Cancer of the thyroid gland in pediatric patients is rare and if left untreated spreads and become lethal. Thyroid nodules in pediatric patients are four times more likely being malignant than adult nodules. The incidenc...Cancer of the thyroid gland in pediatric patients is rare and if left untreated spreads and become lethal. Thyroid nodules in pediatric patients are four times more likely being malignant than adult nodules. The incidence of thyroid cancer in children increases with age, sex, race and nodule size. Exposures to low level of head and neck irradiation at young age, cancer survivors, family history of thyroid cancer and iodine deficiency are specific risk factors to develop thyroid cancer. Thyroid cancer is subdivided into papillary, follicular and medullary thyroid cancer varying in histological characteristics. Children who present with thyroid nodules should undergo ultrasound and fine needle aspiration biopsy to evaluate malignant potential. If biopsy results are positive for malignancy best option is complete surgical resection of the thyroid gland with central lymph node dissection followed by radioactive iodine treatment. Surgeons need to take certain precaution to avoid postoperative complications like hypoparathyroidism or recurrent laryngeal nerve damage. Follow-up is essential in order to evaluate remission or recurrence. An excellent prognosis in pediatric patients is the result of such an aggressive approach that can be supported by the low complications rate and low recurrence rate following surgery.
Brain gliosarcoma is a rare variant of glioblastoma multiforme that occurs primarily between the sixth and seventh decades of life. Few cases have been reported in patients younger than nineteen years. We report a four-y...Brain gliosarcoma is a rare variant of glioblastoma multiforme that occurs primarily between the sixth and seventh decades of life. Few cases have been reported in patients younger than nineteen years. We report a four-year-old male with clinical, imaging and pathology compatible with brain gliosarcoma. Beside surgery he was managed with adjuvant radiotherapy and after follow-up is free of recurrence or neurologic deficit. Brain gliosarcoma is highly aggressive and the median survival is related to the extent of surgical resection.
Kraft Rovere R, Wensing Raimann B, Marcondes LM
… +4 more, Teston Bondan E, Gioppo F, Nunesb T, Dos Santos Borges G
Bol Asoc Med P R
· 2014 · PMID 25470909
We report a case of a very unusual metastasis of multiple myeloma to the testis in a 53-year-old-patient, documented with images and anatomic-pathological exam. Our case report is of interest because it is one of the rar...We report a case of a very unusual metastasis of multiple myeloma to the testis in a 53-year-old-patient, documented with images and anatomic-pathological exam. Our case report is of interest because it is one of the rarest forms ever reported of advanced multiple myeloma.
Alvarado M, Ramirez-Vick M, Lopez L
… +7 more, Marcos-Martinez MJ, Saavedra FM, Negron-Rivera JC, Agosto M, Martinez M, Gonzalez R, Allende-Vigo M
Bol Asoc Med P R
· 2014 · PMID 25470908
Follicular thyroid carcinoma is the second most common type of thyroid cancer, and its incidence has increased dramatically in recent years. Although it typically presents as a thyroid nodule, it can spread to distant si...Follicular thyroid carcinoma is the second most common type of thyroid cancer, and its incidence has increased dramatically in recent years. Although it typically presents as a thyroid nodule, it can spread to distant sites via hematogenous dissemination. Bone metastasis is diagnosed clinically in 2%-13% of patients with differentiated thyroid cancer; nevertheless spinal cord compression complicating thyroid carcinoma is rare and only few cases has been reported in the literature. This case illustrates a strange case of a minimally invasive follicular carcinoma that showed an aggressive behavior, and thus the importance of considering metastatic thyroid carcinoma in the differential diagnosis of chronic back pain progressing to spinal cord compression carrying a severe morbidity.
Retinoblastoma is the most common primary ocular malignancy in childhood and can occur as a germline or somatic mutation. Recent studies have suggested a higher incidence of retinoblastoma in Hispanic children as compare...Retinoblastoma is the most common primary ocular malignancy in childhood and can occur as a germline or somatic mutation. Recent studies have suggested a higher incidence of retinoblastoma in Hispanic children as compared to non-Hispanic white children of the same ages. We report the ocular findings of a 20 years old Hispanic male with a history of bilateral retinoblastoma. Although screening is currently performed with the red reflex test, analysis of current literature suggests the need to reassess screening recommendations for retinoblastoma.
