Ochsner Journal

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ISSN / EISSN : 1524-5012 / 1524-5012
Published by: Ochsner Journal (10.31486)
Total articles ≅ 1,398
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Dennis Sonnier, W. Peter Sawyer, John Seal, Colin Curtis, Jack McGee, Alec Slayden, Korak Sarkar
Published: 22 July 2022
Abstract:
Background: Living donor renal transplant involves highly technical operations in both a healthy donor and a recipient with end-stage kidney disease. Contrast-enhanced computed tomography angiography (CTA) is used to assess critical donor anatomy, but its interpretation becomes increasingly difficult as renal anatomy becomes more complex. Case Report: A related donor was denied because of prohibitive anatomy seen on the pretransplant evaluation CTA. As the donor was highly motivated to donate, CTA DICOM images were segmented to create a 3-dimensional (3D) model that could be evaluated in an immersive and stereoscopic virtual reality (VR) environment. The donor9s anatomy was found to be acceptable, and he was approved. Conclusion: In live donor nephrectomy candidates, 3D reconstruction and VR visualization can be used to facilitate appreciation of complex anatomy.
Angsupat Pornchai, Patarapong Kamalaporn, Chutintorn Sriphrapradang
Published: 22 July 2022
Abstract:
Background: Hyperemesis gravidarum is characterized by intractable vomiting and associated with weight loss exceeding 5% of prepregnancy body weight, dehydration, and ketosis. Hyperemesis gravidarum occurs during the first trimester and typically resolves by 16 to 20 weeks of gestation. Approximately half of all hospitalized females with hyperemesis gravidarum have a mild elevation in liver enzymes; however, jaundice and hepatic synthetic dysfunction are uncommon. Case Report: A 22-year-old gravida 1 para 0 in her ninth week with a singleton gestation was hospitalized with persistent nausea, vomiting, weight loss of 11% of her prepregnancy body weight, dehydration, hypokalemia, and jaundice. Liver function tests showed hyperbilirubinemia of 7.1 mg/dL and alanine aminotransferase levels high as 676 U/L. Other hepatobiliary diseases were excluded. Thyroid function tests revealed thyrotoxicosis. Gestational thyrotoxicosis is often associated with hyperemesis gravidarum because of their shared pathophysiology of high human chorionic gonadotropin levels during the first trimester. After supportive management including hydration, correction of electrolyte disturbance, vitamin supplementation, and antiemetic treatment, the patient9s symptoms resolved. Liver and thyroid dysfunction returned to normal after resolution of vomiting. The patient delivered a healthy child at 38 weeks’ gestation. Conclusion: Elevation of aminotransferase and bilirubin levels may occur in patients with hyperemesis gravidarum. Although jaundice and highly elevated liver enzymes have been reported, investigations to exclude preexisting and concurrent liver diseases are required. Management of hyperemesis gravidarum is supportive, and outcomes are generally favorable.
Ali Ishaque, Eisha Farid, , Laila Tul Qadar, Ammarah Jamal
Published: 18 July 2022
Abstract:
Background: Osteopetrosis includes a variety of rare inherited skeletal disorders characterized by increased bone density and thickness. It has different clinical forms, including infantile autosomal recessive, intermediate autosomal recessive, and late-onset autosomal dominant forms. Intermediate autosomal recessive osteopetrosis (IARO) displays high variability. Case Report: A 10-year-old male presented to our pediatrics emergency department with abdominal distension, low-grade fever, and swelling of the right maxilla with associated discharge. His local physician had treated the lesion with drainage and aspiration of pus without improvement. Examination revealed pallor, hepatosplenomegaly, poor dentition, and dental caries. Eye examination showed reduced visual acuity, absent color vision, nystagmus, and bilateral optic nerve atrophy. Laboratory investigations showed anemia and thrombocytopenia. Radiography yielded classic features of osteopetrosis. Detailed intraoral examination revealed an area of exposed necrotic bone in the alveolar region of the right maxilla, leading to a diagnosis of IARO with underlying osteomyelitis. The intraoral wound was treated with bismuth iodoform paraffin paste dressing, and the infection was treated with antibiotics. Anemia and thrombocytopenia were managed supportively by transfusion of packed red blood cells and platelets. Conclusion: IARO commonly presents with multiple fractures, so the absence of fractures in our patient was unusual. Studies evaluating the intermediate variant are meager; hence, documenting its various presentations is essential to aid physicians in making early diagnoses. Osteomyelitis of the jaws is a feared complication in these patients. Therefore, practitioners need to be cautious of infections of dental origin.
