Ochsner Journal最新文献

{"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}

{"title":"Accuracy of Perfusion Index and Perfusion Index Ratio as a Predictor of a Successful Low Interscalene Brachial Plexus Block: A Prospective Observational Study.","authors":"Anuj Jain, Sanjay Srinivas, Zainab Ahmad, Ashutosh Kaushal, Harish Kumar, Vaishali Waindeskar","doi":"10.31486/toj.24.0119","DOIUrl":"10.31486/toj.24.0119","url":null,"abstract":"<p><strong>Background: </strong>The perfusion index has previously been used to predict the success of brachial plexus blocks but to our knowledge has not yet been studied for the low interscalene block approach. This study evaluated the accuracy of the perfusion index and perfusion index ratio in predicting the success of a low interscalene brachial plexus block in patients undergoing upper limb surgery.</p><p><strong>Methods: </strong>The study included 70 patients undergoing upper limb surgeries under ultrasound-guided low interscalene brachial plexus block. After local anesthetic injection, patients' sensory and motor blocks were assessed every 5 minutes. The perfusion index was recorded at baseline and then at 5-minute intervals until 30 minutes after anesthetic injection in both the blocked and unblocked limbs. The perfusion index ratio (perfusion index at a specific timepoint/baseline perfusion index) was calculated and recorded at each 5-minute time point. Receiver operating characteristic curves were constructed to determine the accurate value of the perfusion index that indicated block success.</p><p><strong>Results: </strong>The mean perfusion index and perfusion index ratio were higher in the blocked limb vs the unblocked limb at all time points. At the 10-minute time point, the cutoff values for the perfusion index and perfusion index ratio for a successful block were 3.24 and 3.54, respectively. At the 10-minute time point, the sensitivities of the perfusion index and perfusion index ratio in predicting a successful block were 95.2% and 100%, respectively; specificity was 100% for both the perfusion index and perfusion index ratio.</p><p><strong>Conclusion: </strong>The perfusion index and perfusion index ratio can accurately predict the success of a low interscalene brachial plexus block well before surgical anesthesia is fully established, thereby saving operating room time. A perfusion index ratio of 3.54 or more at 10 minutes is a reliable predictor of block success.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 2","pages":"85-91"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12175760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334153","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":"Bilateral Hypoglossal Nerve Palsy After Cardiac Surgery.","authors":"Amanda Vining, Jay E Trusheim, Kelly G Ural","doi":"10.31486/toj.24.0126","DOIUrl":"10.31486/toj.24.0126","url":null,"abstract":"<p><strong>Background: </strong>Hypoglossal nerve palsy is a rare perioperative complication caused by excessive stretching of the nerve. Symptoms include tongue deviation, dysarthria, hoarseness, and dysphagia. We present the case of a patient who experienced bilateral hypoglossal nerve palsy after cardiac surgery.</p><p><strong>Case report: </strong>A 68-year-old male with hypertension, sleep apnea, and aortic insufficiency presented for aortic valve replacement. He was easily intubated using video laryngoscopy, and surgery proceeded without incident. He remained intubated overnight and was extubated on postoperative day 1. Initially, hoarseness and tongue edema were noted. Further evaluation revealed oropharyngeal dysphagia, silent aspiration, and inability to protrude the tongue, all consistent with a bilateral hypoglossal nerve injury. Because the patient was unable to swallow, a percutaneous endoscopic gastrostomy (PEG) tube was placed. Three months later, electromyography showed denervation of the tongue, suggestive of hypoglossal nerve injury, with good prognosis for recovery. The PEG tube was removed, and the patient was able to tolerate a soft diet. Eight months postoperatively, the patient was started on a normal diet, and at 18 months postoperatively, his speech and vocal fatigue had improved to approximately 90% of normal.</p><p><strong>Conclusion: </strong>Although rare, hypoglossal nerve palsy is a perioperative complication that can have deleterious effects on patient well-being. Most cases are self-limited and resolve completely in 4 to 6 months; however, some patients experience more lasting effects. Anesthesiologists should take appropriate precautions when positioning a patient's head and neck during intubation and throughout the duration of surgery to help prevent hypoglossal nerve injury.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 2","pages":"148-150"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12175771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334154","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":"Jarcho-Levin Syndrome With Fatal Respiratory Failure.","authors":"Sofien Atitallah, Wiem Ben Othmen, Rania Ben Rabeh, Nada Missaoui, Olfa Bouyahia, Sonia Mazigh, Salem Yahyaoui, Samir Boukthir","doi":"10.31486/toj.24.0111","DOIUrl":"10.31486/toj.24.0111","url":null,"abstract":"<p><strong>Background: </strong>First described in 1938, Jarcho-Levin syndrome is a rare genetic disorder characterized by multiple rib and vertebral anomalies that cause thoracic constriction and severe respiratory complications. Jarcho-Levin syndrome is associated with a high mortality rate.