Profesionalismo y educación médica / Medical education and professionalism

Las diversas amenazas actuales al ejercicio de la medicina requieren que el médico tome conciencia de su rol en la sociedad, identifique los valores permanentes de la profesión y los transmita a las nuevas generaciones. Esto lleva a buscar una definición del profesionalismo médico concebido básicamente como una relación de ayuda, pero en la cual las complejidades del desarrollo científico y tecnológico han creado situaciones enteramente nuevas en las cuales no siempre resulta fácil distinguir el actual bien del actuar mal. De la naturaleza de la medicina y sus valores permanentes por un lado y de la consideración de la rectitud del actuar médico por otro surge un código no escrito de conducta médica que llamamos profesionalismo. Diversas instituciones a nivel internacional se han ocupado de definir el profesionalismo médico, identificar sus componentes y describir las conductas que atentan contra sus principios. La transmisión de los valores del profesionalismo se hace principalmente a través del ejemplo y de la instauración de una cultura de buena actuación profesional en las escuelas de medicina, considerando las particularidades de cada disciplina. En una universidad católica el profesionalismo cobra sentido trascendente como manifestación del amor al prójimo dentro de una antropología que tiene su origen, sentido y trascendencia en la persona de Cristo.

The practice of medicine is currently subjected to threats that require physicians to become more aware of their role in society, to identify the permanent values of the profession and to be able to hand them over to newer generations. This leads to a search for a definition of medical professionalism conceived basically as a relationship of aid but in which the complexities of scientific and technological development have created entirely new situations in which right or wrong doing are not easy to distinguish from each other. From the nature of medicine and its permanent values on the one hand and from the consideration of the righteousness of medical actions on the other a non-written code of medical conduct that we call professionalism has emerged. Internationally, several institutions have attempted to define medical professionalism, to identify its components and to describe behaviors against its principles. The values of professionalism are transmitted mainly through the observation of exemplary conduct and by the installation of a culture of good professional practice in medical schools, considering the peculiarities of each particular discipline. In a Catholic university, professionalism acquires transcendence as a manifestation of love for one’s neighbor within an anthropology that has its origin, significance and transcendence in the person of Christ.

Anticuerpos anti-tiroglobulina en el seguimiento de pacientes con cáncer diferenciado de tiroides: ¿marcadores de enfermedad residual o recidivante? / Anti thyroglobulin antibodies in the follow up of patients with differentiated thyroid cancer

Background: Anti thyroglobulin antibodies are present in 25 percent of patients treated for a differentiated thyroid cancer, invalidating thyroglobulin determination. Those patients subjected to total thyroidectomy and free of disease, should reduce the production of these antibodies, due to the lack of antigenic stimulus. Therefore, anti thyroglobulin antibodies could be useful to detect early relapses. Aim: To assess the relationship between anti thyroglobulin antibodies and the evolution of the disease in patients treated for thyroid cancer. Material and methods: Retrospective analysis of 26 patients treated for thyroid cancer with positive anti thyroglobulin antibodies, followed for three years. These were divided in those with or without lymphocytic thyroiditis (19 and 7 respectively). Results: At the first year of follow up, anti thyroglobulin antibody concentration was 401ñ94.9 UI/ml (xñsem) in patients with thyroiditis and 38.9ñ8.9 UI/ml in those without thyroiditis (p < 0.005). During the three years of follow up, no differences in anti thyroglobulin antibodies were observed between patients with or without tumor relapse. Conclusions: Concentration of anti thyroglobulin antibodies was higher in patients with thyroiditis and did not differentiate patients with tumor relapse

Hipovitaminosis D en mujeres postmenopáusicas con masa ósea baja en la Región Metropolitana / Vitamin D levels in postmenopausal women with low bone mineral density from Región Metropolitana

Background: Low vitamin D levels are a risk factor for osteoporosis. In the Northern hemisphere, a high frequency of low vitamin D levels has been detected. The correction of this deficit is associated with a lower fracture risk. Aim: To measure serum vitamin D levels in postmenopausal women with low bone mineral density. Material and methods: 25-hydroxyvitamin D levels were measured in 40 postmenopausal women aged 50 to 74 years old, with a spine bone mineral density of less than 2 standard deviation of the values for young individuals. Serum calcium, phosphorus and calcium dietary intake were also measured. Results: Mean serum 25-hydroxyvitamin D levels were 32.2 ñ 12.5 ng/ml. No correlation between vitamin D levels and other measured variables was observed. Using a cutoff value of 15 ng/ml, two women had low 25-hydroxyvitamin D levels. Conclusion: In this sample of postmenopausal women, vitamin D deficiency was infrequent

