Revista médica de Chile
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This paper undertakes an analysis of the scientific criteria used in the diagnosis of death and underscores the importance of intellectual rigor in the definition of medical concepts, particularly regarding such a critical issue as the diagnosis of death. Under the cardiorespiratory criterion, death is defined as "the irreversible cessation of the functioning of an organism as a whole", and the tests used to confirm this criterion (negative life-signs) are sensitive and specific. In this case, cadaverous phenomena appear immediately following the diagnosis of death. ⋯ It is clear that brain death marks the beginning of a process that eventually ends in death, though death does not occur at that moment. From an ethical point of view, the conflict arises between the need to provide an unequivocal diagnosis of death and the possibility of saving a life through organ transplantation. The sensitive issue of brain death calls for a more thorough and in-depth discussion among physicians and the community at large.
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Revista médica de Chile · Jan 2004
[Mechanical ventilation in patients with acute neurological disease: survival and functional outcome].
The need of mechanical ventilation among patients with acute neurological diseases is considered a poor prognostic sign. ⋯ Neurological patients requiring mechanical ventilation had a lower mortality than previously reported, and half of the survivors have an independent life. This study supports intensive care management in this group of patients.
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Revista médica de Chile · Dec 2003
Case Reports[Decompressive craniectomy in a patient with herpetic encephalitis associated to refractory intracranial hypertension].
Herpetic encephalitis is the most common cause of viral encephalitis in our country. Pathological studies show progressive necrosis and edema in specific territories of the brain. The mortality of herpetic encephalitis was reduced from 70% to 20% with the use of intravenous aciclovir in the first three days of illness. ⋯ One of the most important causes of death in herpetic encephalitis is the refractory intracranial hypertension. There are anecdotal reports of patients with refractory intracranial hypertension due to herpetic encephalitis that were treated with decompressive craniectomy with good results. We report a 21 years old female patient with herpetic encephalitis and refractory intracranial hypertension that was successfully treated with a decompressive craniectomy.
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Conflicts of interest are frequent in medical practice. They occur when a secondary interest unduly influences professional medical judgment, over and above the patients' benefit, his first real interest. Most of these secondary interests come from particular businesses of the physicians or their relationships with the industry. ⋯ These conflicts of interest vary in types and magnitude and are not recognized by physicians on most occasions. Solutions are inevitably related to the honesty and integrity of each physician. Due to the absence of specific national ethical references, it is necessary to discuss the issue and conclude recommendations that guide interns, residents, clinicians, researchers, medical educators, medical and scientific associations to resolve these types of conflicts.
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Revista médica de Chile · Sep 2003
[Abdominal aortic aneurysms in patients over 80 years of age: conventional surgical treatment in 80 consecutive cases].
Abdominal aortic aneurysms (AAA) may be lethal unless appropriately and timely treated. Since age is a surgical risk, octogenarians are usually not considered as candidates for surgical intervention. ⋯ Elective surgery for asymptomatic AAA can be performed with low operative mortality in octogenarians. However, surgery in emergency cases has an 8 fold increase in risk. Accordingly, octogenarian patients should be considered for elective AAA repair in a selective basis.