Memorial Hermann Texas Medical Center

About: Memorial Hermann Texas Medical Center is a based out in . It is known for research contribution in the topics: Population & Stroke. The organization has 236 authors who have published 199 publications receiving 7405 citations.

Full Remission of Long-Term Premenstrual Dysphoric Disorder-Like Symptoms Following Resection of a Pituitary Adenoma: Case Report.

Abstract: BACKGROUND Few case reports exist in the literature of patients with pituitary adenoma presenting with premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD). Complete remission of persistent PMDD symptoms after surgical removal of a pituitary lesion has not been reported. CASE REPORT We report a case of a 44-year-old woman with childbearing potential who underwent transsphenoidal surgery (TSS) in December 2017 to remove a non-functioning pituitary adenoma. The surgery resulted in full remission of her PMDD symptoms. The patient's hormone levels remained stable before and after the TSS procedure. During 28 months of follow-up, the woman has been asymptomatic for periods of 6 consecutive months or longer without taking antidepressants. Given the patient's current condition, a durable remission from PMDD is anticipated. CONCLUSIONS We believe that refractory PMS/PMDD associated with pituitary lesions is under-diagnosed and under reported. As demonstrated in this case, surgical intervention for a sellar mass has the potential to be effective or even curative for patients with PMS/PMDD. We recommend that physicians consider magnetic resonance imaging of the brain in patients with PMS/PMDD.

Patent Foramen Ovale With Platypnea - Orthodeoxia Syndrome: A Case Report.

Abstract: Platypnea-orthodeoxia syndrome (POS) is an extraordinary medical condition characterized by positional dyspnea (platypnea) and arterial desaturation or hypoxemia (orthodeoxia) in the setting of an upright position. The difficulty breathing is alleviated upon lying down. It is the opposite of orthopnea and is manifested by a decrease in oxygen saturation when changing from supine to an orthostatic position. POS can have an intracardiac or an extracardiac etiology. Herein we report a case of an 87-year-old man presenting with acute on chronic dyspnea who showed promising improvement in oxygen saturation after patent foramen ovale (PFO) closure.

Robot-Assisted Ventral and Incisional Hernia Repair

Abstract: The da Vinci robotic laparoscopic incisional hernia repair with intracorporeal closure of fascial defect and circumferential suturing of mesh may offer an alternative to current fascial closure and transabdominal sutures and tackers. The robotic repair method uses intracorporeal primary closure of fascial defect with a running O-absorbable suture, followed by underlay mesh fixation using a continuous running, circumferential, nonabsorbable suture. It can be performed quickly and safely. Pain control and hospital stay experiences seem similar to standard laparoscopic approaches; however there may be a decreased incidence of chronic suture site pain/discomfort. Further evaluation is needed and long-term data is lacking to assess the benefit to the patient.

When a Patient Says “No”

Abstract: VT is an 18-year-old Asian American male who presents into the hospital with a history of paraplegia secondary to a gunshot wound, neurogenic bladder, and pressure ulcers. Prior to admission, the patient complained of nausea and vomiting for 2 weeks. He also reports a history of urinary-tract infections, the last one a few months prior to his current admission. This patient is cared for at home by his older brother and parents. His brother is the primary caregiver for the patient and provides the patient with care for all his activities of daily living. Although supportive, the patient’s brother and parents have not been at the hospital. During his hospital course, the patient was found to have sepsis with a urinary-tract infection, multiple decubitus ulcers, and osteomyelitis of the right hip with his femur protruding through a large decubitus ulcer. The Infectious Disease Department was consulted and determined that, due to the extensive osteomyelitis, antibiotics alone will not adequately treat the infection, and recommended a surgery consult for possible resection of the bone. The primary team and the infectious disease team discussed the recommended surgery with the patient. After a long discussion, the patient refused surgery and insisted that he be discharged home prior to his upcoming birthday the following week. He stated he did not like the hospital setting and wanted to return home as soon as possible. He also told a nurse he did not want amputation. During the next several days, members of the health care team had multiple discussions with the patient regarding the recommendation and necessity of surgery. The possible consequences of discharge without surgery were explained and included further bone destruction, possible systemic spread of infection to remote areas, and ultimately possible sepsis and death. After each discussion the patient, who was determined to have capacity, continued to refuse surgery and focused on returning home before his birthday. In addition, he did not allow the primary team to discuss his decision with his family. The primary and infectious disease teams have considered various treatment options, but the infectious disease team insists that antibiotics alone will not benefit the patient and may increase the risk for possible toxicity as a result of extended use. After several days of attempting to reach a resolution with the patient and the infectious disease team, the primary team is requesting an ethics consultation. How should the ethics consultant respond? &