Natural Childbirth Options

Bump To Birth

The experience that a woman has during childbirth shapes how the rest of her child-raising experience goes, in many ways. A good birth can have a huge effect on how good you feel about your child, whereas a bad birth can often lead to feelings of sadness or PDST-type symptoms due to the pain and struggle of the birth experience. However, you don't need to worry about that now, because the information in this book gives you ALL of the experience and expert advice that you need in order to have a really amazing birth, that really marked that day as the truly special day that it is. This book teaches you how to use natural, holistic remedies to heal yourself during pregnancy in order to make sure that you feel your best during the whole birth experience. You can also learn everything you need to know about natural birth Everything you need to know to have a great pregnancy and birth is in this guide! More here...

Bump To Birth Summary


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Defining the Female Pelvic Floor

Anatomy of the pelvic floor is described further in Chapter 3-6. The musculature of the pelvic floor includes the levator musculature and the perineal musculature. The levator musculature provides support to all of the pelvic floor organs and is transversed by the urethra, vagina, and anus. Because the levator muscle complex provides support to all three organ systems, its weakness will result in impaired function of any, or all, of the structures that the muscles support. Muscular dysfunction can result from stretch or tear injuries to the pelvic floor muscles. However, the most common etiology for muscular dysfunction is a dener-vation injury from childbirth or lower back trauma. A denervation injury will result in partial paralysis of the supplied muscle groups. As a consequence, any lower back injury can result in weakness of pelvic floor support. This is especially true of the lower components of the pelvic floor. Injury to the pudendal nerve can result in dysfunction of the...

Continence Abnormalities

A published study by Sultan et al.24 revealed anal sphincter defects in 30 to 40 of asymptomatic postpartum females. Fortunately, the minority of these patients were symptomatic (32 ). However, these patients may become symptomatic later in life or with subsequent vaginal deliveries. In addition, pudendal nerve injury documented by electromyography has been demonstrated in 42 of post-partum females by Snooks et al.25,26 Sixty percent of these patients recovered nerve function 2 months after delivery, but 40 did not. Four percent of 906 postpartum women in a study by MacArthur et al.27 reported new symptoms of incontinence after childbirth. Sultan et al.28 showed a 1 incidence of frank fecal incontinence and a 25 incidence of decreased flatal control at 9 months' follow-up after vaginal delivery.

Levine Critchley Syndrome

The eldest died of seizures, bit her tongue and had involuntary limb movements. She became forgetful, emaciated and bedfast with violent shaking of her limbs. Two others also died about the age of 26. The fourth child had an illness of 2 years duration, with passing out spells and rejection of food from the mouth. The fifth gave birth to an unaffected child and soon afterwards became bedfast and emaciated. The ninth remained healthy till aged 31, before developing choreic movements and grand mal fits. She has always refused admission to hospital but did permit an examination on herself and her normal 17-month child. I witnessed what appeared to be an attack of hystero-epilepsy with partial loss of consciousness, opisthotonus (bending the back in hyperextension) and drawing and grasping movements of all four limbs. Speech and swallowing were normal but she showed facial grimacing sans distal choreic movements. The deep tendon reflexes were absent and the diagnosis of acanthocytosis...

Biological Explanations For The Sex Ratio In Depression

Direct evidence linking hormone status to depressive disorder has some face validity oestradiol and progesterone seem to modulate the neurotransmitter and neuroendocrine systems, including those involving monamines, and there are transitions in women's lives characterized by hormonal shifts that may also be associated with mood disturbance (childbirth and the menopause).

Psychosexual development

While sexual activity is often the focus of parental concern when a child reaches adolescence, psychosexual development arises from birth, if not before. In the second half of the first year of life, infants can tell genders apart and by the second year they are aware of their own gender. As noted earlier, they then prefer to play with children of their own gender. In the preschool years, they are increasingly aware of their own bodies. Far from confirming the stereotype of fatness equalling jollity, fat children are more likely than physically disabled children to be rejected by other children and to become depressed. Concern with size and image currently predominate in many Western cultures, and even elementary school children show concerns about being too fat.

Magnetic Resonance Imaging

DeSouza et al.30 reported their experience with endoanal MRI in six women who developed incontinence immediately after childbirth. The MRI revealed the site and extent of the defect in all patients, and the findings were confirmed at the time of surgery. In another group of 16 patients who developed incontinence 15 to 30 years after childbirth, no demonstrable defect was found, but in all cases, atrophy of the external sphincter muscle was revealed. The degree of atrophy did not correlate with the degree of delay in pudendal nerve conduction velocity.

The Partial Seizures

Confusion and headache after an attack are common. The whole episode may last for seconds but occasionally may be prolonged and a rapid succession or cluster of attacks may occur. Attacks show an increased incidence in adolescence and early adult life. A history of birth trauma or febrile convulsions in infancy may be obtained. Lesions in the hippocampus occur as a result of anoxia or from the convulsion itself and act as a source of further epilepsy. When surgery is carried out, hippocampal sclerosis is often found. Occasionally other pathologies are identified, such as hamartomas, vascular malformations and low-grade malignant astrocytomas. 91

Consequences Of A Diabetic Pregnancy

An accelerated foetal growth pattern and a large-for-gestational-age (LGA) infant at birth is the hallmark of a poorly controlled diabetic pregnancy. Foetal insulin is the main foetal anabolic hormone and hyperinsulinaemia can cause excess fat accumulation, organomegaly, especially of the heart and liver, and high birthweight. An LGA infant is a potential cause for birth trauma and a high Caesarean rate. Foetal hyperinsulinaemia is also believed to contribute to adverse foetal metabolic complications in late pregnancy including a tendency to high lactate levels and an increased risk of stillbirth. Foetal hyperinsulinae-mia at delivery can cause transient hypoglycaemia and hypocalcaemia. There is increasing and tantalising evidence that by optimising maternal glycaemia and avoiding foetal hyperinsulinaemia one can reduce the long-term risk of the child becoming obese and insulin-resistant in adult life (5).

Neurological Disorders and Neurodegenerative Diseases

Hyperekplexia, or startle disease, is a rare neurological disorder characterized by an exaggerated response to unexpected stimuli. The response is typically accompanied by a transient but complete muscular rigidity. Suspectibility to startle responses is increased by emotional tension, nervousness, fatigue and the expectation of being frightened. Symptoms of this disease are present from birth, a reason why it is also named stiff baby syndrome, with infants displaying severe muscular rigidity. This disorder has a history of being misdiagnosed as epilepsy, although

Recommended Maternal Weight Gains In Nondiabetic Pregnancies

When the pre-pregnancy BMI is > 35 kg m2, the risk of a SGA infant is low and even when little or no maternal weight gain occurs the risk of a SGA infant does not appear to increase (11). Overweight (BMI 26.1-29 kg m2) and obese (BMI > 29 kg m2) women are more likely to give birth to a LGA infant than normal weight women and this risk increases with increasing maternal weight gain. The US obstetric recommendation for a minimum 7 kg weight gain for all obese women (23,24) may not be universally appropriate (11,25). Nutritional advice given in pregnancy should include appropriate weight gain targets set in early pregnancy and based on pre-pregnancy weight.

Schizoaffective disorder Clinical features

Compared with patients with schizophrenia, patients with schizoaffective disorder tend to demonstrate relatively high levels of premorbid function. One of the most common features of the disorder is a precipitating event, such as a life stressor. For example, Tsuang et al.(1) found a higher percentage of such events in schizoaffective disorder (60 per cent) than they did in either schizophrenia (11 per cent), mania (27 per cent), or depression (39 per cent). Marneros et al.(2) also found a higher percentage of precipitating events in schizoaffective disorder (51 per cent) than in schizophrenia (24 per cent), but did not detect a difference between schizoaffective disorder and affective disorder. The nature of the precipitating stressor may vary widely for instance it may be either physical (e.g. recently giving birth or experiencing a head injury) or interpersonal (e.g. change in an important relationship). The clinical course of the disorder is often characterized by a periodic rapid...

