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71.
Fatal shoulder dystocia: a review of 56 cases reported to the Confidential Enquiry into Stillbirths and Deaths in Infancy 总被引:1,自引:0,他引:1
Peter Hope Paediatrician Sue Breslin Senior Midwife Linda Lamont Lay Member of CESD † Alexandra Lucas Community Midwife †† Denis Martin Obstetrician ‡ Isabella Moore Paediatric Pathologist ‡‡ James Pearson Reader § Dawn Saunders Midwife §§ Ralph Settatree Obstetrician & Director CESD §§ 《BJOG : an international journal of obstetrics and gynaecology》1998,105(12):1256-1261
Objective To use information collected by the Confidential Enquiry into Stillbirths and Deaths in Infancy to help obstetric, midwifery and paediatric practice in the management of shoulder dystocia.
Design Review of casenotes by a multidisciplinary focus group.
Sample All 56 cases reported to the Confidential Enquiry into Stillbirths and Deaths in Infancy from England, Wales and Northern Ireland in 1994 and 1995, where stillbirth or neonatal death was attributed to shoulder dystocia.
Main outcome measures Case notes were reviewed with respect to a range of perinatal variables. Comparisons were made with normative data from other studies when appropriate.
Results Maternal obesity and big babies were over-represented in pregnancies complicated by fatal shoulder dystocia. Fetal compromise was recorded in 26% of labours. The median time interval between delivery of the head and the rest of the body was only five minutes. The lead professional at the time the head was delivered was a midwife in 65% of cases. Middle grade or senior obstetric staff were supervising 47% of cases by the time the body was delivered.
Conclusions Antenatal prediction of shoulder dystocia is imprecise, and the majority of deliveries are attended by midwives. A relatively brief delay in delivery of the shoulders may be associated with a fatal outcome. 相似文献
Design Review of casenotes by a multidisciplinary focus group.
Sample All 56 cases reported to the Confidential Enquiry into Stillbirths and Deaths in Infancy from England, Wales and Northern Ireland in 1994 and 1995, where stillbirth or neonatal death was attributed to shoulder dystocia.
Main outcome measures Case notes were reviewed with respect to a range of perinatal variables. Comparisons were made with normative data from other studies when appropriate.
Results Maternal obesity and big babies were over-represented in pregnancies complicated by fatal shoulder dystocia. Fetal compromise was recorded in 26% of labours. The median time interval between delivery of the head and the rest of the body was only five minutes. The lead professional at the time the head was delivered was a midwife in 65% of cases. Middle grade or senior obstetric staff were supervising 47% of cases by the time the body was delivered.
Conclusions Antenatal prediction of shoulder dystocia is imprecise, and the majority of deliveries are attended by midwives. A relatively brief delay in delivery of the shoulders may be associated with a fatal outcome. 相似文献
72.
Echocardiographic features of post−transcatheter aortic valve implantation thrombosis and endocarditis 下载免费PDF全文
Marco Spartera MD Francesco Ancona MD Marta Barletta MD Isabella Rosa MD Stefano Stella MD Claudia Marini MD Leonardo Italia MD Matteo Montorfano MD Azeem Latib MD Ottavio Alfieri MD Alberto Margonato MD Antonio Colombo MD Eustachio Agricola MD 《Echocardiography (Mount Kisco, N.Y.)》2018,35(3):337-345
73.
Therapeutic plasma exchange for thrombotic thrombocytopenic purpura with refractory thrombocytopenia 下载免费PDF全文
Nolan Maloney Isabella Martin Zbigniew M. Szczepiorkowski Nancy M. Dunbar 《Journal of clinical apheresis》2018,33(3):436-438
Thrombotic thrombocytopenic purpura (TTP) is an acute, life‐threatening illness with disseminated platelet‐rich thromboses of small vessels that variably presents with the classic clinical “pentad” of microangiopathic hemolytic anemia, thrombocytopenia, fever, altered mental status, and acute kidney injury. Most cases are caused by an acquired autoantibody to ADAMTS13, a metalloproteinase that cleaves large von Willebrand Factor (vWF) multimers. The mainstay of treatment is daily therapeutic plasma exchange (TPE), sometimes with adjunctive pharmacologic immunosuppression. TPE is generally continued until the platelet count is greater than 150 × 103/µL and the lactate dehydrogenase is near normal for 2‐3 consecutive days. Unfortunately, there is no clear guidance for when thrombocytopenia is refractory for a prolonged period of time. The following case describes such a scenario in which consecutive ADAMTS13 activity and inhibitor levels were used to guide the decision to stop treatment with TPE in a patient who failed to recover their platelet count. 相似文献
74.
Periodontal treatment limits platelet activation in patients with periodontitis—a controlled‐randomized intervention trial 下载免费PDF全文
75.
Sebastian N. Kunz Jiri Adamec Bettina Zinka Daniela Münzel Peter B. Noël Simon Eichner Axel Manthei Nico Grove M. Graw Oliver Peschel 《International journal of legal medicine》2013,127(1):119-126
The Taser® eXtended Range Electronic Projectile (XREP®) is a wireless conducted electrical weapon (CEW) designed to incapacitate a person from a larger distance. The aim of this study was to analyze the ballistic injury potential of the XREP. Twenty rounds were fired from the Taser®X12 TM shotgun into ballistic soap covered with artificial skin and clothing at different shooting distances (1–25 m). One shot was fired at pig skin at a shooting distance of 10 m. The average projectile velocity was 67.0 m/s. The kinetic energy levels on impact varied from 28–52 J. Depending on the intermediate target, the projectiles penetrated up to 4.2 cm into the ballistic soap. On impact the nose assembly did not separate from the chassis, and no electrical activation was registered. Upon impact, a skin penetration of the XREP cannot be excluded. However, it is very unlikely at shooting distances of 10 m or more. Clothing and a high elasticity limit of the target body area can significantly reduce the penetration risk on impact. 相似文献
76.
