{"title":"Where are we going?","authors":"L. Lowentritt","doi":"10.2307/j.ctvzsmdvh.11","DOIUrl":"https://doi.org/10.2307/j.ctvzsmdvh.11","url":null,"abstract":"","PeriodicalId":22855,"journal":{"name":"The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78291696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T term refractory anemia (RA) may be confusing to those who are not hematologists. RA should be well defined because it means more than what it says. RA is defined as anemia that is not responsive to therapy except transfusion.[1] The term RA is used to rule out those types of anemia with a known cause such as anemia of systemic diseases (liver and kidney) and anemia of inflammation even though they are considered refractory to therapy.[2] RA with cellular or hypercellular bone marrow was formerly used to exclude aplastic anemia. Now, the diagnosis of aplastic anemia describes a hypocellular or acellular marrow, except in transient stage. In practice, RA with cellular or hypercellular bone marrow is used to involve patients with anemia and simultaneously express pancytopenia without splenomegaly.[3] RA is recently considered in the main classification group of myelodysplastic syndromes (MDS). RA has been recognized in many conditions such as anemia transfusion dependent (sickle cell disease, thalassemia major, and aplastic anemia), bone marrow infiltration diseases (leukemia, lymphoma, myeloma, metastatic diseases, myelofibrosis, and granulomatous diseases), secondary idiopathic sideroblastic anemia, congenital dyserythropoietic anemias, and MDS.[4] In other words, RA is recognized as a low risk of MDS with monolineage dysplasia associated with anemia, dyserythropoiesis, and decreased the percentage of blast cells in bone marrow and/ or peripheral blood. RA represents approximately 5–10% of MDS cases and usually affects elderly people with no known etiology recognized so far. According to the recent World Health Organization recommendations, to setup the diagnosis of RA, all other potential etiologies of erythroid abnormalities should be excluded. These etiologies include immunologic diseases, drugs and chemicals, congenital abnormalities, vitamin deficiencies, and viral infections.[5] RA in case of MDS is characterized by anemia, dyserythropoiesis in > 10% of erythroid precursor and may associate with < 15% ring sideroblasts of the nucleated erythrocytes.[4] RA is categorized into primary RA which is characterized by a qualitative disturbance of erythropoiesis with functional and morphological abnormalities in association with variable degree of myelopoiesis and chronic RA in which the general hematopoietic abnormalities are particularly noted.[2] Individuals with RA should be managed according to the underlying etiology of RA. RA may have a long and stable clinical course without intervention to treatment. Therefore, some patients with RA even children become susceptible to infection often due to neutropenia or transfusion dependency. Some reports have proposed immunosuppressive drugs (corticosteroids and cyclosporine) probably effective in subset of individual with MDS-RA. Chemotherapy is rare being used, and hematopoietic stem cell transplant is the curative way.[6]
{"title":"Refractory anemia.","authors":"B. Mohammed","doi":"10.32388/1hboig","DOIUrl":"https://doi.org/10.32388/1hboig","url":null,"abstract":"T term refractory anemia (RA) may be confusing to those who are not hematologists. RA should be well defined because it means more than what it says. RA is defined as anemia that is not responsive to therapy except transfusion.[1] The term RA is used to rule out those types of anemia with a known cause such as anemia of systemic diseases (liver and kidney) and anemia of inflammation even though they are considered refractory to therapy.[2] RA with cellular or hypercellular bone marrow was formerly used to exclude aplastic anemia. Now, the diagnosis of aplastic anemia describes a hypocellular or acellular marrow, except in transient stage. In practice, RA with cellular or hypercellular bone marrow is used to involve patients with anemia and simultaneously express pancytopenia without splenomegaly.[3] RA is recently considered in the main classification group of myelodysplastic syndromes (MDS). RA has been recognized in many conditions such as anemia transfusion dependent (sickle cell disease, thalassemia major, and aplastic anemia), bone marrow infiltration diseases (leukemia, lymphoma, myeloma, metastatic diseases, myelofibrosis, and granulomatous diseases), secondary idiopathic sideroblastic anemia, congenital dyserythropoietic anemias, and MDS.[4] In other words, RA is recognized as a low risk of MDS with monolineage dysplasia associated with anemia, dyserythropoiesis, and decreased the percentage of blast cells in bone marrow and/ or peripheral blood. RA represents approximately 5–10% of MDS cases and usually affects elderly people with no known etiology recognized so far. According to the recent World Health Organization recommendations, to setup the diagnosis of RA, all other potential etiologies of erythroid abnormalities should be excluded. These etiologies include immunologic diseases, drugs and chemicals, congenital abnormalities, vitamin deficiencies, and viral infections.