Peri-conception and first trimester diet modifies reproductive development in bulls.

Nutritional perturbation during gestation alters male reproductive development in rodents and sheep. In cattle both the developmental trajectory of the feto-placental unit and its response to dietary perturbations is dissimilar to that of these species. This study examined the effects of dietary protein perturbation during the peri-conception and first trimester periods upon reproductive development in bulls. Nulliparous heifers (n=360) were individually fed a high- or low-protein diet (HPeri and LPeri) from 60 days before conception. From 24 until 98 days post conception, half of each treatment group changed to the alternative post-conception high- or low-protein diet (HPost and LPost) yielding four treatment groups in a 2×2 factorial design. A subset of male fetuses (n=25) was excised at 98 days post conception and fetal testis development was assessed. Reproductive development of singleton male progeny (n=40) was assessed until slaughter at 598 days of age, when adult testicular cytology was evaluated. Low peri-conception diet delayed reproductive development: sperm quality was lowered during pubertal development with a concomitant delay in reaching puberty. These effects were subsequent to lower FSH concentrations at 330 and 438 days of age. In the fetus, the low peri-conception diet increased the proportion of seminiferous tubules and decreased blood vessel area in the testis, whereas low first trimester diet increased blood vessel number in the adult testis. We conclude that maternal dietary protein perturbation during conception and early gestation may alter male testis development and delay puberty in bulls.

Effects of feeding management and time of day on the occurrence of self-suckling in dairy goats.

The occurrence of self-suckling was recorded in 21 dairy goats during periods of 20 minutes at three different times per day (immediately after milking and the first feed, immediately after the second feed and in the afternoon) for 27 days (divided into three experimental periods of nine days). As expected, negative associations between milk yield and the frequency of self-suckling were observed (P<0.05). Goats suckled on their own right teat more frequently than on the left teat. The width of the right teat (measured at the middle of the teat) was positively associated with the frequency of self-suckling after controlling for the width of the left teat. A higher self-suckling frequency was observed immediately after milking than in the other two periods of the day. The frequency of self-suckling by each goat was reduced when animals were supplemented ad libitum with wheat straw in addition to their ordinary feed.

Impact of a CAD system in a screen-film mammography screening program: a prospective study.

OBJECTIVE: The purpose of our study was to perform a prospective assessment of the impact of a CAD system in a screen-film mammography screening program during a period of 3 years. MATERIALS AND METHODS: Our study was carried out on a population of 21,855 asymptomatic women (45-65 years). Mammograms were processed in a CAD system and independently interpreted by one of six radiologists. We analyzed the following parameters: sensitivity of radiologist's interpretation (without and with CAD), detection increase, recall rate and positive predictive value of biopsy, CAD's marks, radiologist's false negatives and comparative analysis of carcinomas detected and non-detected by CAD. RESULTS: Detection rate was 4.3‰. CAD supposed an increase of 0.1‰ in detection rate and 1% in the total number of cases (p<0.005). The impact on recall rate was not significant (0.4%) and PPV of percutaneous biopsy was unchanged by CAD (20.23%). CAD's marks were 2.7 per case and 0.7 per view. Radiologist's false negatives were 13 lesions which were initially considered as CAD's false positives. CONCLUSIONS: CAD supposed a significant increase in detection, without modifications in recall rates and PPV of biopsy. However, better results could have been achieved if radiologists had considered actionable those cases marked by CAD but initially misinterpreted.

HANOIPC3: a computer program to evaluate executive functions.

This article describes a computer program (HANOIPC3) based on the Tower of Hanoi game that, by analyzing a series of parameters during execution, allows a fast and accurate evaluation of data related to certain executive functions, especially planning, organizing and problem-solving. This computerized version has only one level of difficulty based on the use of 3 disks, but it stipulates an additional rule: only one disk may be moved at a time, and only to an adjacent peg (i.e., no peg can be skipped over). In the original version--without this stipulation--the minimum number of movements required to complete the task is 7, but under the conditions of this computerized version this increases to 26. HANOIPC3 has three important advantages: (1) it allows a researcher or clinician to modify the rules by adding or removing certain conditions, thus augmenting the utility and flexibility in test execution and the interpretation of results; (2) it allows to provide on-line feedback to subjects about their execution; and, (3) it creates a specific file to store the scores that correspond to the parameters obtained during trials. The parameters that can be measured include: latencies (time taken for each movement, measured in seconds), total test time, total number of movements, and the number of correct and incorrect movements. The efficacy and adaptability of this program has been confirmed.

[Identification and early nutritional support in hospitalized malnourished patients]. / Reconocimiento y soporte nutricional precoz en pacientes hospitalizados desnutridos.

