Humanizar la asistencia en los grandes hospitales: un reto para el profesional sanitario / Making healthcare more humane in large hospitals: a challenge for health workers

El problema de la deshumanización de la persona en los ámbitos sanitarios requiere de una aproximación ético-filosófica que desarrolle temas tales como el de la naturaleza del ser humano, su dignidad y su libertad, entre otros. Los hospitales tienen algunas asignaturas pendientes que han de ser afrontadas desde una ética asistencial que se fundamente en la dignidad personal. Los grandes avances científicos y tecnológicos no solamente traen como consecuencia un considerable aumento de la esperanza de vida, sino también una forma de tratar al paciente que puede llegar a producir una especie de "cosificación" de la persona que se aleja de una visión de conjunto de la misma, que repercute en una deshumanización de la asistencia sanitaria y que es debido a su división en partes, que según algunos permite un mayor y mejor conocimiento, y que da lugar a una súper especialización de los profesionales. Muchos profesionales sanitarios presentan déficits en su formación bioética, lo que repercute negativamente a la hora de enfrentarse a los problemas éticos que se dan diariamente en el ámbito hospitalario: el trato de la intimidad y de la autonomía del paciente hospitalizado yla inadecuada comunicación entre el enfermo y el profesional sanitario. Desde la postmodernidad han aparecido otros aspectos de la ética profesional que están intentando ahondar un poco más en las interacciones entre las personas, es decir, en la relación entre usuarios y profesionales, no solamente en los aspectos cognitivos sino también afectivos

Patients' dehumanization in healthcare is a problem requiring an ethical-philosophical approach, which should include issues like human being nature, dignity, and freedom, among others. Hospitals have some pending issues that remain unsolved and should be addressed from an ethical perspective based on personal dignity. Great scientific and technological advances result in a substantially increased life expectancy, and also in a therapeutic style that can lead to an "objectification" of patients, instead of considering a persona as a whole. This can result in dehumanization in healthcare and is mainly due to the division into parts which is supposed to allow a larger and better knowledge and leads to super-specialized professionals. Many healthcare workers have a deficient bioethics training, which has a negative impact when coping with ethical problems that occur daily in a hospital setting: dealing with inpatients intimacy and autonomy, and inadequate communication between patients and healthcare workers. Since post-modernity, additional aspects in professional ethics have emerged in an attempt to go more deeply into personal interactions, i.e., relationships between users and workers, which involves affective and not only cognitive aspects

Progressive multifocal leukoencephalopathy following fludarabine treatment in a chronic lymphocytic leukemia patient.

UNLABELLED: Progressive multifocal leukoencephalopathy (PML) is a neurological disease caused by infection of the central nervous system (CNS) with the JC polyomavirus (JCV). JCV is endemic and infects a large proportion (70-90%) of healthy individuals worldwide, but infection is latent. JCV reactivation may occur, if the immune function is compromised. AIM: To present a PML case in a CLL patient after a long course of disease and treatment with fludarabine. JCV virus infection in this patient was proven both in brain biopsy material and blood. METHODS: Patient with a nine-year history of CLL was hospitalized with the weakness in the right leg and left hand, tremors, speech difficulties. An MRI diagnosed infiltrative glial tumor of the left hemisphere, proliferating predominantly in the frontal lobe, more in the gyrus frontalis superior region. CNS tumor biopsy performed. RESULTS: Morphology and immunoprofile of the lesion consistent with progressive multifocal leukoencephalopathy. The material from biopsy was diagnosed as positive for JCV DNA. JCV and HHV-7 genomic sequences were found in patient's PBL DNA sample. In a plasma DNA sample, only genomic sequences were detected. CONCLUSION: The present case draws attention to the fact that the use of fludarabine and its combinations in CLL therapy increases the risk of JCV infection reactivation and development of serious complications like PML.

[Bronchial and appendiceal carcinoid tumors]. / Tumor carcinoide bronquial y apendicular.

