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1.
Cureus ; 14(2): e22401, 2022 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-35371763

RESUMEN

Thyroid Hemiagenesis (THA) is an uncommon, congenital anomaly defined by the absence of one thyroid lobe with or without the isthmus. Reports suggest it may be found more often in regions endemic for hypothyroidism. Genetic abnormalities are thought to have a role based on findings in monozygotic twins. Most cases are sporadic, however familiar clusters have also been documented. It is found more frequently in females. A majority of patients report no symptoms and THA is found incidentally during investigations or intraoperatively. THA is usually associated with normal thyroid function, but it can present with thyroid hypofunction. Since a majority of patients are asymptomatic, there are no specific recommendations for management. Ultrasound imaging and thyroid scintigraphy using technetium or iodine are useful in diagnosis. Its clinical importance occurs when the remnant thyroid lobe requires excision leading to the lifelong requirement for thyroxine supplementation. Published English literature (Medline, PubMed, and Embase databases) was searched. Medical subject headings (MeSH) terms used were "thyroid hemiagenesis," "one thyroid lobe," and "thyroid aplasia". Case reports, case series, and original articles were selected to provide a framework for this review. Articles reviewed were published in the past 20 years. The association of THA with thyroid cancer was explored. In this group, the F:M ratio was 3.25:1. Left THA constituted 53% of cases, right THA in 29.4%, and isthmus absence in 17.6% of cases. Also, the authors investigated the link between THA and hyperparathyroidism, both left and right THA are seen in an equal number of cases in the hyperparathyroidism subgroup. In patients with THA and Grave's disease, left THA was seen in a majority of cases (86.7%), while an equal number of left and right THA was observed in patients with Hashimoto's thyroiditis. In addition, congenital abnormalities associated with THA were observed, the left THA was seen in 60% and right THA in 40% of cases of this subgroup. The summative review provided a detailed insight into the epidemiology, aetiopathogenesis, genetics, symptomatology, diagnosis, and treatment for THA by combining findings and results from almost a hundred research papers from around the world. THA remains a poorly understood, often incidentally detected, abnormality in euthyroid patients undergoing investigations and treatment for other thyroid disorders.

2.
Cureus ; 12(8): e9568, 2020 Aug 05.
Artículo en Inglés | MEDLINE | ID: mdl-32905543

RESUMEN

INTRODUCTION: Same-day discharge percutaneous coronary interventions (SDD-PCI) may be quite impactful on healthcare burden for small island developing states (SIDS) such as Trinidad and Tobago. METHODS: From June 2012 to November 2014, 11 patients underwent SDD trans-radial PCI and followed up at one-month and three months. Data was retrospectively reviewed from a prospectively entered unit-maintained cardiology database. Baseline patient characteristics, in-hospital expenditure, and complications were assessed. Descriptive statistical analysis was performed in Microsoft Excel. RESULTS: The mean age at SDD-PCI was 50.90±9.96 and nine were male. Nine patients were of East Indian Caribbean ethnicity. Six were diabetic and five were hypertensive. Procedural success was 100% with no major early complication or three-months complications; patient satisfaction was achieved with a potential in-hospital savings up to $1480 USD per patient. CONCLUSION: This SDD approach for elective trans-radial PCI may be safe and cost-effective in properly selected patients and merits a review of relevant policy issues in Trinidad and Tobago.

