Accelerating progress on salt iodisation in Sudan: time for action

This paper uses a public health approach to examine briefly: (a) the progress of universal salt iodisation (USI) in Sudan; (b) the roles of the main actors involved; and (c) the main issues around accelerating USI. The literature, especially that coming from the UN agencies, is analysed and experiences from the recently revitalised USI programme, and related relevant meetings, are distilled. In Sudan the prevalence of goitre is 22 per cent. It is assumed that productivity among the people affected is reduced by 5–25 per cent. Little apparent progress has been made with USI. The Government of Sudan, UN multilateral agencies, international consultative groups, bilateral agencies, global and national non-governmental organisations and, increasingly, the private sector must work together to find innovative approaches to increase awareness of the broader social, public health and nutritional contexts, and to advocate for increased national nd international funding.     

Antenatal ultrasonic diagnosis of dyssegmental dysplasia: A case report

Sonographic prenatal diagnosis and management of a pregnancy complicated by dys-segmental dysplasia of the Silverman-Handmaker type are presented. This is a documented case of this type of short-limbed dwarfism presenting in a family of Hispanic-American ancestry.     

Ultrasonographic scanning of placental thickness and the prenatal diagnosis of homozygous alpha-thalassaemia 1 in the second trimester

In order to evaluate the association between placental thickness (PT) and fetal homozygous alpha-thalassaemia 1 before the appearance of classic ultrasound findings of haemoglobin (Hb) Bart's hydrops fetalis, a total of 473 pregnancies were collected. The control group included 422 normal pregnancies with a gestational age from 14 to 23 weeks and the study group included 51 affected fetuses in the same gestational period. Fetal biparietal diameter (BPD) and PT were measured by high-resolution ultrasound. PT was evaluated against BPD. In the control group, the PT generally increased in parallel with the advancement of gestational age. All PT measurements in the study group were above the mean PT of their respective gestational week in the control group. Forty-six (90 per cent) of the pregnancies in the study group had PT larger than the mean plus two standard deviations of the control group. This study suggests that ultrasound measurement of PT may be a useful aid in the prenatal diagnosis of Hb Bart's hydrops fetalis before its classic findings become apparent in the late second trimester or third trimester.     

The normal fetus of an acardiac twin pregnancy: Perinatal management based on echocardiographic and sonographic evaluation

Experience with three prenatally diagnosed pregnancies complicated by an acardiac twin reveals that ultrasonography and echocardiography are helpful in detecting early signs of in-utero congestive heart failure in the normal twin. The use of Doppler blood flow analysis to determine direction of blood flow, post-mortem placental and fetal angiography, and umbilical cord blood gas determination provided proof that retrograde arterial perfusion occurs in the acardiac fetus. In a fourth pregnancy, an experimental approach to occlude the acardiac twin's umbilical cord was attempted, but was unsuccessful.     

Congenital malformations subsequent to chorionic villus sampling: Outcome analysis of 1048 consecutive procedures

We wished to identify the types and frequencies of malformations among continuing pregnancies exposed to chorionic villus sampling (CVS) and to determine whether selected procedure-related variables differ between the normal and anomalous cohorts. CVS was performed in 1048 patients between May 1988 and January 1992. Prospective assessment of perinatal outcome was ascertained by (1) physician—patient phone contact within 1 week of sampling, (2) ultrasound evaluation of the fetal anatomy at mid-gestation, (3) a detailed post-partum questionnaire completed by the referring obstetrician, and (4) a telephone interview with each patient after the expected date of confinement. Twenty-seven major malformations were documented among 938 pregnancies (live born, n=934; electively terminated, n=4), and included cardiac malformations (5), hypospadias (5), craniosynostosis (2), pyloric stenosis (2), inguinal hernia (2), polydactyly (2), syndactyly, distal extremely hemimelia, anencephaly, hydrocephalus, cleft lip and palate, omphalocele, diaphragmatic hernia, thanatophoric dysplasia, and unilateral cataract. Normal and anomalous cohorts were similar with respect to sampling method (transabdominal/transcervical ratio), mean gestational age at CVS, single-pass success rate, and mean total sample weight. No relationship between any procedure-related variable and the risk of malformation was observed.     

First-trimester ultrasonic diagnosis of twin reversed arterial perfusion sequence

Twin reversed arterial perfusion (TRAP) syndrome sequence is a rare specific anomaly of twin gestation with fused placentae and umbilical anastomosis. This syndrome occurs once in very 35 000–48 000 births and has been described in the second trimester (23-29 weeks of gestation). We report on early sonographic diagnosis (10 and 12 weeks' gestation) of two cases of TRAP sequence, together with their umbilical cord Doppler studies.     

