Sickle cell disease in the People's Republic of Angola. 1. Epidemiology and clinical aspects

In a period of 6 years 819 children affected with drepanocytosis (S. E.) were treated at the children's clinic in Luanda. At the time of diagnosis the age of the 457 boys amounted to 3.4 +/- 2.7 years and that of girls to 4.3 +/- 3.4 years. The age distribution shows that 40.2% of the patients were in their first 2 years of life. Conditions of crisis which affected 70% of the diseased children are typical of this disease. The family anemnesis demonstrated that 13.6% of all brothers and sisters covered were HbSS positive. 34.1% of them died at an age of 3.5 +/- 3.5 years (boys) or 2.4 +/- 2.3 years (girls) respectively. The physical development measured in the body mass shows that it is significantly diminished in comparison with healthy children of the same age. The characteristic symptom of this disease, splenomegaly, existed in 27.8% of the children with a mean age of 2.8 +/- 2.3 years. In one age group of 4.4 +/- 2.6 years it could even be identified in 11.3% of the cases.     

Management of women at increased risk for breast cancer: preliminary results from a new program

OBJECTIVE: To examine the characteristics of malignant tumours that develop in women undergoing surveillance for increased risk for breast cancer and to identify presentation patterns in order to determine the respective roles of mammography, clinical breast examination (CBE) and breast self-examination (BSE). SETTING: Breast Diagnostic Clinic and Familial Breast Cancer Clinic at Toronto-Sunnybrook Regional Cancer Centre. PARTICIPANTS: A total of 1044 women evaluated for breast cancer risk from Oct. 1, 1990, to Dec. 31, 1996, of whom 381 were categorized as being at high risk, 204 as being at moderate risk, 401 as being at slightly increased risk and 58 as being at no appreciably increased risk. PROGRAM COMPONENTS: Comprehensive review and discussion of risk factors, clinical assessment, surveillance recommendations that include mammography, CBE and BSE, genetics consultation (Familial Breast Cancer Clinic) and psychosocial support. Data are captured prospectively, updated at each visit and audited every 3 to 6 months. PROGRAM OUTCOMES: During the study period breast cancer was diagnosed in 24 patients, 12 in the high-risk group, 4 in the moderate-risk group and 8 in the group at slightly increased risk. The mean age at diagnosis was 47 (range 32 to 82) years. Ten cases of cancer were diagnosed during surveillance (incident cancer), 5 in women under age 50. The mean length of time from initial assessment to diagnosis was 28.6 (range 12 to 51) months. Of the 24 women, 17 reported a family history of breast cancer. The mean age at diagnosis in this cohort was 45.5 years, and the diagnosis was made under age 50 in 10 patients (59%). The mean earliest age at which breast cancer was diagnosed in a family member was 42.5 years. CONCLUSIONS: These preliminary results suggest that surveillance of women at increased risk for breast cancer may be useful in detecting disease at an early stage. The regular performance of mammography, CBE and BSE appears necessary to achieve these results.     

Adult outcome of normal children who are short or underweight at age 7 years.

OBJECTIVES--To evaluate the adult growth outcome (at age 23) of children who are short or underweight at age 7 years in whom no identifiable pathological cause exists for their poor growth. DESIGN--Longitudinal follow up of a birth cohort. SETTING--The national child development study (1958 birth cohort) of Great Britain. SUBJECTS--523 children with a height or a weight below the fifth centile at age 7. Of these, 70 (13.4%) were excluded because they had a longstanding illness that could account for their poor growth. The remaining 453 subjects, who were followed to age 23, provided the base group from which those with additional data, such as parental height, were obtained. RESULTS--55/174 (31.6%) boys who were short at age 7 became short men; 60/211 (28.4%) girls who were short at age 7 became short women. Among boys who were underweight at age 7, 46/160 (28.7%) were still underweight at age 23, while 61/200 (30.5%) girls underweight at age 7 became underweight women. Having short parents did not increase the probability of being small as an adult. Children with delayed puberty were as likely to remain small as those in whom puberty was not delayed. CONCLUSIONS--One in three normal children who was short or underweight at age 7 became a short or underweight adult. This informs the management of short children and may be valuable when prolonged growth hormone treatment for short stature is being considered.     

