Paracoccidiodomycosis lung reactivation in a patient with signet-ring cell gastric adenocarcinoma after chemotherapy: Case report.

Although the relationship between paracoccidioidomycosis (PCM) and solid tumors has been described more than 80 years ago, reports of PCM and gastric cancer are rare. PCM can present before or concomitantly with the diagnosis of cancer, and its clinical presentation may rise the suspicion of malignancies or be part of reactivation by immunosuppression. We present the case of a 52-year-old Peruvian man with a signet-ring cell (SRC) gastric adenocarcinoma who after 6 chemotherapy sessions with FLOT (docetaxel, oxaliplatin, leucovorin, 5-fluorouracil) presented rapidly growing lung nodules. The lung biopsy showed yeasts compatible with Paracoccidioides sp., so he received initial treatment with itraconazole and after gastrectomy maintenance therapy with trimethoprim/sulfamethoxazole accompanied by tomographic resolution of lesions.

Enhancing violations of Leggett-Garg inequalities in nonequilibrium correlated many-body systems by interactions and decoherence.

We identify different schemes to enhance the violation of Leggett-Garg inequalities in open many-body systems. Considering a nonequilibrium archetypical setup of quantum transport, we show that particle interactions control the direction and amplitude of maximal violation, and that in the strongly-interacting and strongly-driven regime bulk dephasing enhances the violation. Through an analytical study of a minimal model we unravel the basic ingredients to explain this decoherence-enhanced quantumness, illustrating that such an effect emerges in a wide variety of systems.

Theoretical equations of state for a charged fluid.

In this article, we present a molecular thermodynamic study of a system of N particles contained within a volume V and interacting via a hard-core pair potential with an attractive interaction according to the Wolf model for charged systems. This variable-range potential is characterized by three parameters: the repulsive hard-core diameter σ, the energy-well depth ϵ, and the inverse range α; a fourth parameter of the model is a cut-off distance xc that depends on α according to the relation xc = 2/α. Two equations of state (EOSs) are presented and derived from thermodynamic perturbation theory and Monte Carlo (MC) simulation data. The first EOS is given by the standard Zwanzig's high-temperature expansion of the Helmholtz free energy, where the first three perturbation terms a1, a2, and a3 were obtained from MC simulations in the canonical ensemble (NVT) and parameterized as functions of α and the reduced density of particles ρ* = Nσ3/V. The second EOS was obtained from the discrete perturbation theory applied to a discrete representation of the Wolf potential. Results for pressures, internal energies, and isochoric heat capacities are compared to the MC computer simulation data of the Wolf system, including vapor-liquid coexistence curves, for different values of α. Overall, both EOSs give a very good representation of the thermodynamic properties of the Wolf fluid when 0.3 ≤ α ≤ 1.0 and 0.05 ≤ ρ* ≤ 0.8. Since the Yukawa fluid can reproduce information of screened ionic interactions, we discuss the equivalence between the Wolf and Yukawa fluids in the context of equivalent systems in liquid theory.

Water phase transitions from the perspective of hydrogen-bond network analysis.

We analyze the water vapour-liquid and solid-liquid phase transitions from the perspective of hydrogen bond networks. Using molecular dynamics simulation data for the TIP4P/2005 and TIP4P/ice water models, we built hydrogen bond networks in the neighbourhood of the transitions. We studied the behaviour of some topological network properties: the average degree, clustering coefficient, and average path length. We found that these properties exhibit a discontinuity while approaching a phase transition region, similar to those that appear for some thermodynamic properties in the same region. This approach can be extended to characterize other water phase transitions. Besides, it can also be applied to study the phase transitions of other hydrogen-bonded substances or to other scenarios whose relevant "interaction" could be identified together with a "proper criterion" defined in an analogous way as in the case of hydrogen bonded systems.

Antibiotic-associated diarrhea: Clinical characteristics and the presence of Clostridium difficile. / Diarrea asociada a antibióticos: características clínicas y presencia de Clostridium difficile.