Shruti Vaswani, , Arvind Sinha
Published: 13 July 2022
Abstract:
Background: Fibrous tumors are rare tumors of mesenchymal origin arising in the serosal surfaces within the body. Although commonly seen in adults, solitary fibrous tumors rarely occur in children. Histopathology and immunohistochemistry are the methods of choice for diagnosing solitary fibrous tumors. Case Report: A 2-year-old male presented with a swelling over the umbilicus for the prior 8 months. The umbilical mass was excised and sent for histopathologic examination. The skin-covered greyish soft tissue mass measured 6 × 5.5 × 4.5 cm, and the cut surface showed a homogenous greyish growth. On microscopic examination, a predominantly well-circumscribed encapsulated tumor was noted, with spindle shaped cells arranged in a haphazard manner and ectatic vascular channels. The cells were immunoreactive for CD34 and signal transducer and activator of transcription 6 (STAT6) and negative for smooth muscle actin, desmin, myogenin, MyoD1, CD99, epithelial membrane antigen, and beta-catenin. Conclusion: The aim of this case is to make clinicians aware of the umbilicus as a rare site of solitary fibrous tumor in children and the diagnostic importance of STAT6.
Nourhan Chaaban,
Published: 13 July 2022
Abstract:
Background: Spontaneous coronary artery dissection (SCAD) has been reported to be a rare cause of acute coronary syndrome and sudden cardiac death. The clinical presentation of SCAD varies from asymptomatic to sudden death. Pregnancy is associated with SCAD, and autoimmune diseases, especially systemic lupus erythematosus (SLE), may play an important role in SCAD etiology. Case Report: A 37-year-old female with hypertension, SLE, a history of preeclampsia with 3 cesarean deliveries, and an active smoking habit presented to the emergency department with chest pain. On arrival, the patient was hypertensive with blood pressure of 152/122 mm Hg and a normal heart rate and respiratory rate. Given the patient9s history of SLE and preeclampsia, antiphospholipid antibodies were tested. The anti-β2-glycoprotein 1 immunoglobulin G concentration was elevated at 30 U/mL, and lupus anticoagulant was positive. Electrocardiogram showed minimum ST elevation in lead V2. Initial troponin was 0.1 ng/mL, with a peak of 54.5 ng/mL after 6 hours. Aspirin 325 mg was administered, and the patient underwent urgent cardiac catheterization. Intravascular angiography showed evidence of intimal flap (mid left anterior descending artery) spontaneous dissection with subintimal hematoma. The angioplasty resulted in successful stent placement in the mid left anterior descending artery. Conclusion: SCAD diagnosis is challenging and requires a high index of suspicion. This case shows the challenge of early diagnosis of SCAD and highlights its association with autoimmune diseases, specifically SLE. Early recognition of this pathology results in better outcomes.
Kenneth Leung, Priyanka Yaramada, Preeya Goyal, Cindy X. Cai, Irene Thung,
Published: 13 July 2022
Abstract:
Background: RAD-140, one of the novel selective androgen receptor modulators (SARMs), has potent anabolic effects on bones and muscles with little androgenic effect. Despite the lack of approval for its clinical use, RAD-140 is readily accessible on the consumer market. Hepatotoxicity associated with the use of SARMs has only rarely been reported in the literature. Case Report: A 24-year-old male presented with a 2-week history of diffuse abdominal pain, scleral icterus, pruritus, and jaundice. Prior to presentation, he had been taking the health supplement RAD-140 for muscle growth for 5 weeks. He had a cholestatic pattern of liver injury, with a peak total bilirubin of 38.5 mg/dL. Liver biopsy was supportive of a diagnosis of RAD-140–associated liver injury characterized pathologically by intracytoplasmic and canalicular cholestasis with minimal portal inflammation. Symptoms and liver injury resolved after cessation of the offending agent. Conclusion: To date, only select descriptions of the potential hepatoxicity associated with the use of SARMs, including RAD-140, have been published. Given their potential hepatoxicity and ready availability on the consumer market, RAD-140 and other SARMs should be used judiciously and under close clinical supervision until further hepatic safety data become available.
