[Survey of physicians' attitudes to terminal patients]. / Encuesta de actitudes médicas ante el paciente terminal.

OBJECTIVE: To explore the opinion of physicians about euthanasia and the treatment of dying patients. DESIGN: A comparative survey. MATERIAL AND METHODS: We interviewed 38 family physicians (FP), 38 specialty physicians (SP) and 38 medical students (MS). The survey had 30 items, five of them about experience with terminal patients which were not used for the students. ANALYSIS: Descriptive statistics and chi 2 or Fisher test to compare proportions between groups. RESULTS: One hundred and two (89%) of the interviewed had a correct concept of euthanasia; 105 (92%) thought that life is holy and untouchable; 29 (25%) agreed there are persons more valuable than others, and four (4%) consider that some should die in certain situations. In relation to patients with brain death, 79 (69%) believed they should not receive futile treatment, but 42 (37%) said they should be attended until cardiac arrest occurred. All agreed with the need of the patients to receive comfort and peace, but only 49/76 (64%) of the physicians and 28 (74%) of the students were in favor of sending dying patients to their home. Nine FP (23%) and 14 SP (36%) stated that in many occasions they lacked elements to solve ethical dilemmas. Thirty six (32%) agreed with the use of passive euthanasia and 21 (18%) with active euthanasia; the latter was more frequent among students. Nine FP (24%) and 13 SP (34%) said they had exceeded therapy sometimes and 23 (61%) of the FP and 19 (50%) of the SP considered they had stopped treatment too early in some cases. We found no differences in regard to euthanasia between physicians and students (chi 2 = 0.32, p = 0.71) nor between the physicians with frequent vs occasional contact with terminal patients (Fisher = 0.13). CONCLUSIONS: A third of the physicians agreed with some form of euthanasia but this frequency is smaller than that in other countries.

Comparative tuberculin reactivity to two protein derivatives.

OBJECTIVE: To evaluate the tuberculin reactivity among medical students and the utility of RT-23 (2 tuberculin unit [TU] purified protein derivative [PPD]) produced in Mexico. DESIGN: A blind and comparative study was conducted in a school of medicine using simultaneously RT-23 and an American product (5 TU PPD) randomly assigned to each forearm and read 48 hours later. Ninety eight volunteers were included, 69 from the first year and 29 from the fifth year as medical students. RESULTS: Using 5 TU PPD, 16% of first year students and 41% of fifth grade students were positive (induration > or = 10 mm). The RT-23 worked well and showed a sensitivity of 87% and a specificity of 92%. There was a large difference in the positivity of fifth versus first year students (x2 = 6.00, P = 0.014) with an estimated annual conversion of 5.1%. The high tuberculin conversion rate urges the need to establish preventive and early diagnosis programs for tuberculosis. The utility of RT-23 was found to be comparable to 5 TU PPD in our population.

[The echographic dimensions of the liver in the term newborn and its relation to anthropometric variables]. / Dimensiones ecográficas del hígado del recién nacido a término y su relación con variables antropométricas.

We decided to undergo a study looking for normal liver size in relation with other anthropometric measures. Fifty healthy, appropriate for gestational age term-babies, born at the Hospital de Ginecopediatría Número 48, Centro Médico Nacional del IMSS, León, Guanajuato, México, were examined by hepatic ultrasound. The vertical diameter was 6.0 +/- 0.75 cm, transverse 8.26 +/- 0.72 cm, AP 5.44 +/- 0.5 cm. The longitudinal cross section area was 16.21 +/- 2.5 cm2, and the transverse cross section area 22.53 +/- 3.4 cm2. We found most important correlation between vertical diameter and longitudinal cross section area with the anthropometric measures. The hepatic measures correlate better with the weight. Ultrasound provides a rapid, accurate and convenient method for study the liver size and morphology in the neonate.

[Echographic dimensions of the kidneys of full-term newborns and their relationship with anthropometric variables]. / Dimensiones ecográficas de los riñones de recién nacidos a término y su relación con variables antropométricas.