4.
Int J Angiol ; 27(4): 227-231, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30410295

RESUMEN

The dogma for optimal arteriovenous fistula (AVF) creation is based on starting as distally as possible on the upper limb and progressing proximally. We herein present our findings of an AVF that is as distal as possible on the hand. To document primary patency rates of the distal-to-snuffbox AVF. A 10-year prospective study (2006-2016) involving 31 patients whose distal cephalic vein diameter was ≥3 mm with a normal Allen's test was conducted. Patients were excluded if the radial artery in the wrist was highly calcified, the cephalic vein did not dilate more than 3 mm with proximal compression, and there was previously failed AVF of the limb or previous trauma to the limb. The procedure was performed under local anesthetic, and the anastomosis performed with a 6.0 polypropylene suture in an end-to-side fashion. Thirty-one patients with end-stage renal disease underwent distal vascular access using the distal-to-snuffbox (Hitchhiker's) AVF (HAVF). During follow-up, eight patients died with an adequately functioning HAVF. The primary patency rates at 12, 24, 48, and 60 months were 90, 87, 85, and 82%, respectively. Failure occurred in six (19%) cases over the follow-up period, two in the first 2 weeks and four over a span of 60 months. Conclusion The creation of radiocephalic AVFs in the first web space, distal to the tendon of the extensor pollicis longus, serves as a viable option with acceptable success rates. This allows the surgeon more options with proper patient selection for this procedure.

5.
Am J Case Rep ; 14: 326-8, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23997851

RESUMEN

PATIENT: Male, 26 FINAL DIAGNOSIS: Marihuana addiction Symptoms: Compulsive showering • nausea • vomiting MEDICATION: - Clinical Procedure: - Specialty: Toxicology. OBJECTIVE: Unexpected drug reaction. BACKGROUND: The use or misuse of Cannabis is well recognized in the Caribbean region. Recently, the cannabinoid hyperemesis syndrome has been described. The triad is characterized by chronic marijuana use, cyclical vomiting, and compulsive bathing. With the extensive use to marijuana as a recreational drug and also the increased use as prescription medication, a patient presenting with this symptomatology needs to be assessed appropriately and this syndrome needs to be one of the differential diagnoses. CASE REPORT: To our knowledge, we report the first such case in the Caribbean region. Here, we report on the case of a 26-year-old Caucasian male with a 3-week history of nausea and week of epigastric pain and vomiting. The patient was known to use marijuana daily for 2 years and had similar complaints for the last 6 months. CONCLUSIONS: Because this popular recreational drug is now being used with increased frequency as a prescribed medication, it is crucial that clinicians be aware of this condition, which can present as a diagnostic dilemma.

6.
Microsurgery ; 32(3): 223-6, 2012 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-22371199

RESUMEN

A 26-year-old man presented with a nonhealing ulcer on the plantar aspect of the left foot of five years duration. Initial investigations were unremarkable. It was only after careful neurological examination that an inherited neuropathy was suspected. This was confirmed by nerve conduction studies and serum electrophoresis. He subsequently underwent partial great toe amputation for the ulcer and underlying first phalangeal osteomyelitis with uneventful healing. Neuropathic ulcers are usually associated with several well-known disorders including diabetes mellitus, tabes dorsalis, pernicious anemia, and sickle cell disease. A rarer cause is Charcot-Marie-Tooth Disease (CMTD). The report gives a review of CMTD and emphasizes that when faced with a nonhealing ulcer in the younger age group, such an underlying hereditary neuropathic cause must be considered.


Asunto(s)
Enfermedad de Charcot-Marie-Tooth/diagnóstico , Úlcera del Pie/etiología , Adulto , Enfermedad de Charcot-Marie-Tooth/complicaciones , Humanos , Masculino
7.
Car. med.jour ; 72(3): 4-6, June 2011.
Artículo en Inglés | MedCarib, MedCarib | ID: med-17481

RESUMEN

Patients with chronic venous ulceration (CEAP C6) are traditionally treated conservatively with compression therapy, weight reduction and lef elevation. this is particularly true when the ulcers are infected with a significant amount of bioburden, as traditional open surgery may be complicated by surgical incision infection and dehiscence. We present a case series of nine consecutive patients and venous ulcers who underwent ultrasonic debridement and early minimally invasive vien surgery employing 810nm endovenous laser therapy (EVLT).


