Central Diabetes Insipidus in an Extremely-Low-Birth-Weight Preterm Infant with Suspected Ectopic Posterior Lobe of the Pituitary Gland

Central diabetes insipidus (CDI) is extremely rare in neonates, especially in extremely-low-birth-weight infants, and most cases are secondary to conditions, such as ischemic or hemorrhagic brain damage. Here, we report a case of CDI in a 530-g infant born at 23+3 weeks of gestation, with suspected ectopic posterior pituitary gland. Hypernatremia was noticed at 33+6 weeks of postmenstrual age, and it persisted with in creased volumes of diluted urine, despite adequate sodium intake. Serum and urine osmolality returned to the normal range after administration of a desmopressin injection. The bright spot of the posterior pituitary was absent, and brain magnetic resonance imaging suggested an ectopic posterior pituitary gland. At the time of writing this manuscript, the patient was on oral desmopressin medication without complications at the corrected age of 8 months. Through this report, we emphasize that although CDI is extremely rare in premature infants, it should be suspected when hypernatremia and polyuria that are unexplained by other causes are noted.

Difficulties in End-of-Life Care and Educational Needs of Intensive Care Unit Nurses: A Mixed Methods Study / 한국호스피스완화의료학회지

PURPOSE: This study aimed to identify the difficulties with end-of-life care (EOLC) experienced by intensive care unit (ICU) nurses and to investigate their educational needs for EOLC. METHODS: This study aimed to identify the difficulties with end-of-life care (EOLC) experienced by intensive care unit (ICU) nurses and to investigate their educational needs for EOLC. RESULTS: The mean score on the difficulty of EOLC was 3.41 out of 5. The education needs derived from the qualitative analysis was categorized into four themes: 1) guidelines on professional EOLC, 2) spiritual care, 3) a program to take care of feelings of patients, families and nurses, and 4) activities to think about death. CONCLUSION: This study confirmed that ICU nurses were experiencing an extreme difficulty in providing EOLC. In addition, a qualitative analysis confirmed that they needed an EOL nursing program. To mitigate the difficulties experienced by nurses involved in EOLC, there is an urgent need to develop an education program for EOLC tailored to nurses' needs.

Clinical Characteristics and Expression Pattern of IL-33 and IL-25 According to Histologic Classification in Chronic Rhinosinusitis with Nasal Polyposis

BACKGROUND AND OBJECTIVES: Many kinds of inflammatory cells and cytokines are suggested to be related to the pathophysiology of chronic rhinosinusitis with nasal polyposis (CRSwNP), but not yet fully understood. The objectives of this study were to classify CRSwNP patients according to histologic features and to reveal the roles of IL-33 and IL-25, on the pathophysiology of CRSwNP. MATERIALS AND METHOD: CRSwNP patients (n=122) were divided into 3 groups according to the type of nasal polyp; eosinophilic polyp (EP, n=38), neutrophilic polyp (NeuP, n=15) and non-eosinophilic non-neutrophilic polyp (NENN, n=63) groups. Clinical features and the expressions of IL-25 and IL-33 were evaluated among the groups. RESULTS: The EP group showed many clinical features that were different from the other groups: increased prevalence of asthma and olfactory dysfunction, increased percentage of blood eosinophils, increased E/M ratio, and poor postoperative outcomes such as recurrent polyposis and the need for frequent use of oral steroids. Numbers of IL-33 and IL-25 positive cells were significantly higher in the EP group compared with the other groups in the lamina propria (p=0.001). CONCLUSION: These results suggest that patients with an eosinophilic polyp are clinically and pathogenetically different from patients with other types of polyps, and IL-25 and IL-33 are associated with the pathogenesis of chronic rhinosinusitis with eosinophilic polyps.

A Case of Drooling during Sleep Treated with Wharton's Duct Relocation / 대한이비인후과학회지

Sialorrhea, or drooling, is defined as excessive salivary spillage from the mouth. The exact pathophysiology of drooling is unknown but appears to be a defect in the oral phase of swallowing. The most common cause of drooling is cerebral palsy in children and Parkinson disease in adults. Drooling can cause various medical and psychosocial problems. Various treatment modalities include physical therapy, anticholinergic medications, botulinum toxin injection into salivary glands, and surgical procedures. We report a case of 22-year-old woman with excessive drooling during sleep, which was treated with Wharton's duct relocation.

Solitary Fibrous Tumor of the Suboccipital Area / 대한이비인후과학회지

Solitary Fibrous Tumors (SFTs) are uncommon spindle-cell neoplasms usually arising in the pleura of the thoracic cavity. Thirty percent of SFTs are found frequently in the extrapleural locations, but infrequently in the head and neck region, and very rarly in the suboccipital area. The treatment of choice for SFTs is a complete surgical excision of the tumor. Recurrent SFTs are more often associated with incomplete excision. In this article, we present a by surgical excision case of an 87-year-old woman, who was treated for SFT arising in the suboccipital area by surgical excision with no recurrence after 6 months.