PURPOSE: The purpose of this study was to report on splenic artery aneurysms (SAAs) treated by transcatheter embolization in our single-center institution and to evaluate the clinical outcomes of patients with SAA by aneurysm location. MATERIALS AND METHODS: The original medical records and imaging results of 52 patients with SAA treated in our center between January 1, 1995 and December 31, 2013 were reviewed. Of these cases, 7 patients (13.5%) underwent surgery, 4 patients (7.5%) underwent serial observation, and 1 patient had stent insertion only, leaving 40 patients (78.9%) who underwent endovascular treatment using a coil, with or without N-butyl-2-cyanoacrylate. RESULTS: Aneurysms were located in the distal third of the splenic artery in 27 patients (67.5%), in the middle third in 9 cases (22.5%), and in the proximal third in 4 cases (10%). Of the 40 included patients, 25 were female (62.5%). Twenty-eight patients (70%) were asymptomatic. The mean aneurysm diameter was 2.48 cm (range, 0.8-6.0 cm). Complications involved pancreatitis (n=1) and early spleen infarction (n=29: <1/3 in 14, 1/3-2/3 in 10, and >2/3 in 5). Postembolization syndrome was noted in 26 patients (65%). There were no significant differences by aneurysm location in the postoperative increase in the values of white blood cells, amylase, lipase, and C-reactive protein (P=0.067, P=0.881, P=0.891, and P=0.188, respectively). CONCLUSION: At our institution, endovascular management is safe, has high technical success, and represents the first-line treatment for SAA, regardless of aneurysm location.
Amylases ; Aneurysm* ; C-Reactive Protein ; Embolization, Therapeutic ; Enbucrilate ; Female ; Humans ; Infarction ; Leukocytes ; Lipase ; Medical Records ; Pancreatitis ; Spleen ; Splenic Artery* ; Stents

Purpose: This study was done to identify the effect of adversity quotient and reality shock on the turnover intention among new nurses in general hospitals. Methods: Participants were 158 new nurses in general hospitals. A survey was used and data were collected in April 2019. Data were analyzed using the IBM SPSS/WIN 22.0 program. Results: The significant predictors for the turnover intention of new nurses were training status (β=.38), age (β=.19) and reality shock (β=.51). These variables explained 46.3% of the variance in turnover intention of nurses. Also, reality shock had a total mediating effect on the relationship between adversity quotient and turnover intention. Conclusion Findings indicate that adversity quotient and reality shock are important factors for turnover intention of new nurses in general hospitals.

BACKGROUND: This study was done to examine the impact of diabetes fear of self-injecting (FSI) and fear of self-testing (FST) on glycemic control and diabetes self-management. METHODS: A questionnaire survey was performed in the form of one-on-one interviews with 100 insulin-treated diabetic patients. The questions included subject traits, FSI/FST, and confidence in diabetes self-care (CIDS). Glycemic control was determined by the measurement of glycated hemoglobin (Hemoglobin A1C). RESULTS: The patients who did not have a spouse and were less well educated showed high FSI/FST scores and low CIDS scores. The patients who had taken high quantities of insulin, had diabetes related complications, and performed self-monitoring of blood glucose less frequently showed high FSI/FST scores. The patients who had received diabetes education, possessed glucometer and performed self-monitoring of blood glucose frequently had high CIDS scores. High FSI/FST scores were positively related to each other, negatively related to low CIDS scores and not significantly related to Hemoglobin A1C. On the other hand, a significant correlation was seen between CIDS scores and Hemoglobin A1C. CONCLUSION: High levels of FSI and/or FST were associated with high diabetes-related distress, poor general well-being, and psychologic comorbidity as well as poorer adherence to the diabetes treatment regimen. It is important in diabetes care to lower injection-related fears and improve diabetes self-management through systematic desensitization, relaxation therapy, the use of pen-type injection device, and proper education such as insulin injection amount adjustment, properties of insulin, and the risk of hypoglycemia for the patients and their families.
Blood Glucose ; Comorbidity ; Diabetes Complications ; Hand ; Hemoglobins ; Humans ; Hypoglycemia ; Insulin ; Relaxation Therapy ; Self Care ; Spouses ; Surveys and Questionnaires

