Ochsner Journal最新文献

{"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":"When We Don't Have All the Answers: Long COVID and the Need for Humility in Medicine.","authors":"Liza Di Leo Thomas","doi":"10.31486/toj.25.0074","DOIUrl":"10.31486/toj.25.0074","url":null,"abstract":"","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 3","pages":"152-158"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138751","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":"A Rare Cause of Internal Jugular Vein Thrombosis: Deep Tissue Massage.","authors":"Matthew Sanborn, Matthew Koury, Alisha Maity, Zonera Ali","doi":"10.31486/toj.25.0002","DOIUrl":"10.31486/toj.25.0002","url":null,"abstract":"<p><strong>Background: </strong>Upper extremity deep vein thrombosis accounts for a small percentage of all deep vein thrombosis cases, and internal jugular vein thrombosis is a rare subset within that category. Typically, internal jugular vein thrombosis is found in patients with predisposing risk factors such as infections, local trauma secondary to venous catheterization, intravenous drug use, and malignancy.</p><p><strong>Case report: </strong>We describe the case of a patient with no typical risk factors for thrombus formation who developed internal jugular vein thrombosis following a deep tissue massage with a focus on the neck area. The patient developed right arm pain shortly after the massage, prompting her to present to the emergency department. Ultrasound revealed a nonocclusive thrombus in the right internal jugular vein. The patient was started on rivaroxaban, and her symptoms resolved.</p><p><strong>Conclusion: </strong>Deep tissue massage is not a well-established cause of internal jugular vein thrombosis. This case emphasizes the importance of obtaining a thorough patient history to assess for uncommon traumatic causes of internal jugular vein thrombosis.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 3","pages":"199-200"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139128","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":"Examination of Aeroallergen Sensitization Patterns in Southeastern Louisiana.","authors":"Margaret Huntwork, Andrew McKernan, Estelle Levetin, Derek Werthmann, Felicia Rabito, William Edward Davis, John C Carlson","doi":"10.31486/toj.25.0049","DOIUrl":"10.31486/toj.25.0049","url":null,"abstract":"<p><strong>Background: </strong>Episodic assessment of sensitization patterns within a geographic area helps to monitor the role that specific aeroallergens may play in triggering allergic disease. An assessment of sensitization patterns in New Orleans, Louisiana, after Hurricane Katrina identified patterns of sensitization that were different from pre-Katrina studies. Whether the patterns had changed since the post-Katrina assessment was unknown. We therefore sought to evaluate the current sensitization patterns in the greater New Orleans area.</p><p><strong>Methods: </strong>Seven hundred seventy-six unique patients with at least 1 sensitization identified on a standard 58-allergen skin test panel that includes 24 fungal extracts were evaluated for prevalence, unique sensitization within an allergen group, and patterns of sensitization across patients.</p><p><strong>Results: </strong>Expected results included a high prevalence of sensitization to house dust mites, grass pollen, and spores of <i>Alternaria</i> and <i>Aspergillus</i>. Surprising results included a high prevalence of <i>Acremonium</i> sensitization and very low sensitization to other fungi. Sensitization patterns for patients did not cluster within phylogenetic patterns for most of the pollen and fungal extracts.</p><p><strong>Conclusion: </strong>Ongoing refinement of extracts used in skin prick testing will help to monitor changing patterns of sensitization. This monitoring is especially important as climate change, changes in plant cultivation, and urbanization alter ecosystems.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 4","pages":"232-240"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12704471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769596","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":"Mixed Neuroendocrine Non-Neuroendocrine Neoplasm of the Ampulla of Vater: Report of a Rare Location.","authors":"Ankit Rai, Vaibhav Kumar Varshney, Peeyush Varshney, Lokesh Agarwal, Meenakshi Rao, Ayushi Agarwal","doi":"10.31486/toj.25.0030","DOIUrl":"10.31486/toj.25.0030","url":null,"abstract":"<p><strong>Background: </strong>Mixed neuroendocrine non-neuroendocrine neoplasms (MiNENs) are rare tumors of the gastrointestinal tract with neuroendocrine and non-neuroendocrine components. Ampullary MiNENs are extremely rare, with few cases reported to date.</p><p><strong>Case report: </strong>A 41-year-old male was diagnosed incidentally with a dilated common bile duct and intrahepatic biliary radicles while being evaluated for right ureteric calculi. Contrast-enhanced computed tomography scan of the abdomen showed a mass in the ampullary region with a positive double duct sign. Side-viewing endoscopy indicated an ampullary growth, and biopsy confirmed adenocarcinoma. The patient underwent total robotic pancreatoduodenectomy with an uneventful postoperative course. His final histopathologic examination revealed a tumor with 2 components, each of which accounted for at least 30% of the tumor: a neuroendocrine tumor and an adenocarcinoma with signet ring cells. The patient received adjuvant chemotherapy and at 1-year follow-up showed no evidence of recurrence.</p><p><strong>Conclusion: </strong>Ampullary MiNENs are rare composite gastroenteropancreatic tumors characterized by histologic heterogeneity; they can be effectively treated with robotic pancreatoduodenectomy. The more aggressive component of the MiNEN should be considered when determining an adjuvant therapy.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 3","pages":"209-213"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138570","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":"Concurrent Wernicke Encephalopathy and Posterior Reversible Encephalopathy Syndrome Following Gastric Sleeve Surgery.","authors":"Annika L Chang, Doowon Huh, Kirsten Winter, Can Kocasarac","doi":"10.31486/toj.25.0009","DOIUrl":"10.31486/toj.25.0009","url":null,"abstract":"<p><strong>Background: </strong>Wernicke encephalopathy-an uncommon and severe condition caused by thiamine deficiency-is most often associated with alcohol use but can occur in other settings of nutrient deficiency. Posterior reversible encephalopathy syndrome is an acute neurologic condition characterized by reversible subcortical vasogenic edema that is often associated with hypertension. We present the case of a patient with concurrent Wernicke encephalopathy and posterior reversible encephalopathy syndrome.</p><p><strong>Case report: </strong>A 26-year-old female with a surgical history of laparoscopic sleeve gastrectomy performed 4 months prior presented with ataxia, confusion, bilateral blurred vision, and headache. Initial examination showed reduced visual acuity (20/200 in both eyes), ophthalmoplegia, high-frequency bilateral upbeat and mild horizontal nystagmus, bilateral optic disc swelling with disc hemorrhage, and intraretinal hemorrhages. She was found to have thiamine deficiency resulting in Wernicke encephalopathy, as well as bilateral frontal, parietal, and occipital T2 hyperintensities on magnetic resonance imaging consistent with posterior reversible encephalopathy syndrome. After treatment with pulse dose thiamine repletion and antihypertensives, the patient improved clinically, with increased visual acuity (20/30 in both eyes) and complete resolution of bilateral optic disc edema and intraretinal hemorrhages. However, upbeat nystagmus remained.</p><p><strong>Conclusion: </strong>Neuro-ophthalmic signs may be early indicators of Wernicke encephalopathy and posterior reversible encephalopathy syndrome, underscoring the vital role of eye care providers in recognizing these conditions, particularly in patients who have undergone bariatric surgery. Without a high index of suspicion, Wernicke encephalopathy may be overlooked in these patients.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 3","pages":"201-205"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139141","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}