Ochsner Journal最新文献

{"title":"Achieving the Impossible.","authors":"Ronald G Amedee","doi":"10.31486/toj.26.5059","DOIUrl":"https://doi.org/10.31486/toj.26.5059","url":null,"abstract":"","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"26 1","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12994505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147482028","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":"Primary Ovarian Neuroendocrine Neoplasm With Carcinoid Syndrome and Carcinoid Heart Disease.","authors":"Kitti Thammakosol, Prin Vathesatogkit, Surakiat Leelasithorn, Chutintorn Sriphrapradang","doi":"10.31486/toj.25.0101","DOIUrl":"10.31486/toj.25.0101","url":null,"abstract":"<p><strong>Background: </strong>Neuroendocrine neoplasms commonly arise in the midgut, lungs, or pancreas, while primary ovarian neuroendocrine neoplasms are rare and can present with carcinoid syndrome and carcinoid heart disease even in the absence of hepatic metastases.</p><p><strong>Case report: </strong>A 70-year-old female with coronary artery disease presented with 3 months of dyspnea, leg edema, diarrhea, and facial flushing. Examination suggested right-sided heart failure with a palpable lower abdominal mass. Her 24-hour urinary 5-hydroxyindoleacetic acid level was markedly elevated (106.0 mg), and serum chromogranin A was also elevated (468.6 ng/mL). Echocardiography showed severe tricuspid and pulmonic regurgitation from thickened, immobile leaflets. Imaging identified a DOTATATE-avid left adnexal mass on Gallium-68 DOTATATE positron emission tomography/computed tomography, consistent with primary ovarian neuroendocrine neoplasm. Preoperative management included long-acting octreotide, niacin, and guideline-directed heart failure therapy, followed by tumor resection. Histopathology confirmed insular-type ovarian neuroendocrine neoplasm without invasion or metastasis. Postoperatively, the patient improved clinically, and her biochemical markers normalized.</p><p><strong>Conclusion: </strong>Primary ovarian neuroendocrine neoplasms can cause carcinoid syndrome and right-sided valvulopathy without liver metastasis, likely because ovarian venous drainage bypasses hepatic first-pass metabolism. Multidisciplinary care enables prompt diagnosis, preoperative stabilization, definitive resection, and coordinated surveillance.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"26 2","pages":"173-178"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273270","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":"Announcing a Nice Bump in the <i>Ochsner Journal</i> Impact Factor.","authors":"Ronald G Amedee","doi":"10.31486/toj.26.5064","DOIUrl":"https://doi.org/10.31486/toj.26.5064","url":null,"abstract":"","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"26 3","pages":"183"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978374","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":"Transient Postoperative Myoclonus Following Hypothermic Circulatory Arrest.","authors":"Brock Lingle, Taylor Lambert, Sydney Claypoole, Harsahib Dev, Hunter Douglas, Bobby D Nossaman","doi":"10.31486/toj.25.0085","DOIUrl":"10.31486/toj.25.0085","url":null,"abstract":"<p><strong>Background: </strong>Neurologic complications are a risk of aortic arch surgery performed with hypothermic circulatory arrest. Stroke, encephalopathy, and seizures are well-recognized complications, whereas postoperative movement disorders are rarely reported.</p><p><strong>Case report: </strong>A 72-year-old male underwent elective ascending aorta and hemiarch replacement under hypothermic circulatory arrest (28 minutes, nadir 28.9 °C) with bilateral antegrade cerebral perfusion and stable cerebral oximetry readings. During postoperative weaning from sedation, the patient developed persistent bilateral myoclonus, diffuse rigidity, and suspected eyelid apraxia, present at rest and unaffected by voluntary movement. Although a stroke code was activated, computed tomographic angiography of the head and neck was normal. Laboratory evaluation showed mild hypocalcemia without other metabolic derangements. Electroencephalography and magnetic resonance imaging were not performed. The patient was treated with intravenous levetiracetam and calcium supplementation. The movements resolved by postoperative day 3, and the patient was discharged home neurologically intact on day 5.</p><p><strong>Conclusion: </strong>This case demonstrates a transient form of postoperative myoclonus distinct from Lance-Adams syndrome. Recognition of atypical movement disorders after hypothermic circulatory arrest may help clinicians avoid unnecessary escalation of therapy and provide reassurance regarding the potential for complete recovery.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"26 3","pages":"245-246"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978052","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":"Use of Safety Stand-Down Initiatives to Reduce Hospital Harm Events.","authors":"Armin Schubert, Leslie Norman, Diego Lara, Felecia Denson, Terrence M Truxillo, Emily Bugeaud, Renee Digiovanni, Lori Minor, Slavvy Petrov, Deborah Ford","doi":"10.31486/toj.26.0029","DOIUrl":"10.31486/toj.26.0029","url":null,"abstract":"<p><strong>Background: </strong>Continuous improvement with short-cycle process change has become an accepted and commonly practiced quality tool in health care settings. While these improvement cycles had somewhat reduced our hospital's harm events over the years, patients continued to experience them. Staff and leaders were preoccupied with multiple competing priorities, especially in the aftermath of the COVID-19 pandemic. We report the use of safety stand-down initiatives to focus team attention and complement overall improvement efforts.