Definición actual de la medicina interna y el internista / A consensus definition of internal medicine and the internist

Internal Medicine is a basic clinical specialty in Medicine, but due to it’s vast field of action it is quite difficult to define. This consensus article analyzes different definitions and proposes a current definition while analyzing several aspects of the specialty along with its strengths and weaknesses. We propose to define Internal Medicine as a clinical specialty devoted to the comprehensive care of adults, from adolescence to senility, particularly the diagnosis and non surgical treatment as well as primary and secondary prevention of their diseases, in hospital or ambulatory settings. We propose to define Internal Medicine as a clinical specialty devoted to the comprehensive care of adults in hospital or ambulatory settings, from adolescence to end of life, in terms of prevention, diagnosis and non-surgical treatments of disease.

Curso clínico de la nefropatía membranosa lúpica pura / Long-Term outcome of type V lupus membranous glomerulonephritis

Background: The long-term outcome of the pure form of WHO type V lupus membranous glomerulonephritis is apparently more benign than that of other forms of lupus glomerulonephritis. However 12percent of such patients progress to terminal renal failure. The presence of proteinuria may be an indication of cytotoxic agents. Aim: To study the clinical long-term outcome of WHO type V lupus membranous glomerulonephritis. Material and methods: A retrospective analysis of all kidney biopsies of a University Pathology Department, with the diagnosis of WHO type V lupus membranous glomerulonephritis. Review of medical records of patients with the disease and one clinical assessment of all living patients. Results: Between 1973 and 2000, 703 kidney biopsies were done to patients with systemic lupus erythematosus. Of these, 40 were membranous glomerulonephritis and in 33 patients (28 women, age range 6-71 years), data on the evolution and survival was obtained. Nineteen had type Va and the rest type Vb nephritis. Two presented with renal failure and 11 with proteinuria over 3.5 g/24h. The median follow-up since the renal biopsy was 63 months (range 1-316). At the end of follow-up, four had a creatinine clearance of less then 15 ml/h and four a clearance between 15 and 29 ml/h (one of these received a renal allograft). Eleven (33percent) patients had died, mostly due to infections. Life expectancy at five years with a creatinine clearance over 15 ml/h was 75percent. Bad prognostic factors were an elevated creatinine clearance over 15 ml/h was 75percent. Bad prognostic factors were an elevated creatinine and high blood pressure at the moment of the biopsy. Conclusions: The clinical outcome of these patients was bad. Twelve percent reached a stage of terminal renal failure. This is in contrast with the 3percent progression to a similar stage of proliferative glomerulonephritis treated with i.v. cyclophosphamide. New therapies for this condition must be sought.

Muerte encefálica bioética y trasplante de órganos / Brain death, bioethics and organ transplantation

The concept of death has evolved medically, legally and culturally since the introduction of life support technologies in the middle of the 20th century. The traditional cardiopulmonary and the new neurologically based brain death criterions of death are examined. We conclude that brain death, defined as total and irreversible loss of function of the whole brain, fulfills better "the permanent cessation of functioning of the organism as a whole² definition of death. Brain death diagnosis, based on standard neurologic clinical examination performed accurately, is unequivocal. Transplantation medicine, mostly based on organ donation of brain dead people, has become a routine and universally accepted therapeutic intervention nowadays, which benefits many people. Ethics foundations of organ transplantation are reviewed. Even though brain death and organ donation are widely accepted in medical, legal, religious and public opinion today, the whole society and medical community need to be further educated about these matters, so that unavoidable changes of traditional concepts might be better understood. Permanent education should be the best way to dissipate social fears and distrust towards organ donation and brain death (Rev Méd Chile 2004; 132: 109-18).

Pseudohiponatremia y cambios en el anion gap en un mieloma múltiple / Pseudohyponatremia and ion-gap changes in a patient with multiple myeloma

Pseudo-hyponatremia is a rare condition characterized by a decrease in plasma dodium concentration associated with a normal or increase effective plasma osmolarity. We present the case of a 62 year old woman with multiple myeloma (IgG) who had a plasma sodium of 84,5 mEq/l (as measured with flame photometry) and an anion gap of - 8,8 mEq/l. However, when determined with an ion-selective electrolde, plasma sodium was 135 mEq/l. The patient was treated with an ion-selective electrode, plasma sodium was 135 mEq/l. the patient was treated with chemotherapy and did not receive sodium. One week later, plasma sodium - again measured by flame photometry - was 134 mEq/l and the anion gap 4.0 mEq/l. The pathophysiological and clinical aspects of pseudo-hyponatremia and the anion gap are discussed

Síndrome hepatorrenal / Hepatorrenal syndrome

The clinical and laboratory of this syndrome are reviewed, with special emphasis upon different mechanisms that may be involved in its pathogenesis