Did online publishers "get it right"? Using a naturalistic search strategy to review cognitive health promotion content on internet webpages.

BACKGROUND: One of the most common uses of the Internet is to search for health-related information. Although scientific evidence pertaining to cognitive health promotion has expanded rapidly in recent years, it is unclear how much of this information has been made available to Internet users. Thus, the purpose of our study was to assess the reliability and quality of information about cognitive health promotion encountered by typical Internet users. METHODS: To generate a list of relevant search terms employed by Internet users, we entered seed search terms in Google Trends and recorded any terms consistently used in the prior 2 years. To further approximate the behaviour of typical Internet users, we entered each term in Google and sampled the first two relevant results. This search, completed in October 2014, resulted in a sample of 86 webpages, 48 of which had content related to cognitive health promotion. An interdisciplinary team rated the information reliability and quality of these webpages using a standardized measure. RESULTS: We found that information reliability and quality were moderate, on average. Just one retrieved page mentioned best practice, national recommendations, or consensus guidelines by name. Commercial content (i.e., product promotion, advertising content, or non-commercial) was associated with differences in reliability and quality, with product promoter webpages having the lowest mean reliability and quality ratings. CONCLUSIONS: As efforts to communicate the association between lifestyle and cognitive health continue to expand, we offer these results as a baseline assessment of the reliability and quality of cognitive health promotion on the Internet.

[Breast volume reconstruction by lipomodeling technique: about 15 consecutive cases]. / Reconstruction mammaire par transfert graisseux exclusif: à propos de 15 cas consécutifs.

UNLABELLED: BACKGROUND OF STUDY: The purpose of this prospective study is to detail the preliminary results, the advantages and drawbacks of a new iterative fat transfer protocol in selected breast reconstructions. MATERIAL AND METHODS: Fifteen patients had breast reconstruction following mastectomy for breast cancer by this iterative lipomodeling protocol, between 2002 and 2007. Clinical and technical aspects are described. Indications, advantages, drawbacks, complications and morphological results are discussed. RESULTS: Mean age at first stage procedure was 50 years (min: 41, max: 57). Indications were eight delayed breast reconstructions, three salvage reconstructions after flap failure, two restorations following primary chest wall reconstruction, two immediate breast reconstructions. Two to five sequential procedures were necessary to obtain a satisfactory breast volume (mean: three procedures). Mean total transferred fat volume was 600 cm(3) (min: 266 cm(3), max: 926 cm(3)). Multiple procedures were performed: restoration of breast skin envelope by abdominal advancement fasciocutaneous flap, breast contours liposuction, controlateral breast symmetrisation, nipple areola complex reconstruction. Mean follow-up was 28 months. The aesthetics results have been judged as very good in 10 patients, good in four patients and poor in one patient. The satisfaction rate of the patients is high: 10 patients are pleased, four patients are satisfied and one patient is moderately satisfied. CONCLUSION: Fat transfer alone can efficiently restore breast volume after mastectomy, granting all advantages related with autologous reconstruction. No donor site morbidity is present; in fact some secondary benefits are observed thanks to the correction of eventual disgraceful lipodystrophies. These secondary benefits strengthen patient compliance improving iterative procedures tolerance. Lack of available adipose tissue and high breast volume are the major morphological limits of the technique. In our experience, fat transfer appears to be a promising technique for breast reconstruction. Long term results still have to be evaluated before it can become a standard.

[Skin-sparing mastectomies: how to avoid skin necrosis?]. / Mastectomies avec conservation de l'étui cutané : comment éviter les souffrances cutanées ?

Skin-sparing mastectomy (SSM) has emerged as the surgical technique best adapted to the treatment of early breast cancers or breast cancer recurrences after conservative treatment; the technique is particularly appreciated by the patients who had been expecting the development of immediate, high-quality breast reconstruction for over 15 years. SSM preserves anatomical landmarks on the skin surface (notably the under-breast fold and the conical shape of the breast). The procedure must be performed by a skilled surgical team in order to maximize the quality of breast resection and reconstruction, particularly to avoid postoperative complications, notably damage to blood vessels within the skin flap and prosthesis infection. These complications generally affect the cosmetic outcome of the reconstruction, with serious short-term and long-term consequences for the acceptability of the surgical procedure, and may sometimes compromise the delivery of adjuvant treatments (either chemo- or radiotherapy). Based on our previous experience (1000 new cases since 1992), we will compare the advantages and drawbacks of the procedure, discuss its indications, describe the clinical situations encountered and the various specific interventions available, as well as the methods to reduce the risks of tissue damage and skin necrosis.

