Ochsner Journal最新文献

{"title":"Rare Diagnosis of Localized Breast Amyloidosis in the Setting of Lymphoplasmacytic Lymphoma.","authors":"Matthew Koury, Karthik Shankar, Walter M Klein, Zonera Ali","doi":"10.31486/toj.25.0017","DOIUrl":"10.31486/toj.25.0017","url":null,"abstract":"<p><strong>Background: </strong>Localized amyloidosis of the breast is a rare diagnosis that is most often found incidentally during screening breast examinations or on imaging. This diagnosis can be associated with systemic amyloidosis or malignancy, making further investigation a necessity. Rarely, localized amyloidosis of the breast has been associated with lymphoplasmacytic lymphoma.</p><p><strong>Case report: </strong>A female in her early 70s presented with a mass noted on breast examination. After biopsy, she was diagnosed with localized amyloidosis of the breast. After bone marrow biopsy, the patient was diagnosed with lymphoplasmacytic lymphoma. No evidence of systemic amyloidosis was found. Because the patient is asymptomatic, she is not undergoing treatment, but she is monitored clinically every 6 months.</p><p><strong>Conclusion: </strong>Breast amyloidosis is a rare diagnosis that should be considered when patients present with a breast mass. This case emphasizes the importance of a full diagnostic workup when breast amyloidosis is diagnosed to rule out systemic amyloidosis or an associated malignancy.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 3","pages":"206-208"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138737","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 Conversion Disorder Diagnosis via Telestroke Network Consultation: A Retrospective Cohort Study.","authors":"Mugilan Poongkunran, Robin D Ulep, Himanshu Chokhawala, Alaa E Mohammed, Gabriel Vidal, Ifeanyi O Iwuchukwu, Harold McGrade, Daniel Chehebar, Richard M Zweifler","doi":"10.31486/toj.25.0043","DOIUrl":"10.31486/toj.25.0043","url":null,"abstract":"<p><strong>Background: </strong>Conversion disorder is a common mimic of ischemic stroke (IS) and transient ischemic attack (TIA). Data comparing the demographic and clinical features of patients with conversion disorder and IS/TIA are scarce, as are data evaluating the accuracy of conversion disorder diagnosis via telestroke consultation.</p><p><strong>Methods: </strong>We retrospectively analyzed consecutive patients evaluated through the Ochsner Health TeleStroke program from April 2015 through July 2016. Cases were classified into 2 categories: IS/TIA or conversion disorder. Patients with other stroke mimics and uncertain diagnoses were excluded. Both initial diagnosis and final diagnosis (following review of all records) were determined. The baseline characteristics of patients with conversion disorder were compared with the baseline characteristics of patients with IS/TIA. Initial diagnosis was compared with final diagnosis, and the diagnostic accuracy of telestroke consultations for conversion disorder was calculated.</p><p><strong>Results: </strong>We evaluated 885 patients with complete data. Of the 254 (28.7%) cases of stroke mimics, 50 cases (19.7%) were conversion disorder, representing 6% of all suspected strokes. We analyzed 616 patients with a final diagnosis of IS/TIA or conversion disorder. Compared to patients with IS/TIA, patients with conversion disorder were more likely to be female (<i>P</i>=0.0006) and younger (<i>P</i><0.0001); were less likely to have diabetes mellitus (<i>P</i>=0.0252), hypertension (<i>P</i>=0.0004), or atrial fibrillation (<i>P</i><0.0001); were less likely to receive tissue plasminogen activator (<i>P</i><0.0001); and had a shorter median consultation duration (<i>P</i>=0.0175). The sensitivity, specificity, positive predictive value, and negative predictive value of conversion disorder diagnosis were 0.820, 0.998, 0.976, and 0.989, respectively. The adjusted area under the curve (95% CI) was 0.92 (0.87, 0.97).</p><p><strong>Conclusion: </strong>We found a conversion disorder rate of 19.7% of stroke mimics in the Ochsner Health TeleStroke Network, with a positive predictive value of 0.976 of discriminating conversion disorder from IS/TIA. In our study, patients with conversion disorder were more likely to be female and younger and to have fewer vascular risk factors compared with IS/TIA patients.