Ochsner Journal最新文献_第10页

Acute Vitiligo Repigmentation in the Setting of Suspected Pulmonary Sarcoidosis. 怀疑肺结节病的急性白癜风重色素沉着。

IF 1.2

Ochsner Journal Pub Date : 2022-01-01 DOI: 10.31486/toj.21.0098

Brandon T Thrash, Peter G Pantlin, Brandy C Mize, Colin C Rutner, Cassie A Shaw, Ross E McCarron

{"title":"Acute Vitiligo Repigmentation in the Setting of Suspected Pulmonary Sarcoidosis.","authors":"Brandon T Thrash, Peter G Pantlin, Brandy C Mize, Colin C Rutner, Cassie A Shaw, Ross E McCarron","doi":"10.31486/toj.21.0098","DOIUrl":"https://doi.org/10.31486/toj.21.0098","url":null,"abstract":"Background: Sarcoidosis is a noncaseating granulomatous disease that predominately occurs in the lungs. Vitiligo is the most common depigmentation disorder worldwide. Both diseases are autoimmune-mediated, suggesting that one could have implications for the other. However, relatively few reports have been published about patients presenting with coinciding symptoms of the 2 diseases. We report the case of a patient who presented with focal repigmentation of vitiligo with suspected pulmonary sarcoidosis. Case Report: A 63-year-old female with a medical history of diffuse vitiligo reported to the emergency department with the chief complaint of right lower extremity weakness and numbness for 1 week. She reported that she had had a chronic productive cough for the prior 4 to 6 months and had unintentionally lost 50 to 60 pounds in the prior 3 months. At that time, she began to notice numerous hyperpigmented macules and patches on both forearms and her face. Chest x-ray and chest computed tomography demonstrated bilateral hilar and mediastinal lymph node enlargement with multiple bilateral pulmonary nodules. Cytology and flow cytometry were negative for evidence of B- or T-cell lymphoproliferative disorder with evidence of granulomatous inflammation. Conclusion: This clinical presentation suggests a potential interplay between 2 unique disease processes. While both vitiligo and sarcoidosis share common autoimmune etiologies, little data are available about management when they coincide. This case highlights a patient with 2 seemingly distinct clinical manifestations that could yield further clinical information in the management of both diseases separately and together.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"22 3","pages":"249-252"},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9477125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40391986","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}

引用次数: 0

Local Anesthetic Use in Musculoskeletal Injections. 局部麻醉在肌肉骨骼注射中的应用。

IF 1.2

Ochsner Journal Pub Date : 2022-01-01 DOI: 10.31486/toj.22.0061

Meghan Caballero, Yuka Kobayashi, Andrew W Gottschalk

引用次数: 2

Accidental Ingestion of a NEO-fit Device Component by a Neonate. 新生儿意外摄入NEO-fit设备组件。

IF 1.2

Ochsner Journal Pub Date : 2022-01-01 DOI: 10.31486/toj.21.0111

Omotola O Uwaifo, Ryan Jay Abrigo

{"title":"Accidental Ingestion of a NEO-fit Device Component by a Neonate.","authors":"Omotola O Uwaifo, Ryan Jay Abrigo","doi":"10.31486/toj.21.0111","DOIUrl":"https://doi.org/10.31486/toj.21.0111","url":null,"abstract":"Background: Endotracheal tube securement devices are used to reduce the incidence of unplanned extubation of intubated patients. We describe the ingestion of part of an endotracheal tube securement device by a neonate to bring awareness of the risk of ingestion or aspiration of endotracheal tube securement device components in this population. Case Report: A 13-day-old, former 31-week gestational age female infant was noted on routine radiologic evaluation to have a foreign body in the gastrointestinal tract. The foreign body was thought to be an artifact or an object overlying the radiologic image. However, review of previous imaging showed the object initially in the posterior pharynx with progressive migration into the gastrointestinal tract. The patient did not have any clinical features of gastrointestinal obstruction and had been tolerating enteral feeds. The infant's endotracheal tube securement had been changed from a NEO-fit device (CooperSurgical, Inc.) to a NeoBar device (Neotech Products) on day of life 5. The diagnosis of the foreign body was made 8 days later. The infant was followed with serial imaging per pediatric surgery recommendations. The foreign body was spontaneously passed via the rectum several days later without incident. Pathology identified the foreign body as a piece of the NEO-fit device. Conclusion: Awareness of the possibility of ingestion or aspiration from this endotracheal tube securement device is important for patient safety.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"22 3","pages":"258-260"},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9477129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40391990","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}

