Boletin De La Asociacion Medica De Puerto Rico[JOURNAL]
Sun
200 papers
The Institutionalization and Professionalization of the Medical Library in Puerto Rico: The Conrad F. Asenjo Library’s Legacy.
Santos-Corrada CM
Bol Asoc Med P R · 2016 · PMID 29164843
The discourse about health in Puerto Rico has been constructed using the physician and hospital’s perspective or a particular disease or epidemic. Thus far, this approach has not addressed the health library as an object...
The discourse about health in Puerto Rico has been constructed using the physician and hospital’s perspective or a particular disease or epidemic. Thus far, this approach has not addressed the health library as an object of study. The origins and development of the Conrado F. Asenjo Library (CFAL) will be discussed. Before 1912, there were no medical libraries in Puerto Rico, only private collections. In 1914, the act that created the Institute of Tropical Medicine was amended to allocate funds for the purchase of books to support research in tropical diseases in Puerto Rico. The history of the CFA Library reflects its contribution to issues, concerns, development of research, and to the evolving paradigms in the health field in the Island. Historical documents, such as Bailey K. Ashford’s personal papers located at the CFAL and Georgetown University Archives (GU) were evaluated. Institutional reports from the School of Tropical Medicine (STM) and articles published by Puerto Rican physicians such as Dr. Pedro Gutiérrez Igaravídez and Dr. Isaac González Martínez, affiliated to the Institute of Tropical Medicine, were also studied. Finally, references and bibliographies in articles published between 1912 and 1924 were evaluated and consulted to find additional sources.
Are Young Adults with ADHD Undertreated?
Bonet-Pagan Y, Gonzalez-Alonso R, Castaing-Lespier P
Bol Asoc Med P R · 2015 · PMID 26434095
Abstract loading — click title to view on PubMed.
Lack of training and Comfort level with Provision of Palliative Care in Puerto Rican Emergency Departments.
Rivera MR, Torres FS
Bol Asoc Med P R · 2015 · PMID 26434094
OBJECTIVE: Although many institutions in the United States have incorporated palliative care practices in their emergency departments, very little has occurred in Puerto Rico. Information regarding palliative care traini...
OBJECTIVE: Although many institutions in the United States have incorporated palliative care practices in their emergency departments, very little has occurred in Puerto Rico. Information regarding palliative care training of emergency medicine physicians in Puerto Rico is unclear and most physicians have poor or no access to palliative care services for their patients. This study explores the perceptions and barriers encountered by practicing emergency physicians in providing palliative care in Puerto Rican Emergency Departments. METHODS: A survey was administered to physicians attending the American College of Emergency Physicians Puerto Rico Chapter annual Convention Attending physicians and residents from the University of Puerto Rico School of Medicine validated the survey tool via a "content validity" approach. Participants were asked to respond to Likert scaled statements with options that ranged from "Strongly Agree" to "Strongly Disagree". The statements addressed physician comfort level with provision of palliative care and discussion of end of life issues, as well as barriers encountered by providers such as time constraints, fear of lawsuits, and lack of access to specialists among others. RESULTS: Of the 85 physicians at the convention 59 provided surveys available for review for a response rate of 70%. Of those surveyed, 35% reported feeling some level of discomfort at providing palliative care in the ED and 39.6% agreed or strongly agreed that their lack of training in palliative care affects their ability to provide this service. In addition, 81% lack access to palliative care specialists/teams in the emergency department. However, 82.8% agreed or strongly agreed that palliative care is an important competence for emergency physicians. CONCLUSIONS: Despite recognizing palliative care as an important competence, emergency physicians in Puerto Rico reported insufficiencies in training, decreased level of comfort, and lack of access to specialists in palliative care. Efforts to enhance physician training and provide palliative care resources must be pursued in order to improve the quality of care given to patients visiting Puerto Rican Emergency departments.
Do We Need Hormonal Screening In Patients With Subcentimeter Pituitary Microadenomas?
Martínez-Méndez JH, Gutiérrez-Acevedo M, Palermo-Garofalo C … +6 more , Miranda-Adorno Mde L, Mangual-García M, Sánchez-Cruz A, Rivera-Anaya C, Mansilla-Letelier P, Laboy-Ortiz I
Bol Asoc Med P R · 2015 · PMID 26434093
A 54-year-old woman came to our endocrinology clinics presenting with upper and lower extremity paresthesia, salt cravings, episodes of hypotension, fatigue and a long term history of depression. Physical exam was unrema...
