ABSTRACT
We report a 73 years old male undergoing chronic hemodialysis with a history of seven years of abdominal pain and weight loss. A mesenteric angiography disclosed a critical stenosis of the celiac artery and a partial stenosis of the superior mesenteric artery. Other causes of abdominal pain were excluded. The patient was subjected to a successful angioplasty with stent placement that resulted in a complete relief of the pain
Subject(s)
Humans , Male , Aged , Mesenteric Vascular Occlusion/complications , Abdominal Pain , AngioplastyABSTRACT
Flash pulmonary edema is a paroxismal pulmonary edema associated to a hypertensive crisis, that subsides in hours with the usual therapeutic measures. It occurs in patients with renal artery stenosis. We report two male patients aged 71 and 74 years old, presenting with acute dyspnea and high blood pressure. Diffuse rales were auscultated and arterial blood pressure was high in both. Dyspnea subsided in few hours with diuretics and oxygen. In both, a critical renal arterial stenosis was found and an angioplasty with stent placement was performed. After 5 and 6 months of follow up, the patients remain asymptomatic
Subject(s)
Humans , Male , Aged , Pulmonary Edema , Hypertension, Renovascular/complications , Angioplasty , Hemodynamics/physiology , Renal Artery Obstruction/complicationsABSTRACT
We report a 54 years old male that received a renal allograft without complications. One year after the transplantation, she was receiving cyclosporine doses of 2 to 3 mg/kg and maintained serum levels of 60 to 90 mg/dl. An abrupt increase in cyclosporine serum levels to 469 and 600 mg/dl was noted after 15 months of transplantation. After a careful interrogation the patient admitted the use of Geum chiloense (hierba del clavo). Discontinuing this herbal remedy, cyclosporine levels decreased to 55 mg/dl, despite the maintenance of the same cyclosporine dose. The potential side effects of herbal remedies must be borne in mind
Subject(s)
Humans , Male , Middle Aged , Plants, Medicinal , Cyclosporine , Immunosuppression Therapy , Kidney Transplantation , Virilism , Cyclosporine , Herbal Medicine , Drug Incompatibility , Drug Interactions , Prostatic Hyperplasia/drug therapyABSTRACT
Narrative medicine is becoming an increasingly popular way of communicating medical problems. This a letter that the author sends to a recently deceased patient. He describes his apprehensions on the use of invasive forms of diagnosis or treatments and the use of repeated hospital admissions in the context of a chronic and progressive disease. He also discusses the use of methods to "accelerate" death in suffering patients. He finally describes the dignity of his patient to face a chronic and debilitating condition
Subject(s)
Humans , Ethics, Medical , Minimally Invasive Surgical Procedures , Chronic Disease/psychology , Hospitalization , Physician-Patient Relations , Diagnostic Techniques and ProceduresSubject(s)
Humans , Euthanasia , Suicide, Assisted , Refusal to Treat , Ethics, Medical , Physician-Patient RelationsABSTRACT
A 35 years old male is presented. Eight months after receiving a renal allograft his hypertension worsened and his packed red cell volume raised to 53.7 percent. Enalapril was started and a 500 ml phlebotomy was performed. In three occasions packed red cell volumes decreased excessively and enalapril was discontinued. Finally, the drug was replaced with losartan, normalizing blood pressure values and stabilizing packed red cell volumes. This case illustrates the different reductions in packed red cell volumes induced by enalapril and losartan. These differences could have a therapeutic relevance
Subject(s)
Humans , Male , Adult , Polycythemia/drug therapy , Receptors, Angiotensin/antagonists & inhibitors , Peptidyl-Dipeptidase A/administration & dosage , Kidney Transplantation/immunology , Enalapril/administration & dosage , Losartan/administration & dosage , Erythrocyte Volume/drug effects , Glomerulonephritis, IGA/complications , Hypertension/complicationsABSTRACT
In the last years, evidence based medicine has been considered a main factor for the diagnostic and therapeutic decisions in medical practice. However, one must consider the complexity of human beings and the difficulties in the interpretation of some results obtained in randomized prospective trials that support this theory. Therefore the importance of clinical experience, rational and logical medical thinking and facing patients as individuals must prevail at the moment of complex medical decisions
