A Rare Complication of a Vaginal Breech Delivery

Rectal lesions without anal sphincter trauma in childbirth are only sporadically described in literature. We describe the case of a 29-year-old primigravida who delivered a child in frank breech presentation. During the second stage of labour a foot presented transanally through a rectal laceration with intact anal sphincters. The laceration was repaired immediately after delivery in theatre. Follow-up visits showed a properly cured laceration and no complaints of incontinence or foul discharge

Isolated rectal buttonhole tears in obstetrics: case series and review of the literature.

INTRODUCTION AND HYPOTHESIS: The management of isolated rectal buttonhole tears is not standardised and can be challenging in an acute obstetric setting. Our aim was to review the published literature and describe management and repair techniques in a case series. METHODS: A literature search was carried out. All results were screened and reviewed. Rectal buttonhole tears following vaginal delivery between April 2012 and January 2020 in our institution were identified. Repair technique and post-operative management were recorded. RESULTS: There were nine published case reports (four instrumental deliveries, two vaginal breech and three normal vaginal deliveries). Four case reports described a two-layer closure and five described a three-layer closure. Two cases were repaired in collaboration with colorectal surgeons. All nine cases made an uneventful recovery. We identified three patients with buttonhole tears all of whom had instrumental deliveries. A colorectal surgeon repaired the tear in two layers in one case, and an obstetrician performed the repair in the other two cases, one in three layers and the other in two layers. One patient had a de-functioning stoma at a later date due to a second breakdown of the recto-vaginal fistula repair. CONCLUSION: Buttonhole tears are rare but techniques of repair vary. Most cases reviewed had an uneventful recovery after repair. We provide standardised steps for repair and management of isolated rectal buttonhole tears along with a video demonstrating the repair technique in an animal tissue (pig) model

Patients with cervical cancer: why did screening not prevent these cases?

Item does not contain fulltextOBJECTIVE: The objective of the study was to assess the screening history of women with cervical cancer and review normal cervical smears 5 years preceding the diagnosis. STUDY DESIGN: Cytological and histological results of 401 women treated for invasive cervical cancer between 1991 and 2008 at the Radboud University Nijmegen Medical Center were studied. Ninety-eight normal smears were reviewed. RESULTS: Of the 401 women, 269 (67%) received at least 1 invitation for the national screening program for cervical cancer (NCSP). One- third fell outside the target age of the NCSP. Seventeen percent never responded to the invitation(s). Twenty-one percent had 1 or more normal smears within 5 years preceding the diagnosis. After review, only 39% of those smears were reviewed as a normal smear. CONCLUSION: Half of the women with cervical cancer were never screened because of the limited target age range or nonattendance. Twenty-one percent had a normal smear within 5 years preceding the diagnosis, caused by interpretation and/or sampling errors

Lineamenti per una storia della critica della falsificazione epigrafica

This article offers the first comprehensive investigation of the history of scholarship related to epigraphic forgeries. Fake inscriptions were already produced in Antiquity and throughout the Middle Ages, but their number began to rise dramatically from the Renaissance onwards. By the mid-1500s, scholars became attentive of the risks of using fake sources for antiquarian purposes, while in the 17th and 18th centuries they started isolating forged or suspect texts within specific sections of their new epigraphic corpora. Tentative sets of criteria for isolating non-genuine inscriptions were first identified by Scipione Maffei around 1720, but an actual epistemology for epigraphic criticism was only developed by Theodor Mommsen and his collaborators in the mid-1800s. Since then, most corpora and critical editions have, often implicitly, followed their scientific principles. Current scholars should be well aware of them, because they can present both considerable rewards and serious shortcomings