Ochsner Journal最新文献

{"title":"The Summer of Our Discontent: Facing the Challenge of Increasing Heat-Related Illness.","authors":"Kevin Conrad","doi":"10.31486/toj.23.5039","DOIUrl":"https://doi.org/10.31486/toj.23.5039","url":null,"abstract":"","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"23 4","pages":"268-270"},"PeriodicalIF":1.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10741821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139032756","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":"Preserving Nasal Tip Rotation and Projection in Open Septorhinoplasty.","authors":"Jason D Pou, John Ziegler, Krishna G Patel, Samuel L Oyer","doi":"10.31486/toj.22.0006","DOIUrl":"https://doi.org/10.31486/toj.22.0006","url":null,"abstract":"Background: Open septorhinoplasty is a common facial plastic surgery procedure that requires extensive planning and knowledge to achieve predictable outcomes. Many patients want to keep their nasal tip characteristics, and the surgeon's task is to reliably meet this expectation and provide stable long-term results. Techniques used to reconstruct nasal tip support include the tongue-in-groove, caudal septal extension graft, and caudal septal replacement graft procedures. Methods: We assessed the 1-year reliability of tongue-in-groove, caudal septal extension graft, and caudal septal replacement graft procedures in maintaining nasal tip rotation and projection in open septorhinoplasty. We conducted a retrospective case series review of septorhinoplasty cases between 2015 and 2019 at the Medical University of South Carolina. Cases with intention to change nasal tip rotation or projection were excluded. Two blinded reviewers analyzed standardized preoperative and 1-year postoperative photographs. Results: Fifty-seven patients fit the inclusion criteria and were included in the analysis. Mean preoperative and postoperative nasal tip rotations and projection ratios were similar (P=0.62, P=0.22, respectively). Twenty-six patients underwent a tongue-in-groove procedure, 24 had a caudal septal extension graft, and 7 had a caudal septal replacement graft with preoperative nasal tip rotations of 98.93°, 99.35°, and 96.89°, respectively (P=0.73). At 1 year, patients who received a tongue-in-groove procedure had a significant increase in nasal tip rotation to 101.24° (P=0.013), while patients who received a caudal septal extension graft had a significant decrease in nasal tip rotation to 97.25° (P=0.009). Patients who received a caudal septal replacement graft had no significant change in nasal tip rotation (P=0.117). The preoperative and postoperative projection ratios were not significantly different among the 3 techniques. Conclusion: Tongue-in-groove, caudal septal extension graft, and caudal septal replacement graft are reliable techniques for maintaining nasal tip projection in open septorhinoplasty. In our experience, when attempting to maintain preoperative nasal tip rotation, the tongue-in-groove technique resulted in a significant increase in tip rotation of 2.31°, while the caudal septal extension graft resulted in a significant decrease of 2.1° at 1 year postoperatively.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"22 3","pages":"218-224"},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9477123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40390450","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 Presentation of Wünderlich Syndrome.","authors":"Luis R García-Chairez,&nbsp;Fred A Montelongo-Rodríguez,&nbsp;Ilse A Moreno-Arquieta,&nbsp;Max Molina Ayala,&nbsp;Adrián Gutierrez-González","doi":"10.31486/toj.21.0120","DOIUrl":"https://doi.org/10.31486/toj.21.0120","url":null,"abstract":"<p><p><b>Background:</b> Wünderlich syndrome is a rare but important condition because it involves a sudden blood collection in the renal fossa that can cause hemodynamic instability. <b>Case Report:</b> A 38-year-old female with a history of type 2 diabetes mellitus and hypertension with poor adherence to treatment presented to the emergency department with abdominal pain of 2 weeks' duration accompanied by irritative lower urinary symptoms. Abdominal computed tomography (CT) scan showed bilateral pyelonephritis and an abscess in the lower pole of the right kidney. A second CT scan, performed because of the patient's abrupt decrease in hemoglobin and hematocrit, showed active bleeding secondary to the infectious process in the right kidney. The patient was hemodynamically unstable, so a nephrectomy was performed. <b>Conclusion:</b> Wünderlich syndrome is a spontaneous renal hemorrhage, in most cases attributed to a tumorous etiology and rarely of infectious origin. The clinical picture is varied but can present with the Lenk triad of acute onset flank pain, flank mass, and hypovolemic shock. It is diagnosed principally via an imaging study such as abdominal CT scan. Treatment is conservative in principle, but urgent surgical intervention is sometimes necessary depending on the clinical situation of the patient.