José Hernán Martínez

San Juan City Hospital, San Juan, San Juan, Puerto Rico

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Publications (18)0 Total impact

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    ABSTRACT: Pasteurella multocida a small gram-negative coccobacilli is primarily found as normal flora of cats and dogs. These organisms can cause a variety of infections in humans, usually the result of scratches, bites and licks by percutaneous inoculation of the organism. Most cases of septic arthritis involve a cat or dog bite distal to the involved joint without direct penetrating injury to the joint. On scenarios were Pasteurella infection is suspected within a prosthetic joint, aggressive surgical debridement and/or removal of the prosthesis with intravenous antibiotics is recommended. Prosthetic joint infections secondary to animal bites are an extremely rare complication and few cases have been reported in the literature. This is a case report of a patient that suffered a cat's bite of his right prosthetic knee and against all odd was able to save it without surgical intervention.
    Boletín de la Asociación Médica de Puerto Rico 01/2014; 106(1):43-5.
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    ABSTRACT: Myopathy is a known complication of hypothyroidism, commonly characterized by an elevation in Creatine Kinase (CPK) due to increase capillary permeability proportional to the hypothyroid state. Thyroid hormone is important for the expression of fast myofibrillar proteins in the muscle. In hypothyroidism the expression of these proteins are deficient and there is an increase accumulation of slow myofibrillar proteins. A rapid or abrupt descend in thyroid hormones caused by radioiodine therapy after prolonged hyperthyroidism can lead to local hypothyroid state within the muscle tissue, resulting in CPK elevation and hypothyroid myopathy. Hormone replacement leads to resolution of symptoms and normalization of muscle enzymes serum levels.
    Boletín de la Asociación Médica de Puerto Rico 01/2014; 106(1):40-2.
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    ABSTRACT: 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.
    Boletín de la Asociación Médica de Puerto Rico 01/2014; 106(1):49-53.
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    ABSTRACT: 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.
    Boletín de la Asociación Médica de Puerto Rico 01/2014; 106(1):46-8.
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    ABSTRACT: Diabetic myonecrosis is a frequently unrecognized complication of longstanding and poorly controlled diabetes mellitus. The clinical presentation is swelling, pain, and tenderness of the involved muscle, most commonly the thigh muscles. Management consists of conservative measures including analgesia and rest. Short-term prognosis is good, but long-term prognosis is poor with most patients dying within 5 years. Failure to properly identify this condition will expose the patient to aggressive measures that could result in increased morbidity. To our knowledge this is the first case reported in which there was involvement of multiple muscle groups including upper and lower limbs.
    Case reports in endocrinology. 01/2013; 2013:190962.
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    ABSTRACT: Nontoxic goiter is a diffuse or nodular enlargement of the thyroid gland that does not result from an inflammatory or neoplastic process and is not associated with abnormal thyroid function. Familial forms of goiter in areas not known to feature iodine deficiency are much less common. However, not all individuals in the same iodine deficiency region develop goiter and iodine supplementation does not prevent goiter development in all treated individuals. The etiology of euthyroid goiter is still incompletely understood. It is assumed that the development of goiter depends on various interactions between genetic and environmental factors. We present an overview on the thyroid physiology, which is important for a better understanding of Familial Euthyroid Multinodular Goiter.
    Boletín de la Asociación Médica de Puerto Rico 01/2013; 105(2):68-71.
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    ABSTRACT: We describe a 20-year-old man diagnosed with a myelodysplastic syndrome (MDS), admitted to our hospital due to pancytopenia and fever of undetermined origin after myelosuppression with chemotherapy. Disseminated aspergillosis (DIA) was suspected when he developed skin and lung involvement. A rapidly growing mass was detected on the left neck area, during hospitalization. A thyroid ultrasound reported a 3.7 × 2.5 × 2.9 cm oval heterogeneous structure, suggestive of an abscess versus a hematoma. Fine needle aspiration of the thyroid revealed invasion of aspergillosis. Fungal thyroiditis is a rare occurrence. Thyroid fungal infection is difficult to diagnose; for this reason it is rarely diagnosed antemortem. To our knowledge, this is the 10th case reported in the literature in an adult where the diagnosis of fungal invasion to the thyroid was able to be corroborated antemortem by fine needle aspiration biopsy.
    Case reports in endocrinology. 01/2013; 2013:290843.
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    ABSTRACT: Hashimoto's encephalopathy (HE) is a rarely recognized neurocognitive syndrome that is associated with thyroid autoimmunity. It is more common in women. HE is diagnosed when patients present with nonspecific neurological symptoms associated to elevated titers of antithyroid antibodies and normal or abnormal thyroid function tests. Other neurologic disorders must be ruled out before diagnosis can be established. HE is associated to nonspecific EEG abnormalities as well as elevated cerebrospinal fluid proteins and nonspecific white matter changes. The pathophysiology of HE is unknown but an autoimmune etiology is strongly supported. HE responds to corticosteroids and immunosuppressive therapy, further supporting an autoimmune etiology. A high index of clinical suspicion must be present in order to promptly recognize and treat this disease.