Developmental Aspects Of Photoperiodism

Studies in montane voles (Microtus montanus) first revealed that the photope-riod in effect during gestation can influence the photoperiodic responses of the developing animals (26). Similar studies were performed in Siberian hamsters, revealing that in this species as well the dam is able to transmit a photoperiodic message to her fetuses. Thus, when male Siberian hamsters were raised from birth in 14 L they exhibited larger testes at 1 month of age if their mothers had been exposed to a shorter day length during gestation than if the mother had experienced only photoperiods > 14 L during pregnancy (36,39). This mechanism may enable juvenile hamsters to rapidly assess the significance of a moderately long photoperiod (e.g., 14L) that occurs in both early and late summer. Thus, if photoperiod has increased between the time of gestation and postpartum exposure to 14L, this would be indicative of the early part of the breeding season. Under these conditions, hamsters would rapidly...

Nonaccidental Head Injury

Although seen from birth through adolescence, this diagnosis is most common in children under 3 years of age. Evaluation of a child for head injury outside the setting of a well-documented motor vehicle or other accident must include consideration of nonaccidental trauma. Unless a plausible mechanism of injury is appropriately described and independently verified by any involved adults, further investigation is warranted.

The Exponential Model

As long as the birth rate of a population exceeds the death rate, the population size will continue to increase. At a steady, positive per capita growth rate, the population will add a larger number of individuals with each generation. So, a population can increase rapidly with even a small growth rate. A pattern of increase in number due to a steady growth rate is called exponential growth. The observation that populations can grow in this pattern is called the exponential (EKS-poh-NEN-shuhl) model of population growth.

Genetic predisposition

Precipitating events have been reported in 60 to 96 per cent of cases. These have often centred on separation or loss, relationship difficulties, taking on new responsibility, and physiological stressors (e.g. childbirth, surgery, hyperthyroidism). (55) This is certainly consistent with a diathesis vulnerability model with the illness being precipitated in a predisposed individual in adulthood.

Example of Colorectal Cancer Screening

In 2004, an estimated 146,940 new cases of and 56,730 deaths from colon and rectal cancers were expected.20 Colorectal cancer (CRC) is the third leading cause of new cancer cases (11 of all new cases) and cancer deaths (10 of all cancer deaths) in both men and women.20 In 2000, the age-adjusted incidence rate in nine Surveillance, Epidemiology, and End Results Program (SEER) registries was 55 per 100,000 the age-adjusted mortality rate was 21 per 100,000.21 The lifetime risk from birth of being diagnosed with CRC is about 6 the lifetime risk of dying from CRC is about 2 . Thus, about 1 in 3 people who develop CRC die of this disease. Between 1992 and 2001, mortality from CRC declined by 1.8 per year93 and incidence declined by 0.8 annually in the United States.94 The early detection and removal of precancerous colorectal polyps may have contributed to the decline in CRC incidence and mortality.95

Immediate Questions

Has this murmur been noted previously A murmur from a left-to-right shunting lesion, such a ventricular septal defect, presents as the pulmonary vascular resistance falls and a gradient develops between the systemic and pulmonary circulations (usually in the first week of life). Murmurs due to valve stenosis typically are present from birth. A murmur attributed to carditis (associated with Kawasaki disease, rheumatic fever, endocarditis, or myocarditis) would be a new finding, in association with other systemic signs.

The physiological effects of social relationships

Leaving aside for a moment the fact that, for humans, social signals (like other stimuli) are subject to various forms of complex processing that give meaning to them, social signals can be physiological regulators in their own right, and this regulation starts from birth. For example, the presence of a mother and the way she interacts with her infant have major impacts on the infant's physiological states (Hofer, 1994) and brain maturation (Schore, 1994, 2001). There is increasing evidence that depression in new mothers affects the interactional styles between infant and mother, such as holding, comforting, and looking at the infant, and these can have serious impacts on infant development (Murray & Cooper, 1997). Moreover, unresolved abuse issues or neglect in a mother can have a major impact on her interactional style with her own child (Liotti, 2000 Sloman et al., 2003).

Neurosteroids and CNS Development

Plasma levels of adrenal DHEA and DHEAS undergo dramatic developmental changes (38,39), suggesting that they may be involved in ontogeny. Ther role in brain development is implied by the experiments that showed that DHEA and DHEAS enhance neuronal and glial survival and differentiations in cultures from embryonic brains (40). Neurodevelopmental actions of DHEA(S) may be, in part, mediated via their actions at the GABAa receptors, whose subunit composition changes during fetal and neonatal development (8,9). In early embryonic and postnatal life, GABA acting via GABAA receptors depolarizes neurons from rat cortex, cerebellum, or spinal cord (41) and in immature neurons GABA stimulates chemokinesis (42), thereby facilitating neuronal migration. Because the immature GABAA receptors are modulated by the neurosteroids (15,44), an interplay between expression of distinct receptor subtypes manifesting different sensitivity to neurosteroids (15,44), and changing concentrations of...

Anticonvulsant Drugs And Pregnancy

The treatment of epileptic pregnant women poses particularly difficult questions. There is good evidence of an increased risk of congenital malformations in infants born of women taking antiseizure medication during pregnancy, although most such women give birth to normal infants. Because most patients are taking multiple medications and congenital malformations can occur even without medication, it is difficult or impossible to demonstrate a cause and effect relationship for most agents. In some cases the evidence is clearer. Valproic acid has been known to cause spina bifida in a small percentage of cases. Phenytoin has also long been implicated in causing birth defects, and a specific fetal hy-dantoin syndrome has been suggested. The most common abnormality seen in children of mothers receiving antiepileptic therapy is cleft palate.

Treatment of folate deficiency anemia

Folate supplementation is also recommended for women of child-bearing age to reduce the incidence of fetal neural tube defects. Folic acid should be initiated at 0.4 mg daily before conception. Most prenatal vitamins contain this amount. Women who have previously given birth to a child with a neural tube defect should take 4 to 5 mg of folic acid daily.

And the mt1 mRNA in the PT and SCN of the Syrian Hamster

Animals New born Syrian hamsters (Mesocricetusauratus) from our own colony were kept from birth in long photoperiod (LP, 14L 10D). Animals were sacrificed at various times after birth from birthday to postnatal day 60 (PN 60). All the animals were sacrificed at 5pm (1 hour before lights off). The entire head (PN 0 and PN 8) or brains (PN 21, PN 30 and PN 60) of the animals were rapidly dissected out and frozen in -30 C isopentane, and maintained at -80 C until cryosectioning (20 (im thick).

Receptor Mediated Mechanisms for Endocannabinoid Activities in the Central Nervous System

LPA bears structural similarities to 2-AG. Contos et al. (98) have demonstrated that targeted deletion of the receptor gene for LPA resulted in a defective suckling response in the knockout mice. This phenomenon is strikingly similar to the mortality of SR141716A-treated pups, which also die within days after birth due to a lack of milk ingestion from birth (99). Therefore it is possible that LPA and cannabinoids crossreact with their respective receptors. The sparse data available thus far do not support such a hypothesis. Thus SR141716A-induced inhibition of cannabinoid-stimulated p38 mito-gen-activated protein kinases did not alter the effects of LPA on p38-MAPK phosphorylation (100). Moreover, whereas THC completely reversed the effects of neonatally applied SR141716A, LPA did not (99). In both these reports, oleoyl-sn-glycero-3-phos-phate were used. Thus it remains to be seen whether other LPA species, notably LPA from arachidonic acid, will display cross-reactivity with...

Applications to Differential Equations

Demographic stochasticity refers to random variation in the occurrence of events affecting the state of an individual. For example, an ecological population can be viewed as being composed of an integer number of individuals that undergo at least two important processes birth and death. We can model random variation in an individual's state by assuming there are probabilities associated with an individual giving birth or dying within some small, finite time interval. For example, if the organisms in question give birth to only one offspring at a time, we might assume that the probability of having one offspring in At is r, and that the probability of no offspring is 1 - r. We take a similar approach to mortality. These probabilities may ultimately be caused by chance encounters with a fertile mate or a predator. The important point is that the biological process affecting individuals either occurs, or not, according to random events. The concept of demographic stochasticity can be...