Sanu Rajendraprasad, Zachary A. Creech, Gia Thinh D. Truong, Toan Nguyen, Mounika Addula, Neil Mendoza,
Published: 13 July 2022
Abstract:
Background:Burkholderia gladioli (B gladioli) is a rare, gram-negative rod that was initially regarded as a plant pathogen. However, B gladioli has been reported as the primary pathogen causing pneumonia in organ transplant recipients and in patients with cystic fibrosis. We report a case of bacterial pneumonia caused by B gladioli in a patient hospitalized for coronavirus disease 2019 (COVID-19). Case Report: A 68-year-old male was admitted for acute hypoxic respiratory failure secondary to COVID-19 pneumonia. He was treated with dexamethasone and convalescent plasma, resulting in improvement in the hypoxemia. However, during the latter part of his inpatient stay, the patient developed pneumonia caused by B gladioli. The isolate of B gladioli was sensitive to meropenem, levofloxacin, and trimethoprim/sulfamethoxazole and intermediate to ceftazidime. He was treated with meropenem and levofloxacin. Despite treatment, the patient developed acute respiratory distress syndrome with multiorgan failure, suffered cardiac arrest, and died. Conclusion: To the best of our knowledge, this case is the first report of B gladioli coinfection in a patient hospitalized for COVID-19 and provides insight into the possible detrimental outcome of B gladioli and COVID-19 coinfection.
Carson Flores, Walter S. Choate,
Published: 15 June 2022
Abstract:
Background: 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. Case Report: 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. Conclusion: Based on the combination of history, physical examination findings, and imaging findings, the diagnosis of SIRVA was made with confidence in this clinical scenario.
, Ryan Jay Abrigo
Published: 15 June 2022
Abstract:
Background: Endotracheal tube securement devices are used to reduce the incidence of unplanned extubation of intubated patients. We describe the ingestion of part of an endotracheal tube securement device by a neonate to bring awareness of the risk of ingestion or aspiration of endotracheal tube securement device components in this population. Case Report: A 13-day-old, former 31-week gestational age female infant was noted on routine radiologic evaluation to have a foreign body in the gastrointestinal tract. The foreign body was thought to be an artifact or an object overlying the radiologic image. However, review of previous imaging showed the object initially in the posterior pharynx with progressive migration into the gastrointestinal tract. The patient did not have any clinical features of gastrointestinal obstruction and had been tolerating enteral feeds. The infant9s endotracheal tube securement had been changed from a NEO-fit device (CooperSurgical, Inc.) to a NeoBar device (Neotech Products) on day of life 5. The diagnosis of the foreign body was made 8 days later. The infant was followed with serial imaging per pediatric surgery recommendations. The foreign body was spontaneously passed via the rectum several days later without incident. Pathology identified the foreign body as a piece of the NEO-fit device. Conclusion: Awareness of the possibility of ingestion or aspiration from this endotracheal tube securement device is important for patient safety.
Rev Anthony J. De Conciliis
Published: 14 June 2022
Ochsner Journal, Volume 22, pp 106-106; https://doi.org/10.31486/toj.22.5027

Abstract:
Over the past 10 years, in my role as teacher and consultant at Ochsner Health through the Institute of Medicine, Education, and Spirituality at Ochsner, I have had the privilege to read extensively and develop programs based on the health care literature regarding the character of medicine and, specifically, the care of the patient and the care of the provider. What results from this genuine and caring relationship is reciprocal healing.
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