[5] RA in case of MDS is characterized by anemia, dyserythropoiesis in > 10% of erythroid precursor and may associate with < 15% ring sideroblasts of the nucleated erythrocytes.[4] RA is categorized into primary RA which is characterized by a qualitative disturbance of erythropoiesis with functional and morphological abnormalities in association with variable degree of myelopoiesis and chronic RA in which the general hematopoietic abnormalities are particularly noted.[2] Individuals with RA should be managed according to the underlying etiology of RA. RA may have a long and stable clinical course without intervention to treatment. Therefore, some patients with RA even children become susceptible to infection often due to neutropenia or transfusion dependency. Some reports have proposed immunosuppressive drugs (corticosteroids and cyclosporine) probably effective in subset of individual with MDS-RA. Chemotherapy is rare being used, and hematopoietic stem cell transplant is the curative way.[6]","PeriodicalId":22855,"journal":{"name":"The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72930955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Urinary diversion.","authors":"B. H. Grimm","doi":"10.32388/kxd8ob","DOIUrl":"https://doi.org/10.32388/kxd8ob","url":null,"abstract":"","PeriodicalId":22855,"journal":{"name":"The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73219633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Schneiderian papilloma.","authors":"R. Schultz, J. White","doi":"10.32388/raqeck","DOIUrl":"https://doi.org/10.32388/raqeck","url":null,"abstract":"","PeriodicalId":22855,"journal":{"name":"The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74251630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Recurrent respiratory papillomatosis is a disease characterized by the growth of wart-like neoplasms anywhere along the aerodigestive tract. The etiologic agent is the human papillomavirus, of which 90 subtypes have been described. The age distribution of those affected appears to be a bimodal curve, with the first peak around 5 years of age and the second occurring in adults in the third decade of life. The mainstay of treatment is surgical resection to maintain an adequate airway; patients often require multiple surgeries. The epidemiology, pathogenesis, clinical features, and treatment options are discussed. Current evidence regarding prognosis and the multifactorial nature of pathogenesis are also reviewed.
{"title":"Recurrent respiratory papillomatosis.","authors":"L. Murray, R. Miller","doi":"10.32388/qvzm6t","DOIUrl":"https://doi.org/10.32388/qvzm6t","url":null,"abstract":"Recurrent respiratory papillomatosis is a disease characterized by the growth of wart-like neoplasms anywhere along the aerodigestive tract. The etiologic agent is the human papillomavirus, of which 90 subtypes have been described. The age distribution of those affected appears to be a bimodal curve, with the first peak around 5 years of age and the second occurring in adults in the third decade of life. The mainstay of treatment is surgical resection to maintain an adequate airway; patients often require multiple surgeries. The epidemiology, pathogenesis, clinical features, and treatment options are discussed. Current evidence regarding prognosis and the multifactorial nature of pathogenesis are also reviewed.","PeriodicalId":22855,"journal":{"name":"The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86130585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Medical necessity.","authors":"J. Johnstone","doi":"10.5749/j.ctvthhd8n.5","DOIUrl":"https://doi.org/10.5749/j.ctvthhd8n.5","url":null,"abstract":"","PeriodicalId":22855,"journal":{"name":"The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80092859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-01DOI: 10.1891/9780826179357.0251
P. Noel, C. Norris
{"title":"Motion sickness.","authors":"P. Noel, C. Norris","doi":"10.1891/9780826179357.0251","DOIUrl":"https://doi.org/10.1891/9780826179357.0251","url":null,"abstract":"","PeriodicalId":22855,"journal":{"name":"The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86230263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.1891/9780826159311.0134
A. L. Mcquown
{"title":"Otitis externa.","authors":"A. L. Mcquown","doi":"10.1891/9780826159311.0134","DOIUrl":"https://doi.org/10.1891/9780826159311.0134","url":null,"abstract":"","PeriodicalId":22855,"journal":{"name":"The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88095964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Matthew C Pope, David H Ballard, Alan L Sticker, Scott Adams, Chaitanya Ahuja, Horacio B D'Agostino
Purpose: To describe patterns of fluid flow through locking pigtail and biliary catheters in patients that underwent biliary and abdominopelvic fluid drainage.