Acremonium species are filamentous, cosmopolitan fungi frequently isolated from plant debris and soil that have emerged as an important cause of morbidity and mortality in immunocompromised patients. We present data from...Acremonium species are filamentous, cosmopolitan fungi frequently isolated from plant debris and soil that have emerged as an important cause of morbidity and mortality in immunocompromised patients. We present data from two hematologic malignancy patients with Acremonium fungemia who had refractory disease despite initial treatment with Amphotericin B with clinical response after changing therapy to Voriconazole. Acremonium should be considered in the differential diagnosis of patients with clinical presentation suggestive of fungal infection and special attention should be given to the treatment challenge it represents.
Iron deficiency is the most common nutrient deficiency in the world. Serum ferritin measurement is considered the most reliable test for the diagnosis of Iron Deficiency Anemia. At our institution there seems to be non c...Iron deficiency is the most common nutrient deficiency in the world. Serum ferritin measurement is considered the most reliable test for the diagnosis of Iron Deficiency Anemia. At our institution there seems to be non consensus in terms of the diagnostic workup for patients with microcytic anemia or the application of guidelines. The purpose of this investigation was to examine the compliance of guidelines for the diagnosis of microcytic anemia at Damas Hospital performed by admitting physicians when microcytic anemia is encountered; compared to the proposed algorithm by the American Academy of Family Physicians (AAFP). Of the patients included in the study 82% did not underwent ferritin studies, of this 79% did not underwent any other serum laboratories to assess the cause of the anemia. Of the patients who did not underwent any serum laboratories 18 went straight to colonoscopy without further work up. None of the patients who did undergo serum laboratories for anemia was further investigated with colonoscopy. In comparison with AAFP guidelines, none of the patients with microcytic anemia was adequately studied for the cause of disease. None of the guidelines or algorithms proposed establish a difference between what should be done depending on the setting in which a :patient is been studied either inatient or outpatient.
Gonzélez-Castro J, Pascual J, Tarrats L
… +1 more, González-Aquino C
Bol Asoc Med P R
· 2014 · PMID 25470904
OBJECTIVE: To evaluate the prevalence of smoking operating room personnel and compare this with that of the general public. Given the first hand exposure of these individuals to patients with smoking related illnesses, w...OBJECTIVE: To evaluate the prevalence of smoking operating room personnel and compare this with that of the general public. Given the first hand exposure of these individuals to patients with smoking related illnesses, we believe they should have a decreased tendency to smoke. METHODS: A survey instrument was given to operating room personnel in order to learn the prevalence of smoking and other tobacco use related data. Prevalence for the general population and other healthcare related populations was investigated using various search engines and compared with our results. RESULTS: A total of 113 individuals completed the survey, 6% were found to be current smokers and 15% were found to be past smokers. Data from the Center for Disease Control shows that the prevalence of cigarette smoking among United States adults is 19%, which is significantly higher than what we found in our population (<0.01). In Puerto Rico, the prevalence of smoking is 11%, which is also higher than our study population (p=0.05). Among current smokers, 86% have tried to quit at least once (p=0.02), and all claimed to have knowledge of the possible complications associated with smoking. CONCLUSIONS: Smoking tobacco remains the number one cause of preventable death in the United States despite many efforts to educate the general public on the dangers associated with its use. a more visual or hand's on encounter with the effects of smoking may help decrease tobacco burden in the general population.
The purpose of this pioneer study was to describe the socio-demographics, psychopathological and resilient characteristics in a sample of Puerto Rican women who opted for breast reconstruction surgery after breast cancer...The purpose of this pioneer study was to describe the socio-demographics, psychopathological and resilient characteristics in a sample of Puerto Rican women who opted for breast reconstruction surgery after breast cancer. This research was done in order to provide information and increase research knowledge about breast reconstruction that could be used by public and private breast cancer psycho-psychiatry support programs for patients in Puerto Rico. Research participants were ten Puerto Rican women, aged twenty-one years or older. A socio-demographic questionnaire, The Symptom Checklist- 36, Internal Factors of Resilience Scale, and a Semi-structured interview (qualitative approach) were administered. Main sample findings included psychopathological characteristics such as somatization and depression, and resilient characteristics such as, high spirituality, autonomy, introspection and satisfaction.