A 54-year-old woman came to our endocrinology clinics presenting with upper and lower extremity paresthesia, salt cravings, episodes of hypotension, fatigue and a long term history of depression. Physical exam was unremarkable. Cervical and brain MRI ordered by her neurologist three years ago revealed sella and pituitary normal in size, stable very small 3 mm pituitary incidentaloma and mild disc bulging. Basal pituitary hormonal screening showed low cortisol and ACTH levels. Insulin Tolerance Test and Glucagon Stimulation Test confirmed secondary ACTH deficiency with concomitant GH deficiency. In spite of medical counseling the patient refused glucocorticoid replacement. Due to the non-specific symptoms of this condition it remains a challenge to be diagnosed by clinicians. In conclusion: Our case shows that hormonal deficiencies may occur in small tumors less than 6 mm.
Acquired Von Willebrand Syndrome In Aortic Stenosis: Case Report And Review.
Alsidawi S, Couto M, López-Candales A
Bol Asoc Med P R · 2015 · PMID 26434092
We present a case of a 61 year old man who presented with a 3 week history of easy bruising and ecchymoses in both thighs and right arm without significant trauma. Physical exam was remarkable for oozing gums, diminished...
We present a case of a 61 year old man who presented with a 3 week history of easy bruising and ecchymoses in both thighs and right arm without significant trauma. Physical exam was remarkable for oozing gums, diminished second heart sound, a systolic ejection murmur at the aortic position with radiation to carotids, and delayed pulses. Laboratories were remarkable for iron deficiency anemia. Echocardiogram was consistent with severe aortic stenosis. Colonoscopy revealed several arteriovenous malformations throughout the colon. There is an association between severe aortic stenosis and gastrointestinal bleeding. The pathogenesis of Heyde's Syndrome involves iron deficiency anemia due to acquired von Willebrand factor (vWF) deficiency and ultimately gastrointestinal angiodysplasia. Correct diagnosis and management warrants a multidisciplinary approach.
Use of Screening Tests for Colorectal Cancer Among Gynecologists in Puerto Rico.
Romaguera J, Seymour S, Cabrera V … +3 more , Medina J, De Jesus E, Ortiz AP
Bol Asoc Med P R · 2015 · PMID 26434091
OBJECTIVE: To determine the use of screening tests for colorectal cancer (CRC) among Gynecologists in Puerto Rico. This study evaluates the screening practices used by Gynecologists in PR to diagnose CRC and adherence to...
OBJECTIVE: To determine the use of screening tests for colorectal cancer (CRC) among Gynecologists in Puerto Rico. This study evaluates the screening practices used by Gynecologists in PR to diagnose CRC and adherence to screening guidelines. METHODS: A self-administered anonymous questionnaire was mailed to 440 practicing gynecologists through the College of Physicians and Surgeons of PR. The questionnaire included general and specific questions. RESULTS: Response rate was 23.2% (102/440). Of this group of gynecologists, 77.5% referred screening patients, while 22.5% did not. The majority (28.4%) use Fecal Occult Blood Test (FOBT) as a first screening test, while 27.5% use Colonoscopy. Screening is started by 49% at age 50. Only 7% stop screening at 75 years and 31% never stop screening. CRC Screening performed by participants were: 35% screen annually, 6% screen 2-3 years, 10% screen every 5 years, 6% screen every 10 years and 6% screen 5-10 years. Data for CRC Screening reveals 7% gynecologists comply with all the guidelines; 49% comply with the recommendations regarding the start screening age and 7% stop screening as per guidelines. CONCLUSION: The recommendations are not followed by most of the gynecologists in PR that participated in the study, Further research should be directed towards the reasons for not complying and how to educatethemedical population to achieve adequate screening in the PR female population.
Does Injection Site Matter? A Randomized Controlled Trial to Evaluate Different Entry Site Efficacy of Knee Intra-articular Injections.
Dávila-Parrilla A, Santaella-Santé B, Otero-López A
Bol Asoc Med P R · 2015 · PMID 26434090
BACKGROUND: Complaints of knee pain secondary to early osteoarthritis may account for up to 30% of visits to primary care physicians. Due to the proposed inflammatory changes in early osteoarthritis, intra-articular inje...