BACKGROUND: Carcinoid tumor (CT) is an unusual neoplasm observed in several locations and associated with the production of vasoactive substances and occasionally with carcinoid syndrome (flushing, diarrhea, wheezing). PATIENTS AND METHODS: A retrospective review of the medial records of all children with a diagnosis of CT treated in our service between 1966 and 2003 was performed. RESULTS: Ten patients (5 boys and 5 girls with a mean age of 8 years) were diagnosed with CT. Eight had CT of the appendix, of which 4 showed the typical clinical presentation of acute appendicitis. Seven of these tumors were localized at the tip of the appendix and measured 2 cm or less. In one patient, the tumor was located at the cecum and measured 3.5 cm. In this patient, reoperation with ileocecal resection was performed. Two patients (4 and 6 years old) had bronchial CT associated with chronic respiratory manifestations. An accurate diagnosis was made after a 1-year follow-up. Pneumonectomy and tracheobronchial sleeve resection were carried out. None of the patients showed symptoms of carcinoid syndrome. All the patients underwent biochemical and radiological studies and fiberoptic bronchoscopy during follow-up. All the patients are currently disease-free. CONCLUSIONS: Typical symptoms of acute appendicitis were not observed in half of patients with CT of the appendix. CT associated with carcinoid syndrome is exceptional in pediatric patients. In most CT of the appendix, simple appendicectomy was associated with an excellent prognosis. Diagnosis of bronchial TC tends to be delayed and consequently CT should be considered in the differential diagnosis of children with respiratory symptoms unresponsive to standard medical treatment.

Tumor carcinoide bronquial y apendicular / Bronchial and appendiceal carcinoid tumors

Antecedentes: El tumor carcinoide es una rara neoplasia neuroendocrina con localizaciones diversas, capaz de producir sustancias vasoactivas y asociada ocasionalmente al síndrome carcinoide (enrojecimiento, diarrea y sibilancias). Pacientes y métodos: Revisamos las historias de los pacientes con diagnóstico de tumor carcinoide en nuestro servicio entre 1966 y 2003. Resultados: Diez pacientes (5 niños y 5 niñas con una edad media de 8 años) fueron diagnosticados de tumor carcinoide. Ocho tenían carcinoides apendiculares de los que cuatro presentaron síntomas de apendicitis aguda. De estos ocho, siete eran menores de 2 cm y estaban localizados en la punta del apéndice. El paciente restante presentaba un tumor carcinoide de 3,5 cm en la base apendicular por lo que fue reintervenido para realizar una resección ileocecal. Dos pacientes de 4 y 6 años presentaron un tumor carcinoide bronquial asociado a sintomatología respiratoria crónica y se llegó en ambos al diagnóstico acertado tras un año de seguimiento. Se realizó neumonectomía en un caso y resección bronquial con anastomosis traqueobronquial en el otro. Ningún paciente de la serie presentó sintomatología carcinoide. Se realizaron controles bioquímicos, radiológicos y fibrobroncoscópicos en los bronquiales. Todos se encuentran actualmente libres de enfermedad. Conclusiones: El tumor carcinoide apendicular no se asocia a sintomatología característica de apendicitis aguda en la mitad de los pacientes. Encontramos que el síndrome carcinoide asociado al tumor carcinoide es excepcional en la edad pediátrica. En la mayor parte de los tumores carcinoides apendiculares la apendicectomía simple es suficiente con un pronóstico excelente. El tumor carcinoide bronquial es diagnosticado generalmente de manera tardía por lo que debemos considerar este diagnóstico en pacientes con sintomatología respiratoria crónica

Background: Carcinoid tumor (CT) is an unusual neoplasm observed in several locations and associated with the production of vasoactive substances and occasionally with carcinoid syndrome (flushing, diarrhea, wheezing). Patients and methods: A retrospective review of the medial records of all children with a diagnosis of CT treated in our service between 1966 and 2003 was performed. Results: Ten patients (5 boys and 5 girls with a mean age of 8 years) were diagnosed with CT. Eight had CT of the appendix, of which 4 showed the typical clinical presentation of acute appendicitis. Seven of these tumors were localized at the tip of the appendix and measured 2 cm or less. In one patient, the tumor was located at the cecum and measured 3.5 cm. In this patient, reoperation with ileocecal resection was performed. Two patients (4 and 6 years old) had bronchial CT associated with chronic respiratory manifestations. An accurate diagnosis was made after a 1-year follow-up. Pneumonectomy and tracheobronchial sleeve resection were carried out. None of the patients showed symptoms of carcinoid syndrome. All the patients underwent biochemical and radiological studies and fiberoptic bronchoscopy during follow-up. All the patients are currently disease-free. Conclusions Typical symptoms of acute appendicitis were not observed in half of patients with CT of the appendix. CT associated with carcinoid syndrome is exceptional in pediatric patients. In most CT of the appendix, simple appendicectomy was associated with an excellent prognosis. Diagnosis of bronchial TC tends to be delayed and consequently CT should be considered in the differential diagnosis of children with respiratory symptoms unresponsive to standard medical treatment