Collaborative student-faculty research to support PhD research education.

This paper describes a three-semester hour applied research course taught over three semesters in a revamped PhD research curriculum at a Midwestern high research activity (R2) university-based nursing program. Faculty developed this strategy to help students become adequately prepared nurse scientists. Students and faculty engaged in a collaborative research project to provide students with opportunities to develop, integrate, and apply research knowledge, skills, and attitudes while concurrently advancing through the related research courses.

Added Value of Live 3-Dimensional Transesophageal Echocardiography During Procedures in Fontan Patients.

3D transesophageal echocardiography (3D-TEE) has proven useful and accurate during some operating room (OR), interventional cardiac catheterization (Cath), and electrophysiologic (EP) procedures. The use of 3D-TEE during similar procedures in patients who have undergone Fontan surgery and its additional value have not been previously reported. To determine if live 3D-TEE during procedures post Fontan has added value, 3D-TEEs in 58 post-Fontan patients over a 5-year study period were reviewed.

Pneumorrhachis After an Upper Respiratory Infection: A Case Report of a Rare Phenomenon.

Pneumorrhachis (PR) is the presence of free air within the spinal canal. It is generally benign and improves with conservative management. Case reports and a literature review exist documenting the existence and potential pathogenesis of this phenomenon, but no evidence-based guidelines exist documenting what treatment, if any, is indicated for this condition.

Spontaneous Migration of a Ventriculoperitoneal Shunt into the Venous System: A Multidisciplinary Approach.

Ventriculoperitoneal shunt catheter migration is a rare but documented complication. The exact mechanism of this occurrence is not well understood. We report the case of an 81-year-old male who initially presented with symptoms consistent with normal pressure hydrocephalus.

Tandem Short-length Multi-stent Construct for Emergent Revascularization of Occlusive Long-segment Left Middle Cerebral Artery In-stent Stenosis.

Endovascular stenting and balloon angioplasty is a feasible although controversial option for intracranial atherosclerotic stenosis refractory to maximize medical management. High rates of symptomatic in-stent restenosis (ISR) have been identified with Wingspan stent (Stryker, Fremont, CA, USA) placement. Revascularization of ISR by way of re-stenting is often attempted, albeit with high risk and low durability.

Multidisciplinary Management of Low-velocity Nonmissile Penetrating Head Injuries.

Introduction Penetrating head injuries (PHIs) can have diverse presentations and mechanisms; therefore, treatment methods have not been clearly outlined. Vascular injury is common and foreign body removal is often required. We present three cases to illustrate low-velocity nonmissile penetrating head injuries (NPHIs) and discuss a multidisciplinary approach.

Guillain-Barré Syndrome After a Gunshot Wound to the Thoracic Spine.

Background: Guillain-Barré syndrome (GBS) is a rare but well-documented cause of paralysis, often occurring after infection. Few cases have been reported in association with spinal cord injury (SCI), which masks the characteristic ascending paralysis. To our knowledge, this is the first reported case of confirmed GBS during the clinical course of thoracic paraplegia due to a gunshot wound (GSW).

Long-term Survival in a Patient with Butterfly Glioblastoma: A Case Report.

Butterfly glioblastoma (bGBM) is a malignant glioma that crosses the corpus callous with bilateral cerebral hemisphere involvement. Literature reports are scarce and highlight a dismal prognosis with limited successful treatment options. We describe a patient who survived more than five years from the initial diagnosis.

Using Palliative Care Nurses in a Supportive Care Program to Reduce Hospital Utilization for Patients With Multiple Chronic Conditions.

Background: Health care organizations are designing comprehensive care programs to reduce hospital utilization by high-risk patients with multiple chronic illnesses.

Local Problem: A community hospital recognized patients with multiple chronic conditions had higher rates of inpatient stays and emergency department (ED) visits.

Methods: Patients (n = 36) with multiple chronic conditions enrolled in a supportive care program.

Endovascular Management of Uncontrollable Orbital Hemorrhage Secondary to Blast Injury.

Blast injuries to the face frequently involve vascular injury and have been reported in association with vehicles, including compressed air hoses and car battery explosions. While related to high-pressure releases, we present the first case of a car tire inflation resulting in tire explosion causing uncontrollable orbital hemorrhage, ocular damage, and the first case of endovascular intervention resulting in resolution of hemorrhage. A 63-year-old male presented after a tire explosion with evisceration of the right eye and uncontrollable hemorrhage from the orbit.

Ventral Herniation of the Cervical Cord After Single-Level Corpectomy.

Background: Spinal cord herniation in the cervical spine is an exceptionally rare occurrence. It is most often cited in association with surgery and almost exclusively with a posterior approach. Herniation with an anterior approach has been reported in 3 cases after multilevel corpectomy, all of which involved herniation through a dural defect sustained during surgery.

Traumatic Pseudoaneurysm of the Ascending Cervical Artery Treated with N-butyl Cyanoacrylate Embolization: A Case Report and Review of the Literature.

Pseudoaneurysms of the thyrocervical trunk and its branches are commonly iatrogenic in nature; however, trauma is often an inciting mechanism. Open surgical repair was considered the main treatment modality until recent advances in endovascular therapy proved to be a viable treatment option. We report a case of a traumatic pseudoaneurysm arising from the ascending cervical artery with an associated arteriovenous fistula (AVF) that was treated using n-butyl cyanoacrylate (NBCA) embolization.

Neurosurgical Outcomes of Isolated Hemorrhagic Mild Traumatic Brain Injury.

Introduction Mild traumatic brain injury (TBI) is common but its management is variable. Objectives To describe the acute natural history of isolated hemorrhagic mild TBI. Methods This was a single-center, retrospective chart review of 661 patients.

