Stephen T. Vermillion

Wound infection after cesarean: effect of subcutaneous tissue thickness.

Objective To estimate the effect of the thickness of subcutaneous tissue at the surgery site on abdominal wound infection after cesarean delivery. Methods We measured the maximum vertical depths of subcutaneous incisions of women who had cesarean deliveries. The surgical technique for closure was standardized and drains were not used. Abdominal wound infection was defined by standard criteria and limited to the first 6 postoperative weeks. Additional demographic, intrapartum, and perioperative data previously associated with wound infection also were collected. Data were analyzed by Student t test, χ2 test, and multiple logistic regression. Results Wound infection occurred in 11 of 140 women (7.8%) who delivered by cesarean. Risk factors identified as significantly associated with wound infection by univariate analysis were thickness of subcutaneous tissue, maternal weight, and body mass index. Multiple logistic regression analysis confirmed subcutaneous tissue thickness as the only significant risk factor for wound infection, with a relative risk of 2.8 (95% confidence interval 1.3, 5.9). There were no significant differences between women who developed wound infections and those without infections in terms of selected demographics, duration of ruptured membranes, number of vaginal examinations, chorioamnionitis, type of skin incision, or duration of surgery. Conclusion Thickness of subcutaneous tissue appears to be the only significant risk factor associated with abdominal wound infection after cesarean delivery.

A randomized, double-blind, hemodynamic evaluation of nifedipine and labetalol in preeclamptic hypertensive emergencies

OBJECTIVE Our purpose was to compare the hemodynamic effects of orally administered nifedipine and intravenously administered labetalol in preeclamptic hypertensive emergencies. STUDY DESIGN Our study was a randomized, double-blind evaluation of nifedipine and labetalol in women with preeclampsia and a systolic blood pressure >170 mm Hg or a diastolic blood pressure >105 mm Hg. Nifedipine or labetalol and placebo were given, so patients received both tablet and intravenous solution. Hemodynamic parameters at dosing and at 15, 30, 60, and 120 minutes were recorded. Outcome measures were cardiac index, systemic vascular resistance index, mean arterial pressure, and heart rate. Data were analyzed by repeated-measures analysis of variance (Friedman test) with Dunn posttests, the Mann-Whitney U test, and the chi(2) test with the Yates correction. Significance was set at P <.05. RESULTS At dosing, the nifedipine group (n = 6) had a cardiac index of 3.08 +/- 0.51 L/min per square meter. There was a 43% increase in the cardiac index after nifedipine administration (P =.0008). There was no significant effect in the labetalol group (P =.697). There was a significant decrease in the systemic vascular resistance index after nifedipine dosing (P =.002) but no significant effect on this index after labetalol use (P =.479). The mean arterial pressure was significantly affected in both groups as follows: nifedipine, P =. 001; labetalol, P =.004. The postanalysis showed significance at 60 minutes for both. An insignificant increase in heart rate with nifedipine (P =.147) and a significant decrease with labetalol (P =. 034) were noted. CONCLUSIONS Nifedipine increases cardiac index, whereas labetalol may not do so.

Adolescents and sexually transmissible diseases

Sexually transmitted infections are alarmingly common among adolescents in the United States. Behavioral, biologic, and health care access factors place adolescent girls at high risk for many common infections. This population also experiences a disproportionate burden related to the sequelae of STDs. The costs are high for the individual adolescent and for society. Clinicians treating adolescent girls should address the general lack of knowledge about the risks and consequences of STDs. They should be prepared to offer confidential and comprehensive counseling, screening, and treatment according to established guidelines. Office policies that protect adolescent confidentiality are an important component in providing effective care. Adolescence is a period during which lifelong health behaviors are established. It provides a critical opportunity for promoting responsible behaviors and reducing risks through health promotion and prevention strategies.

A randomized, double-blind, placebo-controlled trial of 5-fluorouracil for the treatment of cervicovaginal human papillomavirus.

OBJECTIVE: To compare intravaginal 5-fluorouracil (5-FU) and placebo for the treatment of cervical and/or vaginal human papillomavirus (HPV). METHODS: A randomized, placebo-controlled trial was performed. Women with HPV detected visually or by Papanicolaou (Pap) test and confirmed by colposcopic biopsy were randomized to receive either intravaginal 5-FU cream or an intravaginal placebo cream. Women with cervical or vaginal intraepithelial neoplasia were excluded. The primary outcome measure was cytologic regression of HPV as determined by Pap test screening 4 to 6 months after treatment. The secondary outcome was cytologic evidence of disease progression at both the 4-6-month and 12-month follow-up evaluations. Data were analyzed using the Chi square test with significance established at P < 0.05. RESULTS: A total of forty patients were randomized, and thirty patients had a follow-up Pap test 4 to 6 months after treatment. Of those patients treated with 5-FU, 28% demonstrated regression of HPV on cytologic evaluation, compared with 69% of those treated with placebo (P < 0.05). Twelve-month follow-up cytology was available from 18 of the study participants. There were no significant differences in the frequency of cytologic progression or regression between groups at 12 months. CONCLUSION: Four to six months post treatment, the use of intravaginal 5-FU for the treatment of cervical or vaginal HPV is associated with a lower rate of regression than the use of placebo.

Sexual dysfunction in women

Abstract Sexuality is an integral componont of a womans global well-being. Sexual dysfunction not only contributes to personal and interpersonal stress, but it also may herald other medical or psychosocial problems that significantly affect a womans health. Many physicians feel uncomfortable or inadequately trained to discuss sexuality issues with their patients, but the vast majority of patients believe that it is appropriate for physicians to address sexual function within the context of routine health assessments. Even though many women experience sexual dysfunction, they may feel uncomfortable volunteering the information. It is crucial that health care providers avoid making assumptions about a patients sexual behaviors or preferences and that they ask directly about sexual functioning and concerns. The physician can become more comfortable discussing sexual issues with patients by gaining an understanding of the normal sexual response and developing an approach to the evaluation and treatment of common sexual dysfunctions. Asking about sexual concerns and problems will provide the physician with an opportunity to educate patients and dispel sexual misconceptions. Furthermore, it will give patients “permission” to address sexual issues in a professional, confidential, and nonjudgmental setting.

A Psychiatrist’s Guide to Sexual Dysfunction in Women

Abstract Sexuality is an integral component of a woman’s global well-being. Sexual dysfunction not only contributes to personal and interpersonal stress but also may herald other medical or psychosocial problems that significantly affect a woman’s health. Many physicians feel uncomfortable or inadequately trained to discuss sexuality issues with their patients, but the vast majority of patients believe that it is appropriate for physicians to address sexual function within the context of routine physical and mental health assessments. While many women experience sexual dissatisfaction or dysfunction, they may feel uncomfortable volunteering the information. It is crucial that health care providers, particularly psychiatrists, avoid making assumptions about a patient’s sexual behaviors or preferences and ask directly about sexual functioning and concerns. The psychiatrist can become more comfortable discussing sexual issues with patients by gaining an understanding of the normal sexual response and developing an approach to the evaluation and treatment of common sexual dysfunctions. Asking about sexual concerns and problems will provide an opportunity to educate patients and dispel sexual misconceptions. Furthermore, it will give patients “permission” to address sexual issues in a professional, confidential, and non-judgmental setting. The information provided in this manuscript is considered to be relevant for psychiatrists who practice in in-patient, out-patient and community care settings.