ABSTRACT
PURPOSE: The purpose of this study was to explore psychiatric nurses' decision making in the use of seclusion and restraint (SR). METHODS: Data were collected using focus group interviews. Two focus group interviews were held with a total of 10 psychiatric nurse participants. All interviews were recorded and transcribed, and data were analyzed using qualitative content analysis. RESULTS: Eleven categories emerged from three main themes. All the themes describe factors that participants took into account when deciding whether to implement SR: 1) Personal factors area: ‘Personal attributes of nurses,’ ‘Attitude of nurses regarding SR,’ ‘Nurses’ ‘physical and emotional states,’ ‘Negative experiences of nurses related to SR’; 2) Relational factors area: ‘The level of cooperation between nurses and doctors,’ ‘Role models created by seniors and colleagues,’ ‘The level of support by nursing assistants,’ ‘Therapeutic relations with patients’; and 3) Environmental factors area: ‘Poor nursing work environment,’ ‘Atmosphere of ward regarding SR,’ and ‘Social atmosphere to raise alarm about SR.’ CONCLUSION: These findings should be considered in the evaluation of the use of SR in psychiatric hospital settings and appropriate strategies used to help minimize the use of restraint.
Subject(s)
Humans , Atmosphere , Decision Making , Focus Groups , Hospitals, Psychiatric , Nursing , Psychiatric Nursing , Qualitative Research , Restraint, PhysicalABSTRACT
We present the case report of a 72-year-old female in whom diaphragmatic eventration and secondary gastric volvulus developed 10 years after a left partial pneumonectomy for a bronchiectasis. Eventration of the diaphragm is defined as an abnormal elevation of an intact diaphragm. The abnormally wide subdiaphragmatic space provides the potential for a gastric volvulus, which results from the strong negative intrathoracic pulling force created by the potential subphrenic space and paradoxical movement of the diaphragm. Unless this strong negative force is first eliminated, gastropexy alone will lead to recurrence. Obliteration of the subphrenic space by colonic displacement is a simple and effective way of abolishing this negative subdiaphragmatic pulling force. Treatment of gastric volvulus requires immediate surgical repair to prevent subsequent necrosis and perforation, with surgical correction of the underlying anatomic abnormality being the treatment of choice for gastric volvulus. We experienced a case of gastric volvulus due to diaphragmatic eventration who was treated with colonic displacement.
Subject(s)
Aged , Female , Humans , Bronchiectasis , Colon , Diaphragm , Diaphragmatic Eventration , Displacement, Psychological , Gastropexy , Necrosis , Pneumonectomy , Recurrence , Stomach VolvulusABSTRACT
A 65-year-old female patient experienced melena for 10 days. Gastroduodenoscopy revealed a tumor in the duodenum, a portion of which was taken for biopsy, which showed a malignant tumor. She underwent pancreatoduodenectomy, and the final tumor pathology revealed invasive ductal carcinoma from the breast, which was confirmed using immunostaining of milk fat globule antigens. Nineteen years before, she had received a radical mastectomy due to invasive ductal carcinoma of the right breast. Hematogenous metastasis occurs in 33% of patients with breast cancer, mainly to the liver and lung, in invasive ductal carcinoma (IDC), and to the gastrointestinal tract, peritoneum, and retroperitoneum in invasive lobular carcinoma (ILC). Solitary metastatic duodenal tumors from breast cancer, especially IDC, is rare, particularly after a long time. This rare case is presented with a literature review.