Puerto Rico has eight hospital blood banks and three community blood banks for a population around four million. The Red Cross has been in existence in Puerto Rico since 1893 under the Spanish Governance but it was not u...Puerto Rico has eight hospital blood banks and three community blood banks for a population around four million. The Red Cross has been in existence in Puerto Rico since 1893 under the Spanish Governance but it was not until 1907 which became the American Red Cross (ARC). Since then it has been serving Puerto Rico and the U.S. Virgin Islands. About 171.222 blood components, which 45% are of the ARC, are used. There are a number of variations in utilization and a number of factors that are influencing us at the national and local level and that is why collaboration is required in the management plan of blood components at each hospital and implementation of maximum units required for each case of surgery.
Gutiérrez-Paternina JJ, Alvis-Miranda HR, Alcalá-Cerra G
… +2 more, Rubiano AM, Moscote-Salazar LR
Bol Asoc Med P R
· 2014 · PMID 25065054
Traumatic brain injury is a public health problem and leading cause of death. In the context of a severe head injury, monitoring strategies give us the option to analyze the posterior intracranial alterations to the prim...Traumatic brain injury is a public health problem and leading cause of death. In the context of a severe head injury, monitoring strategies give us the option to analyze the posterior intracranial alterations to the primary lesion. Neuromonitoring allows us to identify the deterioration of neurological function and the presence of secondary brain injury that may benefit from a therapeutic intervention letting us know pathophysiological changes that occur in a patient with brain injury. Understanding the physiological data allow to individualize therapies and interpret variables that ultimately help us choice a better treatment.
Acosta Martínez AN, Juame Anselmi F, Baez-Torres A
… +3 more, Alvarez R, Ramirez-Lluch N, Sánchez H
Bol Asoc Med P R
· 2014 · PMID 25065053
Primary adenocarcinoma in a permanent ileostomy carries a poor prognosis from other gastrointestinal malignancies. Surveillance and identification of patient at risk for ileostomy malignancies is a challenging problem. T...Primary adenocarcinoma in a permanent ileostomy carries a poor prognosis from other gastrointestinal malignancies. Surveillance and identification of patient at risk for ileostomy malignancies is a challenging problem. There are not reliable biological markers. The clinical evaluation, suspicion of the disease, common presenting symptoms including difficulty fitting the stomal appliance, bowel obstruction, and a friable mass should be considered as part of the evaluation and screening in a long standing terminal ileostomy. Biopsy of newly developed lesions in the periostomal area is recommended for diagnosis and treatment. This is a case of a primary adenocarcinoma in an ileostomy forty years after total colectomy for ulcerative colitis.
Albino-González M, González-Hidalgo H, González Del Rosario M
… +4 more, Totti-Veray N, Gurrea CM, Vilaro J, González-Márquez AL
Bol Asoc Med P R
· 2014 · PMID 25065052
Clear cell carcinoma of the lung is very rare, with few cases reported in the medical literature. Review of case studies show that these tumors have significant variation in clinical outcome, including metastatic disease...Clear cell carcinoma of the lung is very rare, with few cases reported in the medical literature. Review of case studies show that these tumors have significant variation in clinical outcome, including metastatic disease. We present a very unusual case of primary clear cell lung carcinoma of salivary gland type.
Figueroa-Jiménez LA, Santiago-Casiano M, González-Irizarry E
… +5 more, González-Marquez A, Cáceres-Perkins W, Padilla-Ferrer M, González A, Santiago-Casiano V
Bol Asoc Med P R
· 2014 · PMID 25065051
Madelung's disease is an extremely rare disorder of unknown etiology characterized by multiple, non-encapsulated, infiltrative lipomas located symmetrically on the trunk, neck, and proximal parts of the limbs. Approximat...Madelung's disease is an extremely rare disorder of unknown etiology characterized by multiple, non-encapsulated, infiltrative lipomas located symmetrically on the trunk, neck, and proximal parts of the limbs. Approximately 200 patients have been reported in the medical literature. In this case report we present an extremely unusual case of multiple symmetric lipomatosis compatible with Madelung's disease.
