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 & Medicine. The organization has 980 authors who have published 1159 publications receiving 49961 citations. The organization is also known as: Ochsner Hospital & Ochsner Foundation Hospital.

Survival Benefit of Aspirin in Patients With Congestive Heart Failure: A Meta-Analysis.

Abstract: Background: There is no clear consensus on the use of aspirin (ASA) in patients with congestive heart failure (CHF) due to its reported interaction with other cardio-prudent medications. The aim was to evaluate the effect of ASA on all-cause mortality and the frequency of hospitalization for heart failure in patients with CHF using meta-analysis, as well as to study the potential variables interacting with this effect. Methods: Eligible studies were identified via a PubMed search, the “related article” feature and a manual search of references. Studies were included if they had a study population with CHF of any etiology, compared ASA to no ASA or placebo, and reported one or both of the following outcomes: 1) all-cause mortality and 2) the frequency of hospitalization for heart failure. Data were extracted and verified. We used the inverse variance method in a random-effects model to combine effect sizes. Results: A total of 14 studies with a combined study population of 64,550 patients were included in the final analysis. All-cause mortality was found to be significantly lower in patients who were taking ASA (P = 0.003). When examining the use of ASA, no significant difference was found in the frequency of hospitalization for heart failure. ASA use was demonstrated to be more beneficial against mortality in studies with a larger percentage of patients on nitrates (P = 0.008) and oral anticoagulants (P = 0.04). A significantly lower rate of hospitalization for heart failure was observed in patients who used oral anticoagulants and ASA concurrently (P = 0.02). Conclusions: ASA may have beneficial effects on mortality in patients with heart failure of all etiologies. J Clin Med Res. 2021;13(1):38-47 doi: https://doi.org/10.14740/jocmr4389

Lymphedema: An early sign of rodent ulcer metastasis leads to timely intervention.

Abstract: Basal cell carcinoma has a potential for early and late metastasis. Depending on the location of the primary site, the relevant lymphatic drainage routes have to be monitored. Regional lymph edema may be a first indicator for metastasizing disease.

Extreme "cannon A waves" and pulsatile skin color in complete heart block.

Abstract: In extreme circumstances, pulsatile facial redness may result from the same pathophysiology that produces cannon A waves. An 89-year-old man presented with a complaint of decreased exertion tolerance. The electrocardiogram revealed complete atrioventricular block with a ventricular escape at 34 beats/ min. Echocardiography demonstrated normal ventricular function and no significant valvulopathy. On physical examination, there was pulsatile neck fullness and facial flushing, both coinciding with ventricular systole (see Videos 1 and 2). Cannon Awaves are seen during arrhythmias in which the atria and ventricles sometimes contract simultaneously, including complete heart block, ventricular tachycardia, and atrioventricular nodal reentry. The pressure generated by atrial contraction against a closed tricuspid valve is transmitted to the jugular veins, resulting in pulsatile fullness in the neck. This patient demonstrated a particularly pronounced example of this physiology, resulting in not only pulsatile neck fullness but also easily detectable cyclic changes in the color of his skin. These changes were especially obvious when the patient’s P waves coincided exactly with QRS complexes. The remarkable oscillation of facial color may have been particularly evident owing to his fair baseline complexion. After pacemaker implantation, cannon A waves were resolved.

Sacral Dorsal Root Ganglion Spinal Stimulation

Abstract: Sacral dorsal root ganglion stimulation (DRGS) is a valuable tool used in the treatment of chronic neuropathic pain, chronic regional pain syndrome (CRPS) Types I and Type II in the foot and/or ankle. Although both spinal stimulation and DRGS apply energy to disrupt pain signals, DRGS is able to more specifically target areas of focal neuropathic pain. The specialized lead placement developed ensures reproducible results and stability in amount of pain relief provided. Significantly better outcomes are achievable when utilizing sacral DRGS and properly executed lead placement technique in patients who suffer from focal neuropathic pain in the feet and/or ankles without diffuse pain within the lumbar spine and/or lower extremities.

Women and men, the same and different.

Abstract: Cardiovascular disease is the primary cause of death in women in the United States, yet there are significant gender disparities between men and women treated for acute coronary syndrome (ACS) [1]. The Prometheus registry examined gender differences in 4,851 patients under 55 years with ACS undergoing percutaneous coronary intervention (PCI). The authors highlight a higher prevalence of modifiable risk factors, namely smoking, diabetes, and hypertension (HTN). When the study adjusted for the baseline differences between the male and female subjects, there was no statistically significant difference in 1-year major adverse cardiac event (MACE) and bleeding events [2]. Significantly, despite the fact that the women in this study undergoing ACS PCI were an overall sicker population with more comorbidities, they did not receive prasugrel which has been shown to provide superior antiplatelet effects. Yet, you can only find what you are looking for. This registry describes the baseline characteristics and treatment of men and women who have already been diagnosed with ACS. Although it seems that troponin specimens are drawn on everyone who comes in to the emergency department (ED), it is not yet universal. Young women in their fifties have an incidence of myocardial infarction of one in a 1,000 [1]. So it then stands to reason that an emergency physician is more likely to perform an ECG or draw a serum troponin in those who are overweight, diabetic, hypertensive, or with kidney disease. What this registry does not capture is how many women came to the ED with chest pain, epigastric discomfort, or shortness of breath and went home without a diagnosis because a troponin was not drawn. How many of the ACS patients in this cohort had been seen in the ED one or more times before the diagnosis of ACS was made because it was not high enough on our differential diagnosis? Prior studies have demonstrated that female patients have similar benefits from treatment with aspirin, prasugrel, and clopidogrel as their male counterparts. In the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with PrasugrelThrombolysis in Myocardial Infarction (TRITON-TIMI 38), similar efficacy was reported for prasugrel use in men and women once baseline differences were adjusted. PLATO similarly demonstrated that there were no differences between men and women for medication efficacy comparing ticagrelor with clopidogrel [3]. Poon et al. also demonstrated that women with ACS are more likely to be managed conservatively; fewer women were treated with a thienopyridine, heparin, and GPIIb/IIIa inhibitors compared with men and they were also less likely to undergo coronary angiography despite guidelines [4]. This difference was attributed to underestimation of patient risk by physicians [4]. Women presenting with ACS tend to have a significantly higher number of modifiable risk factors. Additionally, certain comorbidities, such as smoking, obesity, and diabetes, tend to confer different risk between men and women. For example, the INTERHEART study demonstrated that diabetes conferred a much higher risk of MI in women than men (4.3% vs. 2.7%). This study further showed that an approximately 90% risk reduction in acute MI can be achieved by reducing risk factors,