Ochsner Journal最新文献

{"title":"The Ochsner Way.","authors":"Ronald G Amedee","doi":"10.31486/toj.22.5026","DOIUrl":"https://doi.org/10.31486/toj.22.5026","url":null,"abstract":"","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"22 2","pages":"105"},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9196965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40399664","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":"Shoulder Injury Related to Vaccine Administration.","authors":"Carson Flores,&nbsp;Walter S Choate,&nbsp;Richard Tupler","doi":"10.31486/toj.21.0114","DOIUrl":"https://doi.org/10.31486/toj.21.0114","url":null,"abstract":"<p><p><b>Background:</b> Shoulder injury related to vaccine administration (SIRVA) is a recognized complication and possible source of morbidity associated with incorrectly administered intramuscular deltoid vaccinations. As this site is commonly used for intramuscular injection, both clinicians and vaccine administrators should be familiar with SIRVA to minimize risk and monitor for its clinical presentation. <b>Case Report:</b> A 49-year-old male presented with shoulder pain that began 1 day after intramuscular administration of an influenza vaccine and point tenderness near the site of injection. Magnetic resonance imaging of the shoulder demonstrated focal osseous edema in the humeral head related to suboptimal needle placement. <b>Conclusion:</b> Based on the combination of history, physical examination findings, and imaging findings, the diagnosis of SIRVA was made with confidence in this clinical scenario.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"22 3","pages":"261-264"},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9477133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40391992","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":"Low Mortality of Orthopedic Trauma Patients With Asymptomatic COVID-19: A Level I Trauma Center Pandemic Experience.","authors":"Patrick A Massey,&nbsp;Lincoln K Andre,&nbsp;Steven M Kautz,&nbsp;Chase Lobrano,&nbsp;R Shane Barton,&nbsp;Kevin J Perry,&nbsp;Brad J Chauvin","doi":"10.31486/toj.21.0117","DOIUrl":"https://doi.org/10.31486/toj.21.0117","url":null,"abstract":"<p><p><b>Background:</b> Early (2020) reports on mortality in patients with coronavirus disease 2019 (COVID-19) who underwent orthopedic surgery ranged from 20.5% to 56%, but these studies included elderly patients with multiple comorbidities. The mortality rate for younger and asymptomatic COVID-19-positive patients undergoing orthopedic surgery after high-energy trauma is underreported. The purpose of this study was to compare the 30-day mortality of asymptomatic COVID-19-positive patients and COVID-19-negative patients surgically treated for orthopedic trauma at a Level I trauma center during the coronavirus pandemic. A secondary objective was to compare the patients' postoperative hospital course and length of stay. <b>Methods:</b> This study is a single-center retrospective review of all patients who underwent an orthopedic surgical procedure at a Level I trauma center during a 3-month period early in the COVID-19 pandemic. All patients received a preoperative nasopharyngeal swab to determine COVID-19 infection status. Preoperative demographic variables, perioperative and postoperative mortality within 30 days, length of stay, and intensive care unit days were compared between COVID-19-positive and COVID-19-negative patients. <b>Results:</b> Of the 471 total patients, 13 were COVID-19-positive and 458 were COVID-19-negative prior to surgery. The average age of all patients was 40.5 ± 19.8 years. The mortality rate in the COVID-19-positive group was 0% vs 0.7% in the COVID-19-negative group, with no significant difference between groups (<i>P</i>=0.77). The COVID-19-positive group vs the COVID-19-negative group had no significant difference in hospital length of stay (7.4 days vs 4.4 days, respectively, <i>P</i>=0.12). <b>Conclusion:</b> Asymptomatic COVID-19-positive orthopedic trauma patients treated with surgery at a Level I trauma center in a 3-month period during the COVID-19 pandemic had a 0% mortality rate, and we found no differences between COVID-19-positive and COVID-19-negative patients with respect to mortality and hospital length of stay.