A Milena: un ensayo de medicina narrativa / A letter to Milena: a narrative medicine assay

Narrative medicine is becoming an increasingly popular way of communicating medical problems. This a letter that the author sends to a recently deceased patient. He describes his apprehensions on the use of invasive forms of diagnosis or treatments and the use of repeated hospital admissions in the context of a chronic and progressive disease. He also discusses the use of methods to "accelerate" death in suffering patients. He finally describes the dignity of his patient to face a chronic and debilitating condition

Hospitalización en el paciente de edad avanzada: ¿un riesgo o beneficio? / Hospitalization in elderly patients: a risk or benefit?

The aim of this work was to study the impact of hospital admission on functional status of elders. 86 patients (63 male) aged 73ñ4 years old admitted to the Internal Medicine Service of a public hospital were studied. Funstional status was measured on admission, discharge and 15 days after discharge using the Northwestern Functional Status Review Instrument. 15 patients died during hospital stay. Functional status improved in patients admitted with disordered consciousness, in those admitted due to neurologic dosirders, in those with less than 2 chronic diseases, in those whose disease cured during hospitalization and those that did not acquire new disease during admission. Prolonged hospitalizations of more than 13 days were associated with functional status worsening. It is concluded that functional status of elders does not always deteriorate during hospital admissions

Eritropoietina y transfusiones en la anemia del insuficiente renal crónico: visión actualizada / Erytropoietin and tranfusions in anemia of chronic renal failure: update view

Aiming to know the factors that influenced the use of erythropoietin (EPO) in chronic hemodialysis patients, we retrospectively studied 82 patients (41 male), of whom 15 received EPO. No differences, between patients receiving or not receiving EPO, were found in age (46.9ñ25 and 57ñ13 years respectively), male/female ratio (9/6 and 32/35 respectively), time on dialysis (36.4ñ25.6 and 36.8ñ31.8 months respectively), dialysis hours (3.19ñ0.6 and 3.33ñ0.39 h respectively) and proportion of diabetics (6.6 and 20.8 percent respectively). Prior to EPO use and compared to untreated patients, treated patients were transfused with a higher frequency (60 vs 22 percent) and with more units/patients/years (0.12 vs 0.08). Hemoglobin levels at the start of the treatment was similar in treated and untreated patients (8.4ñ1.46 vs 8.78ñ1.97 g/dl). Epo was indicated in 11 patients due to general symptomatology associated to anemia and in 4 due to cardiac failure or angina. We conclude that EPO treatment is indicated in approximately 18 percent of patients in dialysis. An adequate dialytic treatment may achieve optimal hemoglobin levels with minimal transfusion requirements and without need of EPO, thus reducing costs

Sustitución de la función renal por diálisis / Substitution of renal function by dialysis

Desde hace 25 años en que el tratamiento dialítico en hospitales y domicilios se hizo una práctica médica habitual, se ha modificado radicalmente el tratamiento y pronóstico de la insuficiencia renal crónica. La diálisis ha sido una de las pocas nuevas terapias de este siglo que ha influído tan drásticamente en el curso de una enfermedad. El destino del paciente con síndrome urémico avanzado, hoy en día es otro mucho mas favorable, aunque no exento de problemas, especialmente en el aspecto psíquico y social. Esta revolución tecnológica tan reciente abre sin lugar a dudas una segura esperanza para el paciente urémico crónico en un futuro muy próximo