Ochsner Journal最新文献

Background: Data on long-term maternal quality of life following a periviable delivery are lacking. We investigated quality of life measures among patients who delivered a periviable infant.

Methods: We conducted a retrospective cohort study of patients who delivered between gestational ages 22^0/7 to 25^6/7 weeks at a single institution from 2013 to 2019 and who completed the validated World Health Organization Quality of Life-Brief Version (WHOQOL-BREF) questionnaire between 2021 and 2022. Mothers who had a surviving infant discharged from the hospital were compared with mothers who had an intrauterine or neonatal demise. Baseline characteristics were summarized, and scores were evaluated based on the 4 prespecified WHOQOL-BREF domains: physical health, psychological health, social relationships, and environment.

Results: Overall, 58 patients participated: 32 mothers with a surviving infant and 26 mothers with a demise. Maternal age was lower in the mothers with a surviving infant (25.2 ± 3.9 years vs 29.0 ± 6.0 years; P=0.01). Mean duration from delivery to study start date was not different between the groups (5.1 ± 2.0 years vs 4.5 ± 2.1 years; P=0.31). Mothers with surviving infants scored higher (indicating higher quality of life) in the WHOQOL-BREF psychological health and social relationships domains compared to mothers with a demise. Mothers with a surviving infant were more likely to be satisfied with their own health than mothers with a demise, but overall quality of life was not different between the 2 groups.

Conclusion: In this small cohort, mothers with an infant who survived a periviable delivery, despite possible long-term health complications for the infant, reported improved quality of life in some domains compared to mothers whose infants did not survive.

Background: Hailey-Hailey disease is an autosomal dominant blistering disorder characterized by junctional abnormalities of epidermal keratinocytes. Vesiculobullous eruptions affect the intertriginous areas of individuals with the condition. Ocular involvement associated with Hailey-Hailey disease is rare.

Case report: A 12-year-old female with a history of recurrent blisters since the age of 3 years presented with concurrent redness, irritation, and watering of both eyes. Slit lamp examination revealed bilateral conjunctival congestion, peripheral corneal neovascularization, lack of corneal luster, and corneal haze. The ocular signs were more prominent in the left eye. Important differentials considered were pemphigus vulgaris and allergic conjunctivitis. However, lack of clinical signs of allergic conjunctivitis, lack of involvement of the oral mucosa, the classic distribution of blisters and their aggravation by triggering factors, the absence of Nikolsky sign, and biopsy of a skin lesion ruled out these 2 diagnoses. The patient was treated with low-potency steroid eye drops, an ocular lubricant, and eye ointment. At her 2-week follow-up examination, the patient exhibited decreased conjunctival congestion, improved corneal luster, and symptomatic relief.

Conclusion: Ocular involvement in Hailey-Hailey disease can lead to chronic ocular inflammation and sequelae, causing a decrease in vision. Our case is noteworthy because of the early onset of Hailey-Hailey disease and the associated ocular manifestations.

Background: Central fever is a noninfectious increase in body temperature to >37.5 °C that commonly occurs in patients with acute brain injury. Because central fever has detrimental effects on the injured brain and is associated with prolonged neurointensive care unit stays, timely diagnosis and treatment are imperative. Management includes both pharmacologic and nonpharmacologic methods. However, the optimal pharmacologic approach for the management of central fever remains unclear, so we conducted a scoping review to evaluate the pharmaceutical therapies currently being used.

Methods: We screened 183 articles from database searches of PubMed, Embase, and Cochrane. Information on study type, interventions, outcomes, and side effects were extracted and analyzed from 13 articles that met inclusion criteria.

Results: Our literature search showed that acetaminophen, baclofen, baclofen with propranolol, bromocriptine, dantrolene, and diclofenac have been administered to patients with central fever. While most of the articles included in this review are case reports, a randomized clinical trial identified continuous diclofenac infusion as a promising intervention. Acetaminophen reduced fever in patients with central fever; however, when compared to placebo, no significant difference in core temperature reduction was observed. In the articles that included a discussion of side effects, hepatotoxicity was the most commonly mentioned adverse effect.

Conclusion: Diclofenac emerged as the most evidence-supported therapy, backed by higher-quality studies and consistent central fever resolution with relatively few side effects. Because of the paucity of high-quality evidence, further research is needed to establish optimal treatment strategies with minimal adverse effects for patients experiencing central fever.

Background: Localized amyloidosis of the breast is a rare diagnosis that is most often found incidentally during screening breast examinations or on imaging. This diagnosis can be associated with systemic amyloidosis or malignancy, making further investigation a necessity. Rarely, localized amyloidosis of the breast has been associated with lymphoplasmacytic lymphoma.

Case report: A female in her early 70s presented with a mass noted on breast examination. After biopsy, she was diagnosed with localized amyloidosis of the breast. After bone marrow biopsy, the patient was diagnosed with lymphoplasmacytic lymphoma. No evidence of systemic amyloidosis was found. Because the patient is asymptomatic, she is not undergoing treatment, but she is monitored clinically every 6 months.

Conclusion: Breast amyloidosis is a rare diagnosis that should be considered when patients present with a breast mass. This case emphasizes the importance of a full diagnostic workup when breast amyloidosis is diagnosed to rule out systemic amyloidosis or an associated malignancy.

