Objective. To assess the feasibility of operative termination of pregnancy between 12 and 14 weeks of gestation and the role of the operator’ s experience in physicians previously unfamiliar to this technique. Materi...Objective. To assess the feasibility of operative termination of pregnancy between 12 and 14 weeks of gestation and the role of the operator’ s experience in physicians previously unfamiliar to this technique. Materials and methods. A prospective study of 251 operative terminations of pregnancy, from July 1st, 2001 to January 31st, 2002, and from May 1st, 2002 to October 31st, 2002, in order to assess the role of operator’ s experience. 104 terminations between 12 and 14 weeks were compared to 147 terminations at earlier gestational ages. All patients received cervical ripening with 400 mcg oral misoprostol 3-4 hours before operation performed under general anesthesia. Evaluation criteria were: duration of operation, need for use of forceps, and complications: uterine perforation, cervical laceration, bleeding > 500 ml and need for blood transfusion. Results. There was no difference in the rate of operative complications between terminations before and after 12 weeks. The duration of operation was slightly longer after 12 weeks than before (12.9 ± 6.7 min versus 11.1 ± 2.8 min.; p < 0.05). Forceps use was 0.7% before 12 weeks, 20% between 12 and 13 weeks, and 59% between 13 and 14 weeks (p < 0.01). There was no difference in the complication rate or in the need for forceps according to the operator’ s experience. The perceived difficulty in cervical dilatation was higher in early experience than in experimented operators (19.6% versus 5.2% ; p < 0.05). Conclusion. Operative termination of pregnancy is technically feasible beyond 12 weeks without dramatic increase in operative complications. Technical skill can be acquired in a short time interval.展开更多
Objective: To determine if the midline subumbilical incision reduces the risk of trauma to bladder and bowel in women undergoing multiple cesarean sections. Study design: Retrospective analysis of hospital histories o...Objective: To determine if the midline subumbilical incision reduces the risk of trauma to bladder and bowel in women undergoing multiple cesarean sections. Study design: Retrospective analysis of hospital histories of 3164 women who had repeat cesarean sections at a referral maternity hospital. Methods: The clinical records of women who had between one and eight cesarean sections over a 4-year period to October 2002 were examined for entries on injury to bladder and bowel. The frequency of these injuries in relation to abdominal incision used was determined. Multiple logistic regression analysis was performed to assess the influence of cesarean number, abdominal incision, intraperitoneal adhesions, operator experience, and anterior placenta previa on risk of bladder injury. Main outcome measure: Frequency of trauma to bladder and bowel associated with either Pfannenstiel or midline incision. Results: There were 3164 women who met the inclusion criteria to the study. The midline incision was associated with significantly higher risk than Pfannenstiel for injury to the bladder (P < 0.0001, OR 6.7, 95% CI 2.6- 16.5). For both incisions, injury to the bladder increased with rising cesarean number. In addition, for a given cesarean other than primary, bladder trauma was more likely with the midline incision. The risk of injury to bowel was higher with the midline incision (RR 5.5), but there were too few events to permit Chi square analysis. Conclusion: In repeat cesarean section, the midline incision is associated with a higher risk of bladder and bowel injury than Pfannenstiel.展开更多
The main aim of this article is to describe the intersubjective relationship between the observer and the subject depicted in a work of art. More precisely, I am interested in the observer＇s imagination as it is mani...The main aim of this article is to describe the intersubjective relationship between the observer and the subject depicted in a work of art. More precisely, I am interested in the observer＇s imagination as it is manifested in this relationship. I argue that every act of empathy involves the imagination, but the act of imagination is never understood as an act of empathy. This article will take a new approach towards the perception of a work of art and challenges the traditional notion of empathy as ＂looking into,＂ ＂looking in,＂ or ＂seeing-in.＂ I describe the experience of empathy as a lived experience, where I understand it as a type of intentional act that is distinct from imagination; meanwhile, I show that the imagination plays a role in the empathetic experience of the work of art. How？ I understand this situation as one that brings the observer into a new reality, an intersubjective mode of being where she finds a better understanding of her own （as an observer） inner world. I wish to argue that empathy gives a new dimension to experience, where being ＂here＂ becomes being ＂there.＂ Empathy is in fact a special form of meeting the Other. In the case of a work of art, we do not meet the Other as a person who lives their daily life like everyone else; instead we have an independent empathetic experience of the world, taking place within the work of art, in relation to the depicted subject. The nature of empathy is that it enables the observer to enter the deepest intimacy of the work of art and dwell inside it. This depends solely on the observer on how open they are to this world and how much it coincides with the observer＇s will, as she always retains limitless freedom when interpreting a work of art.展开更多