</p><p><strong>Case report: </strong>We report the case of a 3-month-old male who was born with Jarcho-Levin syndrome to first-degree consanguineous parents. The infant presented with severe respiratory distress, scoliosis, thoracic cage deformity, and spinal dysraphism. Radiologic findings revealed multilevel vertebral segmentation defects and asymmetric rib deformities. Despite respiratory support, the infant's condition deteriorated, and he died from respiratory failure complicated by pneumonia at 7 months of age.</p><p><strong>Conclusion: </strong>This case highlights the life-threatening nature of Jarcho-Levin syndrome and emphasizes the critical role of early diagnosis in optimizing respiratory support and family planning. Genetic counseling is crucial and ideally recommended preconception or during early pregnancy for consanguineous families, although accessibility to counseling services varies widely. Despite advances in pediatric care, the prognosis for patients with Jarcho-Levin syndrome remains guarded, emphasizing the need for continued research into effective treatments and management strategies.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 2","pages":"119-122"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12175764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334160","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":"Racial Differences in Radium-223 Treatment Response and Adverse Effects in a Small-Cohort, Pilot, Hypothesis-Generating Observational Study.","authors":"Johnny Yang, Mary R Nittala, Srinivasan Vijayakumar, Vani Vijayakumar","doi":"10.31486/toj.25.0023","DOIUrl":"10.31486/toj.25.0023","url":null,"abstract":"","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 2","pages":"75-76"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12175757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334162","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 of Spontaneous Renal Arteriovenous Fistula in Pregnancy.","authors":"Comfort S Tamakloe, Conner Davey, Kaitlyn Dorn, Patrick Gilbert, Frank B Williams","doi":"10.31486/toj.24.0062","DOIUrl":"10.31486/toj.24.0062","url":null,"abstract":"<p><strong>Background: </strong>A renal arteriovenous fistula (RAVF) is an abnormal connection between the artery and vein of the kidney and can result from idiopathic, congenital, or traumatic causes. In the general population, this pathology is rare and has the potential to be life-threatening. The incidence in pregnancy is even rarer.</p><p><strong>Case report: </strong>A pregnant 33-year-old gravida 5, para 4 patient presented with gross hematuria and passage of clots and was diagnosed with a right renal lower pole arteriovenous fistula at 36 weeks, 6 days' gestation. The patient developed gestational hypertension but did not demonstrate severe features of preeclampsia She underwent labor induction, uncomplicated spontaneous vaginal delivery, and subsequent endovascular embolization of the fistula. Hematuria and hypertension resolved postembolization.</p><p><strong>Conclusion: </strong>Because RAVF presents with nonspecific symptoms that mimic other causes of hematuria and hypertension in pregnancy, this rare vascular anomaly poses challenges in diagnosis and management in pregnant patients. Our case was also challenging because of the late-stage pregnancy diagnosis. The case highlights the challenges of diagnosing and managing RAVF during pregnancy and underscores the importance of a multidisciplinary approach.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 1","pages":"59-63"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693733","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":"Evaluation of the Diagnostic Accuracy of the T2Resistance Panel (Research Use Only) in Patients With Possible Bacterial Bloodstream Infections.","authors":"Deborah Ashcraft, Jesse St Pierre, Heather Davis, Susan Scariano, Maria Latsis, Royanne Vortisch, Samantha Smith, George Pankey","doi":"10.31486/toj.24.0101","DOIUrl":"10.31486/toj.24.0101","url":null,"abstract":"<p><strong>Background: </strong>Early identification and antimicrobial susceptibility testing (AST) of bloodstream pathogens are important for promptly determining the appropriate therapy. Currently, positive blood culture results (identification and AST) are reported in 2 to 4 days. The T2Resistance (T2R) Panel (T2 Biosystems, Inc) uses DNA amplification with magnetic resonance from 3 mL of whole blood for direct detection of 13 antibiotic resistance genes: <i>bla</i> _KPC, <i>bla</i> _NDM, <i>bla</i> _VIM, <i>bla</i> _IMP, <i>bla</i> _OXA-48, <i>bla</i> _CTX-M-14/15, AmpC <i>bla</i> _CMY/DHA, <i>van</i>A/B, and <i>mec</i>A/C. We compared the accuracy of T2R testing to AST for positive blood cultures.</p><p><strong>Methods: </strong>This investigator-sponsored, single-center study prospectively enrolled 802 patients with a standard of care blood culture. Five hundred forty-seven patients had adequate blood for culture and T2R testing. Blood cultures with positive isolates were identified, and AST was performed. Blood samples with positive blood cultures were tested with the T2R Panel.