La vocación de curar a través del arte / The vocation of healing through art

La humanización del ejercicio de la medicina considera la vivencia de enfermar del paciente, así como el verdadero sentido del curar, aliviar, sanar y acompañar a la persona. Esa vivencia pone en juego la sensibilidad. La experiencia sensible y afectiva es motor de la capacidad simbólica del género humano, y el símbolo es lazo afectivo-representativo y acuerdo imaginario entre la persona y su mundo. Las imágenes, como símbolos, no pueden ser reducidas al lenguaje verbal racional. El Arte Terapia, a través de esas imágenes, acompaña a la persona en la prevención o tratamiento de enfermedades. Es una disciplina del campo de la salud en desarrollo en todo el mundo, con un creciente número de estudios que sustentan sus efectos positivos. Sus herramientas terapéuticas son la estimulación de la sensibilidad, el uso de la imagen como lenguaje, el juego creativo, la simbolización y la experiencia grupal. Su inclusión en el ámbito hospitalario tiene una fuerte razón de ser: el Arte siempre ha acompañado al hombre y a la Medicina, como otra forma de la vocación de curar. (AU)

Humanization of medical practice takes into account the patient's experience of illness, as well as the true sense to cure, to alleviate, to heal and to care about the person. Sensitiveness comes into play in that experience. The sensitive and emotional experience is the engine of the symbolic capacity of humankind; and the symbol is the representative-affective tie and the imaginary agreement between the person and his world. Images, as symbols, cannot be reduced to the rational verbal language. Art Therapy, through those images, takes care about the person in the prevention or treatment of different diseases. Art Therapy is a health-related discipline in development around the world with an increasing number of studies supporting its positive effects. Its therapeutic tools are the stimulation of the sensitivity, the use of the image as a language, the creative play, the symbolization, and the group experience. Art Therapy incorporation in the hospital setting has a strong rationale: Art has always been along with humankind and Medicine as another vocational way to heal. (AU)

Clinical Features and Long-Term outcomes of Patients with Late Steroid Resistant/Sensitive Nephrotic Syndrome: A Single Center Study

OBJECTIVE: To find out clinical features and long-term outcomes of idiopathic childhood nephrotic syndrome(NS) patients with late steroid resistance(LSR)/late steroid sensitiveness(LSS). PATIENTS AND METHODS: A retrospective chart review was performed on 480 patients diagnosed with idiopathic childhood NS at Asan Medical Center Children's Hospital from 1990 to 2013. Twenty-four patients whose responsiveness to steroids changed over a minimum 2 year follow-up period (2-17.5 years) were investigated. All patients had undergone a renal biopsy. RESULTS: Among 480 nephrotic children, 428 (89%) were sensitive to the first steroid course. Of those who initially responded, 11 (2.5%) developed resistance to steroid therapy after relapses. LSR mostly developed between 1 month and 1 year after the initial episode. Six patients showed a minimal change and five showed focal segmental glomerulosclerosis (FSGS). Nine (82%) responded to cyclosporine or methylprednisolone pulse therapy. Of these, two had no further relapse, whereas the other seven experienced several relapses that ranged in length from 1.1 to 13.9 years. Three of the nine who initially responded to immunosuppression went on to experience several changes in steroid responsiveness. Two (18%) with resistance to immunosuppressants, including steroids, eventually progressed to end stage renal disease. Among the 52 patients (11%) who were initially steroid resistant, 13 (23%) were converted to steroid sensitive at relapses. Among these, 9 showed minimal change and 4 showed FSGS. Two had no further relapse and the other 11 responded to steroids on subsequent relapses ranging in length from 1.3 to 9.4 years. All these patients have had no further changes in steroid responsiveness with normal renal function. CONCLUSIONS: In this study, 2.5% of initial steroid responders and 25% of initial steroid non-responders changed their responsiveness to steroids at subsequent relapses. Eighteen percent of LSR patients developed end stage renal disease. All of the LSS patients showed preserved normal renal function. Responsiveness to immunosuppressants seemed to be the most important factor determining longterm outcomes in LSR/LSS patients.