Subject(s)
Aged , Female , Humans , Biopsy , Breast , Breast Neoplasms , Carcinoma, Ductal , Carcinoma, Lobular , Duodenal Neoplasms , Duodenum , Gastrointestinal Tract , Glycolipids , Glycoproteins , Liver , Lung , Mastectomy, Radical , Melena , Milk , Neoplasm Metastasis , Pancreaticoduodenectomy , PeritoneumABSTRACT
PURPOSE: Colorectal perforation is a rare malady, but it usually presents abdominal emergency with high morbidity and mortality. It is very difficult to diagnose stercoral, idiopathic, or steroid induced perforation because these are very rare, but they show high mortality. The aims of this study are to: 1) evaluate and compare the characteristics of stercoral, idiopathic and steroid induced perforation with other perforations; and to 2) guide the diagnostic approach and treatment of these rare colon perforations. METHODS: We retrospectively reviewed thirty five patients underwent surgery for colorectal perforation at the Department of Surgery, Daedong Hospital, from November 1996 to January 2005. Age, gender, perforation site, grade of peritonitis, methods of operation and mortality rates were compared between the various causes. Logistic regression was used to evaluate their effect on mortality. RESULTS: There were 10 cases of iatrogenic colorectal injuries (28%), 7 of steroid induced colorectal perforation (20%), 5 of stab (14%), 4 of diverticulitis (11%), 4 of stercoral (11%), 3 of idiopathic (8%), and 2 of cancer induced perforation (5%). Total mortality rate of all the cases was 28.5% (10 out of 35) but the mortality of stercoral, steroid induced and idiopathic perforation was 57% (8 out of 14). The mortality rate was higher in older age group (60 years above) (40%), stercoral (75%), steroid induced (57%) and idiopathic (33%), preoperative systemic inflammatory response (SIRS) (42%), preoperative septic shock (83%), abnormal WBC count (10,000/mm3 above or 4,000/mm3 below) (53%), left colon perforation (36%) and diffuse peritonitis (56%). The mortality rate was lower in young age group (13%), iatrogenic (10%), stab (0%), right colon perforation (10%) and localized peritonitis (5%). The peritonitis grade (Hinchey's stage) of idiopathic group, cancer and stercoral was worse (III-IV grade: 75%, 100%, 75%) than that of diverticulitis, iatrogenic and stab (III-IV grade: 25%, 30%, 40%). CONCLUSION: The stercoral, steroid induced and idiopathic colorectal perforation was rare, difficult to diagnose but it showed high mortality. The characteristics of these are an older age, presenting with a high peritonitis grade, preoperative SIRS, preoperative septic shock, and occurrence below the splenic flexure. If surgeons encounter these perforations, they should perform prompt surgical management and intensive postoperative care to reduce the mortality.
Subject(s)
Humans , Colon , Colon, Transverse , Diverticulitis , Emergencies , Logistic Models , Mortality , Peritonitis , Postoperative Care , Retrospective Studies , Shock, SepticABSTRACT
BACKGROUND: Residual and recurrent bile duct stones after biliary surgery cause many difficult problems. and reoperation on biliary tract has limitation due to its high morbidity and mortality. In recent years, various non-operative modalities for management in residual and recurrent stone have been developed. METHODS: We analyzed 69 cases of residual and recurrent bile duct stones which were managed with non-operative modalities at the Department of surgery, Dae Dong Hospital from Jan. 1994 to Dec. 1997, and evaluated the efficacy of these modalities. RESULTS: Female exceeded male with a ratio 1.76:1. and the peak incidence of age group was 6th decade. The most common diagnostic procedure was T-tube cholangiography (53.6%). Interval between previous operation and second procedure for residual or recurrent stones was within 6 months in most cases (82%). Cholecystectomy with T-tube choledochostomy was performed most frequently in previous operation. Residual and recurrent stones were found only at common bile duct in 34 cases (49.3%) most commonly. Common bile duct stones were managed most frequently with endoscopic sphincterotomy (39.5%), but the complete removal rate was heighest in choledochoscopic stone removal (100%). Complete removal rate of intrahepatic duct stone was heighest with interventional radiologic stone removal as well as choledochoscopic stone removal (43.6%), but average number of session was smaller in choledochoscopic stone removal (2.5) than interventional radiologic stone removal (3.5). Associated complication with non-operative management modalities were very low, except three cases of hepaticocutaneous jejunostomy. The latter required reoperation due to continuous bile fistula in two cases, and long jejunal loop in one case. CONCLUSIONS: Choledochoscopic stone removal is most effective method in the management of residual and recurrent bile duct stones.
