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Ochsner Journal

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https://www.readbyqxmd.com/read/27999519/esophageal-granular-cell-tumor-a-benign-tumor-or-an-insidious-cause-for-concern
#1
Kiranya Tipirneni, Ashley Mehl, Blythe Bowman, Virendra Joshi
BACKGROUND: Esophageal granular cell tumors (GCTs) are rare, often benign tumors of neurogenic origin. GCTs most frequently occur in the skin and subcutaneous tissues but are found in the gastrointestinal (GI) tract in 6%-10% of cases, with the distal two-thirds of the esophagus being the most common site. Owing to the insidious nature of GCTs, presentation is typically asymptomatic. In fact, GCTs are often discovered incidentally during investigation of other GI disturbances. CASE REPORT: We report the case of a 36-year-old white male who had a 2...
2016: Ochsner Journal
https://www.readbyqxmd.com/read/27999518/serotonin-syndrome-with-fluoxetine-two-case-reports
#2
Dipen Dineshkumar Patel, David Galarneau
BACKGROUND: Serotonin syndrome is a rare but serious complication of treatment with serotonergic agents. In its severe manifestations, death can ensue. Early recognition and aggressive management are crucial to mitigating the syndrome. Often the presentation can be subtle and easy to miss. CASE REPORTS: We present 2 cases of serotonin syndrome seen in the psychiatric consultation service of a busy academic hospital. Both patients had favorable outcomes because of early recognition and aggressive management...
2016: Ochsner Journal
https://www.readbyqxmd.com/read/27999517/sarcoid-uveitis-a-look-beyond-the-eyes
#3
Daniel Lemor, David B Lazar, W Brooks Emory, Jonathan D Nussdorf
BACKGROUND: Bilateral acute uveitis can cause significant morbidity, and a complete workup is often warranted. This report illustrates a case of sarcoid uveitis definitively diagnosed by skin biopsy in a patient with red tattoo ink. CASE REPORT: A 40-year-old African American male presented with bilateral photophobia and intraocular pressures of 26 mmHg in both eyes, 1+ grade cell and flare in both eyes, and granulomatous (mutton fat) keratic precipitates in both eyes...
2016: Ochsner Journal
https://www.readbyqxmd.com/read/27999516/atypical-presentation-of-cervical-carcinoma-with-cerebral-metastasis
#4
Shabnam Gupta, Sean Bandzar, Hany Atallah
BACKGROUND: Cervical cancer is a leading cause of morbidity and mortality in women, but cerebral metastasis from cervical carcinoma is a rare event with a reported incidence of 0.57%. CASE REPORT: We describe a case of brain metastasis from primary cervical adenocarcinoma with several distinct features. This case illustrates uncommon presenting neurologic symptoms, a rare combination of histopathologic features, and atypical findings on radiographic evaluation. CONCLUSION: Clinicians must maintain a high index of suspicion for cerebral metastasis to make an accurate diagnosis and initiate appropriate management of advanced cervical cancer...
2016: Ochsner Journal
https://www.readbyqxmd.com/read/27999515/spontaneous-unscarred-uterine-rupture-at-15-weeks-of-pregnancy-a-case-report
#5
Luca Mannini, Flavia Sorbi, Viola Ghizzoni, Giulia Masini, Massimiliano Fambrini, Ivo Noci
BACKGROUND: Uterine rupture during pregnancy is a serious obstetric complication. The presence of a previous uterine scar is the most important risk factor, whereas rupture in an unscarred uterus is a rare event. CASE REPORT: A 34-year-old woman, gravida 3 para 1, presented with sudden acute hypogastric pain at 15 weeks of gestation. The patient had no history of cesarean delivery. Ultrasound scans showed an empty endometrial cavity continuing directly into the amniotic sac that developed mainly outside the uterus...
