Metastasis of Follicular Thyroid Carcinoma to Skull Base: A Case Report.

Follicular thyroid carcinoma is a well-differentiated thyroid neoplasm that is classified into widely invasive or minimally invasive carcinoma. Vascular invasion is often characteristic of follicular thyroid carcinoma. There is an estimated 6-20% incidence of distance metastasis with the bone being the most common followed by the lungs and then the lymph nodes. Metastatic spread to the skull base is rare. This case report will cover a patient who presented with follicular thyroid carcinoma and cranial neuropathy and was found to have metastasis to the skull base.

A Case Study of Multiple Endocrine Neoplasia Type 2A.

Multiple endocrine neoplasia type 2 is an autosomal dominant neoplastic syndrome with subtypes multiple endocrine neoplasia type 2A, multiple endocrine neoplasia type 2B, and familial medullary thyroid carcinoma. Medullary thyroid carcinoma universally coincides with multiple endocrine neoplasia type 2. Multiple endocrine neoplasia type 2A is a rare disease and the affected patients are generally asymptomatic. The morbidity and mortality are mainly due to medullary thyroid carcinoma and often proper clinical workup is warranted for expedited surgical intervention. Total thyroidectomy along with neck dissection may be required for disease control. This report will cover a patient who presented with medullary thyroid carcinoma and was worked up to have multiple endocrine neoplasia type 2A. She underwent total thyroidectomy with central neck dissection.

Carbon dioxide levels in neonates: what are safe parameters?

There is no consensus on the optimal pCO2 levels in the newborn. We reviewed the effects of hypercapnia and hypocapnia and existing carbon dioxide thresholds in neonates. A systematic review was conducted in accordance with the PRISMA statement and MOOSE guidelines. Two hundred and ninety-nine studies were screened and 37 studies included. Covidence online software was employed to streamline relevant articles. Hypocapnia was associated with predominantly neurological side effects while hypercapnia was linked with neurological, respiratory and gastrointestinal outcomes and Retinpathy of prematurity (ROP). Permissive hypercapnia did not decrease periventricular leukomalacia (PVL), ROP, hydrocephalus or air leaks. As safe pCO2 ranges were not explicitly concluded in the studies chosen, it was indirectly extrapolated with reference to pCO2 levels that were found to increase the risk of neonatal disease. Although PaCO2 ranges were reported from 2.6 to 8.7 kPa (19.5-64.3 mmHg) in both term and preterm infants, there are little data on the safety of these ranges. For permissive hypercapnia, parameters described for bronchopulmonary dysplasia (BPD; PaCO2 6.0-7.3 kPa: 45.0-54.8 mmHg) and congenital diaphragmatic hernia (CDH; PaCO2 ≤ 8.7 kPa: ≤65.3 mmHg) were identified. Contradictory findings on the effectiveness of permissive hypercapnia highlight the need for further data on appropriate CO2 parameters and correlation with outcomes. IMPACT: There is no consensus on the optimal pCO2 levels in the newborn. There is no consensus on the effectiveness of permissive hypercapnia in neonates. A safe range of pCO2 of 5-7 kPa was inferred following systematic review.

Great suffering, great compassion: a transcultural opportunity for school nurses caring for Cambodian refugee children.

The cultural ways of Cambodian refugee families, combined with the physical and psychological health problems inherent in their refugee experience, present opportunities for nurses to engage in transcultural nursing. The purpose of this descriptive study was to understand the nature and meaning of a school district cross-cultural team's experiences of providing health care for children of Cambodian refugee families. Focus group interviews with school nurses and Cambodian liaisons were conducted utilizing S. M. Dobson's conceptual framework of transcultural health visiting as a guiding theoretical perspective. Transcultural and intracultural reciprocity as experienced with Cambodian families are explored and described. Concrete suggestions for fostering transcultural reciprocity with Cambodian refugee families are provided.