Boletin De La Asociacion Medica De Puerto Rico[JOURNAL]
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200 papers
Adequate Administration of Perioperative Antibiotics in Orthopedic Patients: Quality Assessment Study.
Rivera E, Titley WH, López E … +1 more , Otero A
Bol Asoc Med P R · 2016 · PMID 29192749
The Centers for Disease Control and Prevention (CDC) estimate that nearly 500,000 surgical site infections (SSIs) occur annually.[3] SSIs remain a substantial cause of morbidity and mortality among hospitalized patients....
The Centers for Disease Control and Prevention (CDC) estimate that nearly 500,000 surgical site infections (SSIs) occur annually.[3] SSIs remain a substantial cause of morbidity and mortality among hospitalized patients. For this reason, we developed a quality assessment study with a perioperative antibiotic protocol that included antibiotic type, weight dependent dose, and intraoperative re-dosing regime for the proper administration of prophylaxis antibiotics prior to orthopedic surgery. We restricted our study to knee replacement and hip replacement surgeries. All records from September 2014 to June 2015 were taken into consideration (78 cases). Before February 2015 (protocol implementation date), only 33% or 13 of 39 cases were correctly dosed. After protocol establishment: 44 % or 17 of 39 cases were correctly dosed. Although our p-value suggests no statistical significance, there was an increasing trend of adequate antibiotic administration. In conclusion, we need to educate more our nursing staff and implement monthly audits of our cases to improve our mistakes and ensure that this aspect of practice will remain in the forefront of perioperative orthopedic surgery care.
A middle aged woman with isolated ACTH deficiency associated with transient growth hormone deficiency.
Hernán Martínez J, Mangual Garcia MM, Gutiérrez Acevedo M … +7 more , Sánchez Cruz A, Laboy I, Rivera C, Mansilla P, Palermo Garofalo C, Lourdes Miranda M, Torres Rafael O
Bol Asoc Med P R · 2016 · PMID 29192748
Isolated ACTH deficiency (IAD) is a rare entity characterized by secondary adrenal insufficiency with low levels of serum cortisol, decreased production of ACTH, adequate secretion of other pituitary hormones and normal...
Isolated ACTH deficiency (IAD) is a rare entity characterized by secondary adrenal insufficiency with low levels of serum cortisol, decreased production of ACTH, adequate secretion of other pituitary hormones and normal pituitary structure on radioimaging. The prevalence of IAD as a cause of secondary adrenal insufficiency has not been determined. Impairment of growth hormone (GH) secretion has been noted in 20 to 30% of patients with IAD which is normalized after glucocorticoid replacement. We report the case of a 50 years-old female with symptoms and laboratory results suggestive of adrenal insufficiency. Insulin tolerance test confirmed ACTH and growth hormone deficiency. The rest of the anterior pituitary hormones were normal. A pituitary MRI was unremarkable. Glucocorticoid replacement therapy started and eight months afterwards glucagon stimulation test revealed persistent ACTH deficiency but nor- mal growth hormone secretion. IAD can present with nonspecific symptoms and could be potentially fatal in an acute stressful period. Prompt recognition is essential to decrease morbidity and mortality.
[Not Available].
Carrero T, Padilla Cotto L, Rodríguez-Gómez J
Bol Asoc Med P R · 2016 · PMID 29172373
Abstract loading — click title to view on PubMed.
[Not Available].
Calderon-Miranda W, Villa-Mejia E, Moscote-Salazar LR … +1 more , Escobar N
Bol Asoc Med P R · 2016 · PMID 29172372
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Analysis of clinical characteristics of dialysis patients at the University Hospital.
Cintrón Rosa FB, Soto Hernández E, Rivera Valentín A … +6 more , Díaz Rodríguez HJ, Arroyo Soto JM, Delgado Garrastegui ÁF, Ocasio Meléndez IE, Ortiz Kidd E, Cangiano JL
Bol Asoc Med P R · 2016 · PMID 29172371
OBJECTIVES: The incidence and prevalence of Chronic Kidney Disease (CKD) patients treated with dialysis has continued to increase worldwide. These patients are at the highest risk of developing cardiovascular complicatio...
