In her own words: a phenomenological analysis of stories told by female service members and veterans after traumatic brain injury

PURPOSE

Given the majority of Service Members and Veterans (SMV) who have sustained a traumatic brain injury (TBI) are male, the female experience with TBI has not been captured in the general understanding of TBI. To improve understanding of the experience of female SMV after TBI utilizing a qualitative phenomenological approach on stories as told by female SMV.

MATERIALS AND METHODS

Ten female SMV participated in storytelling workshops and created video stories documenting their personal experience with TBI. Workshops were hosted by the VA Palo Alto Health Care System Polytrauma System of Care (VAPAHCS PSC). A grounded thematic analysis was conducted on the video stories.

RESULTS

Three common content themes emerged from all the stories: (1) negative psychological and emotional impacts of TBI, (2) acceptance and healing process associated with recovery, and (3) military contexts. Negative psychological and emotional impacts included intrapersonal impacts such as negative emotions, suicidal ideation, and dealing with cognitive and physical challenges, and interpersonal impacts in relationships and loss of independence. Notably, all the stories acknowledged an acceptance and healing process, characterized by several subthemes including motivational factors, TBI education, spirituality, and advocacy work. Lastly, each story mentioned military context, highlighting the unique experience within this population.

CONCLUSIONS

This phenomenological examination adds evidence-based understanding to the experience after TBI among female SMV. Each story uncovered nuanced and multifaceted issues that women experience in their TBI recovery. Our findings provide context to guide future intervention on the care, support, and TBI recovery for the female SMV population.

Tall cell papillary thyroid cancer: incidence and prognosis

BACKGROUND

The tall cell variant (TCV) of papillary thyroid cancer is reported to have a poor prognosis. This study examines the incidence and end result of surgical treatment of TCV.

METHODS

In this study, 240 thyroid cancers treated over a 23-year period at two hospital centers are reviewed. A total of 153 patients with papillary cancer were available for follow-up. All microscopic slides were re-examined.

RESULTS

Of the total 183 papillary cancers, 19 (10.4%) were TCV. The remainder were usual papillary or other papillary cancer variants. Patient age, tumor size, lymph node and soft-tissue involvement, recurrence, and death rates were evaluated. Multivariate statistical analysis disclosed that TCV histology, as well as age and tumor size, were significant predictors of recurrence.

CONCLUSION

Despite a high rate of recurrence in TCV cases over age 50 (6/9), there were no recurrent TCVs in cases under age 50 (0/8). Pathologists and surgeons must develop an increased awareness of this entity and implications for more radical treatment in the older age group.

Major salivary gland lymphoepithelial lesions and the acquired immunodeficiency syndrome

Presently, there is no consensus regarding the most appropriate diagnostic and therapeutic approach to patients with human immunodeficiency virus (HIV)-associated lymphoepithelial lesions of the major salivary glands. A retrospective review of 60 consecutive patients with lymphoepithelial lesions is presented. Thirty-eight cases were associated with HIV infection. Lesions associated with HIV infection were usually bilateral, multiple, cystic, and associated with lymphadenopathy. In contrast, in those cases without HIV infection, the lesions tended to be solitary and solid. In the HIV-infected group, treatment included surgery, radiotherapy, zidovudine (AZT), and/or cyst aspiration. All therapeutic regimens, other than aspiration alone, were found to be effective. Eighteen of the patients with HIV infection developed the acquired immunodeficiency syndrome (AIDS) during the study period. Surgical treatment is probably not necessary in the majority of HIV-associated cases. Depending upon individual circumstances, treatment with AZT or low-dose radiotherapy is recommended. A diagnostic and therapeutic algorithm is presented as a guide to the management of future cases.

Unusual cases of perforated diverticulitis of colon

Two extraordinary cases of perforated diverticulitis with extraperitoneal presentation are described. The diagnosis should be kept in mind in unusual cases of pain or sepsis in the elderly. A brief review of pathogenesis is given. Surgical treatment with primary resection and drainage is emphasized.

Warthin's tumor: multicentricity and increasing incidence in women

Warthin's tumors comprised 14 percent of all parotid tumors operated on. The average patient age in our series was 57.2 years. Eighty-seven percent of the tumors occurred in the parotid tail. The rest were in the deep lobe, or in an extraparotid location. Fifteen patients had multifocal tumors. The maximum number of tumor foci in one patient was six. A significant increase in the female incidence was noted with a 1.5:1 male-to-female ratio as compared with the previous male dominant ratio of 8:1. Eighty-two percent of the female patients in our group were smokers. We correlated a very high incidence of cigarette smoking in our series when compared with age-matched groups in both sexes within the general population. Since it is estimated that one of eight patients with Warthin's tumor will have multifocal disease, we suggest wider exposure and more meticulous operative exploration to avoid overlooked synchronous tumor foci and subsequent recurrence.