Boletin de la Asociacion Medica de Puerto Rico最新文献

{"title":"Bacterial Species, Susceptibility to antibiotics and characteristics of patients with surgical\u0000site infections.","authors":"Inés Serrano,&nbsp;Jorge Vera","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Surgical site infections (SSI) are the most common healthcare-associated\u0000infections. Approximately 2-5% of all surgeries develop SSI as a complication.\u0000These infections are responsible for significant fatality, morbidity, and\u0000length of hospital stay. The purpose of this study was to describe characteristics\u0000of SSI in a community hospital in Puerto Rico. This was cross-sectional\u0000study. Between July 2013 and August 2015, 5468 major operative\u0000procedures were performed and 31 SSI were reported for an overall SSI\u0000incidence rate of 0.57%. A total of 31 cases of SSI were studied. The mean\u0000age of patients was 59.4 years, with a range of to 29 to 89 years. The median\u0000age was 64 years. The sex distribution showed 22 women (71%) and 9 men\u0000(29%). The prevalence rate of diabetes mellitus was 13/31 (42%). In this\u0000study 90% of patients with SSI had at least one underlying health condition\u0000(diabetes, hypertension, obesity, age > 65 years). Location of surgical\u0000site infections were: abdominal 16 (52%), orthopedic 4 (13%), pelvic 7\u0000(22%), stump 3 (10%), and chest tube 1 (3%). A total of 12 different bacterial\u0000pathogens were found. A single etiologic agent was identified in 18 patients\u0000(53%) and multiple agents were found in 13 patients (47%). Enterococcus\u0000faecalis was the most common pathogen (45% of patients) followed\u0000by Escherichia coli (39% of patients). The majority of bacteria isolated from\u0000cultures were susceptible to B-lactams and aminoglycosides.</p>","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"108 1","pages":"19-22"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35211103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secondary Resistance to dopamine agonist after thirteen months of successful treatment\u0000in a 42 years old man.","authors":"Iván E Laboy-Ortiz,&nbsp;Sharon Velez-Maymí,&nbsp;José Hernán Martínez,&nbsp;Rafael Trinidad,&nbsp;Michelle Mangual,&nbsp;Alfredo Sanchez,&nbsp;Madeline Gutierrez,&nbsp;Paola Mansilla,&nbsp;Carmen Rivera,&nbsp;Coromoto Palermo,&nbsp;María Lourdes Miranda,&nbsp;Ricardo Brau","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Prolactinomas are the most common hormone-secreting pituitary tumors\u0000and represents approximately 40% of all pituitary adenomas. Pharmacology\u0000therapy with dopamine agonists is the mainstay treatment for prolactinomas\u0000Usually, patients respond to these drugs with decreased level of the serum\u0000prolactin and with time, by tumor shrinkage. Less than 10% of patients\u0000with prolactinomas exhibit resistance to the action of dopamine agonists, as\u0000defined by the lack of normalization of the serum prolactin levels despite long-\u0000term treatment at high doses of these drugs. However secondary resistance\u0000to dopamine agonists therapy has also been described in patients who were\u0000initially responsive to treatment, either with Cabergoline or Bromocriptine\u0000but later develop dopamine agonist resistance, with elevated prolactin levels\u0000and sometimes an enlarging tumor volume several years afterwards. We\u0000report a case of a male patient with prolactinoma who developed drug resistance\u000013 months after initial dopamine agonist therapy.</p>","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"108 10066","pages":"29-34"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35211106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Choledochal Cyst: Hepaticoduodenostomy or hepaticojejunostomy?","authors":"Nicole M Diaz Ramos,&nbsp;Humberto Lugo-Vicente","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Choledochal cysts are cystic dilatation of the common bile duct managed by\u0000excision and hepatico-intestinal reconstruction. The gold standard after choledochal\u0000cyst excision is reconstruction using the jejunum. With the advent of\u0000laparoscopy the pendulum has changed toward hepaticoduodenostomy reconstruction.\u0000We review the classification, diagnosis and recent management of\u0000choledochal cyst.</p>","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"108 1","pages":"41-46"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35211108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Right Heart Thrombus in Transit: Unusual Echocardiographic Finding in a patient with Acute Pulmonary Embolism.","authors":"Sonia I Vicenty-Rivera,&nbsp;Ricardo Perez-Feliciano,&nbsp;Carla P Rodriguez-Monserrate,&nbsp;Gabriela Montes-Rivera,&nbsp;Oscar Nevarez-Pomales","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Eighty year old male patient with heart failure preserved ejection fraction (EF),\u0000Obstructive sleep apnea, peripherovascular disease admitted with increasing\u0000shortness of breath and found with pulmonary emboli. Baseline 2D-echo-cardiogram\u0000performed demonstrated preserved ejection fraction and a right\u0000thrombus in transit. Anticoagulation with weight based-low molecular\u0000weight heparin was given for six days. Follow-up echo performed demonstrated\u0000complete dissolution of right heart thrombi. Since there was complete dis-\u0000solution of thrombi seen on right atrium, anticoagulation with Rivaroxaban\u0000was given instead.