Birth brachial plexus palsy

The overwhelming majority of babies who suffer only an upper plexus injury associated with the birth process rapidly recover high function, though it is occasionally a less than fully normal state. Their nerve injury is rarely to the level of Sunderland IV (severe axonotmesis) or 5 (neu-rotmesis) 23 . The babies that show signs of rapid recovery (ie, within days or weeks) rarely have functional deficits that will be reliably benefited by surgery, either microneurosurgical or conventional. The opposite is true for babies with global palsies who do not recover very rapidly. These babies all have some combination of root rupture and avulsion and will not experience predictable spontaneous recovery. In spite of a large experience in managing babies with birth palsies, there is still controversy regarding the roles of micro-neurosurgical and conventional treatment.

Normal Sleep In Children

In adults and most children, rapid eye movement (REM) periods occur in cycles of approximately 90 minutes throughout the night. REM latencies may be longer in younger children (16). New data suggest that the length of the REM non-REM (NREM) cycle fluctuates with age (17). At the end of every REM cycle there is usually an arousal or brief awakening. In infants REM cycles are shorter (approximately 40-60 minutes). Parents may be concerned that their infant seems to wake up every hour. These brief awakenings may be part of the child's normal rhythm but an overly attentive parent may inadvertently reinforce and prolonged the awakenings. On the other hand, it is possible that the child's awakenings are due to a condition that is exacerbated by REM sleep such as OSA. The percent of the total sleep time spent in REM decreases from birth when it may take up 50 of the total sleep time to approximately 20 at three years of age. It remains at this percent throughout adulthood.

Cone Dysfunction Syndromes

Rod monochromatism is an autosomal recessive disorder characterised by poor vision from birth, nystagmus and photophobia and is consequent upon mutations in CNGA3 or CNGB3 62 . Patients usually attain acuities of about 6 60 and have absent colour vision. Most patients are hyperopic. The fundus is usually normal, although some granularity of the central macula may develop with time. The ERG reveals an absent or severely reduced 30-Hz flicker response, but good rod ERGs following even a limited period of dark adaptation (Fig. 9.2 C). Minor reduction in maximum ERG a-wave may reflect the absence of the cone contribution from this mixed response.

Vertebrate Characteristics

The fertilized eggs of many fishes, amphibians, reptiles, and birds develop outside the body. A developing embryo is nourished by the egg yolk and protected by jellylike layers or a shell. The zygotes of some fishes, amphibians, and reptiles remain inside the body of the female, nourished by the yolk until they hatch. In contrast, most mammals give birth to live offspring. Embryos of pla-cental mammals develop in the female's body, nourished by the mother's blood supply until the young are born. With the exception of amphibians and some fishes, vertebrates undergo direct development. So, the young and the adults can share the same resources an advantage if those resources are plentiful.

Sailor to Farmer to Scientist

Wilmut's next love was farming, because he enjoyed being outdoors and knew that a farmer's life would keep him outside much of the time. Working on farms during weekends, he milked dairy cows and saw them giving birth. Those experiences interested him in the animals' biology.

The psychopathology of parturition

Childbirth can be one of the severest of human ordeals. Its torments occasionally result in acts of desperation, which are fully described in the older literature. They are much rarer now, but may still occur where obstetrics is primitive, or pregnancy denied. Auto-Caesarean section has been documented. (35) There are reports of completed suicide. Rage attacks have been described, which can endanger the fetus, and may be a factor in some cases of neonaticide.

The psychiatry of the postpartum period The normal puerperium

For many or most mothers, giving birth is one of the supreme moments of their lives, and euphoria or elation is common. Some may be too excited to sleep. These feelings of peace, fulfilment, and accomplishment help to sustain mothers during the weeks of strain that follow. Prolonged euphoric reactions, lasting a week or more, are probably mild puerperal mania, and are often followed by depression. complications of childbirth are more numerous and complex than in any other human situation.

Psychopharmacological treatments

One-third of pregnant women take psychotropic drugs at least once during pregnancy, but no preparations are entirely appropriate for expectant mothers. The first trimester is a time of particular risk. Intra-uterine exposure to lithium probably increases the risk of congenital malformation, but such a risk has not been found for most antidepressants and neuroleptics. Intra-uterine exposure during the second and third trimesters can lead to postnatal complications, such as the floppy-infant syndrome after taking benzodiazepines, and extrapyramidal-motor effects on the newborn after neuroleptic therapy during pregnancy. The increased risk of psychiatric disorders during the postpartum period often necessitates psychopharmacological intervention. Lithium prophylaxis in manic-depressive women is indicated after childbirth, and weaning rather than omission of drug treatment is preferable during the puerperium.

Mesenchymal hamartoma

Mesenchymal hamartoma is a 'tumour malformation' that develops in utero. It accounts for 8 of all liver tumours and pseudotumours from birth to 21 years of age, but during the first two years of life it represents 12 of all hepatic tumours and pseudotumours, and for 22 of the benign neoplasms 1839 . It usually manifests in the first two years of life and there is a slight male predominance. Lesions involve the right lobe in 75 of cases, the left lobe in 22 and both lobes in 3 .

Teenage transformations

One thing that is essential to remember as a parent or anyone working with children is that nothing is ever static. Children seem to be 'just at that age' from birth till adulthood. In a larger family it is hard to keep up with the swirling ebbs and flows of each stage of development and it is all too easy to be focused on one particular child and the stage he or she is at, only to turn around and realize that others have moved on to a new stage of development.

Infantile haemangioendothelioma

This lesion is defined as a benign tumour composed of vessels lined by plump endothelial cells, intermingled with bile ducts, that are set in a fibrous stroma. Infantile haemangioendothelioma accounts for about one fifth of all liver tumours and pseudotumours from birth to 21 years of age. It usually presents in the first two years of life, when it represents 40 of all tumours and pseudotumours and 70 of the benign ones 1839 . It occurs more frequently in females (63 ) than in males. Infantile haemangioendothelioma is a localized 'tumour malformation' that develops in utero. There may be a variety of associated congenital anomalies, including hemihypertrophy

Histochemical and Immunohistochemical Detection of lacZPositive Cells at the Light Microscopic Level

The total number of pups should be counted after the pregnant dam has given birth to the injected embryos. Often, fewer pups are born than the number of embryos that were injected. Moreover, one can not correlate individual pups with the number they were assigned prenatally at the time of surgery unless the injection site was substantially different (i.e., right hemisphere vs left hemisphere, or big differences in the volume of retrovirus injected). If the injected animals are retrieved at a later embryonic time point, individual injected animals can be distinguished by their position along each uterine horn.

Pregnancies Fathered By Male Transplant Recipients

A registry study of 204 male recipients who fathered 288 pregnancies revealed 290 evaluable outcomes with 2 neonatal deaths.38,57 One was an infant with Potter's syndrome and another a premature smaller twin with respiratory distress from birth. Analysis of outcomes (n 26) in relation to the new immunosuppressive regimens including Neoral , tacrolimus and MMF, revealed 1 child who required surgery for ureteral obstruction and another for hydrocele. Specifically, none of the offspring of fathers with MMF exposure were reported to have congenital malformations.38

Obstetric Management Issues

Preterm delivery (before 37 weeks gestation) is common because of intervention for obstetric reasons and the tendency to premature labor. Unless there are specific problems, however, spontaneous onset of labor can be awaited. Vaginal delivery is the aim and cesarean section is only necessary for obstetric reasons. Vaginal delivery does not cause mechanical injury to a renal transplant, and neither does the graft obstruct the birth canal.