引用次数: 0

Lumbar Level Peripheral Nerve Stimulation for Low Back Pain. 腰椎水平周围神经刺激治疗腰痛。

IF 1.2

Ochsner Journal Pub Date : 2022-01-01 DOI: 10.31486/toj.21.0115

Kenneth J Fiala, Roy B Kim, Joshua M Martens, Alaa Abd-Elsayed

{"title":"Lumbar Level Peripheral Nerve Stimulation for Low Back Pain.","authors":"Kenneth J Fiala, Roy B Kim, Joshua M Martens, Alaa Abd-Elsayed","doi":"10.31486/toj.21.0115","DOIUrl":"https://doi.org/10.31486/toj.21.0115","url":null,"abstract":"Background: Low back pain affects the lives of millions of people in the United States and the world. Not only does low back pain affect the quality of life for the individual patient, but it also accounts for many emergency department and health care visits. For a subset of patients, conservative measures such as medications and physical therapy, nonsurgical interventions, and surgery are not effective. Peripheral nerve stimulation is an emerging treatment option for patients with chronic low back pain. This case series assesses 6 patients' experiences with lumbar level peripheral nerve stimulation. Case Report: Three male and 3 female patients underwent lumbar level peripheral nerve stimulation as a treatment for chronic low back pain. The average age of the patients was 63.5 years, and they demonstrated an average pain reduction of 64.8%. Conclusion: This series provides evidence that lumbar level peripheral nerve stimulation may be an efficacious treatment for chronic low back pain that is refractory to conservative measures. Large studies are needed to assess the outcomes and durations of improvement associated with this treatment.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"22 3","pages":"265-272"},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9477135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40393495","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}

引用次数: 6

Bilateral Cerebral Mucormycosis in an Immunocompetent Female. 免疫正常女性双侧脑毛霉菌病。

IF 1.2

Ochsner Journal Pub Date : 2022-01-01 DOI: 10.31486/toj.21.0088

Remi T Okwechime, Nicholas Reyes, Darshan Trivedi, Ifeanyi O Iwuchukwu

{"title":"Bilateral Cerebral Mucormycosis in an Immunocompetent Female.","authors":"Remi T Okwechime, Nicholas Reyes, Darshan Trivedi, Ifeanyi O Iwuchukwu","doi":"10.31486/toj.21.0088","DOIUrl":"https://doi.org/10.31486/toj.21.0088","url":null,"abstract":"Background: Mucormycosis is a serious angioinvasive fungal infection. Immunocompromised patients are more likely to be susceptible to mucormycosis than immunocompetent individuals. Cerebral mucormycosis has been reported, but cases have primarily been unilateral. We report a case of bilateral cerebral mucormycosis in an immunocompetent patient. Case Report: A 37-year-old female with no significant medical history was transferred to our tertiary center after cerebrospinal fluid profile following a lumbar puncture at an outside hospital suggested bacterial meningitis. Computed tomography of the head revealed hypodensity and cerebral edema in the left basal ganglia, and magnetic resonance imaging (MRI) brain showed increased T2 signal and mass-like configuration centered in the left basal ganglia. During her hospital stay, she had neurologic decompensation with respiratory failure. She was intubated and placed on mechanical ventilation. Repeat MRI brain revealed evolving cerebral edema signal and interval development of progression across the midline involving the right basal ganglia. Because of the aggressive nature of the lesion and cerebral edema, she underwent a biopsy with placement of an external ventricular drain. Despite medical and surgical interventions, she neurologically worsened and died. Histopathologic evaluation of the biopsied lesion revealed numerous fungal hyphae consistent with mucormycosis. Conclusion: Our patient was not immunocompromised, and this case highlights the clinical challenges in initiating immunosuppressive therapy in a patient with rapidly progressive central nervous system disease.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"22 2","pages":"169-175"},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9196963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40399665","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}

引用次数: 2

Dural-Based Posterior Fossa Medulloblastoma Mimicking a Petrous Meningioma in Late Adulthood. 成年晚期以硬脑膜为基础的后窝髓母细胞瘤与岩状脑膜瘤相似。

IF 1.2

Ochsner Journal Pub Date : 2022-01-01 DOI: 10.31486/toj.21.0064

Daniel W Griepp, Aaron Miller, Jonathan Klein, Ali A Chaudhri, Stephanie Moawad, Razia Rehmani, Ralph Rahme