Subject(s)
Humans , Evidence-Based Medicine/trends , Decision Making , Internal Medicine/trends , Research/trendsABSTRACT
Different causes have hampered the image and appraisal of internists in Chile and abroad. This article emphasizes and underscores the unique features and conditions that render internists as essential conductors of health care in our society. The disappearance of general internists would be a serious and unmendable loss for the future development of high standard medical care
Subject(s)
Education, Medical/methods , Physicians, Family/education , Chile , Internal Medicine/education , Medicine/educationSubject(s)
Humans , Female , Aged , Decision Making , Language , Coronary Disease/surgery , Informed Consent , Physician-Patient Relations , Truth DisclosureABSTRACT
A lateral abdominal bruit is considered an important finding for the detection of renovascular hypertension. However, the precision and accuracy of new techniques such as angiography, Doppler ultrasound and studies with radioisotopes have changed its value and clinical interpretation. We report a 75 years old woman with a bilateral renal artery stenosis in whom a bruit was heard over the artery that did not contribute to the genesis of hypertension and the significant arterial stenosis causing hypertension was silent. This particular situation could lead to erroneous clinical decisions
Subject(s)
Humans , Female , Aged , Hypertension, Renovascular/complications , Renal Artery Obstruction/diagnosis , Angiography , Nitrendipine , Ultrasonography , AngioplastyABSTRACT
Inferior vena cava thrombosis is infrequent and in 30 percent of cases, the potential cause is an alteration of the natural anticoagulant protein system. We report a 18 years old male with an inferior vena cava thrombosis that was associated to a protein C deficiency. He was successfully treated with an infusion of intravenous streptokinase during 30 hours and intravenous heparin during 10 days, followed by oral anticoagulation therapy
Subject(s)
Humans , Male , Adolescent , Thrombosis/diagnosis , Vena Cava, Inferior/physiopathology , Protein C/deficiency , Streptokinase/administration & dosage , Thrombosis/drug therapy , Heparin/administration & dosage , Thrombolytic Therapy/methodsABSTRACT
The aim of this work was to study the impact of hospital admission on functional status of elders. 86 patients (63 male) aged 73ñ4 years old admitted to the Internal Medicine Service of a public hospital were studied. Funstional status was measured on admission, discharge and 15 days after discharge using the Northwestern Functional Status Review Instrument. 15 patients died during hospital stay. Functional status improved in patients admitted with disordered consciousness, in those admitted due to neurologic dosirders, in those with less than 2 chronic diseases, in those whose disease cured during hospitalization and those that did not acquire new disease during admission. Prolonged hospitalizations of more than 13 days were associated with functional status worsening. It is concluded that functional status of elders does not always deteriorate during hospital admissions
Subject(s)
Humans , Male , Female , Aged , Health Services for the Aged/statistics & numerical data , Hospitalization/statistics & numerical data , Health Status , Risk Factors , Health ExpendituresABSTRACT
Aiming to know the factors that influenced the use of erythropoietin (EPO) in chronic hemodialysis patients, we retrospectively studied 82 patients (41 male), of whom 15 received EPO. No differences, between patients receiving or not receiving EPO, were found in age (46.9ñ25 and 57ñ13 years respectively), male/female ratio (9/6 and 32/35 respectively), time on dialysis (36.4ñ25.6 and 36.8ñ31.8 months respectively), dialysis hours (3.19ñ0.6 and 3.33ñ0.39 h respectively) and proportion of diabetics (6.6 and 20.8 percent respectively). Prior to EPO use and compared to untreated patients, treated patients were transfused with a higher frequency (60 vs 22 percent) and with more units/patients/years (0.12 vs 0.08). Hemoglobin levels at the start of the treatment was similar in treated and untreated patients (8.4ñ1.46 vs 8.78ñ1.97 g/dl). Epo was indicated in 11 patients due to general symptomatology associated to anemia and in 4 due to cardiac failure or angina. We conclude that EPO treatment is indicated in approximately 18 percent of patients in dialysis. An adequate dialytic treatment may achieve optimal hemoglobin levels with minimal transfusion requirements and without need of EPO, thus reducing costs