- Email: [email protected]
Baby 1, obstetrician 0
CORRESPONDENCE
life. He was constantly in motion, but seemed to have or make time for important aspects of life outside of his career—including his wife, sons, and friends. He had a sense of his place in the world at large. David made a lasting and important impression on a young medical student from America, who had just begun a career. This dynamo who invented the silver swaddler for thermal control of the low birthweight neonate, conveyed to me a love of learning, a respect for patients and families, and a sense of the wonder and excitement of neonatology. By coincidence last week I found a letter from David written while I was living and working in Bangladesh in 1981. The letter read “I’ve heard about the political upheaval in Bangladesh. I hope you are well. If you have the chance, drop me a note so that I know you are safe”. He was, above all, a caring human being. It is hard to believe that this bouncy curly-haired man with boundless energy and even bigger ideas is no longer with us to make a difference in the world. Barbara Stoll Emory University School of Medicine, 80 Butler Street, SE, Atlanta, Georgia 30335, USA 1
News in brief. John David Baum. Lancet 1999; 354: 1190.
Maurizio Bonati Laboratory for Mother and Child Health, Istituto di Ricerche “Mario Negri”, Via Eritre 62, 20157 Milan, Italy (e-mail: [email protected]) 1
2
3
4
WHO/UNICEF Joint Statement. Protecting, promoting and supporting breastfeeding: the special role of maternity services. Geneva: WHO, 1989. Report to the director-general World Health Organization. Nestlé implementation of the WHO code: official response of governments. Vevey: Nestlé, 1999. Simini B. Breast-milk-substitute business booms in Italy. Lancet 1999; 353: 1077. Huttin C. Drug price divergence in Europe: regulatory aspects. Health Affairs 1999; 18: 245–49.
Youthful memories: a tribute to David Baum Sir—I learned with great sadness of David Baum’s death. The brief notice in The Lancet (Oct 2, p 1190)1 does not provide a personal remembrance of the David Baum I was privileged to know for many years. I met David in 1974 when I was a medical student visiting his unit at the John Radcliffe Hospital, Oxford, UK. At the time, he was younger than I am now—but definitely the chief in my eyes. He was so full of energy, enthusiasm, and exuberance—for babies, for science, for
322
cracking sound was heard. The baby was delivered immediately. The infant’s birthweight was 3800 g and the Apgar score was 9 and 10 at 1 min and 5 min, respectively. The baby had a very mild weakness of the right arm, with no fractures, which resolved completely on discharge from the hospital 2 days later. The obstetrician, however, felt excruciating pain in his right hand while doing the Wood’s manoeuvre. His hand was swollen and painful immediately after delivery. A radiograph of his right hand showed a spiral fracture in the right fourth metacarpal bone and he needed a cast that immobilised his right hand for 6 weeks. Childbirth may sometimes be a traumatic event for the newborn. Shoulder dystocia is a particularly serious and unpredictable event with wellrecognised traumatic complications to the newborn infant and mother.1 This childbirth was definitely a traumatic experience for the obstetrician who was wounded in the line of duty. To the best of our knowledge, this injury has not yet been mentioned as a complication of fetal shoulder dystocia. *Uriel Elchalal, Avi Tsafrir, Asher Shushan, Carole Pidhorz *Department of Obstetrics and Gynaecology, and Hand Unit, Hadassah University Hospital, Jerusalem, Israel 91120 1
Cunningham FG, MacDonald PC, Gant NF, et al, eds. Dystocia, abnormal presentation, position, and development of the fetus. Williams Obstetrics, 20th edn. Norwalk, CT: Appleton and Lange, 435–59.
