Dr. Hull made SOME changes I recommended, but he still 'forgets' those hematomas ABOVE the periosteum...

DR. HULL MADE **SOME** CHANGES I RECOMMENDED, BUT HE STILL "FORGETS"
THOSE HEMATOMAS **ABOVE** THE PERIOSTEUM

Attn Jeffrey Hull, MD (again) ), see below.


First things first...

LARA IS RIGHT...

Lara wrote of the Wikipedia diagram showing cephalhematoma:

"The diagram here [http://en.wikipedia.org/wiki/Cephalhematoma]
makes the anatomy clear..."
http://groups.google.com/group/misc....6854048f8f30db

The Wikipedia diagram appeared (and still appears) to me to show both
cephalhematoma and subgaleal hematoma as being subgaleal - below the
epicranial aponeurosis - above the periosteum.

But as Lara points out...


"...cephalohematoma involves subperiosteal bleeding and is limited by
the suture lines..."
http://www.emedicine.com/ped/topic929.htm

ALSO: The Wikipedia explanation (as opposed to the diagram) clearly
states that cephalhematoma is "between the skull and the periosteum of
a newborn baby secondary to rupture of blood vessels crossing the
periosteum...the swelling is subperiosteal..."
http://en.wikipedia.org/wiki/Cephalhematoma

As a consequence of my post, Jeffrey changed the sentence where he
called external skull periosteum "dura mater."

FORTUNATELY Jeffrey did not ape me in my
cephalhematoma-is-above-the-periosteum error.

The relevant sentence at Jeffrey's website now reads:

"A cephalohematoma is a collection of blood under the periosteum."
http://www.drhull.com/EncyMaster/C/cephalohematoma.html

UNFORTUNATELY, Jeffrey did not mention subgaleal hematoma (which IS
above the skull periosteum) and he will not be assisting me in stopping
MD-obstetricians from vacuuming babies to death with birth canals
senselessly closed the "extra" up to 30%.


JEFFREY WROTE:

----- Original Message -----
From: "Jeffrey Hull"
To: "Todd Gastaldo"
Sent: Saturday, December 09, 2006 8:18 AM
Subject: Babies vacuumed to death (also: The skull has TWO
periosteal layers.)


I've made necessary corrections to the section referenced, but have no
interest in advancing any crusades.

Regards,

Dr. Hull
Saturday, December 9, 2006 - 10:17:12 AM

END Jeffrey's reply to me...



For those who missed it...

Here is my original post to Jeffrey...complete with the error I made...

To my knowledge there are no other errors - but I would appreciate it
if people would point any out - preferably publicly...

Specifically, I would like someone to check my math in regard to the
number of babies being vacuumed to death....




BABIES VACUUMED TO DEATH...

ALSO: THE SKULL HAS **TWO** PERIOSTEAL LAYERS

(Jeffrey Hull, MD alludes to them - incorrectly.)



MORE THAN 2,000 AMERICAN BABIES ARE VACUUMED TO DEATH BY MDs ANNUALLY
(This is a *conservative* estimate based on the three assumptions
below.)

Will someone (Jeffrey Hull, MD?) please check my math? 2,000 seems
high -
but even if I'm wrong and the figure is much lower..don't forget:
MD-obstetricians are not only senselessly closing birth canals up to
30%
they are pulling with vacuums while senselessly KEEPING birth canals
closed
the "extra" up to 30%.

MD-obstetrician experts have been LYING to cover-up.

For the Four OB Lies (they are whoppers)...

See Dents in babies' skulls"
http://groups.google.com/group/
misc.kids.pregnancy/msg/08abfc7ff242150e

Alternate URL:
http://health.groups.yahoo.com/group...t/message/3897

LADIES: To allow your birth canal to OPEN the "extra" up to 30%, just
stay
off your sacrum as you push your baby out. Many women like side-lying
delivery. Kneeling against the raised head of the bed works. So does
standing. So does hands-and-knees. Virtually EVERY delivery position
allows the birth canal to open maximally - except dorsal and
semisitting -
the two most commonly used by obstetricians.






