Boletín de la Asociación Médica de Puerto Rico
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Review Case Reports
Distal fragmented port catheter: case report and review of literature.
Insertion of long-term central venous catheters (CVC) plays a vital role in providing continuous venous access for therapy in children. CVC line fractures are most commonly seen after long-term periods of therapy during removal. Usual place of rupture is proximal, at the point of entrance of the catheter into the vein, when the subclavian approach is utilized. We discuss a case that shows that CVC can also fracture in places different than the most common location and is possible not to detect that a fracture has occurred if a substantial portion of catheter is removed. ⋯ Most important single step in preventing such complication is to keep record of the patient length of catheter that was inserted to be able to measure it after removal confirming it still has the same length. Fragmented CVC should be removed using percutaneous endovascular techniques.
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Hand assisted laparoscopic colectomy (HALS) has been shown to have the advantages of laparoscopic colectomy in terms of pain, recovery and length of hospital stay. Studies have shown similar outcomes in laparoscopic colectomy as in open surgery. There is a learning curve to HALS, the operative time is longer, and it is more difficult than open surgery and requires specialized equipment. In this report we present our initial experience over a 2.5 year period using HALS for colon surgery for diverticulosis, polyps and colon cancer. ⋯ HALS colectomy is a safe and feasible alternative to open colectomy in a community hospital setting with proper expertise and equipment. Patients will benefit from faster recovery time and decreased length of stay in the hospital. Oncologic results are similar to open surgery. Operative times are longer than with open surgery and the operations are difficult to learn and master.
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Actually recommended by the International Liaison Committee on Resuscitation (ILCOR), therapeutic hypothermia has been the only modality shown to improve neurological outcomes after cardiac arrest. This article provides the background for such recommendations as well as: pathophysiology, review of brain injury during cardiac arrest, discussion of beneficial effects of therapeutic hypothermia, different mechanisms used to induce it and the latest clinical trials results.
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Etomidate is a drug commonly used for Rapid Sequence Intubation (RSI) and Procedural Sedation Anesthesia (PSA) in the Emergency Department because of its rapid onset of action and low cardiovascular risk profile. The antiarrhythmic effects of etomidate are presented in a patient with unstable wide complex tachycardia, which converted to sinus rhythm immediately after its administration. This is the first case in the Emergency Medicine literature and the second case reported of possible antiarrhythmic effects of etomidate since its development.
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Sildenafil citrate is a drug used in the treatment of erectile dysfunction. It is an inhibitor of the enzyme phosphordiesterase-5; it slows down the breakdown of c-GMP and nitrous oxide. The cardiac effects associated with Sildenafil citrate have been extensively studied in medical literature, especially its potent vasodilatory effect when combined with nitrate-based medications, producing intractable hypotension, but a lesser known and potentially lethal side effect is prolonged cardiac repolarization when used at dosage greater than recommended, leading to QT prolongation that could theoretically lead to dangerous cardiac dysrrhythmias and sudden death in men with coronary artery disease. ⋯ The patient was found to have an acute ST elevation inferior myocardial infarction (STEMI). Shortly after diagnosis the patient developed a polymorphic ventricular tachycardia (Torsade de pointes) before thrombolytic administration. We present this case followed by a brief discussion, to heighten awareness of the possible association of acute inferior STEMI and the development of Torsade de Pointes after the use of Sildenafil citrate.