[Reproductive health survey of young adults in greater Santiago]

In 1988 a survey was carried out in order to obtain information on knowledge about reproduction, sexual activity, attitudes, and use of contraceptive methods among residents between 15 and 24 years of age in Greater Santiago. For this purpose, a multistage, self-weighted, non-replacement probability sample was chosen from the entire Santiago urban area. After 2,898 households were visited, 865 women and 800 men were selected and interviewed. For the interview, a questionnaire with 156 questions was developed; many questions were similar to those included in similar surveys in Brazil and Guatemala. The interviewers were professionals who had received prior training. Although 75% of the interviewees had attended sex education classes, they had erroneous ideas on various basic subjects. Sixty-nine percent of the women interviewed had undergone menarche before attending these classes. In addition, 35.4% of the women and 65.0% of the men had had sexual relations prior to marriage, and less than 20% had used any contraceptive method. More than 60% of the interviewees who had children had conceived them before marrying. These findings point up the necessity of offering sex education classes for children and young people, as well as facilitating their access to family planning services, in order to decrease the number of illegitimate and unwanted children that are born in Chile.

Developmental regulation of sialoadhesin (sheep erythrocyte receptor), a macrophage-cell interaction molecule expressed in lymphohemopoietic tissues

Stromal macrophages in lymphohemopoietic tissues express novel macrophage-restricted plasma membrane receptors involved in nonphagocytic interactions with other hemopoietic cells. One such receptor with lectinlike specificity for sialylated glycoconjugates on sheep erythrocytes and murine hemopoietic cells has been characterized immunochemically and termed sialoadhesin. We have examined sialoadhesin expression during mouse development to learn more about its regulation and function. Immunocytochemical, rosetting, and Western blot studies show that sialoadhesin is first detected on fetal liver macrophages on day 18 of development, 7 days after numerous F4/80+ macrophages are found within erythroblastic islands. In spleen and bone marrow, sialoadhesin appears between day 18 and birth, in parallel with myeloid development. Strongly labeled macrophages in the marginal zone of spleen, characteristic of adult lymphoid tissues, appeared gradually between 1-4 weeks after birth, as the white pulp became enlarged. Isolation of fetal liver macrophages at day 14 confirmed that sialoadhesin was not involved in the binding of erythroblasts, which is mediated by a distinct cation-dependent receptor (Morris et al., 1988, p. 649). Sialoadhesin could be expressed by isolated fetal liver macrophages after cultivation in adult mouse serum, a known source of inducer activity, but was not dependent on the presence of this inducer, unlike adult-derived macrophages. Fetal plasma contained inducing activity on day 13, but adult levels were not reached until 2 weeks postnatally. These studies show that sialoadhesin is differentially regulated compared with the erythroblast receptor and F4/80 antigen, that it is not required for fetal erythropoiesis, and that its induction on stromal macrophages is delayed until the onset of myeloid and lymphoid development. Sialoadhesin provides a marker to study maturation and functions of macrophages during ontogeny of the lymphohemopoietic system.

Heterogeneity in lymphokine profiles of CD4+ and CD8+ T cells and clones activated in vivo and in vitro

Analysis of lymphokine mRNA expression and protein secretion by about 100 short-term alloreactive T-cell clones revealed marked heterogeneity in the combinations of lymphokines synthesized. This finding argues against a simple model in which T cells express either an unrestricted (Th0) or a restricted (Th1 or Th2) lymphokine profile. Lymphokine titers appeared to be normally distributed, with the percentage of positive clones for any one product determined by the threshold of detection. Accordingly, the observation that CD4+ clones on average produced higher titers of most lymphokines than CD8+ clones indicated that apparent differences between the lymphokine profiles of these two subsets were quantitative rather than qualitative. Patterns of lymphokine gene expression detected in whole tissues or by analysis of single cells and clones were markedly influenced by in vivo priming. Relative levels of expression of IL-4, IFN-gamma and GM-CSF in lymphoid tissues differed in mice undergoing a GvHR or following contact sensitization with OX or immunization with KLH in adjuvant. Consistent with the finding that IL-4 was the major lymphokine mRNA detected in lymph nodes of KLH-primed mice, most short-term KLH-specific clones derived from such mice also expressed IL-4. A similar approach to the detection of lymphokine-secreting T-cell precursors activated late in L. major infection showed that most clones from the L. major-resistant strain, C57BL/6, secreted IFN-gamma without IL-4 whereas most clones from the susceptible strain, BALB/c, secreted IL-4 without IFN-gamma. Differences were also noted in anti-CD3-induced IL-3 production at the single-cell level between CD8+ cells activated in the GvHR or against a tumor allograft. Con A-induced, filler cell-dependent cloning of CD4+ T cells from unprimed mice gave rise both to IFN-gamma-producing and to IL-4-producing clones. A requirement for an undefined, filler cell-dependent signal for development of IL-4-secreting clones was suggested by the finding that clones of normal CD4+ and CD8+ T cells activated in an anti-CD3-induced, filler cell-free system exclusively produced IFN-gamma and IL-3 without detectable IL-4 or IL-6. With a view to developing a single-cell approach to the analysis of lymphokine profiles of in vivo-activated T cells, sensitive assays for IL-3 and other lymphokines were used to measure secreting cells activated in the GvHR or against a tumor allograft.(ABSTRACT TRUNCATED AT 400 WORDS)