Asunto(s)
Humanos , Úlcera Varicosa , Úlcera Varicosa/diagnóstico , Trinidad y Tobago
8.
Gend Med ; 7(2): 179-83, 2010 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-20435280

RESUMEN

BACKGROUND: Men with breast carcinoma have a poor prognosis, especially in the younger age group (30-40 years of age), because most breast enlargements in young men are dismissed as gynecomastia, resulting in an unnecessary delay in treatment. OBJECTIVE: We describe the case of a young male patient with invasive ductal breast carcinoma. CASE SUMMARY: In November 2005, a 30-year-old Afro-Caribbean man presented at St. Clair Medical Centre in Port of Spain, Trinidad, with a painless lump in the right breast. Diagnostic findings revealed that the patient had stage II invasive ductal carcinoma, for which he underwent a mastectomy with total axillary clearance. CONCLUSION: Surgeons investigating unilateral breast swellings in young males should not dismiss them simply as gynecomastia, and should be wary of cancer.


Asunto(s)
Neoplasias de la Mama Masculina , Carcinoma Ductal de Mama , Adulto , Distribución por Edad , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Axila , Biopsia , Neoplasias de la Mama Masculina/diagnóstico , Neoplasias de la Mama Masculina/epidemiología , Neoplasias de la Mama Masculina/terapia , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Ductal de Mama/epidemiología , Carcinoma Ductal de Mama/terapia , Quimioterapia Adyuvante , Diagnóstico Tardío , Humanos , Incidencia , Escisión del Ganglio Linfático , Masculino , Mastectomía Simple , Estadificación de Neoplasias , Pronóstico , Distribución por Sexo , Tomografía Computarizada por Rayos X , Trinidad y Tobago/epidemiología
10.
Indian J Exp Biol ; 45(8): 739-43, 2007 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-17877152

RESUMEN

The aqueous extract of C. papaya fruit (100 mg kg(-1) day(-1) for 10 days) was evaluated for its wound healing activity in streptozotocin-induced diabetic rats using excision and dead space wound models. Extract-treated animals exhibited 77% reduction in the wound area when compared to controls which was 59%. The extract treated wounds were found to epithelize faster as compared to controls. The wet and dry granulation tissue weight and hydroxyproline content increased significantly when compared to controls. The extract exhibited antimicrobial activity against the five organisms tested. Carica papaya promotes significant wound healing in diabetic rats and further evaluation of this activity in humans is suggested.


Asunto(s)
Antibacterianos/farmacología , Carica/química , Diabetes Mellitus Experimental/complicaciones , Cicatrización de Heridas/efectos de los fármacos , Heridas y Lesiones/tratamiento farmacológico , Animales , Antibacterianos/uso terapéutico , Diabetes Mellitus Experimental/inducido químicamente , Modelos Animales de Enfermedad , Masculino , Extractos Vegetales/farmacología , Extractos Vegetales/uso terapéutico , Ratas , Ratas Sprague-Dawley , Heridas y Lesiones/complicaciones , Heridas y Lesiones/microbiología
13.
Vasc Endovascular Surg ; 39(5): 421-3, 2005.
Artículo en Inglés | MEDLINE | ID: mdl-16193214

RESUMEN

The foot comprises 3 compartments bounded by bone and fascia, each compartment containing muscle and vascular and nervous structures. Infection leading to an increase in pressures in the compartments results in rapid necrosis, a pathologic process characteristic of diabetic feet. Treatment involves fasciotomy and complete debridement of devitalized tissue with possible amputation of the involved digits. Knowledge of the anatomic structure of the foot and its compartments is therefore essential in effectively managing the diabetic foot.


Asunto(s)
Pie Diabético/cirugía , Terapia por Láser , Sepsis/cirugía , Síndromes Compartimentales/complicaciones , Síndromes Compartimentales/cirugía , Pie Diabético/complicaciones , Humanos , Sepsis/etiología
14.
Vascular and endovascular surgery ; 39(5): 421-423, 2005.
Artículo en Inglés | MedCarib, MedCarib | ID: med-17566

RESUMEN

The foot comprises 3 compartments bounded by bone and fascia, each compartment containing muscle and vascular and nervous structures. Infection leading to an increase in pressures in the compartments results in rapid necrosis, a pathologic process characteristic of diabetic feet. Treatment involves fasciotomy and complete debridement of devitalized tissue with possible amputation of the involved digits. Knowledge of the anatomic structure of the foot and its compartments is therefore essential in effectively managing the diabetic foot.


