ABSTRACT
OBJECTIVE: To compare birth recommendations for pregnant women with a prior cesarean produced from a decision model using absolute risks vs. one using subjective interpretation of the same risks: (1) a multiattribute decision model based on patient prioritization of risks (subjective risk) and (2) a hybrid model that used absolute risks (objective risk). STUDY DESIGN AND SETTING: The subjective risk multiattribute model used the Analytic Hierarchy Process to elicit priorities for maternal risks, neonatal risks, and the delivery experience from 96 postnatal women with a prior cesarean. The hybrid model combined the priorities for delivery experience obtained in the first model with the unadjusted absolute risk values. RESULTS: The multiattribute model generated more recommendations for repeat cesarean delivery than the hybrid model: 73% vs. 18%, (P-value <0.001). The multiattribute model favored repeat cesarean because women heavily prioritized avoiding any risk (even rare risk) to the infant. The hybrid model favored the trial of labor because of lower probabilities of risk to the mother and its high success rate of vaginal birth after cesarean. CONCLUSION: This study highlights the importance of patients and clinicians discussing the patient's priorities regarding the risks and other nonclinical considerations that may be important to her in the birthing decision.
Subject(s)
Cesarean Section/psychology , Decision Support Techniques , Patient Satisfaction/statistics & numerical data , Trial of Labor , Cesarean Section, Repeat/psychology , Choice Behavior , Female , Health Knowledge, Attitudes, Practice , Humans , Models, Statistical , Pregnancy , Probability , Risk Factors , Surveys and Questionnaires , Vaginal Birth after Cesarean/psychologyABSTRACT
A 52-year-old woman is described in whom cardiac sarcoidosis was diagnosed clinically on the basis of high-grade heart block, recurring ventricular tachyarrhythmias, and acute cardiac decompensation. Confirmation of sarcoidosis was not determined until necropsy. When it causes cardiac dysfunction, sarcoidosis rarely causes dysfunction of another body organ, although small sarcoid granulomas may also be present in noncardiac organs or tissues. In the present patient, neurosarcoidosis accompanied the cardiac sarcoidosis, but it was the latter that produced the life-threatening symptoms and was fatal.
ABSTRACT
PURPOSE: To present a case of corneal blood staining due to a hemorrhagic Descemet membrane detachment and describe a method of surgical intervention. METHODS: Observation of clinical features and outcome of surgical intervention. RESULTS: A 72-year-old man had an anterior-chamber intraocular lens removed for presumed uveitis-glaucoma-hyphema syndrome, and he developed an intraoperative hemorrhagic detachment of the Descemet membrane attributed to peripheral corneal neovascularization. Corneal blood staining rapidly developed, and a partial-thickness paracentesis was required to evacuate the lamellar hematoma and allow reattachment of the Descemet membrane. CONCLUSIONS: Hemorrhage from posterior corneal vessels can result in a hemorrhagic detachment of the Descemet membrane. Corneal blood staining can develop rapidly in an intracorneal or retrocorneal hemorrhage. The blood can be removed without incising the Descemet membrane by making a partial-thickness paracentesis.
