Psychological profile of teenagers toward organ donation: a multicentric study in Spain.

BACKGROUND: It is important for teenagers to have a favorable attitude toward organ donation and transplantation (ODT) in order to increase the number of future donors. To determine the attitude of teenagers in the South East of Spain toward ODT and to analyze the psychosocial variables related to this attitude. METHODS: The study population consisted of young teenagers in the South East of Spain. A stratified sample was selected by geographical location, sex and age (n = 4, 117). Attitude was assessed using a validated questionnaire about ODT (PCID-ODT Ríos). Statistical analysis: Student's t-test, Chi-squared test and a multivariate analysis. RESULTS: The questionnaire completion rate was 87% (n = 3572). Attitude toward ODT was favorable in 46% of cases (n = 1633) and undecided in 43% (n = 1543). Several psychosocial variables had a favorable effect on donation: believing that one has good information about ODT (Odds Ratio [OR] 1.706); discussing the subject with the family (OR 1.543) and friends (OR 1.818); carrying out pro-social activities (OR 1.642); having a favorable attitude toward cremation (OR 1.466) and autopsy (OR 1.470); and, finally, not being afraid of scars (OR 4.184). CONCLUSIONS: Teenagers in the South East of Spain are not currently inclined to support organ donation. This attitude is related to many psychosocial factors, mainly connected to not having good information about the subject, not discussing it in social circles and the fear of body mutilation. It would be appropriate to create educational interventional strategies in this group to prevent a negative impact on future donation rates.

The role of hyperthermic intraperitoneal chemotherapy using paclitaxel in platinum-sensitive recurrent epithelial ovarian cancer patients with microscopic residual disease after cytoreduction.

BACKGROUND: We analyzed the role of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) on the microscopic component of the disease in patients with a first recurrence of platinum-sensitive ovarian cancer after complete cytoreduction (CCR). PATIENTS AND METHODS: We analyzed the data of 54 patients who were operated on between January 2001 and July 2012 with the diagnosis of platinum-sensitive recurrent ovarian cancer. In all patients, it was possible to achieve a CCR. Patients were divided into two groups: group I (cytoreduction alone) consisted of 22 surgical patients and group II (cytoreduction and HIPEC) consisted of 32 patients. RESULTS: There were no significant differences in any of the preoperative variables studied. After a multivariate analysis of factors identified in the univariate analysis, only the presence of tumors with undifferentiated histology (hazard ratio 2.57; 95% CI 1.21-5.46; p < 0.05) was an independent factor associated with a reduced disease-free survival. The 1- and 3-year disease-free survival was 77 and 23% in patients from group I and 77 and 45% in patients from group II, respectively, with a tendency, but no significant differences (p = 0.078). There was no significant difference in postoperative morbidity between the two groups. CONCLUSIONS: The administration of HIPEC in patients in whom it is possible to achieve a CCR of the disease has not increased postoperative morbidity and mortality rates in our center. HIPEC with paclitaxel is effective in the treatment of microscopic disease in platinum-sensitive recurrent epithelial ovarian cancer patients with microscopic residual disease after cytoreduction, although with no statistically significant difference.

Treatment of microscopic disease with hyperthermic intraoperative intraperitoneal chemotherapy after complete cytoreduction improves disease-free survival in patients with stage IIIC/IV ovarian cancer.

