Using advanced wound care and hyperbaric oxygen to manage wound complications following treatment of vulvovaginal carcinoma

Postoperative management of patients with vulvar cancer is associated with a high incidence of poor wound healing and radiation -induced late tissue necrosis. This case series demonstrates the impact on wound healing with the use of hyperbaric oxygen therapy and advanced wound care following radical vulvectomy and/or radiation therapy. A retrospective case series was performed of all patients from 2016 to 2017 with lower genital cancer who underwent radical surgery with or without chemoradiation treatment, experienced wound dehiscence or late tissue radionecrosis, and were treated with advanced wound care, including hyperbaric oxygen therapy (HBO). Five patients were included with a mean age of 63; four had squamous cell carcinoma and one patient had vaginal adenocarcinoma secondary to prior diethylstilbestrol exposure. Three patients underwent radical vulvectomy. All received pelvic radiation therapy, subsequently experienced wound complications, and were managed with advanced wound care and HBO. The mean reduction in wound area at the final wound follow up visit after completion of HBO therapy was found to be 76%, ranging 42-95%, with an average follow up of five months. The mean number of HBO sessions per patient was 58. Complete tissue granulation or significant improvement in tissue radionecrosis was present in all patients. Advanced wound care and hyperbaric oxygen therapy are beneficial in the management of postoperative wound complications. Prospective studies are needed to identify the optimal use of perioperative hyperbaric oxygen and appropriate wound care for patients with gynecologic malignancies.

Agrarian potential, population, and the tarascan state

Estimates based on potential maize crops and maize consumption patterns of the 15th-century Mesoamerican protohistoric Tarascan population living within its geopolitical core (Lake Páttzcuaro Basin) indicate that this population had not maintained itself through agricultural- and lacustrine-carrying capacity alone. It was through having to obtain basic resources such as maize from outside the basin that the Tarascans developed mechanisms that formed the particular character of their state.

Personality characteristics of treatment-seeking HIV+ pregnant drug dependent women

Pregnant, drug dependent women present for treatment with a variety of medical and psychosocial issues. When medical sequelae include HIV infection, effective medical and psychosocial management is essential for both mother and fetus/infant. To better understand and characterize this high-risk population, the present study examined personality features and psychopathology in a sample of HIV+, pregnant, drug dependent women. Personality was assessed using the Minnesota Multiphasic Personality Inventory--Revised (MMPI-2). The mean MMPI-2 codetype, (6-8), although relatively rare in standard drug treatment settings, characterized nearly one-fifth of study participants. The 6-8 codetype is typically associated with unusual thought processes, feelings of hostility and suspiciousness as well as apathy, which may mask symptoms of nervousness, anxiety and depression. Treatment implications of study findings are discussed.

Community-acquired urinary tract infection in adults: a hospital viewpoint

The clinical and epidemiologic spectrum of 175 cases of community-acquired urinary tract infection (UTI) were evaluated at a university hospital. Patients were grouped in five different categories of which complicated UTI was the most common (39%). Bacteraemia was detected in eight patients (18%) of this group and in five (12%) with acute uncomplicated pyelonephritis. A single organism was isolated in 166 cases (95%). The rate of Escherichia coli bacteriuria ranged from 60% (asymptomatic bacteriuria) to 94% (uncomplicated cystitis). Of the 184 isolates, 92% were susceptible to ciprofloxacin and significantly high rates of resistance were found for ampicillin, cefazolin, cefuroxime, and co-trimoxazole. Isolates causing uncomplicated UTI had significantly high rates of resistance to ampicillin, amoxycillin-clavulanate and co-trimoxazole and those causing complicated UTI, had significantly high rates of resistance to most oral antibiotics tested, except quinolones and nitrofurantoine. Community-acquired UTI requiring hospital evaluation occurs in a complex group of patients, and current patterns of antibiotic resistance make it difficult to suggest empiric oral treatments in this setting.