Incorformidad con los sevicios médicos

Throughout humankind history, the doctor � patient relationship has been variable. While in some moments and places, doctors have had a good reputation and the profession was respected by society, in others they were criticized due to a lack of professional competence and the predominance of commercial practices. The appearance of technological devices, complicated the matters worse; the patients expected more than medicine was able to offer, doctors acted defensibly and the human aspect of the practice of medicine has been slowly abandoned. This paper analyzes the principal reasons of the currently bad doctor � patient relationship, and gives some advices to reverse the phenomenon.La revisión de los relatos históricos, muestra el tipo de relación que ha existido entre pacientes y médicos, la cual ha sido variable a través de la historia de la medicina. Mientras que en algunas épocas y culturas, el médico ha sido un personaje respetado, en otras ha sido sujeto de críticas intensas, en ocasiones propiciadas por la falta de conocimiento científico o por la actitud comercial y de charlatanería, de quienes han practicado la profesión. La aparición de recursos tecnológicos, que han permitido un mejor tratamiento y pronóstico de las enfermedades, no se ha acompañado necesariamente de una mejoría de la relación. Este artículo analiza las principales causas de la mala relación entre pacientes y médicos y da algunas sugerencias para mejorarla

Echographic findings in the late stages of Vogt-Koyanagi-Harada disease in mexican population

Purpose: To correlate clinical findings of Vogt-Koyanagi-Harada disease with standardized echography findings in a cross-sectional, descriptive and observational study. Methods: Patients with Vogt-Koyanagi-Harada disease in the convalescent and recurrence phases were evaluated with standardized ocular echography. Eyes with opaque media were excluded. Clinical findings were correlated with echographic data. Results: Thirty-seven eyes of 25 patients were included. Best corrected visual acuity was in average 20/100 (0.70 logMAR). Clinical findings included: sunset glow fundus (92%), pigment migration (92%), nummular chorioretinal depigmented scars (68%) and subretinal fibrosis (64.8%). Standardized echography was able to recognize all the cases with subretinal fibrosis (n=24) described clinically. Standardized echography showed a 100% sensitivity and specificity of finding subretinal fibrosis. Subretinal fibrosis in patients with Vogt-Koyanagi-Harada represents a risk factor for low vision. In our patients’ eyes, presence of subretinal fibrosis had a 2.5 time relative risk of having a visual acuity equal or worst to 20/70. Conclusions: Standardized echography represents a useful tool in patients with VKH in the chronic (convalescence and recurrence) phase of the disease. Subretinal fibrosis, a sight threatening complication in the convalescence and recurrent phases of Vogt-Koyanagi-Harada, can be diagnosed with ocular echography, with characteristic images. Knowledge of these images can be useful in cases with opaque media and bilateral anterior segment granulomatous inflammatory disease

Ocular ultrasound findings in optic disk melanocytoma

Purpose: To describe the echographic characteristics of optic disk melanocytoma using a high resolution 10–20 MHz ophthalmic ultrasound. Methods: We conducted a 10-year retrospective review finding 9 cases with optic disk melanocytoma. The echographic studies were performed by the same experienced ophthalmologist. The form and density of the tumors were evaluated with B-scan ultrasound. Internal reflectivity and vascularity of the tumors were assessed with a standardized A-scan. Base (vertical and horizontal) and height of the tumor were obtained by using both ultrasounds AB modes. Results: The mean age at diagnosis was 43.88 years. There was no evidence of abnormal tumor vascularization in any of the cases. Mean (SD) vertical measurement of the base was 2.53 mm (±1.47). Mean (SD) horizontal measurement of the base was 2.49 mm (±1.03). Mean height (SD) was 1.52 mm (±0.88). Of the assessable cases, 78% had high internal reflectivity, the remaining 22% had medium-high internal reflectivity. All tumors’ internal structure was characteristically homogeneous. Mean follow-up was 33.6 months. Conclusion: Melanocytomas are small, benign tumors that are highly assessable by ocular ultrasound when their elevation surpasses 0.5 mm. In our study, the internal reflectivity ranged from high to very high, unlike other malignancies such as choroidal melanoma which tend to present with low internal reflectivity. The avascularity of the tumor is a common finding. Ultrasound is a remarkable tool that helps detect benign characteristics in a pigmented optic disk tumor and helps establish a more reliable diagnosis