[Continuing medical education at a referral hospital. Quo vadis?].
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Education, Medical, Continuing↗
Biomedical subjects
J Gracia Romero
Publications and source records attributed to J Gracia Romero.
[Fertility survey. Approximation to normal values].
OBJECTIVE: To determine the fertility data in Aragón, Spain. METHODS: A survey was conducted in several companies during 1997 and 1998. Participation in the survey was optional, participants were not identified and a table of random figures was utilized. Error 2 +/- 2.98, 95% confidence interval, P = Q = 50%. RESULTS: 139 employees participated in the survey; 94% were male, 6.4% were single, 87.7% married, 5.7% had a stable partner, 12.3% had higher level, 53.6% medium and 34% elementary level education. Mean number of children per couple was 1.7 and mean number of children desired was 1.9. Mean time from decision to have children to pregnancy was 4.5 months. Mean age at conception of the first child was 28 years for the men and 25 years for the women. One of the partners was employed in 42.7% of the cases. Mean working hours was 8.3 and mean number of years in the same job was 14.5. Twenty-one percent considered they were exposed to toxic substances. Mean hours of sleep was 6 hours, 35% took warm baths and 24.4% used tight-fitting underclothes. Ninety percent drank alcohol and/or coffee mild to moderately and 50% were smokers. No significant differences were found in the number of children according to level of education, type of work or if one of the partners or both were employed. A clearly negative correlation was found between the year of birth and the number of children desired. CONCLUSION: In Aragón, the birthrate trend remains low and does not appear to be influenced by the economic level, life style, type of job or whether or not both partners are employed.
Adult↗
[An experimental study on the effects of maternal hyperphenylalaninemia on the central nervous system and behavior of offspring rats].
OBJECTIVE: This work attempts to study the cerebral alterations in rat offspring of hyperphenylalaninemic mothers, as well as the possibility of preventing them by means of administration of dietetic supplements of valine, leucine and isoleucine during the pregnancy. PATIENTS AND METHODS: An experimental study in two consecutive pregnancies of 18 Wistar rats was carried out. The first pregnancy serves as the control group. In the second pregnancy, an experimental hyperphenylalaninemia was provoked by means of injection of phenylalanine and chlorophenylalanine (phenylalanine-hydroxylase inhibitor). In half of the mothers during the second pregnancy the diet was supplemented with branched-chain amino acids. In the offspring rats, a histological cerebral study was performed (conventional electron microscopy and study of synaptosomes). A behavioral study (T-water maze) was also performed at birth and on the 35th and 65th days of life. RESULTS: The offspring of the group submitted to hyperphenylalaninemia were microcephalic (p = 0.0003) and had fewer synaptosomes that had a larger surface area (p = 0.0081 in newborn rats, p = 0.0028 on the 35th day of life) and of a more immature aspect (less vesicular content). In addition, alteration in the myelinization were detected. In the behavior test (65th day of life), the offspring of the mothers with hyperphenylalaninemia make significantly more mistakes (p = 0.0167) and they needed more time for their resolution (p = 0.059). None of these alterations could be prevented by the administration of supplements of branched-chain amino acids to the mother. These supplements resulted in a higher fertility rate, but this action results in affected young rats, so their administration seems to be counter-productive.
Amino Acids, Branched-Chain↗
[Clinical and anatomopathological study of the contralateral tests in the unilateral cryptorchidism].
We have operated on 2204 cryptorchid testis between 1972 and 1995. We took pathological specimens, not only in the undescended testis but also in the normally descended contralateral testis in 122 children. Clinical, surgical and anatomopathological records were reviewed. Moreover, we have studied the spermiograms in 10 young men. We found the Tubular Fertility Index (TFI) was abnormal in 37% of the contralateral testis. In 5 cases we didn't find germinal line. The Tubular Diameter was abnormal in 6.5% of the contralateral testicles only. When we compared the anatomopathological records in the contralateral testis depending on the surgical age and the surgical location of the undescended testis, we didn't find significant differences. When we studied the spermiograms in the 10 young men we obtained some cases where the TFI and the spermiogram were discordant. In conclusion, more than 1/3 of the children with unilateral undescended testis have an abnormal TFI in both testis. Moreover, neither the surgical age nor surgical location of the undescended testis have an influence on the contralateral TFI. Finally, according to the spermiogram results we should question TFI as a fertility index.
Adolescent↗
[Fecundity following prepubertal orchiopexy in unilateral cryptorchism. Experimental study].