THE SKULL HAS **TWO** PERIOSTEAL LAYERS...

Jeffrey W. Hull, MD alludes to both layers but misnames them...

Open Letter archived for global access

Jeffrey W. Hull, M.D., F.A.A.P.
1215 7th Street SE
Suite 210
Decatur, AL.
Via

Jeffrey,

Your discussion of cephalhematoma was recently posted to the usenet
newsgroup misc.kids.pregnancy.

I see what appear to me rather obvious errors - you may wish to update
your
discussion.

My comments are interspersed #####

##### You write:

http://www.drhull.com/EncyMaster/C/cephalohematoma.html

There is a very tough tissue covering that encapsulates bones, called
the
dura mater (DOO-rah MATE-er). It adheres tenaciously to the outer and
inner
surfaces of all the bones of the body, including the skull. If you have
ever
boiled a soup bone long enough, you have probably noticed this
covering.

#### Skull periosteum is only called dura mater inside the skull.

#### The periosteal layer outside the skull is sometimes called
pericranium.
http://www.emedicine.com/ent/topic1.htm
A cephalohematoma is a collection of blood under the dura mater.

#### Cephalhemotoma is a collection of blood under the SCALP - that is
-
outside the skull deep to the subgaleal aponeurosis (scalp) and
superficial
to (ABOVE) the external skull periosteum/pericranium.
http://www.emedicine.com/ent/topic1.htm

It is almost always a complication of childbirth. It most commonly
occurs
when the fetal head is forced through the birth canal; the head is
propelled
forward while the cervix grips the scalp tenaciously. This sliding,
tearing
force can tear tiny veins that nourish the dura mater from the bone
side.
This tearing of vessles causes bleeding (hemorrhage) under the tough
covering of each bony plate (the "periosteum"), and a tense pocket of
blood
collects. This is apparently a painless process.

#### Under the periosteum? Again, cephalhemotoma is a collection of
blood
outside the skull and superficial to (ABOVE) the external skull
periosteum/pericranium.

The result is a squishy swelling with distinct borders that feels just
as if
there were a tiny water-filled balloon under the scalp. It is
differentiated
from caput succedaneum in that the caput is a more generalised and very

temporary swelling of the scalp and disappears in a day or two, but the

cephalohematoma becomes more distinct to see and feel over the first
few
days of life.

Cephalohematomas are more common with forceps delivery, and can
indicate the
presence of a skull fracture. An underlying skull fracture is
especially
suspected if the cephalohematoma crosses suture lines in the skull.

#### Don't forget to mention subgaleal hematoma - also below the scalp
-
often associated with VACUUM delivery. See below.

The course of a newborn's uncomplicated cephalohematoma is benign. The
trapped blood cells break down and the component parts are reabsorbed
into
the system for recycling or disposal. The heme becomes bilirubin, the
iron
is recycled into new red blood cells. Calcium is deposited in the
resolving
cephalohematoma, especially around the edge where the dura mater has
been
lifted up. As the swelling begins to resolve, you will feel a distinct
hard
ridge around the edge of the swelling, with a soft, balloon-like
center.

Eventually, the entire remaining mass of the cephalohematoma becomes
hard
and calcified, and then it too is reabsorbed and disappears. Within a
few
months there will be no physical or xray detectable trace of the
swelling.

Obviously, there is no treatment necessary or ever warranted for an
uncomplicated cephalohematoma. By no means should they ever be drained
or
needled, because of the risk of introducing infection into the space.

The only problems I have ever seen related remotely to or confused with
a
cephalohematoma were related to underlying skull fracture. Such
problems are
extraordinarily rare. See leptomeningeal cyst.

#### Again - don't forget to mention subgaleal hemorrhage/hematoma....



SUBGALEAL HEMORRHAGE

Subgaleal hemorrhage is a rare but potentially lethal
condition found in newborns.1 It is caused by rupture
of the emissary veins, which are connections between
the dural sinuses and the scalp veins. Blood accumulates between
the epicranial aponeurosis of the scalp and the
periosteum.
http://www.cmaj.ca/cgi/reprint/164/10/1452.pdf

FROM ONE OF MY USENET POSTS...