BACKGROUND: Complaints of knee pain secondary to early osteoarthritis may account for up to 30% of visits to primary care physicians. Due to the proposed inflammatory changes in early osteoarthritis, intra-articular injections of corticosteroids (IACS) have been considered as an option for disease progression modification, pain control, and improvement of function. However, some studies have suggested poor accuracy rates of IA injections depending on the entry site chosen. It is therefore the aim of this study to evaluate the efficacy of IA knee corticosteroid injection in reducing pain and improving function in patients with early osteoarthritis and whether the low accuracy rates reported with the Anterolateral joint line injection site translate to worse functional and pain outcome measures as compared to Suprapatellar lateral injections. MATERIALS AND METHODS: The study was carried out as an open-label, randomized controlled trial with 60 sequential patients recruited. Simple randomization separated groups into anterolateral joint line or suprapatellar lateral injection sites. Improvements were measured with WOMAC and VAS scores after injection of Lidocaine and steroid solution. RESULTS: Patients receiving IACS injections had a measurable improvement in self-reported outcomes as evidenced by standard deviation change in WOMAC and VAS scores. The majority of patients had a clinically significant improvement in VAS scores as compared to their initial measures with a notable amount of patients improving significantly as well on their WOMAC scores, irrespective of the injection site chosen. CONCLUSIONS: We have therefore continued the use of palpation-guided intra-articular knee injections in an effort to reduce costs as compared to other injection modalities with positive results in our osteoarthritis patients.
Functional Brain Imaging in Cornelia de Lange Syndrome: Case Report and Literature review.
Silva-Hernández F, Rodríguez-Cuadrado GI, Martin-Ruaigip RJ … +4 more , Barreras-Ávila L, González-Chevere B, Valentin-Rivera R, Labat-Alvarez E
Bol Asoc Med P R · 2015 · PMID 26434089
Functional brain imaging with brain single photon emission computer tomography (Brain SPECT) has been used for many years in the evaluation of multiple neuro-degenerative and neuro-developmental disorders. Brain SPECT is...
Functional brain imaging with brain single photon emission computer tomography (Brain SPECT) has been used for many years in the evaluation of multiple neuro-degenerative and neuro-developmental disorders. Brain SPECT is a nuclear medicine tomographic study performed with a lipophilic radiopharmaceutical labeled with 99mTc-pertechnetate. It is a cerebral perfusion agent that depicts the global and regional perfusion patterns in the cortical gray matter and subcortical structures. Cornelia de Lange syndrome (CdLS) is a rare neuro-developmental and genetic condition, associated to several malformations. There are a limited number of cases reported in the medical literature and few of them report neuro-radiological and/or neuro-pathologic abnormalities. We report a case of a 15 year old patient, clinically diagnosed at birth with CdLS, who presents limited anatomical findings on Computed Tomography and Magnetic Resonance Imaging. To the best of our knowledge, this is the first report of the Brain SPECT findings in this syndrome.
23 y/o female with dysphagia--Evaluation, intervention and resolution of symptoms in the Psychiatry consultation setting.
Santos-Cubiñá J, Forman HL, Gomez MF … +1 more , O'Dowd MA
Bol Asoc Med P R · 2015 · PMID 26434088
Dysphagia is a symptom shared by many medical and psychiatric conditions. A thorough Psychiatric evaluation could rule in a functional or psychological etiology. If a Psychological etiology is identified, a psychodynamic...
Dysphagia is a symptom shared by many medical and psychiatric conditions. A thorough Psychiatric evaluation could rule in a functional or psychological etiology. If a Psychological etiology is identified, a psychodynamic formulation could help the consultation psychiatrist clarify the origin of the symptom and provide a better explanation to the patient and medical team, resulting in improved care by prevention of unnecessary medical interventions, improvement of symptoms and individualization of the treatment.
Brugada Syndrome in Puerto Rico: a Case Series.
Banchs-Viñas H, Rivera N, Banchs-Pieretti H … +1 more , Altieri P
Bol Asoc Med P R · 2015 · PMID 26434087
Brugada syndrome (BrS) is characterized by ST-segment changes in the right precordial ECG leads and a high incidence of sudden death in patients with structurally normal hearts. Life-threatening ventricular arrhythmias a...
Brugada syndrome (BrS) is characterized by ST-segment changes in the right precordial ECG leads and a high incidence of sudden death in patients with structurally normal hearts. Life-threatening ventricular arrhythmias are the hallmark of Brugada syndrome. The incidence and prevalence of BrS in Puerto Rico, to our knowledge, has never been studied and there is only one case report of BrS in Puerto Rico in the literature [1]. We present 3 cases of BrS in Puerto Rican patients who presented to our institution with syncope and review the literature.