Asunto(s)
Humanos , Sepsis/complicaciones , Sepsis/microbiología , Sepsis/prevención & control , Complicaciones de la Diabetes/complicaciones , Complicaciones de la Diabetes/microbiología , Complicaciones de la Diabetes/patología
17.
J Vasc Surg ; 38(6): 1313-5, 2003 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-14681634

RESUMEN

OBJECTIVE: Patients with end-stage renal failure and upper-extremity arterial occlusive disease sometimes have painful digital ulceration. We evaluated the efficacy of distal bypass grafting from the brachial artery for limb salvage in this setting. METHODS: All patients with end-stage renal disease with painful digital ulceration or gangrene of the hand seen from 1992 to 2002 were evaluated with clinical examination and noninvasive studies. Those with evidence of occlusive disease underwent conventional angiography. Individuals with forearm occlusive disease underwent bypass grafting, from the brachial artery to either the distal radial artery or ulnar artery at the level of the wrist or proximal hand. Follow-up was scheduled at regular intervals, and included duplex scanning. Limb salvage and bypass graft patency were determined with life table analysis. RESULTS: Over 10 years, 18 forearm bypass procedures were performed in 15 patients. The outflow artery was the radial artery in 15 procedures and the ulnar artery in 3 procedures. Bypass conduit was autogenous in all patients. No patient had a functioning arteriovenous fistula at bypass grafting; six limbs had previously occluded fistulas. Two bypass grafts (11%) occluded in the early postoperative period, with resultant progression of gangrene. In the remaining 16 grafts patency was maintained (mean follow-up, 18 months), with pain control and tissue healing. CONCLUSION: Treatment in patients with renal failure with upper extremity occlusive disease may be facilitated with brachiodistal bypass grafting. Pain control and reversal of progression of hand necrosis can be achieved.


Asunto(s)
Arteriopatías Oclusivas/cirugía , Arteria Braquial/cirugía , Fallo Renal Crónico/complicaciones , Recuperación del Miembro/métodos , Arteria Radial/cirugía , Arteria Cubital/cirugía , Adulto , Anciano , Arteriopatías Oclusivas/etiología , Arteriopatías Oclusivas/mortalidad , Femenino , Humanos , Fallo Renal Crónico/mortalidad , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del Tratamiento , Extremidad Superior/irrigación sanguínea , Extremidad Superior/cirugía
18.
Cardiovasc Surg ; 11(5): 337-40, 2003 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-12958542

RESUMEN

PURPOSE: Several investigators have suggested a dismal prognosis of ruptured abdominal aortic aneurysm (rAAA) repair in the elderly. The purpose of this study is to evaluate the morbidity and mortality of rAAA repair in octogenarians and compare it to that of a younger population. METHODS: From 1980 to 2000, all patients undergoing emergent rAAA repair were divided into two groups based on their age; Group I: age <80, Group II: > or =80 years. Outcomes were evaluated based on a Chi-square test and a P-value <0.05 indicated statistical significance. RESULTS: Over a 20-year period, 323 patients underwent rAAA repair through a left retroperitoneal (74%) or standard transperitoneal (26%) approach. In Group I (age <80 years) and II (> or =80 years), the overall 30-day mortality was 25 and 41% (P<0.05), respectively. Furthermore, the elderly population had a higher incidence of death due to myocardial infarction (15 vs. 7%), as well as non-fatal cardiac and cerebrovascular events (17 vs. 4%) when compared to the younger patients. CONCLUSION: Although the elderly patients have an increased risk of having cardiac and cerebrovascular events in the postoperative period, the treatment of rAAAs in these patients should not be any different than that of a younger population. The left retroperitoneal approach is feasible and beneficial for rAAA repair and is associated with a limited morbidity and mortality.


Asunto(s)
Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/cirugía , Rotura de la Aorta/cirugía , Factores de Edad , Anciano , Causas de Muerte , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del Tratamiento
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