Ochsner Journal最新文献_第8页

Treatment of a Child With Submassive Pulmonary Embolism Associated With Hereditary Spherocytosis Using Ultrasound-Assisted Catheter-Directed Thrombolysis 超声辅助导管溶栓治疗遗传性球形红细胞增多症伴亚大块肺栓塞1例

IF 1.2

Ochsner Journal Pub Date : 2019-09-21 DOI: 10.31486/toj.18.0147

Marvin Kajy, N. Blank, M. Alraies, Jyothsna Akam-Venkata, S. Aggarwal, Amir Kaki, T. Mohamad, Mahir D Elder, T. Schreiber

{"title":"Treatment of a Child With Submassive Pulmonary Embolism Associated With Hereditary Spherocytosis Using Ultrasound-Assisted Catheter-Directed Thrombolysis","authors":"Marvin Kajy, N. Blank, M. Alraies, Jyothsna Akam-Venkata, S. Aggarwal, Amir Kaki, T. Mohamad, Mahir D Elder, T. Schreiber","doi":"10.31486/toj.18.0147","DOIUrl":"https://doi.org/10.31486/toj.18.0147","url":null,"abstract":"Background: The clinical presentation of hereditary spherocytosis varies from no symptoms to severe hemolytic anemia requiring splenectomy. Splenectomy imposes the risk of hypercoagulability and acute pulmonary embolism. Catheter-directed thrombolysis is an established treatment for submassive pulmonary embolism in adults. However, the literature regarding its use in children is limited. Case Report: We present the case of a 12-year-old male with hereditary spherocytosis who was diagnosed with pulmonary embolism and successfully treated with catheter-directed thrombolysis. The patient was initially treated with 10.5 mg of recombinant tissue plasminogen activator (r-tPA) delivered over 8 hours. However, because of minimal clinical and hemodynamic improvement, a second course of thrombolytic was administered for an additional 24 hours (25 mg of r-tPA), and the treatment resulted in marked clinical and hemodynamic improvement. Clot resolution was confirmed via angiography. The patient was discharged on enoxaparin and with regular follow-up. One year later, the patient was asymptomatic on enoxaparin. Conclusion: This case demonstrates that catheter-based treatment of submassive pulmonary embolism restores hemodynamic stability and thus is an alternative to surgery or systemic thrombolysis, even in the pediatric setting. While catheter-directed thrombolysis is a safe and effective alternative to systemic thrombolysis, further research is needed to establish appropriate dosing and indications in the adolescent population.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"19 1","pages":"264 - 270"},"PeriodicalIF":1.2,"publicationDate":"2019-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48931262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Respiratory Failure: A Rare Complication of Chronic Kidney Disease Mineral and Bone Disorder 呼吸衰竭:慢性肾脏疾病矿物质和骨骼疾病的罕见并发症

IF 1.2

Ochsner Journal Pub Date : 2019-09-21 DOI: 10.31486/toj.18.0177

J. Yaxley, Tahira Scott

引用次数: 0

The Relationship Between Grit and Resilience in Emergency Medical Service Personnel 急诊医务人员砂砾与复原力的关系

IF 1.2

Ochsner Journal Pub Date : 2019-09-21 DOI: 10.31486/toj.18.0144

M. Musso, D. Tatum, D. Hamer, Rebecca Hammarlund, Leslie Son, Pamela M McMahon

{"title":"The Relationship Between Grit and Resilience in Emergency Medical Service Personnel","authors":"M. Musso, D. Tatum, D. Hamer, Rebecca Hammarlund, Leslie Son, Pamela M McMahon","doi":"10.31486/toj.18.0144","DOIUrl":"https://doi.org/10.31486/toj.18.0144","url":null,"abstract":"Background: Emergency medical service (EMS) personnel are regularly exposed to traumatic incidents and experience higher rates of symptoms of posttraumatic stress disorder (PTSD) than the general population. Grit is a construct proposed to be associated with achievement, but it has demonstrated preliminary evidence of an association with resilience. The current study examined the relationship between grit and resilience among EMS workers. Methods: A link to an online survey was sent to East Baton Rouge Parish Emergency Medical Services personnel via an email distribution list. Demographic variables and the following self-report measures were assessed: the PTSD Checklist for DSM-5 (PCL-5), the Grit Scale, the Brief COPE scale, and the Professional Exposure to Traumatic Experiences scale (modified from the Life Events Checklist). Results: PCL-5 scores were significantly and negatively correlated with the Grit Scale score (r=–0.57, P<0.01). Hierarchical regression revealed that grit and coping mechanisms were predictive of self-reported PTSD symptoms (adjusted R2=68.7%, F(15,67)=9.81, P<0.001). Examination of the coefficients revealed that lower total Grit Scale scores and higher scores on the following Brief COPE scales were significant predictors of PCL-5 scores: denial, substance abuse, disengagement, and self-blame. Conclusion: This study examined the relationship between grit and resilience, measured by self-reported PTSD symptoms. Our results demonstrate a significant relationship between grit and resilience. Grit is related to, but distinct from, other constructs that predict resilience, such as coping mechanisms. Large prospective studies could have significant implications for hiring practices and building grit in existing personnel to bolster resilience.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"19 1","pages":"199 - 203"},"PeriodicalIF":1.2,"publicationDate":"2019-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43917973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 24

