Reoperation for a type I aortic dissection: case report.

Surgery for the repair of a type I aortic dissection presents several difficulties for the surgeon and the perfusionist. One must safely support the patient, while at the same time provide the surgeon with a bloodless field in which to operate. Often, this requires cessation of the circulation for varying amounts of time. Deep hypothermia allows for an extension of the arrest period, while other techniques-- retrograde cerebral perfusion and antegrade cerebral perfusion--provide an additional degree of cerebral protection. Recently, we utilized these techniques concurrently on a 43-year-old female who presented for a reoperation for a type I aortic dissection. Combining these techniques allowed us to adequately support the patient during an anticipated lengthy period of circulatory arrest and insured a successful operation without any adverse cerebral or other organ dysfunction.

Sensitivity of clinically hospitalized adolescents' self-report measures to change over time.

Twenty-five psychiatrically hospitalized adolescents were assessed on three separate occasions (approximately 2 weeks apart) using the Revised Children's Manifest Anxiety Scale (R-CMAS), Beck Depression Inventory (BDI), and Children's Attributional Styles Questionnaire Revised (KASTAN) within 1 week of hospitalization. Attending clinicians also rated each subject concurrently on the Anxiety and Depression factors of the Brief Psychiatric Rating Scale for Children (BPRS-C). Results indicated only modest agreement between self-report measures and clinician ratings over time. Clinician ratings on both BPRS-C factors changed significantly over time, while, of the self-report measures, only the R-CMAS evidenced significant change. Results were discussed in terms of the construct of "negative affectivity," method variance in assessment, and clinical implications.