2016: Ochsner Journal
https://www.readbyqxmd.com/read/27999514/hemorrhagic-stroke-resulting-from-venous-malformation-at-20-weeks-of-pregnancy
#6
Nicole D Ulrich, Elizabeth R Lapeyre, Robert C Moore
BACKGROUND: Stroke in the pregnant patient is not a common occurrence. Despite its relative rarity, stroke during pregnancy is associated with high morbidity and mortality for both mother and infant. We report the case of a patient who experienced a hemorrhagic stroke during pregnancy because of venous cavernoma. CASE REPORT: A 34-year-old patient, gravida 5 para 1-0-3-1, presented to labor and delivery triage at 21 weeks, 0 days' gestation with the concern of sudden-onset right-sided facial, arm, and leg numbness and weakness...
2016: Ochsner Journal
https://www.readbyqxmd.com/read/27999513/choosing-non-vitamin-k-antagonist-oral-anticoagulants-practical-considerations-we-need-to-know
#7
REVIEW
Alpesh Amin
BACKGROUND: Warfarin is a well-established agent for use in the prevention of stroke or systemic embolic event (SEE) in patients with nonvalvular atrial fibrillation (NVAF) and for the treatment of venous thromboembolism (VTE). However, management of patients requiring oral anticoagulation with warfarin can be complicated by the need for frequent monitoring, drug-drug and drug-food interactions, and a variable response based on genetic polymorphisms. The non-vitamin K antagonist oral anticoagulants (NOACs) were developed as alternatives to warfarin; they do not require routine monitoring and have predictable pharmacokinetics, fewer drug-drug interactions, and limited drug-food interactions...
2016: Ochsner Journal
https://www.readbyqxmd.com/read/27999512/review-of-the-diagnostic-evaluation-of-renal-tubular-acidosis
#8
REVIEW
Julian Yaxley, Christine Pirrone
BACKGROUND: The term renal tubular acidosis (RTA) describes a group of uncommon kidney disorders characterized by defective acid-base regulation. Reaching the diagnosis of RTA is complex and often delayed, resulting in suboptimal treatment. METHODS: This article provides an overview of the clinical features of RTA and diagnostic approaches in a format accessible to physicians for everyday use. RESULTS: The 3 major forms of disease are classified by their respective tubular transport defects, each of which produces persistent hyperchloremic metabolic acidosis...
2016: Ochsner Journal
https://www.readbyqxmd.com/read/27999511/a-review-of-herbal-and-pharmaceutical-galactagogues-for-breast-feeding
#9
REVIEW
Alessandra N Bazzano, Rebecca Hofer, Shelley Thibeau, Veronica Gillispie, Marni Jacobs, Katherine P Theall
BACKGROUND: Therapeutic approaches to addressing insufficient lactation are available but remain poorly understood. Current trends in maternal health, such as increasing rates of obesity, delayed age at childbearing, and high rates of cesarean section, may be associated with physiological challenges for lactation that cannot be managed by counseling alone. Women who have not had success with counseling alone, including adoptive mothers seeking to induce lactation, may use galactagogues (pharmaceutical and herbal compounds used to increase lactation)...
2016: Ochsner Journal
https://www.readbyqxmd.com/read/27999510/age-related-macular-degeneration-and-intracrine-biology-an-hypothesis
#10
REVIEW
Richard N Re
This laboratory has studied the intracellular actions of angiotensin II and other signaling proteins that can act in the intracellular space-peptides/proteins we have called intracrines. Moreover, we have suggested that general principles of intracrine action exist and can help explain the progression of some chronic degenerative diseases such as diabetic nephropathy and congestive heart failure. Here, a similar analysis is carried out in the case of age-related macular degeneration. We propose that intracrine mechanisms are operative in this disorder...