Clinicopathological correlations

Associated with PD (Oppenheimer, 1980). In fact, his observations gave birth to the suggestion that the phenotype of this disease correlates with the regional localization of the Lewy bodies a brainstem distribution in parkinsonism, a cortical distribution in dementia, and Lewy bodies in the autonomic pathways in autonomic failure (Oppenheimer, 1980). Based on the same observations, combined with the idea of a stereotypical topographic pathological progression, Braak and colleagues (Braak, 2003b) hypothesized that PD might originate outside of the central nervous system. In that case, they reasoned, a yet unidentified pathogen could be capable of passing the mucosal barrier of the gastrointestinal tract to enter the central nervous system by retrograde axonal and transneuronal transport along post- and preganglionic neurons (Braak, 2003b).

Liaison with traditional healers

Policy will need to set the framework to encourage regular opportunities for discussion, through workshops between mental health personnel, primary health-care teams, and traditional healers working towards gradual agreement of collaborative ways of working which may eventually include criteria for referral, diagnostic algorithms, shared care, and consideration of appropriate research including evaluation of traditional herbal remedies. In a number of countries including Zanzibar there is already good liaison between the obstetric service and traditional birth attendants. In Rawalpindi, Pakistan, diagnostic algorithms have been developed between the psychiatric service and traditional healers to encourage the referral of people with psychosis, and with petit mal and grand mal fits.

Treatment of neonates

Spiramycin until diagnosis P + S + F (4 weeks) + Spiramycin (4-6 weeks) Repeat until 12 months of age Alternative (a) P + S + F (3 months) (b) Fansidar 1 tablet 20kg week P + S + F (from birth until 6-12 months), Alternative after 6 months of age Spiramycin (4 weeks) + P + S + F (4 weeks)

Behavioural determinants of vector competence

Seasonal variation in host feeding and host preference can enhance transmission of pathogens and initiate disease outbreaks. For instance, Culex nigripalpus and Cx. tarsalis are vectors of St. Louis encephalitis virus (SLEV) during summer months in Florida and California, respectively. Both species show a marked seasonal change in their feeding patterns, switching from bird feeding in the winter and spring to mammal feeding in the summer when arbovirus transmission occurs (Edman, 1974 Edman & Taylor, 1968 Tempelis & Washino, 1967). These changes in feeding patterns may affect SLEV epidemiology. It has been suggested that the retreat of Plasmodium malariae and P. falciparum from Europe during the late 19th century was caused by a switch in host preference of several anopheline vectors from humans to domestic animals. Changes in animal husbandry, agricultural practices, housing and a decreased human birth rate may have reduced the number of human hosts available, contributing to...

Thyroid emergencies Thyrotoxic crisis

Presents as an exacerbation of the clinical features of hyperthyroidism (e.g. pyrexia, hyperdynamic circulation, heart failure, confusion). There is usually a precipitating factor such as infection, surgery, ketoacidosis, myocardial infarction or childbirth. It may present with exhaustion in the elderly with few features of hyperthyroidism. The diagnosis is confirmed by standard thyroid function tests.

Pathophysiology of OSAS

The etiology of OSAS is uncertain and multifactorial. For OSAS to occur there must probably be a combination of three factors altered airway structure, diminished neuromuscular control, and miscellaneous factors, such as genetic and hormonal influences. Thus, one child with a narrow airway due to adenotonsillar hypertrophy with a high ventilatory drive may not develop OSAS. An intense local and systemic inflammation tends to presents in these patients. In the upper airway, this process may promote oropharyngeal inspiratory muscle dysfunction and amplify both upper airway narrowing and collapsibility thereby worsening the frequency and duration of apneas during sleep. Adenotonsillar hypertrophy is the commonest condition associated with childhood OSAS. The lymphoid tissue in the upper airway increases in volume from birth to 12 years of age with a peak between 3 and 6 years of age. This coincides with the peak incidence of childhood OSAS. Craniofacial anomalies due to narrowing of the...

Chapter References

Building developmental and etiological theory through epidemiologically based preventive intervention trials. In Preventing antisocial behavior interventions from birth to adolescence (ed. J. McCord and R. Tremblay), pp. 162-95. Guilford Press, New York.

Psychoanalytic theories

The importance of early interpersonal experiences in psychological development was argued for by Melanie Klein (1946), and subsequent object-relations theorists. Klein's proposition that representations may be split into good and bad, and that if these are not in contact with each other there is a price to be paid, is a form of explanation that is highly compatible with a consideration of the consequences of threats to intentionality. However, and with hindsight perhaps surprisingly, Klein assumes that this is the basic universal human condition in early infancy which is 'cured' by good parenting. The evidence, which we reviewed briefly in Chapter 6, would suggest that infants possess substantial integrative capabilities from birth, and that disorder is more likely to arise from threats to the integrity of intentionality. Notwithstanding this difference, both analyses lead to the conclusion that parents, or other committed care-givers, are important to the developmental processes...

Intrapartum stillbirths

Complications of childbirth are the cause of almost all deaths during delivery. Intrapartum deaths are largely avoidable through appropriate care during delivery, and therefore closely related to the place of birth and the availability of qualified birth attendants. In developed countries, most deliveries take place in institutions and almost without exception in the presence of qualified health personnel. In developing countries, just over 40 of deliveries occur in health facilities and only slightly more than 1 in 2 takes place with the assistance of a doctor, midwife or qualified nurse (2,5).

Neurobehavioural teratology

Retardation, and a characteristic facial appearance. (21 The extent of the abnormality depends on the time of maximal exposure to alcohol and the dose. Approximately half of those affected have co-ordination problems, are hypotonic, and have attention deficits. Between 20 and 50 per cent have other birth defects, including eye and ear anomalies and cardiac anomalies. Those children who do not show growth retardation or congenital anomalies may show more subtle changes, such as attention problems, reduced speed of information processing, motor clumsiness, speech disorders, fine motor impairment, and learning problems, especially in mathematics. These findings have been documented in a prospective longitudinal study of the effects of prenatal alcohol exposure on a birth cohort of 500 offspring who were selected from 1529 consecutive pregnant women in prenatal care in community hospitals.(22) Dose-dependent effects are most clear from the neurobehavioural status of subjects with regular...

Assessment and treatment

Treatment often requires a multidisciplinary approach with close liaison between paediatricians and psychosocial services. A detailed medical history should also examine the emotional effects of the adverse medical experiences on the parents and child, and link these effects with a detailed account of the developmental progress of the child's feeding habits from birth. This will start to identify possible areas for intervention. The parents' attitudes to food and eating may also be relevant if these are distorted.

Neurotoxic Effects in Experimental Animals

Sensory effects seen in monkeys include slight constriction of visual fields and age-related differences in both spatial and temporal visual function in animals exposed to MeHg in utero or postpartum for 7 years. Additional effects include delayed decrements in auditory and visual function in monkeys exposed to MeHg in utero through maternal treatment, and impaired spatial vision, clumsiness, decreased fine motor performance, impaired high-frequency hearing, and delayed insensitivity to touch in monkeys fed MeHg for 3-7 years from birth 230-233 .

Supplemental Reading

Patients who are pregnant 2 or more weeks beyond their due date are classified as having postterm or postdate pregnancy. These prolonged pregnancies carry the increased risk of fetal death (2 to 6 times as high as for women who are at 40 weeks' gestation). Women who are postterm have a higher risk of cesarean section, trauma from delivery, prolonged bleeding after delivery, and prolonged hospitalization. Newborns who are born postterm have an increased risk of being pathologically large (macroso-mia), birth trauma, intolerance to labor, meconium staining, meconium aspiration, and possible subsequent hypoxia or anoxia brain injury. With all these concerns, labor induction may be safer than continuing the pregnancy.