Ultrasound is the best non-invasive study to evaluate renal morphology in the neonate; so we decided to undergo a study looking for normal renal size in relation with other anthropometric measures. We performed renal ultrasounds in 50 healthy, appropriate for gestational age, term-babies. We found correlation between several anthropometric measures, but the most significant were weight and height. In most cases the left similar to others. It is important to know normal renal dimensions in newborns, since there are diseases that not only are associated with an increased incidence of renal malformations, but also with a reduced renal size such as Down syndrome, or increased renal size such as Beckwith-Wiedemann syndrome. Renal sonogram; term newborn babies; anthropometric correlation.

[The indigestion cure: a common and dangerous practice]. / La cura del empacho: una práctica común y peligrosa.

PURPOSE: To identify current concepts and practices to treat a folk illness "empacho" in Leon, Guanajuato and a critical appraisal of risk involved. DESIGN: Prospective cross sectional survey. FRAMEWORK: General population. PATIENTS: A random sample of 519 families. MEASUREMENTS: Socioeconomic stratum, the point of view on empacho, the type and kind of treatment undertook and the clinical course observed were recorded. RESULTS: The 45.9% of the families considered empacho as a serious condition, though the prevalence of the concept was less in the high socioeconomic group. The most frequent (44.1%) concept on empacho was "something stuck in the gut" and it use to be deal with abdominal massage and herb infusions. Cooking oil was used in 34.7%, bismuth powder in 36.5%, and an unknown powder in a further 7.9% of cases. The remedy was "prescribed" by the mother herself in 48.3% of patients, whilst in the remaining someone else did it. Simultaneous medical treatment was received by 44.2% of children and 95% of them improved. CONCLUSIONS: There is a high prevalence of the concept of empacho in the general population, mainly in the low and medium socioeconomic strata. In its treatment, dangerous practices are used, which can results in lipidic pneumonia or poisoning and according to their intensity can produce lose of life or deterioration in the respiratory or neurologic functions or both.

[The incidence of external congenital malformations at the Hospital de Ginecopediatría No. 48 in León, Guanajuato]. / Incidencia de malformaciones congénitas externas en el Hospital de Ginecopediatría No. 48 en León, Guanajuato.

From June 1st, 1989 to May 31st, 1990, 16,987 consecutive newborns were examined at the No. 48 Gynecological Pediatric Hospital of the IMSS National Medical Center, looking for external congenital malformations including esophageal atresias, anorectal malformations and congenital hip luxations, all easily detected during a routine exploration. Each deformed newborn assigned two control patients the following two newborn babies showing no birth defects. 308 deformed newborns were detected, an incidence of 1.81%. Among the most frequent defects were midline flat hemangiomas, polyotia, Down syndrome, congenital hip luxation and myelomeningocele. The only significant statistical difference found with respect to the control group was a greater family history of defects in the case group (P less than 0.0001). When comparing our results with those from other studies, including a study done locally 15 years ago, we found differences among specific malformations: congenital hip malformation, polydactylia, foot deformities, flat hemangiomas, nevus and polyotias. Yet, the overall frequency of defects found was similar.

Curva de crecimiento cefalico fetal normal, por medicion seriada del diametro biparietal con ultraecosonografia. / Normal fetal cephalic growth curve, by serial measurement of biparietal diameter by ultrasound echography

Se presenta el resultado de las mediciones seriadas del diametro biparietal del feto (DBP), por medio de ultrasonido con tecnica de A-scan, en 70 casos seleccionados de embarazo normal, con fetos que llegaron al termino y cuyo peso al nacimiento fue mayor de 2,500 g. Se establecen los valores promedio y la variabilidad de las mediciones en razon de la edad gestacional, anotando leves diferencias con los encontrados por otros autores. Asi mismo, las tendencias de crecimiento del DBP entre las semanas 15 y 39 de gestacion. La medicion seriada iniciada alrededor de la semana 20, permite definir la tendencia de crecimiento fetal. La evaluacion aislada es poco confiable en terminos de prediccion del peso al nacimiento