Purpose: The aim of this study was to determine the reliability and validity of the metacognition rating scale (MCRS), which is a revised version of the existing metacognition questionnaire (MCQ) with anger and anxiety added. Methods: A survey was conducted on 591 nursing students at colleges in North and South Gyeongsang Provinces, South Korea. The collected data were processed for the reliability and validity of the MCRS through Cronbach’s ⍺ and confirmatory factor analysis using SPSS 26.0. Results: Cronbach’s ⍺ for the reliability of MCRS was calculated at .88, .86, .77, .74, and .66 for five subfactors. Among the five subfactors, the first, second, third, and fifth factors showed high correlation in each of six items. Factor 4 was highly correlated in 5 out of 6 questions. Conclusion The data confirm that the MCQ revised to include anger and anxiety is both reliable and valid for nursing students. Therefore, this scale can be used to identify the maladaptive metacognition of nursing students in stressful situations.

Purpose: The aim of this study was to determine the reliability and validity of the metacognition rating scale (MCRS), which is a revised version of the existing metacognition questionnaire (MCQ) with anger and anxiety added. Methods: A survey was conducted on 591 nursing students at colleges in North and South Gyeongsang Provinces, South Korea. The collected data were processed for the reliability and validity of the MCRS through Cronbach’s ⍺ and confirmatory factor analysis using SPSS 26.0. Results: Cronbach’s ⍺ for the reliability of MCRS was calculated at .88, .86, .77, .74, and .66 for five subfactors. Among the five subfactors, the first, second, third, and fifth factors showed high correlation in each of six items. Factor 4 was highly correlated in 5 out of 6 questions. Conclusion The data confirm that the MCQ revised to include anger and anxiety is both reliable and valid for nursing students. Therefore, this scale can be used to identify the maladaptive metacognition of nursing students in stressful situations.

Radical nephrectomy with tumor thrombectomy for advanced renal cell carcinoma is an oncologically relevant approach that can achieve long-term survival even in the presence of distant metastases. However, the surgical techniques pose significant challenges. The objective of this clinical review was to present technical recommendations for tumor thrombectomy in the vena cava to facilitate surgical treatment. Transesophageal echocardiography is required to prepare for this procedure. Cardiopulmonary bypass should be considered when the tumor thrombus has invaded the cardiac chamber and clamping is not feasible because of the inability to milk the intracardiac chamber thrombus in the caudal direction. Prior to performing a cavotomy, it is crucial to clamp the contralateral renal vein and infrarenal and suprahepatic inferior vena cava (IVC). If the suprahepatic IVC is separated from the surrounding tissue, it can be gently pulled down toward the patient’s leg until the lower margin of the atrium becomes visible. Subsequently, the tumor thrombus should be carefully pulled downward to a position where it can be clamped. Implementing the Pringle maneuver to reduce blood flow from the hepatic veins to the IVC during IVC cavotomy is simpler than clamping the hepatic veins. Sequential clamping is a two-stage method of dividing thrombectomy by clamping the IVC twice, first suprahepatically and then midretrohepatically. This sequential clamping technique helps minimize hypotension status and the Pringle maneuver time compared to single clamping. Additionally, a spiral cavotomy can decrease the degree of primary closure narrowing. The oncological prognoses of patients can be improved by incorporating these technical recommendations.