Remembering Dr. Ed Frohlich 记住埃德·弗罗利希博士

IF 1.2

Ochsner Journal Pub Date : 2019-09-01 DOI: 10.31486/toj.19.5009

R. Amedee

引用次数: 0

Fever and Leg Pain: Consider ALL the Diagnoses 发烧和腿痛:考虑所有的诊断

IF 1.2

Ochsner Journal Pub Date : 2019-06-20 DOI: 10.31486/toj.18.0122

Lesley N. Desmond, Matthew Fletcher, R. Warrier

引用次数: 1

Reverse Takotsubo Cardiomyopathy in a Patient With Prior Apical Takotsubo Cardiomyopathy: Challenging the Beta Receptor Gradient Theory 既往根尖Takotsubo心肌病患者的逆行Takotsubo心肌病:挑战β受体梯度理论

IF 1.2

Ochsner Journal Pub Date : 2019-03-20 DOI: 10.31486/toj.18.0027

A. Rashed, Mohamed Shokr, A. Subahi, Fayez Siddiqui, A. Alkatib, L. Afonso

{"title":"Reverse Takotsubo Cardiomyopathy in a Patient With Prior Apical Takotsubo Cardiomyopathy: Challenging the Beta Receptor Gradient Theory","authors":"A. Rashed, Mohamed Shokr, A. Subahi, Fayez Siddiqui, A. Alkatib, L. Afonso","doi":"10.31486/toj.18.0027","DOIUrl":"https://doi.org/10.31486/toj.18.0027","url":null,"abstract":"Background: Classic Takotsubo cardiomyopathy has been described as transient apical dyskinesia following major stress that is believed to be related to catecholamine surges. Atypical variants have been described, including the rarer reverse Takotsubo cardiomyopathy. Discrepant gradients of the beta-2 adrenoceptors are thought to determine the different anatomic variants. Case Report: A 43-year-old female presented with chest pain and a mild troponin elevation. Echocardiography and coronary angiography were consistent with stress-induced apical Takotsubo cardiomyopathy. Eight months later, the patient was admitted with a similar presentation; however, workup revealed stress-induced reverse Takotsubo cardiomyopathy. Conclusion: Recurrent Takotsubo cardiomyopathy involving different anatomic regions of the left ventricle is a rare phenomenon yet appears to be similar to typical Takotsubo cardiomyopathy in presentation and hospital course. Chronic therapy with beta blockers and angiotensin-converting enzyme inhibitors did not prevent a recurrence in this patient, suggesting that optimum treatment needs to be determined. Takotsubo cardiomyopathy affecting different myocardial segments may recur in the same patient, implying that the adrenoceptor distribution theory needs further refinement.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"19 1","pages":"256 - 259"},"PeriodicalIF":1.2,"publicationDate":"2019-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45932908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Impella-Induced Incessant Ventricular Tachycardia 叶轮诱发的不间断室性心动过速

IF 1.2

Ochsner Journal Pub Date : 2019-03-20 DOI: 10.31486/toj.18.0018

Amir Kaki, A. Subahi, Mohamed Shokr, Walid Ibrahim, A. Yassin, R. Hasan, M. Alraies, T. Schreiber