[Metabolic correction: a biochemical option against diseases].
Miranda-Massari JR, González MJ, Rodriguez-Gomez JR … +8 more , Duconge J, Allende-Vigo MZ, Jiménez Ramirez FJ, Cintrón K, Ricart C, Zaragoza-Urdaz R, Berdiel MJ, Vázquez A
Bol Asoc Med P R · 2015 · PMID 26434086
Human development and its physiology depends on a number of complex biochemical body processes, many of which are interactive and codependent. The speed and the degree in which many physiological reactions are completed...
Human development and its physiology depends on a number of complex biochemical body processes, many of which are interactive and codependent. The speed and the degree in which many physiological reactions are completed depend on enzyme activity, which in turn depends on the bioavailability of co-factors and micronutrients such as vitamins and minerals. To achieve a healthy physiological state, organism need that biochemical reactions occur in a controlled and specific way at a particular speed and level or grade fully completed. To achieve this, is required an optimal metabolic balance. Factors such as, a particular genetic composition, inadequate dietary consumption patterns, traumas, diseases, toxins and environmental stress all of these factors rising demands for nutrients in order to obtain optimal metabolic balance. Metabolic correction is a biochemical and physiological concept that explains how improvements in cellular biochemistry of an organism can help the body achieve metabolic and physiological optimization. We summarize the contribution of several pioneers in understanding the role of micronutrients in health management. The concept of metabolic correction is becoming a significant term due to the presence of genetic variants that affect the speed of reactions of enzymes, causing metabolic alterations that enhance or promote the state/development of multiple diseases. Decline in the nutritional value of the food we eat, the increase in demand for certain nutrients caused by normal development, diseases and medications induce, usually, nutrients consumption. These nutritional deficiencies and insufficiencies are causing massive economic costs due to increased morbidity and mortality in our society. In summary, metabolic correction improves the enzymatic function, which favors the physiological normal functions, thus, contributing to improving health and the welfare of the human being. The purpose of this paper is to describe and introduce the concept of optimal metabolic correction as a functional cost-effective mechanism against disease, in addition, to contribute to diseases prevention and regeneration of the body and health.
Metabolic Correction as a tool to improve diabetes type 2 management.
Miranda-Massari JR, Gonzalez MJ, Fernando AS … +7 more , Cidre C, Paz IM, Charvel J, Martínez V, Duconge J, Aponte A, Ricart CM
Bol Asoc Med P R · 2015 · PMID 26434085
Diabetes Mellitus type 2 (DM2) is a metabolic disease that develops by a decrease in sensitivity of insulin receptors as an effect of the disruption certain metabolic functions in the processing of glucose. DM2 patients...
Diabetes Mellitus type 2 (DM2) is a metabolic disease that develops by a decrease in sensitivity of insulin receptors as an effect of the disruption certain metabolic functions in the processing of glucose. DM2 patients have, uncontrolled glucose levels, and commonly have problems with obesity and cardiovascular disease. Patients are treated with standard diet, insulin, diabetic oral agents and antihypertensive drugs, but this approach does not completely stops tissue deterioration since it does not address the metabolic root of the disease. Metabolic correction is proposed as a suitable adjunct treatment to improve clinical outcomes. Metabolic correction is based on diet modification, proper hydration and scientific supplementation directed to improve cellular biochemistry and metabolic efficiency. In addition, other possible benefits may include reduction in medication use, disease complications and medical costs. To test the results of a metabolic correction program, 25 patients with DM2 participated in an education program about adequate food consumption that promoted control of blood glucose levels. Anthropometric measurements and blood tests were performed during a 13 week program based on a low carbohydrate diet, proper hydration and magnesium supplementation. The metabolic correction program implemented by a proprietary educational system resulted in significant reductions in glucose, triglycerides, cholesterol, weight and waist circumference. Improvements in these values could represent an important reduction of coronary heart disease risk factors as well as other chronic degenerative diseases. In addition there was medication dosage reduction in one or more medications in 21 of the 25 participating patients, which suggest that the program has the potential to improve health outcomes and reduce health care costs.
Dengue Fever: A Rare Cause Of Immune Thrombocytopenia.
Ramírez-Fonseca T, Segarra-Torres A, Jaume-Anselmi F … +1 more , Ramírez-Rivera J
Bol Asoc Med P R · 2015 · PMID 26434084
Immune thrombocytopenia (ITP) is a rare autoimmune disorder characterized by low platelet count and skin-mucosal bleeding. In adults it is usually idiopathic and may have a chronic onset, while in children it is usually...
