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.

Resolution of pulsatile tinnitus following an upper mediastinal lymph node resection.

Abstract: External compression of extracranial/mediastinal vessels has not been reported as an etiology of pulsatile tinnitus. We present a case in which compression of extracranial vasculature led to long term pulsatile tinnitus which resolved completely with surgical resection of metastatic lymph nodes. This should be included in the list of differential diagnoses when dealing with any patient with a complaint of pulsatile tinnitus. Patients with advanced carcinoid cancer often present with distant metastases to their left superior mediastinum and supraclavicular lymph node chain. We believe a careful search for nodal metastases compressing vascular structures in such patients is warranted as debilitating pulsatile tinnitus may be cured by a simple surgical procedure.

In reply: Impaired myocardial blood flow in atrial fibrillation

Abstract: To the Editor, We thank Cay et al for their interest in our work and we agree that it is important to consider changes in myocardial blood flow (MBF) that may change over time and that may be related to the patient's prevalent heart rhythm. The article cited in the letter examined magnetic resonance imaging‐derived MBF between nonischemic patients with established paroxysmal/persistent atrial fibrillation (AF) and healthy controls recruited via a poster. These two groups showed significant variation in medical therapy, and quite probably comorbidities (though no data on comorbidity were given). As stated in the Letter to the Editor, there was no improvement in MBF among AF patients following ablation resulting in the restoration of sinus rhythm. To our knowledge, there are no well‐matched data showing significant changes in MBF based solely on rhythm. It also is important to note that all patients in our study had atrial fibrillation, and we compared survival among those with occult coronary artery disease (CAD) who were or were not treated with Class 1C antiarrhythmic medication. We were able to identify patients who had CAD based on the relatively novel metric coronary flow capacity (CFC), which differs from global coronary flow reserve (CFR) in that CFC is a pixel‐by‐pixel based metric that combines rest MBF, stress MBF, and CFR into an integrated measurement of CAD severity. We refer the interested reader to references 6 through 9 of our JCE paper, as well as our examination of the impact of revascularization on myocardial blood flow, for further definition, explanation, and examples.

Hypopharyngeal Airway Surgery for Obstructive Sleep Apnea: Morbidity in the Early Postoperative Period:

Abstract: Objectives:Determine if hypopharyngeal surgery for obstructive sleep apnea is associated with significant morbidity in the early postoperative period.Methods:Medical records review and retrospective telephone survey of patients who underwent hypopharyngeal surgery for obstructive sleep apnea between November 2012 and September 2013 at a tertiary care facility.Results:Twenty-two patients underwent hypopharyngeal surgery for obstructive sleep apnea. No patient experienced intraoperative complications, postoperative O2 desaturation <90%, prolonged admission for inadequate pain control, pulmonary edema, or airway compromise requiring re-intubation. Postoperative complications included 1 episode of nasal hemorrhage, 1 infection requiring hospitalization, and 1 episode of dehydration treated with IV fluids. Twenty-five percent of patients experienced some degree of postoperative dysphonia, and 87.5% of patients experienced postoperative dysphagia. The average rating for postoperative pharyngeal pain was 3.5 by ...

Minimally invasive repair of a pseudomeningocele caused by a sheared intrathecal catheter following implantation of a drug delivery system.

Abstract: Background Shearing of an intrathecal catheter during implantation of a drug delivery system is an underreported complication that can be challenging to manage. Case Description A 53-year-old man with refractory cancer pain had an intrathecal pump system implanted. The procedure was complicated with catheter shear and retention in the intrathecal space. A second catheter was successfully placed but formation of a painful pseudomeningocele and ineffective pain relief complicated the outcome. A minimally invasive approach through a tubular retractor was employed to access the spinal canal via a laminotomy, the sheared catheter was removed and the dural defect repaired. Complete resolution of the pseudomeningocele and efficient pain control were observed at follow-up. Conclusion Minimally invasive approach to the spine is demonstrated as a safe and effective alternative in this case of retained catheter induced cerebrospinal fluid (CSF) leak.

Outcomes of precut sphincterotomy techniques in cases of difficult biliary access.

Abstract: Goals Our study aims to define success and complication rates of precut sphincterotomy with the needle-knife and transpancreatic papillary septotomy (TPS) techniques as experienced at a single, high-volume endoscopy centre. Background Complication rates rise with increasing number of failed attempts at biliary cannulation; therefore, early precut sphincterotomy (PS) has been recommended. Selecting the ideal method for PS can be challenging and there is a paucity of data to help guide this decision. Study We performed a retrospective analysis over 37 months of endoscopic retrograde cholangiopancreatography (ERCP) experience at a single institution. We identified all ERCPs performed and stratified based on the presence of PS; if PS occurred, a thorough chart review was performed to identify success and complication rates. Patients received guideline-driven management for post-ERCP pancreatitis including rectal indomethacin and pancreatic duct stenting when appropriate. Results We identified 1808 ERCP procedures performed during this time. Successful biliary cannulation was achieved in 1748 cases, yielding a success rate of 96.7% (Grades I–IV ERCP difficulty/complexity). PS was required in 232 cases (12.8%); we identified 88 TPS cases and 114 needle-knife precut sphincterotomy (NKPS) cases. Complications following PS procedures occurred in 9.1% of TPS patients and 11.4% of NKPS patients. Success rates for TPS and NKPS were 97.7% and 81.6%, respectively—a statistically significant difference (p Conclusion This data supports TPS as a safe and effective option for biliary access in difficult cannulation settings when performed by experienced advanced endoscopists.