Adenoma silente subtipo 3: importancia del estudio ultraestructural en el diagnóstico diferencial del adenoma hipofisiario asociado a hiperprolactinemia en un caso / Silent pituitary adenoma type 3 associated to hyperprolactinemia: report of 1 case

The association of hyperprolactinemia over 100 ng/ml and a pituitary adenoma is usually diagnostic of prolactinoma. However type 3 pituitary adenomas can occur with similar serum prolactin values. We report a 31 years old woman that consulted due to headache and photopsiae. She had a serum prolactin level of 148 ng/ml and imaging studies showed a solid tumor that occupied the selar region and most of the left temporal fossa. The tumor was partially resected and the patient recovered her lost visual field. Light microscopy showed an acidophilic and in part chromophobe adenoma. Immuno-histochemistry was positive for prolactin and growth hormone. Electron microscopy disclosed features of a silent type 3 adenoma such as big cells with cytoplasmic prolongations, pleomorphic nuclei and a greatly developed rough endoplasmic reticulum

Apoplejía en metástasis hipofisiaria de carcinoma de células renales: caso clínico con 7 años de seguimiento / Pituitary apoplexy secondary to a metastatic renal cell carcinoma: report of a case followed for 7 years

We report a man in whom a 15 cm. renal tumor was excised at the age of 49. The pathological examination showed a clear cell carcinoma. Five years later, he presented with headache, vomiting and unilateral palpebral ptosis. Imaging studies showed a sellar tumor with pituitary apoplexy. The tumor was excised and the pathological study disclosed a clear cell tumor, positive for vimentin, cytokeratins AE1 and AE3 and immunohistochemically negative for LH, TSH, ACTH and GH. Considering the similar histopathological features, it was considered as a metastasis of the renal tumor. The patient was supplemented with thyroid, adrenal and gonadal hormones. Seven years later, he presented a new tumor in the remaining kidney, that corresponded to a cystic papillary renal cell carcinoma. Afterwards, he presented a transitional urinary bladder tumor. Mortality associated to renal cell tumors is 90 percent at 5 years, and pituitary metastases are extraordinarily uncommon

Síndrome de exceso aparente de mineralocorticoides por déficit de 11 ß hidroxiesteroide deshidrogenasa / A syndrome of apparent mineralocorticoid excess associated with a deficiency of 11 ß-hydroxysteroid dehydrogenase

An 11-year old girl was seen in 1981 with hypokalemia, low renin, low aldosterone, and severe hypertension. A medical adrenalectomy with dexamethasone and aminoglutethimide, and the blockade of mineralocorticoid receptors with spironolactone improved her condition, but the blockade of glucocorticoid receptors with RU-486 worsened it. An aldosterone infusion induced no changes. A sister was born in 1982 with similar findings. Both patients had an impaired ability to convert cortisol to cortisone after an oral load of 200 mg cortisol. In urine, an elevated ratio for metabolites of cortisol to metabolites of cortisone was found. These data suggested a defect in the activity of renal 11ß-hydroxysteroid dehydrogenase. Both parents were asymptomatic, phenotypically normal and non-consanguineous. Their urinary metabolites of cortisol and cortisone were normal before and after stimulation with ACTH. However, the mother reached a peak plasma cortisone concentration 3 SD below the mean reached by normal subjects after an oral 200-mg cortisol load, a fact that suggests that this test could be used to detect heterozygotes. The genetic studies revealed a homozygous mutation on exon 3 of the HSD11K gene, which by substituting TGC for CGC changes Arg 213 for Cys and induces a loss of 84 percent of the enzymatic activity in transfected cells. Both unrelated parents had the same heterozygous mutation. Both patients have been treated with dexamethasone but have also required spironolactone. The older sister has also required high doses of nifedipine to lower her blood pressure. After 19 years of follow-up, the older sister has become normotensive and normokalemic under therapy, and reached a final height of 140 cm at age 17. The younger sister has increased her mean blood pressure at a rate of 1 mm Hg per year, in spite of treatment. Her final height is 143.5 cm