Immune thrombocytopenia (ITP) is a rare autoimmune disorder characterized by low platelet count and skin-mucosal bleeding. In adults it is usually idiopathic and may have a chronic onset, while in children it is usually acute following a viral illness. Dengue has been rarely reported as a cause of ITP. We report a case of a young adult woman that presented with acute ITP following a dengue virus infection.
Surviving Sepsis Puerto Rico: A Call For Action.
Vigo R, Matos ML, Turbay T
Bol Asoc Med P R · 2015 · PMID 26434083
There are 1.7 million sepsis-related hospitalizations each year making it the sixth most common cause for hospitalization in the United States. Not only are this hospitalizations common, they are expensive to our medical...
There are 1.7 million sepsis-related hospitalizations each year making it the sixth most common cause for hospitalization in the United States. Not only are this hospitalizations common, they are expensive to our medical system with $15.3 billion spent yearly (3) and hospitalizations lasting 75% longer than for other conditions. In 2001, Rivers et al published in the NEJM the results of his study "Early Goal Directed Therapy (EGDT) in The Treatment of Severe Sepsis and Septic Shock". EGDT demonstrated a 16.5% decrease in mortality in septic patients (4). In 2002 the Surviving Sepsis Campaign began as a collaboration between the Society of Critical Care Medicine and European Society of Intensive Care Medicine with goals of reducing worldwide sepsis related mortality by 25% in the next 5 years. Despite the proven benefit of early identification and management, knowledge regarding the topic in Puerto Rico remains scarce. In a study performed in PR by Fernandez et al. in 2006, only an alarming 31.4% of doctors from different specialties correctly identified SIRS criteria. Our goal is to educate physicians about the importance of early identification and treatment of the septic patient. A campaign to increase awareness and improve care is essential and we propose treatment protocols for our Puerto Rican hospitals to help reduce morbidity, mortality, length of stay and costs.
Case Report: Prothesis-patient mismatch after aortic valve replacement.
Rodriguez-Ospina L, Garcia-Morell J, Rodriguez-Monserrate CP … +1 more , Valentin-Nieves J
Bol Asoc Med P R · 2015 · PMID 26434082
Valve replacement is the standard surgical treatment of diseased valves that cannot be repaired. The main goal of replacement is to exchange the diseased valve with one that has the engineering and hemodynamics as close...
Valve replacement is the standard surgical treatment of diseased valves that cannot be repaired. The main goal of replacement is to exchange the diseased valve with one that has the engineering and hemodynamics as close as possible to the disease free native valve. However due to mechanical and fluid dynamic constraints all prosthetic heart valves (PHVs) are smaller than normal and thus are inherently stenotic. This represents a challenge when it comes time to replace a valve. The correct valve with the correct and matching profile has to be selected before the procedure to avoid possible complications. It is well recognized that patients are also prone to patient-prosthesis mismatch at long term which could have consequences in the clinical outcomes (1). The evaluation of patient-prosthesis mismatch (PPM) has not been sufficiently emphasized in common practice. Failure to recognize this fact may lead to significant hemodynamic impairment and worsening of the clinical status over the time. Making efforts to identifying patients at risk may decrease the prevalence of PPM, the economic impact to our health system, the morbidity and mortality involved in these cases as well as creates efforts to standardized pre-operative protocols to minimized risk of PPM. We present a case of a 78 years old male patient who underwent aortic valve replacement due severe aortic stenosis, afterwards his clinical course got complicated with several admissions for shortness of breath and decompensated congestive heart failure (CHF).
Manatí Medical Center Sepsis Management Epidemiological Study.
Morales Serrano T, Ramos S, Lara Gonzalez Y … +7 more , Torres Colberg H, Vera Quiñones A, Miranda Santiago R, Amill S, Otero M, Cintron V, Villarreal Morales ML
Bol Asoc Med P R · 2015 · PMID 26434081
Sepsis is the combination of infection and physiological changes known as the systemic inflammatory response syndrome. There have been improvements in mortality rates and outcomes of septic patients based on "Surviving S...
