Biomedical subjects
Publications and source records attributed to B A Work.
A case of pyoderma gangrenosum of the perineum is presented. The patient's surgical treatment, hospital course, and 10-year follow-up are described. Unusual problems in grafting, perineal support, and patient emotional response are discussed.
Over an 18-month period, the cesarean section rate was 21.6%. THe primary cesarean section rate was 14.9%. The various indications for the primary cesarean section are detailed. Cephalopelvic disproportion and breech presentation accounted for 50% of the primary cesarean sections. The frequencies of various types of morbidity (ie, endometritis, wound infection, and urinary tract infection) are presented and analyzed with respect to several variables. Patients who underwent primary cesarean section were at significantly greater risk of developing postoperative endometritis than were patients undergoing a repeat procedure. Labor, ruptured membranes, and the use of internal fetal-maternal monitoring were not significant risk factors for endometritis in the patients in this study.
The human chorionic gonadotropin-radioreceptor assay (hCG-RRA) offers a rapid and accurate method of diagnosing early and abnormal pregnancies. Such a method is described along with clinical correlations in 139 assays done on 122 patients with amenorrhea, normal pregnancies, infertility, trophoblastic disease, ectopic pregnancies, and missed or incomplete abortions. The accuracy of the test is correlated with weeks of amenorrhea, weeks after ovulation, and clinical diagnoses. The overall accuracy of the assay was 95%. Those performed more than 28 days after the last menstrual period had an accuracy of 96.4%. There were no errors in the diagnosis of eight ectopic pregnancies among 33 suspected cases. Three patients are described who had serial changes from negative to positive early in pregnancy, providing data on precise timing of a positive result. Cases of missed abortion sometimes demonstrate a positive hCG-RRA after documented fetal loss. Recommendations for the most appropriate use of the hCG-RRA are presented based on the clinical experience at one referral center during the period January, 1977, to June, 1978.
A graphic format is presented for the display and storage of data relating to gestational age. The graph permits rapid retrieval and synthesis of often confusion information and is thereby useful in the management of complicated pregnancies.
The relationships among maternal anxiety, selected stress-related biochemical factors, and progress in three defined phases of labor were determined for 32 married, normal, primigravid women, 20 to 32 years of age. Comparisons of plasma epinephrine, norepinephrine, and cortisol in third-trimester pregnancy, during labor, and after delivery are provided. At the onset of Phase 2 of labor (3 cm. of cervical dilatation), self-reported anxiety and endogenous plasma epinephrine are significantly correlated. With the deletion of subjects to control for the effect of medications, higher epinephrine levels are significantly associated with lower uterine contractile activity at the onset of Phase 2 and with longer labor in Phase 2 (3 to 10 cm. of cervical dilatation). The relationship between epinephrine and progress in labor is explained by an adrenoreceptor theory.
Eighty patients in labor and requiring cesarean section were selected randomly for a double-blind study using prophylactic cephalosporin and placebo. There were 26 treated patients who had no morbidity versus 13 in the control group. The reduction in endometritis was significant (P = less than .05). The most prevalent organism was Streptococcus viridans, followed by Escherichia coli. Bacterioides organisms were recovered 17 time in 11 patients. Tabulation of the fever index showed significant difference. No major complication occurred in the treatment group. Gastric aspirates from infants showed a good correlation with maternal morbidity and are suggested as a screening procedure.
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One hundred and eleven cases of vaginal hysterectomy for sterilization, performed over a period of five and a half years, were analyzed and compared with alternative methods of female sterilization. The mean operating time for vaginal hysterectomy was 98 minutes, and the mean length of hospitalization was 9.5 days. Immediate morbidity of one sort or another occurred in 89 cases (90.0 per cent), while the incidence of standard morbidity was 40.9 percent (35 cases). These data compare most unfavorably with findings for interval tubal ligation by either the vaginal or laparoscopic approach. Our data indicate that vaginal hysterectomy for sterilization should be used only in selected patients where there is a clear indication for hysterectomy above and beyond the desire for sterilization.
An analysis was made of 1757 female sterilization procedures performed over a 5 1/2-year period. The majority of these were accomplished by one of 8 technics: puerperal abdominal tubal ligation (TL), cesarean section plus TL, hysterotomy plus TL, interval abdominal TL, colpotomy TL, laparoscopic TL, vaginal hysterectomy, and abdominal hysterectomy. The various technics have been compared with respect to 55 variables. The procedures having the shortest hospital stay, lowest morbidity, lowest blood loss, and shortest operating time were interval laparoscopic TL, colpotomy TO, and puerperal abdominal TL. The more major procedures were attended by significantly more morbidity and longer hospitalization and should be used only when specific indications justify the increased cost and risk.
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