BACKGROUND: We analyze the efficacy of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) for microscopic residual disease in patients with stage IIIC/IV ovarian cancer after a complete cytoreduction of their disease. PATIENTS AND METHODS: We analyzed the data of 87 consecutive patients diagnosed with stage IIIC/IV ovarian cancer operated between December 1998 and July 2011. In every patient it was possible to achieve a complete cytoreduction of their disease. (Since January 2008, our center has incorporated the use of HIPEC in patients with peritoneal surface malignancies, including patients with peritoneal dissemination of primary ovarian cancer.) RESULTS: Of 87 patients, 52 were treated with HIPEC (paclitaxel 60 mg/m(2), 60 min, 42 °C). After a univariate analysis, factors associated with lower disease-free interval were: performing a gastrointestinal anastomosis, operative time greater than 270 min, poorly differentiated histology, and not being treated with HIPEC. After multivariate analysis, independent prognostic factors included not being treated with HIPEC [hazard ratio (HR) 8.77, 95 % CI 2.76-14.42, p < 0.01] and the presence of poorly differentiated tumors (HR 1.98, 95 % CI 1.45-8.56, p < 0.05). Disease-free survival at 1 and 3 years was 66 and 18 %, respectively, in patients without HIPEC and 81 and 63 %, respectively, in patients treated with HIPEC (p < 0.01). HIPEC administration did not alter the results obtained for disease-free survival in patients with undifferentiated tumors. CONCLUSIONS: The treatment of the microscopic disease following complete cytoreduction with HIPEC in patients with advanced ovarian cancer is effective and can prolong disease-free survival. This survival benefit was not seen in undifferentiated tumors.

Increased doses of vaginal progesterone for the prevention of preterm birth in twin pregnancies: a randomised controlled double-blind multicentre trial.

OBJECTIVE: Previous trials have shown little benefit for preventing preterm birth in twin pregnancies using 90-200 mg of daily vaginal natural progesterone. Higher doses have not been tested. Our aim was to determine the efficacy and safety of two different daily doses of vaginal natural progesterone (200 and 400 mg), compared with placebo, for preventing preterm birth in unselected twin pregnancies. DESIGN: Randomised controlled double-blind multicentre trial (1:1:1). SETTING: The study was carried out in five university centres from Valencia, Murcia and Alicante (Spain). POPULATION: Women with dichorionic diamniotic twin pregnancies. METHODS: The women self-inserted two vaginal pessaries daily, containing placebo (n = 96), 200 mg of natural progesterone (n = 97) or 400 mg of natural progesterone (n = 97), from 20 to 34 weeks of gestation or delivery. Randomisation was performed by an external centre. Data were analysed on an intention-to-treat basis. MAIN OUTCOME MEASURE: Preterm birth rate. RESULTS: The baseline characteristics for placebo and progesterone groups were similar. Comparison of the three groups and analysis of progesterone-treated versus untreated women showed similar pregnancy and neonatal outcomes. The proportion of preterm and very preterm births, low birthweight, perinatal mortality and neonatal morbidity showed no differences between the three groups. Similar results were also obtained when comparing the 200- versus 400-mg progesterone groups. No serious adverse effects were encountered. CONCLUSIONS: Vaginal progesterone therapy was generally well tolerated, but failed to prevent preterm births in unselected dichorionic diamniotic twin pregnancies. The 400-mg progesterone dose offered no advantages over the 200-mg regimen.

Mechanisms involved in the selective transfer of long chain polyunsaturated Fatty acids to the fetus.

The concentration of long chain polyunsaturated fatty acid (LCPUFA) in the fetal brain increases dramatically from the third trimester until 18 months of life. Several studies have shown an association between the percentage of maternal plasma docosahexaenoic acid (DHA) during gestation and development of cognitive functions in the neonate. Since only very low levels of LCPUFA are synthesized in the fetus and placenta, their primary source for the fetus is the maternal circulation. Both in vitro and human in vivo studies using labeled fatty acids have shown preferential transfer of LCPUFA from the placenta to the fetus compared with other fatty acids, although the mechanisms involved are still uncertain. The placenta takes up circulating maternal non-esterified fatty acids (NEFA) and fatty acids released mainly by maternal lipoprotein lipase and endothelial lipase. These NEFA may enter the cell by passive diffusion or by means of membrane carrier proteins. Once in the cytosol, NEFA bind to cytosolic fatty acid-binding proteins for transfer to the fetal circulation or can be oxidized within the trophoblasts, and even re-esterified and stored in lipid droplets. Although trophoblast cells are not specialized for lipid storage, LCPUFA may up-regulate peroxisome proliferator activated receptor-γ (PPARγ) and hence the gene expression of fatty acid transport carriers, fatty acid acyl-CoA-synthetases and adipophilin or other enzymes involved in lipolysis, modifying the rate of placental transfer, and metabolism. The placental transfer of LCPUFA during pregnancy seems to be a key factor in the neurological development of the fetus. Increased knowledge of the factors that modify placental transfer of fatty acids would contribute to our understanding of this complex process.

