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.

Positron emission tomography absolute stress myocardial blood flow for risk stratification in nonischemic cardiomyopathy

Abstract: Sudden cardiac death is a substantial cause of mortality in patients with cardiomyopathy, but evidence supporting implantable cardioverter defibrillator (ICD) implantation is less robust in nonischemic cardiomyopathy (NICM) than in ischemic cardiomyopathy. Improved risk stratification is needed. We assessed whether absolute quantification of stress myocardial blood flow (sMBF) measured by positron emission tomography (PET) predicts ventricular arrhythmias (VA) and/or death in patients with NICM. In this pilot study, we prospectively followed patients with NICM (LVEF ≤35%) and an ICD who underwent cardiac PET stress imaging with sMBF quantification. NICM was defined as absence of angiographic obstructive coronary stenosis, significant relative perfusion defects on imaging, coronary revascularization, or acute coronary syndrome. Endpoints were appropriate device therapy for VA and all-cause mortality. Subgroup analysis was performed in patients who had no prior history of VA (i.e., the primary prevention population). We followed 37 patients (60±14 years, 46% male) for 41±23 months. The median sMBF was 1.56 mL/g/min [IQR 1.00-1.82]. Lower sMBF predicted VA, both in the whole population (HR for each 0.1 mL/g/min increase: 0.84, P=0.015) and in the primary prevention subset (n=27; HR for each 0.1 mL/g/min increase: 0.81, P=0.049). Patients with sMBF below the median had significantly more VA than those above the median, both in the whole population (P=0.004) and in the primary prevention subset (P=0.046). Estimated 3-year VA rates in the whole population were 67% among low-flow patients vs. 13% among high-flow patients, and 39% vs. 8% among primary-prevention patients. sMBF did not predict all-cause mortality. In patients with NICM, lower sMBF predicts VA. This relationship may be useful for risk stratification for ventricular arrhythmia and decision-making regarding ICD implantation. This article is protected by copyright. All rights reserved.

Clinical Characteristics and Glycemic Outcomes of Patients with Type 2 Diabetes Requiring Maximum Dose Insulin Glargine/Lixisenatide Fixed-Ratio Combination or Insulin Glargine in the LixiLan-L Trial

Abstract: iGlarLixi is a titratable, fixed-ratio combination of insulin glargine (iGlar, 100 units/ml) and the glucagon-like peptide-1 receptor agonist lixisenatide for the treatment of patients with type 2 diabetes. This post hoc analysis of the phase 3 LixiLan-L trial (NCT02058160) investigated baseline characteristics, glycemic control, and safety outcomes in participants who received the study-specified maximum dose (60 units/day) of iGlarLixi or iGlar vs. those who received < 60 units/day. Outcomes were compared for participants receiving 60 or < 60 units/day at week 30. Endpoints analyzed included change in A1C, fasting plasma glucose (FPG), 2-h postprandial glucose (2-h PPG), body weight, proportion of participants achieving A1C < 7.0%, proportion of participants receiving rescue therapy, documented symptomatic hypoglycemia, and gastrointestinal adverse event (GI AE) incidence. By week 30, 27% (iGlarLixi) and 31% (iGlar) of participants received the maximum dose. Participants on 60 vs. < 60 units/day were younger and had higher body weight, body mass index (BMI), FPG, and baseline insulin dose. In both dose groups, A1C change from baseline was significantly greater with iGlarLixi vs. iGlar, and more participants treated with iGlarLixi vs. iGlar achieved A1C < 7.0%. No significant differences were observed in change from baseline for A1C, FPG, 2-h PPG, or GI AE incidence between insulin dose groups, regardless of treatment. In both treatment arms, incidence of symptomatic hypoglycemia was lower in participants receiving 60 units/day vs. those receiving < 60 units/day. Participants treated with iGlarLixi (< 60 or 60 units/day) had modest weight loss over 30 weeks vs. an increase in weight compared with iGlar. Maximum doses of iGlarLixi were required in participants with a more insulin-resistant clinical phenotype (younger, higher BMI, FPG, and insulin doses). Benefits were observed with iGlarLixi vs. iGlar, even at 60 units/day, with more participants achieving glycemic goals, no increase in symptomatic hypoglycemia, and a modest reduction in body weight. Sanofi US, Inc.

