ABSTRACT
A young woman with aphagia, probably caused by an esophageal cancer that could not be confirmed, is reported. Fully respecting the will of the patient at the end of her life, palliative care measures were instituted, even though the diagnosis was uncertain. This case emphasizes the integrative role of internists and the difficulty of making decisions about life and death without being in close touch with desires of our patients.
Subject(s)
Attitude to Death , Bioethical Issues , Esophageal Neoplasms , Physician-Patient Relations/ethics , Trust , Esophageal Neoplasms/diagnosis , Esophageal Neoplasms/drug therapy , Esophageal Neoplasms/psychology , Female , Humans , Middle Aged , Palliative Care , Right to Die/ethicsABSTRACT
This is a critical overview of an internist with 33 years of practice, about the activities which are inherent to internal medicine. The author analyzes strategies on how to keep updated in the scientific literature, the importance of acquiring, experience from peers and teachers and emphasizes the value of an adequate patient-physician relationship.
Subject(s)
Education, Medical, Continuing , Internal Medicine , Internship and Residency , Practice Patterns, Physicians' , Humans , Physician-Patient RelationsABSTRACT
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)
Abdominal Pain/etiology , Celiac Artery , Mesenteric Vascular Occlusion/etiology , Renal Dialysis/adverse effects , Aged , Angioplasty , Coronary Artery Bypass , Coronary Disease/surgery , Humans , Male , Mesenteric Arteries/surgery , Mesenteric Vascular Occlusion/diagnosis , StentsABSTRACT
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.