Macrophages in haemopoietic and other tissues of the developing mouse detected by the monoclonal antibody F4/80

Macrophages are widely distributed in lymphohaemopoietic and other tissues of the normal and diseased adult, where they play an important role in host defence and repair. Although the development of haemopoiesis has been well studied in several species, the ontogeny of the mononuclear phagocyte system remains poorly understood. We have used a highly specific mAb, F4/80, to examine the distribution of mature macrophages in the developing mouse, with special reference to their presence in the haemopoietic microenvironment. Monocytes and macrophages were first seen in embryos on day 10 in the yolk sac and liver as well as in mesenchyme. In liver, spleen and bone marrow, there was expansion of this population associated with the initiation of haemopoiesis on days 11, 15 and 17, respectively. Macrophages in these sites formed part of the haemopoietic stroma and their extensively spread plasma membrane processes could be seen making intimate contacts with clusters of differentiating haemopoietic cells. F4/80+ cells were widely dispersed in undifferentiated mesenchymal tissue in organs such as lung, kidney and gut. Numbers of F4/80-labelled cells increased concomitantly with organ growth and local mitoses were evident, as well as actively phagocytic macrophages. Our studies establish that macrophages are among the earliest haemopoietic cells to be produced during development and that they are relatively abundant in fetal tissues in the absence of overt inflammatory stimuli. Their distribution is correlated with the sequential migration of haemopoiesis and they constitute a prominent component of the stroma in fetal liver, spleen red pulp and bone marrow. Apart from a role in haemopoietic cellular interactions, their highly developed endocytic and biosynthetic activities suggest that macrophages contribute major undefined functions during growth, turnover and modelling of fetal tissues.

Expression of a divalent cation-dependent erythroblast adhesion receptor by stromal macrophages from murine bone marrow

Stromal macrophages in haemopoietic organs express novel surface receptors that are implicated in trophic interactions with developing blood cells. Macrophages isolated from foetal liver bind erythroblasts (Eb) by a divalent cation-dependent receptor (EbR), whereas stromal macrophages in adult bone marrow and lymphoid organs express a lectin-like receptor, sialoadhesin, which interacts with sialylated structures on sheep erythrocytes and murine haemopoietic cells. In order to learn more about the regulation of these haemagglutinins, we examined binding of Eb by stromal macrophages that had been isolated from adult murine tissues or generated in Dexter-type cultures of bone marrow. Macrophages were purified from bone marrow by collagenase digestion, adherence to a substratum and detachment of clustered haemopoietic cells, and tested for their ability to bind Eb from foetal liver or anaemic adult spleen. Freshly isolated bone marrow macrophages bound Eb mainly by a divalent cation-dependent activity that was not inhibited by neuraminidase treatment of Eb or by specific anti-sialoadhesin monoclonal antibodies, although these macrophages express sialoadhesin and Eb bear a potential ligand for this receptor. Macrophages obtained by digestion from other adult lymphoid tissues also bound Eb by a divalent cation-dependent activity, whereas blood monocytes and lavaged peritoneal macrophages failed to do so. Peritoneal macrophages could be induced to express high levels of sialoadhesin by cultivation in homologous mouse serum, but such macrophages did not acquire sialoadhesin-independent EbR activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical management of the cardiovascular complications of the Marfan syndrome

The Marfan syndrome is an autosomal dominant disorder of connective tissue with manifestations throughout the body. Diagnosis is based on the cardinal effects on the skeletal, ocular, and cardiovascular systems. Long limbs and digits, thoracic cage deformity, dislocation of the ocular lens, mitral valve prolapse, and dilatation of the aortic root are typical signs. Before recent advances in management, valvular regurgitation and aortic dissection accounted for over 90 percent of deaths, often in the third through fifth decades of life. Echocardiography, introduced nearly 2 decades ago, and the recent enhancements of cardiovascular Doppler techniques have greatly improved the ability of identifying patients with Marfan syndrome and following their clinical courses. Cardiovascular surgery has progressed over the same period to provide Marfan patients relatively safe approaches to repair of the life-threatening complications, and surgery should be offered prophylactically. The ability to intervene effectively in the Marfan syndrome requires a clear understanding of its natural history throughout life. This review discusses the clinical course and current management of the cardiovascular complications of the Marfan syndrome in children, young adults, and women considering pregnancy. These approaches have relevance to valvular and aortic problems found in the general population.

