Boletín de la Asociación Médica de Puerto Rico

Fungal infections represent a serious complication for immunosuppressed patients resulting in an increased morbidity and mortality. A non-concurrent prospective study was performed to evaluate the factors associated to invasive fungal infection (IFI) in patients with hematological malignancies admitted to the University Hospital in San Juan, Puerto Rico from January 1st , 2011 through June 15th , 2014. The medical records of 84 patients were evaluated. Fifty-nine patients with IFI and twenty-five without IFI...

No abstract text is available yet for this article.

Prolactinomas are the most common hormone-secreting pituitary tumors and represents approximately 40% of all pituitary adenomas. Pharmacology therapy with dopamine agonists is the mainstay treatment for prolactinomas. Usually, patients respond to these drugs with decreased level of the serum prolactin and with time, by tumor shrinkage. Less than 10% of patients with prolactinomas exhibit resistance to the action of dopamine agonists, as defined by the lack of normalization of the serum prolactin levels despite long- term treatment at high doses of these drugs...

This is the case of a 38 year-old female patient with an intrauterine pregnancy, in which a previous incidentally identified adrenal mass proved to be a pheochromocytoma during the antenatal period. The patient was started on α-and β-adrenergic blockade to maintain hemodynamic stability, and surgical removal of the lesion was performed during the second trimester without major complications. In view of the rarity of this disorder in pregnancy, it is imperative to have a high index of suspicion for a prompt and dedicated management, since this tumor, if unrecognized, is associated with high fetal and maternal mortality...

INTRODUCTION: A traumatic event to the tibia with more than 14 cm of bone and soft tissue loss represents a challenge to most orthopedic surgeons and is considered a limb-threatening condition. Few solutions are available in such clinical situations and among them is the acute shortening and re-lengthening of bone and soft tissue. MATERIALS AND METHODS: Our study presents the management of 7 patients with grade III B open fractures (according to the Gustillo-Anderson classification) of the tibia who underwent resection of all the devitalized tissues, acute limb shortening to close the defect, application of an external fixator, and metaphyseal osteotomy for re-lengthening...

INTRODUCTION: Previous studies have described Klinefelter syndrome as a genetic disorder characterized by at least one extra X chromosome and at least 47 chromosomes. It is the most common sex chromosome aneuploidy among men. Patients may present with large height, gynecomastia, low testosterone levels, infertility, hypogonadism and diseases usually more common in females such as osteoporosis, breast cancer and auto-immune disorders. Other rare ophthalmic associations have been described, such as diffuse choroidal atrophy, microphtalmia, cataracts, juvenile glaucoma, choroid colobomas and goniodysgenesis...

Quadriceps muscle injuries are common in athletes and middle age patients. Strains and tears of the distal portion of the muscle is the most common presentation of these injuries. Isolated rectus femoris tears are rare and few reports are published that evaluate outcomes in of nonsurgical treatment of these injuries. This article will described an unusual case of isolated distal rectus femoris tear in a patient with no associated risk factors, who initially presented with extensor mechanism weakness and limping, treated conservatively with range of motion therapy and strengthening...

End Stage Renal Disease patients undergo profound hemodynamic changes during hemodialysis treatments which are now recognized as a marker for increased risk of morbidity and mortality. Development of intradialytic hypotension or hypertension are a common clinical problem in this population with an incidence of up to 20%. We performed a retrospective review of 49 Hispanic patients receiving ambulatory hemodialysis during a period of 6 months to ascertain the development of aforementioned intradialytic events...

Methicillin-resistant Staphylococcus aureus (MRSA) is a strain of S. aureus that shows resistance to multiple antibiotics. Up to 30% of S. aureus strains isolated from nosocomial infections are MRSA, and it has become a growing problem for public health. The cost of MRSA infection is also having a huge impact financially and results in considerable resource utilization. Puerto Rico’s Legislature passed Law # 298 on October 19, 2012 for the control and prevention of MRSA infections in medical installations in Puerto Rico...