Five-year survival of women with breast cancer in northern Alberta.

Five-year survival rates for all 519 women with breast carcinoma in northern Alberta in 1971 and 1972 were analysed with the use of data from the computerized northern Alberta breast registry and the Alberta cancer registry. The relative 5-year survival was 73%, which is higher than most rates reported from other centres. Lymph node involvement was significant as a prognostic factor, with the relative 5-year survival falling from 92% in the group without lymph node involvement to 58% in the group with three or more involved nodes. The prognosis was also significantly affected by the stage of the disease according to the 1973 TNM classification: the 5-year survival rates ranged from 88% for patients with stage 1 disease to 17% for those with stage IV disease. Women 40 to 59 years of age had a higher survival rate (79%) than those under 40 years (65%) or over 60 years (66%) of age. Analyses by 5-year age groups showed that women 35 to 39 years old had a particularly poor survival rate (59%). Postmenopausal women less than 55 years old had a higher survival rate than did perimenopausal or premenopausal women in the same age group. Further follow-up is indicated to correlate possible high-risk factors with survival.     

Mammographic screening and mortality from breast cancer: the Malm? mammographic screening trial.

STUDY OBJECTIVE--To determine whether mortality from breast cancer could be reduced by repeated mammographic screening. DESIGN--Birth year cohorts of city population separately randomised into study and control groups. SETTING--Screening clinic outside main hospital. PATIENTS--Women aged over 45; 21,088 invited for screening and 21,195 in control group. INTERVENTIONS--Women in the study group were invited to attend for mammographic screening at intervals of 18-24 months. Five rounds of screening were completed. Breast cancer was treated according to stage at diagnosis. END POINT--Mortality from breast cancer. MEASUREMENTS AND MAIN RESULTS--All women were followed up and classed at end point as alive without breast cancer, alive with breast cancer, dead from breast cancer, or dead from other causes. Cause of death was taken from national mortality registry and for patients with breast cancer was validated independently. Mean follow up was 8.8 years. Altogether 588 cases of breast cancer were diagnosed in the study group and 447 in the control group; 99 v 94 women died of all causes and 63 v 66 women died of breast cancer (no significant difference; relative risk 0.96 (95% confidence interval 0.68 to 1.35)). In the study group 29% more women aged less than 55 died of breast cancer (28 v 22; relative risk 1.29 (0.74 to 2.25)). More women in the study group died from breast cancer in the first seven years; after that the trend reversed, especially in women aged greater than or equal to 55 at entry. Overall, women in the study group aged greater than or equal to 55 had a 20% reduction in mortality from breast cancer (35 v 44; relative risk 0.79 (0.51 to 1.24)). OTHER FINDINGS--In the study group 100 (17%) cancers appeared in intervals between screenings and 107 (18%) in non-attenders; 51 of these women died from breast cancer. Cancers classed as stages II-IV comprised 33% (190/579) of cancers in the study group and 52% (231/443) in the control group. CONCLUSIONS--Invitation to mammographic screening may lead to reduced mortality from breast cancer, at least in women aged 55 or over.     