The GnRH analogue triptorelin confers ovarian radio-protection to adult female rats.

There is a controversy regarding the effects of the analogues of the gonadotrophin-releasing hormone (GnRH) in radiotherapy. This has led us to study the possible radio-protection of the ovarian function of a GnRH agonist analogue (GnRHa), triptorelin, in adult, female rats (Rattus norvegicus sp.). The effects of the X-irradiation on the oocytes of ovarian primordial follicles, with and without GnRHa treatment, were compared, directly in the female rats (F(0)) with reproductive parameters, and in the somatic cells of the resulting foetuses (F(1)) with cytogenetical parameters. In order to do this, the ovaries and uteri from 82 females were extracted for the reproductive analysis and 236 foetuses were obtained for cytogenetical analysis. The cytogenetical study was based on the data from 22,151 metaphases analysed. The cytogenetical parameters analysed to assess the existence of chromosomal instability were the number of aberrant metaphases (2234) and the number (2854) and type of structural chromosomal aberrations, including gaps and breaks. Concerning the reproductive analysis of the ovaries and the uteri, the parameters analysed were the number of corpora lutea, implantations, implantation losses and foetuses. Triptorelin confers radio-protection of the ovaries in front of chromosomal instability, which is different, with respect to the single and fractioned dose. The cytogenetical analysis shows a general decrease in most of the parameters of the triptorelin-treated groups, with respect to their controls, and some of these differences were considered to be statistically significant. The reproductive analysis indicates that there is also radio-protection by the agonist, although minor to the cytogenetical one. Only some of the analysed parameters show a statistically significant decrease in the triptorelin-treated groups.

Contraceptive practices and trends in Spain: 1997-2003.

OBJECTIVE: To know the contraceptive use and trends in the Spanish female population. STUDY DESIGN: Since 1997, we have conducted a survey every 2 years on the use of contraceptive methods among a representative sample of Spanish women of childbearing potential (15-49 years). RESULTS: In the period 1997-2003, the percentage of use of contraceptive methods in Spain rose from 55.6% to 71.2%. The most commonly used method was the condom (21% in 1997, 21.9% in 1999, 29.5% in 2001 and 35.7% in 2003), followed by the contraceptive pill (14.2%, 16.5%, 19.2% and 18.3%, respectively). Male or female sterilization remained stable with percentages of use of 5-7%. IUDs are used by about 5% of women. CONCLUSIONS: The use of contraceptive methods among Spanish women of childbearing potential generally fits quite well the patterns found in other developed countries, and we observed a trend towards increased use of effective methods.

Use of contraceptive methods and risk of unwanted pregnancy in Spanish women aged 40-50 years: results of a survey conducted in Spain.

A survey intended to ascertain the rate of use and type of contraceptive methods applied by Spanish women aged 40 to 50 years, and to determine the proportion of women in this group at risk of an unwanted pregnancy, was designed and validated. To achieve representative national results for the study population, it was estimated that a sample size of 2000 women was required. Women were selected using probabilistic, stratified random sampling. The survey questionnaire was prepared by the research group with the collaboration of experts in the conduct of population studies of this type. Participants were interviewed face to face by qualified and trained staff from a specialised company external to the research group. Overall, 1039 women (52%) resorted to some contraceptive method, of which (male or female) sterilisation was the most common. We estimate that in Spain there are 840,000 women (31.8%) aged 40 to 50 years at risk of unwanted pregnancy.

Contraception in the Spanish press: an analysis of the 1997-2002 period.