OBJECTIVES: The incidence and prevalence of Chronic Kidney Disease (CKD) patients treated with dialysis has continued to increase worldwide. These patients are at the highest risk of developing cardiovascular complications which contribute to their demise. The objective of this study was to describe the clinical and demographic characteristics of the patients on maintenance hemodialysis at the University Hospital, in San Juan Puerto Rico. METHODS: We reviewed a total of 55 active patients. Data was collected to identify the demographic and clinical characteristics. Co-morbid conditions such as diabetes mellitus, hypertension, and coronary artery disease (CAD) were noted as well as age, dialysis vintage and social and educational profiles. RESULTS: Patients were divided into two groups according to age (group 1 were less than 60 years and group 2 were more than 60 years). Average age was 42 years in group 1 with 17 females and 24 males and 78 years in group 2 with 6 females and 8 males. Diabetes mellitus was present in 17 (41%) of group 1 and 5 patients (35%) of group 2. Likewise hypertension was present in 26 (63%) of group 1 patients and 11(78%) of group 2 patients. CAD was present in 15 (36%) of group 1 patients and 7 (50%) of group 2 patients. There was an association between low annual income in both groups but not in the level of education. CONCLUSION: A relatively young population was identified in our descriptive analysis of hemodialysis patients at the University Hospital. The expected high incidence of diabetes mellitus observed in the general population of hemodialysis patients in our country was not present. Hypertension and CAD were major risk factors in these patients. In view of these findings we recommend better control of blood pressure, prevention and early detection of CAD in CKD patients before initiating dialysis.
Previous Exposure to Anesthesia and Autism Spectrum Disorder (ASD): A Puerto Rican Population-Based Sibling Cohort Study.
Creagh O, Torres H, Rivera K … +3 more , Morales-Franqui M, Altieri-Acevedo G, Warner D
Bol Asoc Med P R · 2016 · PMID 29172370
BACKGROUND: Autism Spectrum Disorder (ASD) is characterized by impaired social interaction and communication, and by restricted and repetitive behavior, that begins usually before a child is three years old.(1) Researche...
BACKGROUND: Autism Spectrum Disorder (ASD) is characterized by impaired social interaction and communication, and by restricted and repetitive behavior, that begins usually before a child is three years old.(1) Researchers have shown that prevalence rates in the U.S. may be as high as 1 in 68.(52) A number of studies have examined the effects of early exposure to anesthesia on brain development and subsequent impairment in neurocognitive function; yet, little is known about the possible effects of anesthetic agents on social-behavioral functioning. The association between exposure to anesthesia either in uterus, during the first years of life, or later and development of Autistic Spectrum Disorder (ASD) or its severity was determined in a retrospective population based cohort study. OBJECTIVES: Identify if children who had previous exposure to anesthesia either in uterus, first years of life during their developing brain years, or later, are at risk of developing ASD and its severe form of the disease. METHODS: Data was obtained from structured interviews administered to a sample of 515 parents/guardians distributed in two groups: ASD = 262 children diagnosed with this condition and Non-ASD: 253 children (siblings of ASD group) without diagnosis (95% confidence interval) that freely decided to participate and agreed to a consent form. Variables studied include: demographics, diagnosis and severity of ASD, exposure to anesthesia, method of childbirth, and age of exposure Children less than 2 years of age were considered into have developing brain period. Data was analyzed using Chi-square or Fisher exact test. RESULTS: In contrast to non-ASD group, most of the children within ASD group were male, 76% (p=0.0001). With regards to methods of childbirth, 64% of the ASD population were vaginal delivery (VD; Non-anesthesia exposure group) and 36% cesarean delivery (CD) compared to non-autistic population with 71% VD and 29% CD, which demonstrates no statistical difference between both groups (p=0.1113). Out of the 36% of ASD population that underwent CD, 7% were performed using general anesthesia and 93% regional anesthesia, while the 29% of the CD of non-ASD, 5% were performed using general anesthesia and 95% regional anesthesia. This reveals no statistical significance (p=0.7569) with the development