ABSTRACT
The Chilean House of Representatives is discussing the bill on "Dignified death and palliative care", which regulates the so-called medical assistance in dying or euthanasia. This paper will critically analyze the different aspects of the bill, particularly concerning four main dimensions, namely, the patient's condition at the time of requesting euthanasia; the doctor-patient relationship and respect for the autonomy of both parties; the idea of medicine involved in it; and the possible therapeutic alternatives to euthanasia. This critical analysis raises the need to discuss in more depth a project that has to do with such important decisions about our lives and that implies a radical change in the way of thinking and practicing medicine.
Subject(s)
Humans , Palliative Care , Euthanasia , Physician-Patient Relations , ChileABSTRACT
Intracranial sinus thrombosis (1ST) after closed head injury is an uncommon but potentially serious complication. It has no correlation with the severity of the injury. The symptoms and clinical course are highly variable. The most frequent but least specific symptom is severe headache. Cerebral lesions and neurologic signs develop in half of patients with IST. We report a 29 year-old male who had an IST after a severe closed head injury. The patient initially developed headache and had later 2 secondarily generalized seizures. The magnetic resonance imaging showed a superior sagittal sinus thrombosis. Anticoagulation with unfractionated heparin and intravenous phenytoin was started. At the moment of this report he is asymptomatic and continues with oral anticoagulants and phenytoin.
Subject(s)
Adult , Humans , Male , Head Injuries, Closed/complications , Sinus Thrombosis, Intracranial/etiology , Anticoagulants/therapeutic use , Anticonvulsants/therapeutic use , Cerebral Veins , Heparin/therapeutic use , Magnetic Resonance Imaging , Phenytoin/therapeutic use , Sinus Thrombosis, Intracranial/diagnosis , Sinus Thrombosis, Intracranial/drug therapy , Tomography, X-Ray ComputedABSTRACT
Cardiac rate and rhythm due to autonomic activation, may occur during epileptic seizures. They are probably a consequence of the spreading seizure activity to structures involved in the autonomic control of cardiac rhythm. Sinus tachycardia is the most frequent finding (90 percent). Letal bradycardia is rare and life threatening asystoles require cardiac pacemaker insertion. We report two patients with a right frontal seizure associated to bradycardia, during simultaneous EEG/ECG monitoring. Interictal autonomic function tests showed preserved sympathetic and cardiac vagal responses. Normal interictal autonomic function tests, suggested a transient failure of sympatho-vagal balance.
Subject(s)
Adult , Child , Humans , Male , Bradycardia/etiology , Epilepsy/complications , Bradycardia/diagnosis , Electroencephalography , Seizures/complicationsABSTRACT
Background: The use of CPAP is the conventional therapy for the Obstructive Sleep Apnea Syndrome (OSAS). Aim To establish the proportion of OSAS patients with CPAP indication who use it in the long-term and to determine predictive factors of adherence. Patients and Methods: Structured survey through personal interview or phone call, applied to all patients who had polisomnographically documented OSAS and CPAP titration at the Pontificia Universidad Católica de Chile Sleep Disorders Center between January 1998 and November 2001. Patients were divided in "Permanent Users" (Group I) and "Non Users" (Group II). Results: Of 440 patients that fulfilled inclusion criteria, 162 (32.8 percent) answered the survey. Seventy percent (114/162) of these patients had used CPAP and 86 percent (98/114) continued to use it at the time of the interview, with a mean follow-up of 12.3 months (Group I 60.5 percent of the interviewed population). Group II included 64 patients (39.5 percent of the interviewed patients). Among the latter, 25 percent (16/64) stopped using CPAP due to intolerance, 25 percent (16/64) could not use it because of economical restrictions, 20.5 percent (13/64) preferred other therapies and 29.5 percent (15/64) merely refused treatment. Predictors of long-term use of CPAP were number of respiratory events (p <0.01), hypersomnolence (p <0.01) and age (p =0.03). Conclusions: Approximately two thirds of patients with OSAS, with an indication for CPAP, continue to use this therapy in the long term in a Chilean population. This figure is similar to other reports from abroad. It is also possible to identify predictive factors for CPAP discontinuation in this population.
