González-Irizarry EO, Figueroa-Jiménez LA, Ramos Rossy J
… +6 more, Estremera R, Javier Monserrate, González-Márquez AL, Negron-García L, Santiago-Casiano M, Cáceres-Perkins W
Bol Asoc Med P R
· 2014 · PMID 26148400
Kaposi's sarcoma is a rare malignancy requiring infection with human Herpes virus for development. We report a case of a 76-year-old immunocompetent male with recurrent leg cellulitis. The cellulitis eventually developed...Kaposi's sarcoma is a rare malignancy requiring infection with human Herpes virus for development. We report a case of a 76-year-old immunocompetent male with recurrent leg cellulitis. The cellulitis eventually developed into a non-healing ulcer and a palpable nodule consistent with nodular Kaposi's sarcoma.
Humeral shaft non-unions occur in 2-10% of all fracture cases. Increased incidence of these non-unions can be associated with ORIF, comminution, high impact injuries, bone loss or fracture gaping. Treatment guidelines fo...Humeral shaft non-unions occur in 2-10% of all fracture cases. Increased incidence of these non-unions can be associated with ORIF, comminution, high impact injuries, bone loss or fracture gaping. Treatment guidelines for fracture non-union state that fractures with gaps greater than 4 cm should be treated with vascularized fibular autografts or transportation with an external fixator. Unfortunately these modalities carry considerable donor site morbidity and patient will experience considerable discomfort, especially when dealing with an external fixator. This report demonstrates how the use of a nonvascularized fibular strut can be effectively utilized as an alternate treatment modality for large humeral shaft non-union gaps. Further studies should be conducted to support this method as a viable treatment option for non-union gaps greater than 4 cm.
Penetrating injuries are a major cause of mortality and morbidity. The most common diagnostic tool used in this setting is CT scan. We present a case of a traumatic hepatopleural fistula demonstrated by hepatobiliary sci...Penetrating injuries are a major cause of mortality and morbidity. The most common diagnostic tool used in this setting is CT scan. We present a case of a traumatic hepatopleural fistula demonstrated by hepatobiliary scintigraphy. Traumatic abdominal injuries to the liver and diaphragm can result in complications, whose detection by CT scan is not always straightforward. Hepatobiliary scintigraphy is very useful in the search of bilious pleural effusions.
Wegener's Granulomatosis or Granulomatosis with Polyangiitis (WG/GPA) is one of the antineutrophil cytoplasmic antibody associated vasculitis. Ocular manifestations the first presenting signs in patients with WG/GPA. We...Wegener's Granulomatosis or Granulomatosis with Polyangiitis (WG/GPA) is one of the antineutrophil cytoplasmic antibody associated vasculitis. Ocular manifestations the first presenting signs in patients with WG/GPA. We report on two patients diagnosed with WG/GPA and discuss their pertinent clinical findings. Our case report reviews the most common clinical manifestations and ophthalmic associations to compare them with the physical findings of two Hispanic patients. Further, to our knowledge this is the first report of ocular findings in patients with WG/GPA in two Puerto Rican patients.
Immune thrombocytopenia is an autoimmune disorder characterized by immunologic destruction of platelets. It may occur in isolation or in association with other health disorders. We describe a case were the pathology invo...Immune thrombocytopenia is an autoimmune disorder characterized by immunologic destruction of platelets. It may occur in isolation or in association with other health disorders. We describe a case were the pathology involved an immune mediated mechanism initially thought to be isolated and posteriorly linked to secondary causes.
Anal poorly differentiated neuroendocrine carcinomas are very rare aggressive neoplasm with a poor prognosis. This high-grade malignancy carcinoma can have small or non-small cells composition. This case report illustrat...Anal poorly differentiated neuroendocrine carcinomas are very rare aggressive neoplasm with a poor prognosis. This high-grade malignancy carcinoma can have small or non-small cells composition. This case report illustrates a large cell anal neuroendocrine carcinoma with tubulovillous component.
Alvarado M, Ramirez M, Lopez L
… +7 more, Marcos-Martinez MJ, Saavedra FM, Negron-Rivei JC, Agosto M, Martinez M, Gonzalez R, Allende-Vigo M
Bol Asoc Med P R
· 2014 · PMID 26148394
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. Spinal cord compression complicating thyroid carcinoma is rare with only few cases reported in the literature. This case illustrates a minimally invasive follicular carcinoma that showed such an aggressive behavior, and thus the importance of considering metastatic thyroid carcinoma in the differential diagnosis of chronic back pain, which may possibly progress to spinal cord compression carrying severe morbidity.