of ASD and the type of anesthesia used when comparing ASD with non-ASD patients. In view of severity of autism, in VD, 56% of ASD population had mild form of the disorder, 34% moderate, and 10% severe; while CD had a 54% mild form of the disorder, 33% moderate, and 13% severe. This shows no statistical association (p=0.8069) when comparing exposure to anesthesia in uterus to subsequent severe form of ASD. Of the 262 ASD patients, 99 had exposure to anesthetics before their diagnosis, while in Non-ASD population, 110 had exposure to anesthesia, demonstrating no statistically significant association between both groups (p=0.2091). Out of 99 ASD patients exposed to anesthesia prior to their diagnosis, 72 were exposed before age 2. When compared to the 110 Non-ASD patients exposed to anesthesia, 86 had exposure during this developing brain period, which indicates no statistically significant association (p=0.4207). In addition, most of the ASD children exposed to anesthesia during developing brain were diagnosed with mild degree of the disorder when compared to ASD children without any previous exposure to anesthesia (p=0.9700) during the same period. When the exposure occurred after age 2, ASD children developed mild form of the disorder as compared with ASD children without any previous exposure to anesthesia (p=0.1699) in that period. CONCLUSIONS: Children under early exposure to anesthesia in uterus, first 2 years of life, or later are not more likely to develop neither ASD nor severe form of the disorder.
Cerebrospinal Fluids Leaks of the Cranial Vault Management with Compression Cap: Case Series.
Orlando Rojas L, Contento Meléndez D, Maldonado Morán MÁ … +2 more , Esteban Muñoz J, Marcela Restrepo C
Bol Asoc Med P R · 2016 · PMID 29172369
Cerebrospinal fluid leaks of the cranial vault, constitute one of the most common complications after neurosurgical procedures. In this paper we introduce to you an observational study, in which a series of patients with...
Cerebrospinal fluid leaks of the cranial vault, constitute one of the most common complications after neurosurgical procedures. In this paper we introduce to you an observational study, in which a series of patients with this complication where managed by using elastic compression hat during 18 hours per day, for two weeks to four months. Every one of them presented complete resolution of the leak, without any recurrence until actual controls. After that we perform a review of the literature, demonstrating this is a new therapeutic management, being us the first group on reporting it. According to the observed results, it was concluded that despite more studies are required, the use of elastic compression hats for this kind of patients could be effective and safe.
Psoriasis and Coronary Artery Disease in Hispanics.
Nieves-Rivera J, Sulia C, Gonzalez R … +4 more , Figueroa L, Banchs H, Altieri P, González W
Bol Asoc Med P R · 2016 · PMID 29172365
Psoriasis is an immune disorder characterized by chronic activation of systemic inflammation. Morbidity and mortality in patients with psoriasis is attributed mainly to cardiovascular disease. There are studies in Caucas...
Psoriasis is an immune disorder characterized by chronic activation of systemic inflammation. Morbidity and mortality in patients with psoriasis is attributed mainly to cardiovascular disease. There are studies in Caucasians and African- Americans, but little is known about how psoriasis is associated to coronary artery disease (CAD) in Hispanics. We intend to describe the angiographic findings of a group of Puerto Rican patients with psoriasis. Retrospective cohort study of 46 patients with psoriasis were studied. Coronary angiographic reports were reviewed, and collected data was statistically analized. Population median age was 56, and 72% were males. Of the 46 patients, 27 had CAD by angiographic criteria (58.7%). Twelve patients were referred to bypass graft surgery, 8 underwent coronary stent placement, and 7 were treated medically. Whether psoriasis can be considered a risk factor for developing CAD is still on debate. More than 50% of our patients with psoriasis had angiographic evidence of CAD. Adjusting for traditional cardiovascular risk factors, we found no significant association (p>0.05) with CAD. We believe that inflammation plays a contributing role in the increased risk of CAD in these patients. The importance of this study relies on being the first retrospective analysis in a group of Hispanics trying to determine an association between coronary artery disease and psoriasis when in Puerto Rico, coronary artery disease is 30% less than in the United States.
