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.

Efficacy of intravenous administration of combined acid suppressants in healthy dogs.

BACKGROUND: Short-term intravenous co-administration of famotidine and pantoprazole is used by some veterinarians to treat gastrointestinal bleeding in critically ill dogs. However, clinical studies have not evaluated the efficacy of combination acid suppressant treatment in dogs. HYPOTHESIS/OBJECTIVES: To compare the effect of intravenous co-administration of famotidine and pantoprazole to monotherapy with pantoprazole on intragastric pH in dogs. We hypothesized that single agent pantoprazole would be more effective than combination with famotidine. ANIMALS: Twelve healthy adult colony dogs. METHODS: Randomized, 2-way crossover design. All dogs received placebo (0.9% saline) for 24 hours followed by 1.0 mg/kg i.v. q12h pantoprazole or combination treatment with famotidine and pantoprazole for 3 consecutive days. Intragastric pH monitoring was used to continuously record intragastric pH for 96 hours beginning on day 0 of treatment. Mean percentage time (MPT) that intragastric pH was ≥3 and ≥4 were compared between groups using ANOVA with a posthoc Tukey-Kramer test (α = 0.017). RESULTS: The MPT ± standard deviation intragastric pH was greater than ≥3 and 4 were 79 ± 17% and 68 ± 17% for pantoprazole and 74 ± 19% and 64 ± 23% for combination treatment, respectively. There were no significant differences in MPT intragastric pH was ≥3 and 4 between groups. Pantoprazole administered alone achieved pH goals established for humans with acid-related disorders. CONCLUSIONS AND CLINICAL IMPORTANCE: These results suggest that short-term combination treatment with famotidine and pantoprazole is not superior to pantoprazole alone for increasing intragastric pH in dogs.

The sitting position in neurosurgical anaesthesia: a survey of British practice in 1991.

A postal survey of 160 members of the Neurosurgical Anaesthetists' Travelling Club was conducted in 1991 to investigate the current use of the sitting position in neurosurgery. There was a 78% response rate; at least one reply was received from every neurosurgical centre in the UK. Patients were placed normally in the sitting position for posterior fossa surgery in eight (20%) of the centres, compared with 19 (53%) in 1981. For posterior cervical spinal surgery, only three (7%) centres routinely used the sitting position, compared with 11 (31%) in 1981. Thus in the period 1981-1991, the number of neurosurgical centres using the sitting position routinely, decreased by more than 50%. Current techniques of ventilation and monitoring for the sitting position are discussed briefly.

Disseminated herpes simplex virus infection during pregnancy. A case report.

Hepatitis due to herpes simplex virus (HSV) developed in a pregnant women at 38 weeks' gestation. She delivered a live-born infant who had serologically documented HSV 2 infection but did well with acyclovir therapy. The mother, however, died five days postpartum from fulminant hepatic failure despite antiviral treatment, and HSV was demonstrated in the liver. Twenty-three reported cases clearly establish pregnancy as a condition that can predispose to disseminated HSV infection. The majority of cases have been due to HSV 2, and primary infection in the latter part of pregnancy appears to constitute the greatest risk. The major disease manifestations appear to be hepatitis and encephalitis. Historically, maternal and fetal mortality rates have been high, but there is a trend toward improved survival in the acyclovir era.

Field response of predatorRhizophagus grandis to prey frass and synthetic attractants.

A lure based on the proportional composition of monoterpenes inD. micans larval frass and deployed in Theysohn slot traps was highly attractive toR. grandis released in the field. The relative response to frass and lure was consistent over a range of doses, and behavior close to traps baited with either lure or frass appeared to be similar. The monoterpenes, formulated with antioxidant, appear to be stable over several weeks when released from proprietary reservoir and wick "air fresheners." The lure may be of value in monitoring predator populations.

The role of lignin as a defence against the spruce bark beetle Dendroctonus micans: effect on larvae and adults.

The role of lignin as a physical defence against Dendroctonus micans was investigated in laboratory feeding experiments. The effect of lignin is dose-dependent, reducing larval survival, growth rate, and weight, as well as affecting gallery construction. Adults lay fewer eggs in lignified bark and also tend to construct abnormal galleries. The distribution of lignin in trees suggests a role in defence against bark beetles that feed in the thicker bark on the lower bole.

Oxygen concentrators.

Oxygen concentrators offer an alternative source of oxygen to conventional methods of supply. The disadvantage of their high initial purchase price is offset by low running costs. In hospitals they may find a place in providing "oxygen" for some gas pipeline systems. They are the method of choice for supplying oxygen for long-term domiciliary oxygen therapy.

Endoarterial pulmonary metastasis of malignant trophoblast associated with a term intrauterine pregnancy.

A previously healthy gravida 4, para 3, developed preclampsia and progressive dyspnea at the 37th gestational week and had bilateral pulmonary infiltrates on chest roentgenogram. She delivered a healthy, term, male infant with a normal appearing placenta. Postpartum, her respiratory status gradually worsened. A lung biopsy on the 20th postpartum day revealed intravascular trophoblasts, diffuse arteriolar thrombosis with pulmonary infarction, and subacute interstitial pneumonitis. Combination chemotherapy was instituted, but the patient died from respiratory insufficiency.

Mycobacterium terrae tenosynovitis: chronic infection in a previously healthy individual.

We have described a case of Mycobacterium terrae tenosynovitis in an otherwise healthy individual. The chronic nature of this infection suggests that aggressive surgical and medical therapy is the most prudent course for physicians faced with this infection.

Piped medical gas and vacuum systems.

The principles and construction of medical gas and vacuum pipeline systems found in hospitals in the United Kingdom are described, with some reference to overseas practice.

Maglignant giant cell tumor of tendon sheath.

A benign, but aggressive, giant cell tumor of tendon sheath developed over a period of 20 years into a metasasizing, histologiclly malignant giant cell tumor. Ultrastructure of the malignant tumor showed the same five cell types as described in giant cell tumors of tendon sheath. Even the same crystals were identified in the osteoblast-like and osteoclast-like cells. It therefore appears reasonable to assume that giant cell tumors of tendon sheath indeed are neoplasms with a malignant potential and not an inflammatory with partial osseous differentiation. No ultrastructural similarities with fibrous histiocytoma were apparent.

Respiratory failure after liver transplantation.

A rapidly growing haemangioendothelial sarcoma of the liver in a twenty-two year old woman was treated by liver transplantation. Disseminated intravascular coagulation resulted in massive blood loss during surgery, and contributed to the death of the patient from respiratory failure on the fourth post-operative day, despite continuous post-operative intermittent positive-pressure ventilation. Other factors leading to her respiratory failure are discussed. There was no evidence of dysfunction in the transplanted liver.