Boletin de la Asociacion Medica de Puerto Rico最新文献

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.

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.

Systemic lupus erythematosus is a chronic inflammatory autoimmune disease characterized by autoantibodies specific for highly conserved nuclear antigens, such as double-stranded DNA, histones and ribonuclear proteins. The course of the disease is unpredictable and nine times more common in females. Among the neurological manifestations of collagen vascular diseases is the most commonly recognized and better studied disease. Central nervous system lupus is a serious and potentially treatable illness presenting as difficult diagnostic challenge. This is a case report of a patient that suffered central nervous system manifestations of severe active lupus. Early recognition of this entity is essential to expedite appropriate to treatment and avoid future complications.

Pseudoacromegaly is a extremely rare condition previously described and characterized by acromegaloid changes, tissue overgrowth, without elevations in insulin-like growth factor or growth hormone as seen in Acromegaly. We present the case of a young female seen initially with acromegaloid features and a pituitary microadenoma. After work-up the patient was diagnosed as insulin-mediated pseudoacromegaly. Only a few cases of pseudoacromegaly has been reported and should always be considered when evaluating patients for acromegaloid features with negative biochemical and hormonal levels.

Wandering spleen is a rare occurrence where the spleen normal fixation to the abdominal wall is lost and thus allowed to change in position. We report a case of a child who presented with acute abdominal pain secondary to a wandering spleen complicated by torsion of its vascular pedicle. The diagnosis was promptly made using computed tomography and managed with splenectomy.

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.

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.

Acute respiratory infections are the main reason for pediatric visits both to physician's offices and emergency departments. Bronchiolitis is an acute viral respiratory disease that affects about 10% of infants each year and mostly those under age two. The aim of this study was to identify demographic, epidemiological characteristics and risk factors associated with cases of bronchiolitis admitted to the Manati Medical Center (MMC). In addition, we tried to establish the basis for the development of strategies to prevent of hospitalizations and complications in our Institution. A retrospective descriptive study was conducted in the pediatric wing of MMC in Manati, Puerto Rico between January and December 2009. A total of 508 children were included, 58 % of them male. The average age and weight were 12 +/- 5.3 months and 8.1 +/- 1.4 kg, respectively. We observed a higher predisposition among males as well as a statistically significant relationship between breastfeeding and protection from the disease. No relationship was observed between preterm birth and the parents' smoking habit and the development of the disease. However, the latter factor influences the length of hospital stay. The risk of bronchiolitis was seasonal with a peak between October and November. The presence of respiratory syncitial virus was confirmed in 67 % of the cases.

End-stage renal disease is frequently complicated with anemia. Iron deficiency anemia occurs in most hemodialysis patients secondary to increased iron demand driven by the accelerated erythropoiesis that occurs when stimulating agents are administered as treatment of the anemia. The purpose of this study was to determine the prevalence of anemia and iron stores in patients undergoing hemodialysis at our unit; identify their treatment and effectiveness. Medical records of fifty-three patients undergoing ambulatory hemodialysis were evaluated for three months. Patient's hemoglobin, ferritin, iron, total iron binding capacity and percent transferrin saturation were recorded. 91% patients had arterial hypertension and 62% were diabetic. The prevalence of anemia was 34%, 57% and 47% during the three-month period respectively. Only 21% of the population had transferrin saturation less than 20% and none had ferritin below 200 ng/ml. Throughout the study, the majority of patients were managed with combination of iron and erythropoietin stimulating agents (ESAs). The prevalence of anemia remained elevated despite treatment with iron and ESAs. However, 56% of anemic patients throughout the three months showed an increase in hemoglobin levels by the end of the observation period. 53% of patients were treated with iron alone or with ESAs for the three consecutive month periods and only two had transferrin saturation less than 20%. In our population, ESAs low responsiveness is not related to iron deficiency but to the morbidity of their disease.

Purpose: To determine the level of knowledge about osteoporosis and factors associated with low level of knowledge in patients with a first osteoporotic fracture.

Methods: A cross-sectional study in adult patients with a first osteoporotic fracture admitted to the University Hospital of the Puerto Rico Medical Center, San Juan, Puerto Rico was performed. Socio-demographic parameters, clinical features, and pharmacologic treatment were examined. A validated questionnaire was used to assess subjects' level of knowledge about osteoporosis. Differences between study groups were evaluated using chi-square and Student's t tests, as appropriate.

Results: A total of 54 patients participated in the study. The mean (SD) age was 73.7 (10.7) years; 77.8% were females. Overall, 61.1% of the participants had a low level of knowledge about osteoporosis. Patients with low level of knowledge were more likely to have the Puerto Rico Government health insurance, lower level of education, and higher hip FRAX scores than those with mid/high level of knowledge. Also, they were less likely to receive osteoporosis counseling by their primary care physicians (PCP), have prior BMD measurement, receive bisphosphonates/raloxifene treatment, and to take calcium and vitamin D supplements.

Conclusions: In this population of Hispanic patients with a first osteoporotic fracture, the majority had a low level of knowledge about osteoporosis. Low knowledge was associated with low socio-economic status, lack of counseling about osteoporosis by PCP, prior BMD measurement, and osteoporosis treatment. Better efforts should be undertaken to educate, identify, and manage patients at risk for osteoporotic fractures.