"Subgaleal haematoma/subaponeurotic haemorrhage...can almost
exsanguinate
the infant."
--Kathrin W. Dahl, MD et al. [Ugeskr Laeger. 2002 Nov
18;164(47):5525-6.
PubMed abstract]


"Bleeding into the subaponeurotic space can cross the suture lines and
occupy the entire subaponeurotic space. It has been estimated that when
this
space is filled to a depth of one centimetre it can hold as much as 260
mls
of blood - approximately the total blood volume of a 3 kg neonate..."
----Calum Macleod, MD (with O'Neill) [Ir Med J. 2003 May;96(5):147-8.
See
also: http://www.imj.ie/news_detail.php?nN...60&nVolId=102]


A 23% MORTALITY from subgaleal hematoma/subaponeurotic hemorrhage has
been
reported...


"In the United Kingdom and Republic of Ireland 10% of all deliveries
are
vacuum assisted...6.4 per 1000 [of these result in subgaleal
haematoma/subaponeurotic haemorrhage]...mortality...23%."
--Calum Macleod, MD (with O'Neill) [Ir Med J. 2003 May;96(5):147-8.
PubMed
abstract. See also:
http://www.imj.ie/news_detail.php?nN...60&nVolId=102]


VACUUM DEATHS IN THE UNITED STATES...


Check my math...


In 2002, there were 4,019,280 births in the United States...
http://www.cdc.gov/nchs/releases/03news/lowbirth.htm


1. Assume US vacuum delivery rate 5% (half that in the United Kingdom
and
Republic of Ireland) = (roughly) 200,000 vacuum deliveries per year


2. Assume same subgaleal haematoma/subaponeurotic haemorrhage rate
6.4%...
6.4% of 200,000 = (roughly) 12,000 subgaleal haematomas/subaponeurotic
haemorrhages per year


3. Assume same (23%) mortality from subgaleal haematoma/subaponeurotic
haemorrhage...


23% of 12,000 = (roughly) 2,400 deaths from vacuum delivery per year!


**MORE** THAN 2,000 AMERICAN BABIES ARE VACUUMED TO DEATH BY MDs
ANNUALLY!
(This is a
*conservative* estimate based on the three assumptions above.)


WARNING: "Given the low rates of neonatal autopsy and the relatively
high
rates of vacuum assisted delivery the real extent of vacuum associated
morbidity and mortality may be much higher than realised. When the
federal
authorities in the United States and Canada issued public health
advisories
for vacuum assisted delivery a 22-fold increase in notification of
adverse
outcomes was observed...Subaponeurotic haemorrhage is difficult to
diagnose
as clinical signs may be minimal or absent."
--Calum Macleod, MD (with O'Neill) [Ir Med J. 2003 May;96(5):147-8.
See
also: http://www.imj.ie/news_detail.php?nN...60&nVolId=102]


VACUUM PUBLIC HEALTH ADVISORIES..


Calum MacLeod, MD (just cited) writes: "In North America concerns
about
the safety of vacuum assisted delivery resulted in the issuing of
public
health advisories in both Canada and the United States." [MacLeod and
O'Neill. Ir Med J. 2003 May;96(5):147-8. PubMed
abstract]


ATTENTION CALUM: While it is true that vacuums can save tiny lives -
and
while it is true that not all vacuum extractions are
solely due to MDs and MBs (and midwives) closing birth canals - all
countries should issue public health advisories that MDs
and MBs are closing birth canals up to 30%.


Copied to: Kathrin W. Dahl, MD
Ved Furesøen 22
DK-2840 Holte

http://www.dadlnet.dk/ufl/0247/VP-html/VP38751.htm


Copied to: Calum Macleod, MD, Department of Paediatrics, Antrim Area
Hospital, 45 Bush Road, Antrim BT41
2RL, Northern Ireland.