[Post-treatment sequelae after breast cancer conservative surgery]. / Séquelles thérapeutiques du sein après traitement conservateur du cancer du sein.

Thanks to the earlier detection of breast cancer, the advent of neoadjuvant therapy and the development of more effective surgical procedures reducing treatment sequelae, conservative treatment has dramatically expanded over the past 15 years. Several factors have recognized negative aesthetic consequences for breast cancer patients: being overweight, having voluminous or on the contrary, very small breasts, having a tumor located in the lower quadrant, having high breast-tumor: breast-volume ratio. Tissue injuries induced by radiotherapy and chemotherapy, such as shrinking, fibrosis or induration, maximize the deleterious impact of surgery. The results of conservative treatment also deteriorate with time: weight gain is common and may result in increased breast asymmetry. Patients undergoing conservative treatment may experience sequelae including various degrees of the following dimorphisms, all possibly responsible for minor or even major breast deformity: breast asymmetry, loss of the nipple/areola complex, scar shrinkage and skin impairment, irregular shape and position of the nipple and areola. Various sensory symptoms have also been reported following conservative treatment, with patients complaining of hypo- or dysesthesia or even suffering actual pain. Breast lymphedema is also a common incapacitating after-effect that is believed to be largely underdiagnosed in clinical practice. Finally, like mastectomy, conservative breast surgery may induce serious psychological distress in patients who suffer the loss of physical integrity, womanhood or sexual arousal. Clinicians must be aware of the radiological changes indicative of late cancer recurrence. There are four types of modifications as follows: increased breast density, architectural distortion at the surgical site and formation of scar, mammary fat necrosis, and occurrence of microcalcifications. The management of sequelae of conservative breast treatment must therefore involve a multidisciplinary approach; patients not only expect better cosmetic appearance, but also a focus on other treatment advances such as improvement of psychological and sensory outcome. The interpretation of radiological images is also an integral part of the management of these patients at significant risk of recurrence.

[Extra-abdominal desmoid tumor in a scar of donor-site of a latissimus dorsi flap: case report]. / Tumeur desmoïde extra-abdominale survenue sur cicatrice de prélèvement de lambeau de grand dorsal: à propos d'un cas.

Tumefaction arising lately after latissimus dorsi flap harvest are rare and observed in 1 or 2% of the cases. These lesions are frequently related to kystic sero-hematoma and are easily and efficiently treated with surgical excision. In some rare circumstances, a tumoral evolution can mimic a kystic sero-hematoma. We will discuss one case of desmoid tumor arising from a latissimus dorsi flap donor-site scar. The subject was a 45 years old woman who had a breast reconstruction following mastectomy. A dorsal tumefaction, with a benign aspect, was observed during the follow-up period. The biopsy showed an extra-abdominal desmoid tumor. The patient was treated with a large excision of the lesion and reconstructed using two opposing local cutaneous advancing flaps. No radicalization was necessary. No sign of recurrence has been observed at 4 years follow-up.

[Efficacy of lipomodelling for the management of sequelae of breast cancer conservative treatment]. / Efficacité du lipomodelage pour la correction des séquelles du traitement conservateur du cancer du sein.

We report a study of 42 breast cancer patients undergoing lipomodelling, or fat transfer, for sequelae of conservative treatment. Detailed clinical and radiological data of the patients have been collected. These data demonstrate the feasibility of lipomodelling: the technique is simple but requires a learning curve to avoid cytosteatonecrotic lesions; the excellent results obtained in terms of shape and softness of the breast; no surgical implant or flap reconstruction is necessary; the reliability of the procedure: there is normal fat wasting within the first months after treatment, then results stabilize as the patient maintains a healthy weight; the small number of side-effects: only rare, predominantly infectious, rapidly resolving complications are induced. In conclusion, the fat transfer approach presented here represents a considerable advance for the management of moderate sequelae of conservative breast treatment. Using this technique makes it possible to restore the shape and softness of the breast better than any other surgical procedure before, particularly for patients with mild breast deformity.

East African Trypanosomiasis in Nkhotakota District

A marked increase in trypanosomiasis has been seen at Nkhotakota District Hospital since September 1989. This report presents background information; the extent of the recent outbreak and suggested revised treatment protocol. Suggestions are made for preventative measures against the spread of trypanosomiasis