Ochsner Journal最新文献

{"title":"Excessive Ingestion of Almond Milk Causes Severe Hypercalcemia and Acute Kidney Injury in a Patient With Chronic Kidney Disease.","authors":"Ahmad Bouhuwaish, Elgassi Ehnisch, Ahmed Abdullah Husayn Arhaym, Muner M B Mohamed, Juan Carlos Q Velez","doi":"10.31486/toj.24.0067","DOIUrl":"10.31486/toj.24.0067","url":null,"abstract":"<p><strong>Background: </strong>Almond milk has a higher calcium content than cow's milk. Hypercalcemia after consuming almond milk has been reported in infants, but to our knowledge, we report the first case of almond milk-induced severe hypercalcemia in an adult.</p><p><strong>Case report: </strong>A 66-year-old male with a history of diabetes and chronic kidney disease was referred to the emergency department because of laboratory results that showed severe hypercalcemia and acutely elevated serum creatinine. The family member who brought the patient to the hospital reported that he had displayed intermittent confusion. History revealed that 4 weeks prior, the patient had stopped his habit of consuming a gallon of cow's milk every day because of hyperglycemia. He switched to consuming a gallon of unsweetened almond milk every day, leading to severe hypercalcemia. Other causes of hypercalcemia were ruled out. Treatment with intravenous fluids and calcitonin normalized the patient's serum calcium level and improved his kidney function.</p><p><strong>Conclusion: </strong>The consumption of almond milk in large quantities is associated with the potential risk of hypercalcemia, especially in patients with chronic kidney disease. Careful consideration of the mineral content is recommended.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 1","pages":"64-66"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Idiopathic Arginine Vasopressin Deficiency With Mild and Reversible Hypercalcemia.","authors":"Aayush Malik, Alpesh Goyal, Rahul Gupta, Abhinav Bhagat","doi":"10.31486/toj.24.0089","DOIUrl":"10.31486/toj.24.0089","url":null,"abstract":"<p><strong>Background: </strong>Arginine vasopressin deficiency (central diabetes insipidus) results from impaired hypothalamic-neurohypophyseal secretion of arginine vasopressin and leads to hypotonic polyuria and polydipsia. Common causes of arginine vasopressin deficiency include head trauma, pituitary surgery, neoplasms, and inflammatory stalk lesions; however, 25% to 50% of cases are idiopathic. Hypercalcemia can result in arginine vasopressin resistance (nephrogenic diabetes insipidus) and is an important differential in the evaluation of patients with hypotonic polyuria-polydipsia syndrome.</p><p><strong>Case report: </strong>A 32-year-old male presented with polyuria (24-hour urine output of 144 mL/kg), polydipsia (24-hour fluid intake of 130 mL/kg), and nocturia of 6 months' duration. Baseline investigations revealed normal liver, renal, serum potassium, and blood glucose levels. After overnight dehydration, serum osmolality increased to 317 mOsm/kg, while urine osmolality remained inappropriately low at 156 mOsm/kg. Mild hypercalcemia (serum calcium of 11.1 mg/dL) was noted. Upon arginine vasopressin challenge, urine osmolality increased by nearly 300%, suggesting complete arginine vasopressin deficiency. Evaluation for secondary causes was unremarkable. Magnetic resonance imaging of the pituitary revealed a normal anterior pituitary and pituitary stalk with an absent posterior pituitary bright spot. Idiopathic arginine vasopressin deficiency was diagnosed. The patient responded to oral desmopressin replacement, and normocalcemia was documented in multiple samples repeated when the patient was in a hydrated state.</p><p><strong>Conclusion: </strong>Patients with arginine vasopressin deficiency can manifest concomitant mild and reversible dehydration-related hypercalcemia. A brisk increase in urine osmolality following subcutaneous arginine vasopressin injection and normal serum calcium levels after desmopressin therapy can establish that hypercalcemia is the effect and not the cause of the primary disorder.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 1","pages":"67-72"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Following Multiple Failed Reconstructions of a Distal Femur Fracture, Osseous Union Achieved After Superficial Femoral Artery Endarterectomy.","authors":"Shane Johns, William Curtis, Rick Gehlert","doi":"10.31486/toj.24.0058","DOIUrl":"10.31486/toj.24.0058","url":null,"abstract":"<p><strong>Background: </strong>Nonunion of a distal femur fracture is a serious complication in which bone healing ceases or fails to resolve, often necessitating further surgical intervention. Poor blood supply and unstable fixation have been identified as contributing factors to osseous nonunion. In this case, we highlight a challenging femur fracture that achieved osseous union only after resolution of a superficial femoral artery occlusion via endarterectomy that improved blood flow to the fracture site.