Family planning in Jordan: 1983 survey data

Data from the 1983 fertility survey in Jordan indicate that 26 percent of married women were using contraceptives, reflecting a very small relative increase in use in the seven years before the survey. Only 5 percent of nonusers stated that they desired to use a method. Other data from the same survey suggest a potential demand for contraception, for spacing as well as limiting births, among those not using. For example, many recent pregnancies were reported to be unplanned. Also, among nonusers who did not desire to use a method, many stated they did not desire to become pregnant, yet were exposed to the risk of pregnancy. A pool of potential users exists who can be considered in need of contraception (i.e., fecund, not pregnant or desiring pregnancy, and not using contraceptives)--20 percent of all currently married, childbearing-age women--who may become contraceptive users as attitudes toward contraception change.

Side effects and discontinuation of oral contraceptive use in southern Brazil

The subsequent contraceptive behaviour following reported side effects in users of oral contraceptives in the southern region of Brazil is examined in relation to discontinuation of pill use, changing to other methods, termination of contraceptive use, the role of the physician in influencing a woman's decision to discontinue pill use, and discontinuation according to the type of problem experienced.

In 2904 currently married women, aged 15–44, almost 75% reported that they had used the pill at some time, and of these 45.6% were still doing so. Women who reported problems with the pill were less likely to be current users (25%) than the women who did not (65%). However, overall contraceptive prevalence was about the same in both groups. Women who stop using oral contraceptives are more likely to be using traditional methods than women in the general population, especially if they want more children. Termination of pill use varies little according to the type of problem reported. Women with problems who sought medical attention were more likely to stop using the pill and so were women advised to stop by their physician, but the major factor affecting discontinuation was the reported experience of a problem.

Focal fatty liver lesions in alcoholic liver disease: a broadened spectrum of CT appearances

The CT examinations of 26 consecutive alcoholic patients with focal fatty infiltration of the liver were analyzed. Five different patterns of focal fatty infiltration were noted. In most alcoholic patients these appearances present no diagnostic problem and further confirmation can be obtained by repeating the CT scan within 1-2 weeks to see if interval resolution occurs following enforced abstinence. In select instances, more invasive and definitive procedures such as superselective angiography or liver biopsy may be necessary to differentiate these findings from other more serious diseases they may closely resemble, such as primary or secondary liver neoplasms.

Cesarean delivery in northeast region of Brazil, 1978-80

This study presents information on cesarean section rates for the last baby born to 1,746 women in Northeast Brazil between January 1978 and the date of a 1980 household survey. For hospital deliveries, the c-section rate is 19 per cent. Rates were highest in the major urban areas and lowest in rural areas. Within residence categories, the section rate was related directly to education, early prenatal care, and delivery in private hospitals.

Radiographic and CT demonstration of mammary emphysema

The radiographic and CT appearance of air within the mammary parenchyma is described along with a discussion of the possible routes of dissection of gas from regions of subcutaneous emphysema into the breast tissue.

Contraceptive use in Georgia: estimation by telephone survey

Because household surveys are expensive and time consuming, determination of state or local family planning needs is based on national household survey estimates of contraceptive use rather than state-specific estimates. In June 1982, the University of Georgia Survey Research Center invited the Georgia Department of Human Resources (DHR) to add questions to a Statewide Omnibus Telephone Survey to obtain information on contraceptive use, source of contraception, and reasons for not using contraception. The survey used two-stage random digit dialing to select 1,737 households. From these households, we have complete information on 332 women aged 18 to 44. The definition of contraception included use by either the respondent or partner. Fifty-six percent of female respondents were using contraception; oral contraceptives (22%) and contraceptive sterilization (21%) were the primary methods used. Private sources provided 78% of nonpermanent contraceptive methods. The majority of women not using contraception reported a noncontraceptive sterilization or infertility (31%) or were pregnant, desiring a pregnancy, or not sexually active (29%). The advantages of this method over household surveys are rapid turnaround of data and relatively low cost.