2016: Ochsner Journal
https://www.readbyqxmd.com/read/27999509/the-close-exposure-to-radiology-program-educational-benefits-to-medical-students
#11
Guang-Bin Cui, Lin-Feng Yan, Hai-Yan Nan, Xin Zhao, Yu-Chuan Hu, Alan David Kaye, Thea Moran, Wen Wang
BACKGROUND: Radiology clerkships during medical school provide a suboptimal training experience in the Chinese medical doctor training program. Staff radiologists are heavily occupied with clinic tasks which decreases teaching quality. The close exposure to radiology program (CERP) is a novel pathway designed to improve teaching quality, yet students' expectations of the potential benefits of such a program and their willingness to join CERP still have not been investigated among Chinese medical students...
2016: Ochsner Journal
https://www.readbyqxmd.com/read/27999508/validation-of-the-patient-global-impression-of-improvement-for-penile-prosthesis
#12
Sean Douglas, Austin Lutz, Kevin T McVary, Puneet Masson, Jack Christian Winters, Eric Laborde
BACKGROUND: No consensus on the preferred means of evaluating patients after surgical placement of an inflatable penile prosthesis (IPP) currently exists. Many self-assessment questionnaires are available, but none specifically targets patients with IPPs. The purpose of this study was to assess the construct validity of the Patient Global Impression of Improvement (PGI-I) for evaluating patient satisfaction after placement of an IPP. METHODS: We conducted a multicenter prospective trial and enrolled patients who elected to have a 3-piece IPP surgically implanted...
2016: Ochsner Journal
https://www.readbyqxmd.com/read/27999507/the-penumbra-5max-ace-catheter-is-safe-efficient-and-cost-saving-as-a-primary-mechanical-thrombectomy-device-for-large-vessel-occlusions-in-acute-ischemic-stroke
#13
Gabriel A Vidal, James M Milburn
BACKGROUND: Reperfusion of large vessel occlusions in acute stroke can improve patient outcomes. The purposes of this study were to assess the safety and efficacy of the Penumbra 5MAX ACE catheter for revascularization of large vessels and to compare its cost to the cost of stent retrievers. METHODS: In this retrospective, single-center case review study, data were captured on consecutive patients treated with the Penumbra 5MAX ACE as first-line therapy during an 11-month period...
2016: Ochsner Journal
https://www.readbyqxmd.com/read/27999506/preoperative-acute-inflammatory-markers-as-predictors-for-postoperative-complications-in-primary-total-knee-arthroplasty
#14
Gustavo Godoy, Gonzalo Sumarriva, J Lockwood Ochsner, George Chimento, Dana Schmucker, Vinod Dasa, Mark Meyer
BACKGROUND: C-reactive protein (CRP) has been suggested as an independent risk factor for cardiovascular pathology in the nonsurgical setting. While postoperative CRP and erythrocyte sedimentation rate (ESR) have an established role in aiding the diagnosis of periprosthetic joint infections, some authors suggest a link between preoperative CRP and postoperative complications in patients undergoing total joint arthroplasty. METHODS: We conducted a retrospective cohort study of 351 patients who underwent unilateral primary total knee arthroplasty by a single surgeon during a 28-month period (January 2013 through April 2015)...
2016: Ochsner Journal
https://www.readbyqxmd.com/read/27999505/osteochondral-allograft-transplantation-for-femoral-trochlear-dysplasia
#15
Dharmpal V Vansadia, James R Heltsley, Scott Montgomery, Misty Suri, Deryk G Jones
BACKGROUND: The risk factors for patellofemoral joint instability include laxity of medial patellar restraints, abnormal limb geometry, femoral and tibial malrotation, patella alta, and trochlear dysplasia. Femoral trochlear dysplasia is characterized by a hypoplastic or shallow trochlear groove. CASE REPORT: We report the case of a 31-year-old female with trochlear dysplasia and recurrent patella dislocations, laxity of the medial patellofemoral ligament (MPFL), and high-grade chondromalacia of the trochlea and the patella...
