Acute Complex Type A Dissection associated with peripheral malperfusion syndrome treated with a staged approach guided by lactate levels

Acute type A aortic dissection can be complicated by visceral malperfusion and is associated with a significant surgical morbidity and mortality. We describe a case of successful management of a complex acute type A dissection with mesenteric and lower limb ischemia treated with endovascular thoracic stenting and femoro-femoral crossover bypass grafting followed by aortic arch repair. To accomplish this, we applied a staged therapeutic approach using serial lactate measurements to assess the adequacy of peripheral perfusion and metabolic status prior to surgical repair of the proximal dissection

A randomized controlled trial of a decision aid for women considering genetic testing for breast and ovarian cancer risk

PURPOSE: To measure the effectiveness of a tailored decision aid (DA) designed to help women make informed decisions about genetic testing for breast/ovarian cancer risk. METHODS: A total of 145 women were randomized to receive the DA or a control pamphlet at the end of their first genetic counseling consultation. Of these, 120 (82.8%) completed two questionnaires, 1 week and 6 months post-consultation. RESULTS: While the DA had no effect on informed choice, post-decisional regret or actual genetic testing decision, the trial showed that women who received the DA had higher knowledge levels and felt more informed about genetic testing than women who received the control pamphlet (chi(2)(2) = 6.82; P = 0.033; chi(2)(1) = 4.86; P = 0.028 respectively). The DA also helped women who did not have blood drawn at their first consultation to clarify their values with regards to genetic testing (chi(2)(1) = 5.27; P = 0.022). Women who received the DA were less likely to share the information with other family members than women in the control condition (chi(2)(1) = 8.78; P = 0.003). CONCLUSIONS: Decision aids are an effective decision-support strategy for women considering genetic testing for breast/ovarian cancer risk, and are most effective before the patient has made a decision, which is generally at the point of having blood drawn

Psychological adjustment among partners of women at high risk of developing breast/ovarian cancer

Purpose: The aim of the current research was to characterize psychological adjustment among partners of women at high risk of developing breast/ovarian cancer and to explore the relationship between women's and partners' adjustment. Methods: A study of 95 unaffected at-risk women and 95 partners was carried out using mailed, self-administered questionnaires with validated measures of psychological outcome. Results: Elevated levels of distress were noted in up to 10% of partners. High monitoring coping style and greater perceived breast cancer risk for their wife were associated with higher distress levels for partners. However, communicating openly with their wife and the occurrence of a recent cancer-related event in the woman's family were related to lower distress for partners. Partners' cancer-specific distress was positively related to their wives' distress. Conclusion: Among partners with elevated levels of distress, the ability to provide effective support to the at-risk women and participate appropriately in their decision making may be compromised. These partners are likely to benefit from targeted clinical interventions designed to reduce their distress levels. The findings emphasize the importance of considering partners of at-risk women in service provision and highlight the need for partners to obtain information and support specifically tailored to their needs.10 page(s