INTRODUCTION AND AIMS: Evidence in Colombia and Latin America has been insufficient for establishing the clinical characteristics of patients with antibiotic-associated diarrhea (AAD). The present study attempts to describe the clinical characteristics of patients with AAD and to determine the presence of Clostridium difficile, utilizing the polymerase chain reaction (PCR) technique. MATERIALS AND METHODS: Forty-three patients with AAD, managed at the Hospital Universitario San Ignacio in Bogotá, Colombia, were evaluated. Prospective patient information was collected, with respect to demographic characteristics, profile of the antibiotic management received, clinical manifestations, risk factors, and paraclinical reports. In addition, the real time PCR test for Clostridium difficile (Cepheid Xpert®, Sunnyvale, CA, United States) was performed. RESULTS: Patient mean age was 58 years (19.31 SD). The majority of the patients received 2 or more antibiotics (62.9%) and the beta-lactams were the most frequently used. Hospital stay ranged from 2 to 104 days with a median of 10 days. The most frequent clinical manifestations were abdominal pain and bloating, followed by fever and tachycardia. At the time of diagnosis, 23 patients had noninflammatory results in the stool sample analyses and 18 had kidney failure. The mean level of albumin was 2.4mg/dl (0.7 SD). The presence of Clostridium difficile was documented through PCR in 6 patients (13.95% of the cases). CONCLUSIONS: AAD patients were characterized by a high frequency of severe comorbidities and prolonged hospital stay. The presence of Clostridium difficile in only 13.9% of the cases suggests that other causes of diarrhea in the hospitalized patient should be considered.

Self-fertilization, long-distance flash invasion and biogeography shape the population structure of Pseudosuccinea columella at the worldwide scale.

Population genetic studies are efficient for inferring the invasion history based on a comparison of native and invasive populations, especially when conducted at species scale. An expected outcome in invasive populations is variability loss, and this is especially true in self-fertilizing species. We here focus on the self-fertilizing Pseudosuccinea columella, an invasive hermaphroditic freshwater snail that has greatly expanded its geographic distribution and that acts as intermediate host of Fasciola hepatica, the causative agent of human and veterinary fasciolosis. We evaluated the distribution of genetic diversity at the largest geographic scale analysed to date in this species by surveying 80 populations collected during 16 years from 14 countries, using eight nuclear microsatellites and two mitochondrial genes. As expected, populations from North America, the putative origin area, were strongly structured by selfing and history and harboured much more genetic variability than invasive populations. We found high selfing rates (when it was possible to infer it), none-to-low genetic variability and strong population structure in most invasive populations. Strikingly, we found a unique genotype/haplotype in populations from eight invaded regions sampled all over the world. Moreover, snail populations resistant to infection by the parasite are genetically distinct from susceptible populations. Our results are compatible with repeated introductions in South America and flash worldwide invasion by this unique genotype/haplotype. Our study illustrates the population genetic consequences of biological invasion in a highly selfing species at very large geographic scale. We discuss how such a large-scale flash invasion may affect the spread of fasciolosis.

Electrochemical reactor with rotating cylinder electrode for optimum electrochemical recovery of nickel from plating rinsing effluents.

This study is devoted to analyze the metallic electrochemical recovery of nickel from synthetic solutions simulating plating rinsing discharges, in order to meet the water recycling policies implemented in these industries. These effluents present dilute Ni(II) concentrations (100 and 200 ppm) in chloride and sulfate media without supporting electrolyte (397-4202 µS cm(-1)), which stems poor current distribution, limited mass transfer, ohmic drops and enhancement of parasitic reactions. An electrochemical reactor with rotating cylinder electrode (RCE) and a pH controller were utilized to overcome these problems. The pH control around 4 was crucial to yield high purity nickel, and thus prevent the precipitation of hydroxides and oxides. Macroelectrolysis experiments were systematically conducted to analyze the impacts of the applied current density in the recovery efficiency and energy consumption, particularly for very diluted effluents (100 and 200 ppm Ni(II)), which present major recovery problems. Promising nickel recoveries in the order of 90% were found in the former baths using a current density of -3.08 mA cm(-2), and with overall profits of 9.64 and 14.69 USD kg(-1), respectively. These estimations were based on the international market price for nickel ($18 USD kg(-1)).

Síndrome de Budd-Chiari: una rara presentación de un cáncer renal / Budd-Chiari syndrome: a rare presentation of renal cancer

El Cáncer Renal se presenta habitualmente como un hallazgo de las imágenes abdominales y cuando se manifiesta clínicamente lo hace a través de los efectos que produce una gran masa abdominal o las metástasis a distancia. En este trabajo se presenta un caso de cáncer renal cuyas manifestaciones clínicas fueron secundarias a la obstrucción de las venas supra hepáticas, es decir un síndrome de Budd-Chiari florido por la presencia de un trombo tumoral en la cava retro hepática. El diagnóstico oportuno y una evaluación adecuada con imágenes permitieron la ejecución de un plan de tratamiento que incluyó un abordaje combinado abdominal y torácico que permitió un tratamiento no solo sintomático sino que potencialmente curativo de un cáncer renal con esta rara presentación.