Carmelo Caldarella Lucia Leccisotti Isabella Bruno Angela Collarino Fabio Maggi Alessandro Giordano 《Pediatric cardiology》2012,33(8):1435-1439
Congenitally corrected transposition of great arteries (ccTGA) consists of both atrioventricular and ventriculo-arterial discordance. In patients with ccTGA, the pulmonary artery arises from the left ventricle, whereas the aorta arises from the right ventricle. The burden of the systemic blood pressure on the right ventricle involves an increased risk of coronary artery disease (CAD) and, as a long-term consequence, myocardial hypertrophy and gradual failure. This report describes the case of an adult patient affected by ccTGA who was referred for an episode of atypical chest pain while at rest. First-line diagnostic examinations were inconclusive. Myocardial perfusion single-photon emission tomography (SPET) was performed to exclude CAD, but the congenital abnormalities of the patient??s heart made interpretation of the images particularly difficult. A perfusion positron emission tomography?Ccomputed tomography (PET-CT) scan with 13N-ammonia then was suggested, which unmasked an unexpected artifact. The case report demonstrates that hybrid imaging techniques such as SPET-CT and PET-CT should be used systematically when CAD is suspected for patients with abnormal anatomy of the heart, including ccTGA. 相似文献
77.
Patient organizations are increasingly involved in national and international bioethical debates and health policy deliberations. In order to examine how and to what extent cultural factors and organizational contexts influence the positions of patient organizations, this study compares the positions of German and Israeli patient organizations (POs) on issues related to end-of-life medical care. We draw on a qualitative pilot study of thirteen POs, using as a unit of analysis pairs comprised of one German PO and one Israeli PO that were matched on the basis of organizational category. Bioethical positions that emanated from the interviews concerned advance directives—general views, recent legal framework, and formalization; as well as active and passive euthanasia, withholding and withdrawing of treatment, and physician-assisted suicide. In addition to the unifying, within-country impact of cultural factors, we found that constituency-based organizations and partner organizations in both countries often share common views, whereas disease-based support organizations have very heterogeneous positions. We conclude by discussing how organizational contexts provide a source of uniformity as well as diversity in the positions of POs. 相似文献
78.
Joanna d'Arc Lyra Batista Maria de Fátima Pessoa Milit?o de Albuquerque Marcela Lopes Santos Demócrito de Barros Miranda-Filho Heloísa Ramos Lacerda Magda Maruza Libia Vilela Moura Isabella Coimbra Ricardo Arraes de Alencar Ximenes 《Revista do Instituto de Medicina Tropical de S?o Paulo》2014,56(2):127-132
Despite the effectiveness of combination antiretroviral therapy in the
treatment of people living with HIV/AIDS (PLWHA), nonadherence to medication has
become a major threat to its effectiveness. This study aimed to estimate the
prevalence of self-reported irregular use of antiretroviral therapy and the factors
associated with such an irregularity in PLWHA. A cross-sectional study of PLWHA who
attended two referral centers in the city of Recife, in Northeastern Brazil, between
June 2007 and October 2009 was carried out. The study analyzed socioeconomic factors,
social service support and personal habits associated with nonadherence to
antiretroviral therapy, adjusted by multivariable logistic regression analysis. The
prevalence of PLWHA who reported irregular use of combination antiretroviral therapy
(cART) was 25.7%. In the final multivariate model, the irregular use of cART was
associated with the following variables: being aged less than 40 years (OR =
1.66, 95%-CI: 1.29-2.13), current smokers (OR = 1.76, 95%-CI: 1.31-2.37) or
former smokers (OR = 1.43, 95%-CI: 1.05-1.95), and crack cocaine users (OR
= 2.79, 95%-CI: 1.24-6.32). Special measures should be directed towards each
of the following groups: individuals aged less than 40 years, smokers, former smokers
and crack cocaine users. Measures for giving up smoking and crack cocaine should be
incorporated into HIV-control programs in order to promote greater adherence to
antiretroviral drugs and thus improve the quality of life and prolong life
expectancy. 相似文献
79.
Isabella Grishkan 《Journal of basic microbiology》2018,58(1):30-40
Composition of thermotolerant mycobiota in the soil of Israeli deserts and northern territories was examined in spatiotemporal dynamics. A total of 165 species from 82 genera were isolated at 37 °C using the soil dilution plate method. Aspergilli (Aspergillus fumigatus and A. niger) and teleomorphic ascomycetes (Canariomyces notabilis, Chaetomium nigricolor, and Ch. strumarium) comprised the basic part of the thermotolerant communities. The desert communities remarkably differed from the northern communities by a much higher abundance of A. fumigatus and teleomorphic species, as well as by a lower abundance of A. niger and Rhizopus arrhyzus. Seasonal dynamics revealed for the southern Negev was expressed mainly in the variations of species richness (substantially lower in the winter), and abundances of A. fumigatus (dominant in the summer) and A. niger (dominant in the winter). The composition of thermotolerant mycobiota was almost entirely different from the composition of mesophilic mycobiota at 25 °C. Melanin‐containing fungi with many‐celled conidia that dominated mesophilic communities in the deserts did not grow at 37 °C, while prevailing aspergilli accompanied by teleomorphic species with perithecial fruit bodies were apparently able not only to survive but also to germinate at this temperature and be active during a long hot period in the desert. 相似文献
80.
Indoor fungal diversity in primary schools may differently influence allergic sensitization and asthma in children 下载免费PDF全文