Study of fecundation ability following unilateral experimental cryptorchism as a function of the timing of orchiopexy. Two groups of 45 Wistar rats underwent unilateral mechanical cryptorchism and early and late prepuberal posterior orchyopexy, respectively. A third group of 45 rats underwent a dummy intervention. Mating taking place in subgroups of 15 animals at different ages showed that in the experimental animal, and therefore in any non-dysgenetic test, orchiopexy performed at the prepuberal period allows preservation of fecundation ability.
Animals↗
[Dog bites in children. Epidemiologic and clinical study of 144 cases].
We have done a prospective study of 144 cases of dog bites in children between 1 and 13 years of age that were attended at the Emergency Department of the "Miguel Servet" Children's Hospital of Zaragoza over a period of 30 months. The average child is an 8 year old boy who is bitten at 4 p.m. in the lower limbs by a dog belonging to either the family, a neighbor, or to some friends. The dog of unknown breed and the German shepherd are those most frequently involved (39.5% and 22.2%, respectively). There is a low incidence of infection (4.8%). The attacks were provoked by petting in 52.7%; therefore, we recommend not to get close to the animals even if they are known. In our area, 83.3% of the children are correctly vaccinated. Finally, we compare our results with other studies and we suggest that it is of great interest to establish measures in order to reduce the incidence of dog bites.
Adolescent↗
[Experimental cryptorchism in the Wistar rat].
Experimental cryptorchidism was performed on Wistar rats, fixing the left testicle into the peritoneum for a month. Animals under study (84) were divided into four groups: control, control treated with hCG, cryptorchid and cryptorchid treated with hCG. Cryptorchid testes were biopsied at three, five and eight months and all were excised at 12 months. Cellular counts on spermatogonia, young and late spermatocytes, Sertoli cells and vacuolized Sertoli cells, together with the slough tubular and germinal cell percentage and the tubular diameter, let us affirm by means statistical studies (ANOVA, Chi square) that a testes recovering is already shown at the age of five months, although this recovering still differs from the one shown in the control groups.
Animals↗
[A new clinical evaluation scale for incontinence: its use in anorectal atresias].
We present a clinical scoring system to obtain a quantitative and accurate assessment of anorectal incontinence. We evaluate ten components, each of one is pointed between 0 and two, then overall incontinence punctuation (I.P.) is between 0 and 20. Variables define clinical data relative to patient's intestinal habits and hygienic methods, voluntary control degree of defecation and repercussion of patient's incontinence in social and physical capabilities. Punctuation lower than nine concerns to a poor continence; It is fair between nine and 14 points and 15 or higher punctuation indicates a good continence mechanism. This incontinence punctuation method (I.P.) has been applied to 23 patients, aged between two and 17 years, operated because high imperforate anus by PSARP procedure in 15 cases and by abdomino-perineal pull-through according to Romualdi-Soave technique in eight cases. We found statistic significative difference between the group of patients aged less than 5 years and the group aged between 5 and 10 years. There is not statistic significative differences between the two procedures used in surgical treatment, although I.P. is slightly higher in cases operated by PSARP procedure than in cases treated with Romualdi-Soave technique, when we compare the two groups with similar mean age.
Adolescent↗
[Epididymo-testicular disjunction. Presentation of 23 cases and review of the literature].
Twenty three cases of alterations of the epididymis-testicular union found in 1,000 children with cryptorchism are discussed. Anatomical and pathological findings are described and world literature on the subject is reviewed, finding very scanty references to this problem in spite of the fact that expected incidence of epididymis testicular non-junction is between 1 and 2% of the patients with cryptorchism.
Child↗
[Analysis of mortality in myelomeningocele].
Authors present a study of 84 patients with myelomeningocele between years 1971 to 1985. They analyze morbimortality related to level and condition of the lesion, Lorber's selection criteria and treatment received. They find better survival in females and in patients in whom surgical closure of the lesion was carried out without variations if one Lorber's criteria is present. The moment of operation did not change survival and was not related with development of hydrocephaly.
Adolescent↗
[Intestinal invagination: 12 years of experience].
One hundred and forty two cases of intussusception were treated in our hospital since 1970 to 1982. Patients were divided for analysis into two groups, each consisting of 71 consecutively treated patients. In the second group (1977-1982) the hydrostatic pressure reduction was attempted under general anaesthesia an was successful in 50% of the patients. We compare both groups from the point of view of hydrostatic pressure reduction and conclude that anaesthesia significantly reduces the number of surgical procedures in children with intussusception.
Adolescent↗
[Anesthesia in intestinal invagination].
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Adolescent↗