Ochsner Journal最新文献

{"title":"The Deceptive Nature of Pneumatosis Intestinalis: From Spontaneous Resolution to Bowel Ischemia.","authors":"Carolina Baz, Ian Bussey, Jennifer Wormuth","doi":"10.31486/toj.25.0075","DOIUrl":"10.31486/toj.25.0075","url":null,"abstract":"<p><strong>Background: </strong>Pneumatosis intestinalis, a rare condition characterized by the presence of gas within the bowel wall, has an estimated incidence of 0.03% in the general population. Although the exact etiology of the condition remains uncertain, pneumatosis intestinalis is broadly classified as primary (idiopathic) or secondary (associated with an underlying condition), and the secondary form accounts for approximately 85% of cases. Secondary pneumatosis intestinalis has been associated with up to 60 potential causes and presents with a wide range of clinical manifestations, making thorough physical examination and imaging essential for appropriate management. Diagnosis is typically based on characteristic computed tomography (CT) findings.</p><p><strong>Case report: </strong>An 89-year-old female presented with shortness of breath, abdominal pain, nausea, vomiting, and diarrhea. CT imaging revealed extensive pneumatosis intestinalis in the small intestine. Despite the patient's stable hemodynamics and a mostly unremarkable physical examination, focal abdominal tenderness raised concern for bowel ischemia. The patient underwent an exploratory laparotomy that revealed patchy areas of pneumatosis intestinalis in an otherwise normal-appearing small bowel, with no evidence of ischemia or necrosis.</p><p><strong>Conclusion: </strong>Because of the deceptive nature of pneumatosis intestinalis, the mere presence of the condition is not enough to justify surgery. Cases with benign causes can often be managed conservatively and resolve spontaneously, whereas concerning findings that may indicate a surgically treatable cause may require urgent intervention to reduce mortality.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"26 1","pages":"45-49"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12994495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147482135","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":"Isolated Herniation of Gallbladder Through Diaphragmatic Defect Following Hepatic Microwave Ablation.","authors":"Ivan Buitrago, Jordan Spring, William C Conway","doi":"10.31486/toj.25.0071","DOIUrl":"10.31486/toj.25.0071","url":null,"abstract":"<p><strong>Background: </strong>Thermal ablation is commonly used to control metastatic hepatic lesions. The documented overall major complication rate is low (4.1%), with a lower incidence of damage to organs (<0.7%). Diaphragmatic injuries resulting from thermal ablation can cause pain and pleural effusions and, rarely, herniation of intra-abdominal contents into the thoracic cavity.</p><p><strong>Case report: </strong>We present a case of isolated gallbladder herniation through a diaphragmatic defect after microwave ablation. The patient's complication was corrected surgically with robotic reduction of the herniated gallbladder, closure of the diaphragmatic defect, and cholecystectomy.</p><p><strong>Conclusion: </strong>To our knowledge, diaphragmatic hernia causing herniation of the gallbladder has not been previously reported. Our patient's diaphragmatic defect became symptomatic after a delay of 2 years. Such a delay is common, and practitioners should be aware of delayed symptoms after ablation as early detection can improve patient outcomes.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"26 1","pages":"41-44"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12994486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147482081","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":"Avascular Necrosis Secondary to Traumatic Posterior Hip Dislocation.","authors":"Eden Schoofs, Michael Christopher Marshall, Jonathan Willard, Deryk Jones","doi":"10.31486/toj.25.0062","DOIUrl":"10.31486/toj.25.0062","url":null,"abstract":"<p><strong>Background: </strong>Avascular necrosis of the femoral head, a known long-term complication following traumatic posterior hip dislocation, can result in femoral head collapse, osteochondral defects, and eventual posttraumatic osteoarthritis. This condition is especially problematic in young, active patients for whom total hip arthroplasty survivorship is a concern. Biologic treatments are therefore preferable to delay or avoid total hip arthroplasty.</p><p><strong>Case report: </strong>A 16-year-old male developed progressive left hip pain after a posterior dislocation sustained while playing football. The hip was emergently reduced. Imaging (x-ray, computed tomography, and magnetic resonance imaging [MRI]) showed a small depressed cortical fracture on the anterior and superior femoral head. Conservative treatment included protected weight-bearing for 6 weeks, knee immobilization to restrict hip flexion, physical therapy, and a home exercise program. However, symptoms worsened after 5 months of conservative care. Repeat MRI demonstrated avascular necrosis with associated cartilage loss, hip effusion, and femoroacetabular impingement (a cam deformity). Given the patient's young age, persistent symptoms, functional limitations, and radiographic findings, the decision was made to perform surgical intervention. Surgical hip dislocation via an anterolateral approach with a small trochanteric osteotomy (modified Hardinge approach) was used to expose the femoral head while maintaining the remaining blood supply. Fresh femoral head osteochondral allograft transplantation was performed, along with femoral neck osteoplasty to address the cam deformity.</p><p><strong>Conclusion: </strong>Osteochondral allograft transplantation is an effective technique to treat osteochondral defects of the femoral head in the setting of avascular necrosis following traumatic hip dislocation. This surgical option restores hip function and may delay or prevent total hip arthroplasty in young, active patients.