Aborto diferido como origen de una enfermedad trofoblástica persistente / Persistent trophoblastic disease presenting as missed abortion

La enfermedad trofoblástica persistente puede ser diagnosticada después de cualquier tipo de gestación, pero su frecuencia aumenta tras el hallazgo de un embarazo molar, con lo que su adecuado diagnóstico y seguimiento es vital para un tratamiento temprano y eficaz. Presentamos un caso de un aborto diferido, en el que se diagnosticó mola completa y tras la confirmación de persistencia de esta, precisó de tratamiento poliquimioterápico para lograr su curación (AU)

Persistent trophoblastic disease can be diagnosed after any type of pregnancy, but the frequency of this entity increases after molar pregnancies and consequently early diagnosis and follow-up is vital for prompt and effective treatment. We present a case of missed abortion, with diagnosis of a complete hydatiform mole. Persistent trophoblastic disease was subsequently diagnosed, requiring treatment with multiple drug therapy to achieve complete resolution (AU)

[The sick individual as a concept]. / El enfermo como concepto.

We start from the premise, shared by some current philosophical movements and by the author, which states that philosophy is not contemplation, or reflection, or introspection or communication. Philosophy is the art of shaping, inventing and creating concepts. It is an explicit way of introducing new differences in life, a different reading level, a specific jargon, which may imply revealing the flip side of the coin, or a dissimilar view of the side facing us. The philosopher is the friend of the concept, he holds it in his power, which means, basically and in all honesty, that philosophy is the discipline of creating concepts. Let us remember the brilliant idea of the Russian director Tarkovsky, who announced his greatest ambition as an artist: "To capture time". At the same time, we must recall one of the sayings of this director: "Every film I have directed and I intend to direct is always tied to characters who have something to overcome". The healthy individual lives in a specific time, with precise coordinates, aware that his life consists only of living that time. That is, living as defined by Josep María Esquirol: "Then we could also see that the best way of living the present is not to run after the fleeing time, but to see and live the opportunity that appears before us". One of the many circumstances that can intercept the way we see and live the opportunity that appears before us is sickness, one of those inescapable experiences we have not been taught how to pay an adequate attention to, and the meaning of which can, in a way, go unnoticed. As "time" goes by, the circumstance that we consider to be the basis on which existence is founded, sickness can appear, thus introducing a new dimension in the time of the healthy individual. For this reason we, as doctors and professionals, know that sickness "is tied to characters who have something to overcome". In view of the fact that a sickness invades a healthy individual and transforms him into a sick one, this paper supports the philosophical idea of the creation of a new concept: We have to create the concept of the sick with a philosophical basis, we must establish the idea that the sick individual lives, since the very moment he starts being sick, in a new and different time. The sick individual lives in a different time and, if we identify--with a certain boldness, just as Esquirol points out--"time" and "life", then we shall be bold enough to create a new entity, the sick individual, whose circumstances and new supports turn him into a new concept, they turn him into an idea--which shall be well defined and better shaped--after which we can think and act according to the belief of the sick individual as a concept, which is radically different from the healthy individual as a concept. The sick individual has nothing to do, if we can say so with a certain emphasis, with the healthy individual. They live in different times, although those times are not entirely unknown for each other. Every individual has the ability of thought. I think that the doctor, now become philosopher, must integrate the creation in its routine in order to be a better professional. He must create the concept of the sick individual, whose time has more different connotations than those found in the healthy individual. Accordingly, we want to think that the fabricated reality of the time of the healthy individual is not useful anymore, because the sick individual is an entity "in the distance", in which the course of time is fragmented as soon as he assimilates the crisis brought by the sickness. We have to properly shape and define that crisis and use it to philosophically establish the concept of the sick individual. Our plan is to produce a book after this conference.