Congenital ossifying fibroma (osteofibrous dysplasia) of the tibia--a case report

Ossifying fibromas of the long bones of the leg are benign lesions occurring in the pediatric age group identical in histological appearance to the similarly named tumor of the jaw in adults. Most frequently presentation occurs after minor trauma with symptoms of a swelling of the tibia or fibula which may be painful. Pathological fracture or limp are also occasional presentations. Congenital cases are extremely rare. We describe an otherwise normal male neonate who presented at birth with a bowed right lower leg. The limb was 1 cm shorter than the other side, with tibia vara and a firm mass situated anteriorly. X-ray showed a mixed lytic and sclerotic lesion in the proximal metaphysis of the tibia. Biopsy showed collagenous stroma containing spindle cells and irregular trabeculae of woven bone rimmed by plump osteoblasts. As the appearances were typical of an ossifying fibroma (osteofibrous dysplasia) no surgical treatment was given. The patient was well with no growth of the tumor and with radiological evidence of healing at 1 year follow up. This case is presented to draw attention to the clinicopathological features of this unusual lesion which must be considered in the differential diagnosis of congenital lesions of the tibia.

[Reproductive health survey in young adults: sexual experience and use of contraceptives in Santiago, Chile]

A self weighted, 2 stage probability sample of households in greater Santiago was obtained to select women and men between 15 and 24 years of age in order to obtain information about knowledge of sexual aspects, sexual activity and use of contraception. 35% of females and 65% of males declared to have had premarital sexual intercourse. Mean age at first premarital coitus was 18 and 16 years for women and men, respectively. Partners were 3.5 years older for females and 2.5 years older for males. A steady boy friend was the most common first sexual partner for females. Only 20% of women and 19% of males used contraception at first coitus. Rhythm, pills and withdrawal were the most commonly used methods. Less than 4 coituses in the 2 months preceding the survey were declared by 75% of subjects. All women declared themselves monogamous; 8% of males acknowledged more than one sexual partner in the last month.

Fertility and family planning in Jordan: results from the 1985 Jordan Husbands' Fertility Survey

The 1985 Jordan Husbands' Fertility Survey (JHFS) was designed to assess husbands' attitudes and behavior toward fertility and family planning. The 1985 JHFS was a follow-up survey to obtain data from husbands of women who were currently married in the 1983 Jordan Fertility and Family Health Survey (JFFHS). The results from the 1985 JHFS point to the usefulness of collecting fertility and family planning information from husbands. These findings showed that nearly 40 percent of the husbands do not believe in practicing contraception, and more than 50 percent of the husbands report that family size should be "up to God." How program officials address these issues will be important for the future success of the family planning program in Jordan.

Rare, primary iliac, pubic and ischial tumours in children (report of 14 cases)--Part II

14 cases of rare, primary iliac, pubic and ischial bone tumours or tumorous conditions are reported. These include aneurysmal bone cyst, eosinophilic granuloma, cavernous haemangioma, osteoid osteoma, fibrous dysplasia, fibrous dysplasia with sarcomatous degeneration, chondrosarcoma, lymphoma and atypical malignant histiocytosis. The possibilities to be considered in the accurate radiographic recognition of primary tumours of iliac, pelvic and ischial bones are discussed.

Primary bone tumours of the pelvis in childhood--Ewing's sarcoma of the ilium, pubis and ischium (report of 30 cases). (Part I)

30 children with Ewing's sarcoma, the most common malignant pelvic tumour in childhood, were analysed. The diagnosis of Ewing's sarcoma is relatively easy and can be established in most of the cases on plain radiography. The diagnostic radiographic features of the tumour are discussed. The two most important conditions in differential diagnosis are eosinophilic granuloma and the rare primary bone lymphoma. Osteomyelitis should rarely cause confusion unless the clinico-radiographic findings are not properly evaluated.