Incidences of breast cancer throughout long-term hormone replacement therapy

OBJECTIVE: To report the main incidences related to diagnosis of breast cancer in a randomly selected cohort population of women treated with conjugated equine estrogens (CEE), always in conjunction with the opposed progestin, medroxy progesterone acetate (MPA) throughout prolonged oral administration. MATERIAL AND METHODS: One hundred and seventy-eight women were subsequently studied before and during the treatment (cohort study). The profile of studied patients included family and personal histories, gynecological and breast examinations, basal hormonal levels, bone mass concentration (BMC) as well as total cholesterol levels and their fractions. The usual clinical cut off age was applied at the beginning of treatment according to following criteria: (a) women less than 60 years old (91.60%), and (b) women more than 60 years old (8.40%), by assuming that a primary protective effect of HRT might be lost or diminished after surpassing this age threshold. In all the treated women were thoroughly advised about the importance of diet, exercises and self-determination. Both oral CEE 0.625 mg/daily and either 2.5 mg/daily or 5 mg/daily of MPA were administrated in accordance with The American Fertility Society Meeting after 1995 (Seattle) recommendations, following two patterns: (1) cycles or perimenopausal women: from days 1 to 25, and (2) postmenopausal women, from Monday to Friday. No other specific treatments were prescribed. Statistical analysis was performed by using SPSS 12.0 and G-stat 2.0. RESULTS: Evaluation of basal hormonal levels, BMC, cholesterol levels and their fractions were not included in the current study. Data from the statistical analysis of 178 treated women were as follow: mean duration of treatment 8.06 years for all women; in the younger age group 7.97, and in the older age group 9.04. Total of 1405.5 woman-years of follow-up, 119 women for more than 5 years (66.85%), and more times (68.18%) with CEE plus MPA 5 mg/daily regime. Dropouts occurred in 34 women (19.10%). Main incidences: no deaths occurred during the treatment. Four cardiovascular events (2.24%) were reported. No spontaneous bone fractures were documented. Nonetheless, there were 11 bone fractures of traumatic origin (6.17%), none of them hip fractures. Four breast cancer. Likewise, one diagnosis of breast cancer in each of 45 treated women from our series was evidenced. One hundred and twenty-one women (67.97%) without incidences. COMMENTS: In our cohort study advices on diet, exercises and self-determination were reinforced for 1405.5 woman-years of follow-up. Combined CEE plus MPA for more than 5 years are no more risk related to breast cancer and cardiovascular events versus shorter treatments. Long-term CEE plus MPA were well tolerated and we did not find statistical evidence which would allow deducing higher rates of morbidity in those entities. Likewise, no deaths were document during the treatments.     

Reproductive pattern,perinatal mortality,and sex preference in rural Tamil Nadu,south India: community based,cross sectional study.

OBJECTIVES: To study reproductive pattern and perinatal mortality in rural Tamil Nadu, South India. DESIGN: Community based, cross sectional questionnaire study of 30 randomly selected areas served by health subcentres. SETTING: Rural parts of Salem District, Tamil Nadu, South India. SUBJECTS: 1321 women and their offspring delivered in the 6 months before the interview. MAIN OUTCOME MEASURES: Number of pregnancies, pregnancy outcome, spacing of pregnancies, sex of offspring, perinatal and neonatal mortality rates. RESULTS: 41% of the women (535) were primiparous; 7 women (0.5%) were grand multiparous (> 6 births). The women had a mean age of 22 years and a mean of 2.3 pregnancies and 1.8 live children. The sex ratio at birth of the index children was 107 boys per 100 girls. The stillbirth rate was 13.5/1000 births, the neonatal mortality rate was 35.3/1000, and the perinatal mortality rate was 42.0/1000. Girls had an excess neonatal mortality (rate ratio 3.42%; 95% confidence interval 1.68 to 6.98; this was most pronounced among girls born to multiparous women with no living sons (rate ratio 15.48 (2.04 to 177.73) v 1.87 (0.63 to 5.58) in multiparous women with at least one son alive). CONCLUSIONS: In this rural part of Tamil Nadu, women had a controlled reproductive pattern. The excess neonatal mortality among girls constitutes about one third of the perinatal mortality rate. It seems to be linked to a preference for sons and should therefore be addressed through a holistic societal approach rather than through specific healthcare measures.     

The interval between the diagnosis of malignancy and the development of effusions, with reference to the role of cytologic diagnosis

