¿Qué aporta la denominada «medicina integrativa» a la asistencia clínica científica cotidiana? / What does «integrative medicine» provide to daily scientific clinical care?

La medicina integrativa es un intento ambicioso y, a la vez, generoso de suplir las deficiencias del sistema de salud operativo en nuestras sociedades occidentales, lastradas por la limitación de tiempo disponible, sobre todo en consultas externas. Por otro lado, supone no finiquitar las posibilidades de cierta utilidad terapéutica contrastada a través de los siglos (China, India, etc.), amén de algunos recursos que no alcanzan el nivel de fiabilidad científica deseable, pero que suponen un cierto apoyo terapéutico en determinados casos (homeopatía, acupuntura, etc.), y que siguen requiriendo un abordaje científico. Finalmente, el recurso de productos botánicos (fitoterapia) constituye un amplio mundo de posibilidades en el que se debe avanzar por parte de las universidades —y se está haciendo— al ir adquiriendo dichas sustancias un marchamo farmacológico asentado en el método científico y en los criterios de la medicina basada en la evidencia. Con ello se evitaría la sinrazón que supone el enfrentamiento cotidiano entre la medicina convencional científica, a la que nos sometemos la inmensa mayoría de los pacientes, y las otras «orientaciones» diagnóstico-terapéuticas (medicina naturista, medicina alternativa, medicina complementaria, medicina centrada en el paciente y otras) (AU)

Integrative medicine is an ambitious and noble-minded attempt to address the shortcomings of the current public health systems in our Western societies, which is restricted by the limited time available, especially in outpatient clinics. Integrative medicine also does not limit the possibilities of useful therapies that have been tested over the centuries (from China, India, etc.) or of certain resources that do not achieve the level of desired scientific credibility but that present certain therapeutic support in specific cases (homeopathy, acupuncture, etc.) but still require a scientific approach. Finally, the resource of botanical products (phytotherapy) constitutes a wide range of possibilities that universities can (and do) make progress on by providing drug brands for these products through the use of the scientific method and evidence-based medical criteria. This approach will help avoid the irrationality of the daily struggle between conventional scientific medicine (which we apply to the immense majority of patients) and the other diagnostic-therapeutic «guidelines» (natural medicine, alternative medicine, complementary medicine, patient-focused medicine and others) (AU)

What does «integrative medicine¼ provide to daily scientific clinical care? / ¿Qué aporta la denominada «medicina integrativa¼ a la asistencia clínica científica cotidiana?

Integrative medicine is an ambitious and noble-minded attempt to address the shortcomings of the current public health systems in our Western societies, which is restricted by the limited time available, especially in outpatient clinics. Integrative medicine also does not limit the possibilities of useful therapies that have been tested over the centuries (from China, India, etc.) or of certain resources that do not achieve the level of desired scientific credibility but that present certain therapeutic support in specific cases (homeopathy, acupuncture, etc.) but still require a scientific approach. Finally, the resource of botanical products (phytotherapy) constitutes a wide range of possibilities that universities can (and do) make progress on by providing drug brands for these products through the use of the scientific method and evidence-based medical criteria. This approach will help avoid the irrationality of the daily struggle between conventional scientific medicine (which we apply to the immense majority of patients) and the other diagnostic-therapeutic «guidelines¼ (natural medicine, alternative medicine, complementary medicine, patient-focused medicine and others).

La denominación “marcador tumoral”, un léxico en revisión. Presentación de una paciente demostrativa de dicha necesidad (cirrosis hepática y marcador CA 12.5) / No disponible

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La toxicología clínica, un renovado componente de la Medicina Interna / Clinical toxicology, a renewed of Internal Medicine

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Lo permanente y lo cambiante de la Medicina Interna: hacia una precisión de su especificidad / What is permanent and changing in internal medicine: toward a better undestanding of its specificity

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La osteología clínica, ¿una necesidad o un atavismo? / The clinic osteology, a necessity or an atavism?