Chavier-Roper RG, Alick-Ortiz S, Davila-Plaza G
… +1 more, Morales-Quiñones AG
Bol Asoc Med P R
· 2014 · PMID 26148393
UNLABELLED: Obesity is a major risk factor in the development of Diabetes Mellitus (DM). Body Mass Index (BMI), an estimation based on the persons weight and height, helps identify patients at risk to develop DM. We repo...UNLABELLED: Obesity is a major risk factor in the development of Diabetes Mellitus (DM). Body Mass Index (BMI), an estimation based on the persons weight and height, helps identify patients at risk to develop DM. We report the relationship between DM and BMI using data from a primary care facility in Puerto Rico. METHOD: Patients were chosen at random with the only requirement to be included in this study was age over 50. A population of 200 patients was obtained and each participant was categorized by gender, weight, height, BMI and their status as a known diabetic or not. RESULTS: In respect to the diabetic population identified, which totaled 67 patients, 1 out of 67 (1%) were underweight, 14 out of 67 (20%) were normal, 28 out of 67 (42%) were overweight, and 24 out of 67 (36%) obese. CONCLUSION: 78% of the diabetic population fell in the categories of either overweight or obese. BMI increases the incidence of Diabetes Mellitus in patients older than 50 years of age.
García Aríz M, Otero López A, Otero López ER
… +3 more, García B, Marrero Barrera PA, Fernindez S
Bol Asoc Med P R
· 2014 · PMID 26148392
UNLABELLED: The thenar flap technique is a time-tested method of fingertip reconstruction that has been criticized due to possible finger flexion contractures and unsightly donor site scars. Functional outcome data on th...UNLABELLED: The thenar flap technique is a time-tested method of fingertip reconstruction that has been criticized due to possible finger flexion contractures and unsightly donor site scars. Functional outcome data on thenar flaps on the pediatric population is poor in the medical literature. METHOD: In this retrospective chart review we acquired information from sixteen patients who underwent a "Shark Bite" incision thenar flap reconstruction. RESULTS: Patients ranged in age from 0-17 years. Time to division ranged from 16-30 days. All 16 patients' affected finger ROM were measured in DIP, PIP and MCP joints and compared with corresponding finger on contralateral hand. A questionnaire measured subjective satisfaction in: sensibility, appearance, and function. Fingertip sensation was preserved in both affected finger and donor site. The most persistent patient complaint involved fingertip contour, were most patients rated it as "Fair"(43%) and "Good" (56%). After statistical analysis of the data we found no statistical difference in range of motion (ROM) between affected finger and the same finger on the contralateral hand on both PIP and MCP joints (p=0.08, 0.06 respectively). CONCLUSIONS: The "Shark Mouth" incision thenar flap is an effective strategy for fingertip reconstruction. The results demonstrate this technique has excellent functional and aesthetic results and is not associated with flexion contractures, excessive sensibility or pain in the pediatric population.
Muñoz-Matta A, Osorio R, Cabrera-León V
… +3 more, Oquendo H, Torres E, Romaguera J
Bol Asoc Med P R
· 2014 · PMID 26148391
OBJECTIVE OF THE STUDY: To describe cervical cytology trends in a sample of patients with Inflammatory Bowel Disease (IBD) and to provide an overview of aspects such as contraception and menstrual patterns. STUDY DESIGN:...OBJECTIVE OF THE STUDY: To describe cervical cytology trends in a sample of patients with Inflammatory Bowel Disease (IBD) and to provide an overview of aspects such as contraception and menstrual patterns. STUDY DESIGN: We identified women with diagnosis of IBD of ages between 21-49 years followed at the IBD clinics of the Medical Sciences Campus from June 2012 to April 2014. A 15-minute questionnaire was administered. Data was entered and analyzed calculating frequencies and percentages. RESULTS: Sixty-three subjects were recruited. After reviewing the questionnaires, 52 subjects remained for analysis. All women were between 21 and 49 years of age. Thirty (58%) patients had a diagnosis of ulcerative colitis (UC), while 22 (42%) patients had Crohn's Disease (CD). Twenty-seven IBD patients (52%) were in remission. Use of immunomodulators was reported in ten (33%) and seventeen (61%) of patients for UC and CD respectively. Sixty six percent (67%) of participants specified having their cervical cytology for cervical cancer screening done a nually. Twenty patients (38%) reported abnormal cytology including 13 patients (43%) with UC and 7 patients (23%) with CD. No significant relation was found between the two conditions and the self-reported history of abnormal cervical cytology. Almost one-half of IBD patients reported a menstrual cycle of 25-30 days (45%). Duration of menses was described as normal (lasting between 4-6 days) in 45% of IBD patients (95% CI 31.13-59.66). Patients with UC were more likely to report regular menses than patients with CD. Eighty-six percent of participants reported no use of contraception. CONCLUSION: This is the first descriptive report of gynecologic conditions in which Puerto Rican patients with IBD have been studied. It is imperative to continue with similar larger studies to gain a broader idea of what are the gynecological needs of this population.