</p><p><strong>Case report: </strong>A 54-year-old male was involved in a high-speed motor vehicle accident that resulted in a left distal femur fracture. The patient underwent multiple reconstructive procedures that were complicated by hardware failure and recurrent nonunion. Prior to the sixth reconstruction, a superficial femoral artery occlusion was discovered and addressed with endarterectomy. The sixth and final procedure resulted in osseous union and stable fixation of the femur fracture.</p><p><strong>Conclusion: </strong>A missed superficial femoral artery occlusion likely contributed to the delay in achieving osseous union of a traumatic comminuted distal femur fracture.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 1","pages":"54-58"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Weekend Admission on Hip Fracture Mortality.","authors":"Nicholas L Newcomb, Marlena Urvater, Ian E Doig, Michael Mullen, Cameron M Cooke","doi":"10.31486/toj.24.0017","DOIUrl":"10.31486/toj.24.0017","url":null,"abstract":"<p><strong>Background: </strong>Weekend vs weekday hospital admission has been associated with poorer mortality rates for many conditions. Studies evaluating weekend admission for hip fractures have resulted in contradictory conclusions regarding outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of all patients who underwent surgery for a fragility hip fracture at a quaternary level teaching hospital during a 6-year period. A total of 1,164 patients were included: 796 weekday admissions (Monday through Friday) vs 368 weekend admissions (Saturday and Sunday). Patients were subdivided based on surgeon experience level (473 consultants vs 690 nonconsultants). Statistical tests included chi-square tests and logistic regression. Demographic data included age, sex, prior hip fracture, fracture type, operation, and American Society of Anesthesiologists grade. The primary outcome was 1-year mortality. Secondary outcomes were acute mortality (<24 hours), subacute mortality (1 to 30 days), change in mobility from baseline at 1 year, preoperative delay (>48 hours), and surgical duration.</p><p><strong>Results: </strong>The weekend admission cohort had a higher 1-year mortality rate than the weekday admission cohort (30.4% vs 23.2%; <i>P</i>=0.029), while subacute mortality trended toward significance (<i>P</i>=0.083). No significant difference was seen in acute mortality (<i>P</i>=0.5). Hemiarthroplasty was associated with increased mortality at 12 months (<i>P</i>=0.012) compared to the other operative interventions. The median duration of surgery was lower in the weekend cohort vs the weekday cohort (1.15 hours [69 minutes] vs 1.23 hours [73.8 minutes]; <i>P</i><0.001). Consultants performed surgeries 16.2 minutes faster than nonconsultants (<i>P</i><0.001) and trended toward a lower 1-year mortality rate (22.1% vs 27.9%; <i>P</i>=0.058). No significant difference was seen in mobility change at 1 year in both the consultant vs nonconsultant analysis (<i>P</i>>0.9) and in the weekday vs weekend analysis (<i>P</i>>0.12).</p><p><strong>Conclusion: </strong>A significantly increased 1-year mortality rate and a shorter surgical duration were observed among patients admitted on the weekends.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 1","pages":"2-10"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Partnering With Schools for Community-Based Health Interventions: How Educating Children Improves Hypertension Awareness.","authors":"Jennifer Hundley, Kristine Olson, Cherylann Rocha, Margaret K Wallace, Grace Smith, Katharina Martin, Micheal Crane, Ralph D'Agostino, Amy Ladd, Sangeeta Shah","doi":"10.31486/toj.24.0099","DOIUrl":"10.31486/toj.24.0099","url":null,"abstract":"<p><strong>Background: </strong>More than 16,000 Virginians die of cardiovascular disease each year, with increased morbidity among Black and low-income adults. Hypertension (HTN) is the most modifiable cardiovascular disease risk factor. A community-based health intervention administered in partnership with schools may increase HTN awareness and reduce the development of unhealthy practices.