</p>","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"108 24","pages":"43-6"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35276770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Fibrinolytic Therapy in the Emergency Department.","authors":"Wanda L Rivera-Bou,&nbsp;Adriana Chersich","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Emergency physicians are many times the first-line practitioners to encounter\u0000circulatory emergencies. Amongst these many diseases we face, of importance\u0000are acute myocardial infarction, ischemic cerebrovascular accidents and pulmonary\u0000embolism. Familiarity with fibrinolytic agents and regimens, as well as indications\u0000and contraindications, are crucial to the emergency department physician.\u0000Fibrinolytic therapy has been shown to be beneficial and can serve as a bridge to\u0000definite treatment, while lowering the risk of morbidity and mortality. Unfortunately\u0000fibrinolytic therapy is underused and often administered later than optimum.\u0000The aim of fibrinolytics is to dissolve blood clots that can cause serious and potentially\u0000life-threatening damage if not removed in a timely manner. The mechanism of\u0000this benefit relates to maximizing tissue salvage by early restoration of blood flow\u0000and thereby enhancing both early and long-term survival. Older thrombi have\u0000extensive fibrin polymerization making them more resistant to thrombolysis;\u0000hence, the importance of early administration of fibrinolytic therapy.</p>","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"108 2","pages":"61-4"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35582688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A middle aged woman with isolated ACTH deficiency associated with transient growth hormone deficiency.","authors":"José Hernán Martínez,&nbsp;Michelle M Mangual Garcia,&nbsp;Madeleine Gutiérrez Acevedo,&nbsp;Alfredo Sánchez Cruz,&nbsp;Ivan Laboy,&nbsp;Carmen Rivera,&nbsp;Paola Mansilla,&nbsp;Coromoto Palermo Garofalo,&nbsp;María Lourdes Miranda,&nbsp;Oberto Torres Rafael","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Isolated ACTH deficiency (IAD) is a rare entity characterized by secondary\u0000adrenal insufficiency with low levels of serum cortisol, decreased\u0000production of ACTH, adequate secretion of other pituitary hormones\u0000and normal pituitary structure on radioimaging. The prevalence of\u0000IAD as a cause of secondary adrenal insufficiency has not been determined.\u0000Impairment of growth hormone (GH) secretion has been\u0000noted in 20 to 30% of patients with IAD which is normalized after glucocorticoid\u0000replacement. We report the case of a 50 years-old female\u0000with symptoms and laboratory results suggestive of adrenal insufficiency.\u0000Insulin tolerance test confirmed ACTH and growth hormone\u0000deficiency. The rest of the anterior pituitary hormones were normal. A\u0000pituitary MRI was unremarkable. Glucocorticoid replacement therapy\u0000started and eight months afterwards glucagon stimulation test revealed\u0000persistent ACTH deficiency but nor-\u0000mal growth hormone secretion. IAD can present with nonspecific symptoms\u0000and could be potentially fatal in an acute stressful period. Prompt\u0000recognition is essential to decrease morbidity and mortality.</p>","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"108 1","pages":"5-8"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35208148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adequate Administration of Perioperative Antibiotics in Orthopedic Patients: Quality Assessment Study.","authors":"Emanuel Rivera,&nbsp;William H Titley,&nbsp;Emmanuel López,&nbsp;Antonio Otero","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The Centers for Disease Control and Prevention (CDC) estimate that\u0000nearly 500,000 surgical site infections (SSIs) occur annually.[3] SSIs remain\u0000a substantial cause of morbidity and mortality among hospitalized patients.\u0000For this reason, we developed a quality assessment study with a\u0000perioperative antibiotic protocol that included antibiotic type, weight dependent\u0000dose, and intraoperative re-dosing regime for the proper administration of prophylaxis antibiotics\u0000prior to orthopedic surgery. We restricted our study to knee replacement\u0000and hip replacement surgeries. All records from September 2014 to June\u00002015 were taken into consideration (78 cases). Before February 2015\u0000(protocol implementation date), only 33% or 13 of 39 cases were correctly\u0000dosed. After protocol establishment: 44 % or 17 of 39 cases were correctly\u0000dosed. Although our p-value suggests no statistical significance, there was\u0000an increasing trend of adequate antibiotic administration. In conclusion,\u0000we need to educate more our nursing staff and implement monthly audits\u0000of our cases to improve our mistakes and ensure that this aspect of practice\u0000will remain in the forefront of perioperative orthopedic surgery care.</p>","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"108 1","pages":"9-11"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35208541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Shortening and re-lengthening in the management of open tibia fractures with severe bone\u0000of 14 CMS or more and extensive soft tissue loss.","authors":"Charles Zierenberg García,&nbsp;David Beaton Comulada,&nbsp;José Carlos Pérez López,&nbsp;Alfredo Lamela Domenech,&nbsp;Gabriella Rivera Ortiz,&nbsp;Héctor M González Montalvo,&nbsp;Pedro J Reyes-Martínez","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>A traumatic event to the tibia with more than 14 cm of bone and\u0000soft tissue loss represents a challenge to most orthopedic surgeons and is \u0000considered a limb-threatening condition. Few solutions are available in such \u0000clinical situations and among them is the acute shortening and re-lengthening of\u0000bone and soft tissue.