[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.

[Acute complications in full term neonates with severe neonatal asphyxia]. / Complicaciones agudas en neonatos de término con asfixia perinatal severa.

The acute systemic complications of perinatal asphyxia, defined as an umbilical artery pH at birth of 7.10 or less, were evaluated in fifty full-term newborn infants. We also investigated the prenatal complications that lead to asphyxia, and the relationship between Apgar score and cord pH. Asphyxia or fetal distress was not identified in 56% of the cases. The most common condition associated with asphyxia was prolonged labor followed by abruptio placentae. About half of the babies studied, suffered some degree of renal and brain dysfunction; 24% had severe respiratory disease. Myocardial failure was present in 24%. Regarding metabolic complications, the most frequent was hypocalcemia, present in 44%. On the other hand, there was no correlation between Apgar score and cord pH. Mortality was 22%. The main cause of death was Persistent Pulmonary Hypertension.

[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 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.