{"title":"Dural-Based Posterior Fossa Medulloblastoma Mimicking a Petrous Meningioma in Late Adulthood.","authors":"Daniel W Griepp, Aaron Miller, Jonathan Klein, Ali A Chaudhri, Stephanie Moawad, Razia Rehmani, Ralph Rahme","doi":"10.31486/toj.21.0064","DOIUrl":"https://doi.org/10.31486/toj.21.0064","url":null,"abstract":"Background: Medulloblastoma of the posterior fossa is commonly encountered in pediatric populations but rarely reported in adults. Adult cases of medulloblastoma typically occur in younger patients, tend to arise intra-axially within the cerebellar hemisphere, and usually exhibit classic histopathologic features. Case Report: A 54-year-old male presented with headaches, dizziness, gait instability, and frequent falls that had worsened during the prior 3 months. Imaging and histopathologic analysis revealed extra-axial, dural-based posterior fossa medulloblastoma with desmoplastic/nodular histopathology, mimicking a petrous meningioma. The mass occupied the left cerebellopontine angle. The patient underwent microsurgical gross total resection of the tumor followed by proton beam radiation therapy and was disease-free at 1-year follow-up. Conclusion: Few dural-based posterior fossa medulloblastomas resembling petrous meningiomas have been reported, and to our knowledge, this is the first description of a case to be treated successfully with proton beam therapy in an older adult. Although rare, medulloblastoma can occur extra-axially in the cerebellopontine angle of older adults, potentially mimicking a petrous meningioma. This rare possibility should always be kept in mind, especially if expectant, nonsurgical management is being considered. To optimize outcome, posterior fossa medulloblastoma should be treated with aggressive microsurgical resection followed by radiation therapy. When available, proton beam therapy should be considered.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"22 2","pages":"176-181"},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9196958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40401471","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}

引用次数: 0

Splenic Infarct as the Presenting Manifestation of Essential Thrombocythemia. 脾梗死是原发性血小板增多症的主要表现。

IF 1.2

Ochsner Journal Pub Date : 2022-01-01 DOI: 10.31486/toj.21.0073

Shalaka Khade, Sudeep Khera, Vaibhav Kumar Varshney, Deepak Kumar Sharma, Raghav Nayar, Abhishek Purohit

引用次数: 0

A Basic Intervention to Improve Compliance With Thromboprophylaxis in Patients With Neck of Femur Fracture. 提高股骨颈骨折患者血栓预防依从性的基本干预措施。

IF 1.2

Ochsner Journal Pub Date : 2021-01-01 DOI: 10.31486/toj.20.0093

Vinay Kumar Gupta, Keshav Kumar Gupta, Ranjodh Singh Sanghera, Sreenadh Gella

{"title":"A Basic Intervention to Improve Compliance With Thromboprophylaxis in Patients With Neck of Femur Fracture.","authors":"Vinay Kumar Gupta, Keshav Kumar Gupta, Ranjodh Singh Sanghera, Sreenadh Gella","doi":"10.31486/toj.20.0093","DOIUrl":"https://doi.org/10.31486/toj.20.0093","url":null,"abstract":"Background: Venous thromboembolism (VTE) is a significant complication following orthopedic intervention for neck of femur fracture. Our aim was to evaluate compliance with The National Institute for Health and Care Excellence guidance surrounding VTE prophylaxis before and after a brief intervention in an orthopedic department at a district general hospital. Methods: A 2-cycle quality improvement project was conducted. The primary outcome measure was whether adequate thromboprophylaxis was appropriately prescribed. For the intervention between the 2 cycles, posters were placed in key prescribing areas of all orthopedic wards. Results: In cycle 1, 63 (76.8%) patients were correctly prescribed enoxaparin, and 14 (17.1%) were prescribed other anticoagulants, leaving 5 patients (6.1%) who did not receive thromboprophylaxis for no apparent reason. In cycle 2, 56 (87.5%) patients were correctly prescribed enoxaparin, and the remaining patients were covered with alternative therapies. Conclusion: Small but basic interventions can lead to improvements in VTE prophylaxis prescribing. Future focus should be on implementing similar interventions across hospitals.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"21 2","pages":"173-176"},"PeriodicalIF":1.2,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8238106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39165951","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}

