Revista médica de Chile
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Revista médica de Chile · May 1996
[Pragmatism versus metaphysics: a controversy about brain death].
The concept of brain death is still controversial. The Chilean case, as a result of a future transplantation law, seem to demonstrate this issue. The aim of this work is to contribute to the debate. ⋯ The metaphysical rejection and the socio-cultural frame of the medical attitude that accepts brain death, are commented. It is concluded that the best defense of metaphysical point of view is the right to exclusion of minorities. Finally, brain death is criticized from a socio-cultural point of view of medical acts as a post-metaphysical concept of "useful death" and because of its relationship with "health production".
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Revista médica de Chile · Apr 1996
[Inhibition of the nitric oxide pathway in refractory septic shock].
To assess the acute effects of methylene blue infusion, an inhibitor of nitric oxide synthesis, on hemodynamic parameters in patients with refractory septic shock. ⋯ Methylene blue has an acute pressor effect in patients with septic shock.
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Revista médica de Chile · Jan 1996
[Extracorporeal respiratory assistance. Experience in the treatment of severe acute respiratory failure].
Acute respiratory distress syndrome (ARDS) secondary to systemic injury has a high mortality. Symptomatic treatment with mechanical ventilation, PEEP and high levels of inspired oxygen is effective for most of the patients. When ventilatory support fails in reversing hypoxemia, extracorporeal respiratory assistance has been advocated as a temporary treatment until lung repair occurs. ⋯ Extracorporeal assistance was maintained for 52 +/- 34 h (19-134). Five (45%) patients were weaned off the pump and two (18%) survived and were discharged. Despite the high cost, extracorporeal respiratory assistance, when applied to selected patients, can reverse hypoxia and may save some previously unsalvagable patients, allowing them to return to a normal life.
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The informed consent, in which the physician informs about procedures to be performed and requests approval, puts into practice the communication between physicians and patients. The consent will always be verbal and will only put writing in complex or risky situations. This doctrine, that promotes the recognition of patients autonomy, is employed since the end of World War II. ⋯ In the situations of requested paternalism, therapeutic privilege and placebo use, information is not given and the consent is not requested. In all research protocols, a written informed consent must be requested. The consent is a form of communication that tries to defend patients rights as something close and alive, and should not become a ritual.
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Revista médica de Chile · Nov 1995
[Vital prognosis in severe acute hepatic failure. Value of the quantitative indexes of evaluation].
The aim of this study was to assess the predictive value for mortality of admission and daily APACHE II score, mortality due to multiple organ failure and the Organ Failure Score in patients with acute hepatic failure. We retrospectively studied 15 such patients admitted to an intensive care unit. ⋯ The predictive accuracies of multiple organ failure and multiple organ failure score were 80% and significantly better than the accuracy of admission APACHE II score (53%). We conclude that these prognostic scores can be useful in the assessment of patients with acute hepatic failure.