Tortuosity of the cervical segment of the internal carotid artery (ICA) can hinder navigation intravascular devices for treating intracranial aneurysms and even complex ICA access techniques can fail. Variations in the c...Tortuosity of the cervical segment of the internal carotid artery (ICA) can hinder navigation intravascular devices for treating intracranial aneurysms and even complex ICA access techniques can fail. Variations in the course of the internal carotid artery are known as coiling, kinking or tortuosity of the vessel. Such failures have clinical relevance. During endovascular procedures these anomalies difficult the intravascular surgical procedure. A potential alternative is the reconstruction of these anatomic anomalies of the carotid artery using neuro-interventional methods. We present a practical review of the literature.
Valentín-Mendoza S, Nieves-Nieves J, Fernández-Medero R
… +3 more, Fernández-Gonzales R, Adorno-Fontánez J, Adorno-Fontánez E
Bol Asoc Med P R
· 2013 · PMID 24282925
Pulmonary lymphangioleiomyomatosis is an uncommon disease of unknown etiology characterized by the proliferation of abnormal smooth muscle cells in the lungs, leading to parenchymal destruction and progressive respirator...Pulmonary lymphangioleiomyomatosis is an uncommon disease of unknown etiology characterized by the proliferation of abnormal smooth muscle cells in the lungs, leading to parenchymal destruction and progressive respiratory failure. The natural history of this disease remains poorly understood, primarily seen in women of childbearing age. The diagnosis can be difficult because symptoms are nonspecific and very similar to other respiratory diseases like asthma, emphysema and bronchitis. Lymphangioleiomyomatosis may not be diagnosed until a pneumothorax, chylothorax, interstitial lung disease or angiomyolipomas are discovered. The recent advances in genetic and molecular research provide new hope to discover the intricate mechanism of disease and evaluate new therapies. Internists, primary care physicians and pulmonologists should be aware of this condition in order to avoid delay in the diagnosis and institute appropriate therapy. The clinical features, pathophysiology, molecular genetics and medical treatment will be reviewed.
Altieri PI, Marcial JM, Banchs H
… +2 more, Escobales N, Crespo M
Bol Asoc Med P R
· 2013 · PMID 24282924
Metabolic syndrome is a cluster of risk factors for cardiovascular disease that affects an estimated 50 million Americans. The present article reviews the metabolic syndrome with respect to its definition, epidemiology,...Metabolic syndrome is a cluster of risk factors for cardiovascular disease that affects an estimated 50 million Americans. The present article reviews the metabolic syndrome with respect to its definition, epidemiology, pathophysiology and management. A primary focus in research has been to elucidate the processes determined to cause insulin resistance, the fundamental mechanism underlying the metabolic syndrome. Namely, the incidence, component characteristics and complications of the metabolic syndrome in the island of Puerto Rico are described alongside 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 disease and a relatively normal lipid profile. This suggests that the cardiovascular complications are more influenced by genetics and culture than diabetes mellitus and hypertension.
Santos-Cubiñá J, Castaing-Lespier PA, Sabaté N
… +2 more, Torres-Martin A, Quiñones-Fernandini VM
Bol Asoc Med P R
· 2013 · PMID 24282923
Exacerbation of symptoms in mood disorders such as bipolar disorders, major depressive disorders and premenstrual dysphoric disorders could be influenced by the hormonal changes of the menstrual cycles in female patients...Exacerbation of symptoms in mood disorders such as bipolar disorders, major depressive disorders and premenstrual dysphoric disorders could be influenced by the hormonal changes of the menstrual cycles in female patients. Menarche has been related to onset of mood symptoms, which at times have been described as menstrual psychoses and could represent an early presentation of Pediatric bipolar disorders. Pediatric bipolar disorders appear to be characterized by less clearly defined mood episodes, shorter duration of these episodes, and different hallmark symptoms than in adults. This report describes a pediatric patient who had no previous psychiatric symptoms and for whom menstrual psychosis was the presenting symptom of bipolar disorder not otherwise specified.
Fernández González F, Miranda S, Santiago Casiano M
… +3 more, Nieves J, Adorno E, Fernández González R
Bol Asoc Med P R
· 2013 · PMID 24282922
We report a case of a 68 year-old-female patient with clinical features of drug-induced lupus erythematosus after five years of treatment with amiodarone. She presented generalized skin rash, arthralgia on upper and lowe...We report a case of a 68 year-old-female patient with clinical features of drug-induced lupus erythematosus after five years of treatment with amiodarone. She presented generalized skin rash, arthralgia on upper and lower extremities, associated with difficulty to walk. Remarkable laboratory results revealed a positive antinuclear antibody test and a skin rash biopsy showing a superficial and deep perivascular infiltrate of lymphocytes, histiocytes, and eosinophils. Once the etiology of the patient's symptoms was identified, the culprit drug was removed and she had a complete remission of all signs and symptoms. Early diagnose should be recognized for prompt intervention and avoid further complications associated with this rare side-effect.