Baby 1, obstetrician 0 Sir—If you think that newborn infants are helpless little creatures, think again! We present an unusual traumatic injury of childbirth to defy such simplistic notion. A 28-year-old woman was admitted to the delivery room in labour. Her pregnancy had been normal, and a routine glucose-challenge screening test done at 25 weeks was normal. Estimation of fetal weight at admission was 3600 g, and intravenous oxytocin was given in the second stage of labour for augmentation of contractions because the infant’s head had stopped descending. 2 h after complete cervical dilatation, we noted a long period of fetal bradycardia and did a vacuum extraction. The infant’s head was delivered, but delivery of the shoulders was unsuccessful, and shoulder dystocia was diagnosed. McRoberts manoeuvre (hyperflexion of the mother’s hips) combined with suprapubic pressure did not resolve the critical situation. The obstetrician (UE) decided to do Wood’s manoeuvre. With his right hand deep in the womans pelvis he tried to rotate the infant’s posterior shoulder. However, while the shoulders were rotated a
DEPARTMENT OF ERROR Monitoring antibody responses to cancer vaccination with a resonant mirror biosensor— In this Research letter by Steve Nicholson and colleagues (March 6, 1999, p 808), the key to the figure is incorrect. The solid line should be Initial slope (arcseconds/s) and the dashed line should be Dissociation rate constant, koff (s⫺1). Truth telling in the case of a pessimistic diagnosis in Japan—In this Research letter by A Akabayashi and colleagues (Oct 9, 1999 p 1263), the figure was incorrect. This is the correct version: 100
Very pessimistic Somewhat pessimistic Pure medical judgements Somewhat optimistic Very optimistic
80
60 (%)
role of which should also be to vouch for the relationship between consumers and industry, is probably favouring the divergence. However, medical professionals could also help to limit extreme overpricing. In Italy, formula companies support the majority of initiatives of national paediatric and obstetric societies, fund attendance at scientific meetings, donate complimentary textbooks, journals, or software products, and support the publishing of journals (a few of questionable scientific merit). All of these marketing actions affect the price. Thus, the declining of these forms of support would be a welcome move by professionals not only to protect breastfeeding but also to help restrain prices. The basic EU principle of the free market supports the need to reduce the price divergence in important market segments (eg, for drugs)4 in the interests of both industry and citizens. With a view to increasing harmonisation and transparency across the countries a European Commission on car prices is working; although differences remain, important improvements have been achieved (http:// europa.eu.int/comm/dg04/aid/en/car. htm). This aim is desirable also for breastmilk substitutes, as well as for all common goods in a common market.
40
20
0 To patients
To family
THE LANCET • Vol 355 • January 22, 2000
life. He was constantly in motion, but seemed to have or make time for important aspects of life outside of his career—including his wife, sons, and friends. He had a sense of his place in the world at large. David made a lasting and important impression on a young medical student from America, who had just begun a career. This dynamo who invented the silver swaddler for thermal control of the low birthweight neonate, conveyed to me a love of learning, a respect for patients and families, and a sense of the wonder and excitement of neonatology. By coincidence last week I found a letter from David written while I was living and working in Bangladesh in 1981. The letter read “I’ve heard about the political upheaval in Bangladesh. I hope you are well. If you have the chance, drop me a note so that I know you are safe”. He was, above all, a caring human being. It is hard to believe that this bouncy curly-haired man with boundless energy and even bigger ideas is no longer with us to make a difference in the world. Barbara Stoll Emory University School of Medicine, 80 Butler Street, SE, Atlanta, Georgia 30335, USA 1
News in brief. John David Baum. Lancet 1999; 354: 1190.
Maurizio Bonati Laboratory for Mother and Child Health, Istituto di Ricerche “Mario Negri”, Via Eritre 62, 20157 Milan, Italy (e-mail: [email protected]) 1
2
3
4
WHO/UNICEF Joint Statement. Protecting, promoting and supporting breastfeeding: the special role of maternity services. Geneva: WHO, 1989. Report to the director-general World Health Organization. Nestlé implementation of the WHO code: official response of governments. Vevey: Nestlé, 1999. Simini B. Breast-milk-substitute business booms in Italy. Lancet 1999; 353: 1077. Huttin C. Drug price divergence in Europe: regulatory aspects. Health Affairs 1999; 18: 245–49.