An analysis was made of the time lapse between the diagnosis of malignancy and the development of an effusion in relation to the sex and age of the patients and the site of the primary malignancy. The total number of patients studied was 254; of these, 171 patients had a pleural and 83 patients a peritoneal effusion. In the total group, sex distribution was two men to three women: about equal in the pleural effusion group and about two men to nine women in the ascites group, with the latter ratio reflecting the large number of primary malignant processes in the breast and ovaries. The average age at the time of the effusion, whether it was located in the pleural or in the peritoneal cavity, was about 55 years. This figure was roughly 60 years for men and 51 years for women. The nine-year average age difference between sexes can be explained by the size of the four largest groups of different primary malignant localizations and their sex distribution. The interval between the discovery of the primary malignancy and the first fluid sample was longer for patients with a pleural effusion (average of 77.0 weeks) than for patients with ascites (average of 54.5 weeks). The longest interval was seen in the breast carcinoma group, with the shortest interval in lung carcinoma patients. The interval was significantly longer for women, being 111.9 weeks for pleural effusions and 57.9 weeks for ascites (average for both sites of 88.7 weeks). In 30.7% of the patients, the primary malignancy was discovered at the same time or later than the effusion; in patients with lung cancer, a strikingly higher percentage of 53.0% was found. In this respect, the cytologic diagnosis of effusions is of great importance not only for the detection and proper identification of a malignant process but also as an indicator of the life expectancy of a patient.     

Breast-feeding after vertical mammaplasty with medial pedicle

A retrospective study was performed in which the breast-feeding success of women of childbearing age (15 to 40 years) with macromastia but no prior breast surgery was compared with that of women of similar age who had undergone medial pedicle/vertical pattern reduction mammaplasty. All women completed a self-administered questionnaire that provided information on their breast-feeding success. The control group consisted of 149 women with macromastia (mean age, 27 years) who had been evaluated for possible breast reduction surgery and who had children before their consultation. The study group consisted of 58 women (mean age, 29 years) who had children after their vertical mammaplasty. The mean weight of breast tissue removed was 610 g per breast. None of the patients had absent nipple sensation. A period of 2 weeks or more was chosen as the defining duration of a successful breast-feeding attempt. Those individuals judged able to breast-feed were further classified on the basis of having breast-fed exclusively or with supplementation. The results demonstrated that, of the women who attempted to breast-feed, 61 percent in the control group and 65 percent in the study group were successful, with no significant difference between the groups (p > 0.05). The breakdown of the successful groups indicated that 36 percent in the control group and 38 percent in the study group supplemented their breast-feeding with formula. The groups were not significantly different (p > 0.05). In conclusion, this study found no significant difference in the rate of breast-feeding success between women who had medial pedicle/vertical pattern reduction mammaplasty and women who had no prior breast surgery.     

Sociodemographic attributes of Iranian wives who reported unwanted pregnancies

In a 1989 Family Planning Study in Iran, 40 percent of the married women of reproductive age reported that their last or current pregnancies were unwanted and unintended. This finding is consistent with the results obtained from a number of studies undertaken in the countries of North Africa and the Middle East. Although the phenomenon of unwanted pregnancy is a significant topic in the population studies, it has received very little attention. This paper shows the differences between two groups: group A, those married women who reported that their last or current pregnancies were wanted, and group B, those married women who reported that their last or current pregnancies were unwanted. The findings of this study clearly show significant differences between these two groups in regard to some key sociodemographic attributes: wife/husband's education, actual and desired fertility, wife's current age, past and present practice of contraceptive methods, and extent of satisfaction with family planning services are among the attributes differentiating these two groups. Our examination of these variables suggests that group B had higher parity, fertility, less desire for more children, less use of contraceptive techniques, and less satisfaction with the efficiency of the contraceptive techniques than group A. The relationship between education and wanted/unwanted pregnancies is mixed. The urban women who wanted pregnancies and were 25 years old or older were more educated than those who did not want pregnancies. On the contrary, the rural women whose pregnancies were not wanted were more educated than those who wanted pregnancies regardless of age, parity, and locality differences. Furthermore, the urban/rural women with different levels of parities who did not want to be pregnant were more educated than the urban/rural women who wanted pregnancies. Finally, the standardized regression coefficients, obtained in logistic regression, reveal that among urban women the desire for more children and parity are the first and second most significant independent variables differentiating between group A and group B. Among rural women, living children and the desire for more children were the first and second most important variables differentiating between group A and group B.     