引用次数: 4

Primary Squamous Cell Carcinoma of the Thyroid 原发性甲状腺鳞状细胞癌

IF 1.2

Ochsner Journal Pub Date : 2019-03-20 DOI: 10.31486/toj.18.0002

Blake S. Raggio, J. Barr, Zahraa Ghandour, P. Friedlander

{"title":"Primary Squamous Cell Carcinoma of the Thyroid","authors":"Blake S. Raggio, J. Barr, Zahraa Ghandour, P. Friedlander","doi":"10.31486/toj.18.0002","DOIUrl":"https://doi.org/10.31486/toj.18.0002","url":null,"abstract":"Background: Primary squamous cell carcinoma of the thyroid (PSCCT) is a rare malignancy of the head and neck, with fewer than 60 cases reported in the literature. We report a case of PSCCT and provide a brief review of the literature. Case Report: A 66-year-old female with a history of a hemithyroidectomy for a benign thyroid lesion presented with 3 months of progressively worsening compressive symptoms and shortness of breath. Physical examination revealed right-sided thyromegaly and right-sided true vocal fold immobility. Preoperative imaging with ultrasound and computed tomography scan confirmed an enlarged right thyroid, as well as right anterior cervical lymphadenopathy, subglottic stenosis, and bilateral pulmonary nodules. Fine needle aspiration of the thyroid was suggestive of carcinoma. Intraoperative findings of gross tracheal invasion during a planned completion thyroidectomy prompted limited resection and impromptu tracheotomy. Histopathologic and immunohistochemical evaluation confirmed a squamous cell carcinoma of thyroid origin. Further oncologic workup with core lung biopsy and positron emission tomography scan demonstrated metastasis to the lung and cervical spine. Palliative chemotherapy was begun, but the patient died 1 week into therapy. Conclusion: PSCCT is a rare but aggressive malignancy of the head and neck. Histopathologic and immunohistochemical evaluations are essential for diagnosis. While locoregional surgery and radiation therapy may improve the length of survival, the prognosis of patients with PSCCT is poor. Physicians should be mindful of this unique but deadly disease process, as early diagnosis and rapid treatment initiation are essential to optimize treatment outcomes.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"19 1","pages":"290 - 292"},"PeriodicalIF":1.2,"publicationDate":"2019-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49006341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 5

Prevalence of Infertility Among Patients With Isthmocele and Fertility Outcome After Isthmocele Surgical Treatment: A Retrospective Study 峡部膨出患者不孕症患病率及峡部膨出手术治疗后生育结果:一项回顾性研究

IF 1.2

Ochsner Journal Pub Date : 2019-03-20 DOI: 10.31486/toj.18.0048

S. Calzolari, G. Sisti, Dora Pavone, E. Ciocia, Natalia Bianchini, M. Cozzolino

{"title":"Prevalence of Infertility Among Patients With Isthmocele and Fertility Outcome After Isthmocele Surgical Treatment: A Retrospective Study","authors":"S. Calzolari, G. Sisti, Dora Pavone, E. Ciocia, Natalia Bianchini, M. Cozzolino","doi":"10.31486/toj.18.0048","DOIUrl":"https://doi.org/10.31486/toj.18.0048","url":null,"abstract":"Background: An isthmocele is a diverticulum on the anterior wall of the uterine isthmus at the site of a cesarean delivery scar. We evaluated the prevalence of infertility among patients with isthmocele, the resolution of symptoms, and infertility outcomes after hysteroscopic isthmoplasty. Methods: We conducted a retrospective study of 35 consecutive patients with symptomatic isthmocele between 2010 and 2015 at Hospital Piero Palagi in Florence, Italy. Patients with symptomatic isthmocele had postmenstrual abnormal uterine bleeding, sovrapubic pain, and infertility. Results: The study population was divided into Group A – Fertile Patients (n=19) and Group B – Infertile Patients (n=16) according to the prevalence of infertility after the diagnosis of isthmocele. Group B was subdivided into Group B1 (became pregnant, n=9) and B2 (did not become pregnant, n=7) according to infertility resolution after isthmocele treatment. We found statistically significant differences between Groups A and B regarding the number of cesarean sections (P=0.0205), the grade of isthmocele (P=0.0421), and body mass index (P=0.0001). In the subgroup analysis, we found statistically significant differences between Groups B1 and B2 for age (P=0.0151), grade of isthmocele (P=0.0361), and cervical dilatation (P=0.0293). Conclusion: We identified a subgroup of patients at higher risk of being infertile after the diagnosis of isthmocele and a subgroup of patients who could benefit the most in terms of fertility after minimally invasive hysteroscopic surgery.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"19 1","pages":"204 - 209"},"PeriodicalIF":1.2,"publicationDate":"2019-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47878056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 19

IF 1.3

Ochsner Journal Pub Date : 2016-01-01

Richard N Re

引用次数: 0