Ochsner Medical Center

About: Ochsner Medical Center is a healthcare organization based out in New Orleans, Louisiana, United States. It is known for research contribution in the topics: Population & Heart failure. The organization has 980 authors who have published 1159 publications receiving 49961 citations. The organization is also known as: Ochsner Hospital & Ochsner Foundation Hospital.

SAGES VTE prophylaxis for laparoscopic surgery guidelines: an update.

Abstract: Since the publication of the SAGES guidelines for venous thromboembolism (VTE) prophylaxis during laparoscopic surgery in 2007 [1], the American College of Chest Physicians (ACCP) has published their comprehensive guidelines that address VTE prophylaxis for non-orthopedic surgery patients [2]. After careful review, the SAGES guidelines committee has approved the endorsement of the ACCP guidelines rather than updating our previous VTE guidelines. The ACCP guidelines utilize the VTE risk stratification systems by Rogers et al. [3] and Caprini [4] and outline prophylaxis strategies based on the calculated risk of VTE. For very low-risk patients, ambulation without chemoprophylaxis or mechanical prophylaxis is recommended. For low-risk patients, mechanical prophylaxis with intermittent pneumatic compression (IPC) is advised. For patients at moderate risk for VTE, the guidelines suggest low molecular weight heparin (LMWH), unfractionated heparin (UH), or mechanical prevention with IPC. For high-risk patients, the ACCP guidelines recommend LMWH or UH plus elastic stockings or IPC. The 2012 ACCP guidelines are easy to use, are more comprehensive, and are based on stronger evidence than the 2007 SAGES VTE prevention guidelines. However, they are not specifically directed at laparoscopic surgery patients. There are differences in VTE risk between open procedures compared with those performed laparoscopically. In a study comparing the incidence of VTE following laparoscopic versus open surgery in 138,595 patients, there was a statistically significant reduction in risk of VTE after laparoscopic surgery compared to open surgery [5]. The specific type of procedure is not considered in the calculation of VTE risk. A meta-analysis on laparoscopic cholecystectomy indicated that routine use of VTE chemoprophylaxis was likely to be unnecessary and suggested considering its use only in higher-risk patients based on risk stratification [6]. The overall incidence of clinically evident deep venous thrombosis (DVT) was 1.6% without prophylaxis. Two randomized studies included in that analysis reported on the risk of major bleeding; one reported no major bleeding, while the other study reported major bleeding in 2% in the heparin group versus 3% in the group without chemoprophylaxis. Using the ACCP guidelines, many patients from this study may have been at low to moderate risk using either of the scoring systems and would be given no prophylaxis for a Caprini score of 0, IPC for a score of 1–2, or UH, LMWH, or IPC for a score of 3–4 (moderate risk). Based on the meta-analysis, there was no significant benefit of chemoprophylaxis in cholecystectomy patients. Among patients undergoing colon surgery with or without cancer, there is a reduction in VTE using a combination of IPC and chemoprophylaxis. Data from the Michigan Collaborative of 3464 patients on dual therapy showed a 1.7% risk of VTE with laparoscopic left versus 0.5% for right colectomy [7]. In this study, older patients, & William S. Richardson wrichardson@ochsner.org

Multisociety consensus quality improvement guidelines for intraarterial catheter‐directed treatment of acute ischemic stroke, from the American Society of Neuroradiology, Canadian Interventional Radiology Association, Cardiovascular and Interventional Radiological Society of Europe, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, European Society of Minimally Invasive Neurological Therapy, and Society of Vascular and Interventional Neurology