Sterilization in the northeast of Brazil

Results of household surveys carried out in four states in the Northeast of Brazil showed that female sterilization is the most prevalent method among women who want no more children. Many women who indicated an interest in tubal ligation, however, had not been sterilized. Access to sterilization depends on the type of hospital in which the child was delivered and the type of delivery the woman had. Over 60% of the sterilized women reported that they had a tubal ligation at the time they were hospitalized for a cesarean delivery. Compared with unsterilized women, the sterilized women are characterized by relatively higher education levels and a greater likelihood of urban residence and were far more likely to have had cesarean deliveries and, therefore, to have qualified for postpartum sterilization on medical grounds.

Assessment of tissue viability in frostbite by 99mTc pertechnetate scintigraphy

Technetium-99m pertechnetate scintigraphy was performed in the involved extremities of six patients with severe frostbite of the hands (six cases) and feet (one case). There was good correlation between the scintigraphic findings and the extent of deep tissue ultimately requiring surgical resection. Technetium-99m pertechnetate imaging distinguishes viable from dead tissue in frostbite in a simple, noninvasive manner, and findings are easy to interpret. A persistent perfusion defect is seen in nonviable tissue.

Congenital left coronary artery - right ventricular fistula

The case of a neonate with heart failure and myocardial ischaemia due to a large coronary artery fistula is reported. ECG monitoring and Thallium - 201 imaging indicated pre-operative myocardial ischaemia. The diagnosis was confirmed by cardiac catheterization. Successful surgical ligation of the fistula was performed at the age of 10 days and to our knowledge is the first successful ligation in the neonatal period. Follow up Thallium - 201 imaging was normal. Repeat cardiac catheterization demonstrated complete closure of the fistula and normal left ventricular function.

Bacillus stearothermophilus Disc Assay for Detection of Inhibitors in Milk: Collaborative Study

A 2-part (A and B) collaborative study was conducted on a Bacillus stearothermophilus paper disc (12.7 mm) method to detect residual inhibitors in milk. The 18 participating collaborators assayed raw milk samples spiked with a beta-lactam (penicillin G). Of the 18 collaborators, 14 participated in part A and 16 in part B. Part A demonstrated that either Antibiotic Medium No. 4 or PM Indicator Agar is suitable for use in the assay. The lowest concentration detectable, not significantly different from 100% at the α = 0.05 level, was 0.008 unit/mL with either medium. Part B demonstrated that the sensitivity of the method is equal to that of the current AOAC method (16.131- 16.136). The concentration of beta-lactam detected by 50% of the analysts was 0.003-0.005 unit/mL in this study, compared with 0.005 unit/mL reported in an earlier collaborative study on the current AOAC method. No false positive results were reported in part A or part B. All samples found positive by the confirmatory test in part B were correctly identified as a beta-lactam with commercial Penase discs. The lowest concentration detectable by the method, not significantly different from 100% at the α = 0.05 level, was 0.008 unit/mL. The method was adopted official first action.

Impaired antibody-dependent cell-mediated cytotoxicity in cryptogenic fibrosing alveolitis (synonym: idiopathic pulmonary fibrosis)

Mononuclear cells from the blood of 26 patients with the 'autoimmune' connective tissue disorder cryptogenic fibrosing alveolitis (CFA) were examined in Chang cell cytotoxicity assays for their capacity to mediate antibody-dependent cell-mediated cytotoxicity (ADCC). The results showed an impairment for the group by comparison with a group of 45 normal healthy controls (P less than 0.01). The impairment was greater in patients with associated connective tissue disorders of other systems (CFA+CT) than in those having the lung disorder alone (lone CFA); (P less than 0.001). The reduction in ADCC showed a correlation with reducing counts of cells bearing Fc gamma G surface receptors (P less than 0.05), and with increasing levels of soluble immune complexes in the blood of these patients by C1q binding (P=0.05). Non-specific esterase staining indicated that the Fc gamma G rosetting cells were subpopulations of lymphocytes not monocytes. We therefore suggest that the observed ADCC impairment may be due to impairment of lymphocyte Fc receptor function, and we speculate that this may influence immune regulation.

