ESPRAS Survey on Breast Reconstruction in Europe.

BACKGROUND: The European Leadership Forum (ELF) of the European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS) previously identified the need for harmonisation of breast reconstruction standards in Europe, in order to strengthen the role of plastic surgeons. This study aims to survey the status, current trends and potential regional differences in the practice of breast reconstruction in Europe, with emphasis on equity and access. MATERIALS AND METHODS: A largescale web-based questionnaire was sent to consultant plastic and reconstructive surgeons, who are experienced in breast reconstruction and with understanding of the national situation in their country. Suitable participants were identified via the Executive Committee (ExCo) of ESPRAS and national delegates of ESPRAS. The results were evaluated and related to evidence-based literature. RESULTS: A total of 33 participants from 29 European countries participated in this study. Overall, the incidence of breast reconstruction was reported to be relatively low across Europe, comparable to other large geographic regions, such as North America. Equity of provision and access to breast reconstruction was distributed evenly within Europe, with geographic regions potentially affecting the type of reconstruction offered. Standard practices with regard to radiotherapy differed between countries and a clear demand for European guidelines on breast reconstruction was reported. CONCLUSION: This study identified distinct lack of consistency in international practice patterns across European countries and a strong demand for consistent European guidance. Large-scale and multi-centre European clinical trials are required to further elucidate the presented areas of interest and to define European standard operating procedures.

Inhalation of warm and cold air does not influence brain stem or core temperature in normothermic humans.

The present study tested the hypothesis that inhalation rewarming provides a thermal increment to central neural structures adjacent to the nasopharyngeal region. Auditory-evoked brain stem responses of 14 subjects (7 men and 7 women) were monitored for 25 min while they inspired room air (24 degrees C) followed by hot air (41 degrees C) saturated with water vapor and cold dry air (-1 degrees C). The latencies of peaks I, III, and V and the interpeak latencies (IPLs) I-III, III-V, and I-V were compared among the three conditions with a repeated-measures ANOVA. Changes in IPLs are sensitive markers of changes in brain stem temperature. Tympanic temperature (T(ty)) was measured with an infrared tympanic thermometer. There were no significant differences in T(ty), peak latencies I, III, and V, and IPLs I-III, III-V, and I-V. The results indicate that inhalation of hot and cold air does not influence T(ty), nor does it influence the temperature of the brain stem. We conclude that inhalation rewarming is not capable of warming the vital central neural structures adjacent to the naropharynx.