Ochsner Journal最新文献

{"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":"Family Connects New Orleans: Redefining Fourth Trimester Care.","authors":"Christopher Levi Griffin, Zoë Merritts, Charlene Ho","doi":"10.31486/toj.25.0099","DOIUrl":"10.31486/toj.25.0099","url":null,"abstract":"","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 4","pages":"222-224"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12704470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769577","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":"Incidental Finding of an Infarcted Epiploic Appendage Attached to the Sigmoid Colon.","authors":"Ifeanyi K Uche, Alec A Hirsch","doi":"10.31486/toj.24.0123","DOIUrl":"10.31486/toj.24.0123","url":null,"abstract":"<p><strong>Background: </strong>Epiploic appendagitis is a condition usually caused by infarction of the epiploic appendages, small outpouchings of adipose tissue found on the serosal surface of the colon. Epiploic appendagitis is a rare cause of acute lower abdominal pain, but the condition does not have any specific presenting clinical features and is often misdiagnosed as acute diverticulitis, appendicitis, or other gastrointestinal disorder.</p><p><strong>Case report: </strong>A 53-year-old female presented with abnormal uterine bleeding and pelvic pain and was seeking definitive surgical management. During the patient's total laparoscopic hysterectomy with bilateral salpingo-oophorectomy, an infarcted epiploic appendage attached to the sigmoid colon was found. An intraoperative general surgery consultation was obtained, and the infarcted epiploic appendage was laparoscopically excised.</p><p><strong>Conclusion: </strong>This case provides information about epiploic appendagitis, a rare cause of abdominal pain that can clinically mimic other acute or subacute disorders. The goal is to increase awareness of this rare intra-abdominal condition.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 2","pages":"144-147"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12175762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334159","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":"Late Pancreatic Metastasis From Papillary Thyroid Carcinoma Diagnosed by Endoscopic Ultrasound-Guided Tissue Acquisition.","authors":"César Vivian Lopes, Júlia Fernanda Semmelmann Pereira-Lima, Marianna Lins de Souza Salerno, Felipe Luzzatto","doi":"10.31486/toj.24.0115","DOIUrl":"10.31486/toj.24.0115","url":null,"abstract":"<p><strong>Background: </strong>Papillary thyroid carcinoma, the most common differentiated thyroid cancer, has an indolent clinical course and a good prognosis. Metastases to the gastrointestinal tract account for <1% of all distant metastases, and the pancreas is an extremely rare site for metastasis from thyroid cancer.</p><p><strong>Case report: </strong>We report the case of a patient who developed a pancreatic metastasis from a classic variant papillary thyroid carcinoma 11 years after total thyroidectomy, cervical lymphadenectomy, and radioactive iodine ablation. The patient experienced increased thyroglobulin levels, and abdominal computed tomography scan revealed a lesion in the uncinate process of the pancreas. Tissue samples obtained by endoscopic ultrasound-guided biopsy were positive for thyroglobulin and thyroid transcription factor 1. Because the patient was not a candidate for surgery, the metastatic lesion was not iodine-avid, and tyrosine kinase inhibitors could not be offered because of tumor-related symptoms, the patient was treated with stereotactic body radiotherapy only. The patient died almost 2 years after the diagnosis of metastatic papillary thyroid carcinoma to the pancreas (13 years after total thyroidectomy for the primary cancer).</p><p><strong>Conclusion: </strong>If pancreatic lesions are discovered during regular follow-up of patients who have previously been treated for papillary thyroid carcinoma, pancreatic metastasis must be considered, and imaging procedures other than whole-body iodine scintigraphy are required. Histopathology and iodine avidity will define the best therapeutic strategy. Radioactive iodine ablation should be considered for iodine-avid metastases, and surgery or tyrosine kinase inhibitors are promising options for non-iodine-avid lesions.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 2","pages":"123-132"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12175758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334161","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":"Hydrocodone-Induced Delirium in an Otherwise Healthy 20-Year-Old Male.","authors":"Andrew Ginsberg, Ravi Chauhan","doi":"10.31486/toj.24.0129","DOIUrl":"10.31486/toj.24.0129","url":null,"abstract":"<p><strong>Background: </strong>Hydrocodone is a commonly prescribed analgesic for acute, chronic, and postoperative pain because of its relatively weaker strength compared to other opioids and its generally effective symptomatic control. Like any medication, however, hydrocodone is associated with side effects. An infrequent side effect is delirium.</p><p><strong>Case report: </strong>A 20-year-old male with no psychiatric medical history presented to the emergency department (ED) with visual hallucinations, limited ability to communicate, and the inability to move his right lower extremity. In addition, the patient experienced multiple apneic incidents in the ED. His delirium was determined to be secondary to taking a single 5-325 mg hydrocodone tablet. Administration of naloxone reversed the patient's symptoms.