Total pubertal growth and markers of puberty onset in adolescents with GHD: comparison between mathematical growth analysis and pubertal staging methods

Two methods of determining puberty onset (Preece- Baines model 1 (PB1) and Tanner staging) were used to calculate total pubertal growth (TPG) in adolescents with growth hormone deficiency (GHD). PATIENTS AND METHODS: 34 patients (11 girls) met the following inclusion criteria: isolated GHD, >2 years growth hormone therapy prior to puberty onset, regular weight-adjusted GH dosage, known final height (age >21 years or height velocity <0.5 cm/year), no induction of puberty. PB1 was used to define age and height at onset of the pubertal growth spurt ("take-off"). RESULTS: The results (mean +/- SD) were as follows: in girls, mean age at take-off was 9.8 years; 2.0 +/- 1.1 years before breast stage B2. In boys, mean age at take-off was 11.3 years; 1.4 +/- 0.8 years before testes volume >3 ml. Height at take-off was lower than at Tanner stage 2 by 12.4 +/- 7.6 cm in girls and 7.7 +/- 5.3 cm in boys. TPG was thus markedly greater (p < 0.001) using the PB1 method, as compared with Tanner stage2. Peak height velocity was normal. Final height was -0.5 +/- 0.7 SDS in females and -0.4 +/- 0.9 SDS in males. CONCLUSIONS: The method of measuring TPG from take-off is more objective, and has potentially greater implications for GH therapeutics than the Tanner stage method. In our study, 40% of TPG occurred before "breast stage B2" was attained in GHD girls; whereas 23% of TPG occurred before "testes >3 ml" in GHD boys.     

Sociodemographic attributes of Iranian wives who reported unwanted pregnancies

Abstract

In a 1989 Family Planning Study in Iran, 40 percent of the married women of reproductive age reported that their last or current pregnancies were unwanted and unintended. This finding is consistent with the results obtained from a number of studies undertaken in the countries of North Africa and the Middle East. Although the phenomenon of unwanted pregnancy is a significant topic in the population studies, it has received very little attention. This paper shows the differences between two groups: group A, those married women who reported that their last or current pregnancies were wanted, and group B, those married women who reported that their last or current pregnancies were unwanted. The findings of this study clearly show significant differences between these two groups in regard to some key sociodemographic attributes: wife/husband's education, actual and desired fertility, wife's current age, past and present practice of contraceptive methods, and extent of satisfaction with family planning services are among the attributes differentiating these two groups. Our examination of these variables suggests that group B had higher parity, fertility, less desire for more children, less use of contraceptive techniques, and less satisfaction with the efficiency of the contraceptive techniques than group A. The relationship between education and wanted/unwanted pregnancies is mixed. The urban women who wanted‐pregnancies and were 25 years old or older were more educated than those who did not want pregnancies. On the contrary, the rural women whose pregnancies were not wanted were more educated than those who wanted pregnancies regardless of age, parity, and locality differences. Furthermore, the urban/rural women with different levels of parities who did not want to be pregnant were more educated than the urban/rural women who wanted pregnancies. Finally, the standardized regression coefficients, obtained in logistic regression, reveal that among urban women the desire for more children and parity are the first and second most significant independent variables differentiating between group A and group B. Among rural women, living children and the desire for more children were the first and second most important variables differentiating between group A and group B.     

Elevated serum silicon levels in women with silicone gel breast implants

The metatolic fate of silicone gel leaked from an intact or ruptured prosthesis is unknown. In this study, serum was blindly assayed by inductively coupled plasma atomic emission spectroscopy (ICP-AES) for elemental silicon in 72 women with silicone gel breast implants and 55 control women (mean age 48 yr, both groups). Blood was drawn and processed using silicon-free materials. The mean silicon level in controls was 0.13±0.07 mg/L (range 0.06–0.35 mg/L), whereas in implant patients, the mean was significantly higher at 0.28±0.22 mg/L (range 0.06–0.87 mg/L) (P<0.01, Student'st-test with correction for unequal variances). Using the mean of the control group +2 SD as a cutoff for normal range (0.27 mg/L), 25/72 (34.7%) implant patients exceeded this value, compared with 2/55 (3.6%) controls. There was no significant correlation between past rupture of one or both implants, current rupture at the time of the blood draw, or the number of years with implants and silicon levels. The results suggest that serum silicon levels are elevated in many women with silicone gel breast implants. The chemical species involved and kinetics of this elevation remain to be determined.     

