Antenatally diagnosed cloacal exstrophy variant with intravesical phallus in a twin pregnancy.

We report a rare case of covered cloacal exstrophy variant with a hemiphallus trapped within partially closed bladder halves. The persistence of the cloacal membrane until at least 18 weeks' gestation, confirmed by antenatal ultrasound scanning, is discordant with existing theories of embryogenesis of cloacal exstrophy. The clinical presentation highlights the need for careful assessment, before and during surgery, to obtain a complete understanding of the anatomic defect before gender assignment and appropriate reconstructive efforts. A multispecialty approach and antenatal counseling are important, especially when only one fetus of twins has major birth defects.

Comparison of field performance of the Andersen N6 single stage and the SAS sampler for airborne fungal propagules.

Comparisons of two common bioaerosol samplers were made after sampling and enumeration of airborne fungal propagules in several office structures on a university campus in Southern California. Data collected on five occasions throughout the year showed that a Surface Air Systems (SAS) high flow portable sampler recovered consistently lower levels of colony forming units (cfu) than an Andersen N6 single stage impactor. There was no difference statistically between the samplers when concentrations of Cladosporium were compared. Compared to the Andersen N6, the SAS sampler recovered about half the number of cfu for three other fungal categories, i.e. non-sporulating species, Aspergillus and Penicillium and others. Differences in sampler efficiencies are discussed in terms of effective particle diameters. Counts of culturable airborne fungal spores obtained with the SAS sampler should be interpreted with caution when genera other than Cladosporium predominate.

Results of a multicenter trial of the CapSure (Re/Stor) Continence shield on women with stress urinary incontinence.

OBJECTIVES: To prospectively study the impact of the CapSure (Re/Stor) Continence shield for the treatment of stress urinary incontinence. METHODS: One hundred women with pure stress urinary incontinence were enrolled in a 6-month study. Objective measures of urine loss included pad weight test (PdWt) and provocative stress test (PST). Subjective measures included incontinence diaries documenting the number of incontinence episodes per day (IEPD), quality of life questionnaires, and satisfaction surveys. Objective and subjective measures were performed prior to enrollment, during use of the CapSure shield, and after discontinuation of the device. RESULTS: During the 12-week device utilization period, PdWt measurements demonstrated a 96% reduction in urine loss by week 1 and 97% by week 12. Eighty-two percent of subjects were completely dry by week 12. PST demonstrated 100% reduction in urine loss at each visit, with 91% of subjects completely dry by week 12. IEPD also demonstrated a 91% reduction in incontinence episodes by week 12. Quality of life scores and patient satisfaction surveys demonstrated significant improvement. During the 6-week post device utilization period (PUP), subjects continued to demonstrate a reduction in urine loss compared to pre-enrollment data, despite discontinuation of use. PdWt measurements demonstrated a 73% and 79% reduction in urine loss at weeks 14 and 18, respectively. Measurements of PST and IEPD demonstrated significant reductions in urine loss at weeks 14 and 18. A 1.5% prevalence of positive urine cultures was noted during device use. Bothersome vaginal or urethral irritation occurred in 12% of patients. Adverse events were few and required no therapeutic intervention. CONCLUSIONS: The CapSure shield is a safe and efficacious method of managing stress urinary incontinence in women.

The effect of respirator dead space and lung retention on exposure estimates.

This paper develops, tests, and applies equations that predict the magnitude of the effect of lung retention and respirator dead space on average inhalation concentration and other related quantities. The equations were validated by numerical simulation and experimental measurement with a respirator on a mannequin connected to a breathing machine. Experimental data are presented verifying the applicability of the equations. The authors present applications of the equations and procedures to various types of respirator performance measurements and to a predictive respirator performance model. Graphs are presented giving correction factors. In all cases the correction factors are less than 2. Under typical conditions of workplace protection factor measurement with half-mask respirators, average inhalation concentration will be 105% to 125% of full-cycle average concentration.

Aerosol penetration through respirator exhalation valves.

Exhalation valves are a critical component of industrial respirators. They are designed to permit minimal inward leakage of air contaminants during inhalation and provide low resistance during exhalation. Under normal conditions, penetration of aerosol through exhalation valves is minimal. The exhalation valve is, however, a vulnerable component of a respirator and under actual working conditions may become dirty or damaged to the point of causing significant leakage. Aerosol penetration was measured for normal exhalation valves and valves compromised by paint or fine copper wires on the valve seat. Penetration increased with increasing wire diameter. A wire 250 microns in diameter allowed greater than 1% penetration into the mask cavity. Dirt or paint accumulated on the exhalation valve allowed a similar level of penetration. Work rate had little effect on observed penetration. Penetration decreased significantly with increasing aerosol particle size. The amount of material on the valve or valve seat necessary for significant (greater than 0.5%) inward leakage in a half-mask respirator could be readily observed by careful inspection of the exhalation valve and its seat in good lighting conditions.

Performance of dust respirators with facial seal leaks: II. Predictive model.

A performance model for half-mask and single-use respirators is presented. It represents a possible alternative to field measurements of respirator performance. Experimental data on filter and leak performance given in Part I were used to develop a model that allows one to predict 1) the overall respirator penetration as a function of particle size for any work rate and 2) overall total mass penetration for any work rate and exposure aerosol-size distribution for a known respirator filter and facial seal leak condition. A simplified method based on general regression equations is presented that allows one to estimate these quantities based on QNFT (quantitative fit testing) measurements and a knowledge of the exposure aerosol-size distribution. Example calculations are given for a situation in which QNFT gives a fit factor of 50 for a half-mask with dust, fume and mist filter cartridges, but predicted protection factors for various use conditions range from 20 to 81 depending on exposure particle-size distribution and work rate of the wearer.