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 3","pages":"181-186"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139153","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":"Focusing on Long COVID and HIV Prevention.","authors":"Ronald G Amedee","doi":"10.31486/toj.25.5056","DOIUrl":"https://doi.org/10.31486/toj.25.5056","url":null,"abstract":"","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 3","pages":"151"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139171","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":"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":"Short-Term Risk of Complications Related to Obstructive Sleep Apnea After Sinonasal Surgery.","authors":"Nrusheel Kattar, Dylan A Levy, Edward D McCoul","doi":"10.31486/toj.25.0013","DOIUrl":"10.31486/toj.25.0013","url":null,"abstract":"<p><strong>Background: </strong>Surgical manipulation in the sinonasal cavity may transiently increase airflow resistance in patients with obstructive sleep apnea (OSA), predisposing them to inspiratory collapse of the oropharynx and/or hypopharynx. We hypothesized that patients with OSA undergoing sinonasal surgery would have higher rates of unplanned postoperative admission and respiratory complications than patients without OSA.</p><p><strong>Methods: </strong>In this retrospective cohort study, patients ≥18 years undergoing sinonasal surgery were compared to patients having oropharyngeal, laryngeal, otologic, rotator cuff, and inguinal hernia surgery between January 2013 and December 2020. Cohorts were defined by the presence or absence of a preoperative diagnosis of OSA. All outcome variables were measured based on unique patient encounters for surgery; the total number of surgeries for the overall patient population (n=17,373) was greater than the total number of patients (n=11,951).</p><p><strong>Results: </strong>Study groups consisted of 4,575 sinonasal, 2,301 oropharyngeal, 1,231 laryngeal, 1,353 otologic, 434 rotator cuff, and 2,057 inguinal hernia surgical patients. Among patients undergoing sinonasal surgery, patients with OSA had more unplanned admissions than patients without OSA (risk ratio [RR] 3.12; 95% CI 2.07-4.70). In all surgery groups, postoperative supplemental oxygen therapy was required more often in patients with OSA. Patients with OSA had the greatest incidence of oxygen desaturation after oropharyngeal surgery (RR 1.95; 95% CI 1.34-2.85). Incidence of 30-day readmission did not differ between patients with and without OSA in any surgical group.</p><p><strong>Conclusion: </strong>In this study, patients with OSA undergoing sinonasal surgery had a greater risk of unplanned hospital admission than patients without OSA, and patients with OSA undergoing oropharyngeal surgery had a greater risk of postoperative desaturation than patients without OSA. Patients with OSA undergoing any surgery had a greater incidence of supplemental oxygen requirement compared to patients without OSA.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 4","pages":"225-231"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12704475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769547","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":"Cobalt Toxicity Presenting as Bilateral Optic Neuropathy.","authors":"Fatima-Tun-Nissa Raza, Can Kocasarac","doi":"10.31486/toj.25.0025","DOIUrl":"10.31486/toj.25.0025","url":null,"abstract":"<p><strong>Background: </strong>Cobalt, a ferromagnetic metal with a wide range of uses, has been known to cause systemic toxicity in humans that results in thyroid dysfunction, cardiomyopathy, hematologic abnormalities, and neuropathy. Arthroprosthetic cobaltism is a term used to describe systemic cobalt toxicity originating from cobalt-containing prosthetic joints. Ocular toxicity from elevated serum levels of cobalt is a rare phenomenon.</p><p><strong>Case report: </strong>We describe a case of bilateral toxic optic neuropathy resulting from a damaged cobalt-containing shoulder prosthesis in a 76-year-old female. The patient exhibited classic clinical findings of toxic optic neuropathy, with painless insidious vision loss, dyschromatopsia, and bilateral central scotomas. Clinical testing showed a progressive reduction in the thickness of the peripapillary retinal nerve fiber layer and ganglion cell complex on optical coherence tomography. Magnetic resonance imaging of the brain and orbits without contrast were unrevealing. Extensive laboratory testing ruled out infectious, inflammatory, demyelinating, and nutritional causes of optic neuropathy. However, slightly elevated levels of serum cobalt were found. Considering the possibility of arthroprosthetic cobaltism, arthrocentesis from the patient's shoulder prosthesis was performed and revealed that the cobalt levels in her synovial fluid were 35 times higher than the normal limit. Replacement of the damaged prosthetic joint resulted in a decrease in the patient's serum cobalt levels and improvement of her vision.