INTRODUCTION: The prevalence of hyponutrition in hospitalized patients in our setting is 53%. The therapeutic approach is controversial. OBJECTIVES: To determine whether an early nutritional intervention in hospitalized patients by means of oral nutritional support can improve their prognosis regarding decreased morbimortality and hospital stay. MATERIAL AND METHODS: Randomized prospective study comprised by a treatment group and a control group of malnourished patients hospitalized at the Internal Medicine and Respiratory Medicine Departments. The nutritional diagnosis was made by using the Subjective Global Assessment. Groups B and C were assigned to receive the hospital diet according to their needs and pathology (control group) and the treatment group also received a standard nutritional supplement. We recorded the development of infections, pressure ulcers, hospitalization days, mortality, and weight. RESULTS: We performed more than 1,700 Subjective Global Assessments. Five hundred and thirty seven patients (264 treated and 273 controls) were followed-up until hospital discharge or death. We did not find statistically significant differences in mortality, hospital stay, or occurrence of complications between the treatment group and the control group. The treatment group presented statistically significant weight increase as compared with the control group. CONCLUSIONS: We could not demonstrate benefits when using the oral nutritional supplement in terms of mortality, hospital stay, infectious complications, or pressure ulcers. The significant weight increase in the treatment group allowed us concluding that the supplement effectively treated hyponutrition in this group. This new clinical status implies a better prognosis, as it has already been shown. However, this could not be observed by means of the study parameters. Long-term studies are required to determine for how long this nutritional improvement can be sustained, implying a better prognosis in the long run.

[Attitudes and needs of pediatric intensivists in relation to the death of their patients]. / Actitudes y necesidades de los intensivistas pediátricos ante la muerte de sus pacientes.

INTRODUCTION: Most deaths in infants and children occur in hospitals and especially in pediatric and neonatal intensive care units. OBJECTIVES: To determine 1) how often pediatric intensivists have to manage dying patients, 2) their approach to these patients, and 3) their knowledge of this field and their needs. MATERIAL AND METHOD: A 28-item questionnaire was sent by surface mail to each physician, as well as another questionnaire with general questions on the work of the pediatric intensive care unit (PICU) in 2000. RESULTS: Responses were obtained from 20 PICUs (54 %) from different parts of Spain. There where 373 deaths. More of the half of the deaths (62 %) were due to acute events or occurred during the neonatal period. Ninety-four physicians completed the questionnaire. Each physician attended four deaths (SD = 3.1; range 0-20). Sixty-eight percent of the physicians believed that families were helped by knowing the possibility that the child might die. Intensivists believed that pediatric patients should not be informed that they were dying. In 64 % of deaths, the physicians were with their patients at the moment of death. More than half of the patients died without physical contact with their parents. Forty-six percent of the physicians interpreted death among their patients as a personal or professional failure and most (92 %) wanted training. Only three PICUs allowed parents to stay all day with their children. CONCLUSIONS: Almost half the physicians experienced death as a personal or professional failure and most wanted training to help them deal with death in their professional work. Most PICUs restrict the time parents are allowed to stay with their children.

Actitudes y necesidades de los intensivistas pediátricos ante la muerte de sus pacientes / Attitudes and needs of pediatric intensivists in relation to the death of their patients

Introducción: Los niños mueren mayoritariamente en los hospitales y, sobre todo, en las unidades de cuidados intensivos pediátricos (UCIP) y neonatales. Objetivos: Conocer la frecuencia con la que los intensivistas pediátricos se enfrentan a la muerte; saber cómo actúan frente a los pacientes que se mueren en sus unidades, y saber cuál es su formación al respecto y qué necesidades tienen. Material y métodos: Se elaboró un cuestionario personal para cada médico con 28 preguntas y otro general sobre la UCIP y su actividad asistencial, con datos referidos al año 2000, que se enviaron por vía postal. Resultados: Respondieron 20 UCIP (54 %) de toda España. Hubo 373 fallecidos. Más de la mitad (62 %) fallecieron por una enfermedad aguda o del período neonatal. Un total de 94 médicos respondieron al cuestionario. Cada médico atendió 4 muertes (desviación típica = 3,1; rango = 0-20). El 68 % de los profesionales opina que el hecho de que la familia conozca la posibilidad del fallecimiento del niño ayuda a la familia. Los intensivistas piensan que no se debe informar al niño de que va a morir. Los médicos estuvieron junto a su paciente en el fallecimiento en el 64 % de las ocasiones. Más de la mitad de los niños murieron sin contacto físico con sus padres. Un 46 % de los profesionales manifiestan haber interpretado el fallecimiento como un fracaso personal o profesional al menos en una ocasión y la mayoría (92 %) desea formación. Sólo en 3 UCIP los padres pueden estar todo el día con sus hijos. Conclusiones: Casi la mitad experimentan la muerte de sus pacientes como un fracaso personal o profesional. La casi totalidad de los médicos desean formación que les ayude a afrontar la muerte en su ejercicio profesional. En la mayor parte de las UCIP hay restricciones para que los niños estén acompañados