Ethical problems of prevention

Ethical questions arise if there are no measures to prevent the effects of an identified genetic or other cause of mental retardation identified during pregnancy. Disordered genes, other genetic rearrangements, or accidental mutations cannot be removed from a population. Primary prevention of a mental retardation becomes the prevention of childbirth or selective abortion. The latter is usually on the grounds that the burden of caring for the child would be too great for the parents, an indication that is more social than medical. We do everything to prevent heart attacks, but still treat coronary infarcts as effectively as possible. Similarly, the prevention of mental retardation need not imply negative attitudes towards disability. (4,4 43 and 44)

Incidence And Risk Factors For Peripartum Cardiomyopathy

The true incidence of PPCM is not known. This is because most PPCM series are reported from tertiary referral hospitals and by their nature contain significant referral bias. To date, no population-based estimate of the occurrence of left ventricular dysfunction in pregnant women has been reported. The best reported incidence rates for PPCM range between 1 per 1,500 and 1 per 15,000 live births the currently accepted best estimate of incidence in the United States is approximately 1 per 3,000 live births. From the 1999 birth rate of 14.5 live births per 1,000 population in the United States, this translates into about 1,500 new cases of PPCM each year in the United States.4 A variant of PPCM occurs in northern Nigeria that may be related to the local tribal custom of ingesting large quantities of salt during pregnancy.

Leber Congenital Amaurosis

RP is just one type of inherited disease that affects the retina. Leber congenital amaurosis (LCA) is an early-onset form of retinal degeneration characterized by severe blindness from birth or early childhood. Individuals with LCA have no detectable electroretinogram measurements because the retina is unable to respond to light (17). Only recently, a mutation in a gene called RPE65 was identified as the cause of a specific form of LCA (18). RPE65 is a product of the RPE cells and supports the function of photoreceptor cells. The gene is involved in the biochemical cascade of phototransduction and is important in converting light to neural signals. Since the LCA mutation was defined, many experiments to replace the

Evidence for biological determinants of offending behaviour

Gene expression is likely to interact with environmental factors such as violent or incompetent parents, or inadequate role models. In a Danish study of 397 males followed from birth to early adult life, a subgroup with early neuromotor deficits who also had unstable families showed more than twice the adolescent disturbance and adult criminal behaviour than subgroups with either neuromotor deficits or family instability alone. (23) The subgroup with both neuromotor and social disadvantages (44 per cent of the cohort) accounted for 70 per cent of the total crime committed by the cohort.

Diminished responsibility and infanticide

The Infanticide Act 1938 provides that a woman who kills her child in the first year of its life may be convicted of infanticide (rather than murder) if, at the time, 'the balance of her mind was disturbed' by the effects of childbirth. In other homicide cases where defendants are charged with murder, they may plead guilty to manslaughter on the grounds of diminished responsibility if there is psychiatric evidence that they were suffering from mental disorder at the time of the offence. Under the Homicide Act 1957 the criterion for a diminished responsibility verdict is that at the time of the killing the accused was suffering from an abnormality of mind which substantially impaired his mental responsibility for his acts. The mental abnormality must arise from arrested or retarded development, disease or injury, or 'inherent causes'. Conventionally, 'disease' usually equates to mental illness, and 'inherent causes' usually equates to personality disorder.

Cross Sectional Survey

An even weaker method of establishing causal relationships than the prospective survey or the case-control study is the cross-sectional design, which also uses one group. At one point in time, the subjects are interviewed and or examined to determine whether or not they were exposed to the agent and whether they have the outcome of interest. For example, a large group of women could be interviewed to determine (1) if they had given birth to a child with a cleft lip and (2) if they had used tricyclic antide-pressants during the pregnancy. A higher proportion of women who used these medications and had children with this deformity may indicate that the antidepressant was responsible.

Delusional misidentification syndromes DMIS8

The abilities to recognize individual faces and to discriminate between different faces are fundamental human processes and normally we are extraordinarily adept at them. The biological need for face recognition is present from birth and the capacity elaborates throughout earlier life. Changes in a familiar facial appearance can be unsettling and even frightening, not just in children but also in adults. A great deal of sophisticated neurophysiological and neuropsychological investigation has been carried out on normal and abnormal human face-recognition abilities.

Insulin Like Growth Factors Insulin IGFs 1 and

- Relaxin is a peptide hormone produced by the corpora lutea of ovaries during pregnancy. The secretion of the hormone into the blood stream just before parturition results in softening and lengthening of the pubic symphysis and a softening of the cervix, which facilitates the birth process. By inhibiting uterine contractions, Relaxin may influence the timing of parturition. The factor consists of two peptide chains covalently linked by disulfide bonds.

Neurologic Evaluation of the Pelvic Floor

Pudendal Electromyography

In our institution, my colleagues and I have considerable experience in measurement of pudendal nerve terminal motor latencies (PNTML) and external anal sphincter muscle concentric needle electromyography (AEMG), as part of the routine evaluation of bowel evacuatory disorders, especially fecal incontinence. In a 1991 survey of American and British colorectal surgeons, PNTML and AEMG were available only in 15 and 34 of anorectal physiology laboratories, respectively. Neurogenic injury in fecal incontinence was suggested by histometric and single fiber electromyogram (EMG) studies of the anal sphincter. Conditions that promote traction injury to the pudendal nerves (as in childbirth and prolapse) may lead to fecal incontinence. These neurophysiologic techniques provide objective assessment of nerve and or muscle injury, and allow for optimal treatment approach.3

The Biological Perspective

Sean's problems had their origin with his father, an aggressive and financially successful physician, noted for authoring a breakthrough surgical procedure. His mother was a shy woman who had worked as a high school teacher before they were married. From birth, he was an unusual baby. He cried incessantly and failed to develop a coherent schedule of feeding and sleeping. Worse, he was easily upset, and cried at the sight of anyone other than his mother.

The Real Fountain of Youth

Cynthia Kenyon, however, thinks that antiaging treatments will develop slowly enough for society to have time to adjust to them. If everyone ages twice as slowly, you'll still have the same percentage of old and young. So we're not talking about filling up the world with old and infirm people, she told David Duncan. On the contrary, she says, life-extended people would continue working and would be active contributors to society. The overpopulation problem, Kenyon says, can be solved by lowering the birth rate encouraging people to have fewer children and have them later in life. With a life-span-extending pill, the birthrate would have to come down just a little more than it needs to do already, she thinks.

Infanticide and maternal filicide

Infanticide has a legal definition in England and Wales that is narrower than the generally accepted meaning of the term (see Chapter 5.4). It is the killing of a baby aged under 12 months by its mother, the balance of whose mind is disturbed at the time by the effects of childbirth (Section l(i), Infanticide Act 1938). In recent years there have been fewer than five infanticides per year. Infant killing today has little to do with outdated notions of 'milk fever' upon which infanticide legislation was premised. Some result from a psychiatric disorder such as depression, and rarely a psychotic illness, while others seem to follow a loss of temper by the mother in relation to an aspect of the baby's behaviour. Payne(l65) has drawn attention to the association with similar psychosocial antecedents to those seen in child battering and neglect.

Vitamin A And Cancer In Experimental Animals

Keratinizing epithelial as the most conspicuous effects of vitamin A deficiency. These observations focused attention of vitamin A function on epithelia, and gave birth to the conclusion that the primary systemic function of vitamin A was to control epithelial differentiation.1 These observations also prompted multiple intervention studies with laboratory animals, which concluded that dosing with various retinoids (retinyl palmitate, retinyl acetate, RA) reduced the incidence of chemically induced (7,12-dimethyl-1,2-benzanthracene, benzo a pyrine, 3-meth-ylcholanthrene, N-methyl-N-nitrosourea) lesions in several epithelial targets, including the respiratory tract, the stomach, the vagina, and skin.17 Most likely because of poorly controlled protocols and or different protocols that really were not comparable, the earliest animal studies reported mixed results of dietary vitamin A supplementation on the incidence of chemically caused carcinogenesis. Many studies, however, showed...