OBJECTIVE: Based on the hypothesis that the media represent an important source of information about contraceptive methods and sexuality, this paper reviews the news items about contraception published by four important Spanish newspapers and four women's magazines. MATERIALS AND METHODS: All news items appearing from January 1, 1997 to December 31, 2002 in the following publications: El País, El Mundo, ABC, La Vanguardia, Mía, Clara, Ragazza, and Epoca were collected during the first 6 months of 2003. Results Seven hundred and ten news items about contraception were identified during the period analysed, of which 117 (16.5%) had a negative character. CONCLUSIONS: Over 80% of news items appearing in the Spanish press in the 1997-2002 period give a positive information about contraceptive methods.

La práctica de ''escansos'' en el uso de anticoncepción hormonal oral en España. Resultados de cuatro encuestas de ámbito nacional / Pill-free intervals in the use of oral hormonal contraception in Spain. Results of four national surveys

Objetivo: Investigar si las usuarias españolas de anticonceptivos hormonales orales realizan "descansos". Sujetos y método: Se han realizado 4 encuestas nacionales, en intervalos de 2 años, entre 1997 y 2003. El número de mujeres encuestadas, de edades comprendidas entre los 15 y los 49 años, osciló entre 2.076 en el año 1997 y 2.218 en 2001. La información se obtuvo mediante entrevistas personales. Resultados: En 1997, el 42% de las usuarias de la píldora realizaba "descansos", frente al 37% en el año 2003. En más del 60% de los casos fueron recomendados por un médico. Conclusiones: Hay que elaborar una estrategia para la formación, tanto de los profesionales de la salud como de las usuarias, que permita erradicar esta práctica inadecuada

Objective: To investigate whether Spanish women taking oral contraceptives have pill-free intervals. Subjects and method: Four national surveys were performed at 2-yearly intervals between 1997 and 2003. The number of women aged between 15 and 49 years who were surveyed ranged from 2,076 in 1997 to 2,218 in 2001. Information was obtained from personal interviews. Results: In 1997, 42% of pill users reported pill-free intervals compared with 37% in 2003. More than 60% of these women reported that these intervals were recommended by a doctor. Conclusions: A training strategy should be devised, aimed at both health professionals and users of hormonal contraceptives, that would eradicate this incorrect practice

Tamoxifen and endometrial cancer. Is screening necessary? A review of the literature.

Tamoxifen is a selective oestrogen receptor modulator (SERM) with anti-oestrogenic activity in the breast and oestrogenic effects in various tissues such as the endometrium, bone and cardiovascular territory. As adjuvant hormone therapy, it has a clear beneficial effect in patients with breast cancer, reducing relapses, contralateral breast cancer and mortality. Its most important secondary effect is a greater rate of occurrence of endometrial cancer. Although the risk/benefit ratio is clearly positive, the follow-up on these patients is still an issue. In women with metrorrhagia, it is clear that an endometrial sample must be obtained for histological examination and the best procedure today is hysteroscopic-directed biopsy. Nevertheless, the need to screen asymptomatic patients is not universally accepted. The vaginal ultrasound scan gives a great number of false positives. This entails more aggressive and more expensive procedures such as hysteroscopic-directed biopsy, meaning greater expense and more complications. As a result, the cost/benefit ratio is not very favourable. The rate of occurrence of endometrial cancer in 1026 tamoxifen-treated patients with breast cancer in our hospital between 1999 and 2001 was 1.25%. Two cases were diagnosed in asymptomatic patients. In this article, we analyse the literature on the need to screen patients on tamoxifen and about the most appropriate diagnostic protocol.

Symmetrical fetal growth retardation after gestational cocaine exposure in the rat.

