P R Health Sci J
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A retrospective study of the experience at the University Pediatric Hospital during a six-year period when 2529 patients were admitted to the Pediatric Intensive Care Unit (PICU) and 80 were diagnosed with brain death. Etiologic causes, age and sex distribution and use of confirmatory studies were evaluated. The specific criterias for brain death determination in children are discussed and it was found that 3.1% of all the admissions to PICU were diagnosed with brain death. ⋯ Trauma accounted for 41.0% of the cases. In babies less than 6 months of age, 71.4% were battered. Only 11% accepted organ donation.
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Melasma is an acquired symmetrical brown hypermelanosis of the face. Three clinical patterns are recognized, namely centrofacial, malar and mandibular. This study addresses the clinical and histopathological features of ten women with mandibular melasma to determine its relation to other types of melasma. ⋯ Histopathologically, all patients demonstrated severe sundamage and hyperpigmentation of the epidermis. Nine of them had melanophages or melanin in the papillary dermis. We conclude than mandibular melasma may be a clinicopathologic entity different to other types of melasma.
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Review Comparative Study
The sixth Carlos E. Rubio Memorial Lecture. Prevention and treatment of variceal hemorrhage.
The medical treatment of portal hypertension has experienced a marked progress in the past decade due to the introduction of effective portal hypotensive therapy. This has been possible because of the better understanding of the pathophysiological mechanisms leading to portal hypertension. A major step forward was the introduction of beta-blockers for the prevention of bleeding and rebleeding from gastroesophageal varices. ⋯ There is an increasing trend for initiating therapy with a pharmacological agent, followed by semi-emergency endoscopic therapy as soon as a well trained endoscopist is available (within 12-24 hours), while maintaining drug therapy for 5 days. Failures of medical therapy may be treated by a second session of endoscopic treatment, but if this fails TIPS of emergency surgery should be done. In high-risk situations, such as bleeding from gastric varices or in patients with advanced liver failure, the decision for TIPS or surgery should be done earlier, after failure of the initial treatment.
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Historical Article
The history of cardiovascular surgery in Puerto Rico.
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Aspiration of foreign bodies is more common in children than adults. The clinical and radiological findings between these two age groups are different. It is a clinical diagnosis often overlooked in adults. ⋯ Upon bronchoscopic evaluation, a foreign object was found which is very uncommon in adults. The unusual location of the aspirated material is another interesting feature of our case. Clinicians should be aware that aspiration of foreign objects may occur also in adults.