Postmarketing Sources Of Data Regarding Reproductive Safety

Large cohort studies can involve open cohorts that are population-based and ongoing, or can be hospital-based and of limited duration. For example, the Swedish Registry of Congenital Malformations in combination with the Swedish Medical Birth Registry encompasses all births in Sweden and utilizes exposure interviews conducted by midwives during the first trimester of pregnancy as well as data recorded prospectively in medical records (Ericson et al., 1999). The Collaborative Perinatal Project conducted in the 1960s was a study involving over 50 000 mother -child pairs identified at multiple sites throughout the United States (Chung and Myrianthopoulos,

Coagulation Factors VII and V

Population possess the factor V Leiden mutation (132), which may therefore be regarded as a fairly frequent polymorphism with phenotypic effect. Because the factor V Leiden mutation is also associated with a relative risk of 6.0 for venous thrombosis, this also represents a polymorphism with clinical effect. Why is this factor V variant so common Its high frequency in the general population suggests that it confers, or has conferred, some selective advantage on its bearers. Dahlback (132) speculated that a slight hypercoagulable state associated with possession of the factor V Leiden variant might have been advantageous in certain situations, such as traumatic injury and childbirth. Consistent with this postulate, carriers of the factor V Leiden variant have a significantly reduced risk of bleeding during surgery (133) and childbirth (134), despite a higher than normal risk of fetal loss (135).

Patterns and stages of the course of schizophrenia

At present it does not seem possible to define with any precision discrete stages in the progression of schizophrenic illnesses using combined clinical and pathological criteria, as in cancer or cardiovascular disease. Nevertheless, a 'softer' form of staging is feasible since there is on the whole a good agreement between the results of different studies on the general pattern of course in schizophrenia. On the basis of long-term follow-up studies, the lifetime course of schizophrenia can be articulated into a premorbid phase (from birth to the onset of psychosis), a phase of acute or positive schizophrenic symptomatology, and a residual phase. (34' Various substages have been proposed to describe in finer detail the pre-onset period, (35,36) and theorizing about the implications of the so-called neurodevelopmental model of the aetiology of schizophrenia has led to suggestions about backdating the premorbid period to include gestation. However, for most practical and research...

Mild intellectual impairment

Prevalence of a group defined by IQ of 50 to 69 reflects largely the 'normal' population distribution of IQs. For a test of mean 100, standard deviation 15, 2.27 per cent of the population will fall below IQ 70 plus a small effect (mostly IQ < 50) from specific pathologies. The few populations providing data confirm this with figures of 25 to 30 per 1000. Intelligence tests should be validated for specific populations. Test means and standard deviations should be known from recent studies, because population means, to which all IQ scores are related, change over time. Data are not available for most populations Because measured intelligence in populations varies, studies of the effects on intelligence of environmental hazards (e.g. birth trauma or lead) must assess outcome in relation to population norms in a related cohort of births.

Non Venereal Genital System Diseases

Puerperal (childbed) fever, which can still occur occasionally following childbirth, is an example of a non-venereal genital system infection. Other serious infections are associated with menstruation and spontaneous or induced abortions. Organisms from dirt and dust and from a woman's own fecal bacteria can attack the traumatized uterus. One of the most feared bacteria, Clostridium perfringens, causes uterine gas gangrene and has been responsible for many fatalities following abortions induced under unclean conditions. Also, the normal vagina can be colonized by various pathogens, producing symptoms that range from annoying to life threatening. puerperal fever, p. 485

Demographic Transition

Human populations have undergone rapid growth, yet in some developed countries, populations have stopped growing. The demographic transition model shows how these population changes happen. The theory behind the model is that industrial development causes economic and social progress that then affects population growth rates. Figure 19-13 compares general trends in birth rates, death rates, and population sizes during four stages. In the first stage of the model, the birth rate and the death rate are both at high levels, and the population size is stable. In the second stage, a population explosion occurs. Death rates decline as hygiene, nutrition, and education improve. But birth rates remain high, so the population grows very fast. In the third stage, population growth slows because the birth rate decreases. As the birth rate becomes close to the death rate, the population size stabilizes. In the fourth stage, the birth rate drops below replacement level, so the size of the...

Diversification Of Mammals

Dinosaurs dominated most terrestrial habitats while populations of small mammals continued to evolve. By the middle of the Cretaceous period, about 100 million years ago, three different kinds of mammals had appeared. Modern mammals belong to one of these three groups. The first group is made up of monotremes. They are oviparous, meaning that they lay eggs. The second group is made up of marsupials. They are viviparous, which means that they give birth to live young. In marsupials, the young develop within a pouch on the mother's body for some time after birth. The third group is made up of placental mammals. They are also viviparous, but in this group, the fetus typically develops within the mother's reproductive system for a longer time than it does in marsupials. Also, in this group, the developing fetus receives nourishment through a blood-rich structure called the placenta.

Acute Subdural Hematoma

Acute subdural hematomas result from accidental and nonaccidental trauma, as well as birth trauma. Generalized seizures and severe cerebral edema are relatively common in the presence of traumatic subdural hematomas. Critical care interventions to control the impact of these complications (outlined above) should be aggressively pursued. The hematoma and edematous injured brain may result in shift of midline structures (such as the interhemispheric fissure) away from the midline skull and dural landmarks, and efface the basilar cisterns. A large amount of midline shift with only a thin hematoma generally results from severe underlying brain injury and edema and carries a particularly grim prognosis. At any time during this clinical sequence, the patient may demonstrate the Cushing reflex systemic arterial hypertension and bradycardia which is also a secondary sign of severe intracranial hypertension. A large, unilateral subdural hematoma may cause an 'uncal herniation syndrome.' By...

Populations and Individuals

We have already introduced, through examples in Part , density-independent and density-dependent population growth. We will not repeat that now, but rather will give a simple, phenomenological generalization of the models. We wish to formulate an hypothesis of population growth based on the effects that the entire population has on the reproduction of an average individual. (By average, we mean average in all respects sex, weight, age, and so on.) In density-independent models, the relation is a straight line with zero slope in the density-dependent logistic model, it is a straight line with negative slope (Sec. 2.3). To generalize the biological hypothesis that increased population size always decreases per capita birth rate, we could use a nonlinear relation such as Richard's equation as illustrated in Chapter 5. A more dramatic departure is a phenomenon called the Allee effect in which two processes are operating decreases in per capita birth rate due to competition, and increases...

Female Reproductive Structures

The lower entrance to the uterus is called the cervix (SUHR-VIKS). A sphincter muscle in the cervix controls the opening to the uterus. Leading from the cervix to the outside of the body is a muscular tube called the vagina (vuh-JIE-nuh), as shown in Figure 51-6. The vagina receives sperm from the penis it is also the channel through which a baby passes during childbirth. The external structures of the female reproductive system are collectively called the vulva (VUHL-vuh). The vulva includes the labia (LAY-bee-uh) (singular, labium), folds of skin and mucous membranes that cover and protect the opening to the female reproductive system.

Clinical Studies Low IGF1 Is Associated with Degree of ROP

The degree of Phase I determines the degree of Phase II, the later destructive phase of ROP. Normal vessel development in the retina precludes the development of proliferative ROP. Because ROP is initiated by abnormal postnatal retinal development, we hypothesized that prolonged low IGF-I in premature infants might be a risk factor for ROP. We conducted a prospective, longitudinal study measuring serum IGF-I concentrations weekly in 84 premature infants from birth (postmenstrual ages 24-32 weeks) until discharge from the hospital. Infants were evaluated for ROP and other morbidity of prematurity bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC). Low serum IGF-I values correlated with later development of ROP.

Early adolescent gender identity disorder

The psychiatric management dilemma is in predicting which gender dysphoric adolescents will mature into adult transsexuals, and which will be able to live in the gender role expected from birth, perhaps as homosexual adult men and women. More time is needed to evaluate these adolescents' evolving gender identity, without the troubling somatic changes of puberty. Therefore, gonadal hormone antagonists have been utilized in a small number of such patients. (36)

Overlapping Sphincter Repair

Anorectal Surgery Pictures

To complete the physiologic evaluation of the patient with incontinence, measurement of the PNTML is routinely performed. Damage to the EAS may be accompanied by injury to the pudendal nerve that manifests as prolonged pudendal nerve latency (see Chapter 3-6). A PNTML of more than 2.2 milliseconds is considered abnormal at our institution. Pudendal neuropathy corresponds on EMG to a decreased or absent action potentials or polyphasia. Pudendal nerve damage may contribute to incontinence after obstetric trauma and is found to be a poor prognostic factor after overlapping sphincteroplasty. However, prolonged PNTML may not preclude sphincteroplasty after extensive counseling.5 A waiting period of 6 to 12 months may allow time to recover after a birthing injury however, if the injury is remote, recovery is unlikely.