Abstract: Purpose In this international multispecialty document, quality benchmarks for processes of care and clinical outcomes are defined. It is intended that these benchmarks be used in a quality assurance program to assess and improve processes and outcomes in acute stroke revascularization. Materials and Methods Members of the writing group were appointed by the American Society of Neuroradiology, Canadian Interventional Radiology Association, Cardiovascular and Interventional Radiological Society of Europe, Society of Cardiac Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, European Society of Minimally Invasive Neurological Therapy, and Society of Vascular and Interventional Neurology. The writing group reviewed the relevant literature from 1986 through February 2012 to create an evidence table summarizing processes and outcomes of care. Performance metrics and thresholds were then created by consensus. The guideline was approved by the sponsoring societies. It is intended that this guideline be fully updated in 3 years. Results In this international multispecialty document, quality benchmarks for processes of care and clinical outcomes are defined. These include process measures of time to imaging, arterial puncture, and revascularization and measures of clinical outcome up to 90 days. Conclusions Quality improvement guidelines are provided for endovascular acute ischemic stroke revascularization procedures. © 2013 Wiley Periodicals, Inc.

Antihypertensive therapy: safety and efficacy of drugs and publications.

Abstract: Periodically, in the history of antihypertensive therapeutics, there have been minor tempests that have significantly affected the utilization of entire classes of agents. The first storm struck with the case study report that suggested reserpine and its related compounds were associated with increased risk of carcinoma of the breast.1 Despite its subsequent disproval of this association, the use of these agents was dramatically reduced in favor of newer agents. The second storm was initiated by subanalysis of the MRFIT study,2 from which it was inferred that in a subset of hypertensive patients (those with evidence of electrocardiographic abnormality) diuretic treatment may have been harmful rather than beneficial. Fuel was added to this fire from consecutive meta-analysis of available multicenter antihypertensive drug trials, in which diuretic- or beta-adrenergic receptor blocker-based therapy failed to reduce coronary events to a statistically significant extent. Even when in a further meta-analysis3 a statistically significant reduction was finally attained ( P <.01), it was emphasized that, while a predicted 40 percent reduction in stroke was achieved, the significant 14 percent reduction in coronary morbidity and mortality was definitely lower than the predicted 20 to 25 percent reduction. The results of these publications was an avalanche of speculative talks, articles, and editorials that suggested an adverse effect of diuretics that, either by raising serum lipid levels or by lowering serum potassium, led to a so-called “failure to prevent myocardial infarction.” A subsequent meta-analysis included additional studies which employed lower diuretic doses and reported a reduction in cardiac events satisfying the predicted 25 …

Suprasellar Epidermoid Cyst Originating from the Infundibulum: Case Report and Literature Review.

Abstract: Epidermoid cysts account for a small fraction of intracranial brain tumors, most commonly found in the cerebellopontine angle and parasellar cisterns. Here we present a rare case of an epidermoid cyst located in the suprasellar region, specifically originating from the infundibulum. Only one additional case with an epidermoid cyst originating within the pituitary stalk has been previously reported in the literature. The patient in this case presented with headaches, diplopia and blurred vision without any endocrinopathy. The patient’s pre-operative evaluation was significant for pseudotumor cerebri, hyponatremia, obesity, and a history of smoking; post-operative course was significant for neurogenic diabetes insipidus.

A rat study of the use of end-to-side peripheral nerve repair as a "babysitting" technique to reduce the deleterious effect of chronic denervation.

Abstract: OBJECTIVEFunctional recovery is disappointing after surgical repair of nerves that are injured far from their target organs and/or after delayed repair. In the former case, a nerve transfer that transects a distal nerve fascicle to innervate denervated targets is one strategy to promote nerve regeneration and functional recovery. An alternate strategy tested in this study is to perform an end-to-side neurorrhaphy to “babysit” (protect) the denervated distal nerve stump at the time of nerve repair and reduce the deleterious effect of chronic denervation on nerve regeneration.METHODSIn the hindlimbs of Sprague-Dawley rats, the common peroneal (CP) nerve was transected unilaterally and the distal CP nerve stump inserted through a perineurial window into the intact tibial (TIB) nerve, i.e., CP-TIB end-to-side neurorrhaphy. In the first experiment, TIB nerve motoneurons that had regenerated and/or sprouted axons into the CP nerve within 3 months were stimulated to elicit contractions, and thereafter, identifie...