Circulatory and respiratory responses to muscular exercise in Czech and Norwegian children

This paper presents a comparison between Czech and Norwegian rural healthy children with regard to the functional characteristics of the circulatory and respiratory system based upon work physiological variables and measurements of some pulmonary volumes. The study included randomised samples of boys and girls at the age of 8, 12 and 16 years, 66 Czech boys and 63 girls, 54 Norwegian boys and 57 girls. At the age of 8 years the maximal aerobic power was closely similar in both countries, but in the older age groups the Norwegian children exhibited lower physical fitness. The maximal heart rate was close to 200 min-1 on the average without any sex, age or ethnic differences. In agreement with the higher maximal aerobic power the 12 and 16 year old Czech children had lower submaximal heart rates for the same oxygen uptake than the Norwegian children. The forced vital capacity and forced expiratory volume in one second was significantly higher on the average in Czech than in Norwegian children but the latter, expressed in percent age of the former, averaged 87 to 91% without any sex, age or ethnic differences. The maximal ventilation volumes during muscular exercise reached higher values in Czech than in Norwegian children of the same age, but the mean maximal respiratory rate was close to 60 min-1, being independent of age, sex and cultural differences. During heavy exercise only 40 to 50% of the vital capacity and 45 to 55% of the forced expiratory volume were taken into account and this index of pulmonary function did not differ with sex, age or ethnic differences.     

Thyroid autoimmunity in children and adolescents with type 1 diabetes mellitus. Effect of age, gender and HLA type

Type 1 diabetes is often associated with additional autoimmune phenomena. However, data reported on the frequency of thyroid autoimmunity differ vastly. Therefore, the prevalence of thyroid autoantibodies was evaluated at a large pediatric diabetes center in Southern Germany. 2,305 determinations (TPO and TG, ELISA) were performed in 495 patients with type 1 diabetes (234 boys, 261 girls; age at last measurement: 15.4 +/- 0.3 years, duration of diabetes 7. 5 +/- 0.2 years). The prevalence of elevated thyroid antibodies increased dramatically with age: from 3.7% in patients less than 5 years of age up to 25.3% in the age group 15-20 years (p < 0.0001). For children older than 10 years, girls were significantly more affected than boys (p < 0.0001). Thyroid autoimmunity tended to be more prevalent in the subgroup of patients with the HLA type DR3/DR4 compared to patients with other HLA types (p = 0.08). In children older than 10 years, basal TSH concentrations were significantly elevated in antibody-positive patients (p < 0.05). In conclusion, thyroid autoimmunity is prevalent in children and adolescents with type 1 diabetes. Adolescent girls and young women are especially affected. Yearly routine determinations of thyroid antibodies are therefore recommended.     

Comparison of breast carcinomas diagnosed in the 1980s with those diagnosed in the 1940s to 1960s.

OBJECTIVE--To find out if breast carcinomas diagnosed in the 1980s differ from those diagnosed a few decades ago. DESIGN--Retrospective comparative cohort study. SETTING--City of Turku, south western Finland. PATIENTS--439 patients with breast carcinoma diagnosed in 1945-65 with a median follow up of 27 years (95% of all those histologically diagnosed in Turku); and 370 patients with breast carcinoma diagnosed in 1980-4 with a median follow up of 6 years (94% of all those histologically diagnosed in Turku). MAIN OUTCOME MEASURES--Breast cancer incidence, mortality from breast cancer, age at diagnosis, stage of cancer, seven histological factors, DNA ploidy. RESULTS--Age adjusted incidence of breast cancer increased from 30.8/100,000 person years in 1953-7 to 62.2/100,000 in 1983-7; mortality in breast cancer increased from 16.7 to 17.2/100,000 person years. Survival of patients with stages II to IV (but not with stage I) improved. The mean age at diagnosis increased from 55.5 years in 1945-55 to 62.5 years in 1980-4 (p less than 0.0001); the proportion of patients with T0-1 carcinomas increased from 13% to 41% (p less than 0.0001) and with pN0 carcinomas from 43% to 55% (p = 0.003) from 1945-65 to 1980-4. There was no change in histological type or DNA ploidy of breast cancer, but in the 1980-4 cohort carcinomas were more often well differentiated, had lower mitotic counts and less nuclear pleomorphism, more often had a well defined tumour margin, and had less tumour necrosis. There was, however, no difference between the two cohorts in these histological characteristics except for tumour necrosis when they were compared in a multivariate log linear model at a given size of primary tumour. CONCLUSION--Improved survival with breast cancer can at least partially be explained by detection of increased numbers of small carcinomas with favourable histological characteristics.     