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"26 3","pages":"237-244"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977898","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":"Focus on POCUS.","authors":"Joseph Koveleskie, Bobby D Nossaman","doi":"10.31486/toj.26.0001","DOIUrl":"10.31486/toj.26.0001","url":null,"abstract":"","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"26 3","pages":"184-185"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977990","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":"Attention-Deficit/Hyperactivity Disorder in Anterior Cruciate Ligament Reconstruction Patients ≤25 Years of Age: A National Database Study of Prevalence and Outcomes.","authors":"David Lutati, Jane C Brennan, Matthew Peterman, Andrea H Johnson, James York, Benjamin M Petre, Daniel E Redziniak, Justin J Turcotte","doi":"10.31486/toj.26.0021","DOIUrl":"10.31486/toj.26.0021","url":null,"abstract":"<p><strong>Background: </strong>A growing body of research indicates that psychiatric conditions put patients at risk for worse outcomes after anterior cruciate ligament (ACL) reconstruction. However, attention-deficit/hyperactivity disorder (ADHD) is an understudied comorbidity in patients undergoing ACL reconstruction.</p><p><strong>Methods: </strong>Using the PearlDiver national database, we conducted a retrospective review of 9,352 patients ≤25 years who underwent isolated ACL reconstruction during the period 2010 to 2023. We compared demographics, comorbidities, and outcomes between patients with and without an ADHD diagnosis before and after 1:3 propensity score matching. We also performed a subgroup analysis of ADHD patients who were on and off medication.</p><p><strong>Results: </strong>On average, patients with ADHD were younger than patients without ADHD (<i>P</i><0.001); were significantly more likely to be male; and had increased rates of obesity, alcohol use disorders, anxiety disorders/depression, tobacco use, and developmental disorders (all <i>P</i><0.001). Postoperatively, we found no differences in rates of 90-day readmission or in 2-year prolonged opioid use, repeat ACL reconstruction, other knee surgery, or stiffness either before or after propensity score matching. Among the patients with ADHD, 420 (67.9%) filled a prescription for ADHD medication in the 90 days prior to ACL reconstruction. No significant differences were detected in 90-day or 2-year outcomes between patients who used ADHD medication and those who did not.</p><p><strong>Conclusion: </strong>In this retrospective database study, 6.6% of patients ≤25 years who underwent ACL reconstruction had a diagnosis of ADHD prior to surgery. Neither a diagnosis of ADHD nor ADHD medication use was associated with worse outcomes after ACL reconstruction. Given the high prevalence of ADHD, further study of its effects on outcomes of ACL reconstruction and other orthopedic conditions is needed.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"26 3","pages":"186-204"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978408","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":"A History of Vena Cava Interruption to Treat Pulmonary Embolism: The Ben Hogan Case.","authors":"Theodore N Pappas, Tiffany Lim, Justin Barr","doi":"10.31486/toj.26.0038","DOIUrl":"10.31486/toj.26.0038","url":null,"abstract":"","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"26 2","pages":"70-75"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148272622","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":"Immune Checkpoint Inhibitor-Induced Myocarditis: A Late Presentation.","authors":"Adrienne Koos, Farnoosh Shariati, Senthil Anand","doi":"10.31486/toj.25.0063","DOIUrl":"10.31486/toj.25.0063","url":null,"abstract":"<p><strong>Background: </strong>Immune checkpoint inhibitors (ICIs) have revolutionized oncology by providing a new treatment modality for a wide range of malignancies. ICIs have been shown to aid in remission of cancers with poor prognosis, including stage IV malignancies. The first ICI was approved for metastatic melanoma, but now ICI indications range from melanoma to small cell lung cancer and triple-negative breast cancer. While this drug class has revolutionized cancer treatment, ICIs can also cause a broad range of immune-related adverse events, including myocarditis. ICI myocarditis has a broad clinical presentation, from fulminant heart failure to cardiac arrhythmia, and is confirmed with a histopathology finding of myocardial infiltration by T lymphocytes and macrophages and cell death. We present a case of cardiogenic shock secondary to ICI-associated myocarditis with onset 13 months after administration of pembrolizumab for triple-negative breast cancer.</p><p><strong>Case report: </strong>A 30-year-old female with history of triple-negative breast cancer presented to the emergency department with a 1-month history of progressive chest tightness, dyspnea on exertion, and dry cough. The patient was diagnosed with acute decompensated heart failure (stage C cardiogenic shock), started on milrinone and vasopressin, and transferred to our institution for a higher level of care. At that time, she progressed to stage D cardiogenic shock. A presumptive diagnosis of ICI-associated myocarditis was made within 12 hours, and treatment with high-dose intravenous methylprednisolone was initiated. Despite the high mortality associated with ICI-associated myocarditis, the patient improved and was discharged 9 weeks after admission.</p><p><strong>Conclusion: </strong>This case highlights the importance of considering ICI myocarditis in the differential diagnosis of cardiogenic symptoms, even in delayed presentations, and supports the lifesaving potential of early recognition and treatment.