</p><p><strong>Methods: </strong>The safety stand-down concept was adapted from industry to rapidly focus attention on safety and further reduce hospital harm events. We describe a stand-down process that harnesses stakeholder commitment, team attention, and resources so that stand-down actions can be initiated quickly. Four hospital-wide and 3 unit-based safety stand-downs were initiated in response to outliers or rapidly rising counts of hospital-acquired <i>Clostridioides difficile</i> infection, central line-associated bloodstream infection (CLABSI), and inpatient falls. Run charts were used to compare performance 12 months before and 6 to 9 months after the hospital-wide stand-down interventions.</p><p><strong>Results: </strong>Postintervention, <i>C difficile</i> infections, CLABSIs, and inpatient falls improved significantly based on meeting the run chart rules for constituting a shift. Reductions (39.2%, 78.9%, and 20.4%, respectively) were statistically significant at the <i>P</i><0.05 level.</p><p><strong>Conclusion: </strong>Our experience demonstrates that safety stand-down initiatives can synergize with ongoing improvement cycles to mitigate adverse trends in hospital harm events.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"26 3","pages":"214-226"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978162","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":"Management and Outcomes of Complications Related to BioZorb Use in Breast-Conserving Surgery: A Retrospective Single-Center Case Series Analysis.","authors":"Carolina Baz, Eve Paxton, Justin Turcotte, Meghan Milburn, Steven Woodward, Rubie Sue Jackson","doi":"10.31486/toj.25.0104","DOIUrl":"10.31486/toj.25.0104","url":null,"abstract":"<p><strong>Background: </strong>BioZorb (Hologic, Inc) is an implantable fiducial marker used in breast-conserving surgery. Since the US Food and Drug Administration (FDA) approved BioZorb in 2012, numerous adverse effects have been reported, prompting the FDA to issue a warning about potential risks on February 27, 2024. BioZorb was subsequently recalled, and on October 25, 2024, the FDA classified the recall as a Class 1, the most serious category, because of the risk of severe injury or death associated with the device. Limited research is available on the management of BioZorb-related complications.</p><p><strong>Methods: </strong>In a retrospective medical records review of 296 patients who had BioZorb placed and had more than 30 days of follow-up in the electronic medical record, we identified the patients who were treated for BioZorb complications from January 2012 to February 2025.</p><p><strong>Results: </strong>With an average follow-up of 38.4 months, 13 patients (4%) experienced device-related complications, identified at a median of 6.2 months. Most affected patients had multiple complications, with the most common being chronic pain (54%), surgical site infection (39%), and wound dehiscence (31%). BioZorb was removed in 62% of patients; the remainder of the patients were managed nonoperatively.</p><p><strong>Conclusion: </strong>We identified several complications associated with the use of BioZorb in our patient population, and most of the patients who experienced complications required device removal. Because complications can develop many years after the initial surgery, surgeons should be aware of the existence of complications and the varied presentations. To our knowledge, this study is the first report on the management of BioZorb complications and subsequent outcomes, providing valuable insights for surgeons.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"26 1","pages":"5-8"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12994488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147482086","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":"Examining New Mothers' Access to Zuranolone.","authors":"Turner J O Simmers, David W Galarneau","doi":"10.31486/toj.25.0120","DOIUrl":"10.31486/toj.25.0120","url":null,"abstract":"","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"26 1","pages":"2-4"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12994493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147482091","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":"Development and Implementation of a Radiation Safety Screening Protocol for a Clinical Study Using Amyloid Positron Emission Tomography Imaging.","authors":"Tamara G Fong, Madeleine Martine, Cole Heine, Yonah Joffe, Julianna Liu, Mackenzie Topper, Eva M Schmitt, Phillip H Kuo, Carrie A Redlich, Sharon K Inouye","doi":"10.31486/toj.25.0095","DOIUrl":"10.31486/toj.25.0095","url":null,"abstract":"<p><strong>Background: </strong>Amyloid positron emission tomography (PET) is gaining popularity for clinical and research purposes, particularly since the US Food and Drug Administration approval of anti-amyloid therapies. While the benefits of PET imaging in clinical care outweigh the risks associated with radiation exposure, the risks from elective radiation exposure in research should be carefully considered. Currently, no published or widely used guidelines consider prior radiation exposure as part of the eligibility determination for prospective participants in a clinical trial that includes ionizing radiation exposure.</p><p><strong>Methods: </strong>We reviewed the medical literature and current studies listed on ClinicalTrials.gov for radiation safety criteria and study protocols that include amyloid PET scans. We then developed a safety screening procedure to systematically estimate prior radiation exposure to determine eligibility for participation in an amyloid PET substudy and implemented this procedure in the Successful AGing after Elective Surgery (SAGES) study.