JHN Journal最新文献

{"title":"Glucose Control in the (Neuro) Intensive Care Unit","authors":"M. Moussouttas","doi":"10.29046/JHNJ.004.4.005","DOIUrl":"https://doi.org/10.29046/JHNJ.004.4.005","url":null,"abstract":"Introduction The vexing question of optimal glucose level in the intensive care unit has long perplexed intensivists. Hyperglycemia is a natural response to physiologic stress,1 and in the critically ill patient has been attributed to inflammatory processes, insulin counter-regulatory hormones, organ dysfunction, iatrogenic carbohydrate or medication related hyperglycemia, and insulin resistance as evidenced by concurrently elevated insulin levels.1 Hyperglycemia occurs in 50-75% of patients admitted to an ICU, and has been associated with various adverse outcomes including increased mortality, organ dysfunction, susceptibility to infections, and neurological complications.1,2 On the cellular level, tissue/organ damage is theorized to be mediated via the production of toxic polyol metabolites and reactive oxygen species,3 with compromise of mitochondrial/cellular function.1 At the opposite extreme, hypoglycemia is acutely detrimental and clearly mandates avoidance. Glucose variability has also been linked to adverse outcomes,4 and insulin administration itself has been associated with increased mortality.5 As such, it is believed that resolution of hypoglycemia, and not insulin administration, is the determinant of improved outcomes.5","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"252 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122861585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anemia and Blood Transfusion in Subarachnoid Hemorrhage","authors":"Monisha A. Kumar","doi":"10.29046/JHNJ.004.4.006","DOIUrl":"https://doi.org/10.29046/JHNJ.004.4.006","url":null,"abstract":"Anemia in Subarachnoid Hemorrhage Anemia is a common problem among critically ill patients. Nearly two thirds of patients are anemic on admission to the intensive care unit (ICU)1 and between 70-95% of patients develop anemia by day 3.2,3 Lower hemoglobin levels decrease the oxygen carrying capacity of blood and may reduce tissue oxygenation. This is particularly detrimental for patients with subarachnoid hemorrhage (SAH) as they are subject to increased metabolic demand for oxygen from cerebral ischemia.","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125087345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Systems Thinking Approach to Redesigning the Patient Experience to Reduce 30 Day Hospital Readmission","authors":"William Flounders, J. Gates, Steven Heffner, Bs Rn Msn Fnp-Bc Mba Michael Lawler, J. Pardini, Rn Ba Ccrn Scrn Maureen DePrince, Md Mba Facs Faha Robert H. Rosenwasswer","doi":"10.29046/jhnj.013.2.001","DOIUrl":"https://doi.org/10.29046/jhnj.013.2.001","url":null,"abstract":"","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130848904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phase I Study of Ipilimumab Combined with Whole Brain Radiation Therapy or Radiosurgery for Melanoma Patients with Brain Metastases","authors":"N. Williams, E. Wuthrick, Hyun Kim, J. Palmer, S. Garg, H. Eldredge-Hindy, C. Daskalakis, K. Feeney, M. Mastrangelo, L. Kim, Takami Sato, T. Olencki, D. Liebner, C. Farrell, James J. Evans, K. Judy, D. Andrews, A. Dicker, M. Werner-Wasik, W. Shi, K. Kendra","doi":"10.29046/jhnj.013.1.003","DOIUrl":"https://doi.org/10.29046/jhnj.013.1.003","url":null,"abstract":"","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128913318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal Epidural Abscesses","authors":"Sonia Teufack","doi":"10.29046/jhnj.005.1.002","DOIUrl":"https://doi.org/10.29046/jhnj.005.1.002","url":null,"abstract":"Despite advances in the diagnosis and treatment of neurosurgical diseases, spinal epidural abscesses (SEA) remain challenging. The diagnosis is complex, treatments are controversial, and the potential for adverse outcomes is significant. SEA accounts for 2 of every 10,000 of hospital admissions, an incidence which has doubled in the past twenty years. Reasons which may account for this include an aging population, increased IV drug use, and increase in number of vascular and spinal procedures. SEA can arise from an underlying medical condition, such as diabetes mellitus, alcoholism, chronic obstructive pulmonary disease (COPD), or HIV infection. Loci for SEA can be formed by other spinal abnormalities or by prior invasive spinal procedures, including epidurals, nerve blocks, or steroid injections. Sources for systemic infection may include vascular access catheters, IV drug use, or chronic UTI. 50% of spinal epidural infections have hematogenous origin, 30% arise from the skin or connective tissue, and 20% are unclassified. Common pathogens include S. aureus and P. aeruginosa. From 15% to 40% of SEA may be due to MRSA. In cases of spine trauma or spinal surgery, S. epidermidis may also be a pathogen. 79% of SEA appear dorsal to the spinal cord. A possible explanation for this finding is that the largest extent of the epidural space lies posterior to the nerve roots. The 21% that appear anterior are often associated with vertebral discitis and/ or osteomyelitis. Achieving correct diagnosis in cases of SEA may be challenging. 