Cocaine use during pregnancy results in an increase in different maternal and perinatal complications. The fetal effects of cocaine could be mainly related to the disturbances in the brain development, microcephaly being the most common brain abnormality. The aim of this study was to analyze maternal outcome and fetal somatic effects of cocaine and to evaluate the hypothesis that maternal cocaine exposure would specifically impair fetal global brain development. Fifty-four timed-pregnant female Sprague-Dawley rats were daily injected with 15 or 40 mg/kg per day from gestational day (GD) 1 or 8 and sacrificed at gestational day 20. By analyzing different maternal and fetal outcomes, it could be suggested that the cocaine exposure in pregnant rats decreased maternal weight gain without significant maternal mortality, did not affect the mean number of fetuses by litter, although notably increased stillbirths, reduced fetal birth weight, and reduced the fetal central nervous system weight. Present results are globally in agreement with the literature and underline a possible selective effect of cocaine on the fetal CNS resulting in symmetrical intrauterine fetal growth retardation in contrast to the asymmetrical retardation of undernutrition.

Spanish population at risk of unwanted pregnancy: results of a national survey.

OBJECTIVE: We performed a personal survey in 2218 Spanish women aged from 15 to 49 years to establish the contraceptive methods used by this population and to determine the number of Spanish women of childbearing age exposed to unwanted pregnancy. METHODS: Stratified random sampling was performed to select the women to be interviewed; this sampling design ensured adequate representation of the sample in Spain. RESULTS: At the time of the survey, 69.1% of the women were using some contraceptive method, but 5% of them used poorly effective contraceptive methods, and their exposure to the risk of an unwanted pregnancy was therefore high. Moreover, among the 30.9% not using any contraceptive method, 21.1% were at risk because they were having sexual intercourse, did not want to become pregnant and did not use a contraceptive method. CONCLUSIONS: A little over one million Spanish women are exposed to the risk of having an unwanted pregnancy. Compiling the data on this significant problem is the first step in designing appropriate solutions.

Effect of angiotensin-converting enzyme inhibitor on renal function in ovarian hyperstimulation syndrome in the rabbit.

OBJECTIVE: To investigate renal function and whether captopril prevents alterations in the handling of sodium and water in the ovarian hyperstimulation syndrome (OHSS) in the rabbit. DESIGN: Experimental study SETTING: Physiology laboratory. ANIMAL(S): Six female New Zealand white rabbits were used as controls, and 13 were hyperstimulated with gonadotropins. INTERVENTION(S): Saline or captopril. MAIN OUTCOME MEASURE(S): Renal excretory and hemodynamic variables. RESULT(S): The 3% extracellular volume expansion in OHSS animals induced a significant elevation in mean arterial pressure by 27%, although increments in natriuresis and diuresis were similar to those observed in controls. The OHSS group had impaired pressure-natriuresis sensitivity compared with controls (0.36 +/- 0.07 microEq/min/g of Na excreted per mm Hg vs. 1.74 +/- 0.45 microEq/min/g of Na excreted per mm Hg; P<.05. Captopril significantly reduced mean arterial pressure (P<.05) and shifted the pressure-natriuresis response to the left by 0.85 +/- 0.17 microEq/min/g of Na excreted per mm Hg (P<.05). CONCLUSION(S): In OHSS in the rabbit model, pressure-natriuresis sensitivity is impaired. Angiotensin II may play a significant role in this phenomenon, since angiotensin-converting enzyme inhibition normalized the pressure-natriuresis relationship.

Use of contraceptive methods in Spain: results of a national survey.

We conducted a personal interview of 2136 Spanish women aged 15 to 49 years with the aim of determining the contraceptive attitudes of this population. A stratified random sampling was performed to select the women who were to be interviewed, and this sampling design ensured adequate representation of the sample in Spain. At the time of the survey, only 1296 of the 2136 women used some type of contraceptive method (60.6%); the most commonly used method was the condom. The major reason given by the 840 women not using contraceptive methods was the absence of sexual intercourse. Nearly 25% of the Spanish women aged 15-49 years reported that they have no sexual relations.

Increased chromosome abnormalities in human preimplantation embryos after in-vitro fertilization in patients with recurrent miscarriage.