</p><p><strong>Conclusion: </strong>While arthroprosthetic cobaltism from hip joints has been reported, to our knowledge, ours is the first case to prove a damaged shoulder prosthesis was the etiology. The patient's relatively low levels of serum cobalt and the lack of systemic features are also intriguing.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 4","pages":"265-274"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12704472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769556","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":"Treatment of Spinal Epidural Abscess With Limited Decompression.","authors":"Alhasan Alani, Spencer Taylor, Charles Yu","doi":"10.31486/toj.24.0132","DOIUrl":"10.31486/toj.24.0132","url":null,"abstract":"<p><strong>Background: </strong>Spinal epidural abscess, the collection of purulent material in the epidural space, can cause spinal cord compression and neurologic deficits, including paralysis. Management of spinal epidural abscess includes antibiotic therapy and surgical decompression. Limited evidence is available to guide the extent of surgical decompression necessary for symptom and abscess resolution. Treatment depends on a variety of factors including the size, orientation (ventral or dorsal), and location of the spinal epidural abscess, along with patient-specific factors such as neurologic status.</p><p><strong>Case report: </strong>A 75-year-old male presented with increasing back pain and altered mental status 7 weeks after a motor vehicle crash. The patient had elevated inflammatory markers and was without focal neurologic deficit. Advanced imaging demonstrated a ventral abscess from C2 to T11, a dorsal abscess extending from T9 to T12, ventral and dorsal abscesses from L1 to the sacrum, and myelomalacia from T10 to T12. Limited decompression was performed in the form of T9 to L1 laminectomy for evacuation of the abscess, followed by irrigation with a pediatric Foley catheter. Imaging obtained after surgical intervention and intravenous antibiotic therapy demonstrated complete resolution of the abscesses. The patient's symptoms resolved, and he was doing well at postoperative follow-up.</p><p><strong>Conclusion: </strong>Our case suggests that extensive decompression may not be necessary for treatment of a large spinal epidural abscess, thus preserving the structural integrity of the spine and potentially minimizing morbidity.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 4","pages":"260-264"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12704467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769580","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":"Esophageal Cancer in a Patient With Poland Syndrome.","authors":"Glen D Myatt, Kyle Finney, Vani Vijayakumar","doi":"10.31486/toj.25.0036","DOIUrl":"10.31486/toj.25.0036","url":null,"abstract":"<p><strong>Background: </strong>Poland syndrome is an uncommon congenital condition marked by the absence of major chest muscles, typically on one side. Individuals with congenital abnormalities such as Poland syndrome are at increased risk for cancer.</p><p><strong>Case report: </strong>A 53-year-old male with undiagnosed Poland syndrome initially presented with dysphagia. The patient had a 20 pack-year smoking history but had quit smoking at the time of presentation. Endoscopic ultrasound showed a large obstructing mass in the distal third of the esophagus, and computed tomography (CT) scan showed an esophageal mass and congenital absence of the left pectoralis major and pectoralis minor muscles. Positron emission tomography-CT (PET-CT) showed a hypermetabolic mass with no evidence of distant metastases. The patient was treated with radiation, chemotherapy, and distal esophagectomy. PET-CT obtained nearly a year postoperatively showed no esophageal mass but some reactive hilar and mediastinal lymph nodes. The patient is monitored annually via CT imaging for recurrent or metastatic disease.</p><p><strong>Conclusion: </strong>While Poland syndrome has been associated with various malignancies, to our knowledge, the occurrence of esophageal adenocarcinoma in a patient with Poland syndrome has not been previously reported.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 4","pages":"279-282"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12704465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769590","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}