La relación médico-paciente: un nuevo patrimonio cultural inmaterial de la humanidad

 Vivimos en un mundo tecnológico, donde algunas veces las máquinas reemplazan a los hombres, al bien o al mal. Esta sustitución no puede ocurrir cuando un médico atiende a un paciente, porque esa relación es de extrema confianza y también de extrema vulnerabilidad por parte del enfermo. Nada sustituirá una conversación frente a frente, un tacto, una explicación cordial de la enfermedad y del proceso del enfermar. Somos seres humanos y necesitamos ser tratados como humanos y nunca con el automatismo de las máquinas. Los médicos hacemos ciencia y buscamos soluciones para humanos. De nada nos sirven médicos que sólo miran exámenes, la buena medicina se practica cuando el profesional desciende del trono y hace empatía para colocarse al mismo nivel de su paciente, deshaciendo cualquier asimetría en esa relación

Aneurisma de aorta abdominal na infância

The authors report a case of an abdominal aortic aneurism involving all visceral branches minus the Inferior Mesenteric artery in a 4-year-old girl. There was sugestive evidence that the arterial disease had an inflamatory or infectious etiologic factor. The most probable etiological factors could be salmonelas infection of the arterial wall or Takayasu's disease secondary to tuberculosis. The treatment with antibiotic to salmonelas infection during ten days, followed by tuberculostatic therapy for six months was chosen. Concerning the age, the arteries involved and the inflamatory aspect of the aneurysm, the surgical option became an alternative to the clinic treatment in case of any future evidence of the aneurysm enlargement. The patient became asymptomatic as soon as the antibiotic has been started. The control of the aneurysm evolution will be made by ecography each three months

Total gastrectomy with substitution of stomach by jejunal pouch with and without duodenal passage: study in rats

PURPOSE: A comparison was done between the F. Paulino jejunal pouch (FP) and a jejunal pouch (JP) as esophagus-duodenum interpositional graft, for replacing the stomach after total gastrectomy. It was investigated the effect of the two procedures on esophagus histology, nutritional state and serum gastrin in rats. METHODS: Male Wistar rats weighing 282&plusmn;17g were randomly submitted to sham operation (S), FP and JP after total gastrectomy. After eight weeks the rats were killed with overdose of anesthetic and tissue was taken from the distal esophagus for histology. Serum levels of total proteins, albumin, iron, transferring, folate, cobalamine, calcium, as well as serum gastrin were determined. Survival was considered. RESULTS: Fourty six rats were operated and thirty survived for eight weeks. Five (33.3%) died after FP and 11 (52.3%) after JP (p<0.05). Postoperative esophagitis occurred in 6 JP rats. At 8th week, no difference was observed on body weight when compared FP and JP rats (p>0.05). The JP rats had a significant decrease in serum albumin, glucose, transferrin, iron, folate and calcium, compared to sham (p<0.05). Serum gastrin, iron and calcium were significantly higher in JP rats than in FP rats (p<0.05). In FP rats, transferrin and cobalamine showed significant decrease comparing the preoperative with 8th week levels (p<0.05). CONCLUSION: F. Paulino pouch in rats had lower mortality than JP, and esophagitis was not detected in it. JP rats had serum gastrin, iron and calcium unaffected, possibly because of preservation of duodenal passage

Total gastrectomy with substitution of stomach by jejunal pouch with and without duodenal passage: study in rats Gastrectomy total com substituição do estômago por bolsa jejunal com e sem passagem do alimento pelo duodeno: estudo em ratos

PURPOSE: A comparison was done between the F. Paulino jejunal pouch (FP) and a jejunal pouch (JP) as esophagus-duodenum interpositional graft, for replacing the stomach after total gastrectomy. It was investigated the effect of the two procedures on esophagus histology, nutritional state and serum gastrin in rats. METHODS: Male Wistar rats weighing 282&plusmn;17g were randomly submitted to sham operation (S), FP and JP after total gastrectomy. After eight weeks the rats were killed with overdose of anesthetic and tissue was taken from the distal esophagus for histology. Serum levels of total proteins, albumin, iron, transferring, folate, cobalamine, calcium, as well as serum gastrin were determined. Survival was considered. RESULTS: Fourty six rats were operated and thirty survived for eight weeks. Five (33.3%) died after FP and 11 (52.3%) after JP (p<0.05). Postoperative esophagitis occurred in 6 JP rats. At 8th week, no difference was observed on body weight when compared FP and JP rats (p>0.05). The JP rats had a significant decrease in serum albumin, glucose, transferrin, iron, folate and calcium, compared to sham (p<0.05). Serum gastrin, iron and calcium were significantly higher in JP rats than in FP rats (p<0.05). In FP rats, transferrin and cobalamine showed significant decrease comparing the preoperative with 8th week levels (p<0.05). CONCLUSION: F. Paulino pouch in rats had lower mortality than JP, and esophagitis was not detected in it. JP rats had serum gastrin, iron and calcium unaffected, possibly because of preservation of duodenal passage.<br>OBJETIVO: Estudo comparativo foi realizado entre a bolsa jejunal de Fernando Paulino (FP) e uma bolsa jejunal (JP) interposta entre o esôfago e duodeno, para substituir o estômago após gastrectomia . Foi investigado o efeito dos dois procedimentos na histologia do esôfago, estado nutricional e gastrinemia sérica em ratos. MÉTODOS: Quarenta e seis ratos Wistar pesando 282&plusmn;17g foram aleatoriamente submetidos a sham operation (S), FP e JP após gastectomia total. Decorridas 8 semanas, foi colhido sangue por punção cardíaca para dosagem de proteínas totais, albumina, ferro, transferrina, folato, cobalamina, calcio, e gastrina. Os animais receberam dose letal de anestésico e tecido do esôfago terminal foi retirado para histologia. Foi observada a mortalidade operatória dos animais. RESULTADOS: Quarenta e seis ratos foram operados e 30 sobreviveram por 8 semanas. Cinco (33,3 %) morreram após FP e 11 (52,3%) após JP (p<0.05). Esophagitis pós-operatória ocorreu em 6 ratos JP. Na 8ª semana o peso corporal foi maior nosratos submetidos a FP do que JP (p>0.05). Os ratos submetidos a JP tiveram uma diminuição significativa na albumina, glucose, transferrina, ferro, folato e cálcio, comparado com o sham (p<0.05). Os níveis de gastrina sérica, ferro e calcio mostraram-se significantemente maiores nos ratos submetidos a JP do que nos FP (p<0.05). Nos ratos FP a transferrina e a cobalamina estiveram significantemente diminuídas comparando-se os níveis do pré-operatório com a 8ª semana (p<0.05). CONCLUSÃO: A bolsa jejunal de F. Paulino, em ratos, resultou em mortalidade operatória e incidência de esofagite de refluxo menor do que a interposição de JP. A JP não afetou a dosagem sérica de gastrina, ferro e cálcio, provavelmente devido à preservação da passagem dos alimentos pelo duodeno