    Boletín de la Asociación Médica de Puerto Rico 01/2013; 105(1):57-61.
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    ABSTRACT: Amiodarone is used in a large number of cardiac conditions. Amiodarone-induced thyroid dysfunction has been reported to affect up to 20% of users. Amiodarone can lead to both amiodarone-induced hypothyroidism (AIH) and less commonly amiodarone-induced thyrotoxicosis (AIT). There are two main forms of AIT. Type 1 AIT, a form of io-dine-induced hyperthyroidism, and type 2, a drug-induced destructive thyroiditis. Type 1 AIT develops on individuals with underlying thyroid disease. Treatment of Type 1 AIT includes the use of antithyroid drugs and discontinuation of amiodarone. Type 2 AIT is commonly self-limiting in nature. In this article wedescribe a patient with Amiodarone-induced thyrotoxicosis discussing its clinical features and medical therapeutic approach.
    Boletín de la Asociación Médica de Puerto Rico 01/2013; 105(2):47-53.
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    ABSTRACT: to determine the prevalence of thyroid disease in an asymptomatic Puerto Rican adult population within an iodine sufficient area. Correlate the clinical thyroic features during palpation with thyroid sonographic findings. Relate gender, laboratory data, and family history with the presence or absence of thyroid pathology. Cross-sectional, descriptive, comparative study performed during the period of February 2008-January 2009 in an asymptomatic Puerto Rican copulation. The study sample size consisted of 110 adult participants, employees of the San Juan City Hospital in apparent good health. A questionnaire emphasizing relevant personal and family thyroid pathology (benign and malignant) was obtained. A complete physical examination was performed emphasizing thyroid gland palpation, utilizing a posterior approach. for detection of any abnormal thyroid features. All participants underwent thyroid ultrasonographic (US) examination and blood sampling for ultrasensitive TSH and antiperoxidase antibodies. Subjects with thyroid nodules over one centimeter, found on thyroid US, were encouraged to undergo fine-needle aspiration biopsy (FNAB). The prevalence of thyroid pathology detected by palpation was 52.72% and 38.23% by US. The most frequent thyroid pathology found on palpation was goiter (41.37%) and multinodular goiter (64.85%). Twenty-four percent (24%) of the participants with normal findings on palpation had abnormal findings by US and 33.33% of those met criteria for FNAB. In sixteen patients with abnormal US, only six agreed to have FNAB, all were reported negative for malignancy. Our results suggest that routine thyroid US should be seriously considered for all patients with suspected thyroid disease. Statistical analysis demonstrated a significant correlation between palpation findings performed by an experience physician and thyroid ultrasonography results. Even in patients with negative family history of thyroid pathology, abnormal thyroid ultrasound abnormalities were detected in 35.73%. To our knowledge this is the first study done in Puerto Rico, comparing thyroid palpation and ultrasonographic findings.
    Boletín de la Asociación Médica de Puerto Rico 01/2011; 103(1):26-32.
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    ABSTRACT: The concomitant presence of three histopathologically different entities in the pituitary gland is a rare occurrence. Most publications identify at least two distinct pathologies, mainly, a pituitary adenoma coexisting with a second intrasellar lesion. We present a case of a 71-year-old female referred for evaluation and treatment of acromegaly. Questioning revealed she was experiencing facial palsy, visual disturbances, and syncopal spells for several weeks. When laboratory evaluation showed elevated somatomedin (IGF-I) levels and an oral glucose tolerance test failed to demonstrate any suppression of her growth hormone (GH) values, an MRI of the pituitary revealed a sellar mass. A presumptive diagnosis of pituitary adenoma was established. The patient underwent transsphenoidal resection of the sellar mass, which proved to be a large B-cell lymphoma (Stage I-E) associated with areas of adenoma and lymphocytic hypophysitis.
    Case reports in endocrinology. 01/2011; 2011:941738.
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    ABSTRACT: This is a case of 49 year-old-female with left lower quadrant pain. Initial diagnosis of acute diverticulitis entertained and treated accordingly. Diagnosis of epiploic appendagitis was done by abdominal CT-Scan. Epiploic appendagitis is commonly misdiagnosed as diverticulitis and appendicitis. Non-invasive studies may lead to early diagnosis avoiding unnecessary hospitalizations, antibiotic therapy and surgical intervention.
    Boletín de la Asociación Médica de Puerto Rico 01/2011; 103(1):45-6.