Subject(s)
Humans , Middle Aged , Continuous Positive Airway Pressure , Patient Acceptance of Health Care , Sleep Apnea, Obstructive/therapy , Disorders of Excessive Somnolence/therapy , Follow-Up Studies , Long-Term Care , Patient Compliance , Polysomnography , Severity of Illness Index , Sleep Apnea, Obstructive/pathology , Snoring/therapy , Treatment RefusalABSTRACT
Malignant neuroleptic syndrome is a complication of antipsychotic medication use. Clozapine use is also associated with polyserositis and eosinophilia. We report a 17 years old female treated with clozapine, valproic acid, lithium carbonate and lorazepam that consulted in the emergency room for confusion, lethargy, catatonia, rigidity, myalgya and fever. Complete blood count showed eosinophilia. An abdominal CAT scan showed ascites and pleural effusion. Clozapine was discontinued and bromocriptine was started. One week after admission, the patient remained febrile and liver enzymes were elevated. Valproic acid was discontinued. Inflammatory parameters stated to subside and the patient was discharged afebrile days after admission.
Subject(s)
Adolescent , Female , Humans , Antipsychotic Agents/adverse effects , Clozapine/adverse effects , Neuroleptic Malignant Syndrome/etiology , Bipolar Disorder/drug therapyABSTRACT
Background: Stroke is the second cause of mortality and the first cause of morbidity in Chile and worldwide. Nowadays there is a major interest in introducing new therapies applying evidence based medicine for these patients. Aim: To describe the clinical profile of patients attended after a stroke, to determine stroke subtypes and their risk factors. Material and methods: Retrospective review of clinical records of 459 patients (mean age 65±48 years, 238 female) that were admitted to our unit during a period of 37 months. Results: Sixty three percent of patients had an ischemic stroke, 14% had an hemorrhagic stroke, 15% had a transient ischemic attack, 2% had a cerebral venous thrombosis and 6% a subarachnoidal hemorrhage. The global mortality was 1%. Seventy percent of patients had a history of high blood pressure. Conclusions: The most common type of stroke is ischemic and high blood pressure is the main risk factor.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Stroke/epidemiology , Hospital Units/statistics & numerical data , Age Distribution , Stroke/classification , Stroke/etiology , Chi-Square Distribution , Chile/epidemiology , Diabetes Complications , Hypertension/complications , Retrospective Studies , Risk Factors , Sex DistributionABSTRACT
El insomnio crónico es un problema frecuente en la población general. Entre sus causas destacan la depresión, el insomnio psicofisiológico, uso de drogas y alcohol, mioclonus nocturno y el síndrome de piernas inquietas. En la mayoría de los casos su etiología puede determinarse con la anamnesis y examen físico. En ocasiones, sin embargo, se debe recurrir a exámenes especiales, tales como el polisomnograma. El tratamiento del insomnio debe ser en lo posible etiológico. El insomnio psicofisiológico crónico requiere ser manejado con medidas de higiene del sueño. El uso de hipnóticos debe limitarse a insomnios agudos o breves períodos en el insomnio crónico
Subject(s)
Humans , Hypnotics and Sedatives/administration & dosage , Sleep Initiation and Maintenance Disorders , Chronic Disease , Sleep Deprivation/physiology , Sleep Initiation and Maintenance Disorders/diagnosis , Sleep Initiation and Maintenance Disorders/etiology , Sleep Initiation and Maintenance Disorders/therapy , Sleep, REMABSTRACT
We report a 69 years old male with a parkinsonian syndrome and a 50 years old female without neurological problems who showed violent behavior during REM sleep. Polysomnography showed that both had tonic or phasic muscular activity during REM sleep and a REM sleep behavior disorder was diagnosed. Clonazepam was used in both, with good clinical response. This condition is frequently unrecognized and confused with nightmares, nocturnal delirium or other parasomnias