Methods: Contrast movement through catheter sideholes in pigtail and biliary catheters was evaluated retrospectively using sinograms and cholangiograms at 7-10 days post insertion. Dilute contrast injected through the catheter was evaluated by following flow through the catheter shaft and exit from side holes within the body cavity. Exit of contrast through side holes was appreciated and recorded. Included patients underwent biliary and abdominopelvic fluid drainage using 10.2-F catheters. Exclusion criteria included masking of contrast flow through sideholes by catheter angulation, contrast pooling or other imaging artifacts.
Results: A total of 99 patients meeting inclusion criteria underwent evaluation of contrast flow through pigtail (n = 81) and biliary (n = 18) catheters. For pigtail and biliary catheters, 91/99 cases (91.9%) showed contrast exiting the catheter from only the sidehole located most proximally to the catheter hub. In 6/99 cases (6.1%) contrast exited no further than the second most proximal sidehole. In 2/99 cases (2.0%) contrast exited no further than the third most proximal sidehole. In no cases was contrast observed exiting from distal sideholes beyond the third most proximal sidehole.
Conclusion: Retrograde contrast injection through catheters suggests that the majority of the contribution to total output in drainage catheters comes from the most proximal side hole. Contribution of distal side holes to total drainage is negligible or non-existent, therefore the distal segment of the catheter may be considered non-functional.
{"title":"Fluid Flow Patterns Through Drainage Catheters: Clinical Observations in 99 Patients.","authors":"Matthew C Pope, David H Ballard, Alan L Sticker, Scott Adams, Chaitanya Ahuja, Horacio B D'Agostino","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>To describe patterns of fluid flow through locking pigtail and biliary catheters in patients that underwent biliary and abdominopelvic fluid drainage.</p><p><strong>Methods: </strong>Contrast movement through catheter sideholes in pigtail and biliary catheters was evaluated retrospectively using sinograms and cholangiograms at 7-10 days post insertion. Dilute contrast injected through the catheter was evaluated by following flow through the catheter shaft and exit from side holes within the body cavity. Exit of contrast through side holes was appreciated and recorded. Included patients underwent biliary and abdominopelvic fluid drainage using 10.2-F catheters. Exclusion criteria included masking of contrast flow through sideholes by catheter angulation, contrast pooling or other imaging artifacts.</p><p><strong>Results: </strong>A total of 99 patients meeting inclusion criteria underwent evaluation of contrast flow through pigtail (n = 81) and biliary (n = 18) catheters. For pigtail and biliary catheters, 91/99 cases (91.9%) showed contrast exiting the catheter from only the sidehole located most proximally to the catheter hub. In 6/99 cases (6.1%) contrast exited no further than the second most proximal sidehole. In 2/99 cases (2.0%) contrast exited no further than the third most proximal sidehole. In no cases was contrast observed exiting from distal sideholes beyond the third most proximal sidehole.</p><p><strong>Conclusion: </strong>Retrograde contrast injection through catheters suggests that the majority of the contribution to total output in drainage catheters comes from the most proximal side hole. Contribution of distal side holes to total drainage is negligible or non-existent, therefore the distal segment of the catheter may be considered non-functional.</p>","PeriodicalId":22855,"journal":{"name":"The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6347390/pdf/nihms-1006497.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36945695","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}
Within the last decade, minimally invasive valve replacements have become exceedingly popular, and as a result, so has the rise of technology aimed at refining and simplifying these techniques. With new technology, new complications are inevitable. We present a routine Minimally invasive aortic valve replacement through a right anterior minithoracotomy complicated by pledget impaction in a coronary artery.
{"title":"Pledget Induced Cardiogenic Shock Following a Minimally Invasive Aortic Valve Replacement.","authors":"Alexandra E Tedesco, Victor E Tedesco","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Within the last decade, minimally invasive valve replacements have become exceedingly popular, and as a result, so has the rise of technology aimed at refining and simplifying these techniques. With new technology, new complications are inevitable. We present a routine Minimally invasive aortic valve replacement through a right anterior minithoracotomy complicated by pledget impaction in a coronary artery.</p>","PeriodicalId":22855,"journal":{"name":"The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35354825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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