Renal Cancer usually occurs as a finding of abdominal imaging and when it clinically manifests itself it does so through a large abdominal mass or distant metastases. In this paper we present a case of renal cancer whose clinical manifestations were secondary to obstruction of hepatic veins, a Budd-Chiari syndrome because of the presence of a tumor thrombus in the retro hepatic vena cava. Early diagnosis and appropriate imaging evaluation allowed the implementation of a treatment plan that included a combined abdominal and thoracic approach allowing not only a symptomatic treatment but potentially curative treatment of renal cancer with this rare presentation.

[Impact of consumption of corn flour with low level enrichment in children of rural zones]. / Impacto del consumo de harina de maíz con un bajo nivel de enriquecimiento en niños de zonas rurales.

INTRODUCTION: Corn has been from the prehispanic era, the most important feeding plant in the Mexican population, particularly in the most important sectors and in marginal areas. In this setting, enriching the product as flour implies an increase in its nutritional quality, especially because corn is the basic food. OBJECTIVE: To assess the effect of the consumption of corn flour enriched with 3% soybean, vitamins, and minerals on the growth and development of infants and preschool children. MATERIAL AND METHODS: experimental study lasting 10 months. The experimental group (n=195) received enriched corn flour whereas the control group (n=200) received non-enriched flour. The indicators were: nutritional status, mental and psychomotor development, and blood hemoglobin levels. RESULTS: in the total sample, there were no differences between the experimental group and the control group. However, there were improvements in the weight-to-height and weight-to-age indexes in the children consuming enriched flour and in children older than one year, who were the babies of indigenous women living in marginal areas. CONCLUSIONS: enriched corn flour appears to be an alternative benefitting the children population with higher nutritional deficiencies. However, a longer intervention is necessary to obtain better results.

Discrete perturbation theory for the hard-core attractive and repulsive Yukawa potentials.

In this work we apply the discrete perturbation theory [A. L. Benavides and A. Gil-Villegas, Mol. Phys. 97, 1225 (1999)] to obtain an equation of state for the case of two continuous potentials: the hard-core attractive Yukawa potential and the hard-core repulsive Yukawa potential. The main advantage of the presented equation of state is that it is an explicit analytical expression in the parameters that characterize the intermolecular interactions. With a suitable choice of their inverse screening length parameter one can model the behavior of different systems. This feature allows us to make a systematic study of the effect of the variation in the parameters on the thermodynamic properties of this system. We analyze single phase properties at different conditions of density and temperature, and vapor-liquid phase diagrams for several values of the reduced inverse screening length parameter within the interval kappa( *)=0.1-5.0. The theoretical predictions are compared with available and new Monte Carlo simulation data. Good agreement is found for most of the cases and better predictions are found for the long-range ones. The Yukawa potential is an example of a family of hard-core plus a tail (attractive or repulsive) function that asymptotically goes to zero as the separations between particles increase. We would expect that similar results could be found for other potentials with these characteristics.

Impacto de la obesidad central en el diagnóstico de cáncer prostático y su agresividad en tumores cT1c / Impact of central obesity in the diagnosis and prognosis of cT1c prostate cancer