Primary Sex Organs Ovaries

The vagina is a tubular canal connecting the cervix of the uterus with the outside. It serves as a birth canal and as an organ of copulation. It is capable of stretching during childbirth. The low opening of the vagina may be partially closed by a thin membrane known as the hymen.

Extracranial Hematomas

Subgaleal hematomas fill the large potential space between the galea and periosteum. In neonates and infants, up to 250 cc of blood (a life-threatening hemorrhage) can accumulate in the subgaleal space, and are not restricted to the suture sites. Subgaleal hematoma commonly results from birth injury. Hematocrit should be followed closely and transfusions given if needed. Surgical evacuation is rarely indicated. Needle drainage should be avoided because of the potential for infection. Most lesions spontaneously resolve. Subperiosteal hematomas (equivalent to 'cephalhematomas') are limited in extent by sutural attachments of the periosteum to the outer table of the skull. They may result from birth or other trauma and are commonly associated with a linear

Review The Concepts

In 1997, Dolly the sheep was cloned by a technique called somatic cell nuclear transfer. A nucleus from an adult mammary cell was transferred into an egg from which the nucleus had been removed. The egg was allowed to divide several times in culture, then the embryo was transferred to a surrogate mother who gave birth to Dolly. Dolly died in 2003 after mating and giving birth herself to viable offspring. What does the creation of Dolly tell us about the potential of nuclear material derived from a fully differentiated adult cell Does the creation of Dolly tell us anything about the potential of an intact, fully differentiated adult cell Name three types of information that function to preserve cell type. Which of these types of information was shown to be reversible by the Dolly experiment

Potential Risk Factors

Pregnancy and Childbirth Urinary incontinence in women is often assumed to be attributable to the effects of pregnancy and childbirth. The literature shows that UI is a more common occurrence among pregnant women compared with other groups of women,with reported prevalence rates of 31 and 60 .17,18 Urinary incontinence during pregnancy is a self-limited condition. Viktrup et al.19 found a 28 prevalence rate of SUI during pregnancy, with 16 becoming free of symptoms in the puerperium. It is still questionable whether pregnancy itself is a risk factor for UI in later life or if it is the vaginal delivery that is the main risk factor. The authors also compared continent women having delivered vagi-nally with women who underwent a cesarean delivery and found a difference in favor of cesarean delivery. However, 3 months after delivery, the difference became statistically insignificant. A link between UI and parity has been demonstrated, and several explanations have been offered. First,...

Group A Streptococcal Flesh Eaters

Strep Fasciitis

Streptococcus pyogenes was introduced in the chapters on skin and respiratory infections as the cause of strep throat, scarlet fever, and other conditions. It is also a common cause of wound infections, which have generally been easy to treat since the bacteria are consistently susceptible to penicillin. Occasionally, however, S. pyogenes infections can progress rapidly, even leading to death despite antimicrobial treatment. These more severe infections are called invasive and include pneumonia, meningitis, puerperal or childbirth fever, necrotizing fasciitis or flesh-eating disease, and worst of all, streptococcal toxic shock, which is similar to staphylococcal toxic shock. Deaths from invasive strep infections have caused widespread popular concern as S. pyogenes became the flesh-eating bacterium of the tabloid press. This section will focus on necrotizing fasciitis (figure 27.5), a rare but dramatic complication of S. pyogenes infection. Streptococcus pyogenes, p. 565...

Estimates And Projections For Neurological Disorders

For the purpose of calculation of estimates of the global burden of disease, the neurological disorders are included from two categories neurological disorders within the neuropsychiatric category, and neurological disorders from other categories. Neurological disorders within the neuropsychiatric category refer to the cause category listed in Group II under neuropsychiatric disorders and include epilepsy, Alzheimer and other dementias, Parkinson's disease, multiple sclerosis and migraine. Neurological disorders from other categories include diseases and injuries which have neurological sequelae and are listed elsewhere in cause category Groups I, II and III (10). The complete list used for calculation of GBD estimates for neurological disorders is given in Annex 3. Among the various neurological disorders discussed in this report, please note that for headache disorders, GBD includes migraine only (see Chapter 3.3). Also, GBD does not describe separately the burden associated with...

Spinal Dysraphism in Adults

Adult patients with spinal dysraphism include those with new symptomatic onset of a previously unsuspected occult dysraphic condition and those with a known dysraphic lesion in childhood but with symptom onset only in adulthood. In both groups, unlike in childhood, pain is the most frequent presenting symptom. This may be poorly localized and bilateral, and coupled with weakness in the legs as well as sensory disturbance. Problems with bladder control, as well as erectile dysfunction, also occur frequently. Not infrequently, the problem only comes to light as a result of excessive stretching of the conus, as may occur in childbirth or trauma 25 . In those with a known dysraphic lesion, presentation in adulthood may be with a progressive scoliosis or foot deformity, although these features are generally not seen in an adult with a previously unsuspected dysraphism.

Obstetric Factors

The vaginal birth process represents the common denominator for many pelvic floor dysfunction symptoms. Our understanding of neuromuscular damage, which occurs during the vaginal birth process, has been enhanced with the use of neurophysiologic testing and endoanal ultrasound. As such, the vaginal birth process not only results in significant stretching of the levator musculatures in a vertical direction, but, more importantly, in stretching of the pudendal nerves in the vertical direction. Any stretch of a somatic nerve of more than 12 has been reported to lead to a degree of permanent injury to that nerve. During the vaginal birth process, perineal descent results in stretching of the pudendal nerve to a degree in which permanent injury can result. Beyond direct injury to muscles and nerves of the pelvic floor, the vaginal birth process also results in significant symptomatic as well as occult injury to the anal sphincteric mechanism. Many anal sphincter tears are symptomatic....

Bowel Dysfunction

Pelvic floor disorders involving bowel dysfunction include several different clinical problems such as fecal incontinence, constipation, and prolapse of the rectum. These disorders are often complex, involving the functions of smooth and skeletal muscles, their nerves, and connective tissues. Etiologies of these disorders are either posttrau-matic (such as from vaginal birth or prior anorectal surgery) or acquired, developing from chronic evacuation problems or with age. In some cases, the cause is idiopathic. Management strategies for the treatment of these disorders have evolved and continue to evolve as we better understand the nature of these problems.


A 29-year-old woman presented with a 2-year history of persistent mechanical left hip pain. She attributed the onset of her symptoms to childbirth. Otherwise, no specific episode of trauma occurred. Examination findings were consistent with hip joint pathology. Radiographs were unremarkable for any underlying disease, and an MRA revealed evidence of tearing of the anterior labrum (Figure 2.7A). She also experienced temporary pain relief from the anesthetic effect of the marcaine used to dilute the intraarticular contrast. Arthroscopy substantiated the labral tearing (Figure 2.7B), which was debrided. No significant associated articular pathology was seen, and the patient experienced prompt symptomatic improvement.

Patient Selection

In this review we analyze the last thirteen patients with Lennox-Gastaut syndrome (LGS) selected from patients of the Epilepsy Surgery Clinic of the General Hospital of Mexico on the basis of having generalized difficult-to-control seizures of the LGS type. They underwent ESCM with the idea to correlate seizure type, stereotaxic targeting, and neurophysiologic responses with the final outcome of the patient. The Lennox-Gastaut syndrome is one of the severest forms of childhood epilepsy. It is characterized by drug-resistant generalized seizures, the tonic and atonic seizures, atypical absences, myoclonic attacks, and episodes of nonconvulsive and tonic status epilepticus being most characteristic. The peak onset is known to be between 1 and 7 years of age. It is usually preceded by other types of seizure disorders, especially infantile spasms. LGS is accompanied by severe mental deterioration as it progresses. From the electroencephalograph (EEG) standpoint, the diagnosis is based on...