文摘Objective. To assess the feasibility of operative termination of pregnancy between 12 and 14 weeks of gestation and the role of the operator’ s experience in physicians previously unfamiliar to this technique. Materials and methods. A prospective study of 251 operative terminations of pregnancy, from July 1st, 2001 to January 31st, 2002, and from May 1st, 2002 to October 31st, 2002, in order to assess the role of operator’ s experience. 104 terminations between 12 and 14 weeks were compared to 147 terminations at earlier gestational ages. All patients received cervical ripening with 400 mcg oral misoprostol 3-4 hours before operation performed under general anesthesia. Evaluation criteria were: duration of operation, need for use of forceps, and complications: uterine perforation, cervical laceration, bleeding > 500 ml and need for blood transfusion. Results. There was no difference in the rate of operative complications between terminations before and after 12 weeks. The duration of operation was slightly longer after 12 weeks than before (12.9 ± 6.7 min versus 11.1 ± 2.8 min.; p < 0.05). Forceps use was 0.7% before 12 weeks, 20% between 12 and 13 weeks, and 59% between 13 and 14 weeks (p < 0.01). There was no difference in the complication rate or in the need for forceps according to the operator’ s experience. The perceived difficulty in cervical dilatation was higher in early experience than in experimented operators (19.6% versus 5.2% ; p < 0.05). Conclusion. Operative termination of pregnancy is technically feasible beyond 12 weeks without dramatic increase in operative complications. Technical skill can be acquired in a short time interval.
文摘Objective: To determine if the midline subumbilical incision reduces the risk of trauma to bladder and bowel in women undergoing multiple cesarean sections. Study design: Retrospective analysis of hospital histories of 3164 women who had repeat cesarean sections at a referral maternity hospital. Methods: The clinical records of women who had between one and eight cesarean sections over a 4-year period to October 2002 were examined for entries on injury to bladder and bowel. The frequency of these injuries in relation to abdominal incision used was determined. Multiple logistic regression analysis was performed to assess the influence of cesarean number, abdominal incision, intraperitoneal adhesions, operator experience, and anterior placenta previa on risk of bladder injury. Main outcome measure: Frequency of trauma to bladder and bowel associated with either Pfannenstiel or midline incision. Results: There were 3164 women who met the inclusion criteria to the study. The midline incision was associated with significantly higher risk than Pfannenstiel for injury to the bladder (P < 0.0001, OR 6.7, 95% CI 2.6- 16.5). For both incisions, injury to the bladder increased with rising cesarean number. In addition, for a given cesarean other than primary, bladder trauma was more likely with the midline incision. The risk of injury to bowel was higher with the midline incision (RR 5.5), but there were too few events to permit Chi square analysis. Conclusion: In repeat cesarean section, the midline incision is associated with a higher risk of bladder and bowel injury than Pfannenstiel.
文摘The main aim of this article is to describe the intersubjective relationship between the observer and the subject depicted in a work of art. More precisely, I am interested in the observer＇s imagination as it is manifested in this relationship. I argue that every act of empathy involves the imagination, but the act of imagination is never understood as an act of empathy. This article will take a new approach towards the perception of a work of art and challenges the traditional notion of empathy as ＂looking into,＂ ＂looking in,＂ or ＂seeing-in.＂ I describe the experience of empathy as a lived experience, where I understand it as a type of intentional act that is distinct from imagination; meanwhile, I show that the imagination plays a role in the empathetic experience of the work of art. How？ I understand this situation as one that brings the observer into a new reality, an intersubjective mode of being where she finds a better understanding of her own （as an observer） inner world. I wish to argue that empathy gives a new dimension to experience, where being ＂here＂ becomes being ＂there.＂ Empathy is in fact a special form of meeting the Other. In the case of a work of art, we do not meet the Other as a person who lives their daily life like everyone else; instead we have an independent empathetic experience of the world, taking place within the work of art, in relation to the depicted subject. The nature of empathy is that it enables the observer to enter the deepest intimacy of the work of art and dwell inside it. This depends solely on the observer on how open they are to this world and how much it coincides with the observer＇s will, as she always retains limitless freedom when interpreting a work of art.