La obesidad y el sobrepeso afectan al 62,8 por ciento de la población chilena. Esta condición aumenta los niveles de insulina, IGF-1 y otros mediadores inflamatorios asociados al cáncer prostático (CaP). La relación entre CaP y obesidad, utilizando al índice de masa corporal (IMC) como indicador, ha evidenciado resultados inconsistentes. Sin embargo, la obesidad central (OC), determinada por una circunferencia de cintura (CC) mayor de 95 cm, es en la actualidad un mejor predictor de los efectos metabólicos y cardiovasculares de la adiposidad. El objetivo de este estudio fue evaluar la asociación entre OC y CaP. Como objetivo secundario se evaluó los efectos de la OC sobre: volumen prostático (VP), APE, score de Gleason y porcentaje de cáncer en biopsia transrectal (BTR).Materiales y Método: Se diseñó un estudio de casos y controles prospectivo. Se incluyeron todos los pacientes sometidos a BTR, con clasificación cT1c, en dos hospitales de Santiago, entre junio de 2008 y julio de 2009. Se realizó medición de IMC y CC previo a la BTR, según protocolos validados. Se realizaron tests estadísticos bivariados y multivariados, para medir asociaciones brutas y ajustadas entre las variables estudiadas y el resultado histológico de la BTR. Resultados: Se incluyeron 150 pacientes. El promedio de edad fue 63,1 años. El 53,3 por ciento tuvo una CC mayor de 95 cm. Ambos grupos de exposición fueron comparables. Hubo 40,0 por ciento con CaP y, entre ellos, el 40,0 por ciento fue considerado de alto riesgo. No se encontró asociación significativa entre CC y las variables: VP, APE y presencia de cáncer en la biopsia. Sin embargo, en el análisis multivariado la CC se asoció positivamente con el score de Gleason (p= 0,0352) y con el porcentaje total de CaP en la BTR (p= 0,0341). A mayor VP fue menos probable hallar CaP, y la densidad del APE predijo significativamente el 70 por ciento Conclusiones: En este estudio, la CC no fue un factor de riesgo significativo para la...

Obesity and overweight affect 62 percent of the Chilean population. This condition increases insulin levels, IGF-1 levels and other inflammatory mediators associated to prostate cancer (PCa). The relationship between PCa and obesity using the body mass index (BMI) as an indicator, has been inconsistent. However, central obesity (CO), determined by a waist circumference (WC) over 95 cm, is currently a better predictor for the metabolic and cardiovascular effects of adiposity. The objective of this study was to evaluate the association between CO and PCa. As a secondary objective, we evaluated the effects of CO on: prostate volume (PV), serum PSA, Gleason score and percentage of cancer in the transrectal biopsy (TRB).Materials and method: We designed a prospective case control study. All patients submitted to TRB, with cT1c tumors, at 2 hospitals in Santiago between June 2008 and July 2009, were included. Before TRB, BMI and WC were measured, according to standard protocols. Bivariated and multivariated statistical tests were used to measure both raw and adjusted associations between the studied variables and the histologic result of the TRB. Results: The study included 150 patients. Average age was 53.1 years. A WC over 95 cm was found in 53 percent of them. Both groups were comparable. PCa was present in 40 per cent of the subjects; among them, 40 percent had high risk tumors. No significant association was found between WC and the following variables: PV, PSA level and the presence of cancer in the TRB. However, in the multivariate analysis, WC was associated with Gleason score (p =0.0352). Also, the total percentage of PCa in the TRB was associated with WC (p =0.0341). At higher PV, PCa was less frequent and PSA level predicted 70 percent of PCa. Conclusions: In this study, WC was a significant risk factor for the presence of PCa. Nevertheless, a pathologic WC was associated with higher Gleason scores and higher percentage of PCa in the TRB...

¿Se justifica el uso rutinario de catéter ureteral post trasplante renal? / Is routinary ureteral stenting indicated in kidney transplant?

Introducción: El uso rutinario de de stent ureterales en trasplante renal (TR) es controvertido. Nosotros evaluamos la experiencia del stent selectivo basado en la decisión del cirujano comparando las tasas de complicaciones ureterales (filtración y/o obstrucción) en el grupo que recibió o (SU+) o no un stent (SU-). El objetivo del estudio es identificar factores de riesgo para filtración y/o obstrucción. Materiales y Métodos: Entre septiembre de 1994 y octubre de 2005, 160pacientes consecutivos se sometieron a un trasplante renal en nuestro centro. El uso de SU estuvo basado en la decisión del cirujano y fue insertado después de que un lado de la anastomosis estuvo completada. Se identificaron las complicaciones urológicas dentro de los primeros 90 días después del TR. Las complicaciones ureterales fueron definidas como: filtración, obstrucción, Infección del tracto urinario, lesión arterial y necrosis tubular aguda. Los datos demográficos fueron recolectados desde la revisión de fichas clínicas y base de datos computarizada de TR. Resultados: Se evaluaron 113 pacientes del grupo total. La incidencia global de complicaciones urológicas en este estudio fue de 8 por ciento (9), filtración fue vista en 5 por ciento (6), obstrucción en 3 por ciento (3) y 28 por ciento de TU entre los primeros 90 días después de un IR. Cuarenta y un pacientes (36 por ciento) recibieron un stent (SU+) y setenta y dos (64 por ciento) no (SU-). Los grupos fueron comparables. La frecuencia complicaciones ureterales (obstrucción, filtración y obstrucción más filtración) y de TU entre los grupos no mostró diferencia estadística. En el análisis univariado se demostró que la edad y sexo del receptor, edad del donante, la fuente del donante (cadáver o vivo), tiempo de isquemia (caliente y fría), presencia de NTA y lesiones arteriales no fueron asociadas con la presencia de obstrucción, filtración o ambas...

