És possible una nova comunicació entre metge i malalt?

La comunicació, privilegi de la condició humana, està present i influeix de manera decisiva sobre totes les àrees de la vida. La medicina actual ha perdut molta sensibilitat a causa del fet que no es reforça la comunicació, que passa a segon lloc. En canvi, agafa preeminència el coneixement. La sanitat actual -abans la medicina- tracta usuaris -abans malalts-, i valorant-los així actua com un problema tècnic que s’ha de solucionar. Els patiments com el dolor o l'angoixa vital s’enfoquen com a problemes tècnics que s’han de reparar. Però des del moment en què s’han codificat els drets del malalt, la salut és un dret fonamental, recollit en la nova legislació. Els malalts passen a tenir un paper central en la presa de decisions sobre la seva salut. És un canvi radical sobre el concepte anterior de la praxis mèdica. Ara les habilitats de comunicació estan especialment indicades i destinades a millorar la relació metge-malalt, en general, i de manera especial en les malalties greus. D’aquí la importància que el metge tingui formació en habilitats de comunicació per poder comprendre el seu significat. Les directrius de Bolonya i els nous programes formatius de medicina van en aquesta direcció.Mots clau: medicina, relació entre metge i malalt, comunicació, males noticies, directrius de Bolonya.ResumenLa comunicación, privilegio de la condición humana, está presente e influye de manera decisiva en todas las áreas de la vida. La medicina actual ha perdido mucha sensibilidad, debido a que no se refuerza la comunicación y pasa a un segundo lugar. En cambio toma preeminencia, el conocimiento. La sanidad actual, antes la medicina, trata usuarios, antes enfermos, y valorándolos así actúa como un problema técnico que tiene que solucionar. Los sufrimientos con dolor o angustia vital, se enfocan como problemas técnicos que deben ser reparados. Pero desde el momento en el que se han codificado los derechos de los enfermos, la salud es un derecho fundamental, recogido en la nueva legislación. Los enfermos, pasan a tener un papel central en la toma de decisiones sobre su salud. Es un cambio radical sobre el concepto anterior de la praxis médica. Ahora les habilidades de comunicación están especialmente indicadas y destinadas a mejorar la relación entre médico y enfermo, en general, y de manera especial en las enfermedades graves. De aquí la importancia que el médico tinga formación en habilidades de comunicación para poder comprender su significado. Las directrices de Boloña y los nuevos programas formativos de Medicina van en esta dirección.Palabras clave: medicina, relación entre médico y enfermo, comunicación, malas noticias, directrices de Boloña.AbstractThe communication is a privilege of the human condition, and is present and decisively influence in all areas of life. Medicine has lost a lot of sensitivity, because it strengthens the communication, which happens to second place. Instead take preeminence, knowledge.  Healthcare now, Medicine before, valuing them users so it's acting as a technical problem should solve.  Pain or vital anguish, sufferings as technical problems that they'd focus be repaired. But from the moment that the rights of the sick it's been encoded, health is a fundamental right, picked up on the new legislation. The sick, they play a central role in making decisions about your health. The concept is a radical change on the previous medical practice. Now communication skills are specially indicated and doctor-patient relationship, aimed at improving in general, and especially in the serious diseases. From here the importance that the doctor has training in communication skills to be able to understand their meaning. The guidelines of Bologna and new medical training programs were in that direction.Key words: medicine, doctor-patient relationship, communication, bad  news, guidelines of Bologna

Interrelations of the endocrine organs

Thesis (M.A.)--Boston Universit

The transplantation of gastrointestinal organs

Over a period of 33 years, it has become possible to successfully transplant individual intra-abdominal viscera or combinations of these organs. The consequences have been, first, new information about the metabolic interrelations that the visceral organs have in disease or health; second, the addition of several procedures to the treatment armamentarium of gastrointestinal diseases; and third, a more profound understanding of the means by which all whole organ grafts are accepted. © 1993

