PURPOSE: The purpose of this study was to describe feelings and actions of nurses following withdrawal of life-sustaining treatment from children being cared for by the nurses. METHODS: Data were collected by in-depth interviews with 7 nurses from different hospitals where children receiving nursing care had life-sustaining treatment withdrawn. The interviews were conducted from August 2016 to February 2017 when all data were saturated. Interviews lasted 30~90 minutes and were conducted 2~3 times per participant. Data were analyzed using Giorgi's phenomenological research methodology. RESULTS: The following factors constituted experiences of nurses working in pediatric wards when life-sustaining treatment was withdrawn from children: “agony and conflict in the aspects of care”, “heavy mind and regret for exhausting care”, “intentionally avoiding parents' sadness”, “comforting sadness in the heart” and “orientation in the role of caring for children undergoing withdrawal of life-sustaining treatment.” CONCLUSION: Findings indicate that support systems and intervention programs need to be developed so that nurses can understand and wisely deal with experiences of withdrawal of life-sustaining treatment from children who receive care from nurses.
Child* ; Humans ; Nursing Care ; Pediatric Nursing ; Qualitative Research ; Research Design ; Withholding Treatment

Fine-needle aspiration (FNA) with ultrasonography is considered a minimally invasive and safe procedure. Complications of it are infrequent and occur immediately or within a few days after FNA. Such complications may occur mainly in patients with underlying problems. We here report a rare case of thyroid cystic nodule infection occurring 1 month after FNA in an immunocompetent patient and serial sonographic findings in this patient. A 33-year-old woman with a cystic nodule including partially isoechoic solid areas on the right thyroid gland complained of difficulty swallowing and painful sensations in the right neck 1 month after FNA. On follow-up examination, the cystic nodule and perithyroidal soft tissue were suspicious of infection. The possibility of infection after FNA should be considered even if the patient is immunocompetent in order to prompt evaluation and immediate management with empirical antibiotic therapy to avoid life-threatening complications.
Adult ; Biopsy, Fine-Needle ; Deglutition ; Female ; Follow-Up Studies ; Humans ; Neck ; Sensation ; Thyroid Gland ; Ultrasonography

A 44-year-old woman who comlpained of dizziness and generalized weakness was admitted. The hemoglobin was 6.6g/dL, hematocrit 25.5%, and serum ferritin 2.14 ng/mL Stool occult blood was positive and microcytic hypochromic anemia was found on periyheral blood smear. Gastroscopic examination showed about 2 x 1 cm sized hemispherical sebmucosal tumor on antrum. The patient underwent operatioh for confirmatory diagnosis and treatment. The final pathologic diagnosis of the resected lesion was hemangioma of stomach. Cavernous hemangioma of stomach is a rare disease.Mostly, it has a benign course clinically, but early diagnosis is important because massive hemorrhage and anemia by chronic blood loss can occur. We report a case of hemangioma of stomach with review of literature.
Adult ; Anemia ; Anemia, Hypochromic ; Diagnosis ; Dizziness ; Early Diagnosis ; Female ; Ferritins ; Hemangioma ; Hemangioma, Cavernous* ; Hematocrit ; Hemorrhage ; Humans ; Occult Blood ; Stomach*

Typical transcranial approaches are insufficient for adequate visualization and resection of skull base tumors. Different approaches with multiple modifications have been attempted. Here, we describe a new approach for a lesion that is central and hard to treat by conventional craniotomy and successful reconstruction with calvarial bone graft and titanium mesh plate. A 69-year-old female patient presented with recurrent meningioma. The tumor had invaded the frontal lobe, right supraorbital rim, and ethmoidal bone. We performed a modified anterior craniofacial approach that fully exposed the tumor and invaded bone. In consideration of the patient's age and cosmetic result, the tumor and invaded bone was resected and the defect area was reconstructed with titanium mesh and calvarial bone graft. At 6 months postoperative the patient had no complications and was satisfied with the esthetic result. We report this case to demonstrate the successful approach and reconstruction using this technique.
Aged ; Autografts ; Craniotomy ; Female ; Frontal Lobe ; Humans ; Meningioma* ; Nasal Bone* ; Osteotomy* ; Skull Base ; Titanium ; Transplants

Typical transcranial approaches are insufficient for adequate visualization and resection of skull base tumors. Different approaches with multiple modifications have been attempted. Here, we describe a new approach for a lesion that is central and hard to treat by conventional craniotomy and successful reconstruction with calvarial bone graft and titanium mesh plate. A 69-year-old female patient presented with recurrent meningioma. The tumor had invaded the frontal lobe, right supraorbital rim, and ethmoidal bone. We performed a modified anterior craniofacial approach that fully exposed the tumor and invaded bone. In consideration of the patient's age and cosmetic result, the tumor and invaded bone was resected and the defect area was reconstructed with titanium mesh and calvarial bone graft. At 6 months postoperative the patient had no complications and was satisfied with the esthetic result. We report this case to demonstrate the successful approach and reconstruction using this technique.
Aged ; Autografts ; Craniotomy ; Female ; Frontal Lobe ; Humans ; Meningioma* ; Nasal Bone* ; Osteotomy* ; Skull Base ; Titanium ; Transplants