</p><p><strong>Conclusion: </strong>Cases reporting the development of delirium in patients who have taken opioid-based medications have been published, but these cases involved combinations of medications, higher doses of opioids than our patient ingested, and presentations after multiple days of drug use. Our case is unique given the patient's acute onset of symptoms 4 hours after hydrocodone ingestion, as well as the low dose that triggered his symptoms.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 3","pages":"196-198"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139148","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":"\"Not Today\": Overcoming PrEP Hesitancy, Stigma, and Adherence Barriers With Lenacapavir.","authors":"Margaret Conrad, Meredith Clement","doi":"10.31486/toj.25.5057","DOIUrl":"10.31486/toj.25.5057","url":null,"abstract":"","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 3","pages":"159-161"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139136","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":"Hope and Optimism in 2026.","authors":"Ronald G Amedee","doi":"10.31486/toj.25.5058","DOIUrl":"https://doi.org/10.31486/toj.25.5058","url":null,"abstract":"","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 4","pages":"217"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12704466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769554","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":"3D-Printed Patient-Specific Models of the Aortic Arch for Advanced Visualization of Complex Neurointerventional Cases.","authors":"Smruti Mahapatra, Vishal N Bhimarasetty, Abdul Rahim, Colin N Curtis, Paul Gulotta, Korak Sarkar","doi":"10.31486/toj.24.0124","DOIUrl":"10.31486/toj.24.0124","url":null,"abstract":"<p><strong>Background: </strong>Cerebrovascular disease is a leading cause of death and disability worldwide, and endovascular therapies have become a mainstay of treatment for ischemic stroke. However, tortuous anatomy, particularly of the aortic arch, presents formidable treatment challenges by impeding access to intracranial circulation and thus affecting clinical outcomes.</p><p><strong>Methods: </strong>To better understand the challenges of tortuous anatomy, we fabricated 3D-printed models of the aortic arch and major branch vessels based on the imaging of 4 patients.</p><p><strong>Results: </strong>These patient-specific models were realistic representations of the intricate vascular pathways and provided enhanced visualization of the complex vascular structures. The measured diameters of the 3D-fabricated models closely matched the values reported in the literature, confirming the physical accuracy of the models. Creating an individual anatomic model required an average of 4 hours of digital processing and 13.71 hours of 3D printing, with a materials cost of approximately $17.31.</p><p><strong>Conclusion: </strong>3D-printed patient-specific models used for neurointerventional training and preprocedural planning are a valuable tool for managing complex cerebrovascular anatomy. The advanced visualization provided by these models may enhance preparedness and potentially improve ischemic stroke treatment outcomes.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 2","pages":"92-98"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12175768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334152","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":"Developing an Ownership Model for Experiential Learning of Social Determinants of Health for Medical Residents.","authors":"Abdullah Noor, Karam Rahat, Koshy George, Luis Capuchina, Brent Ruiz, Matthew Broussard, Yvens Laborde","doi":"10.31486/toj.24.0120","DOIUrl":"10.31486/toj.24.0120","url":null,"abstract":"<p><strong>Background: </strong>Historically, community engagement activities for Ochsner Health internal medicine residents were primarily task-based, involving opportunities to participate in a food drive or a community education project. As an alternative approach, we aimed to create a model that reflected residents' collective interests, could be meaningfully linked to a community issue, and fostered ownership and sustainability in community engagement.</p><p><strong>Methods: </strong>This project was conducted at Ochsner Medical Center in the internal medicine residency program during the 2022-2023 academic year with ambulatory clinic groups A, B, and C. In September 2022, we asked each group to respond to the following prompt: \"Please identify an issue that you feel most passionate about and would like to contribute to.\" Once we identified the issues of interest based on responses and group discussion, we partnered with the community-based organization Giving Hope Foundation New Orleans to plan and carry out projects reflecting resident interests.</p><p><strong>Results: </strong>Clinic Group A and Group B selected promoting health education as their project and provided one-on-one education based on a resident-prepared health brochure. Five residents participated in the education outreach project for a total of 40 educational encounters. For their project, clinic Group C organized a health fair to promote health education, disease screening, and access. The health fair stations included blood pressure and body mass index screening, nutritional counseling, Medicare/Medicaid application assistance, and cardiopulmonary resuscitation training. The total number of encounters during the event was 100.</p><p><strong>Conclusion: </strong>Our model showed the possibility of facilitating ownership in the community engagement process among medical residents. However, sustainability depends on replication and incorporation into the residency curriculum.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 2","pages":"107-113"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12175766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334155","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}