Congenital rectovestibular fistulas with normal anus are a rare form of anorectal malformations, especially in the Western hemisphere. Due to its rarity, consensus on preoperative management, surgical technique and posto...Congenital rectovestibular fistulas with normal anus are a rare form of anorectal malformations, especially in the Western hemisphere. Due to its rarity, consensus on preoperative management, surgical technique and postoperative care is still in debate. We describe a specific case with its management plan and outcomes while providing an up to date literature review on current management trends.
Santos-Cubiñá J, Torres-Rodríguez A, Castaing-Lespier PA
… +3 more, Sabaté N, Torres-Martin A, Carlo S
Bol Asoc Med P R
· 2013 · PMID 24282920
Rarely screened in psychiatric patients, primary and/or secondary Carnitine deficiency could be influencing and/or mimicking the mood symptoms of our patient population. The brain and specifically neurons are highly vuln...Rarely screened in psychiatric patients, primary and/or secondary Carnitine deficiency could be influencing and/or mimicking the mood symptoms of our patient population. The brain and specifically neurons are highly vulnerable to impairments in oxidative metabolism, which can lead to neuronal cell death and disorders of neurotransmitters causing changes in cognition and behavior. For this reason, identification of this disorder is important since its treatment could result in symptom improvement and better quality of life of our patients. We present a case where exacerbation of mood symptoms was associated to primary and secondary Carnitine deficiency.
The aim of this pioneer study is to begin to create and validate a scale to measure Quality of Life in cancer patients in Puerto Rico (ECVCA-PR) in order to provide local health professionals with a reliable instrument t...The aim of this pioneer study is to begin to create and validate a scale to measure Quality of Life in cancer patients in Puerto Rico (ECVCA-PR) in order to provide local health professionals with a reliable instrument that help to measure attitudes that could affect different patient's quality of life aspects and allows knowing the needs of those cancer patients. Sample consisted of 32 patients (9 men, 23 women), between ages of 30 to 83 years that were receiving services (i.e., hospitalization, treatment, and follow up) at Dr. Isaac González Martínez Oncological Hospital in San Juan, Puerto Rico. The psychometric properties of the instrument indicate a reliability index (Cronbach's Alpha) of 0.927 with 164 items, an excellent index according to the literature.
Astudillo B, Cruz M, del Prado L
… +4 more, Domenack R, Nasi E, Seche S, Iriarte RI
Bol Asoc Med P R
· 2013 · PMID 24282918
UNLABELLED: The purpose of this study is to evaluate the characteristics of patients admitted to Bella Vista Hospital in Mayagüez with a diagnosis of infected skin ulcer, the most common microorganisms recovered in cultu...UNLABELLED: The purpose of this study is to evaluate the characteristics of patients admitted to Bella Vista Hospital in Mayagüez with a diagnosis of infected skin ulcer, the most common microorganisms recovered in cultures, and their antimicrobial sensitivity patterns. METHODS: All patients discharged with the diagnosis of infected skin ulcer from January 1 through December 31, 2012 were selected. Following variables were extracted: sex, age, hospital stay, morbid conditions, antibiotics used, microorganisms identified on cultures and sensitivity of microorganisms to different antimicrobials. Prevalence rates were estimated for different conditions and different microorganisms. The use of empirical antibiotics were described and compared with the antimicrobial sensitivity of the microorganisms. RESULTS: The study population consisted of 98 subjects (54% female, 46% male). Mean age was 71 years old, with 71% of subjects older than 65 years old. Prevalence rates of diabetes mellitus, peripheral vascular disease, hypertension and osteomyelitis were 74.5%, 74.5%, 79.6%, and 17.5% respectively. The antibiotic most frequently used was piperacyllin-tazobactam (PTZ). The organisms most frequently found on cultures were Staphylococcus (37.8%), distributed as 20.4% methicillin resistant and 17.3 sensitive to methicillin, followed by E. coli (30.6%), Streptococcus (29.6%), and Pseudomonas (27.6%). The majority of microorganisms were sensitive to PTZ. There was a higher prevalence of osteomyelitis in diabetic patients than in non-diabetic patients but the difference was not statistically significant. CONCLUSIONS: Antibiotic sensitivity patterns were consistent with the expected, according to the literature. Empirically used antibiotics were appropriate according to sensitivity patterns shown in the study.