Bruising, Tingling, and Numbness in a Pale Adolescent

Abstract: A 14-year-old male, with a past medical history of vitiligo was referred from an outside hospital for management of thrombocytopenia and left-sided numbness and tingling. The patient bumped the top of his head on a locker 5 days prior to presenting to an outside hospital emergency department. He denied any loss of consciousness, headache, or bleeding during the event. He complained of nausea, vomiting, abdominal pain, subjective fevers, and chills on the day prior to the visit. He was diagnosed with a “stomach virus” and given per oral Bactrim. The next day he returned to the outside hospital emergency department with increased bruising and short episodes of tingling and numbness lasting less than a minute on the left side of his body. Workup at the outside hospital was as follows: white blood cell count 7900/μL; hemoglobin(Hb) 8.9 g/dL; hematocrit (Hct) 25.1%; and platelets 8000/μL with a differential of 55.3% neutrophils, 31% lymphocytes, 12.3% monocytes, and 1% eosinophils. C-reactive protein was 3.9 mg/L (normal = 0.1-8.2 mg/L) and erythrocyte sedimentation rate was 84 mm/h. Liver function tests revealed an elevated total bilirubin level at 2.1 mg/dL. Basic metabolic panel was unremarkable. Review of systems revealed fatigue, nausea, vomiting, and abdominal pain. He denied any changes in weight, hematuria, arthralgia, seizures, epistaxis, or bleeding. The patient’s past medical history was significant for vitiligo and seasonal allergies. Current medications included Bactrim and topical treatments for the vitiligo. Family history was negative for hematologic and oncologic disorders. The physical exam was significant for scattered petechiae on the trunk, back, and lower extremities. There were hypopigmented macular lesions on the posterior neck, fingertips, and at the hairline on the forehead. The rest of the physical exam was unremarkable. Complete blood count showed thrombocytopenia with platelet count of 5000 and anemia (Hb = 7.3 g/dL). The basic metabolic panel was unremarkable. Uric acid level was 7.5 mg/dL with total bilirubin of 1.8 mg/dL. Coagulation studies were within normal limits. Lactate dehydrogenase was elevated at 901 U/L. Direct Coombs test was negative. His total bilirubin was increased to 2.1 mg/dL (normal <1 mg/dL). Urinalysis was positive for 4+ blood, 10 to 20 red blood cells, and 2+ bacteria. The patient was negative for antinuclear antibody, cytomegalovirus IgG and IgM, Epstein–Barr virus IgM, and Monospot test. Epstein–Barr virus IgG was elevated indicating a past infection. Abdominal ultrasound showed hepatosplenomegaly. Magnetic resonance imaging of the brain was unremarkable.

A Propeller Perforator Flap in the Distal Lower Extremity: An Alternative to Free Flap Coverage Near the Ankle.

Abstract: As perfusion assessment technologies and microsurgical techniques have evolved, plastic surgeons have become increasingly aggressive and creative in offering reconstructive solutions to limb salvage problems. In the distal lower extremity, pedicled perforator flap transfer has grown in popularity as compared to the historically reliable option of free tissue transfer. Pedicled perforator flaps typically avoid muscle harvest and restore the thin, supple soft tissue in the distal extremity, where there is a relative lack of redundancy of soft tissues. They also allow for a shorter operative time and recovery in otherwise complex wounds of the foot and ankle. This case report highlights the indications, nuance, and post-operative course of a patient who underwent peroneal perforator flap for coverage of a complex ankle wound in the setting of a calcaneal fracture.