Testicular dysfunction at diagnosis in children and teenagers with haematopoietic malignancies improves after initial chemotherapy.

Introduction: Hematopoietic malignancies are the most frequent type of cancer in childhood. Recent advances in cancer treatment have significantly improved survival until adulthood. There is an extensive literature on the effects of cancer treatment on the gonadal axis in adult survivors of childhood cancer mainly focused on sperm production, but scarce information exists on the immediate impact of cancer and its treatment in boys. Objectives: In this work, we determined the status of the hypothalamic-pituitary-testicular (HPT) axis function at diagnosis and the immediate impact of chemotherapy at the start of treatment in children and adolescents with hematopoietic malignancies. Subjects and methods: In a prospective study of 94 boys and adolescents with acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML) or non-Hodgkin lymphoma (NHL), we determined serum AMH, inhibin B and FSH to assess the gonadotrophin-Sertoli cell component of the HPT axis, and testosterone and LH to evaluate the gonadotrophin-Leydig cell component, at diagnosis and after 3 months of chemotherapy. Secondarily, the general health state was evaluated. Results: In prepubertal boys, at diagnosis, AMH, inhibin B and FSH were lower compared to the reference population, reflecting an FSH-Sertoli cell axis dysfunction. After 3 months of chemotherapy, all hormone concentrations increased. At pubertal age, at diagnosis, AMH and inhibin B were lower compared to the reference population for Tanner stage, with inappropriately normal FSH, suggesting a primary Sertoli cell dysfunction with insufficient gonadotrophin compensation. The LH-Leydig cell axis was mildly disrupted. After 3 months of chemotherapy, inhibin B and AMH were unchanged while median FSH levels rose to values that exceeded the reference range, indicating a significant impairment of Sertoli cell function. Testosterone normalized concomitantly with an abnormal LH elevation reflecting a compensated Leydig cell impairment. General health biomarkers were impaired at diagnosis and improved after 3 months. Conclusion: The HPT axis function is impaired in boys with hematopoietic malignancies before the initiation of chemotherapy. There is a primary testicular dysfunction and a concomitant functional central hypogonadism that could be due to an impaired overall health. The HPT axis function improves during the initial 3 months of chemotherapy concomitantly with the general health state. However, in pubertal boys the dysfunction persists as shown by elevated gonadotropin levels after 3 months.

Autonomía del paciente: alcances del consentimiento informado en la práctica médica / Patient autonomy: scope of informed consent in medical practice

Introducción: El consentimiento informado se ha constituido en un aspecto muy importante en la medicina en los últimos 25 años. El cambio ha sido vertiginoso, no sólo como una visión de protección -de instituciones y profesionales- sobre litigios y problemas legales, sino dentro del campo de la bioética, como una herramienta de gran importancia para el respeto de la autonomía de los pacientes. Objetivo: Determinar el grado de comprensión de la población de profesionales de nuestro hospital sobre el modelo de Consentimiento Informado. Materiales y Métodos: En el período comprendido entre los meses de julio a noviembre de 2003, se realizó una encuesta autoadministrada en una población conformada por profesionales estables de los servicios de Clínica Médica (n=10), Cirugía (n=8), Radio-diagnóstico (n=2), Bioquímicos (n=8), Oncología (n=2), Fonoaudiología (n=4). Resultados: Del total de encuestas recibidas (n=34) el 50% de los profesionales encuestados (17/34) contestó correctamente los 10 ítems. El 50% restante contestó correctamente 4 de los 10 ítems (n=3), 7 de los 10 ítems (n=4), 9 de los 10 ítems (n=8) y los dos profesionales restantes respondieron 6 y 8 ítems cada uno. Conclusiones: Se esperaba que en la población estudiada, con el grado máximo de instrucción escolar, el porcentaje de aciertos correctos debiera haber sido de un 100%. Sin embargo, los resultados obtenidos no lo demuestran dado que sólo la mitad de los profesionales estudiados acertaron correctamente la encuesta.

Introduction: Informed consent has turned into a very important issue in medicine in the last 25 years. The change has been really fast, not only as protection ­for institutions and professionals- against lawsuits and legal problems, but also within the bioethical field, as a major tool for respecting the patients' autonomy. Objective: To determine the degree of un- derstanding of the professional population at our hospital of the Informed Consent model. Mate- rials and Methods: During the months of July and November 2003, a self-administered survey was performed on a population that consisted on regular professionals for the following services: Internal Medicine (n=10), Surgery (n=8), Radiodiag- nosis (n=2), Biochemistry (n=8), Oncology (n=2), Speech and Lan- guage Pathology (n=4). Results: From the total number of surveys received (n=34), 50% of the surveyed professionals (17/34) answered the 10 items correctly. The remaining 50% had the following number of correct answers: 4 out of 10 items correctly (n=3), 7 out of 10 items (n=4), 9 out of 10 items (n=8), and the remaining two professionals answered 6 and 8 items correctly each. Conclusions: It was expected that, in the population group being studied having the highest school degree, the percentage of correct answers should have been 100 %. However, the results obtained do not show this, since only half of the professionals surveyed answered correctly.