Introduction: Most deaths in infants and children occur in hospitals and especially in pediatric and neonatal intensive care units. Objectives: To determine 1) how often pediatric intensivists have to manage dying patients, 2) their approach to these patients, and 3) their knowledge of this field and their needs. Material and method: A 28-item questionnaire was sent by surface mail to each physician, as well as another questionnaire with general questions on the work of the pediatric intensive care unit (PICU) in 2000. Results: Responses were obtained from 20 PICUs (54 %) from different parts of Spain. There where 373 deaths. More of the half of the deaths (62 %) were due to acute events or occurred during the neonatal period. Ninety-four physicians completed the questionnaire. Each physician attended four deaths (SD = 3.1; range 0-20). Sixty-eight percent of the physicians believed that families were helped by knowing the possibility that the child might die. Intensivists believed that pediatric patients should not be informed that they were dying. In 64 % of deaths, the physicians were with their patients at the moment of death. More than half of the patients died without physical contact with their parents. Forty-six percent of the physicians interpreted death among their patients as a personal or professional failure and most (92 %) wanted training. Only three PICUs allowed parents to stay all day with their children. Conclusions: Almost half the physicians experienced death as a personal or professional failure and most wanted training to help them deal with death in their professional work. Most PICUs restrict the time parents are allowed to stay with their children

Anorexia nerviosa. Caso clínico-Actualización / Anorexia nervosa. Clinical case-Update

Presentamos el caso de una paciente de 24 años con anorexia nerviosa con elementos de severidad que requirieron internación. Durante el tratamiento presentó Síndrome de Realimentación bajo la forma de convulsiones tónico-clónicas generalizadas. La Anorexia Nerviosa es una patología psiquiátrica frecuente entre los adolescentes, con alta mortalidad vinculada a las complicaciones médicas o suicidio. Presenta repercusiones en todos los aparatos o sistemas. Su reconocimiento precoz y el inicio temprano de la terapéutica son elementos que mejoran el pronóstico.

[Radioguided occult breast lesion location (ROLL)]. / Localización radioguiada de lesiones ocultas de mama (ROLL).

OBJECTIVE: To obtain correct location of occult breast lesions by radiopharmaceutical methods. MATERIAL AND METHODS: Sixty-one patients whose ages ranged from 32 to 83 years (average: 57), with non-palpable breast lesions detected by mammography were studied. Six of them had a background of previous breast cancer. Sixty-three lesions were found. The lesions were classified into 34 clusters of microcalcifications, 25 nodules and 4 others parenchymal distortions. All patients received one dose of 0.3-0.5 mCi (11.1-18.5 MBq) of macroaggregates of 99mTc-labelled human serum albumin (99mTc-MAA) into the lesion under stereotactic mammographic or ultrasonography guidance. Anterior and lateral scintigraphic images were acquired in order to verify the correct location of the radiopharmaceutical. Intraoperative location of the lesion was performed using a gammaprobe. In case of microcalcifications, the entire removal of the lesion was verified by X-ray of the specimen. RESULTS: Placement of the radiotracer was good in 60 of 63 (95.2%) cases. Sixty-one lesions were completely removed. Pathological examination revealed 29 (47.6%) breast cancers and 32 (52.4%) benign lesions. CONCLUSION: Radioguided occult breast lesion location by radiopharmaceutical methods is a simple, safe and well-tolerated method by patients.