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"22 3","pages":"204-210"},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9477134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40393497","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":"Optimizing Pain Control and Function in Patients With Adhesive Capsulitis by Choosing the Best Injection Site.","authors":"Sherilyn DeStefano,&nbsp;Lauren Oberle,&nbsp;Brian Donohoe,&nbsp;Yuka Kobayashi,&nbsp;Andrew W Gottschalk","doi":"10.31486/toj.22.0014","DOIUrl":"https://doi.org/10.31486/toj.22.0014","url":null,"abstract":"Two patients present to the sports medicine clinic with shoulder pain and limited range of motion. A 51-year-old healthy female rower presents 5 months after developing left shoulder pain. She had no specific inciting injury, although she increased overhead workouts with dumbbells prior to the onset of pain. She describes soreness that started in the left biceps and then shifted to the lateral shoulder. The other patient, a 61-year-old male golfer with a history of hyperlipidemia and hypertension, developed right shoulder pain also after increasing overhead exercises with weights 3 months prior to presentation. His pain is most significant with sleeping on the right side, abducting the right arm, and lifting heavy objects. Both patients have limited shoulder flexion, abduction, and internal rotation despite 8 weeks of physical therapy.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"22 2","pages":"107-109"},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9196967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40401476","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":"Tubulocystic Renal Cell Carcinoma: An Underrecognized Clinicopathologic Entity.","authors":"Sudeep Khera,&nbsp;Poonam Elhence,&nbsp;Taruna Yadav,&nbsp;Himanshu Pandey","doi":"10.31486/toj.21.0065","DOIUrl":"https://doi.org/10.31486/toj.21.0065","url":null,"abstract":"<p><p><b>Background:</b> Tubulocystic renal cell carcinoma is a lesser-known neoplastic entity compared to other common histologic variants of renal cell carcinoma. The World Health Organization identified tubulocystic renal cell carcinoma as a newly recognized renal tumor in 2016. We report a case of tubulocystic renal cell carcinoma in a young adult. <b>Case Report:</b> A 21-year-old male presented with the chief complaint of a lump on the right side of his abdomen since childhood. Magnetic resonance imaging revealed an enlarged right kidney with multiple large multiloculated cysts with hemorrhagic contents and enhancing peripheral nodular solid components with enhancing septa in some of the cysts, suggesting the possibility of multifocal intracystic papillary renal cell carcinoma. Imaging showed a Bosniak type IV cystic lesion in the right kidney. Right radical nephrectomy was performed. Grossly, the kidney was almost replaced by variable-sized cystic lesions with thick septations filled with serous fluid to gelatinous material. The tubules and cysts were lined by a single layer of flat, hobnail, and cuboidal cells with high-grade nuclear features. No ovarian-type stroma was identified. In places, a papillary component was also identified. Tubulocystic renal cell carcinoma was diagnosed based on microscopy and immunohistochemistry results. <b>Conclusion:</b> Tubulocystic renal cell carcinoma is a rare entity that was previously called Bellini duct carcinoma and low-grade collecting duct carcinoma. Because of the limited number of cases reported, tubulocystic renal cell carcinoma needs to be followed to determine the biologic behavior and metastatic potential of these tumors so that management guidelines for such cases can be developed.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"22 2","pages":"182-187"},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9196962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40399666","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 Antepartum Factors for Predicting the Risk of Emergency Cesarean Delivery in Pregnancies Complicated With Placenta Previa.","authors":"Süleyman Cemil Oğlak,&nbsp;Fatma Ölmez,&nbsp;Şeyhmus Tunç","doi":"10.31486/toj.21.0138","DOIUrl":"https://doi.org/10.31486/toj.21.0138","url":null,"abstract":"<p><p><b>Background:</b> The optimal delivery timing for patients with placenta previa remains controversial in the literature. To reduce spontaneous vaginal bleeding rates, which occur increasingly with advancing gestational weeks, elective cesarean delivery is advocated between 36^0/7 and 37^6/7 weeks of gestation, but this clinical approach does not take into consideration numerous patient variables. Few papers identify the risk factors for emergency cesarean delivery in patients with placenta previa. An enhanced understanding of these variables could help with determining patients at high risk for emergency cesarean delivery and individualizing delivery date scheduling. This study sought to identify predictor variables associated with emergency cesarean delivery in pregnant patients with placenta previa in a tertiary referral hospital. We also investigated differences in maternal and perinatal outcomes between patients with placenta previa who underwent emergency vs planned cesarean delivery. <b>Methods:</b> This retrospective cohort study included 208 singleton pregnancy patients who had a confirmed diagnosis of placenta previa at the time of delivery and who underwent cesarean delivery in our hospital beyond 24 weeks of gestation. To define risk factors of the outcome variable (emergency vs planned cesarean delivery), univariate and multiple logistic regression