Pituitary adenoma revealed by paracentral junctional scotoma of traquair.

The term junctional scotoma of Traquair is used to describe a unilateral temporal visual field defect due to pathology of the ipsilateral optic nerve where it joins the chiasm. We report a 26-year-old woman who presented with blurred vision of her left eye. Examination revealed visual acuity of 20/20 OU, AO-HRR color plates 6/6 OD and 4.5/6 OS, and a 0.3 log unit relative afferent pupillary defect on the left side. Computer and Goldmann perimetry revealed a normal visual field OD and a paracentral temporal scotoma OS. Magnetic resonance imaging scan disclosed a sellar mass, expanding mainly into the left suprasellar area. Laboratory findings and pathological studies were consistent with a prolactin-secreting pituitary adenoma. While involvement of the temporal visual field in only one eye (junctional scotoma of Traquair) is found in about 10% of patients with pituitary adenoma, involvement of only the paracentral temporal visual field in one eye is rare (1-2%). Recognition of this rare syndrome is important because careful visual field analysis discloses a vertical step and helps to avoid misdiagnosing optic neuritis.

Economic development and family size.

PIP: The demographic transition in Latin America has resulted in increased family size rather than the Western European model of reduced family size. In 1905, both fertility and mortality were high in Latin America, but mortality declined more rapidly in Latin America than in Europe. In 1905, the crude birth rate for 15 selected countries averaged 44/1000 population. Western fertility at a comparable transition point was much lower at 30/1000. Between 1905 and 1960, fertility declines were evident in Uruguay, Argentina, Cuba, and Chile. Between 1960 and 1985, fertility declines appeared in Costa Rica, Panama, Brazil, and Colombia. Fertility declines were smaller in the other Latin American countries. Crude birth rates declined markedly by 1985 but may overestimate fertility decline, which is more accurately measured by standardized birth rates. Fertility decline was evident in Argentina, Chile, and Costa Rica for standardized birth rates, survivorship ratio, and births surviving past the age of 15 years. Theoretically, families are expected to reduce family size when survivorship is assured; when mortality is 25%, only four children need be planned instead of six when mortality is 50%. A result of falling mortality is a cheaper cost of producing children, which may stimulate parents to raise bigger families. Western fertility decline has been attributed to mortality decline, urbanization, increased female labor force participation, rising wages, and more efficient contraception. Comparable economic development in Latin America has not resulted in large enough changes to encourage family size limitation. A table of fertility and economic indicators for selected countries in Latin America and Europe reflects the inverse relationship between income growth, urban growth, and growth in female educational status and fertility. The regression equation explains 60% of the variation in fertility rates among Latin American countries. Explanatory power increases to 75% when female high school enrollment is added to per capita gross national product. Fertility declines in Latin America in the future will be dependent on economic development, educational advancement for women, and a reduction in rural population.^ieng