The Role of Fibrinolytic Therapy in the Emergency Department.
Rivera-Bou WL, Chersich A
Bol Asoc Med P R · 2016 · PMID 29172357
Emergency physicians are many times the first-line practitioners to encounter circulatory emergencies. Amongst these many diseases we face, of importance are acute myocardial infarction, ischemic cerebrovascular accident...
Emergency physicians are many times the first-line practitioners to encounter circulatory emergencies. Amongst these many diseases we face, of importance are acute myocardial infarction, ischemic cerebrovascular accidents and pulmonary embolism. Familiarity with fibrinolytic agents and regimens, as well as indications and contraindications, are crucial to the emergency department physician. Fibrinolytic therapy has been shown to be beneficial and can serve as a bridge to definite treatment, while lowering the risk of morbidity and mortality. Unfortunately fibrinolytic therapy is underused and often administered later than optimum. The aim of fibrinolytics is to dissolve blood clots that can cause serious and potentially life-threatening damage if not removed in a timely manner. The mechanism of this benefit relates to maximizing tissue salvage by early restoration of blood flow and thereby enhancing both early and long-term survival. Older thrombi have extensive fibrin polymerization making them more resistant to thrombolysis; hence, the importance of early administration of fibrinolytic therapy.
The Perils of Diagnosing and Treating Overlap Syndrome.
Class-Vázquez W, Olivero-Rivera S, Rosa-Cruz S … +2 more , Laboy-Olivieri C, Toro DH
Bol Asoc Med P R · 2016 · PMID 29172353
Autoimmune hepatitis (AIH) may present with clinical, laboratory abnormalities and histological features suggestive of primary biliary cirrhosis (PBC) or primary sclerosing cholangitis (PSC). These variants of AIH are kn...
Autoimmune hepatitis (AIH) may present with clinical, laboratory abnormalities and histological features suggestive of primary biliary cirrhosis (PBC) or primary sclerosing cholangitis (PSC). These variants of AIH are known as overlap syndromes. We present a case of a 62 year-old-male who presented with altered liver function tests, anemia and unintentional weight loss. Initial laboratories revealed anemia and a cholestatic pattern. Diagnostic work-up was remarkable for a positive antinuclear antibodies (ANA) test and a liver biopsy suggestive of an AIH-PBC overlap syndrome. This case illustrates the complexity of establishing the diagnosis and effective therapy in this condition.
Right Heart Thrombus in Transit: Unusual Echocardiographic Finding in a patient with Acute Pulmonary Embolism.
Vicenty-Rivera SI, Perez-Feliciano R, Rodriguez-Monserrate CP … +2 more , Montes-Rivera, G, Nevarez-Pomales O
Bol Asoc Med P R · 2016 · PMID 29172298
Eighty year old male patient with heart failure preserved ejection fraction (EF), Obstructive sleep apnea, peripherovascular disease admitted with increasing shortness of breath and found with pulmonary emboli. Baseline...
Eighty year old male patient with heart failure preserved ejection fraction (EF), Obstructive sleep apnea, peripherovascular disease admitted with increasing shortness of breath and found with pulmonary emboli. Baseline 2D-echocardiogram performed demonstrated preserved ejection fraction and a right thrombus in transit. Anticoagulation with weight based-low molecular weight heparin was given for six days. Follow-up echo performed demonstrated complete dissolution of right heart thrombi. Since there was complete dissolution of thrombi seen on right atrium, anticoagulation with Rivaroxaban was given instead.
