Background: Primary aldosteronism (PA) was previously thought to be uncommon. With the utilization of plasma aldosterone concentration and plasma renin activity ratio (PAC/PRA) as a mode of screening, the frequency of its detection increased significantly. Among the population with an indication for PA screening, resistant hypertension has the highest prevalence. Detection of PA in this group is essential since it is associated with increased cardiovascular and cerebrovascular complications. Objective: To determine the prevalence of PA among adult Filipinos at Capitol University Medical Center, Cagayan de Oro City, Misamis Oriental. Methods: Adult Filipino patients with resistant hypertension underwent PA screening using the PAC/PRA. Patients with positive results were confirmed for PA either through IV saline infusion or using the following criteria: history of spontaneous hypokalemia or documented hypokalemia prior to screening, undetectable PRA (< 1 ng/ml/hour), and a PAC of > 15 ng/dl. Results: Twenty-one patients were recruited, but only fourteen participated in the study. Thirty five percent of those who participated screened positive for PA. Among those who screened positive, three patients were confirmed of having PA. Conclusion The prevalence of PA in adult Filipinos with resistant hypertension in Capitol University Medical Center, Cagayan de Oro City, Misamis Oriental is estimated to be 21.43%.
Primary aldosteronism ; Resistant hypertension

BACKGROUND: Implant-based breast reconstruction is being performed more frequently, and implants are associated with an increased risk of infection. We reviewed the clinical features of cases of implant infection and investigated the risk factors for breast device salvage failure. METHODS: We retrospectively analyzed 771 patients who underwent implant-based breast reconstruction between January 2010 and December 2016. Age, body mass index, chemotherapy history, radiation exposure, and smoking history were assessed as potential risk factors for postoperative infection. We also evaluated the presence and onset of infection symptoms, wound culture pathogens, and other complications, including seroma, hematoma, and mastectomy skin necrosis. Additionally, we examined the mastectomy type, the use of acellular dermal matrix, the presence of an underlying disease such as hypertension or diabetes, and axillary node dissection. RESULTS: The total infection rate was 4.99% (58 of 1,163 cases) and the total salvage rate was 58.6% (34 of 58). The postoperative duration to closed suction drain removal was significantly different between the cellulitis and implant removal groups. Staphylococcus aureus infection was most frequently found, with methicillin resistance in 37.5% of the cases of explantation. Explantation after infection was performed more often in patients who had undergone 2-stage expander/implant reconstruction than in those who had undergone direct-to-implant reconstruction. CONCLUSIONS: Preventing infection is essential in implant-based breast reconstruction. The high salvage rate argues against early implant removal. However, when infection is due to methicillin-resistant S. aureus and the patient's clinical symptoms do not improve, surgeons should consider implant removal.
Acellular Dermis ; Body Mass Index ; Breast Implants* ; Breast* ; Cellulitis ; Drug Therapy ; Female ; Hematoma ; Humans ; Hypertension ; Mammaplasty ; Mastectomy ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Necrosis ; Radiation Exposure ; Retrospective Studies ; Risk Factors ; Seroma ; Skin ; Smoke ; Smoking ; Staphylococcus aureus ; Suction ; Surgeons ; Wounds and Injuries

PURPOSE: The vegetative state is a clinical condition with complete unawareness of self and environment, but with preservation of brain-stem functions. Vegetative patients may have nosocomial infections in their wounds, such as pressure sores and infected craniums after cranioplasties. Flap surgery is usually necessary for those wounds, but decision of undergoing surgery is difficult because of various adverse conditions of vegetative patients. We share our experience of several successful flap surgeries in vegetative patients, and evaluate obstacles and requirements to obtain satisfactory results. METHODS: From December 2005 to September 2008, a total of 4 vegetative patients underwent surgeries. In case of 2 patients with infected artificial craniums, scalp reconstructions with free flaps were performed. In case of other 2 patients with huge pressure sores with sepsis, island flap coverage of wounds was performed. Retrospective study was made of hospitalization period, vegetative period, number of surgeries performed, underlying diseases, causative bacteria, and contents of informed consent. RESULTS: Mean hospital day was 14 months and mean vegetative period was 17.5 months. Patients underwent average of 4.5 surgeries under general anesthesia. There were several underlying diseases like hypertension, DM, CHF and chronic anemia. MRSA (Methicilinresistant Staphylococcus aureus) was cultured from every patient's wounds. Informed consent included a warning for high mortality and a need of attentive familial cooperation. CONCLUSION: There are three requirements for doing flap surgeries in vegetative patients. First, to prevent aggravation of brain damage and underlying diseases by general anesthesia, multidisciplinary team approach is needed. Second, operation should be beneficial for prolonging patient's lifespan. Third, because postoperative care is very difficult and long hospitalization is needed, detailed informed consent and highly cooperative attitude of family should be confirmed before operation.
Anemia ; Anesthesia, General ; Bacteria ; Brain ; Cross Infection ; Free Tissue Flaps ; Hospitalization ; Humans ; Hypertension ; Informed Consent ; Methicillin-Resistant Staphylococcus aureus ; Persistent Vegetative State ; Postoperative Care ; Pressure Ulcer ; Retrospective Studies ; Scalp ; Sepsis ; Skull ; Staphylococcus