引用次数: 0

Suspected COVID-19-Induced Myopericarditis. 疑似covid -19型心肌炎。

IF 1.2

Ochsner Journal Pub Date : 2021-01-01 DOI: 10.31486/toj.20.0090

Ivana Okor, Amber Sleem, Alice Zhang, Rikin Kadakia, Tamunoinemi Bob-Manuel, Selim R Krim

{"title":"Suspected COVID-19-Induced Myopericarditis.","authors":"Ivana Okor, Amber Sleem, Alice Zhang, Rikin Kadakia, Tamunoinemi Bob-Manuel, Selim R Krim","doi":"10.31486/toj.20.0090","DOIUrl":"https://doi.org/10.31486/toj.20.0090","url":null,"abstract":"Background: The incidence of myocarditis in patients with coronavirus disease 2019 (COVID-19) remains unknown; however, increasing evidence links COVID-19 to cardiovascular complications such as arrhythmias, heart failure, cardiogenic shock, fulminant myocarditis, and cardiac death. We present a case of suspected COVID-19-induced myopericarditis and discuss the diagnostic implications, pathophysiology, and management. Case Report: A 72-year-old female was admitted to the hospital with acute on chronic respiratory failure in the setting of COVID-19. The next day, she developed pressure-like retrosternal chest pain. Laboratory findings revealed elevated cardiac enzymes and inflammatory markers consistent with myocardial injury. Electrocardiogram revealed diffuse ST segment elevations without reciprocal changes, concerning for myopericarditis. Transthoracic echocardiography showed new findings of severely reduced left ventricular (LV) systolic function, with an estimated ejection fraction (EF) of 20%. Her hospital course was further complicated by cardiogenic shock that required treatment in the intensive care unit with vasopressors and inotropes. During the next few days, she had almost full recovery of her LV function, with EF improving to 50%. However, her clinical status deteriorated, likely the result of a bowel obstruction. She was transitioned to comfort care at the request of her family, and she died shortly after. Conclusion: This case highlights diagnostic and therapeutic challenges that physicians may encounter when managing acute cardiac injury in the setting of COVID-19. The multiple mechanisms of COVID-19-related myocardial injury may influence the approach to diagnosis and treatment.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"21 2","pages":"181-186"},"PeriodicalIF":1.2,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8238094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39165953","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}

引用次数: 7

Rare Case of Primary Pulmonary Pleomorphic Liposarcoma Treated With Multimodal Therapy. 多模式治疗原发性肺多形性脂肪肉瘤罕见病例。

IF 1.2

Ochsner Journal Pub Date : 2021-01-01 DOI: 10.31486/toj.20.0164

Treshita Dey, Divya Khosla, Divyesh Kumar, Debajyoti Chatterjee, Renu Madan, Harjeet Singh, Harkant Singh, Rakesh Kapoor

{"title":"Rare Case of Primary Pulmonary Pleomorphic Liposarcoma Treated With Multimodal Therapy.","authors":"Treshita Dey, Divya Khosla, Divyesh Kumar, Debajyoti Chatterjee, Renu Madan, Harjeet Singh, Harkant Singh, Rakesh Kapoor","doi":"10.31486/toj.20.0164","DOIUrl":"https://doi.org/10.31486/toj.20.0164","url":null,"abstract":"Background: Pleomorphic liposarcoma (PLS) is a very rare type of primary pulmonary sarcoma. Clinical data about these tumors are limited, and optimal treatment has not yet been defined. Case Report: A 32-year-old male presented with pain and heaviness over the right chest. Contrast-enhanced computed tomography (CECT) of the chest showed a heterogeneous hypodense pleural-based mass and a mediastinal mass. The patient was treated with chemoradiotherapy, followed by excision and adjuvant chemotherapy. Seven months after completion of treatment, he presented with an abdominopelvic mass and soft tissue peritoneal deposits. The mass was resected, and second line chemotherapy resulted in a partial response. The patient was routinely followed. Six months after completion of the second round of chemotherapy, CECT showed multiple soft tissue deposits in the right lumbar region, right hemipelvis, and presacral region with no evidence of pulmonary disease. Chemotherapy elicited a partial response. Three years from the date of diagnosis, the patient was alive with stable disease. Conclusion: This case is unique because of the rare primary site of PLS presentation and the rare presentation of peritoneal metastasis. Citing such cases would help us to define adequate treatment protocols for this aggressive tumor.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"21 4","pages":"431-435"},"PeriodicalIF":1.2,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8675617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39785162","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}

引用次数: 2