Useful Contacts

The Cochrane Collaboration developed in response to Archie Cochrane's call for systematic, up-to-date reviews of all relevant randomised clinical trials of healthcare. Cochrane's suggestion that the methods used to prepare and maintain reviews of controlled trials in pregnancy and childbirth should be applied more widely was taken up by the Research and Development Programme initiated to support the United Kingdom's National Health Service. Funds were provided to establish a Cochrane Centre to collaborate with other organizations in the U.K. and elsewhere to facilitate systematic reviews of randomised controlled trials across all areas of healthcare. For more information about the Cochrane Collaboration see http . The sections of the Cochrane Collaboration that relate most specifically to cardiovascular disease include

Year Product

Jamaican sarsaparilla has been exported from the island as a raw material since the 19th century. It has been listed in the U.S. Pharmacopeia from as early as 1820 to 1910, and is regarded as GRAS, generally recognized as safe. It has a wide range of claims energy restorer, tonic and aphrodisiac, antibiotic, hormone regulator, blood purifier, general health restorer for nervous system disorders, for premenstrual syndrome, and for use after childbirth 4-6 .


Although it is difficult to study episodic movements in slice or dish, important advances in our understanding of the structure and function of the brain areas involved in the generation of episodic movements are occurring at a rapid rate. In this chapter, we highlighted some of the new knowledge that has been gained from studies of tectal slices. The number of studies of the oculomotor system using isolated preparations and or genetic manipulations is also increasing rapidly. A variety of methods are being used, and studies similar to those described for the SC are being performed in other regions of the oculomotor system. For example, the photolysis of caged glutamate is being used in SC slices to study intrinsic connections (Helms et al. 2004). Neurons in the vestibular nucleus that are the postsynaptic targets of floccular Purkinje cells expressing a fluorescent protein were found to possess unique physiological properties (Sekirnjak et al. 2003). In vivo intracellular recordings...

Diagnostic Setting

Genetic conditions can occur with unique symptoms at all stages of life, from birth defects in a newborn to cognitive changes in an older adult. When a patient has a symptom or medical complaint, a diagnosis is needed, especially for treatable disorders. Initially, genetic disorders were considered untreatable and often investigated in the final stages of evaluation. However, biomedical research advances and recognition of the genetic contribution to more common disorders is changing the evaluation paradigm. Also, the increasing access and availability of genetic testing have improved the diagnostic capabilities for many disorders. When providing genetic counseling in a pretesting scenario for diagnostic purposes, genetic counselors may make testing recommendations, especially when medical intervention is available for the condition.9 Diagnosis of a genetic condition brings emotional, social, and financial burden for the patient and the family.10 Unlike many other areas of medicine,...

Image Interpretation

Defects of the EAS occur for a variety of reasons such as birthing injuries, prior anal fistula surgery, and trauma. The appearance of an EAS defect is, by definition, a break in the circumferential integrity of the mixed hyperechoic density pattern. A defect can have either a hypoechoic or a hyperechoic density pattern. It can be difficult to differentiate between scarring from prior surgery and a true defect. In these difficult cases, there may be a role for electromyo-graphy single-fiber density studies. A good example of an anterior EAS defect is demonstrated on Figure 3-5.5, where the EAS is discontinuous anteriorly with a defect measuring 142 degrees.


Stillbirth is a professional and lay term that refers to a deadborn fetus (9). Intrauterine death occurs either before onset of labour (antepartum death) or during labour (intrapartum death). Fetuses may die intra utero, before onset of labour, because of pregnancy complications or maternal diseases however, no special reason can be found for many antepartum intrauterine deaths. Complications arising during birth are the main cause of death among almost all infants who were alive when labour started, but were born dead. It is therefore important to know at what point before birth the baby died, so that appropriate interventions can be planned accordingly. It is relatively easy to determine, in the context of childbirth care, approximately when the death occurred. The proportion of babies that die intrapartum is, therefore, a very important indicator enabling health personnel to take the most appropriate measures to prevent such deaths. Where women receive good care during childbirth,...

Phase I of ROP

In the first phase of ROP, the normal retinal vascular growth that would occur in utero slows or ceases, and there is loss of some of the developed vessels. This is thought to be due in part to the influence of oxygen given to premature infants to overcome poor oxygenation secondary to lung immaturity but in part because of the relative hyperoxia of the extrauterine environment. With maturation of the premature infant, the resulting nonvascularized retina becomes increasingly metabolically active and without a blood supply, increasingly hypoxic. This phase occurs from birth to postmenstrual age (PMA) approximately 30-32 weeks.


The neurovascular anatomy of the perineum is illustrated in Figure 4-2.6. The motor and sensory innervation of the perineum is via the pudendal nerve. The pudendal nerve originates from S2-S4 and exits the pelvis through the greater sciatic foramen, hooks around the ischial spine, then reenters the pelvis through the lesser sciatic foramen. It then travels along the medial surface of the obturator internus, through the ischiorectal fossa in a thickening of fascia called Alcock's canal. It emerges posterior and medial to the ischial tuberosity where it pierces the perineal membrane and divides into three branches to supply the perineum clitoral, perineal, and inferior rectal (inferior hemorrhoidal). Damage to the pudendal nerve (i.e., birth trauma) can result in denervation of the periurethral muscles involved in reflex contraction during increased intraabdominal pressure resulting in stress urinary incontinence.

Evacuation Disorders

The descending perineum syndrome occurs as a result of either injury of the sacral or pudendal nerves or damage to the pelvic floor muscles. Most often, this injury occurs secondary to childbirth or chronic straining at stool. The descending perineum syndrome is frequently associated with constipation and, later, development of fecal incontinence. Its incidence increases with age and it is more common in women than men.7


Appropriate technologies for most critical medical problems and complications are best delivered within a programme that ensures a continuum of care for the woman and her baby throughout pregnancy, childbirth and the postpartum period, at the primary care level for all pregnant women and at higher levels of care for women and babies with complications. Depending on disease patterns, other key interventions for optimal pregnancy outcomes can be integrated into maternity services. At the beginning of the 21st century, half of the world's women still give birth at home without skilled care. This global average conceals large differences among and within countries, between rural and urban settings, between rich and poor. Furthermore, not all institutions offering maternity services meet minimum standards for safe childbirth and newborn care absence of health-care providers, outdated knowledge and inadequate skills, lack of essential medicines, supplies and equipment, overcrowding and...

Sexual Pain Disorder

Sexual pain disorder is the persistence or recurrence of genital pain associated with sexual stimulation and intercourse, which causes personal stress. Dyspareunia, pain upon intromission, and vaginismus, or the reflexive closing of the vaginal introitus, are types of sexual pain disorders. Pelvic trauma, such as seen with childbirth injuries and CRS, as well as psychological trauma, may be associated with this disorder.


Once a complete diagnostic evaluation has been performed, the patient's sexual dysfunction can be accurately classified. One should note that there is often overlap of symptoms, such as hypoactive sexual desire and arousal insufficiency. It is also important to educate the patient and partner about normal physiologic response and sexual function, especially as it pertains to such issues as aging and childbirth. It is important to identify to the patient any obvious reversible causes of FSD or potential lifestyle changes that may be beneficial to her sexual function, such as stopping smoking, eating a healthy diet, regular exercise, improving partner communication, and stress reduction, because clearly there is a correlation between the patient's general health and her sexual function.

Pregnancy And Childbirth

Pregnancy And Childbirth

If Pregnancy Is Something That Frightens You, It's Time To Convert Your Fear Into Joy. Ready To Give Birth To A Child? Is The New Status Hitting Your State Of Mind? Are You Still Scared To Undergo All The Pain That Your Best Friend Underwent Just A Few Days Back? Not Convinced With The Answers Given By The Experts?

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