Computational design of artificial organs

C

Organs from animals for man

In the following review some of the problems of xenotransplantation shall be discussed, based on the few experimental data available so far and on reports in the literature describing investigations which may be of importance for xenotransplantation. The impact of gravity on the upright posture of man versus almost all other mammals, the dysfunction between enzymes and hormones in different species and the lack of interactions between interleukins, cytokines and vasoactive substances will be taken into consideration. The question must be asked whether different levels of carrier molecules or serum proteins play a role in the physiological network. Even though the development of transgenic animals or other imaginative manipulations may lead to the acceptance of any type of xenografted organ, it has to be established for how long the products of the xenografts are able to act in the multifactorial orchestra. We are far from understanding xenogeneic molecular mechanisms involved in toxicity, necrosis and apoptosis or even reperfusion injury and ischemia in addition to the immediate mechanisms of the hyperacute xenogeneic rejection. Here, cell adhesion, blood clotting and vasomotion collide and bring micro-and macrocirculation to a standstill. All types of xenogeneic immunological mechanisms studied so far were found to have a more serious impact than those seen in allogeneic transplantation. In addition we are now only beginning to understand that so-called immunological parameters in allogeneic mechanisms act also in a true physiological manner in the xenogeneic situation. These molecular mechanisms occur behind the curtain of hyperacute, accelerated, acute or chronic xenograft rejection of which only some folds have been lifted to allow glimpses of part of the total scene. Other obstacles are likely to arise when long-term survival is achieved. These obstacles include retroviral infections, transfer of prions and severe side effects of the massive immunosuppression which will be needed. Moral, ethical and religious concerns are under debate and the species-specific production of proteins of the foreign donor species developed for clinical use suddenly appears to be a greater problem than anticipated

Benzo[a]pyrene-induced DNA adducts and gene expression profiles in target and non-target organs for carcinogenesis in mice

Background: Gene expression changes induced by carcinogens may identify differences in molecular function between target and non-target organs. Target organs for benzo[a]pyrene (BaP) carcinogenicity in mice (lung, spleen and forestomach) and three non-target organs (liver, colon and glandular stomach) were investigated for DNA adducts by 32P-postlabelling, for gene expression changes by cDNA microarray and for miRNA expression changes by miRNA microarray after exposure of animals to BaP. Results: BaP-DNA adduct formation occurred in all six organs at levels that did not distinguish between target and non-target. cDNA microarray analysis showed a variety of genes modulated significantly by BaP in the six organs and the overall gene expression patterns were tissue specific. Gene ontology analysis also revealed that BaP-induced bioactivities were tissue specific; eight genes (Tubb5, Fos, Cdh1, Cyp1a1, Apc, Myc, Ctnnb1 and Cav) showed significant expression difference between three target and three non-target organs. Additionally, several gene expression changes, such as in Trp53 activation and Stat3 activity suggested some similarities in molecular mechanisms in two target organs (lung and spleen), which were not found in the other four organs. Changes in miRNA expression were generally tissue specific, involving, in total, 21/54 miRNAs significantly up- or down-regulated. Conclusions: Altogether, these findings showed that DNA adduct levels and early gene expression changes did not fully distinguish target from non-target organs. However, mechanisms related to early changes in p53, Stat3 and Wnt/β-catenin pathways may play roles in defining BaP organotropism

Homotransplantation of multiple visceral organs

It was technically possible to perform simultaneous homotransplantation of multiple visceral organs including the liver, spleen, pancreas, omentum and the entire gastrointestinal tract. Arterialization of the cooled graft was accomplished through the donor aorta which was removed with the graft and attached to that of the recipient dog. Gastrointestinal hemorrhage after surgery accounted for a high operative mortality and was thought to be due to denervation of the graft. The five dogs which survived the immediate trauma of surgery lived for five and a half to nine days. After the second day, these animals were physically active and able to resume oral alimentation. In three dogs, there was metabolic evidence of rejection of the liver. In two others, jaundice did not develop. These observations were compared with chemical, hematologic and pathologic data obtained in previous experiments involving homotransplantation of the liver alone. In some cases, there was less evidence of host versus graft rejection after the multiple organ transplants. Other data in the present study suggested the possibility that a significant graft versus host reaction may have been an important contributory cause of death. © 1962