The impact of a nationwide hands-on workshop on the diagnostic rates and management of obstetrical anal sphincter Injuries in Israel.

AIM: The aim was to evaluate the influence of a half day, hands-on, workshop on the detection and repair of obstetric anal sphincter injuries (OASIs). METHOD: Starting in February 2011, hands-on workshops for the diagnosis and repair of OASIs were delivered by trained urogynaecologists in departments of tertiary medical centres in Israel. The structure of the hands-on workshop resembles the workshop organized at the International Urogynecological Association annual conferences. Participants included medical staff, midwives and surgical residents from each medical centre. We collected data regarding the rate of OASIs, 1 year before and 1 year following the workshop, in 11 medical centres. The study population was composed of parturients with the following inclusion criteria: singleton pregnancy, vertex presentation and vaginal delivery. Pre-viable preterm gestations (< 24 weeks), birth weight < 500 g, stillborn, and those with major congenital anomalies, multifoetal pregnancies, breech presentations and caesarean deliveries were excluded from the analysis. RESULTS: In the reviewed centres, 70 663 (49.3%) women delivered prior to the workshop (pre-workshop group) and 72 616 (50.7%) women delivered following the workshop (post-workshop group). Third- or fourth-degree perineal tears occurred in 248 women (0.35%) before the workshop, and in 328 (0.45%) following the workshop, a significant increase of 28.7% (P = 0.002). The increase in diagnosis was significant also in women with third-degree tears alone, 226 women (0.32%) before the workshop and 298 (0.41%) following the workshop, an increase of 28.3% (P = 0.005). CONCLUSION: The detection rate of OASIs has significantly increased following the hands-on workshop. The implementation of such programmes is crucial for increasing awareness and detection rates of OASI following vaginal deliveries.

31P-NMR studies of normal and dystrophic chicken muscle.

Phosphorus-31 nuclear magnetic resonance (31P-NMR) analysis was performed on normal (line 412) and dystrophic (line 413) superficial pectoralis muscles excised from chickens between 15 and 116 days after hatching. An apparent alteration in dystrophic muscle energy metabolism was abolished by pretreatment with curare and was attributed to muscle hyperexcitability. Time-dependent 31P-NMR studies demonstrated no apparent difference in the overall tissue adenosine triphosphatase (ATPase) activity of dystrophic as compared to normal muscle. After 55 days of age, a resonance signal attributed to serine ethanolamine phosphodiester (SEPDE) was observed only in dystrophic muscle. Adding the paramagnetic cation Mn2+ to the buffer surrounding the muscle resulted in an approximate 80% decrement in the dystrophic SEPDE signal without apparent alteration of the other phosphatic signals in either the normal or dystrophic muscle. This would argue against any generalized membrane defect in dystrophic chicken muscle and suggest that SEPDE is in a compartment accessible to Mn2+.

Lead poisoning from retained bullets. Pathogenesis, diagnosis, and management.

Lead intoxication (plumbism) from retained bullets has rarely been reported but may be fatal if unrecognized. Bullets lodged within joint spaces or pseudocysts are more likely to develop this complication, although patients with retained missiles in other locations may also be at risk. Subtle findings such as the occurrence of unexplained anemia, abdominal colic, nephropathy, or neurologic deterioration in patients with retained missiles may suggest consideration of plumbism. An intercurrent metabolic stress such as infection, endocrinopathy, or alcoholism may be a precipitating factor. Among the various diagnostic studies available, mass spectrometric stable isotope dilution analysis may be the most reliable. It is important to employ chelation therapy prior to any operative intervention. This will reduce the mobilization of lead from bone during or following the surgical procedure.