Effects of female genital mutilation on birth outcomes in Switzerland.

OBJECTIVE: The primary aim of this study was to determine the desires and wishes of pregnant patients vis-à-vis their external genital anatomy after female genital mutilation (FGM) in the context of antenatal care and delivery in a teaching hospital setting in Switzerland. Our secondary aim was to determine whether women with FGM and non-mutilated women have different fetal and maternal outcomes. DESIGN: A retrospective case-control study. SETTING: A teaching hospital. POPULATION: One hundred and twenty-two patients after FGM who gave consent to participate in this study and who delivered in the Department of Obstetrics and Gynaecology in the University Hospital of Berne and 110 controls. METHODS: Data for patients' wishes concerning their FGM management, their satisfaction with the postpartum outcome and intrapartum and postpartum maternal and fetal data. As a control group, we used a group of pregnant women without FGM who delivered at the same time and who were matched for maternal age. MAIN OUTCOME MEASURES: Patients' satisfaction after delivery and defibulation after FGM, maternal and fetal delivery data and postpartum outcome measures. RESULTS: Six percent of patients wished to have their FGM defibulated antenatally, 43% requested a defibulation during labour, 34% desired a defibulation during labour only if considered necessary by the medical staff and 17% were unable to express their expectations. There were no differences for FGM patients and controls regarding fetal outcome, maternal blood loss or duration of delivery. FGM patients had significantly more often an emergency Caesarean section and third-degree vaginal tears, and significantly less first-degree and second-degree tears. CONCLUSION: An interdisciplinary approach may support optimal antenatal and intrapartum management and also the prevention of FGM in newborn daughters.

Reduce costs and generate revenue with telecommunications.

Financial managers are constantly faced with the pressures of running a cost efficient organization, and must look for new and innovative ways to reduce costs and generate revenue. Telecommunications can provide the financial manager with opportunities to save money and produce income. Ideas such as disposable or dispensible telephones, call tracking systems, and pay telephones can all become important steps to improving the financial health of an organization.

Vertebral artery strains during high-speed, low amplitude cervical spinal manipulation.

Spinal manipulative therapy (SMT) has been recognized as an effective treatment modality for many back, neck and musculoskeletal problems. One of the major issues of the use of SMT is its safety, especially with regards to neck manipulation and the risk of stroke. The vast majority of these accidents involve the vertebro-basilar system, specifically the vertebral artery (VA) between C2/C1. However, the mechanics of this region of the VA during SMT are unexplored. Here, we present first ever data on the mechanics of this region during cervical SMT performed by clinicians. VA strains obtained during SMT are significantly smaller than those obtained during diagnostic and range of motion testing, and are much smaller than failure strains. We conclude from this work that cervical SMT performed by trained clinicians does not appear to place undue strain on VA, and thus does not seem to be a factor in vertebro-basilar injuries.

Residual vision in transition zones in patients with cerebral blindness.

Using high resolution perimetry in repeated sessions, we investigated 27 patients with homonymous visual field defects in order to detect islands of vision within the damaged area, and to determine color- and form-recognition abilities within these zones of residual vision. In most patients we found circumscribed areas within the "blind" field in which the stimulus was detected in about 50% of presentations. Only one patient had an island of vision greater than 5 degrees within the defective area. We also found an area of variable performance between the blind and the intact field. Borders of field defects were classified as being: (a) sharp (small transition zone), (b) medium, or (c) fuzzy (scattered deficits). We propose that transition zones are functional representations of partially spared neuronal structures in areas of the brain which are only partially injured.