</p><p><strong>Results: </strong>Blood cultures were positive for 58/547 (10.6%) patients. Contaminants (18/547 [3.3%]) were excluded. T2R testing results (n=31) showed 2 <i>bla</i> _CTX-M-14/15 genes with 100% sensitivity; the remaining gram-negative resistance genes were not detected, so sensitivity could not accurately be determined. Specificity was 100% for the 16 gram-negative bacilli. Three enterococci and 2 <i>Staphylococcus aureus</i> showed 100% sensitivity/specificity. However, 10 coagulase-negative staphylococci showed 17% sensitivity/100% specificity. Antibiotic resistance genes identified were 2 <i>bla</i> _CTX-M-14/15, 2 <i>mec</i>A/C, and 1 <i>van</i>A/B. T2R testing results were obtained in an average of 7 hours.</p><p><strong>Conclusion: </strong>T2R testing is highly specific (100%) for the 13 antibiotic resistance genes on the panel. Sensitivity was 100% for the genes detected but was low (17%) for coagulase-negative staphylococci. T2R testing has the potential to diagnose certain antibiotic resistance genes from bacterial bloodstream infections in hours vs the days required for a positive blood culture with AST. Additional studies that include larger numbers of samples with antimicrobial resistance genes are needed.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 1","pages":"24-33"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694113","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 Endoscopic Scissors to Remove a Foreign Body Impacted in the Proximal Esophagus.","authors":"Muhammad F Mubarak","doi":"10.31486/toj.24.0117","DOIUrl":"10.31486/toj.24.0117","url":null,"abstract":"<p><strong>Background: </strong>The majority of ingested foreign bodies are uneventfully expelled through the gastrointestinal tract. However, anatomically narrowed areas in the proximal gastrointestinal tract create sites of increased retention/impaction of ingested foreign bodies. Foreign body impaction in the esophagus poses a medical emergency because of the complications associated with delayed management: esophageal perforation, infection, and fistula formation. Thus, urgent endoscopic intervention to remove sharp esophageal foreign bodies is necessary.</p><p><strong>Case report: </strong>A 45-year-old male presented with a 3-day history of a foreign body in the esophagus. Esophagogastroduodenoscopy identified a horizontally lodged V-shaped fishbone with both lateral edges deeply embedded in the esophageal mucosa. When endoscopic removal using traditional removal accessories failed, endoscopic scissors were used to fracture the spinous process edge of the fishbone, and the fishbone was advanced into the gastric lumen. A makeshift endoscope hood was fashioned from a sterile glove, attached to the distal end of the endoscope, and used to remove the fishbone.</p><p><strong>Conclusion: </strong>The off-label use of endoscopic scissors to relieve the proximal esophageal obstruction by fracturing the fishbone was integral in achieving successful removal.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 2","pages":"137-143"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12175765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334176","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":"Evidence for Combining Conservative Treatments for Adhesive Capsulitis.","authors":"Jordan L Hill","doi":"10.31486/toj.23.0128","DOIUrl":"10.31486/toj.23.0128","url":null,"abstract":"<p><p><b>Background:</b> Adhesive capsulitis, also known as frozen shoulder, is a challenge to treat clinically. Common first-line treatment options are suprascapular nerve block (SSNB), intra-articular corticosteroid (IACS) injection, hydrodilatation, and physical therapy. This literature review summarizes each of these conservative treatments and discusses the evidence base for combining treatment options for potential additive benefits to improve patient outcomes (ie, pain, range of motion [ROM], and shoulder function). <b>Methods:</b> The PubMed and Google Scholar databases were searched using the search terms \"adhesive capsulitis,\" \"frozen shoulder,\" \"corticosteroids,\" \"physical therapy,\" \"suprascapular nerve block,\" \"hydrodilatation,\" and \"conservative care.\" Pertinent articles were identified and synthesized to provide a comprehensive review of 4 common conservative treatments for adhesive capsulitis. <b>Results:</b> Combining SSNB with physical therapy and/or IACS injection and combining IACS injection with physical therapy have support in the literature for improving shoulder pain, ROM, and function, while hydrodilatation and physical therapy seem to offer some additive benefits for improving shoulder ROM when used as adjunct treatments for adhesive capsulitis. <b>Conclusion:</b> Adhesive capsulitis remains a challenge to treat clinically with much still unknown regarding treatment optimization. For the foreseeable future, first-line conservative management will continue to be the mainstay of managing adhesive capsulitis. Thus, knowing how to best use and optimize these various options-both individually and in combination-is vital for effective treatment.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"24 1","pages":"47-52"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10949050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177098","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":"The Xavier Ochsner College of Medicine - \"The Time Is Always Right To Do What Is Right\".","authors":"Yvens Laborde","doi":"10.31486/toj.24.5049","DOIUrl":"10.31486/toj.24.5049","url":null,"abstract":"","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"24 4","pages":"242-244"},"PeriodicalIF":1.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886164","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}