Iatrogenic chyloma in the neck: lymphoscintigraphic findings.

Iatrogenic chyle leak with chyloma formation in the neck is a rare complication of neck dissection resulting from injury to the thoracic duct. We present the case of a 37-year-old woman who complained of left-sided neck swelling within days after total thyroidectomy and lateral neck dissection for papillary thyroid cancer. Lymphoscintigraphy demonstrated the chyle leak in the left cervical region, and subsequent aspiration of the left neck swelling showed radioactivity in the aspirate. After successful operative repair of the thoracic duct, the patient was able to undergo radioactive ablative thyroid treatment.

Beneficiary or benefactor: are people more prosocial when they reflect on receiving or giving?

Research shows that reflecting on benefits received can make people happier, but it is unclear whether or not such reflection makes them more helpful. Receiving benefits can promote prosocial behavior through reciprocity and positive affect, but these effects are often relationship-specific, short-lived, and complicated by ambivalent reactions. We propose that prosocial behavior is more likely when people reflect on being a benefactor to others, rather than a beneficiary. The experience of giving benefits may encourage prosocial behavior by increasing the salience and strength of one's identity as a capable, caring contributor. In field and laboratory experiments, we found that participants who reflected about giving benefits voluntarily contributed more time to their university, and were more likely to donate money to natural-disaster victims, than were participants who reflected about receiving benefits. When it comes to reflection, giving may be more powerful than receiving as a driver of prosocial behavior.

Young tertiary students and help-seeking for health advice.

Help-seeking is an active process used by people of all ages to obtain assistance to solve problems. This research sought to investigate a component of help-seeking related to health concerns. A health related help-seeking model, was adapted to frame questions for an anonymous, self-administered questionnaire. Seventy-five students aged between 16 and 24 years responded and data were analysed using content and descriptive statistical techniques. Findings indicated that young people perceived the need to seek advice when unwell, needing support or information, are resourceful, and were motivated to seek help from a variety of sources. Parents and whanau formed one usual source of advice, but young people reported one of the best sources of advice as General Practice nurses and doctors. Barriers to seeking advice included distrusting sources, and concerns about confidentiality. Unsurprisingly, many respondents used the Internet for health information, although some mistrusted that information. Nurses need to be aware of the sources of health advice and support that young people choose to use. Motivations for selecting services, providers, or sources clearly replicated what young people hold as important--sources with which they feel comfortable, have a relationship, trust, and which they perceived as maintaining confidentiality.

Primary health care for youth in New Zealand. Are current health strategies working?

This article presents a critique of New Zealand health strategies in terms of how well they are serving youth. It is argued that over the last two decades successive changes in government policy, while aimed at improving people's health, have either not worked or had negative effects for specific population groups. There is now clear evidence that lower socio-economic status has an adverse affect on health, particularly among disadvantaged groups such as Maori and Pacific Islanders. In discussions about disadvantage and health inequalities youth as an age group is often ignored. Yet young people have special needs in relation to their developmental stage, the transition between child and adult. They have high potential for behaviours identified as placing them 'at risk'; and that may impact on their future health. The New Zealand Health Strategy released by the Government in 2000, and the Primary Health Strategy (King, 2001) were intended, through additional funding and emphasis on primary health care, to lead to better health for all New Zealanders. For some groups, such as youth, these gains have not been achieved, and in many instanced the situation has worsened.

How to play to your strengths.

Most feedback accentuates the negative. During formal employee evaluations, discussions invariably focus on "opportunities for improvement," even if the overall evaluation is laudatory. No wonder most executives--and their direct reports--dread them. Traditional, corrective feedback has its place, of course; every organization must filter out failing employees and ensure that everyone performs at an expected level of competence. But too much emphasis on problem areas prevents companies from reaping the best from their people. After all, it's a rare baseball player who is equally good at every position. Why should a natural third baseman labor to develop his skills as a right fielder? This article presents a tool to help you understand and leverage your strengths. Called the Reflected Best Self (RBS) exercise, it offers a unique feedback experience that counterbalances negative input. It allows you to tap into talents you may or may not be aware of and so increase your career potential. To begin the RBS exercise, you first need to solicit comments from family, friends, colleagues, and teachers, asking them to give specific examples of times in which those strengths were particularly beneficial. Next, you need to search for common themes in the feedback, organizing them in a table to develop a clear picture of your strong suits. Third, you must write a self-portrait--a description of yourself that summarizes and distills the accumulated information. And finally, you need to redesign your personal job description to build on what you're good at. The RBS exercise will help you discover who you are at the top of your game. Once you're aware of your best self, you can shape the positions you choose to play--both now and in the next phase of your career.