</p><p><strong>Results: </strong>Of the studies including amyloid PET that were listed on ClinicalTrials.gov (n=92), prespecified exclusion criteria with specific amounts of radiation exposure were provided in only 1% of studies; 37% of studies did not report any screening for prior radiation exposure. Using the screening protocol we developed for the SAGES study, 17% of 101 participants were deemed ineligible for the amyloid PET procedure because of prior exposure.</p><p><strong>Conclusion: </strong>A systematic, standardized screening protocol to determine the prior radiation exposure of potential participants should be used as a tool in clinical studies involving elective radiologic procedures to minimize risk to participants.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"26 2","pages":"93-131"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273212","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":"Phlegmasia Cerulea Dolens Secondary to Iliac Vein Compression From Posttransplant Hematoma Despite Anticoagulation.","authors":"Tiffany Xiu Zhen Lim, Godfrey R Parkerson, Justin Barr","doi":"10.31486/toj.25.0097","DOIUrl":"10.31486/toj.25.0097","url":null,"abstract":"<p><strong>Background: </strong>Phlegmasia cerulea dolens is a rare, life- and limb-threatening form of venous thrombosis that is often seen in the setting of hypercoagulable states or mechanical obstruction.</p><p><strong>Case report: </strong>We report the case of a 49-year-old female with a history of multiple thromboembolic events and a methylenetetrahydrofolate reductase mutation who, despite therapeutic anticoagulation, developed phlegmasia cerulea dolens following renal transplantation. Her postoperative course was marked by recurrent hemorrhage with rapidly reaccumulating subincision and perinephric hematomas, requiring 4 exploratory laparotomies for hematoma evacuation and graft evaluation. In addition, the patient underwent urgent endovascular suction thrombectomy for extensive iliofemoral thrombosis caused by extrinsic iliac vein compression.</p><p><strong>Conclusion: </strong>This case highlights the complex interplay between bleeding and clotting in high-risk transplant recipients and the need for nuanced anticoagulation management. Although phlegmasia cerulea dolens is rare, clinicians must keep a high index of suspicion for the pathology, as early recognition and timely intervention can be both life- and limb-saving.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"26 1","pages":"54-57"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12994500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147482149","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":"Spurious Plasma Adrenocorticotropic Hormone Level in a Patient With Adrenal Cushing Syndrome.","authors":"Sarath Chandran, Alpesh Goyal, Mangesh Mane, Rahul Gupta, Akansha Choudhary","doi":"10.31486/toj.25.0093","DOIUrl":"10.31486/toj.25.0093","url":null,"abstract":"<p><strong>Background: </strong>Endogenous Cushing syndrome results from excessive cortisol production by the adrenal glands and is characterized by the loss of circadian rhythm of cortisol secretion and negative feedback regulation of the hypothalamic-pituitary-adrenal axis. This condition is broadly subtyped into adrenocorticotropic hormone (ACTH)-dependent and ACTH-independent types based on ACTH measurement. A plasma ACTH level <5 pg/mL suggests ACTH-independent Cushing syndrome (adrenal source), while a level >15 pg/mL suggests ACTH-dependent Cushing syndrome (pituitary or ectopic source). A certain immunoassay platform (Immulite 1000 [Siemens AG]) has a known positive ACTH bias, so a patient with ACTH-independent Cushing syndrome may be falsely labeled as having ACTH-dependent disease. This misclassification can lead to unnecessary investigations and interventions such as pituitary imaging, inferior petrosal sinus sampling, and even pituitary surgery.</p><p><strong>Case report: </strong>A 41-year-old male with a history of right open adrenalectomy presented for evaluation of recent-onset abdominal distension, weight gain, facial fullness, and fatigue. He also had newly diagnosed diabetes and hypertension. Physical examination revealed facial fullness with plethora, centripetal obesity, and dilated abdominal veins. Biochemical evaluation revealed endogenous Cushing syndrome (late-night serum cortisol of 30.9 μg/dL, late-night salivary cortisol of 3.42 μg/dL, and overnight dexamethasone suppression test cortisol of 30.5 μg/dL), with hypokalemia (3.2 mmol/L) and grossly elevated dehydroepiandrosterone sulphate (2,857 μg/dL). Plasma ACTH as measured by the Immulite 1000 was unsuppressed (17.2 pg/mL) in the face of hypercortisolism, indicating ACTH dependence. Because of the patient's history and the known positive bias of plasma ACTH measurements from the immunoassay platform used for the assay, abdominal and thoracic imaging was performed, revealing multiple metastatic deposits in the liver and lungs. The left adrenal gland was atrophic, confirming that ACTH was truly suppressed. A diagnosis of metastatic adrenocortical carcinoma with adrenal Cushing syndrome was considered, and a chemotherapy regimen comprising etoposide, doxorubicin, and cisplatin was initiated. Ketoconazole was added later to control hypercortisolism. The patient took ketoconazole for 1 month and was then lost to follow-up.</p><p><strong>Conclusion: </strong>Spurious plasma ACTH measurements can occur with the Immulite 1000 and falsely indicate ACTH-dependent Cushing syndrome. Consequently, the clinical context must be carefully considered when evaluating patients with hypothalamic-pituitary-adrenal axis disorders.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"26 2","pages":"162-166"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273411","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}