Prenatal diagnosis of acute bladder distension associated with fetal sacrococcygeal teratoma—a case report

A case report of sacrococcygeal teratoma prenatally diagnosed at 23 weeks of amenorrhea, subsequently causing dilatation of both lower and upper urinary tracts is presented. The importance of repeated ultrasonographic evaluation of fetuses with sacrococcygeal teratoma is discussed.     

Sustainable metal management exemplified by copper in the USA

A sustainable management of non-renewable metals calls for scientific-ecological understanding of the regional material household. The copper household in the USA between 1900 and 2100 was chosen to illustrate mathematical modelling of such systems. Relatively limited and inaccurate sets of data already allow a first approximation of the metal management system. The copper fluxes of the 20th century have contributed to the formation of two new ore deposits of the same order of magnitude as the currently still available reservoir (90 million tons), i.e. copper stock in consumption products (approx. 70 million tons) and in landfills (approx. 40 million tons). The “landfill”, therefore, contains copper whose potential use is lost due to dilution. The long-term copper consumption stock is greater than the short-term stock. Scenarios show that the current economically mineable Cu-stocks will be exhausted in 30 to 50 years if a change in the existing management system does not occur. In case of a reorientation, the use of copper as a “new resource” in the consumption stocks appears to be the most promising strategy. The future waste management processes will have to increase their copper recycling rates. Received: 24 February 1999 · Accepted: 8 June 1999     

Temporal analysis of airborne particulate matter reveals a dose-rate effect on mortality in El Paso: indications of differential toxicity for different particle mixtures

One of two topics explored is the limitations of the daily average in summarizing pollutant hourly profiles. The daily average of hourly measurements of air pollutant constituents provides continuity with previous studies using monitoring technology that only provided the daily average. However, other summary statistics are needed that make better use of all available information in 24-hr profiles. The daily average reflects the total daily dose, obscuring hourly resolution of the dose rate. Air pollutant exposures with comparable total daily doses may have very different effects when occurring at high levels over a few hours as opposed to low levels over a longer time. Alternative data-based choices for summary statistics are provided using principal component analysis to capture the exposure dose rate, while preserving ease of interpretation. This is demonstrated using the earliest hourly particle concentration data available for El Paso from archived records of particulate matter (PM)10. In this way, a significant association between evening PM10 exposures and nonaccidental daily mortality is found in El Paso from 1992 to 1995, otherwise missed using the daily average. Secondly, the nature and, hence, effects of particles in the ambient aerosol during El Paso sandstorms is believed different from that of particles present during still-air conditions resulting from atmospheric temperature inversions. To investigate this, wind speed (ws) is used as a surrogate variable to label PM10 exposures as Low-ws (primarily fine particles), High-ws (primarily coarse particles), or Mid-ws (a mixture of fine and coarse particles). A High-ws evening is significantly associated with a 10% lower risk of mortality on the succeeding third day, as compared with comparable exposures at Low- or Mid-ws. Although this analysis cannot be used to form firm conclusions because it uses a very small data set, it demonstrates the limitations of the daily average and suggests differential toxicity for different particle compositions.     

Prenatal diagnosis of smith–lemli–opitz syndrome is possible by measurement of 7-dehydrocholesterol in amniotic fluid

Amniocentesis was performed at 17.3 weeks in a pregnancy with severe intrauterine growth retardation. Cytogenetic studies on amniocytes were normal, 46,XX, and the pregnancy was continued. The diagnosis of Smith–Lemli–Opitz syndrome was suspected in the neonatal period and confirmed by the presence of 7-dehydrocholesterol (7-DHC) in the plasma (0.4 mmol/l, normal = not detectable) associated with a low total cholesterol concentration (0.4 mmol/l, normal = 2.56 ± 0.23). Retrospective analysis of the amniotic fluid sample revealed an elevated level of 7-DHC (0.022 mmol/l; normal = undetectable). Therefore measurement of 7-DHC levels in amniotic fluid during the second trimester of pregnancy is useful for the prenatal diagnosis of Smith–Lemli–Opitz syndrome in families at risk and should be considered in cases of severe growth retardation of unknown aetiology for which amniotic fluid is available and in which a normal chromosomal pattern in amniocytes is present.