Evaluation of a 3-hour indium-111 leukocyte image as a surrogate for a technetium-99m nanocolloid marrow scan in the diagnosis of orthopedic infection.

OBJECTIVES: This is a retrospective study to evaluate a 3-hour In-111-labeled leukocyte image as a surrogate for a Tc-99m nanocolloid marrow scan in the investigation of suspected orthopedic infection using In-111 leukocyte scintigraphy. METHODS: Images from 51 patients who had received contemporaneous In-111-labeled leukocyte scintigraphy and Tc-99m nanocolloid marrow scintigraphy were reviewed. Initially, the 3-hour and 22-hour In-111-labeled leukocyte images were compared. Sites of abnormal uptake on the 22-hour image were correlated with the 3-hour image and were graded according to the level of concordance or discordance. One week later, the Tc-99m nanocolloid images and 22-hour In-111-labeled leukocyte images of the same patients were compared and graded for concordance or discordance. When discrepancies in grading arose between the observers, a consensus opinion was achieved after additional review of the images a week later. RESULTS: On inspection of the 22-hour In-111 leukocyte images, 93 sites of focal, potentially abnormal leukocyte accumulation were identified. When the grading system was reduced to simply "concordant" or "discordant," there was good agreement between the observers in the majority of cases, with kappa statistics 0.77 for Tc-99m nanocolloid versus 22-hour In-111-labeled leukocyte images and 0.78 for 3-hour versus 22-hour In-111-labeled leukocyte images. Using the comparison of the Tc-99m nanocolloid marrow scan and the 22-hour In-111-labeled leukocyte images to identify concordance or discordance as the "gold standard" for scintigraphic evaluation of suspected orthopedic infection, comparison of the 3-hour In-111-labeled leukocyte images with the 3-hour In-111-labeled leukocyte images gave a sensitivity of 77%, a specificity of 77%, and an accuracy of 77%. CONCLUSIONS: A 3-hour image is helpful using In-111-labeled leukocyte scintigraphy.

Clinical value of grading the scintigraphic appearances of tibial stress fractures in military recruits.

PURPOSE: This study evaluated the relation between the scintigraphic appearances of tibial stress fracture in military recruits and the likelihood that they would complete basic military training. MATERIALS AND METHODS: The authors retrospectively reviewed 58 Tc-99m MDP scans of recruits referred for possible tibial stress fracture and graded them according to the criteria of Zwas et al. (1987). Stress fracture appearances were correlated with clinical information such as the duration of rehabilitation and final outcome with regard to completion of the initial basic military training program. RESULTS: Thirty-seven of the 58 patients (64%) had tibial stress fractures, all of which were located in the tibial diaphysis, with most occurring in the middle and lower thirds. Most (23 of 37) patients had stress fractures of grade I or II, and the others had grade III or IV stress fractures. There was no statistical difference in the proportion of patients with bilateral fractures between grades I-II and III-IV. There was no significant difference in the duration of rehabilitation for recruits successfully recovering from grade III-IV fractures compared with grade I-II fracture. There was a greater proportion of patients with lower grade fractures than higher grade fractures (P = 0.0006) who, despite rehabilitation, could not continue training because of unremitting or recurring pain at the fracture site and were medically discharged from military service. CONCLUSIONS: Contrary to expectation, recruits with higher-grade stress fractures were not less likely to complete basic military training compared with recruits with lower grade stress fractures.

Leading in times of trauma.

An employee is diagnosed with cancer or loses a family member unexpectedly. An earthquake destroys an entire section of a city, leaving hundreds dead, injured, or homeless. At time like these, managerial handbooks fail us. After all, leaders can't eliminate personal suffering, nor can they ask employees who are dealing with these crises to check their emotions at the door. But compassionate leadership can facilitate personal as well as organizational healing. Based on research the authors have conducted at the University of Michigan and the University of British Columbia's CompassionLab, this article describes what leaders can do to foster organizational compassion in times of trauma. They recount real-world examples, including a story of personal tragedy at Newsweek, natural disasters that affected Macy's and Malden Mills, and the events of September 11, 2001. During times of collective pain and confusion, compassionate leaders take some form of public action, however small, that is intended to ease people's pain and inspire others to act. By openly demonstrating their own humanity, executives can unleash a compassionate response throughout the whole company, increasing bonds among employees and attachments to the organization. The authors say compassionate leaders uniformly provide two things: a "context for meaning"--creating an environment in which people can freely express and discuss how they feel--and a "context for action"--creating an environment in which those who experience or witness pain can find ways to alleviate their own and others' suffering. A leader's competence in demonstrating and fostering compassion is vital, the authors conclude, to nourishing the very humanity that can make people--and organizations--great.