Recurrent miscarriage is a pathological condition induced by maternal and embryonic causes. This paper describes a prospective study to determine the real incidence of aneuploidy for autosomes 13, 16, 18, 21, 22, and gonosomes in preimplantation human embryos obtained from patients with recurrent pregnancy loss after ovarian stimulation in an IVF-ET programme. Our results indicate that aneuploidy for the chromosomes analysed are abnormally higher in embryos obtained after IVF from recurrent abortion patients (58%) compared to non-recurrent abortion patients undergoing IVF. Furthermore, monosomies are six times more frequent than trisomies (47:8) in preimplantation embryos from recurrent abortion patients. Based on the present study, preimplantation genetic diagnosis (PGD) of embryos obtained from patients with recurrent miscarriage could prove advantageous in diagnosing abnormal embryos and selecting normal embryos for transfer.

Role of nitric oxide on the central hemodynamic response to acute volume expansion in the pregnant rat.

OBJECTIVES: Our hypothesis was that during pregnancy nitric oxide acts as mediator in the hemodynamic response to volume expansion. STUDY DESIGN: The study was performed on 12 rats on days 19 to 20 of pregnancy. Six rats were injected intravenously with hexamethonium bromide plus the inhibitor of nitric oxide synthase L-nitro-arginine methyl ester. For a control group, six rats were injected with hexamethonium bromide plus the L-nitro-arginine methyl ester vehicle. A volume expansion (1.2% body weight) was performed in both groups by intravenous infusion of bovine albumin (6%) solution. RESULTS: In the control group volume expansion induced a hyperdynamic circulation characterized by increased cardiac output, decreased total vascular resistance, and no change in arterial pressure; however, in the study group volume expansion induced a pressor response without hyperdynamic circulation. CONCLUSION: During pregnancy volume expansion induces a hyperdynamic circulatory state possibly mediated by nitric oxide release. A defect in the release of nitric oxide may be responsible for an inadequate hemodynamic response to volume expansion.

Analysis of compliance with oral contraception in Spain.

OBJECTIVE: The study was designed to analyze factors related to compliance in oral hormonal contraception in Spain. METHOD: A review study and a multicenter analysis of experience of compliance by 300 doctors, by means of a questionnaire and discussion about the determinants of contraceptive use. RESULTS: Compliance is a major problem in Spain, being influenced mainly by side-effects, the general perception of the method and personal factors. The different factors involved in non-compliance in Spain were analyzed, with regard to the perspective of the professionals. CONCLUSIONS: Strategies to improve compliance in Spain aim mainly at improving the general perception of the method and the accessibility of family planning centers. Factors associated with compliance are still not well known in our country. Better knowledge of the determinants of non-compliance in Spain is needed. For this purpose, another research group was formed to conduct a national study among women.

Non-surgical treatment of ectopic pregnancy in the sole remaining tube.

We reported on three successive cases of intrauterine term pregnancy obtained in patients with an ectopic gestation in their solitary remaining tube who were treated by three different non-surgical conservative methods: parenteral methotrexate, local injection of methotrexate combined with systemic administration, and expectant management respectively. The opposite tube had been removed because of previous tubal ectopic pregnancy. The cases, which were at a high risk of repeated ectopic implantation, are unequivocal proof of intact function of a tube after conservative non-surgical procedures for ectopic pregnancy. Thus, our report adds further evidence favouring the feasibility, the safety and fertility potential of these procedures for selected unruptured tubal gestations.

Immunoradiometric studies with a monoclonal antibody against an estrogen-receptor-related protein in human breast cancer.

The concentration of P29, a phosphoprotein related to estradiol receptor (RE), was measured by an immunoradiometric assay in human breast cancer cytosol and the results compared with the levels of RE and progesterone receptors (RP), as measured by the classical ligand-binding assay. Good linear correlation was found between P29 and RE, but not RP. Tumors which were positive for both RE and RP had a higher P29 mean value than RE-negative, RP-negative tumors. Menopausal status of the patients influenced the result, since premenopausal women had lower mean concentrations or were P29-positive less frequently than postmenopausal women. RE-negative, RP-positive tumors tended to have positive P29 levels. The correlation between RE and P29 corroborates results obtained with other techniques and supports a role for P29 in predicting response to hormonal treatment.