[Chronic end-stage kidney failure in Mexico]. / Algunas reflexiones sobre la insuficiencia renal crónica terminal en México.

Chronic renal failure is an expanding and complex problem in Mexico. This work analyzes its current situation and finds a clear imbalance between supply and demand for specialized services, that favors the latter. To explain said imbalance, it invokes four factors: the recent innovation in nephrology and parallel disciplines; educational deficit of medical schools; high costs of rehabilitation of the uremic patient, and the absence of specifically designed mechanisms for financing the treatment of this disease.

[Clinico-pathological diagnostic agreement among 429 autopsies from the Instituto Nacional de la Nutrición Salvador Zubirán]. / Concordancia diagnóstica clinico-patológica en 429 autopsias del Instituto Nacional de la Nutrición Salvador Zubirán.

Comparison of clinical and autopsy findings of the cases studied between 1984 and 1988, were made at the Department of Pathology of the Instituto Nacional de la Nutricion Salvador Zubiran in Mexico City. The goal was to determine the accuracy of clinical diagnoses. The total number of cases was 429. A decreasing number of autopsies as a function of time was observed. Thus, in 1985, 34.65% of the deaths was autopsied, whereas in 1988, the number dropped to 21.16%, overall mean of 27.31%. In 229 autopsies (53.8%), 353 findings of clinical significance were found; of these, 86 were in the main diagnoses and 267 in the causes of death. There were 171 overdiagnoses with therapeutic implications, 38 in the main diagnoses and 133 in the causes of death. Overdiagnoses and underdiagnoses were most common in infectious diseases, followed by respiratory and digestive diseases, while endocrinologic and rheumatologic diseases had the highest diagnostic concordance. It was also found that the diagnostic accuracy did not improve with time of hospitalization. A brief analyses of the probable causes of the decrease in the number of autopsies is made. It is concluded that, in spite of the great advances in clinical and technological knowledge, the high frequency of disagreements between clinical and anatomical diagnoses, indicate that autopsy continues playing a key role in the quality control of medical practice. This justifies by itself the performance of necropsies.