Psychological impact of multigene cancer panel testing in patients with a clinical suspicion of hereditary cancer across Spain.

OBJECTIVE: Patients' psychological reactions to multigene cancer panel testing might differ compared with the single-gene testing reactions because of the complexity and uncertainty associated with the different possible results. Understanding patients' preferences and psychological impact of multigene panel testing is important to adapt the genetic counselling model. METHODS: One hundred eighty-seven unrelated patients with clinical suspicion of hereditary cancer undergoing a 25-gene panel test completed questionnaires after pretest genetic counselling and at 1 week, 3 months, and 12 months after results to elicit their preferences regarding results disclosure and to measure their cancer worry and testing-specific distress and uncertainty. RESULTS: A pathogenic variant was identified in 38 patients (34 high penetrance and 4 moderate penetrance variants), and 54 patients had at least one variant of uncertain significance. Overall, cancer panel testing was not associated with an increase in cancer worry after results disclosure (P value = .87). Twelve months after results, carriers of a moderate penetrance variant had higher distress and uncertainty scores compared with carriers of high penetrance variants. Cancer worry prior to genetic testing predicted genetic testing specific distress after results, especially at long term (P value <.001). Most of the patients reported the wish to know all genetic results. CONCLUSIONS: Our results suggest that patients can psychologically cope with cancer panel testing, but distress and uncertainty observed in carriers of moderate penetrance cancer variants in this cohort warrant further research.

Esophagoenteral stents in patients with recurrent gastric adenocarcinoma.

One of the problems that can appear in patients with total gastrectomy for adenocarcinoma with esophagoenteral anastomosis is the appearance of a stenosis of the anastomosis. These stenosis are frequently malignant due to relapse of neoplasia. The therapeutic possibilities available are the surgical bypass or palliative treatment. There is very little experience described in the literature (21 cases) on the placing of self-expandable metal stents as a palliative treatment for the symptoms of stenosis.We present our experience of 3 patients, in whom 4 esophageal stents were fitted (1 covered and 3 uncovered) with good results. The dysphagia disappeared or improved, it allowed the ingestion of a soft diet and meant an improvement in the quality of life and at the same time stopped the weight loss. It seems an effective palliative treatment as a treatment for dysphagia in patients with tumoral relapse in the anastomosis of total gastrectomies.

Prótesis esofagoenterales en pacientes con recidiva de adenocarcinoma gástrico / Esophagoenteral stents in patients with recurrent gastric adenocarcinoma

Uno de los problemas que puede aparecer en los pacientescon gastrectomía total por adenocarcinoma con anastomosis esofagoenterales la aparición de estenosis de la anastomosis o próximaa ella. Estas estenosis con frecuencia son malignas debido a laaparición de recidiva en la neoplasia. Las posibilidades terapéuticasde las que disponemos son el bypass quirúrgico o bien el tratamientopaliativo. Existe muy poca experiencia descrita en la literatura(21 casos) sobre la colocación de prótesis metálicasautoexpandibles como tratamiento paliativo de los síntomas de laestenosis.Presentamos nuestra experiencia en 3 pacientes, en los que secolocaron 4 prótesis esofágicas (1 recubierta y 3 no recubiertas)con buenos resultados. Desapareció o mejoró la disfagia, permitióla ingesta de dieta blanda y supuso una mejora en la calidad devida a la vez que impide la pérdida ponderal. Parece un tratamientopaliativo eficaz como tratamiento de la disfagia en pacientescon recidiva tumoral en la anastomosis de las gastrectomías totales

One of the problems that can appear in patients with total gastrectomyfor adenocarcinoma with esophagoenteral anastomosisis the appearance of a stenosis of the anastomosis. These stenosisare frequently malignant due to relapse of neoplasia. The therapeuticpossibilities available are the surgical bypass or palliativetreatment. There is very little experience described in the literature(21 cases) on the placing of self-expandable metal stents as a palliativetreatment for the symptoms of stenosis.We present our experience of 3 patients, in whom 4esophageal stents were fitted (1 covered and 3 uncovered) withgood results. The dysphagia disappeared or improved, it allowedthe ingestion of a soft diet and meant an improvement in the qualityof life and at the same time stopped the weight loss. It seemsan effective palliative treatment as a treatment for dysphagia inpatients with tumoral relapse in the anastomosis of total gastrectomies

[Mycotic aneurism in aortic arch by Aspergillus fumigatus: contribution of a case and review of the literature]. / Aneurisma micótico en cayado aórtico por Aspergillus fumigatus: aportación de un caso y revisión en la literatura.

The micotic aneurisms by Aspergillus are rare and usually appear in the context of an invasive pulmonary aspergilosis, or by septicum embolism or direct extension from the lungs, for that reason the location the more frequents is in aortic arch and the ascending aorta.8 cases of micotic aneurisms by Aspergillus spp. have been described in literature between 1966 and 2000, being the most frequent location the ascending aorta or the aortic arch. The Aspergillus fumigatus is the isolated species with more frequency, affecting mainly to patients undergoing inmunosupression. The diagnosis of a micotic aneurism requires a high clinical suspicion, given to its peculiarity and the presence of inespecific symptoms, being frequently an accidental finding in an invasive pulmonary aspergilosis.The case of a patient with a micotic aneurism by A. fumigatus appears and we reviewed the similar cases previously disclosed.