Family planning communications and contraceptive use in Guatemala, El Salvador, and Panama

Recent contraceptive prevalence surveys in Guatemala, El Salvador, and panama included a module on family planning communications. This module provided useful feedback on the reach of each program and facilitated comparisons between countries. While almost all women in El Salvador have been reached by family planning messages, the percentage of women reached was lower in Panama and Guatemala. In all three countries rural, less educated, and unemployed women who worked inside the home or not at all were least likely to have seen or heard the messages. Exposure to family planning communications emerged as a strong correlate of contraceptive use, as shown in two separate analyses. These findings underscore the importance of communications in promoting contraceptive use.

Autoimmune thrombocytopenic purpura in homosexual men

Since November 1980 we have diagnosed 11 cases of severe autoimmune thrombocytopenic purpura in homosexual men; their mean platelet count (+/- SE) was 16 000 +/- 3000/mm3. All patients have been sexually active with multiple partners and exposed to numerous viruses and drugs. During this period, we also have diagnosed 20 cases of classic autoimmune thrombocytopenic purpura in heterosexual persons, with a normal women to men ratio of 3:1. Eight of nine homosexual patients had elevated platelet IgG compared with normal values in eight of 10 homosexual control subjects having normal hemograms (p less than 0.01). All responded moderately or completely to steroids. The three patients who had splenectomy had excellent responses. Four of five patients had a decreased helper/suppressor T cell ratio compared to healthy controls (p less than 0.001). Circulating immune complexes and total gamma globulin levels were elevated and lymphocytes relatively decreased in homosexual patients compared with homosexual controls (p less than 0.05). Thus, some sexually-active homosexual men seem to have an increased incidence of an immune regulation disorder directed against platelets.

Intracranial hypertension during surgery for supratentorial tumor: correlation with preoperative computed tomography scans

To test the hypothesis that preoperative head computed tomography scans could be used to predict the likelihood that a patient with a supratentorial brain tumor would develop intracranial hypertension during surgery before the cranium was opened, intraoperative intracranial pressure and blood pressure records of 60 patients undergoing craniotomy were compared with the appearance of their preoperative computed tomography scans. The scans were interpreted by a neuroradiologist who was unaware of the clinical events in each case. A positive correlation was found between the amount of preoperative brain edema observed surrounding tumors (on an arbitrary 0 to 3 + scale) and subsequent increases in intracranial pressure greater than base line values. No such correlation could be found with regard to tumor size, shift of midline structures, or effacement of the lateral ventricles. When preoperative brain edema seen on computed tomography scan was taken into consideration, increases in intracranial pressure during craniotomy also correlated with simultaneous increases in blood pressure. It is concluded that patients with large amounts of preoperative brain edema surrounding supratentorial tumors should be considered at risk for developing intraoperative intracranial hypertension and may benefit from preoperative insertion of an intracranial pressure monitor before general anesthesia is induced.

Defining legitimate births in Fulton County, Georgia, 1977

In 1977, the parents of 1,043 births recorded for 15 to 19 year old women in Fulton County, Georgia, were classified as married. However, only 36 per cent of these births could be linked with marriage certificates. An analysis of the unlinked birth certificates showed that the overwhelming majority of teenage parents did not appear to be legally married. The absence of a specific statement regarding marital status on birth certificates results in inaccuracies in the reporting of births according to marital status of parents.

Contraceptive use and fertility in the Republic of Panama

Panama has a high prevalence of contraception, with surgical sterilization being the dominant method. Use of contraception is fairly high even in rural areas. Seventy-one percent of users named a public sector source for their contraception. High use of contraception is part of an overall program of public sector maternal and child health services that also shows substantial penetration of rural areas. The high reliance on public sector sources in panama distinguishes it from other Latin American populations with comparable levels of contraceptive use, such as Sao Paulo state, Brazil, and Costa Rica. These populations also differ in that oral contraceptives are the most prevalent method of contraception. The survey results indicate that the risk of unplanned pregnancy is greatest for unemployed married women who have children. It is particularly important to expand program coverage in rural areas, where two-thirds of those at risk of unplanned pregnancies reside; risk of an unplanned pregnancy for rural women is more than twice that for urban women. While unmarried teenage women do not appear to constitute an important group by this definition, there are other compelling reasons, some supported by other results of the survey, for a special effort oriented toward teenagers. The experience of Panama may be unique in many ways. It shows that an integrated MCH-FP public sector program can meet a high demand for surgical contraception and achieve a fairly high level of contraceptive use. Finally, the results illustrate the value of periodic surveys to gauge the impact of public health programs by monitoring trends in contraceptive use, fertility, breastfeeding, and other aspects of reproductive health.