Introduction: Routine use of ureteral stent (US) after transplanstation remains controversial. We evaluate the experience of selective stent use based on surgeon decision comparing the ureteral complicationrates (leaking and / or obstruction) between the group receiving (US+) or another group without not astent (SU-). The aim of the study was to identify risk factors for leaking and / or obstruction in patients receiving ureteral stent after transplantation. Materials and Methods: Between September 1994 and October 2005, 160 consecutive patients underwent a renal transplant in our center. The use of US was based on the decision of the surgical team. Urological complications were identified within the first 90 days after RT. The ureteral complications were defined as: leaking, obstruction, urinary tract infection, arterial injury and acute tubular necrosis (ATN). Demographic data were collected prospectively and retrospectively analized from the review of clinical data base. Results: We evaluated 113 patients of the total group. The overall incidence of urological complications in this study was 8 percent (9), leaking was seen in 5 percent (6), obstruction in 3 percent (3) and 28 percent of the TU first 90days after an IR. Forty-one patients (36 percent ) received a stent (SU +) and seventy and two (64 percent) no(SU-). The groups were comparable. The frequency of ureteral complications (obstruction, leaking and obstruction-filtration) and TU between groups showed no statistical difference. In the Univariate analysis showed age, sex of recipient, donor´s age, the source of graft (living of dead), ischemia time(hot and cold), presence of ATN and arterial lesions were not associated with the presence of obstruction, leaking or both. However, among patients with obstruction leaking a higher probability of developing TU was verified. Conclusions: Our experience shows that routine stent use has no clear benefit in transplantation´s outcomes...

Anatomical studies of sibling species within neotropical lymnaeids, snail intermediate hosts of fascioliasis.

Several anatomical parameters of the reproductive system have been used to distinguish Lymnaea cubensis from L. viatrix, the snail hosts of fascioliasis in South America and the Caribbean area. Three samples have been collected in the type localities of L. cubensis (Cuba), L. viatrix var. A ventricosa (Argentina, Río Negro Lower Valley), and L. viatrix var. B elongata (Peru, Lima), respectively. Only one parameter, the relative lengths of the penis sheath and preputium, showed significant differences between L. viatrix var. ventricosa and the two other taxa. None of the studied parameters separated L. cubensis from L. viatrix var. elongata.

Anatomical studies of sibling species within neotropical lymnaeids, snail intermediate hosts of fascioliasis

Several anatomical parameters of the reproductive system have been used to distinguish Lymnaea cubensis from L. viatrix, the snail hosts of fascioliasis in South America and the Caribbean area. Three samples have been collected in the type localities of L. cubensis (Cuba), L. viatrix var. A ventricosa (Argentina, Río Negro Lower Valley), and L. viatrix var. B elongata (Peru, Lima), respectively. Only one parameter, the relative lengths of the penis sheath and preputium, showed significant differences between L. viatrix var. ventricosa and the two other taxa. None of the studied parameters separated L. cubensis from L. viatrix var. elongata.

Preoperative progressive pneumoperitoneum in patients with abdominal-wall hernias.