</p><p><strong>Methods: </strong>Elementary school students (n=52) attending a majority Black and low-income school participated in an educational intervention program called Teach BP that is designed to increase HTN awareness across 4 topics: knowledge of blood pressure (BP) and HTN, organ systems impacted by HTN, habits to maintain a healthy BP, and competency in operating a BP monitor.</p><p><strong>Results: </strong>Students' ability to define and recognize HTN increased by an average of 62.7%. Their awareness of how HTN affects the body increased by an average of 92.1%. Additionally, students demonstrated competency in operating a BP monitor.</p><p><strong>Conclusion: </strong>The Teach BP program was effective at increasing students' awareness of HTN.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 1","pages":"34-43"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebellar Ataxia With Neuropathy and Bilateral Vestibular Areflexia Syndrome Coexisting With JAK2-Positive Polycythemia Vera and Myelofibrosis.","authors":"Jayaram Saibaba, Jayachandran Selvaraj, Stalin Viswanathan, Vivekanandan Pillai","doi":"10.31486/toj.24.0056","DOIUrl":"10.31486/toj.24.0056","url":null,"abstract":"<p><strong>Background: </strong>Cerebellar ataxia with neuropathy and bilateral vestibular areflexia syndrome (CANVAS) is a rare, progressive, neurodegenerative disorder characterized by late-onset ataxia, bilateral vestibular impairment, and sensory neuropathy.</p><p><strong>Case report: </strong>A 51-year-old male presented to the hospital with worsening dizziness, tremulousness of limbs, and falls during the preceding year. The patient experienced gradually progressive sensorimotor lower motor neuron quadriparesis, asymmetric ataxia, chronic pancerebellar dysfunction, oscillopsia, and impaired vestibulo-ocular reflex. His comorbidities included poorly controlled type 2 diabetes mellitus, chronic alcohol use, and thalidomide therapy for polycythemia vera with myelofibrosis. Diagnostic workup revealed sensory axonal neuropathy, hypercellular bone marrow with myelofibrosis, and utriculo-saccular dysfunction. Diabetes and thalidomide- and alcohol-related complications were presumed to be the reason for the patient's symptoms, but investigations revealed a diagnosis of CANVAS coexisting with polycythemia vera. The patient was treated with rehabilitation exercises and medications that slightly improved but did not resolve his symptoms. More than 1 year after the patient's last follow-up, a physician at another hospital discontinued the thalidomide prescription because of the patient's neuropathy. Two months later, the patient developed febrile neutropenia and died of pneumonia and sepsis.</p><p><strong>Conclusion: </strong>To our knowledge, CANVAS coexisting with polycythemia vera has only been reported once in the literature. The significance of this coexistence is not clear. Future case studies may help elucidate a link between these two entities.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 1","pages":"50-53"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Role of the Jaw Thrust Maneuver During Tracheal Intubation in Reducing the Incidence of Postoperative Sore Throat: A Prospective Randomized Study.","authors":"Dipti Saxena, Arohi Rathore, Pallavi Jain, Anuj Jain, Swapnil Kumar Barasker","doi":"10.31486/toj.24.0072","DOIUrl":"10.31486/toj.24.0072","url":null,"abstract":"<p><strong>Background: </strong>Endotracheal intubation is commonly associated with postoperative sore throat. We evaluated the effect of the jaw thrust maneuver on the incidence and severity of sore throat.</p><p><strong>Methods: </strong>A total of 110 female patients undergoing laparoscopic abdominal procedures were enrolled in the study, and 99 patients were included in the final analysis. The patients were randomized into 2 groups: the jaw thrust group (n=49) and the non-jaw thrust group (n=50). Sore throat monitoring and grading were performed at 0, 2, 4, 8, 12, and 24 hours postextubation.</p><p><strong>Results: </strong>The overall incidence of sore throat was higher in the non-jaw thrust group than in the jaw thrust group, with a maximum incidence at 4 hours, and the difference in incidence between the 2 groups was significant at the 4-, 8-, 12-, and 24-hour time points postextubation. However, no significant difference in sore throat severity was found between the non-jaw thrust and jaw thrust groups. The time of laryngoscopy was significantly less for patients in the jaw thrust group.</p><p><strong>Conclusion: </strong>In our population, the jaw thrust maneuver lowered the incidence but not the severity of sore throat during the initial 24 hours after extubation. The jaw thrust maneuver also significantly lowered laryngoscopy time.