Determinants of fertility in Guatemala

The 1978 Contraceptive Prevalence Survey for Guatemala provides an opportunity to examine fertility levels and a number of determinants of fertility for three broad segments of the country: the Department of Guatemala and, in the remainder of the country, the Ladino and Indian populations. While Ladinos had a much higher rate of contraceptive use than did Indians, the two groups had similar birth rates. The lack of difference in fertility appears to be due to the pattern of prolonged breastfeeding among Indians and perhaps to differences in the rate of conception due to nutrition, coital frequency, or other factors.

Observations on the structure of the subepithelial nerve plexus in the tongue

The intrinsic innervation of the anterior two thirds of the tongue in adult dogs of both sexes was studied in paraffin sections stained with Bodian, Holmes, cholinesterase and other stains. In all the sections, a subepithelial plexus of nerve fibres and cells was always seen on the dorsum of the tongue. Nerve endings were seen extending in between the epithelial cells on the dorsum of the tongue. The nerve cells were usually spindle-shaped and collected to form numerous ganglia in the submucosa. There were other ganglia in the tongue whose structure was very much similar to terminal autonomic ganglia. The significance of the ganglia consisting of biopolar nerve cells is being discussed.

Histocompatibility antigens in asthma: population and family studies

One hundred and twenty-two patients with intrinsic asthma, extrinsic atopic asthma, or asthma with allergic bronchopulmonary aspergillosis were tissue typed for the HLA A, B, and C loci. No associations were found with any of the clinical groups, or with serum total IgE concentrations. Sixty-eight members of 10 families where more than one member was affected by asthma were studied. The segregation of haplotypes in siblings of the propositi who were or were not affected by asthma did not differ from the predicted segregation, and there were no differences when atopy or serum total IgE were considered. No biologically important association between HLA and asthma has been shown.

Neonatal death dwarfism. (A further report)

Seven cases of rare "Neonatal Death Dwarfism" observed recently in three major Children's Hospitals in Australia are reported. These include Diastrophic Dwarfism, Achondrogenesis II, Lethal Form of Hypophosphatasia, Homozygous Achondroplasia, Minor Form of Asphyxiating Thoracic Dystrophy, Achondrogenesis II (?) and Unclassified Lethal Bone Dysplasia. In all the patients the clinical diagnosis was uncertain or incorrect, whereas a conclusive radiographic diagnosis could be made after X-ray examination in all but one of the cases. Skeletal survey should be performed in each case of neonatal death dwarfism.

Contraceptive prevalence in Paraguay

Contraceptive use, source of contraception, history of abortion, current pregnancy intention, and fertility rates are evaluated for a national sample of women using data from the Paraguay Contraceptive Prevalence Survey, conducted in 1977. The survey found that 15.5 percent of all women aged 15--44 and 23.6 percent of ever-married women were using effective contraceptive methods. The urban/rural difference in contraceptive use paralleled fertility differentials: over 40 percent of ever-married women were using contraception in Greater Asuncion and other urban areas compared with 15 percent in rural areas. Overall, the data indicate that high-parity rural women have the greatest need for family planning services in Paraguay.

Antithrombin III deficiency causing postsplenectomy mesenteric venous thrombosis coincident with thrombocytopenia

The most commonly recognized cause of mesenteric venous thrombosis following splenectomy is hypercoagulation secondary to reactive thrombocytosis. A case is reviewed in which hypercoagulation followed splenectomy for idiopathic thrombocytopenic purpura (ITP) in spite of persistent thrombocytopenia. Episodic mesenteric venous occlusion occurred due to antithrombin III deficiency. This hypercoagulable state may be the cause of primary acute mesenteric venous occlusive disease. Symptoms and signs suggesting thrombosis in the portal circulation demand immediate coagulation studies since even in the thrombocytopenic patient thrombotic proglems can occur. Surgical intervention is the treatment of choice for segmental small bowel ischemia; warfarin therapy is indicated when there is evidence of antithrombin III deficiency.