</p><p><strong>Materials and methods: </strong>Our study presents the management of 7 patients\u0000with grade III B open fractures (according to the Gustillo-Anderson\u0000classification) of the tibia who underwent resection\u0000of all the devitalized tissues, acute limb shortening to close the defect,\u0000application of an external fixator, and metaphyseal osteotomy for \u0000re-lengthening. The patient outcomes were based\u0000on different parameters using the evaluation system established by Paley et al.</p><p><strong>Results: </strong>Results acquired during the study show an average bone loss of 19cm\u0000(with a minimum of 14 cm and a maximum of 31.50cm). The average time\u0000to full recovery of all patients was 19 months with a minimum of 14 months\u0000and a max of 34 months. Patient presented with excellent bony union and\u0000none existent or small refractory leg length discrepancy and did not require\u0000bone grafts or free flaps. Complications that the patients had were contractures,\u0000which required secondary procedures such as Achilles tendon re-lengthening\u0000and recurrent infections.</p><p><strong>Discussion: </strong>Overall patients had excellent bone union and were able to \u0000perform activities of their daily living. The Ilizarov technique of compression-dis-\u0000traction osteogenesis is an elegant treatment option that should be considered\u0000in patients suffering such traumatic events providing excellent bony union\u0000and good functional outcomes for the patient.</p>","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"108 1","pages":"91-94"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35211929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between fine needle aspiration cytology\u0000and final pathology in the diagnosis of thyroid nodules\u0000with surgical indications.","authors":"Marla Servilla,&nbsp;César Trabanco,&nbsp;Walter Feliciano,&nbsp;Rafael E Bredy,&nbsp;Shirley Lojo","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Fine needle aspiration of thyroid (FNA) is broadly used as the preferred\u0000preoperatory test to evaluate thyroid nodules. The clinical importance of\u0000this procedure is primarily related the need to exclude Thyroid Cancer.\u0000There are few studies investigating the association between FNA and final\u0000pathology in patients with thyroid nodules with surgical indications.\u0000There is no evidence from studies in the southern area of Puerto Rico that\u0000investigate this association. This was a randomized cross-sectional study, 82\u0000medical records were evaluated. Data were obtained for FNA diagnosis,\u0000demographics, body mass index, findings on ultrasound and histopathology\u0000results. In this study the sensitivity of FNA was 73.53% and specificity of\u0000100%. The accuracy of the study was 78%. The study reported a prevalence\u0000of 83% malignant tumors in the final pathology and 61% in the FNA. The\u0000positive predictive value was 100% and negative 43.75%, suggesting that\u0000FNA is a good diagnostic test to detect thyroid nodules suspicious for\u0000malignancy. FNA of 33 patients was reported with undetermined cytopathology.\u0000The measure of agreement and correlation coefficient showed a\u0000moderate agreement between both studies with a Kappa value of 0.487,\u0000suggesting that the test results of FNA and final pathology are associated.\u0000Of the indeterminate nodules, final pathology reported 15 benign and 18\u0000malignant. This study demonstrated that the FNA is reliable in identifying\u0000thyroid nodules in patients with surgical indications.</p>","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"108 1","pages":"13-18"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35208544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary cutaneous B-cell lymphoblastic lymphoma: A pediatric case report.","authors":"Rocío Cardona,&nbsp;Lilliana Ramírez-García,&nbsp;Francisco Colón-Fontanez","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>FPrecursor T- or B-cell non-Hodgkin lymphoblastic lymphomas represent\u0000only a small fraction of pediatric cancer cases. Due to its rarity, the diagnosis of\u0000lymphoblastic lymphoma (LBL) in a pediatric patient is challenging, particularly\u0000if its manifestation is solely cutaneous. We describe the case of an infant with primary cutaneous B-cell LBL who\u0000was initially diagnosed by a primary care physician with an infectious etiology\u0000and consequently treated with topical and oral antibiotics. Subcutaneous nodules\u0000located on the head or neck of infants should raise suspicion for lymphoma\u0000and biopsy should be performed in order to rule out malignancy. A prompt\u0000diagnosis is imperative when considering the aggressive nature of LBLs. Expedited\u0000therapy has been known to help cease systemic involvement of primary\u0000cutaneous B-cell LBLs and encourage a more favorable outcome.</p>","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"108 2","pages":"35-8"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35276767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}