Residual cholesteatoma results from an incomplete surgical removal of the cholesteatoma matrix. A variety of surgical procedures are used to remove cholesteatomas with varying success rates. In extensive cholesteatomas with minimal possibility of conductive system reconstruction, subtotal petrosectomy with blind sac closure is an effective surgical procedure. Diffusion-weighted magnetic resonance imaging (DWI) and ADC maps are used in the diagnosis of recurrent cholesteatoma. We present the case of a 40-year-old man, who repeatedly underwent revision surgeries for extensive cholesteatoma recidivism. An early postoperative DWI in the first days after the revision intervention did not show residual cholesteatoma. Surprisingly, a follow-up DWI detected the presence of cholesteatoma a few months later. The goal of this paper is to open the discussion on early postoperative DW MRI. Key words recidivism – residual and recurrent cholesteatoma – DWI – ADC map – subtotal petrosectomy – blind sac closure
The human being does not loss his/her dignity in the process of dying. The hospice movement attempts to provide the humanization of the dying process. The ambition of the state healthcare system should be providing the quality and appropriately affordable care for dying people. Dying is a process, in which healthcare professionals and relatives of the dying person play their important roles. The quality of taking care of the dying person on the one hand affects accepting the fact of the approaching death and, on the other hand, reduces the emotional load to the relatives. In the research, contemporary opinions concerning dying and quality of taking care of dying people in the present and future healthcare professionals were determined. The target of this was to determine opinions concerning the quality of care and fears and desires associated with dying. The research mapped opinions in two research groups based on a questionnaire compiled. The first research group were students of the second, third and fourth years of the branch nursing and public health and of the branch of medicine at the Jessenius Medical Faculty in Martin. The second research group were staff members of hospices and palliative institutions from the whole Slovakia. The results of the research of opinions may be analyzed and interpreted in particular regions investigated: − evaluation of taking care of dying people, − fears and desires associated with dying. Results of the evaluation of taking care of dying people indicate that the respondents consider the currently existing level of taking the health care of dying people as rather insufficient. More than half the respondents considered the level of information of the patient about his/her terminal stage as rather insufficient. A high level of satisfaction with the inhibition of pains in dying people is demonstrated. Half the respondents consider satisfaction of spiritual needs as good; the level of the interest of relatives in the patient at terminal stage is evaluated by respondents as rather good. The research supported a considerable difference in the evaluation of taking care of mental requirements compared to the attention paid to relatives among students and staff members in the palliative and hospice care. There is the most significant difference in the evaluation between students and staff members in the field of taking care of spiritual needs. Taking care of mental needs is negatively evaluated by students as well as staff members in the palliative and hospice care. In the field of rights, fears and desires associated with dying, the results of the research support the fact that there is a significant desire of respondents to die at home. The respondents considered the fear of separation from their relatives and loneliness as the most important factor. Key words: dignity-dying-quality of taking care-contemporary level of the health care-level of information-level of inhibiting pains-mental needs-spiritual needs-attention paid to relativesfears-desires-home Súhrn Ľudská bytosť nestráca...
The expert as well as lay consideration of conditions of dying is currently critical. Dying in hospitals is unsatisfactory. Appropriate possibilities have not yet been established for dying in hospice institutions and in the hospice care. Still persisting transfer of a patient into a social institution is an unpleasant variant of taking care of a dying person. The death is a fact stressing the dying patient as well as his/her relatives. There is an association between the death and dying and successful life relationships. Man is bound to the relationships even in the process of dying. In the light of this knowledge, the position of dying people is unsatisfactory. Imaginations and desires concerning one´s own death and dying are formed based on experience of relatives with the death and dying. This experience is determined by the quality of the care provided for the dying person. It is possible to expect that a human can only accept his/her death and dying as a natural part of the life, if quality care for dying people is provided. Care for dying people must be complex and must include not only alleviation of pain but also care for psychosocial and spiritual needs of the dying person.
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