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"22 3","pages":"273-276"},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9477127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40391985","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":"Improving Pneumococcal Vaccination Rates in an Inpatient Pediatric Diabetic Population.","authors":"Aymen Mirza,&nbsp;Apoorva Jagadish,&nbsp;Kelsey Trimble,&nbsp;Adijat Olanrewaju","doi":"10.31486/toj.22.0036","DOIUrl":"https://doi.org/10.31486/toj.22.0036","url":null,"abstract":"<p><p><b>Background:</b> Diabetes is an immunocompromising condition, and diabetic children should receive the 23-valent pneumococcal polysaccharide (PPSV23) vaccine as part of their preventive care because of their increased risk for invasive pneumococcal disease. This recommendation is often not followed, however, and at our institution, we discovered that a factor limiting vaccine administration was lack of knowledge about the recommendation among residents. <b>Methods:</b> Our objective with this quality improvement initiative was to improve pneumococcal vaccination rates among the inpatient pediatric diabetic population to 70% in 6 months. Three education and awareness initiatives were conducted during the postintervention period of March 2021 to August 2021 at St. Mary Medical Center in Shreveport, Louisiana. All pediatric diabetic patients from age 2 to 18 years who were admitted to the inpatient general pediatrics or critical care services were included. The primary outcome was vaccination with PPSV23. <b>Results:</b> We studied 63 pediatric patients with a mean age of 12.7 years. The vaccination ordering rate during the 6 months prior to the implementation of the quality improvement initiatives was 41%. In the 6 months postintervention, the overall vaccination ordering rate improved to 81%. During data collection, however, we discovered that even though the residents were assessing for vaccine eligibility and ordering the vaccines, not all vaccines were administered prior to discharge. In the preintervention period, the overall vaccine administration rate was 27%, improving to 42% in the postintervention period. <b>Conclusion:</b> Simple interventions that included resident education, development of a smart phrase in the electronic medical record, and liaison with pharmacy led to an increase in the pneumococcal vaccination ordering rate for pediatric patients with diabetes. However, we did not anticipate that the vaccination ordering and administration rates would be different when we initiated the project and had therefore focused our interventions on resident education only. Our discovery of the difference between vaccination ordering and vaccination administration helped identify 2 other areas for improvement: nursing education and additional improvement of the electronic medical record.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"22 3","pages":"239-243"},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9477126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40391988","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":"About Surgery, Ketamine, and Quality Improvement.","authors":"Ronald G Amedee","doi":"10.31486/toj.22.5028","DOIUrl":"https://doi.org/10.31486/toj.22.5028","url":null,"abstract":"","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"22 3","pages":"199"},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9477138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40391991","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":"Hemodynamic Effects of Ketamine Infusion in the Intensive Care Unit for Maintenance Sedation Compared With Propofol and Midazolam: A Retrospective Cohort Study.","authors":"Sohaib Khatib,&nbsp;David Roelofsz,&nbsp;Som Singh,&nbsp;Arjun Rao,&nbsp;Taylor Brinton,&nbsp;Gregory Howell","doi":"10.31486/toj.22.0032","DOIUrl":"https://doi.org/10.31486/toj.22.0032","url":null,"abstract":"<p><p><b>Background:</b> Sedation and analgesia in the intensive care unit (ICU) are major clinical challenges, and several continuous infusion medications have been used for these purposes. The use of these sedative medications has been associated with hemodynamic effects that complicate the patient's critical illness. Continuous ketamine infusion is an emerging sedative option that has been used more frequently in the ICU since 2017. The purpose of this study was to characterize the hemodynamic differences between 3 continuous sedative infusions: ketamine, propofol, and midazolam. <b>Methods:</b> For this single-center retrospective cohort study, we collected data for patients hospitalized between January 2015 and April 2020 at Saint Luke's Health System in Kansas City, Missouri. Adult patients in the ICU requiring a norepinephrine infusion and sedation were included. The change in norepinephrine requirement from baseline at 1 hour was the primary outcome. The change in vasopressor requirement at 3 and 30 hours after initiation of the infusion was also tabulated. <b>Results:</b> Sixty-eight critically ill patients with several types of shock requiring vasopressor support with norepinephrine were enrolled in our study. Patients who received ketamine had an increase in norepinephrine requirement compared to midazolam and propofol, although this difference was not statistically significant. <b>Conclusion:</b> In our study, continuous ketamine infusion did not reveal a statistically significant favorable hemodynamic effect compared with propofol and midazolam because of the small sample size. A trend toward an unfavorable hemodynamic effect is not expected, but large randomized trials are needed to further evaluate the hemodynamic effects of continuous ketamine infusion in the ICU.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"22 3","pages":"225-229"},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9477136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40393493","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":"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}