Reasons for risk-reducing mastectomy versus MRI-screening in a cohort of women at high hereditary risk of breast cancer

Objective

To determine the reasons that motivate women in a cohort of women under intensive surveillance for breast cancer to undergo risk-reducing mastectomy (RRM).

Patients and methods

Women with a BRCA1 or BRCA2 mutation who were enrolled in an MRI-based breast screening study were eligible to participate in this survey. A self-administered questionnaire was given to women who did, and who did not terminate annual MRI-based surveillance in order to undergo RRM. The questionnaire included information on family history, risk perception and satisfaction with screening. In addition, women were asked to provide the principal reason for their choice of having preventive surgery or not, and were asked about their satisfaction with this choice.

Results

246 women without breast cancer participated in the study. Of these, 39 women (16%) elected to have RRM at some point after initiating screening. Although women who had a mother or sister with breast cancer were more likely to opt for RRM than were women with no affected first-degree relative (21% versus 10%) this did not reach statistical significance. Women who perceived their breast cancer risk to be greater than 50% were more likely to opt for RRM than were women who estimated their risk to be less than 50% (19% versus 6%). Fear of cancer was the most common reason cited for choosing to have RRM (38% of respondents) followed by having had a previous cancer, (25%), then concern over their children (16%).

Conclusion

Among women with a BRCA mutation who are enrolled in an MRI-based screening program, a high perception of personal breast cancer risk and a history of breast cancer in a first-degree relative are predictors of the decision to have RRM.     

Scientific and ethical concerns regarding engineering human longevity

The goal of biogerontological research is to elucidate the biological factors underlying adverse age-related changes in structure and function of molecules, cells, tissues, and organisms. In spite of the considerable progress achieved so far, it is still too early to predict what strategies will be both safe and effective at preventing, delaying, or reversing these changes in humans, and whether such strategies will also increase longevity.     

Interval between clinical presentation of necrotizing enterocolitis and bowel perforation in neonates

Objective  

To define the interval between clinical presentation of necrotizing enterocolitis (NEC) and bowel perforation in neonates.     

Grandmothers, caregiving, and family functioning

OBJECTIVES: We used McCubbin's Resiliency Model of Family Stress, Adjustment and Adaptation ( McCubbin, Thompson, & McCubbin, 2001) to examine how demographic factors, family stress, grandmother resourcefulness, support, and role reward affect perceptions of family functioning for grandmothers raising grandchildren, grandmothers living in multigenerational households, and grandmothers not caregiving for grandchildren. METHODS: A sample of 486 grandmothers completed a mailed questionnaire. We used structural equation modeling to (a) test the effects of demographic factors (i.e., grandmother's age, race, marital status, and employment), family stressful life events and strain, grandmother's resourcefulness, subjective and instrumental support, and role reward on perceptions of family functioning for each grandmother group; (b) evaluate differences in the measurement and structural models between the grandmother groups using multisample analysis; and (c) test the model on the full sample, coding for caregiver status. RESULTS: The models did not differ significantly by grandmother group; therefore we assessed the composite model using a multisample analysis. We found general support for the resiliency model and equivalence of the models across grandmother groups. Less support, resourcefulness, and reward, and more intrafamily strain and stressful family life events contributed to perceptions of worse family functioning. DISCUSSION: Findings demonstrate the importance of the quality of family functioning for grandmothers in all types of families.     

Surgical and medical management of mesenteric ischemia

Opinion statement Acute mesenteric ischemia frequently results in bowel necrosis, which necessitates laparotomy to assess bowel viability. Reduction in mortality requires a high index of suspicion and prompt diagnosis. Bowel resection should be preceded by visceral artery revascularization. Medical management includes the use of anticoagulation, vasodilators, and the use of inhibitors of reperfusion injury. The management of chronic mesenteric ischemia largely depends on the general condition of the patient, who is often affected by malnutrition and dehydration. Surgery, although associated with greater morbidity and mortality, is more durable and effective in relieving the symptoms of chronic mesenteric ischemia. Endovascular treatment options for chronic mesenteric ischemia include percutaneous balloon angioplasty and stenting. This treatment is more likely to be successful in dealing with stenotic rather than occlusive lesions and offers a minimal invasive approach but is associated with a smaller primary success rate and a higher recurrence rate.     

Predicting the outcome of physeal fractures of the distal femur

BACKGROUND:: Distal femoral epiphyseal fractures are uncommon but have a high incidence rate of complications. It is not clear whether there are any reliable predictor factors and whether the type of fracture, displacement (degree and direction), and treatment method alter the outcome. METHODS:: We retrospectively reviewed the medical charts and images of all patients who sustained a distal femoral epiphyseal fracture and were treated at 2 large level I pediatric centers during the past 10 years. RESULTS:: The selected group included 73 patients (boys, 59; mean age, 10 years). On the basis of the Salter-Harris classification (SH), 43 fractures (59%) were of type II. Fifty-nine percent of the fractures were displaced; 36 fractures were managed conservatively with long leg cast (with or without pelvic band) in 33 patients, cylinder cast in 2, and posterior splint in 1. Thirty-seven patients underwent surgery, and 34 underwent closed reduction followed by percutaneous fixation (crossed Steinman pins, 20; cannulated screws, 13; open reduction, 3; external fixation, 1). The overall complication rate was 40% (29/73), and growth arrest was the most frequent. The SH classification significantly correlated with the incidence of complications (P = 0.031). There was also a significantly higher (P < 0.0001) incidence rate of complications among displaced fractures (48.8% vs 26.6%); the amount and direction of displacement did not correlate with the outcome (P > 0.05). The group treated conservatively had a lower incidence rate of complications (25%) than did the surgical group (54%) (P < 0.05). Among the surgical group, a higher incidence rate of complications occurred when the physis was violated by hardware (65% vs 30%; P = 0.06). CONCLUSIONS:: Both SH classification and displacement of the fracture are significant predictors of the final outcome. The degree and the direction of displacement do not statistically correlate with outcome. The treatment method may influence the final outcome.