ABSTRACT
Introducción. El carcinoma de Merkel es un tumor maligno poco frecuente, que afecta principalmente a la población caucásica y cuya etiología guarda relación con el poliomavirus de las células de Merkel. Conlleva mal pronóstico, especialmente en estadios finales. Caso clínico. Se expone el caso de una paciente que presentaba un tumor primario facial de grandes dimensiones, con avanzado grado de extensión, afectación linfática cervical y metástasis parotídea derecha. Fue tratada mediante exéresis de la lesión primaria y cobertura con injerto de piel parcial, linfadenectomía cervical y parotidectomía ipsilateral. Resultados. Se logró mejoría importante en la calidad de vida de la paciente y sobrevida de al menos seis meses. Conclusión. Aunque no está claro el manejo óptimo del carcinoma de Merkel avanzado debido a su mal pronóstico, la cirugía favorece una mejoría en la calidad de vida del paciente y puede tener un papel clave en el manejo del carcinoma de Merkel en los estadios avanzados.
Introduction. Merkel carcinoma is a rare malignant tumor that mainly affects the Caucasian population and whose etiology is related to the Merkel cell polyomavirus. It has a poor prognosis, especially in the final stages. Clinical case. The case of a patient who presented a large primary facial tumor, with an advanced degree of extension, cervical lymphatic involvement and right parotid metastasis is described. She was treated surgically by excision of the primary lesion and coverage with partial skin graft, cervical lymphadenectomy, and ipsilateral parotidectomy. Results. A significant improvement was achieved in the patient's quality of life and survival of at least six months.Conclusion. Although the optimal management of advanced Merkel carcinoma is unclear due to its poor prognosis, surgery improves the patient's quality of life and it can play a key role in the management of Merkel carcinoma in advanced stages.
Subject(s)
Humans , Carcinoma, Merkel Cell , Skin Transplantation , Surgery, Plastic , Carcinoma, Neuroendocrine , Head and Neck NeoplasmsABSTRACT
La relación médico-paciente es un pilar fundamental para la buena práctica de la medicina, aunque en la medida en que esta se ha visto cada vez más influenciada por la tecnología y la ciencia, puede estar en riesgo de perder el contacto con valores humanos básicos de respeto por las creencias y preferencias de la otra persona. En este trabajo de investigación, hemos analizado la visión deontológica de la relación médico-paciente percibida a través de las situaciones clínicas plasmadas en los portafolios realizados por 225 estudiantes del 5º curso del Grado de Medicina de la Universidad de Córdoba, durante los cursos 2014/15 y 2015/16. De las 833 consideraciones deontológicas sobre artículos del Código de Deontología Médica, 2011 constituyen incumplimientos. Llama la atención que estas faltas al Código de Deontología Médica consideradas, se refieren mayoritariamente (73%) al Capítulo III (Relaciones del médico con sus pacientes), y particularmente los problemas detectados con más frecuencia son los relacionados con la actitud, formas o lenguaje y falta de entendimiento/confianza del médico con el paciente (art. 8 con 46 incumplimientos), así como los problemas al proporcionar la información (arts. 12.1 y 15, con 18 y 42 incumplimientos respectivamente)
Doctor-patient relationship is of paramount importance for a good medical practice, however as long as medicine has been increasingly influenced by technology and science, it may be at risk of losing contact with basic human values of respect for the beliefs and preferences of the other person. In this study, we have analyzed the deontological vision of the physician-patient relationship perceived through clinical situations reflected in the portfolios carried out by 225 students of the 5th year of the Degree of Medicine at the University of Córdoba, during the courses 2014/15 and 2015/16. 201 out of 833 deontological considerations on articles of the Code of Medical Ethics constitute non-compliances. It is noteworthy that these breaches to the Code of Medical Ethics considered refer mainly (73%) to Chapter III (doctor-patient relationship). It is particularly interesting that the problems most frequently detected are those related to attitude, forms or language and lack of understanding/confidence of the physician with the patient (article 8 with 46 noncompliances), as well as problems in providing information (articles 12.1 and 15, with 18 and 42 noncompliances respectively)
Subject(s)
Humans , Physician-Patient Relations/ethics , Students, Medical/statistics & numerical data , Bioethics , Cross-Sectional Studies , Ethical Theory , Personal AutonomyABSTRACT
Doctor-patient relationship is of paramount importance for a good medical practice, however as long as medicine has been increasingly influenced by technology and science, it may be at risk of losing contact with basic human values of respect for the beliefs and preferences of the other person. In this study, we have analyzed the deontological vision of the physician-patient relationship perceived through clinical situations reflected in the portfolios carried out by 225 students of the 5th year of the Degree of Medicine at the University of Córdoba, during the courses 2014/15 and 2015/16. 201 out of 833 deontological considerations on articles of the Code of Medical Ethics constitute non-compliances. It is noteworthy that these breaches to the Code of Medical Ethics considered refer mainly (73%) to Chapter III (doctor-patient relationship). It is particularly interesting that the problems most frequently detected are those related to attitude, forms or language and lack of understanding/confidence of the physician with the patient (article 8 with 46 noncompliances), as well as problems in providing information (articles 12.1 and 15, with 18 and 42 noncompliances respectively).
