[Death as a moment of peace and trust].

A young woman with aphagia, probably caused by an esophageal cancer that could not be confirmed, is reported. Fully respecting the will of the patient at the end of her life, palliative care measures were instituted, even though the diagnosis was uncertain. This case emphasizes the integrative role of internists and the difficulty of making decisions about life and death without being in close touch with desires of our patients.

[The internist: a human being that helps others. On the training and clinical practice of the specialty].

This is a critical overview of an internist with 33 years of practice, about the activities which are inherent to internal medicine. The author analyzes strategies on how to keep updated in the scientific literature, the importance of acquiring, experience from peers and teachers and emphasizes the value of an adequate patient-physician relationship.

[Mesenteric angina: infrequent cause of chronic pain in hemodialysis patient].

We report a 73 years old male undergoing chronic hemodialysis with a history of seven years of abdominal pain and weight loss. A mesenteric angiography disclosed a critical stenosis of the celiac artery and a partial stenosis of the superior mesenteric artery. Other causes of abdominal pain were excluded.

[Flash pulmonary edema: when the kidney causes decompensation of the heart].

Flash pulmonary edema is a paroxismal pulmonary edema associated to a hypertensive crisis, that subsides in hours with the usual therapeutic measures. It occurs in patients with renal artery stenosis. We report two male patients aged 71 and 74 years old, presenting with acute dyspnea and high blood pressure.