2016: Ochsner Journal
https://www.readbyqxmd.com/read/27999504/neurectomy-outcomes-in-patients-with-morton-neuroma-comparison-of-plantar-vs-dorsal-approaches
#16
Alexander Habashy, Gonzalo Sumarriva, Robert J Treuting
BACKGROUND: Morton neuroma is a compressive neuropathy of the plantar digital nerve. Several surgical approaches have been used to treat painful Morton neuroma, with each approach having distinct advantages and disadvantages. For this study, we used validated outcome assessment tools to retrospectively compare patient satisfaction with 2 approaches. METHODS: The medical records and survey responses of 37 patients with 42 neuromas were evaluated with respect to outcomes and patient satisfaction after neurectomies performed through either a plantar or dorsal surgical approach by one Ochsner Clinic Foundation attending physician...
2016: Ochsner Journal
https://www.readbyqxmd.com/read/27999503/factors-affecting-the-union-of-opening-wedge-high-tibial-osteotomy-using-a-titanium-wedge-plate
#17
Husam T Nawas, Dharmpal V Vansadia, James R Heltsley, Misty Suri, Scott Montgomery, Deryk G Jones
BACKGROUND: Factors that can affect the success rate of high tibial osteotomy (HTO) include patient selection, surgical technique, type of fixation hardware, supplemental fixation, choice of bone graft, and rehabilitation protocol. The purpose of this study was to define the role of cortical hinge fractures in the risk of nonunion and collapse of opening wedge high tibial osteotomy. METHODS: A total of 60 patients (mean age, 40 years) who underwent 64 primary HTO procedures were identified from our operational database and observed at a mean follow-up of 2 years...
2016: Ochsner Journal
https://www.readbyqxmd.com/read/27999502/pain-functional-scores-and-radiographic-severity-of-illness-influence-the-perception-of-time-spent-with-the-physician-by-patients-presenting-for-initial-evaluation-of-knee-osteoarthritis
#18
Ronak Kedia, Chandni Dargan, Omar Hassan, Vinod Dasa
BACKGROUND: Patient satisfaction has become a significant factor in reimbursement schedules for physicians. A matter of debate is whether the patient's perception of time spent with the physician improves patient satisfaction. We sought to determine whether patient-physican time correlates with patient satisfaction and which factors are associated with patient perception of time. METHODS: A total of 73 patients who presented for an initial evaluation of knee osteoarthritis were evaluated by the same orthopedic surgeon at an outpatient clinic in New Orleans, LA...
2016: Ochsner Journal
https://www.readbyqxmd.com/read/27999501/axillary-block-induced-chemical-sympathectomy-in-the-setting-of-digital-ischemia
#19
José R Soberón, T Michael Truxillo, Christin C Gethers, Taylor A Smith, William E Davis
BACKGROUND: Digital ischemia is associated with several rheumatologic disorders and is often difficult to treat. Symptoms and sequelae can include pain, disability, need for amputation, and poor quality of life. METHODS: Patients diagnosed with digital ischemia were referred for an ultrasound-guided axillary nerve block using liposomal bupivacaine (Exparel, Pacira Pharmaceuticals). The primary outcome measure was radial and ulnar artery diameter preprocedure and postprocedure...
2016: Ochsner Journal
https://www.readbyqxmd.com/read/27999500/benefits-of-limited-use-of-a-tourniquet-combined-with-intravenous-tranexamic-acid-during-total-knee-arthroplasty
#20
Alexander D Rosenstein, Yehuda A Michelov, Stephanie Thompson, Alan D Kaye
BACKGROUND: Blood loss during total knee arthroplasty (TKA) may require blood transfusions that are associated with increased risk, morbidity, and cost. Multiple techniques exist to reduce blood loss in TKA, including the use of a tourniquet and tranexamic acid (TXA). While multiple studies suggest that TXA is effective in reducing blood loss, the use of a tourniquet is more controversial. We studied the combined effect of TXA with a limited-use tourniquet on blood loss and complications in the setting of primary TKA...
2016: Ochsner Journal
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