Subject(s)
Female , Humans , Male , Bile Ducts , Bile , Biliary Tract , Cholangiography , Cholecystectomy , Choledochostomy , Common Bile Duct , Fistula , Incidence , Jejunostomy , Methods , Mortality , Reoperation , Sphincterotomy, EndoscopicABSTRACT
Due to its anatomical position and histological characteristics of thin capsule and low abundance of connective tissue, the spleen is a prime target for damage from blunt injury or during operation. Until recently, total splenectomy has been considered as safe operation for splenic injuries. But now, splenic salvage procedure or non operative treatment have become the standard care with knowledge for immunologic function of spleen, development of radiologic examination such as ultrasonography and abdominal CT, and report about high risk of mortality after splenectomy. Authors have experienced 27 patients with splenic injury admitted to the emergency department during 5 years 4 months period from 1991 to 1996. Among them, 10 patients were received total splenectomy, 2 patients partial splenectomy, 8 patients splenorrhaphy, one patients hemostasis, and 6 patients underwent nonoperative management.
Subject(s)
Humans , Connective Tissue , Emergency Service, Hospital , Hemostasis , Mortality , Spleen , Splenectomy , Tomography, X-Ray Computed , Ultrasonography , Wounds, NonpenetratingABSTRACT
Malignant melanoma has shown a dramatic increase in its incidence in the last two decades in the western hemisphere, but it is still rare in Korea. We respectively reviewed the medical records of 10 melanoma patients who had been admitted to and treated at Daedong Hospital between January 1986 and December 1996. The age of the patients was between 26 and 81 (average 60). There were 4 men and 6 women, most often over the fifth decade of life. Malignant melanoma was common in the extremities, especially the acral portion of the lower extremities: 4 in the sole, 2 in the dorsum of the foot, 1 in the palm, 1 in the thumb, 1 in the neck, and 1 in the anus. The sizes of the melanoma were from 0.4 cm to 4.5 cm in diameter and depths of invasion were from 0.8 mm to 6 mm microscopically. According to the TNM staging of the American Joint Committee on Cancer, the distribution of the patients was one for IB, two for IIA, two for III, and four for IV. In one case, the staging was difficult. Wide excision with skin graft was carried out in six patients with a 2-cm excision margin. Another two patients were treated with a 1-cm excision margin. In the other two patients, the melanoma was found in the biopsy of the cervical lymph node and in the widely excised anus. Elective inguinal lymph node dissection was carried out around the femoral and the external iliac arteries in 3 patients whose inguinal lymph nodes were palpated during physical examination. One patient with an anal lesion was vaccinated with BCG, but without much benifit. One patient was treated with radiation and chemotherapy, but he suffered brain metastasis. Four patients with stage IV melanoma died due to metastasis to the brain or the iver. The others were being follow up. Supportive treatments were under investigation, therfore early detection followed by wide excision is the best way to obtain a better outcome in malignant melanoma.
Subject(s)
Female , Humans , Male , Anal Canal , Biopsy , Brain , Drug Therapy , Extremities , Follow-Up Studies , Foot , Iliac Artery , Incidence , Joints , Korea , Lower Extremity , Lymph Node Excision , Lymph Nodes , Medical Records , Melanoma , Mycobacterium bovis , Neck , Neoplasm Metastasis , Neoplasm Staging , Physical Examination , Skin , Thumb , TransplantsABSTRACT
Supracondylar fracfture of the humerus is the most common fracture about the elbow joint in children. Early accurate reduction is very important to obtain good results. The authors reviewed 44 cases of supracondylar fractures treated at Inje Universsity Pusan Paik Hospital from January 1986 to December 1990. Average follow-up time was 1 year 6 months. The results were as follows; 1. Thirty cases were treated with closed reduction and percutaneous pinning, ten with manipulation and cast immobilization, three with skeletal traction and the rest one with open reduction and internal fixation. 2. If there was a difference of the angle within 10-degree in post-reduction X-ray, deformity did not follow at the last follow-up. 3. The common formula was that a change of 5-degree in Baumann's angle corresponded to a 2- degree change in the clinical carrying angle. 4. Baumann's angle did not change between that of initially accepted and that of the final follow up X-ray. So, the authors recommend post-reduction measurements of the Baumann's angle as the adequancy of reduction of supracondylar fractures in children.