Localización radioguiada de lesiones ocultas de mama (ROLL) / Radioguided occult breast lesion location (ROLL)

Objetivo: Obtener una correcta localización de lesiones ocultas de mama mediante técnicas radioisotópicas. Material y métodos: Se han estudiado 61 pacientes con edades comprendidas entre 32 y 83 años (media de 57 años), con lesiones no palpables de mama, detectadas por mamografía. Seis pacientes tenían antecedentes de cáncer de mama. Sesenta y tres lesiones fueron encontradas. Las lesiones se clasificaron en 34 grupos de microcalcificaciones, 25 nódulos y 4 otras distorsiones de parénquima. Todas las pacientes recibieron una dosis de 0,3-0,5 mCi (11,1-18,5 MBq) de macroagregados de albúmina humana marcados con 99mTc ( 99mTc-MAA) intralesionalmente mediante mamografía estereotáxica o ecografía. Se adquirieron imágenes gammagráficas en proyecciones anterior y lateral, para valorar la correcta colocación del radiotrazador. La localización quirúrgica se realizó mediante la ayuda de una sonda gammadetectora (SGD). En el caso de microcalcificaciones, se realizó comprobación mamográfica de la pieza quirúrgica para confirmar su correcta exéresis. Resultados: La colocación del radiotrazador fue correcta en 60 de 63 casos (95,2 %). Sesenta y una lesiones fueron extraídas totalmente. La anatomía patológica reveló 29 (47,6 %) lesiones malignas y las 32 (52,4 %) restantes fueron benignas. Conclusión: La localización radioguiada de lesiones ocultas de mama mediante técnica radioisotópica es un método sencillo, seguro y bien tolerado por las pacientes

Objective: To obtain correct location of occult breast lesions by radiopharmaceutical methods. Material and methods: Sixty-one patients whose ages ranged from 32 to 83 years (average: 57), with non-palpable breast lesions detected by mammography were studied. Six of them had a background of previous breast cancer. Sixty-three lesions were found. The lesions were classified into 34 clusters of microcalcifications, 25 nodules and 4 others parenchymal distortions. All patients received one dose of 0.3-0.5 mCi (11.1-18.5 MBq) of macroaggregates of 99mTc-labelled human serum albumin ( 99mTc-MAA) into the lesion under stereotactic mammographic or ultrasonography guidance. Anterior and lateral scintigraphic images were acquired in order to verify the correct location of the radiopharmaceutical. Intraoperative location of the lesion was performed using a gammaprobe. In case of microcalcifications, the entire removal of the lesion was verified by X-ray of the specimen. Results: Placement of the radiotracer was good in 60 of 63 (95.2 %) cases. Sixty-one lesions were completely removed. Pathological examination revealed 29 (47.6 %) breast cancers and 32 (52.4 %) benign lesions. Conclusion: Radioguided occult breast lesion location by radiopharmaceutical methods is a simple, safe and well-tolerated method by patients

[Indications of transduodenal papillotomy for choledochal cyst]. / Indicaciones de la papilotomía transduodenal en el tratamiento del quiste de colédoco.

UNLABELLED: The Choledochal Cyst is a dilatation of the biliary tract whose etiology is still under debate. OBJECTIVE: This paper analyzes the cases of our group an contributes on the indications of transduodenal papilotomy in the surgical treatment of this process. MATERIAL AND METHODS: Seven cases diagnosed as choledochal cysts are presented with mean age between 3 and 10 years (5 females and 2 males). Six cases were presented with abdominal pain, four with jaundice, three presented with biliary stones and one cases was a casual discovery during an US examination. In all cases US and magnetic resonance cholangiopancreatography (MRCP) were performed as preoperative work-up. In one case an endoscopic retrograde cholangiopancreatography (ERCP) was made. In all cases intraoperative cholangiography was carried out. The surgical treatment was quistectomy and hepatico yeyunostomy Roux-Y in four cases; in one of them a transduodenal papilotomy was added. Cholecystectomy and transduodenal papilotomy was made in three cases, two of them presented choledocholithiasys. RESULTS: All patients are symptoms free after a mean follow up period of 2 years and 3 months (range: 1 year and 6 months to 4 years and 10 months). In one case persists dilated choledochal distal stump on MRCP.

Indicaciones de la papilotomía transduodenal en el tratamiento del quiste de colédoco / Indications of transduodenal papilotomy for choledochal cyst

El Quiste de Colédoco es una dilatación de la vía biliar cuya etiología sigue sujeta a debate. Objetivos: Análisis de la casuística del Servicio y aportación de las indicaciones de la papilotomía transduodenal en el tratamiento quirúrgica de esta patología. Material y métodos: Se presentan siete casos diagnosticados de quiste de colédoco con una edad entre 3 y 10 años ( 5 hembras y 2 varones). Seis casos presentaron dolor abdominal, cuatro ictericia, tres eran portadores de litiasis biliar y un caso fue un hallazgo casual en el curso de una exploración ecográfica. En todos ellos se realizó ecografia y colangio-pancreato-resonancia magnética (CPRM) preoperatorias. En un caso se realizó una colangio-pancreatografía retrógrada endoscópica (CPRE). En todos se realizó colangiografía intraoperatoria. El tratamiento quirúrgico realizado fue Quistectomia y hepático- yeyunostomía en Y de Roux en cuatro casos. En uno de ellos se añadió una papilotomía transduodenal. En tres casos se efectuó colecistectomía y papilotomía transduodenal. Dos de estos pacientes presentaban coledocolitiasis. Resultados: Todos los pacientes están asintomáticos tras un periodo de seguimiento medio de 2 años y 3 meses (rango: laño y 6 meses a 4 años y 10 meses). En un caso se aprecia en la CPRM postoperatoria la existencia de un muñón residual del colédoco distal con ectasia. (AU)