The course of diagnosis in autistic patients: the delay between recognition of the first symptoms by parents and correct diagnosis

The primary aim of the research was to find the delay between the first symptoms of an autistic disorder being recognized by parents and diagnosis in our centre. A secondary objective was to evaluate the number of contacts with professionals (physicians, teachers, and speech therapists) in which parents pointed out special manifestations seen in children and, in spite of that, the children were not referred to a specialist. A retrospective study assessed 204 children (59 girls, 145 boys) in total; 126 children (39 girls, 87 boys) with childhood autism (CHA), 57 (17 girls, 40 boys) with atypical autism (AA), and 21 (3 girls, 18 boys) with Asperger's syndrome (AS). The mean age at appearance of the first signs was 29.7 months (range 0-70, median 30+/-17.0) in N=201, and the average age at diagnosis was 81.5 months (range 13-276, median 69.5+/-45.2) in N=204. The mean delay in making a diagnosis was 51.3 months (range 0-246, median 39+/-40.9) in N=201. The delay in diagnosis is shortest in patients with AA (a mean period of 44.4 months = 3 years and 8 months), longer in CHA patients (49.5 months = 4 years and 2 months), and longest in patients with AS (80.8 months = 6 years and 9 months). A statistically significant difference in the period to diagnosis was found between CHA and AS patients (p=0.023) and between AA and AS patients (p=0.019). The mean number of visits to physicians and other specialists before referring to a specialized centre for diagnosis in N=133 was 2.4 (range 1-5, median 2+/-0.9). The diagnosis of autism is made late and early educational and behavioural interventions cannot be initiated.     

Bone mineral density in patients with breast cancer in the perimenopausal period

Dual-energy X-ray absorptiometry was used to examine 54 patients with breast cancer. A clinical comparison group comprised 50 healthy women. All the examinees were aged 45 to 55 years. Bone mineral density was measured in the lumbar spine, proximal femur, and ultradistal antibrachium. The X-ray densitometric values of bone tissues in perimenopausal women with breast cancer were not found to be abnormal, which led to the conclusion that there were no significant bone metabolic disturbances. Along with this it was established that the women at this age had considerably reduced bone mineral density in the epimetaphyseal (ultradistal) forearm with evolving osteopenia. In this connection, it is expedient to identify an ultradistal portion of the antibrachium as an object of X-ray densitometric examination for the early diagnosis of impaired bone mineralization in women in the 45-to-55-year-old age group.     

Serum ferritin and the iron status of Canadians.

Serum ferritin concentration was determined in 1105 Canadians aged 1 to 90 years. Geometric mean values (ng/ml) were as follows: children 1 to 4 years old, 12; children 5 to 9 years old, 15; adolescent girls, 17; adolescent boys, 18; women 20 to 39 years, 23; women 65 years and older, 52; men 20 to 39 years, 93; and men 40 and older, 92. Ranges were side in all age groups, reflecting variations in size of body iron stores. From analysis of the ferritin values it is highly probably that iron stores were greatly reduced in approximately 25% of children, 30% of adolescents, 30% of menstruating women, 60% of pregnant women and 3% of men. Iron-deficiency anemia was noted in only 2% of subjects. If "normality" requires more than small amounts of storage iron to meet physiologic demands, the study results suggest a high probability of iron deficiency in 60% of the pregnant women and in 19% of the other subjects; but if normality is defined as maintenance of adequate iron stores for erythropoiesis, the prevalence of iron deficiency was zero in the pregnant women and 2% in the other subjects.