50% of epidural spinal abscesses are initially misdiagnosed. The most common presenting symptom is back pain, present in up to 85% of patients. Fever is present in up to 50%. Less common symptoms are paresthesias, sensory deficits, radicular pain, or motor deficits. SEA can occur spontaneously in patients with increased co-morbidi-ties. In post-operative patients, SEA may take days to weeks to appear. A dorsal SEA results from the spontaneous seeding of the dorsal epidural fat. As the abscess enlarges, neural compression may occur. Conversely, a ventral SEA may result from either spontaneous seed-ing of the ventral epidural fat or seeding of the disc space with secondary extension into the ventral epidural space. A ventral SEA is more likely to present with systemic symptoms (i.e., fevers, septicemia) prior to presentation of neurological deficits. The best way to diagnose SEA is to approach high-risk patients with suspicion. The neuro-logical exam may aid in localizing the level of spinal involvement in cases …","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"229 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121107218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Guidelines Written by Residents","authors":"Andrews, W. David","doi":"10.29046/JHNJ.004.2.003","DOIUrl":"https://doi.org/10.29046/JHNJ.004.2.003","url":null,"abstract":"","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122208659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Intradural Extramedullary Spinal Tuberculosis Diagnosed 8 Years After Treatment of the Primary Infection","authors":"K. Verma, T. Crothers, Brian J. Neuman, A. Vaccaro, J. Heller","doi":"10.29046/JHNJ.008.1.005","DOIUrl":"https://doi.org/10.29046/JHNJ.008.1.005","url":null,"abstract":"","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131401921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trigeminal Neuralgia: Case Report and Review","authors":"B. Zussman, Y. Moshel","doi":"10.29046/JHNJ.007.2.003","DOIUrl":"https://doi.org/10.29046/JHNJ.007.2.003","url":null,"abstract":"","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128447404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of Biomarkers in the Evaluation of Fever in the Intensive Care Unit After Brain Injury","authors":"Umer Mukhtar, Umer Shoukat, M. Athar, F. Rincon","doi":"10.29046/JHNJ.012.1.006","DOIUrl":"https://doi.org/10.29046/JHNJ.012.1.006","url":null,"abstract":"Fever is frequent in patients with neurologic injury. Differentiating infectious fever from central fever can be challenging. It is important to diagnose the cause of fever in the neurological intensive care unit because of the detrimental effects of fever on brain injured patients. This is a comprehensive review of the role of the two commonly available biomarkers, C-reactive protein and procalcitonin in differentiating the central fever from infectious fever.","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132007468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Expandable Cages in Metastasis to the Spine","authors":"Shiveindra B. Jeyamohan, A. Vaccaro, J. Harrop","doi":"10.29046/jhnj.004.4.002","DOIUrl":"https://doi.org/10.29046/jhnj.004.4.002","url":null,"abstract":"Introduction: Expandable cages have been utilized as an option for immediate spinal stabilization after vertebrectomy. However, long-term follow-up in the oncology population has not been studied, and results remain unclear. This single-institution series of patients represents our success in utilizing expandable cages. Methods: A retrospective chart review for patients with spinal metastasis treated with expandable cages between 2001 and 2006 was performed with IRB approval. Data regarding date of anterior and posterior surgery, immediate postoperative neurological status versus preoperative status, revision, equipment status, pseudoarthrosis, time to ambulation, and mortality were gathered and analyzed. Results: Twenty-four patients with metastatic cancer to the spine were studied. Cages were placed from T5-L5, 21 of which were single level. Of the 24 patients, 5 (21%) were neurologically intact pre-operatively and postoperatively. 13 of the 24 (54%) improved postoperatively. The remaining six (25%) illustrated no change in neurologic status. No patients deteriorated. At two years’ follow-up, overall patient survival was 79%. Average time to ambulation for patients followed was 11.5 days. No revisions were done for hardware failure, while one revision was performed for tumor progression. Conclusions: Expandable cages appear to be a valid treatment option for the immediate stabilization of the spine following corpectomy from spinal metastasis. Results indicate that fast recovery, reasonable long-term mortality, and immediate stabilization are achievable with this modality. Consequently, expandable cages should be considered as a valid option in the treatment for stabilization following corpectomy in metastasis to the spine. Introduction The spinal column is a frequent site of metastatic disease, particularly from lung, prostate, breast, kidney as the primary sources, whereas primary spinal column tumors comprise a minority of spinal pathology (<2%) 4. Although patients may present in a variety of conditions, pathologic fractures or increased axial spinal pain are frequent issues. Surgical treatment for this disease includes decompression of the neural elements, alleviation of painful symptoms, resolution of mechanical instabilization, and resection of the oncologic burden 2. Surgical treatment options for patients with progressive neurologic deterioration include anterior, posterior or combined decompression with subsequent spinal reconstructions. Expandable cages have recently been utilized as a treatment option for spinal reconstruction after vertebrectomy, particularly in the trauma population1. With increased familiarity of these devices, cages are now being utilized after corpectomy from tumor metastasis, but data regarding this treatment option is lacking 2-3. Vertebral body replacement with expandable cages may provide several potential theoretical advantages such as permitting optimal anatomic placement in addition to concurrent correcti","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"142 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132064929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}