Sepsis is the combination of infection and physiological changes known as the systemic inflammatory response syndrome. There have been improvements in mortality rates and outcomes of septic patients based on "Surviving Sepsis Campaign" guidelines. Current management of sepsis at our Institution follows no specific mandatory protocols. This study aimed to verify the incidence and outcome of sepsis in Manati Medical Center, Puerto Rico. An observational retrospective study was conducted. All the Emergency Department admissions from May 1/ to October 31/ 2013 were screened for sepsis per ICD-9 code. For all included patients, demographic and clinical data at ED admission were collected. During this period 8931 patients were admitted and 148 met criteria for sepsis and related conditions. The overall mortality rate was 43.91%. Mortality increased with age, from 10.52% among ≤ 44 years old to 68.75% in those ≥ 85 years old. The main infection sources were respiratory (32.66%) and urinary tract (24.62%). Mean age among non-survivors was 10.8 years higher than the survivor group (95% Cl 5.2-1 6.5, p < 0.05). Multivariate analysis showed an increased fatality rate associated to severity of sepsis (HR 1.33; 95% Cl; 1.03-1.72, p = 0.02) and the APACHE2 score (HR 1.05; 95% Cl, 1.01-1.09 p = 0.03). Our data suggests that sepsis is an important problem to consider. We strongly encourage an institutional standardized protocol to diminish the mortality impact. Our results will allow adequate preventive strategies to improve early diagnosis, mortality rates and outcomes of septic patients.
Isolated Xanthoma Of The Sphenoid Sinus: A Rare Presentation.
Bol Asoc Med P R · 2015 · PMID 26434080
OBJECTIVE: To present the first case in the English literature of a sphenoid xanthoma. METHODS: Case Report DISCUSSION: A 36 year-old Hispanic female with past medical history of Hashimoto's hypothyroidism and family his...
OBJECTIVE: To present the first case in the English literature of a sphenoid xanthoma. METHODS: Case Report DISCUSSION: A 36 year-old Hispanic female with past medical history of Hashimoto's hypothyroidism and family history of hyperlipidemia that presented with a 1-year history of sporadic left sided epistaxis. A paranasal sinus Computed Tomography (CT) was performed revealing a soft tissue lesion infiltrating the left sphenoid sinus. Patient underwent endoscopic sinus sphenoidotomy with intraoperative findings of a yellow-tan, friable soft tissue mass filling the left sphenoid sinus. Biopsies were taken which exhibited histologically findings consistent with a xanthoma. CONCLUSION: In a patient with hyperlipidemia isolated lesions on paransasal sinuses can be related to xanthoma formation.
Endoscopic Resection of a Posterior Nasal Septum Pleomorphic Adenoma.
Tarrats LA, Torre-León C, Almodóvar G … +1 more , Portela JC
Bol Asoc Med P R · 2015 · PMID 26434079
A 60 year-old female presented to our clinic with a two-year history of progressive nasal obstruction and one isolated episode of epistaxis that did not respond to medical treatment. Endoscopic evaluation revealed roundi...
A 60 year-old female presented to our clinic with a two-year history of progressive nasal obstruction and one isolated episode of epistaxis that did not respond to medical treatment. Endoscopic evaluation revealed roundish, dumbbell-shape, smooth-surfaced, submucosal mass with prominent vessels of approximately 2 cm in the posterior nasal septum,. A paranasal CT scan revealed a well-circumscribed oval shape mass (1.7 cm x 1.6 x 1.5 cm) arising from the posterior border of the bony nasal septum. The tumor was removed en-bloc with 1-centimeter free margins confirmed by intra-operative frozen sections through a completely endoscopic approach. Pathology results confirmed the diagnosis of a pleomorphic adenoma.
Endoscopic- Assisted Trephination approach for repair of Frontal Sinus posterior wall fracture in a Child.
Tarrats LA, Torre-León C, Almodóvar G … +1 more , Portela JC
Bol Asoc Med P R · 2015 · PMID 26434078
A 9 year-old male sustained multiple maxillofacial fractures after falling from a two-store building. Frontal sinuses suffered a bilateral non-displaced linear fractures extending into the anterior and posterior walls. M...
A 9 year-old male sustained multiple maxillofacial fractures after falling from a two-store building. Frontal sinuses suffered a bilateral non-displaced linear fractures extending into the anterior and posterior walls. Magnetic resonance imaging (MRI) at this time showed a small encephalocele extending into the right frontal sinus. Operative repair was performed using an Endoscopic-Assisted Trephination approach.
Knee avascular necrosis in HIV patient.
Declet VR, Salas AS
Bol Asoc Med P R · 2015 · PMID 26434077
Abstract loading — click title to view on PubMed.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe