Impericia médica en Puerto Rico: 1990-1996 / medical negligence in Puerto Rico: 1990-1996

The purpose of this communication is to present the statistical information of the medical and hospital professional liability situation in Puerto Rico from 1990 to 1996. The Medical Institutional liability is a topic of great relevancy and importance to the people of Puerto Rico and the leaders responsible for establishing policies for the health care services. The Reports on Medical and Hospital Professional Liability from 1991 to the 1996 produced by the Examining Physicians Board were reviewed. The liability claims from 1991 to the 1996 totaled 4054. During the seven years analyzed, 3506 cases were closed against physicians and institutions, a payment was issued in 1272 cases (36.3 percent), for a total compensation of $56,268,053. The risk of a legal claim is greater for the group of Plastic Surgeons and Emergency Medicine. The probability of a plaintiff receiving a compensation payment in a case of medical malpractice is approximately 36 percent, usually receiving a third of the total of the award as suggested by the medical literature. A thoughtful analysis of the current medical liability situation and defensive medicine should be done with the purpose of protecting the fiduciary function of the physicians with respect to the health of their patients, this is the function that guarantees a physician-patient relationship that is healthy, righteous and empathic

Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) and extranodal involvement of the orbit

We present the case of a 5-year-old boy who was referred to the Neurosurgical Service of the San Jorge Children's Hospital for evaluation of right eye proptosis. At the age of one year the diagnosis of sinus histiocytosis with massive lymphadenopathy (SHML) had been rendered on a cervical lymph node biopsy. The right orbit mass causing the proptosis was the result of extranodal involvement of the orbital tissue by SHML. The clinical and pathologic features of this entity are discussed

Mielomeningocele en Puerto Rico / Myelomeningocele in Puerto Rico

Los expedientes médicos de 128 niños tratados por su condición de mielomeningocele en el Hospital Pediátrico Universitario del Centro Médico de Puerto Rico durante el período de enero de 1980 a julio de 1985 fueron revisados retrospectivamente. Diferentes parámetros previamente definidos de la primera hospitalización de estos niños fueron analizados en detalle. La edad promedio a la cual se reparó el defecto de mielomeningocele fue de 6.6 días. Analisis estádistico demostró que reparar el defecto de mielomeningocele antes de la primeras 48 horas de vida no disminuye el riesgo de desarrollar infecciones en el sistema nervioso central (ventriculitis). Complicaciones del sanado de la reparación del mielomeningocele (como necrosis de los colgagos de piel, escape de líquido cefalorraquídeo e infección de la herida) estuvieron presentes en el 43.8% de los pacientes que desarrollaron ventriculitis y solo en el 19.0% de los que no desarrollaron infecciones del sistema nervioso central. Esta observación estadísticamente válida (P=0.03) establece que complicaciones del sanado de la reparación del mielomeningocele constituyen el factor de riesgo principal para el desarrollo de ventriculitis. Esta observación constituye una aportación significativa a la literatura médica mundial