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    ABSTRACT: Subacute thyroiditis (SAT) is an extremely rare complication of influenza vaccination. Several infectious agents have been related with SAT. It is also well known the association between HLA-B35 and the development of SAT. We describe a case of subacute thyroiditis and dyserythropoesis occurring shortly after administration of an influenza vaccine in a 55-year-old man with history of diabetes and psoriasis, family history of autoimmunity without clinical evidence of acute viral infection prior to the onset of symptoms. We propose that, the events occurring in the patient may be explained as result of complex interactions between the individual genetic background and environmental exposure to infectious agents that generated a pro-inflammatory status, where the vaccine was the trigger for the subsequent alterations in thyroid and bone marrow. These findings highlight the importance of immunogenetic factors involved in response to vaccination that is the central theme in the growing field of 'vaccinomics'.
    Boletín de la Asociación Médica de Puerto Rico 01/2011; 103(2):48-52.
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    ABSTRACT: This is the case of a 32 year-old-male with chronic kidney disease in hemodialysis who presented with uncontrolled blood pressure after admission to the hospital further complicated with seizures. Head CT-Scan revealed hypodensives areas in sub-cortical white matter and parietal-occipital lobes. Posterior reversible leukoencephalopathy syndrome (PRES) was diagnosed by radiologic findings. The underlying cause of PRES was treated with good resolution of hypodensives areas. Good prognostic outcome of PRES depends on prompt recognition and treatment to avoid excessive morbidity and/or mortality.
    Boletín de la Asociación Médica de Puerto Rico 01/2011; 103(2):55-8.
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    ABSTRACT: We report a case of a young female patient presenting with a high serum beta-HCG levels, amenorrhea, nausea and anemia which mimicked pregnancy followed by upper gastrointestinal bleeding. A gastric tumor was shown on endoscopy. Histopathologic evaluation revealed Primary Gastric Choriocarcinoma (PGC). The patient was treated with three cycles of standard nongestational choriocarcinoma chemotherapy. Tumor persistence was evidenced by CT Scans and high serum beta-HCG levels. The patient died approximately six months after diagnosis. Our case report suggest that PGC is a highly aggressive tumor that is often associated with liver and lungs metastasis without evidence of pelvic organ abnormality and is associated with some hormonal effects, such as amenorrhea, anemia, nausea and vomiting mimicking pregnancy in young adult female
    Boletín de la Asociación Médica de Puerto Rico 01/2011; 103(2):77-9.
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    ABSTRACT: This is a case of a 34 years old male Hispanic patient with history of AIDS who presented to the ER with severe right lower quadrant abdominal pain of three days of evolution, associated with fever, chills, nausea, vomiting, watery diarrhea, weakness and general malaise. Acute appendicitis, Clostridium Difficile Colitis and Ischemic Colitis were the most important clinical conditions to consider in the differential diagnosis. Abdominal CT with IV contrast demonstrated thickening of the ascending colonic wall a finding highly suggestive of a transmural inflammatory necrotizing colitis of infectious etiology. Broad-spectrum antibiotic therapy, cancidas and ganciclovir were started with mark clinical improvement. IgG antibodies against CMV were elevated. Typhlitis is a serious illness that affects patients with impairment in immunity. It is important to include it in the differential diagnosis of an HIV/AIDS patient that presents with RLQ pain and fever. Contrast enhanced CT-Scan is mandatory to establish the diagnosis and to differentiate typhlitis from other intra-abdominal pathologies. Therapy needs to be individualized.
    Boletín de la Asociación Médica de Puerto Rico 103(1):51-3.
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    ABSTRACT: We report a case of 24 year-old-female presenting with bilateral leg heaviness sensation and difficult walking of one-day duration. Over the past three months she developed progressive and frequent tingling sensation on her hands accompanied by headache and increased thirst. Hypokalemia was identified and treated with resolution of symptoms. She was later found to have Graves' disease. After propranolol and radioiodine therapy no further episodes were reported. Thyrotoxic hypokalemic periodic paralysis is an alarming, potentially lethal, and rare complication of hyperthyroidism. The pathogenesis is uncertain. Because the condition is rare, it is frequently overlooked and misdiagnosed on presentation. It is important to recognize these clinical settings in hypokalemic patients in order to promptly start adequate medical therapy and avoid the lethal complications caused by prolonged sustained potassium depletion.
    Boletín de la Asociación Médica de Puerto Rico 103(1):54-6.
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    ABSTRACT: This case report describes the clinical presentation, imaging findings and pathologic features of a rare aggressive breast tumor in a pre-menopausal woman, namely primary angiosarcoma. Recognition of this extremely rare entity is needed to make an early diagnosis, institute early therapy and eventually improve patient's survival.
    Boletín de la Asociación Médica de Puerto Rico 103(3):39-41.