Background: Conversion disorder is a common mimic of ischemic stroke (IS) and transient ischemic attack (TIA). Data comparing the demographic and clinical features of patients with conversion disorder and IS/TIA are scarce, as are data evaluating the accuracy of conversion disorder diagnosis via telestroke consultation.

Methods: We retrospectively analyzed consecutive patients evaluated through the Ochsner Health TeleStroke program from April 2015 through July 2016. Cases were classified into 2 categories: IS/TIA or conversion disorder. Patients with other stroke mimics and uncertain diagnoses were excluded. Both initial diagnosis and final diagnosis (following review of all records) were determined. The baseline characteristics of patients with conversion disorder were compared with the baseline characteristics of patients with IS/TIA. Initial diagnosis was compared with final diagnosis, and the diagnostic accuracy of telestroke consultations for conversion disorder was calculated.

Results: We evaluated 885 patients with complete data. Of the 254 (28.7%) cases of stroke mimics, 50 cases (19.7%) were conversion disorder, representing 6% of all suspected strokes. We analyzed 616 patients with a final diagnosis of IS/TIA or conversion disorder. Compared to patients with IS/TIA, patients with conversion disorder were more likely to be female (P=0.0006) and younger (P<0.0001); were less likely to have diabetes mellitus (P=0.0252), hypertension (P=0.0004), or atrial fibrillation (P<0.0001); were less likely to receive tissue plasminogen activator (P<0.0001); and had a shorter median consultation duration (P=0.0175). The sensitivity, specificity, positive predictive value, and negative predictive value of conversion disorder diagnosis were 0.820, 0.998, 0.976, and 0.989, respectively. The adjusted area under the curve (95% CI) was 0.92 (0.87, 0.97).

Conclusion: We found a conversion disorder rate of 19.7% of stroke mimics in the Ochsner Health TeleStroke Network, with a positive predictive value of 0.976 of discriminating conversion disorder from IS/TIA. In our study, patients with conversion disorder were more likely to be female and younger and to have fewer vascular risk factors compared with IS/TIA patients.

Background: The perfusion index has previously been used to predict the success of brachial plexus blocks but to our knowledge has not yet been studied for the low interscalene block approach. This study evaluated the accuracy of the perfusion index and perfusion index ratio in predicting the success of a low interscalene brachial plexus block in patients undergoing upper limb surgery.

Methods: The study included 70 patients undergoing upper limb surgeries under ultrasound-guided low interscalene brachial plexus block. After local anesthetic injection, patients' sensory and motor blocks were assessed every 5 minutes. The perfusion index was recorded at baseline and then at 5-minute intervals until 30 minutes after anesthetic injection in both the blocked and unblocked limbs. The perfusion index ratio (perfusion index at a specific timepoint/baseline perfusion index) was calculated and recorded at each 5-minute time point. Receiver operating characteristic curves were constructed to determine the accurate value of the perfusion index that indicated block success.

Results: The mean perfusion index and perfusion index ratio were higher in the blocked limb vs the unblocked limb at all time points. At the 10-minute time point, the cutoff values for the perfusion index and perfusion index ratio for a successful block were 3.24 and 3.54, respectively. At the 10-minute time point, the sensitivities of the perfusion index and perfusion index ratio in predicting a successful block were 95.2% and 100%, respectively; specificity was 100% for both the perfusion index and perfusion index ratio.

Conclusion: The perfusion index and perfusion index ratio can accurately predict the success of a low interscalene brachial plexus block well before surgical anesthesia is fully established, thereby saving operating room time. A perfusion index ratio of 3.54 or more at 10 minutes is a reliable predictor of block success.

Background: Hypoglossal nerve palsy is a rare perioperative complication caused by excessive stretching of the nerve. Symptoms include tongue deviation, dysarthria, hoarseness, and dysphagia. We present the case of a patient who experienced bilateral hypoglossal nerve palsy after cardiac surgery.

Case report: A 68-year-old male with hypertension, sleep apnea, and aortic insufficiency presented for aortic valve replacement. He was easily intubated using video laryngoscopy, and surgery proceeded without incident. He remained intubated overnight and was extubated on postoperative day 1. Initially, hoarseness and tongue edema were noted. Further evaluation revealed oropharyngeal dysphagia, silent aspiration, and inability to protrude the tongue, all consistent with a bilateral hypoglossal nerve injury. Because the patient was unable to swallow, a percutaneous endoscopic gastrostomy (PEG) tube was placed. Three months later, electromyography showed denervation of the tongue, suggestive of hypoglossal nerve injury, with good prognosis for recovery. The PEG tube was removed, and the patient was able to tolerate a soft diet. Eight months postoperatively, the patient was started on a normal diet, and at 18 months postoperatively, his speech and vocal fatigue had improved to approximately 90% of normal.

Conclusion: Although rare, hypoglossal nerve palsy is a perioperative complication that can have deleterious effects on patient well-being. Most cases are self-limited and resolve completely in 4 to 6 months; however, some patients experience more lasting effects. Anesthesiologists should take appropriate precautions when positioning a patient's head and neck during intubation and throughout the duration of surgery to help prevent hypoglossal nerve injury.

Background: 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.

Case report: 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.

Conclusion: 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.