Complex Regional Pain Syndromes (CRPS) type I and type II are neuropathic pain conditions that are being increasingly recognized in children and adolescents. The special distinctive features of pediatric CRPS are the milder course, the better response to treatment and the higher recurrence rate than that of adults and the lower extremity is commonly affected. We report here on a case of pediatric CRPS that was derived from ankle trauma and long term splint application at the left ankle. The final diagnoses were CRPS type I in the right upper limb, CRPS type II in the left lower limb and unclassified neuropathy in the head, neck and precordium. The results of various treatments such as medication, physical therapy and nerve blocks, including lumbar sympathetic ganglion blocks, were not effective, so implantation of a spinal cord stimulator was performed. In order to control the pain in his left lower limb, one electrode tip was located at the 7th thoracic vertebral level and two electrode tips were located at the 7th and 2nd cervical vertebral levels for pain control in right upper limb, head, neck and right precordium. After the permanent insertion of the stimulator, the patient's pain was significantly resolved and his disabilities were restored without recurrence. The patient's pain worsened irregularly, which might have been caused by psychological stress. But the patient has been treated with medicine at our pain clinic and he is being followed up by a psychiatrist.
Adolescent ; Adult ; Ankle ; Causalgia ; Child ; Complex Regional Pain Syndromes ; Diagnosis ; Electrodes ; Ganglia, Sympathetic ; Head ; Humans ; Lower Extremity ; Neck ; Nerve Block ; Neuralgia ; Pain Clinics ; Psychiatry ; Recurrence ; Spinal Cord Stimulation* ; Spinal Cord* ; Splints ; Stress, Psychological ; Upper Extremity

The umbilicus is of paramount aesthetic importance for the abdomen, and its absence can be psychologically distressing to patients for cosmetic reasons. An aesthetically-pleasing umbilicus tends to be small and vertically oriented in nature, with superior hooding and shadow, inferior retraction and slope, and a position at the topmost level of the iliac crest. A 42-year-old woman had undergone delayed breast reconstruction using a transverse rectus abdominis myocutaneous (TRAM) flap. Unfortunately, the patient developed umbilical necrosis following surgery. She underwent complete surgical debridement, which resulted in a large vertical scar. Delayed umbilical reconstruction was performed with four transposition flaps. The patient underwent follow-up at 11 months postoperatively, and the umbilicus had a satisfactory appearance. This case shows that using four transposition flaps can yield sufficient depth and an aesthetically pleasing shape for the umbilicus.
Abdomen ; Abdominoplasty ; Adult ; Cicatrix ; Debridement ; Female ; Follow-Up Studies ; Humans ; Mammaplasty ; Necrosis ; Rectus Abdominis ; Surgical Flaps ; Umbilicus

No abstract available.
Urinary Bladder

Follicular variant papillary thyroid cancer (FVPTC) is the second most common subtype after conventional PTC. We compared ultrasonographic (US) features of FVPTC to those of conventional PTC according to tumor size. We reviewed US findings, pathologic reports, and medical charts of 249 PTC patients with surgically proven disease (83 FVPTCs, 166 conventional PTCs) at our institution from January 2007 to December 2012. FVPTCs were divided into PTC-like and follicular neoplasm (FN)-like based on sonographic characteristics. PTC-like features were defined as having at least one malignant feature (taller-than-wide shape, infiltrative margin, marked hypoechogenicity, and micro-calcifications), whereas FN-like cancers showed oval solid features without malignant features. FVPTCs showed a higher rate of FN-like features than conventional PTCs. Of 166 conventional PTCs, 13 (7.8%) had FN-like features and 153 (92.2%) had PTC-like features, whereas of the 83 FVPTCs, 31 (37.3%) had FN-like features and 52 (62.7%) had PTC-like features. Macro-FVPTCs showed a higher rate of FN-like features than micro-FVPTCs (P < 0.001). Of 21 macro-FVPTCs, 18 (85.7%) had FN-like features and 3 (14.3%) had PTC-like features, whereas of the 62 micro-FVPTCs, 13 (21%) had FN-like features and 49 (79%) had PTC-like features. There were no differences in multifocality, extrathyroidal invasion, and lymph node metastasis between PTC-like FVPTCs and FN-like FVPTCs. FVPTCs showed fewer sonographic malignant features than conventional PTCs. In particular, FVPTCs larger than 1 cm had a more frequent benign sonographic appearance. Therefore, if fine-needle aspiration result is suspicious for PTC in a nodule larger than 1 cm with no suspicious US features, the possibility of FVPTC might be considered.
Adult ; Carcinoma, Papillary, Follicular/*diagnostic imaging/pathology ; Demography ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Thyroid Neoplasms/*diagnostic imaging/pathology ; *Ultrasonography

Neuroendocrine lesions of the thyroid are rare. The most common types are medullary thyroid carcinomas (MTCs) and C-cell hyperplasia. MTCs originate from thyroid parafollicular cells that secrete calcitonin which serves as a serum marker of MTCs. Here, the rare case of a calcitonin-negative neuroendocrine tumor (NET) derived from follicular lesions of the thyroid is described. A 34-year-old man presented at our hospital for the surgical management of an incidental thyroid nodule that was observed on an ultrasound sonography (USG) of the neck. Initially, USG-guided aspiration cytology was performed, and a MTC was suspected. The expressions of thyroglobulin and thyroid transcription factor-1, which are thyroid follicular cell markers, and synaptophysin and chromogranin A, which are neuroendocrine markers, was confirmed following surgical pathology. However, the staining of calcitonin, a marker of MTCs, was not observed. A nonmedullary NET of the thyroid is uncommon, and the distinction between calcitonin-negative NETs and MTCs of the thyroid may be important due to differences in their clinical courses and management.
Adult ; Calcitonin ; Carcinoma, Medullary ; Chromogranin A ; Humans ; Hyperplasia ; Neck ; Neuroendocrine Tumors* ; Pathology, Surgical ; Synaptophysin ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule ; Ultrasonography ; Biomarkers