Primary rib tumours in children (report of 27 cases with short literature review)

27 cases of primary malignant and benign rib tumours are reported. The most common malignant rib tumour in childhood is Ewing sarcoma (20 cases). Some other rare bone tumours and tumorous conditions (reticulosarcoma, aneurysmal bone cyst, monostotic rib eosinophilic granuloma, osteoid osteoma and lymphangioma) are also described. In the authors' opinion Ewing sarcoma presents with characteristic clinico-radiographic findings in most of the cases. Other monostotic, primary rib tumours and tumorous conditions in childhood--with the exception of exchondroma and enchondroma--rarely show diagnostic radiographic features.

Congenital cystic adenomatoid malformation of the lung. Presentation of 16 cases

Congenital cystic adenomatoid malformation (CCAM) of the lung is one of the rarest causes of neonatal distress. The principal radiological sign of CCAM is an intrapulmonary mass of soft tissue density, containing cystic areas of different sizes and shapes. The mass usually compresses the rest of the affected lung and displaces the mediastinum and heart to the opposite side, compressing the lung which is often therefore hypoplastic. If CCAM is diagnosed in utero by ultrasound, the treatment of choice is surgery as soon as possible after birth, with good survival rates. Sixteen cases of CCAM are presented, one with bilateral disease, diagnosed at different times, and one with an associated prune belly syndrome, to be added to the 405 already reported in the literature, and their clinical, radiological and pathological features are described.

Peripheral dysplasia. Report of a new genetic syndrome

A new, dominantly inherited form of peripheral dysplasia in three members of an Algerian family is reported. Two further individuals, not investigated, are also probably affected. The disease is characterised by distinctive clinico-radiological findings. A case of acromesomelic dysplasia of Maroteaux is also reported and the differential diagnosis of peripheral dysplasias is discussed.

Spontaneous perforation of the common bile-duct in the neonate: imaging and treatment

The presence of bile in the peritoneal cavity and obstructive jaundice without liver derangement in the neonatal period is pathognomonic of spontaneous perforation of the bile-ducts. These features can be demonstrated preoperatively with ultrasound, nuclide imaging and liver function tests, without recourse to paracentesis, and the risk of contaminating the bile ascites. Furthermore, the presence of isotope in the general peritoneal cavity will exclude the diagnosis of a choledochal cyst so that jejunum should not be anastamosed to the 'false capsule' of a spontaneous perforation.

Skeletal age estimation in leg length discrepancy

Sixty hand radiographs of children with known leg length discrepancy were reported independently in a "blind" manner by four radiologists using the Greulich and Pyle Atlas. Significant variation was found. Fifty percent of the children were assigned a skeletal age that differed by more than 1 year between radiologists; 10% varied by more than 2 years (p less than 0.05). Female skeletal age was considerably underestimated by an average of 11 months. Skeletal age estimation is one source of error in the timing of surgery for leg length equalization, especially when a single estimate is used. Skeletal age also appears to be more variable in children with leg length discrepancy.

Contraceptive use and fertility in Paraguay, 1987

In 1987, 38 percent of married Paraguayan women aged 15-44 were practicing contraception, with oral contraceptives being the most prevalent method. Fertility rates for the population were at corresponding levels, with an overall fertility rate of 5.4 births per woman. Fertility has not changed substantially for the nation as a whole since 1979, and contraceptive use has increased by only 6 percentage points. Findings from the present study are consistent with the lack of a public sector family planning program in the country. Pharmacies are the principal source of contraceptives in the country. Twenty-two percent of all women and one-third of married women are at risk of having an unplanned pregnancy. The greatest impact on contraceptive use can be made if new and continued program efforts focus n the interior of the Oriental region of the country.

Serum immunoglobulins and immunoglobulin G subclasses in cystic fibrosis related to the clinical state of the patient

Levels of serum immunoglobulins and immunoglobulin G subclasses were measured in 32 cystic fibrosis (CF) patients, 30 asthmatics and 27 controls. When compared with the asthmatic patients and controls, the CF patients had raised levels of all IgG subclasses as well as total IgG, IgM and IgA, but there was not a statistically significant increase in IgE. The levels of immunoglobulins in the CF patients were examined in relation to the clinical features of the disease. Raised levels of IgG4 were related to levels of IgE, but these raised levels of IgG4 appeared to be part of a general increase in total IgG and not an isolated feature. There was a significant correlation between the total IgG level and its subclasses, IgG1, IgG2, IgG3, IgG4 and IgA. IgG1 was significantly correlated with IgG2 and IgG4; IgG2 with IgG4; and IgG4 with IgE. Total IgG was the immunoglobulin most closely correlated with poor lung function. Serum IgA was higher in patients with positive immediate skin prick reactions to pollens (p less than 0.005) and death within two years of the study was related to high levels of total IgG (p less than 0.01), IgG3 (p less than 0.001), IgA (p less than 0.001), and IgE (p less than 0.005).