No abstract available.
Carcinoid Tumor* ; Goblet Cells* ; Humans ; Neurofibromatoses* ; Neurofibromatosis 1* ; Rectum*

Major peripheral arterial graft infection is a potentially devastating complication of vascular surgery, associated with significant mortality and high amputation rates. Autologous saphenous veins are considered optimal arterial conduits for lower extremity revascularization in infected fields, but they are often unavailable or unsuitable in these patients. This study describes two patients with major peripheral graft infection, but without available autologous veins, who underwent graft excision and cryopreserved cadaveric arterial allograft reconstruction. Although long-term graft durability is unclear because of gradual deterioration and degeneration, these findings suggest that cadaveric allografts may be good options for patients with major peripheral graft infection.
Allografts* ; Amputation ; Blood Vessel Prosthesis ; Cadaver* ; Humans ; Lower Extremity ; Mortality ; Saphenous Vein ; Tissue Preservation ; Transplants* ; Veins

PURPOSE: Type II endoleaks (T2ELs) are the most common type of endoleaks observed after endovascular aneurysm repair (EVAR). However, whether T2ELs should be treated remains debatable. In the present study, we aimed to describe the natural course of T2ELs and suggest the direction of their management. MATERIALS AND METHODS: We reviewed the data of 383 patients who underwent EVAR between 2007 and 2016. Data, including demographic and anatomical details, were collected, and patients with T2ELs were compared to those without them. Patients with T2ELs were categorized into subgroups according to changes in sac size and treatment requirement. RESULTS: We found patent lumbar artery count and lesser thickness of mural thrombi to be significant risk factors for T2ELs. Among the 383 patients, 85 (22.2%) patients were diagnosed with pure T2ELs. Among these 85 patients, the sac size increased in 29 (34.1%) patients, showed no significant change in 39 (45.9%) patients, and decreased in 17 (20.0%) patients. Fifteen (17.6%) patients, among 85 with initial pure T2ELs, showed spontaneous resolution. Five (5.9%) patients among 29, in whom the sac size increased, developed combined-type endoleaks. No sac ruptures were noted among the patients with T2ELs. CONCLUSION: T2ELs with sac expansion potentially contribute to other types of endoleaks. Therefore, periodic screening is important for these patients, particularly for those showing an increasing sac size. In addition, intervention should be considered when other types of endoleaks occur.
Aneurysm ; Aortic Aneurysm ; Arteries ; Endoleak ; Endovascular Procedures ; Humans ; Mass Screening ; Mesenteric Artery, Inferior ; Risk Factors ; Rupture

BACKGROUND AND OBJECTIVES: Cervical metastasis of unknown origin (MUO) comprises 3-5% of all head and neck malignancy. Standardized diagnostic approach is not established and standard treatment regimen is not established either. The purpose of this study was to evaluate diagnostic approaches to detect the primary site in patients with neck mass of metastatic squamous cell carcinoma and analyze treatment modalities and their outcomes as well. SUBJECTS AND METHOD: Of 710 patients who had been diagnosed with squamous cell carcinoma of the head and neck site from Jan. 1992 through Dec. 2005, 73 patients were referred to or visited our clinic regarding the presence of neck mass. With retrospective review of the medical record, the diagnostic approaches were evaluated. Thirty patients, in whom the primary sites were not found after all, were included for analysis of treatments and outcomes. RESULTS: The diagnostic steps that revealed the primary sites were as follows: physical examination in 29 cases (39.7%), conventional imaging (CT or MRI) in 5 cases (6.8%), PET scan in 1 case (1.4%), OPD based directed biopsy in 3 cases (4.1%), and intraoperative directed biopsy in 5 cases (6.8%). Primary sites were not detected in 30 cases (41.1%). Complete remission was obtained in 24 patients, for whom 5-year disease free survival rate was 62.1%. CONCLUSION: Thorough physical examination and directed biopsy are strongly recommended for the diagnosis of MUO, but the diagnostic value of PET scan needs to be followed up with more cases.
Biopsy ; Carcinoma, Squamous Cell ; Diagnosis ; Disease-Free Survival ; Head ; Humans ; Medical Records ; Neck ; Neoplasm Metastasis ; Physical Examination ; Positron-Emission Tomography ; Prognosis* ; Retrospective Studies