analysis and adjusted odds ratios with their confidence intervals were calculated. <b>Results:</b> Ninety-seven patients (46.6%) required emergency cesarean delivery, and 111 patients (53.4%) underwent planned cesarean delivery. Antepartum bleeding episode (37.1% and 20.7%, <i>P</i>=0.013) and first antepartum bleeding episode ≤28 weeks of gestation (36.1% and 14.4%, <i>P</i><0.001) were significantly higher in the emergency group than the planned group. Antepartum bleeding episode (odds ratio [OR]=1.968, 95% CI 1.001-4.200, <i>P</i>=0.042), first antepartum bleeding episode ≤28 weeks of gestation (OR=2.750, 95% CI 1.315-5.748, <i>P</i>=0.007), and preoperative hemoglobin level (OR=0.713, 95% CI 0.595-0.854, <i>P</i><0.001) were the independent predictors significantly associated with emergency cesarean delivery. <b>Conclusion:</b> Three factors-antepartum bleeding episode during pregnancy, first antepartum bleeding episode ≤28 weeks of gestation, and lower preoperative hemoglobin level-might be useful in predicting emergency cesarean delivery in pregnancies complicated with placenta previa.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"22 2","pages":"146-153"},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9196971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40399669","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":"Unusual Cause of Respiratory Distress in a Term Neonate.","authors":"Aymen Mirza,&nbsp;Maribel Martinez,&nbsp;Sasikumar Kilaikode","doi":"10.31486/toj.21.0101","DOIUrl":"https://doi.org/10.31486/toj.21.0101","url":null,"abstract":"<p><p><b>Background:</b> Respiratory distress is a clinical finding often seen in neonates. Common causes of respiratory distress in this population include respiratory distress syndrome, transient tachypnea of the newborn, infection, aspiration, and cardiac etiologies. We present the case of a neonate who presented with respiratory distress with no identifiable cause on initial workup. The patient was eventually found to have a variant of a genetic mutation that predisposed the infant to this presentation. <b>Case Report:</b> A term male infant born via spontaneous vaginal delivery was admitted to the pediatric service at 3 weeks of age because of tachypnea. Chest x-ray showed perihilar infiltrates. Septic screen, thyroid function test, sweat test, echocardiogram, intracranial ultrasound, and modified barium swallow were normal. Computed tomography scan of the chest showed ground glass opacities in the upper and lower lobes. Airway evaluation showed no evidence of obstruction or anatomic abnormalities. Bronchoscopy showed no masses or tracheomalacia. Bronchoalveolar lavage was negative for infection. The infant was treated with intravenous antibiotics, steroids, and furosemide but continued to be tachypneic and required supplemental oxygen. Genetic studies were obtained to assess for surfactant deficiencies, and the patient was transferred to another center for a higher level of care. Genetic evaluation was positive for NKX2.1 variance mutation C.190C. The patient's symptoms improved, and he was weaned to room air by 3 months of age. <b>Conclusion:</b> When evaluating a child with unexplained pulmonary disease, clinicians should have a high index of suspicion for interstitial lung disease including surfactant protein mutations.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"22 2","pages":"196-198"},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9196966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40401473","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":"Multiple Biventricular Thrombi Associated With Methamphetamine-Associated Cardiomyopathy.","authors":"Syeda H Zaidi,&nbsp;Umair A Khan,&nbsp;Shazib Sagheer,&nbsp;Abubaker Sheikh,&nbsp;Mark E Garcia","doi":"10.31486/toj.21.0097","DOIUrl":"https://doi.org/10.31486/toj.21.0097","url":null,"abstract":"<p><p><b>Background:</b> As methamphetamine use has increased around the world, cardiovascular mortality has also increased. Methamphetamine-associated cardiomyopathy (MACM) is one of the serious cardiovascular complications of methamphetamine use. Limited evidence has been published regarding the increased risk of thrombogenicity in the setting of methamphetamine use. We propose that increased thrombogenicity presents a risk factor for intracardiac thrombi. <b>Case Report:</b> A 48-year-old female with a history of MACM was admitted to the hospital with acute decompensated heart failure. Transthoracic echocardiogram revealed multiple biventricular masses requiring further workup, but the patient left against medical advice on warfarin. The patient presented again 2.5 months later with decompensated heart failure. During the second admission, cardiac magnetic resonance imaging (CMR) characterized the masses in the left ventricle as thrombi, and computed tomography of the chest with contrast showed pulmonary embolism. Although the right ventricle mass was not seen on CMR, we believe the mass was a thrombus that either had migrated into the lungs or had resolved with warfarin use. <b>Conclusion:</b> MACM and biventricular thrombi are associated, but the association is rare and not well studied. Although the exact mechanism of this association is unknown, the increased circulating catecholamines are believed to be a contributing factor for increased thrombogenicity in the setting of active methamphetamine use. We suggest keeping a low threshold for surveillance echocardiography to screen for intracardiac thrombi in MACM patients with active methamphetamine use when they present with even mild symptoms of decompensated heart failure.