Epidemiology of pediatric bone fractures across age groups: Analysis of a pediatric population at an outpatient clinic in the Southwest region of Puerto Rico.
Ortiz-Fullana J, Valentín P, Ramírez N
Bol Asoc Med P R · 2016 · PMID 29165974
BACKGROUND: Background: Gender disparities in pediatric fracture events has been well-documented however, less is known about racial disparities. The aim of this study is to investigate the epidemiology of pediatric bone...
BACKGROUND: Background: Gender disparities in pediatric fracture events has been well-documented however, less is known about racial disparities. The aim of this study is to investigate the epidemiology of pediatric bone fractures in a Hispanic population. METHODS: This is a retrospective cross-sectional analysis of patient’s records from a Pediatric Orthopeadic outpatient clinic in the Southwest region of Puerto Rico during a 1-year span (August 2014 – August 2015). Differences in sex, BMI, health insurance coverage, parental educational level and employment status, mechanism of fracture, fracture site, and seasonality were investigated among three age classes (pre-school children, school children and adolescents). RESULTS: The sample consited of 243 subjects (0-21 y/o) sustaining a fracture of any extremity within the study period. Boys were at a higher risk of having a fracture event and as age increased, the male/female ratio also increased. The mean BMI was 18.0 kg/m2, with the highest in the school children age group (20.3 kg/m2). Slighlty more than half of the subjects (55.7%) benefitted from public health insurance coverage. The typical father was a laborer with a high school diploma, while the mother had a high school diploma but was unemployed There was a tendency for the children to suffer a bone fracture while at school (49.4%), followed by fractures at home (34.6%). In both the pre-school and school children groups, the upper extremity was more frequently involved (66.7% and 63.9%, respectively) in fracture events. Finally, there was very little variation in the seasonality of fracture events. CONCLUSION: This study provided valuable epidemiological information about pediatric bone fractures within a Hispanic population. It may contribute to the development and implementation of educational and preventive strategies appropriate to age and sex-differences.
ST Elevations and Elevated Cardiac Enzymes Not Always a STEMI: Two Case Reports.
Fernández Fernández J, Deliz-Guzmán C, Andino-Colón C … +2 more , Claudio-Hernández H, Lugo-Amador N
Bol Asoc Med P R · 2016 · PMID 29165973
Chest pain is a common complaint in the emergency department (ED). Besides a careful history and physical exam; electrocardiogram, laboratory tests and imaging studies are widely available diagnostic tests that are used...
Chest pain is a common complaint in the emergency department (ED). Besides a careful history and physical exam; electrocardiogram, laboratory tests and imaging studies are widely available diagnostic tests that are used for patient assessment. When ST elevation and elevated cardiac enzymes are present the most likely diagnosis are ST elevation myocardial infarction (STEMI) or myocarditis. In this case report we present two low risk patients for major adverse cardiac event with ST elevation and elevated cardiac enzymes and how a careful risk assessment and detailed electrocardiogram evaluation could help differentiating between these two diagnoses.
Right Heart Thrombus in Transit: Unusual Echocardiographic Finding in a patient with Acute Pulmonary Embolism.
Vicenty-Rivera SI, Perez-Feliciano R, Rodriguez-Monserrate CP … +2 more , Montes-Rivera G, Nevarez-Pomales O
Bol Asoc Med P R · 2016 · PMID 29165972
Eighty year old male patient with heart failure preserved ejection fraction (EF), Obstructive sleep apnea, peripherovascular disease admitted with increasing shortness of breath and found with pulmonary emboli. Baseline...
Eighty year old male patient with heart failure preserved ejection fraction (EF), Obstructive sleep apnea, peripherovascular disease admitted with increasing shortness of breath and found with pulmonary emboli. Baseline 2D-echo-cardiogram performed demonstrated preserved ejection fraction and a right thrombus in transit. Anticoagulation with weight based-low molecular weight heparin was given for six days. Follow-up echo performed demonstrated complete dissolution of right heart thrombi. Since there was complete dis- solution of thrombi seen on right atrium, anticoagulation with Rivaroxaban was given instead.