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Contenido y enclave docente y asistencial de la Reumatología. Anotaciones para un más ajustado enfoque del problema / Contents and educational frame in Rheumatology. Comments for a better approach to the problem

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[Hepatobiliary clearance of glycocholic acid in Gilbert's disease]. / Aclaramiento hepatobiliar de ácido glico-cólico en la enfermedad de Gilbert.

AIM: To research the behaviour of one biliary acid (glyco-cholic) i.v. injected in patients with Gilbert's disease and in healthy controls, so that contribute to the knowledge of the pathophysiological correlate between bilirubin and biliary acids. PATIENTS AND METHODS: We include 15 patients with Gilbert's disease and 7 healthy voluntary ones. We injected i.v. glycocholic acid and obtained the clearance curve (CG-RIA Abbot method). We evaluated the possible biostatistically significant differences between the obtained values of both groups though the non-parametric method of Mann-Whitney. RESULTS: The clearance curve of both groups had a similar profile; biostatisticaly there are not significant differences between the serum values of glyco-cholic acid in both groups. CONCLUSIONS: The clearance of the glyco-cholic acid in patients with Gilbert's disease had a similar behaviour as in healthy controls, without biostatisticaly significant differences between both groups.

[Heterozygotic alpha-1 antitrypsin deficiency. A case report]. / Déficit heterozigótico de alfa-1-antitripsina. Presentación de un caso.

The clinical, analytical (including phenotypical) and histologic (optical and ultrastructural) data of a 34-years-old male patient attended for evaluation of moderate hypertransaminasemia discovered following a company screening examination. The existence of an alpha-1-antitrypsin heterozygotic deficit (MZ) was detected with flattening of the alpha wave in the proteinogram and a decreased serum level of this glycoprotein. Morpho-pathologically no PAS positive globules were optically found on liver biopsy although dilatation of the rough RE was observed with deposition in the medium electrodensity material, the significance of which is discussed on the basis of the patient's phenotype. It is suggested that serum studies of alpha-1-antitrypsin should be included in the routine evaluation of chronic liver diseases.

[The correlation of the isotopic liver/spleen ratio with the tissue damage in chronic diffuse hepatopathies]. / Correlación del cociente hígado/bazo isotópico con el daño hístico en hepatopatías crónicas difusas.

The purpose of the study was to determine whether a correlation between the radioisotopic "spleen-to-liver" ratio and the hepatic damage (according to Knodell's Index) exists in patients with chronic liver disease, in order to ascertain whether hepatic biopsy should be performed under visual (laparoscopic) control or not (blind liver biopsy). Thirty patients with inflammatory chronic hepatic disease were studied (9 chronic persistent hepatitis, 14 active chronic hepatitis and 7 hepatic cirrhosis). An inverse correlation was found between Knodell's Index and the "spleen-to-liver" ratio with moderate statistical significance (r = -0.46). In conclusion, the isotopic "spleen-to-liver" ratio correlates moderately well with the degree of hepatic damage and consequently it can only be used as orientation about the preferable way for obtaining a liver biopsy (laparoscopically or not).

[Adverse effects of 2 forms of therapy with heparin in patients with non-surgical risk factors of venous thromboembolism]. / Reacciones adversas de dos formas de heparinoterapia en pacientes con factores de riesgo no quirúrgicos de thromboembolismo venoso.

Venous thromboembolism (VTE) is a frequent complication in hospitalized patients who have to stay in bed for long periods of time or with diseases favouring of low molecular weight (HLMW) developed during the past years have demonstrated that they are as effective as the non-fractionated heparins, but with the advantage of a better cutaneous absorption, greater bioavailability and plasmatic half-life, a more favourable antithrombotic/hemorrhagic ratio and a lower variability in the anticoagulant response to fixed doses. We have investigated the efficacy, efficiency and security of an HLMW (Enoxaparine) for the prevention of VTE, comparing it with an standard calcic heparin, subcutaneously administrated, in patients with non-surgical risk factors and more than 65 years of age. Based on our results, we cannot conclude that one therapy is better than the other, although the enoxaparine needs only one daily injection and it can be administrated in an out-patient basis for long periods of time, without the need of laboratory controls and the resulting cost savings.