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"26 1","pages":"37-40"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12994503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147482078","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 Distribution of High-Risk Human Papillomavirus (HPV) Genotypes in India vs World Health Organization Regions and Countries: Implications for HPV Vaccination.","authors":"Anusree Prabhakaran, Srinivasan Vijayakumar, Nikitha S, Arathi P Rao","doi":"10.31486/toj.25.0082","DOIUrl":"10.31486/toj.25.0082","url":null,"abstract":"<p><strong>Background: </strong>High-risk human papillomavirus (HPV)-induced cervical cancer is a major cause of mortality worldwide. Published data suggest geographic variations in the prevalence of some of the 12 high-risk HPV genotypes. Although the variations in prevalence of the 2 most common high-risk HPV genotypes-16 and 18-have been relatively well documented, the variations in prevalence of the other 10 high-risk genotypes are not as well documented. Reliable proof of variations in prevalence may warrant different high-risk HPV vaccine compositions/vaccination strategies in specific geographic areas. To explore the adequacy of the HPV vaccines available in India, we focused this study on the following: (1) confirming that high-risk HPV genotype variations exist on the Indian subcontinent, (2) determining how the genotype variations differ from the variations in other WHO regions/countries and among different regions/states in India, (3) determining whether any regional variations are sufficiently different to warrant changes in high-risk HPV vaccine compositions and/or vaccination strategies, and (4) determining whether the collected data could lead to new hypothesis generation and study design.</p><p><strong>Methods: </strong>We used 2 methods to gather information. To examine variations in prevalence, we conducted a secondary analysis (data mining) of publicly available data from the HPV Information Centre. The HPV Information Centre data were obtained from a systematic review of studies published from 1990 to 2015. We also conducted a scoping review of the literature published from 2015 to 2024.</p><p><strong>Results: </strong>As expected, we found variations in the prevalence of high-risk HPV genotypes among different regions on the Indian subcontinent. The predominant genotypes identified on the Indian subcontinent, in World Health Organization (WHO) regions, and in WHO South-East Asia Region countries were HPV 16 and HPV 18; other genotypes had varied prevalences. The scoping review of the literature revealed many inhomogeneities among the studies. None of the studies included testing for all 12 high-risk HPV genotypes, confidence intervals were rarely reported, and the quality assurance details of the studies are unknown.</p><p><strong>Conclusion: </strong>Although high-risk HPV genotype variations in prevalence were detected among different regions on the Indian subcontinent, the strength of the data does not justify different HPV vaccination compositions and strategies at this time. Studies are needed that include all 12 high-risk HPV genotypes, use uniform state-of-the-art high-risk HPV detection technologies, and document stringent quality assurance procedures. While our results must be interpreted with caution, our data can help inform future well-designed, homogenous, high-quality studies.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"26 2","pages":"76-92"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273226","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":"Benefits of Point-of-Care Ultrasound for Assessing Gastric Contents.","authors":"Joseph Koveleskie, Sydney Labat, Matthew Palascak, David Broussard, William Sumrall, Bobby D Nossaman","doi":"10.31486/toj.26.0002","DOIUrl":"10.31486/toj.26.0002","url":null,"abstract":"<p><strong>Background: </strong>Point-of-care ultrasound (POCUS) has emerged as a valuable bedside tool for assessment of gastric contents in perioperative and emergency settings. Accurate identification of gastric volume and composition is critical for estimating pulmonary aspiration risk, particularly when fasting history is unreliable or gastric emptying is impaired. Visualization of the gastric antrum enables qualitative grading and semiquantitative estimation of gastric volume, offering a practical alternative to traditional assessment methods.</p><p><strong>Case report: </strong>An 85-year-old female with multiple comorbidities-including chronic obstructive pulmonary disease, heart failure, chronic kidney disease, and diabetes-presented with small bowel obstruction. Despite intrahospital fasting, preoperative gastric POCUS demonstrated substantial gastric contents consistent with a full stomach. Sedation was administered to facilitate nasogastric sump tube placement, resulting in effective gastric decompression. The patient underwent exploratory laparotomy with lysis of adhesions and ventral hernia repair without intraoperative complications or vasopressor requirement. Postoperatively, she was transferred to the surgical intensive care unit in stable condition. Given the patient's advanced age and cardiopulmonary comorbidities, ongoing management emphasized careful fluid balance and continued gastric decompression.</p><p><strong>Conclusion: </strong>Gastric POCUS provides high diagnostic accuracy for detecting clinically significant gastric volumes associated with aspiration risk and maintains reliability across diverse patient populations. The ability of gastric POCUS to support dynamic, real-time decision-making enhances patient safety, informs airway management strategies, and improves perioperative workflow efficiency. Future advances, including artificial intelligence-assisted interpretation, are expected to further expand the role of gastric POCUS in anesthesia and critical care practice.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"26 3","pages":"262-265"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977852","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":"Academic Aspirations.","authors":"Ronald G Amedee","doi":"10.31486/toj.26.5061","DOIUrl":"https://doi.org/10.31486/toj.26.5061","url":null,"abstract":"","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"26 2","pages":"67"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148272904","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}