END excerpt of Dr. Gastaldo's usenet post

Neither Kathrin nor Calum ever replied.

Hopefully, Jeffrey Hull, MD will mention subgaleal hematoma and vacuum
deaths on his website.

Hopefully Jeffrey will mention the bizarre birth-canal-closing behavior
of
obstetricians who are pulling with vacuums and forceps with birth
canals
senselessly KEPT closed the "extra" up to 30%...



I SAY AGAIN...

MORE THAN 2,000 AMERICAN BABIES ARE VACUUMED TO DEATH BY MDs ANNUALLY
(This is a *conservative* estimate based on the three assumptions
below.)

Will someone (Jeffrey?) please check my math? 2,000 seems high - but
even
if I'm wrong and the figure is much lower..don't forget:
MD-obstetricians
are not only senselessly closing birth canals up to 30% they are
pulling
with vacuums while senselessly KEEPING birth canals closed the "extra"
up to
30%.

MD-obstetrician experts have been LYING to cover-up.

For the Four OB Lies (they are whoppers)...

See Dents in babies' skulls"
http://groups.google.com/group/
misc.kids.pregnancy/msg/08abfc7ff242150e

Alternate URL:
http://health.groups.yahoo.com/group...t/message/3897

LADIES: To allow your birth canal to OPEN the "extra" up to 30%, just
stay
off your sacrum as you push your baby out. Many women like side-lying
delivery. Kneeling against the raised head of the bed works. So does
standing. So does hands-and-knees. Virtually EVERY delivery position
allows the birth canal to open maximally - except dorsal and
semisitting -
the two most commonly used by obstetricians.


Thanks for reading everyone.
Sincerely,

Todd

Dr. Gastaldo
Hillsboro, Oregon
USA


This post will be archived for global access in the Google usenet
archive.
Search http://groups.google.com for "Babies vacuumed to death (also:
The
skull has TWO periosteal layers.)

END Dr. Gastaldo's post, complete with error - which Lara corrected.

ONE LAST MATTER...

LARA READ JEFFREY'S WEBSITE AND WROTE:

"...I thought drhull was normally a fairly good site?...The dura mater
is the outer layer of the meninges; it lies around the
brain and spinal cord and inside the skull/vertebral column. The bone
lining he is referring to is called the periosteum."
http://groups.google.com/group/misc....6854048f8f30db

Both the inside and outside of the skull are lined with periosteum with
inside periosteum being dura mater.

This is likely what caused Jeffrey to say (erroneously) that both the
inside and outside of the skull are covered with "dura mater."

I am glad Lara corrected my error - and I am glad that Jeffrey made
some changes I recommended.

I am sad though that Jeffrey did not mention subgaleal hematoma - which
IS above the periosteum.

I am also sad that Jeffrey will not help me stop MD-obstetricians from
vacuuming babies to death with birth canals senselessly closed the
"extra" up to 30%.

I SAY AGAIN...

MORE THAN 2,000 AMERICAN BABIES ARE VACUUMED TO DEATH BY MDs ANNUALLY
(This is a *conservative* estimate based on the three assumptions
below.)

Will someone (Jeffrey?) please check my math? 2,000 seems high - but
even
if I'm wrong and the figure is much lower..don't forget:
MD-obstetricians
are not only senselessly closing birth canals up to 30% they are
pulling
with vacuums while senselessly KEEPING birth canals closed the "extra"
up to
30%.

I am convinced that some subgaleal hematoma deaths are preventable -
but regardless - MD-obstetricians have no business senselessly closing
birth canals the "extra" up to 30% - and MD-pediatricians have no
business remaining silent about this obvious negligence.

Thanks for reading everyone.

Sincerely,

Todd

Dr. Gastaldo
Hillsboro, Oregon
USA


This post will be archived for global access in the Google usenet
archive. Search http://groups.google.com for "Dr. Hull made SOME
changes I recommended, but he still 'forgets' those hematomas ABOVE the
periosteum..."