Acute Formation of a Blunt Trauma-induced Vertebral Artery Arteriovenous Fistula Treated with Endovascular Occlusion of Vertebral Artery.

Fistulous cerebrovascular injuries can occur spontaneously, iatrogenically following surgical procedures, or can result as a consequence of penetrating trauma. To our knowledge, this is only the second reported case of blunt-trauma induced cervical vertebral artery arteriovenous fistula (AVF) formation in a 55-year-old male. This was successfully occluded with N-butyl cyanoacrylate (NBCA) embolization of the recipient vein and endovascular coil ligation of the vertebral artery.

Single Dose of Ketamine During Kyphoplasty Procedures Does Not Reduce Postoperative Narcotic Consumption.

This retrospective cohort study aimed to explore the study institution’s intraoperative ketamine use during kyphoplasty and compare narcotic requirements in patients who received intraoperative ketamine with those who did not. The authors hypothesized that a single dose of ketamine during kyphoplasty would reduce postoperative narcotic consumption. Included patients underwent kyphoplasty under monitored anesthesia care between 2012 and 2013.

Duplication of Vertebral Pedicles Associated with a Thoracic Burst Fracture Resulting in Spinal Cord Compression: A Case Report.

Vertebral body fractures are well-known sources of axial back pain with the potential to cause neurological deficits. Duplication of a component of the vertebral column is a rare phenomenon; however, vertebral pedicle duplication is an unreported phenomenon, and has not been reported in association with a vertebral burst fracture and kyphotic deformity. We present a unique case of vertebral pedicle duplication in association with a T11 vertebral burst fracture in a 72-year-old female.

De Novo Formation of Direct Arteriovenous Fistula Involving Anterior Communicating Artery Aneurysm in Remote Site from Prior Ruptured Arteriovenous Malformation in Pediatric Patient: Case Report and Review of Literature.

Background: De novo formation of arteriovenous malformations (AVMs) and arteriovenous fistulas (AVFs) is increasingly being reported in the neurosurgical literature, challenging the notion that AVMs are congenital in origin. Most of this literature centers around the pediatric population. After treatment of an AVM or AVF, recurrence, if any, appears to occur locally to the original insult.

Delayed Rupture of a Cortical Traumatic Intracranial Aneurysm.

Traumatic intracranial aneurysms are rare lesions that occur after blunt or primarily penetrating mechanisms. These are extremely fragile vessel injuries associated with significant morbidity and mortality, especially after rupture. Disease natural history, surveillance strategies, and management are based on small case series.

Spontaneous Acute Subdural Hematoma Associated with Arachnoid Cyst and Intra-cystic Hemorrhage.

Arachnoid cysts (ACs) are congenital, extra-axial lesions containing fluid similar to the composition of cerebrospinal fluid. Usually found incidentally, these lesions are observed with serial imaging to document their growth patterns and stability, and are then followed conservatively until clinical symptoms develop. Surgical options for symptomatic arachnoid cysts include cyst aspiration, cyst evacuation with fenestration into the subarachnoid space, and shunt procedures including cysto-peritoneal and cysto-ventricular shunts.

A Comprehensive Review of Skull Base Osteomyelitis: Diagnostic and Therapeutic Challenges among Various Presentations.

Skull base osteomyelitis (SBO) is a complex and fatal clinical entity that is often misdiagnosed for malignancy. SBO is commonly a direct complication of otogenic, sinogenic, odontogenic, and rhinogenic infections and can present as central, atypical, or pediatric clival SBO. This review describes the clinical profile, investigational approach, and management techniques for these variants.

Posterior Epidural Migration of a Lumbar Disc Herniation Causing Cauda Equina Syndrome: A Case Report.

We report an uncommon case of posterior epidural migration of a lumbar disc fragment (PEMLDF) in a patient presenting with acute, progressive back pain, radiculopathy, and weakness. PEMLDF can be mistaken for neoplastic or infectious etiologies on imaging, presenting a diagnostic and management challenge. Our patient underwent an urgent decompressive lumbar laminectomy, which revealed a PEMLDF intraoperatively.

Pseudohypoxic Brain Swelling After Elective Lumbar Spinal Surgery: Case Report.

Pseudohypoxic brain swelling (or the more recent term, postoperative intracranial hypotension-associated venous congestion) is a rare and potentially deadly complication that can occur after routine spine or brain surgery. The mechanism of this injury has been described as a rapid cerebral spinal fluid drainage leading to venous cerebral congestion. The clinical and radiographic findings mimic those found in a patient who has suffered an anoxic brain injury.

Innovations and Challenges of Implementing a Glucose Gel Toolkit for Neonatal Hypoglycemia.

Background: Transient neonatal hypoglycemia occurs most commonly in newborns who are small for gestational age, large for gestational age, infants of diabetic mothers, and late preterm infants. An exact blood glucose value has not been determined for neonatal hypoglycemia, and it is important to note that poor neurologic outcomes can occur if hypoglycemia is left untreated. Interventions that separate mothers and newborns, as well as use of formula to treat hypoglycemia, have the potential to disrupt exclusive breastfeeding.

Right Ventricular Systolic Function Parameters in Hypoplastic Left Heart Syndrome.

Assessment of the systolic function of the right ventricle (RV) in patients with hypoplastic left heart syndrome (HLHS) is important. The asymmetric shape and heavy trabeculations make accurate assessment of RV systolic function challenging. Novel measures of RV function could be helpful in distinguishing reduced versus preserved function in HLHS and may also be worse in HLHS with preserved function compared to normal controls.