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"22 2","pages":"192-195"},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9196964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40401472","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 Medicaid Expansion on Visit Composition in a Louisiana Health Care System.","authors":"Diana Hamer,&nbsp;Deekshith Mandala,&nbsp;Glenn Jones,&nbsp;Gerald M Knapp,&nbsp;Tonya Jagneaux","doi":"10.31486/toj.21.0106","DOIUrl":"https://doi.org/10.31486/toj.21.0106","url":null,"abstract":"<p><p><b>Background:</b> In 2016, Louisiana expanded Medicaid to low-income adults under the Patient Protection and Affordable Care Act. By 2020, the uninsured rate of adults in Louisiana had dropped from 22.7% to 8.9%; however, few reports describe the effect Medicaid expansion has had on access and utilization of health care services in Louisiana. <b>Methods:</b> For this study, we collected all-payer emergency department and clinic visits from one health care system in Louisiana from 2015 to 2019. We used a time series analysis to compare trends before and after Medicaid expansion in health insurance coverage and emergency department visit type. <b>Results:</b> The changes in payer mix in the urgent care and primary care clinics and emergency departments after Medicaid expansion was driven by the uptake of Medicaid coverage in the previously uninsured. Medicaid expansion had a limited impact on the number of urgent care and emergent and nonemergent emergency department visits, but an increase in primary care visits was observed. <b>Conclusion:</b> Medicaid expansion reduced uncompensated care in our patient population and expanded the access to primary care clinics. Ongoing research is needed to understand the effect of nonfinancial barriers to care on access to and utilization of services in Louisiana.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"22 2","pages":"154-162"},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9196955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40401475","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":"Uncommon Cause of Internal Mammary Artery Pseudoaneurysm.","authors":"Rohan M Prasad,&nbsp;Jason Z Liu,&nbsp;Christopher Garces,&nbsp;Ayushma Duwadi,&nbsp;James Choi,&nbsp;Farah Anwar,&nbsp;Adesuwa Olomu","doi":"10.31486/toj.21.0090","DOIUrl":"https://doi.org/10.31486/toj.21.0090","url":null,"abstract":"<p><p><b>Background:</b> Internal mammary artery pseudoaneurysms most commonly develop from thoracic penetrating trauma or procedures. However, other important etiologies should not be overlooked. <b>Case Report:</b> A 27-year-old female presented with antiphospholipid antibody syndrome, thrombotic microangiopathy, end-stage renal disease on hemodialysis, and epilepsy. On admission, the patient had pulseless electrical activity and hypertensive emergency. After the patient was successfully resuscitated, she developed status epilepticus. Laboratory workup on admission revealed a subtherapeutic international normalized ratio, elevated C-reactive protein and sedimentation rate, and acute anemia. Imaging showed a right-sided subdural hematoma with a midline shift and likely internal mammary artery pseudoaneurysm. Angiography demonstrated aneurysmal dilation, segmental narrowing, and a string of beads appearance. Because of our patient's demographics, string of beads appearance on diagnostic angiography, history of renal disease, and negative hepatitis serology, fibromuscular dysplasia was considered the etiology of the internal mammary artery pseudoaneurysm. The family opted for 2 burr holes and a subdural drain but declined further diagnostic and therapeutic interventions because of anoxic brain injury and poor prognosis. <b>Conclusion:</b> In this patient, the etiology of the internal mammary artery pseudoaneurysm was attributed to fibromuscular dysplasia. Although this patient's family chose comfort measures, treatment methods are available for internal mammary artery pseudoaneurysms.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"22 3","pages":"244-248"},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9477130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40390449","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}