Youthful memories: a tribute to David Baum Sir—I learned with great sadness of David Baum’s death. The brief notice in The Lancet (Oct 2, p 1190)1 does not provide a personal remembrance of the David Baum I was privileged to know for many years. I met David in 1974 when I was a medical student visiting his unit at the John Radcliffe Hospital, Oxford, UK. At the time, he was younger than I am now—but definitely the chief in my eyes. He was so full of energy, enthusiasm, and exuberance—for babies, for science, for
322
cracking sound was heard. The baby was delivered immediately. The infant’s birthweight was 3800 g and the Apgar score was 9 and 10 at 1 min and 5 min, respectively. The baby had a very mild weakness of the right arm, with no fractures, which resolved completely on discharge from the hospital 2 days later. The obstetrician, however, felt excruciating pain in his right hand while doing the Wood’s manoeuvre. His hand was swollen and painful immediately after delivery. A radiograph of his right hand showed a spiral fracture in the right fourth metacarpal bone and he needed a cast that immobilised his right hand for 6 weeks. Childbirth may sometimes be a traumatic event for the newborn. Shoulder dystocia is a particularly serious and unpredictable event with wellrecognised traumatic complications to the newborn infant and mother.1 This childbirth was definitely a traumatic experience for the obstetrician who was wounded in the line of duty. To the best of our knowledge, this injury has not yet been mentioned as a complication of fetal shoulder dystocia. *Uriel Elchalal, Avi Tsafrir, Asher Shushan, Carole Pidhorz *Department of Obstetrics and Gynaecology, and Hand Unit, Hadassah University Hospital, Jerusalem, Israel 91120 1
Cunningham FG, MacDonald PC, Gant NF, et al, eds. Dystocia, abnormal presentation, position, and development of the fetus. Williams Obstetrics, 20th edn. Norwalk, CT: Appleton and Lange, 435–59.
Baby 1, obstetrician 0 Sir—If you think that newborn infants are helpless little creatures, think again! We present an unusual traumatic injury of childbirth to defy such simplistic notion. A 28-year-old woman was admitted to the delivery room in labour. Her pregnancy had been normal, and a routine glucose-challenge screening test done at 25 weeks was normal. Estimation of fetal weight at admission was 3600 g, and intravenous oxytocin was given in the second stage of labour for augmentation of contractions because the infant’s head had stopped descending. 2 h after complete cervical dilatation, we noted a long period of fetal bradycardia and did a vacuum extraction. The infant’s head was delivered, but delivery of the shoulders was unsuccessful, and shoulder dystocia was diagnosed. McRoberts manoeuvre (hyperflexion of the mother’s hips) combined with suprapubic pressure did not resolve the critical situation. The obstetrician (UE) decided to do Wood’s manoeuvre. With his right hand deep in the womans pelvis he tried to rotate the infant’s posterior shoulder. However, while the shoulders were rotated a
DEPARTMENT OF ERROR Monitoring antibody responses to cancer vaccination with a resonant mirror biosensor— In this Research letter by Steve Nicholson and colleagues (March 6, 1999, p 808), the key to the figure is incorrect. The solid line should be Initial slope (arcseconds/s) and the dashed line should be Dissociation rate constant, koff (s⫺1). Truth telling in the case of a pessimistic diagnosis in Japan—In this Research letter by A Akabayashi and colleagues (Oct 9, 1999 p 1263), the figure was incorrect. This is the correct version: 100
Very pessimistic Somewhat pessimistic Pure medical judgements Somewhat optimistic Very optimistic
80
60 (%)
role of which should also be to vouch for the relationship between consumers and industry, is probably favouring the divergence. However, medical professionals could also help to limit extreme overpricing. In Italy, formula companies support the majority of initiatives of national paediatric and obstetric societies, fund attendance at scientific meetings, donate complimentary textbooks, journals, or software products, and support the publishing of journals (a few of questionable scientific merit). All of these marketing actions affect the price. Thus, the declining of these forms of support would be a welcome move by professionals not only to protect breastfeeding but also to help restrain prices. The basic EU principle of the free market supports the need to reduce the price divergence in important market segments (eg, for drugs)4 in the interests of both industry and citizens. With a view to increasing harmonisation and transparency across the countries a European Commission on car prices is working; although differences remain, important improvements have been achieved (http:// europa.eu.int/comm/dg04/aid/en/car. htm). This aim is desirable also for breastmilk substitutes, as well as for all common goods in a common market.
40
20
0 To patients
To family
THE LANCET • Vol 355 • January 22, 2000