A New South Wales Population-based Study of Stillbirths Weighing 2,500 g or More

Summary: This paper describes factors associated with singleton stillbirths weighing 2,500 g or more, born in 1987 and reported to the NSW Midwives' Data Collection (MDC), a statewide perinatal data collection system. A total of 136 singleton stillbirths in this weight range were notified to the MDC, representing one-quarter of all singleton stillbirths in NSW. MDC records on these stillbirths were linked with perinatal death registrations for 125 of the 136. The death registrations indicated that fetal death occurred during labour in 20 cases, prior to the onset of labour in 98, and at an unknown time in the remaining 7 cases. Placental complications, including haemorrhage and functional abnormalities of the placenta, were the most frequent group of conditions associated with the stillbirths, being recorded as the underlying cause of death in 42 (34%) of the 125 cases. Cord complications (such as cord compression or cord around the neck) were given as the underlying cause of death in 30 cases (24%). The death certificate diagnosis was confirmed by autopsy in only 27 of the 125 cases (22%), although autopsies may have been done on a further 45 cases (36%). An adequate explanation of the cause appeared to be lacking for many of the fetal deaths. This highlights the importance of a thorough and systematic investigation of stillbirths. A list of standard investigations to be carried out following a stillbirth is proposed.     

Comparison of Cytology and Cervkography in Screening a High Risk Australian Population for Cervical Human Papillomavirus and Cervical intraepithelial Neoplasia

Summary: Two different screening methods, the Papanicolaou (Pap) smear and cervigram were compared in screening 245 Sydney women over a 6-month period in 1988 at a city sexually transmitted diseases (STD) centre, for cervical human papillomavirus (HPV), cervical intraepithelial neoplasia (CIN) and cervical cancer. The Pap smear through the identification of cytologically abnormal cells correctly detected 54% of cases of histologically proven CIN and 39.2% of cases of HPV. The cervigram through the identification of acetowhite epithelium and/or abnormal vessels on the cervix correctly detected 64% of cases of histologically proven CIN and 70.6% of cases of HPV. However, when both tests were used together, 92% of CIN lesions and 82.4% of HPV lesions were correctly identified. Histology of a colposcopically directed biopsy was used as the 'gold standard'. The sensitivity and specificity of the Pap smear after correction for verification bias was 46% and 78% respectively, and for the cervigram was 49% and 60% respectively. Hence neither screening test appears adequate on its own, at least in an STD population.     

Clinical significance of anismus in encopresis

Treatments designed to relieve paradoxical contraction of the anal sphincters during defecation (anismus) have had limited success in children with encopresis. This has raised doubts as to the clinical relevance of this diagnosis in childhood as anorectal dysfunction. Our aim was to determine whether, in patients who had treatment-resistant encopresis, the presence of electromyographic anismus was associated with increased faecal retention. Sixty-eight children with soiling (mean age 8.7 ± 2.06 years) were assessed by clinical examination, abdominal radiography and then with anorectal manometry. Patients with electromyographic anismus (n= 32; 47%) had significantly increased radiographic rectal faecal retention and were significantly less likely to be able to defecate water-filled balloons. There were no significant differences in response to prior therapy, history of primary encopresis, behavioural adjustment or in sociodemographic data. Our results suggest that electromyographic anismus is associated with obstructed defecation and faecal retention.     

Mine Blast Injuries - Our Experience

Background

The sudden increase in incidence and magnitude of mine blast injuries prompted us to highlight the problem and its management.

Methods

The cases of mine blast injuries occurring during mining and demining in a particular geographical area were analysed. Total 27 cases of mine blast injuries occurred during mining or demining operations in a period of 13 months.

Results

Various body regions were involved in the mine blast injuries but the main brunt was borne by feet and legs followed by multiple body regions due to splinters. 14 patients underwent below knee (BK) amputation while 4 patients required through knee (TK) amputations. The effect of blast was so severe that most of the cases required 2 to 5 times wound debridements. The initial aggressive debridement / open stump amputation saved the limb and life of all patients.

Conclusion

A mine blast causes extensive injuries and psychological trauma. Management is needed urgently, surgery is difficult, and amputation is often inevitable. Maximum lives and limbs can be saved with aggressive debridement, repeated inspections and dressings under anaesthesia and definitive closure at optimum time.Key Words: Amputation, Antipersonnel mine, Crush syndrome, Debridements, Mine blast injury, Secondary missiles, Shrapenels     

Prekallikrein-Kallikrein conversion rate as a predictor of contrast material catastrophies

An in vitro is described that attempts to detect patients with a potential for adverse systemic reactions to contrast material. This test involves measuring the rate of conversion of prekallikrein to kallikrein under certain standard conditions. In a preliminary retrospective study, the test could be used to identify such patients with a sensitivity of 88%, a specificity of 82%, and a predictive value of 79%.     

Using Standardized Oral Examinations to Evaluate General Competencies

Emergency medicine residency programs are required by the Accreditation Council for Graduate Medical Education (ACGME) to formally evaluate each resident with oral and written examinations. The Michigan State University Emergency Medicine Residency Program in Lansing conducts monthly standardized oral examinations (SOEs) as part of each resident's evaluation. Recently, the ACGME has advanced six areas, termed "general competencies," that should be acquired during graduate medical education. According to the ACGME, these competencies should be included in the educational process of all residency programs. In promulgating these competencies, the ACGME did not provide examples of core content, strategies for implementation, or methods of evaluation; rather, individual residency programs are required to develop their own methods. The authors describe a modification of an existing SOE strategy that assesses residents' knowledge, skills, experiences, and attitudes as reflected in the general competencies.     

Gamma-knife radiosurgery for trigeminal neuralgia

Gamma knife was installed at the PD Hinduja National Hospital and Medical Research Centre, Mumbai, India, in January 1997. In the first year of gamma-knife radiosurgery to January 1998, we treated 110 patients, of whom six had medically refractory trigeminal neuralgia. Seven treatments were administered to this group of six patients (one had bilateral neuralgia). This report evaluates the effectiveness of radiosurgery treatment in these patients. The median age of the patients was 56 years and there were five males and one female. Following Leksell stereotactic frame fixation, a magnetic resonance imaging scan was done in all. The Leksell gamma plan was used for planning. A radiosurgery dose of 70–80 Gy was delivered to the trigeminal root entry zone, 2–4 mm anterior to the junction of the pons and trigeminal nerve with a single 4 mm collimator helmet. Complete pain relief was achieved in four patients. Two had partial relief. No patient developed any radiosurgery related morbidity during the follow-up period of 5–16 months. Radiosurgery seems to be an effective approach for medically or surgically refractory trigeminal neuralgia.