Suspensión de talco para efusión pleural maligna / Talc suspension to treat malignant pleural effusion

El talco es uno de los agentes esclerosantes más efectivos de los que se dispone actualmente para el tratamiento de la efusión pleural maligna. Al no existir como preparado comercial es necesario proceder a su formulación, siendo el aspecto más problemático la esterilización.En el presente trabajo se describe la preparación de una suspensión de talco, usando como método de esterilización el calor húmedo. La fórmula que se propone es segura, de fácil elaboración, efectiva y de bajo coste. Asimismo se valora la efectividad de dicha fórmula en un total de 10 pacientes, obteniendo un porcentaje de efectividad del 80 por ciento. La incidencia de efectos adversos fue baja y concordante con los datos publicados en la literatura (AU)

Hormonal and anthropometric predictors of bone mass in healthy elderly men: major effect of sex hormone binding globulin, parathyroid hormone and body weight.

Osteoporosis in men is a significant health problem, and factors associated with bone mass are being investigated. Although osteoporosis is a typical feature of hypogonadism, the influence of testosterone levels and other hormonal factors on bone mass of eugonadal males is unknown. Our aim was to identify several anthropometric and hormonal predictors that could be responsible for the variability in bone mineral density (BMD) in healthy men. One hundred elderly men (age 68 +/- 7 years) were investigated in this cross-sectional study. BMD was measured by dual-energy X-ray absorptiometry (DXA) at the lumbar spine and femoral sites (femoral neck, Ward's triangle, trochanter, intertrochanter and total femur). Anthropometric measures were obtained including: weight, height, body mass index (BMI), waist-hip ratio and testicular volume. Hormonal data measures were total, free and bioavailable testosterone, dihidrotestosterone, estradiol, sex hormone binding globulin (SHBG), insulin-like growth factor I (IGF-I), intact parathyroid hormone (iPTH) and 1,25-dihydroxyvitamin D3 (1,25(OH)2D3). One subject was excluded because primary hypogonadism was found. SHBG levels were increased in 53.5% of men, and 8% showed a mild increase in iPTH levels. Twenty-eight subjects had densitometric criteria of osteoporosis (T-score < or = -2.5). All BMD sites were positively correlated with body weight (r = 0.29-0.48, p < 0.001) and BMI (r = 0.24-0.47, p < 0.001). A negative correlation between SHBG levels and intertrochanter (IT) and total femur (TL) BMD was found (r = -0.24 and r = -0.22, p < 0.05). After adjusting for age and BMI, SHBG and IGF-I levels were negatively correlated (r = -0.33, p < 0.001). In multiple linear regression analysis independent predictors of bone mass were body weight, SHBG and iPTH levels. The best predictive model accounted for 24-40% of the observed variability of BMD. However, most of the BMD variability was explained by body weight. In conclusion, in our study body weight, SHBG and iPTH levels were predictors of BMD in healthy elderly men.

[Abused children. Role of the pediatrician]. / Niños maltratados. El papel del pediatra.

Child maltreatment, in it's different forms (physical, negligence, Münchausen syndrome by proxy, sexual abuses.), represents an important morbidity cause, especially in the first years of the life. Nowadays, the battered child syndrome includes forms of abuse and different degrees of negligence (moderate, serious and light) in which the physical abuse could be absent. Determination of the forms of abuse, their diagnosis, intervention and prevention, corresponds to multidisciplinary teams, in which the pediatrician has a crucial role.

Niños maltratados. El papel del pediatra / Abused children. Role of the pediatrician

Los malos tratos a los niños, en sus distintas formas, físico, negligencia, síndrome de Münchhausen, abusos sexuales... representan una importante causa de morbilidad, especialmente en los primeros años de la vida. El síndrome del niño apaleado incluye en la actulidad formas de abuso y negligencias moderadas, graves y leves en las que el maltrato físico puede estar ausente. La determinación de las formas de maltrato, su diagnóstico, la intervención y prevención corresponden a equipos multidisciplinarios en los que el pediatra tiene un papel fundamental (AU)