Stress fractures and muscle strains are common in marathon runners. Most stress fractures occur in lower extremities and tibia stress fractures comprise almost half. Iliac wing stress fractures are not commonly found in runners and are usually related to osteoporosis. There have been 4 previous reports of iliac stress fractures in marathon runners none reported an associated isolated gluteus minimus tendon tears. We will report a case of a female marathon runner with iliac wing stress fracture with associated isolated gluteus minimus tendon tear...

In this case report a patient presents with high-output cardiac failure in the clinical setting of acute leukemia and leukostasis. Case particulars are presented, literature is reviewed and a potential mechanistic explanation is proposed to describe presentation and clinical findings.

OBJECTIVES: The aim of this work is to determine the diabetes treatment satisfaction in a group of hospitalized patients with type 2 diabetes. METHODS: observational cross research. Patients over the age of 18 with diagnosed type 2 diabetes of at least one year until the present study were included. Those presenting pathologies attributed to diabetes were excluded. Patients should have responded to the DTSQ questionnaire upon admission. r Pearson regression, multivariate linear regression and U Mann-Whitney tests were analyzed...

Dengue is an endemic disease in Puerto Rico, with three to nine thousand suspected dengue cases reported yearly. In PR, physicians are required to maintain medical education courses about dengue in order to recertify their medical licenses. The purpose of this study was to describe characteristics of patients admitted to Bella Vista Hospital with suspected dengue and estimate the compliance with guidelines established by the CDC documented in medical records. A total of 197 medical records of patients admitted with diagnosis of suspected dengue during January 1, 2013 through December 31, 2013 were reviewed...

No abstract text is available yet for this article.

Choledochal cysts are cystic dilatation of the common bile duct managed by excision and hepatico-intestinal reconstruction. The gold standard after choledochal cyst excision is reconstruction using the jejunum. With the advent of laparoscopy the pendulum has changed toward hepaticoduodenostomy reconstruction. We review the classification, diagnosis and recent management of choledochal cyst.

No abstract text is available yet for this article.

Prolactinomas are the most common hormone-secreting pituitary tumors and represents approximately 40% of all pituitary adenomas. Pharmacology therapy with dopamine agonists is the mainstay treatment for prolactinomas Usually, patients respond to these drugs with decreased level of the serum prolactin and with time, by tumor shrinkage. Less than 10% of patients with prolactinomas exhibit resistance to the action of dopamine agonists, as defined by the lack of normalization of the serum prolactin levels despite long- term treatment at high doses of these drugs...

This case illustrates the unusual presentation of Takotsubo cardiomyopathy in an elderly male patient with characteristic chest pain and dyspnea associated with electrocardiographic changes of biphasic T wave inversions and QT-interval prolongation on anterior segment, mimicking acute coronary syndrome. Takotsubo cardiomyopathy is a transient systolic dysfunction of the apical and/or mid and anterior segments of left ventricle most frequently seen in post- menopausal women, up to 80 to 100% of cases. Often there is a history of a recent (within the previous two months) episode of severe emotional or physical stress associated with the event...

Fibrous dysplasia is benign developmental disorders of bone where normal lamellar cancellous bone is replaced with immature fibro-osseus tissue resulting in poorly formed trabeculae of immature woven bone. It may affect one (monostotic) or multiple bones (polyostotic). Polyostotic disease is less common, 20-25% of patients, mostly in children below 10 years old and tends to enlarge beyond bone maturation ration which can cause pain, progressive damage and higher tendency of pathological fractures.(1) We report a case of polyostotic fibrous dysplasia present on bilateral tibia diaphysis...

Surgical site infections (SSI) are the most common healthcare-associated infections. Approximately 2-5% of all surgeries develop SSI as a complication. These infections are responsible for significant fatality, morbidity, and length of hospital stay. The purpose of this study was to describe characteristics of SSI in a community hospital in Puerto Rico. This was cross-sectional study. Between July 2013 and August 2015, 5468 major operative procedures were performed and 31 SSI were reported for an overall SSI incidence rate of 0...