Seiglie V, Freire V, Rosado-Carrión B
… +2 more, Bredy R, Lozada C
Bol Asoc Med P R
· 2014 · PMID 25065050
Primary biliary cirrhosis with autoimmune hepatitis (PCB/AIH) overlap is characterized by uncertain behavior and no standardized treatment. A 35 year-old-woman with vitiligo, jaundice and cholestasis fulfilled serologica...Primary biliary cirrhosis with autoimmune hepatitis (PCB/AIH) overlap is characterized by uncertain behavior and no standardized treatment. A 35 year-old-woman with vitiligo, jaundice and cholestasis fulfilled serological, biochemical and histological criteria for PBC/AIH overlap. Treatment was initiated with conventional doses of corticosteroid and ursodeoxycholic acid. Her condition worsened with poor biochemical hepatic response. The course of action was altered to institute high doses of ursodiol, azathioprine and corticosteroids for extended periods of time. This case illustrates how increased understanding of the overlap PBC/AIH leads to new interventions. Recognition of these variant forms is critical for institutional management of both disease entities.
Hypereosinophilic syndromes are a wide group of entities. We present a 24-year-old-male with left lower quadrant abdominal pain, elevated eosinophil counts and splenomegaly. Molecular analysis was positive for FIP1LI -PD...Hypereosinophilic syndromes are a wide group of entities. We present a 24-year-old-male with left lower quadrant abdominal pain, elevated eosinophil counts and splenomegaly. Molecular analysis was positive for FIP1LI -PDGFRA gene compatible with chronic eosinophilic leukemia. He was managed with Imatinib producing resolution of the disease.
A 17-year-old-male with Sickle Cell Disease underwent allogenic bone marrow transplant. Two years after the transplant the patient developed violaceous lichenoid papules coalescing into plaques over the face and upper ex...A 17-year-old-male with Sickle Cell Disease underwent allogenic bone marrow transplant. Two years after the transplant the patient developed violaceous lichenoid papules coalescing into plaques over the face and upper extremities complaining of decrease visual acuity, foreign body sensation, and eye pain. A slit lamp examination showed injected conjunctiva, superficial I punctate keratopathy and decreased baseline Schirmmer test. Dermatologic evaluation and biopsy demonstrated chronic graft versus host disease along with the diagnosis of secondary keratoconjunctivitis sicca.
Del Pilar Morales E, Bertrán Pasarell J, Cardona Rodriguez Z
… +2 more, Almodovar Mercado JC, Figueroa Navarro A
Bol Asoc Med P R
· 2014 · PMID 25065047
Tetanus is a potentially life-threatening infection characterized by muscle spasms. Cephalic tetanus is limited to muscles and nerves in the head and can occur after trauma to this area. Because of the rarity of cephalic...Tetanus is a potentially life-threatening infection characterized by muscle spasms. Cephalic tetanus is limited to muscles and nerves in the head and can occur after trauma to this area. Because of the rarity of cephalic tetanus clinicians may be unfamiliar with the clinical presentation unsuspecting of the diagnosis.
UNLABELLED: One of the most common indications of Eptifibatide, a GP IIb/IIIa inhibitor, is non-ST segment elevation myocardial infarction (NSTEMI) due to its great antiplatelet activity. The aim of this study was to fin...UNLABELLED: One of the most common indications of Eptifibatide, a GP IIb/IIIa inhibitor, is non-ST segment elevation myocardial infarction (NSTEMI) due to its great antiplatelet activity. The aim of this study was to find out if there are gender discrepancies when comparing complications in Hispanics treated th Eptifibatide. METHODS: A cross-sectional study. 116 medical records with diagnosis ofNSTEMI managed with Eptifibatide during 2010-2012 were included. Bleeding, thrombocytopenia, new ischemia, anemia and death were variables compared. RESULTS: The most common complication was death. There were four cases of bleeding, all of them occurred in the female gender, reaching a statistically significant difference compared to male gender (p = 0.0173); 8% of patients had thrombocytopenia; 9% had new ischemia during hospitalization; 13% died; 19% of patients developed anemia including the four cases of bleeding. CONCLUSION: Bleeding occurred only in women, and this difference was statistically significant when compared to males. More studies emphasizing the differences in Eptifibatide complications by gender are needed. Furthermore, it would be important to compare these results to non-Hispanic women. The difference found in the other complications analyzed was not statistically significant.