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 1","pages":"17-23"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Physician Satisfaction and Patient Safety Through an Artificial Intelligence-Driven Scheduling System in Anesthesiology.","authors":"William D Sumrall, Jakob V Oury, George M Gilly","doi":"10.31486/toj.24.0104","DOIUrl":"10.31486/toj.24.0104","url":null,"abstract":"<p><strong>Background: </strong>Overcoming challenges to effective clinical practice depends on finding dynamic solutions to issues such as physician burnout and patient safety. This study evaluated the impact of an artificial intelligence (AI)-driven scheduling system on physician burnout and patient safety, using intraoperative transitions of care as an operative metric for patient safety.</p><p><strong>Methods: </strong>In May 2019, the Department of Anesthesiology at Ochsner Health in New Orleans, Louisiana, implemented an AI-driven scheduling system called Lightning Bolt Scheduling (PerfectServe, Inc). Utilizing an idealized design framework, the department steering committee analyzed 12 months of historic operating room data and developed more than 400 scheduling rules to optimize staffing. The scheduling rules, representing the steering committee's new work model, were provided as inputs into Lightning Bolt Scheduling, which then used combinatorial optimization to recommend an ideal staff schedule. Preimplementation and postimplementation data were collected on physician satisfaction, vacation approval rates, and intraoperative transitions of care.</p><p><strong>Results: </strong>Six months postimplementation, physician satisfaction scores and vacation approvals increased, reflecting improved work-life balance, schedule flexibility, and decreased symptoms of burnout. Additionally, 1,072 fewer handoffs occurred, equating to 71.5 fewer adverse events and a savings of approximately $335,550 in health care costs during the 21 months after implementation.</p><p><strong>Conclusion: </strong>Our study findings underscore the potential of data-driven scheduling systems to enhance physician well-being and patient safety, thereby promoting continuous improvement and adaptability in health care operations.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 1","pages":"44-49"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Analysis of Ultrasound-Guided Pain Management Approaches for Sternotomy in Cardiac Surgeries-Transversus Thoracic Muscle Plane Block vs Pecto-Intercostal Fascial Block.","authors":"Hemant Vanjare, Chetana Prakash Deshmukh, Swapnil Kumar Barasker, Akheela Mohamed Kassim, Bipin Arya","doi":"10.31486/toj.24.0052","DOIUrl":"10.31486/toj.24.0052","url":null,"abstract":"<p><strong>Background: </strong>Pain management after sternotomy in cardiac surgery is vital for recovery. Opioids are commonly used, but they carry risk. Central neuraxial techniques and nerve blocks are options for a multimodality approach. Fascial plane blocks such as the transversus thoracic muscle plane block (TTMPB) and the pecto-intercostal fascial block (PIFB) are a relatively new way to relieve pain, and their popularity has increased with the use of ultrasound for precise anatomic visualization. Because the effectiveness of both blocks is similar, we conducted this study to compare the pain management of the TTMPB and the PIFB after sternotomy in cardiac surgery.</p><p><strong>Methods: </strong>This randomized double-blind study included 118 patients who underwent cardiac surgery. In the TTMPB group (n=59), 20 mL of 0.2% ropivacaine was injected bilaterally using ultrasound assistance in the transversus thoracic plane. In the PIFB group (n=59), 20 mL of 0.2% ropivacaine was injected in the pecto-intercostal plane. Study outcomes were opioid consumption in the first 24 hours and pain scores at 0, 3, 6, 12, and 24 hours postoperatively.</p><p><strong>Results: </strong>Patient characteristics in the 2 groups were similar. Opioid consumption was similar in both groups (<i>P</i>=0.672), and we found no difference in pain scores between the 2 groups at any of the time intervals.</p><p><strong>Conclusion: </strong>The TTMPB and the PIFB were similarly effective in treating acute poststernotomy pain in our patient population.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 1","pages":"11-16"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Key <i>Ochsner Journal</i> Metrics Increased Year Over Year.","authors":"Ronald G Amedee","doi":"10.31486/toj.25.5053","DOIUrl":"https://doi.org/10.31486/toj.25.5053","url":null,"abstract":"","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 1","pages":"1"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}