Rejection, Recurrence, or Something Else?
Vélez-González F, Ballester V, Antúnez I … +3 more , Pastranal R, Torres EA, González-Keelan C
Bol Asoc Med P R · 2016 · PMID 29165971
Since the introduction of liver transplant as treatment for end-stage liver disease, thousands of lives have been saved. To prevent organ rejection, immunosuppression is given chronically and hence, patients are at incre...
Since the introduction of liver transplant as treatment for end-stage liver disease, thousands of lives have been saved. To prevent organ rejection, immunosuppression is given chronically and hence, patients are at increased risk for opportunistic infections related to immunosuppression, especially within the first year after the transplant. However, opportunistic infections can occur years after the transplantation. Disseminated nocardiosis is one of these infections, and although the common presentation includes involvement of skin, lungs, and central nervous system. We present an uncommon presentation of nocardiosis in which cholestasis and elevated liver enzymes predominate, mimicking organ rejection and liver disease recurrence. Infectious etiologies, including opportunistic microorganisms, must always be ruled out in patients presenting elevation in liver enzymes and cholestasis after liver transplant as early diagnosis can prevent complications such as re-transplantation and even death.
Primary cutaneous B-cell lymphoblastic lymphoma: A pediatric case report.
Cardona R, Ramírez-García L, Colón-Fontanez F
Bol Asoc Med P R · 2016 · PMID 29165970
FPrecursor T- or B-cell non-Hodgkin lymphoblastic lymphomas represent only a small fraction of pediatric cancer cases. Due to its rarity, the diagnosis of lymphoblastic lymphoma (LBL) in a pediatric patient is challengin...
FPrecursor T- or B-cell non-Hodgkin lymphoblastic lymphomas represent only a small fraction of pediatric cancer cases. Due to its rarity, the diagnosis of lymphoblastic lymphoma (LBL) in a pediatric patient is challenging, particularly if its manifestation is solely cutaneous. We describe the case of an infant with primary cutaneous B-cell LBL who was initially diagnosed by a primary care physician with an infectious etiology and consequently treated with topical and oral antibiotics. Subcutaneous nodules located on the head or neck of infants should raise suspicion for lymphoma and biopsy should be performed in order to rule out malignancy. A prompt diagnosis is imperative when considering the aggressive nature of LBLs. Expedited therapy has been known to help cease systemic involvement of primary cutaneous B-cell LBLs and encourage a more favorable outcome.
Prevalence of Hypothyroidism and Its Association with Diabetes Mellitus in Patients of an Ambulatory Clinic.
Bernal M, Escobar E, Rodríguez González CE
Bol Asoc Med P R · 2016 · PMID 29165670
Hypothyroidism is the most common thyroid disorder in the adult population. Studies have found a higher prevalence of overt hypothyroidism in type 2 diabetic population than in the general population, but the relationshi...
Hypothyroidism is the most common thyroid disorder in the adult population. Studies have found a higher prevalence of overt hypothyroidism in type 2 diabetic population than in the general population, but the relationship between subclinical hypothyroidism and diabetes mellitus 2 is still controversial. The aim of this study is to estimate the prevalence rate of hypothyroidism in the adult population receiving services in an ambulatory clinic and to determine if there is an association between hypothyroidism and diabetes mellitus. From the database of all adult patients who attended the outpatient clinic at Family Medicine Center Policlínica Bella Vista in Mayagüez, P.R. during 2014, a random sample of 200 subjects was obtained and the medical records were reviewed. The prevalence rate of diabetes mellitus in this group was 22% and the prevalence rate of hypothyroidism was 17%. The prevalence rate of hypothyroidism in diabetic patients was 10/44 (22.7%). The prevalence rate of hypothyroidism in non-diabetic patients was 24/156 (15.4%). The prevalence ratio was 1.48 (95% CI: 0.77, 2.85; X2 = 1.31, p = 0.25). The results of this cross-sectional study showed a non-statistically significant tendency for a higher prevalence of hypothyroidism in diabetic patients, which suggest that screening for hypothyroidism among patients with diabetes should be considered. More studies with more patients are necessary to investigate the association between thyroid dysfunction and diabetic patients.