Induction of preoperative progressive pneumoperitoneum is an elective procedure in patients with hernias with loss of domain. A prospective study was carried out from June 2003 to May 2005 at the Hospital de Especialidades, Instituto Mexicano del Seguro Social, Leon, Mexico. Preoperative progressive pneumoperitoneum was induced using a double-lumen intraabdominal catheter inserted through a Veress needle and daily insufflation of ambient air. Variables analyzed were age, sex, body mass index, type, location and size of defective hernia, number of previous repairs, number of days pneumoperitoneum was maintained, type of hernioplasty, and incidence of complications. Of 12 patients, 2 were excluded because it was technically impossible to induce pneumoperitoneum. Of the remaining 10 patients, 60% were female and 40% were male. The patients' average age was 51.5 years, average body mass index was 34.7, and evolution time of their hernias ranged from 8 months to 23 years. Nine patients had ventral hernias and one had an inguinal hernia. Pneumoperitoneum was maintained for an average of 9.3 days and there were no serious complications relating to the puncture or the maintenance of the pneumoperitoneum. One patient who previously had undergone a mastectomy experienced minor complications. We were able to perform hernioplasty on all patients, eight with the Rives technique, one with supra-aponeurotic mesh, and one using the Lichtenstein method for inguinal hernia repair. One patient's wound became infected postoperatively. Preoperative progressive pneumoperitoneum is a safe procedure that is easy to perform and that facilitates surgical hernia repair in patients with hernia with loss of domain. Complications are infrequent, patient tolerability is adequate, and the proposed modification to the puncture technique makes the procedure even safer.

Epidemiología del cáncer prostático en Chile: estudio a nivel regional de la mortalidad, en el período 1998-2002 / Prostate Cancer Epidemiology in Chile: mortality study at a regional level, since 1998 to 2002

Los cambios epidemiológicos experimentados en el país han permitido presenciar la existencia de patologías de curso crónico. A lo largo de Chile las condiciones propias de cada población, afectadas por factores ambientales específicas, permiten plantear la presencia de diferentes frecuencias en la repetición de enfermedades crónicas no transmisibles como el cáncer. Se analizó la base de datos de mortalidad por cáncer prostático durante el período 1998-2002 en cada región geográfica, disponible en el Instituto Nacional de Estadísticas (INE). Este trabajo ha permitido identificar concentraciones de mortalidad por cáncer prostático en zonas geográficas precisas, situación que pudiera reflejar la existencia de factores de riesgos locales.

Información y consentimiento en la práctica urológica: revisión de la doctrina, legislación y jurisprudencia / Information and consent in practice of urology: review of doctrine, legislation and jurisprudence

Una creciente toma de conciencia ciudadana frente al derecho del paciente de ser informado, y consentir libremente, ha llevado a mayores exigencias en torno a ejercer efectivamente la autonomía de la voluntad frente a decisiones de procedimientos médicos. En los registros de Asistencia Legal del Colegio Médico, un importante número de demandas por supuesta negligencia no corresponden a una mala práctica médica en sí, sino más bien a una falta de información proporcionada al paciente respecto del curso natural de la enfermedad o a los riesgos y consecuencias del tratamiento. Material y Métodos: Revisión crítica de las leyes actuales que rigen el quehacer médico y sus bases doctrinarias. Análisis descriptivo de las estadísticas sobre querellas y demandas registradas en los archivos del Colegio Médico de Chile. Búsqueda sistemática vía internet en las bases de datos electrónicas de Lexis Nersis y Microjuris, de los fallos judiciales en los tribunales chilenos, mediante palabras claves en torno al tema. Resultados: La Reforma a la Salud ha cambiado el escenario jurídico en los últimos cuatro años con la promulgación de la Leyes Nº 19.937 Autoridad Sanitaria y Gestión, Nº 19.966 Establece Régimen de Garantías en Salud (AUGE/GES) y Nº 20.015 Modifica la Ley de Isapres. Este nuevo marco regulatorio genera garantías explícitas para los usuarios con obligatoriedad de prestaciones que pueden ser exigibles en tribunales, de no ser cumplidas. La doctrina ha entendido que la Información y Consentimiento son un proceso desarrollado al interior de la relación médico-paciente de carácter dinámico, no es su esencia que se escriture, pero es fundamental como medio de prueba en caso de enfrentar una eventual querella o demanda. En junio de 2001 se envió al parlamento el Proyecto de Ley Sobre los Derechos y Deberes de las Personas en Salud, donde se regula expresamente el Consentimiento Informado. El ®Protocolo de Consentimiento Informado¼ debe contener básicamente: Descripción del procedimiento, objetivos, riesgos, posibles complicaciones, beneficios, alternativas, efectos de la no realización, disposición del médico de ampliar la información, libertad del paciente para reconsiderar la decisión tomada. La redacción debe ser simple y no abusiva, en el entendido de hacerlo renunciar a acciones legales. Conclusiones: Las Reformas a la Salud y la Justicia han determinado una judialización de la medicina...