ABSTRACT
La ética médica, basada en un modelo paternalista y con raíces en la filosofía aristotélica, dominó la forma de practicar la medicina hasta bien avanzado el siglo XX. Los acontecimientos provocados por la segunda guerra mundial y los cambios sociales de este siglo, proporcionaron argumentos suficientes para la irrupción de la filosofía en los problemas relacionados con la ética médica. El principialismo, en especial el principio de autonomía, y la teoría del consentimiento informado, cambiaron el carácter tradicional en la que se apoyaba la relación médico-enfermo. Lejos de quedar asentado, el principialismo no ha resuelto la esencia de los problemas éticos que con frecuencia se plantean en la actualidad. Las exigencias sociales e individuales sobre lo que hoy se espera que la medicina logre, colisionan frecuentemente con la forma de entender el médico su profesión. El argumento ético que sustente la actuación de un médico por el bien de su enfermo se ha convertido, en no pocas ocasiones, en una fuente de incertidumbre para la profesión (AU)
Medical ethics based on a paternalistic model inspired by aristotelic philosophy, prevailed in medical practice well into the 20th century. The events of the Second World War and social changes of the century provided enough arguments for philosophy to burst into medical ethics related issues. Principlism, especially the principle of autonomy, and the theory of informed consent, changed the traditional character of the relation physician-patient. Far from being established principlism has not solved the essence of the ethical issues that often appear nowadays. Individual and social demands about expected medical advances often clash with the physicians understanding of their profession. The ethical argument to support the physicians behavior for the good of the patient, in quite a few occasions, has become a source of uncertainty for the physician (AU)
Subject(s)
Humans , Ethics, Medical , Bioethics/trends , Physician-Patient Relations/ethics , Personal Autonomy , Informed Consent/ethicsABSTRACT
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Subject(s)
Humans , Informed Consent By Minors/ethics , Third-Party Consent/ethics , Hospital Information Systems , Unaccompanied Minor , Guideline AdherenceABSTRACT
A case of a 32 years old woman with fever and exudative ascites is described. Tuberculous peritonitis was confirmed by abdominal laparoscopy, peritoneal biopsy and Lowënstein culture. A serum CA 125 level was 861 U/ml before therapy. The CA 125 level decreased a 30% after three weeks of antituberculous treatment. This tumor marker may be used to follow disease activity in tuberculous ascites.
Subject(s)
Antitubercular Agents/therapeutic use , CA-125 Antigen/blood , Peritonitis, Tuberculous/blood , Peritonitis, Tuberculous/drug therapy , Adult , Ascites/etiology , Biomarkers/blood , Female , HumansABSTRACT
OBJECTIVE: To value the effects of megestrol acetate wer the weight and the body composition (fat, lean and body water) in patients with AIDS associated cachexia, by bioelectric impedance analysis. SUBJECTS: 25 patients between 23 and 57 years of age, with confirmed HIV infection and prior weight lost of 7.96 +/- 4.6 kg in relation to their habitual weight in the previous months. All the patients were under antiretroviral therapy. METHOD: Basal determination, before the beginning of the antianorexic treatment and at the end of it, using bioelectric impedance analysis by Maltron BF 905 analyzer, calculating fat, lean and total body water in relation to weight, height, age and sex. Oral administration of 320 mg/day megestrol acetate for three consecutive months. Statistical comparation (RSIGMA and SPSS) by paired t-test of the mean weight, body mass index, fat, lean and total body water. RESULTS: During the three months treatment the mean basal body weight of the patients increased 3.54 Kg (p < 0.001) at the expense of an increase of 2.24 kg in the total body lean (p < 0.01), while the increment of the body fat (1.2 kg) was not statistically significant. The total body water increased 1.48 L (p < 0.001) and the body mass index in 1.22 kg/m2 (p < 0.001). CONCLUSION: Treatment with megestrol acetate results in a substained and very significant increase of the weight and body mass index in patients with AIDS related cachexia. This increment in weight is at the expense of body lean.
Subject(s)
Appetite Stimulants/therapeutic use , HIV Wasting Syndrome/drug therapy , Megestrol Acetate/therapeutic use , Progesterone Congeners/therapeutic use , Adult , Body Composition , Electric Impedance , Female , Humans , Male , Middle AgedABSTRACT
The mesothelioma is a rare tumor, especially in its peritoneal location (20%). Most of these cases are related to an exposition to asbestos long time age. We present a patient with long-evolution ascites and without any other clinical manifestations. The study of the ascitic fluid, the imaging techniques and the peritoneoscopy did not allow the diagnosis in the first place. Only after one year of follow-up and when the patient recalled, in a directed interrogation, her occupational contact with asbestos thirty years age, the diagnosis could be established.