Inflammation, Obesity and the Metabolic Syndrome. Implications in Hispanics.
Marcial J, Altieri PI, Banchs HL
Bol Asoc Med P R · 2016 · PMID 29164847
We report clinical and molecular mechanisms relating the process of inflammation involved in the progression of obesity and the metabolic syndrome, emphasizing the cardiovascular problems developed in Hispanic population...
We report clinical and molecular mechanisms relating the process of inflammation involved in the progression of obesity and the metabolic syndrome, emphasizing the cardiovascular problems developed in Hispanic populations. Namely, the incidence, component characteristics and complications of obesity and metabolic syndrome in island Puerto Ricans are described and evidence is presented supporting the fact that the metabolic syndrome may be milder in Puerto Rico than in the mainland United States because it is characterized by less aggressive coronary artery disease and a relatively normal lipid profile. Moreover, data supports the fact that increased serum cholesterol levels produce less myocardial infarctions in Puerto Rico than in mainland Hispanics and Caucasians. In addition, the incidence of ventricular tachycardia, a complication caused by remodeling and ischemia of the heart, may be lower in Puerto Rico than in the United States, although the prevalence of the metabolic syndrome is higher in the island. On the other hand, there is evidence of a rising epidemic of obesity and vascular inflammation in Puerto Rico that suggests that cardiovascular morbidity and mortality in the island will continue to increase in the future decades.
Anesthetic Challenges and Management in a case of Jarcho-Levin Syndrome with a Neural Tube Defect in a Newborn.
Kaya C, Cebeci H
Bol Asoc Med P R · 2016 · PMID 29164846
Jarcho-Levin syndrome (JLS) is a rare axial skeletal growth disorder characterized by the presence of multi-level costovertebral malformations, a short neck, a short trunk, and kyphoscoliosis at birth. Neural tube defect...
Jarcho-Levin syndrome (JLS) is a rare axial skeletal growth disorder characterized by the presence of multi-level costovertebral malformations, a short neck, a short trunk, and kyphoscoliosis at birth. Neural tube defects appear to be common findings in patients with JLS, and chest hypoplasia frequently leads to respiratory insufficiency and death in early childhood. There have been no previous studies in the literature on the anesthetic management of JLS with neural tube defects and hydrocephalus. Therefore, we have reported a case of JLS in a female full-term newborn, who underwent surgery for myelomeningocele repair and ventriculoperitoneal shunting, with the associated anesthetic challenges and their management.
Uncommon cause of dysphagia, shortness of breath and hoarseness: Large subclavian artery pseudoaneurysm.
Figueroa-Jiménez LA, Alemar H, Aponte D … +12 more , Colon X, Cruz AR, Farinacci M, González H, Méndez OF, Puello PE, Rivera CA, Torres TA, Yunes M, Fornaris R, Colon M, Martínez J
Bol Asoc Med P R · 2016 · PMID 29164844
The subclavian artery pseudoaneurysm is a rare entity with only few cases re- ported in the literature. Most injuries were related to iatrogenic manipulation with catheters for canalization of central lines in the hospit...
The subclavian artery pseudoaneurysm is a rare entity with only few cases re- ported in the literature. Most injuries were related to iatrogenic manipulation with catheters for canalization of central lines in the hospital setting. In rare cases, this injury has been described secondary to a blunt trauma and motor vehicle accidents with traumatic injury to the subclavian artery caused by seatbelt use. We report an unusual case presentation of subclavian artery pseudoaneurysm.
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