiopian highlands

Excessive runoff and soil erosion in the upper Blue Nile Basin poses a threat that has attracted the attention of the Ethiopian government because of the serious on-site effects in addition to downstream effects, such as the siltation of water harvesting structures and reservoirs. The objective of the study was to evaluate and recommend effective biophysical soil and water conservation measure(s) in the Debre Mewi watershed, about 30 km south of the Lake Tana. Six conservation measures were evaluated for their effects on runoff, soil loss, and forage yield using runoff plots. There was a significant difference between treatments for both runoff and soil loss. The four-year average annual soil loss in the different plots ranged from 26 to 71 t ha−1, and total runoff ranged from 180 to 302 mm, while annual rainfall varied between 854 mm in 2008 and 1247 mm in 2011. Soil bund combined with elephant grass had the lowest runoff and soil loss as compared to the other treatments, whereas the untreated control plot had the highest for both parameters. As an additional benefit, 2.8 and 0.7 t ha−1 year−1 of dried forage was obtained from elephant and local grasses, respectively. Furthermore, it was found that soil bund combined with Tephrosia increased soil organic matter by 13% compared to the control plot. Soil bund efficiency was significantly enhanced by combining them with biological measures and improved farmers’ perception of soil and water conservation measures.

Risk assessment and causal preventive measures.

A prerequisite for preventive measures is to diagnose erosive tooth wear and to evaluate the different etiological factors in order to identify persons at risk. No diagnostic device is available for the assessment of erosive defects. Thus, they can only be detected clinically. Consequently, erosion not diagnosed at an early stage may render timely preventive measures difficult. In order to assess the risk factors, patients should record their dietary intake for a distinct period of time. Then a dentist can determine the erosive potential of the diet. A table with common beverages and foodstuffs is presented for judging the erosive potential. Particularly, patients with more than 4 dietary acid intakes have a higher risk for erosion when other risk factors are present. Regurgitation of gastric acids is a further important risk factor for the development of erosion which has to be taken into account. Based on these analyses, an individually tailored preventive program may be suggested to the patients. It may comprise dietary advice, use of calcium-enriched beverages, optimization of prophylactic regimes, stimulation of salivary flow rate, use of buffering medicaments and particular motivation for nondestructive toothbrushing habits with an erosive-protecting toothpaste as well as rinsing solutions. Since erosion and abrasion often occur simultaneously, all of the causative components must be taken into consideration when planning preventive strategies but only those important and feasible for an individual should be communicated to the patient.

Multi-slice computed tomography (MSCT) of mountaineering casualties in the Swiss Alps - Advantages and limitations

As an Alpine country, Switzerland has not only a thriving mountaineering tourist industry, but also many mountaineering casualties. At the request of the state attorney, most of the victims undergo only an external inspection without autopsy. One of the main tasks of the forensic pathologist under these circumstances is the correct identification of the deceased for a fast release to their kin. Nevertheless, detailed knowledge of the injuries sustained may lead to improved safety measures, such as better protective equipment. In this study, we examined the feasibility of using cross-sectional imaging with postmortem multi-slice computed tomography (MSCT) to detect lesions of the skeletal structures and internal organs. For this purpose, we used whole-body MSCT to examine 10 corpses that suffered fatal falls from great height while climbing in the Swiss part of the European Alps from the years 2007 to 2009. We conclude that postmortem CT imaging is a valuable tool for dental identification and is superior to plain X-rays as a viable compromise between a solely external legal inspection and an autopsy because it delivers otherwise irretrievable additional internal findings non-invasively. This fact is of great importance in cases where an autopsy is refused.