Association of wild bird density and farm management factors with the prevalence of E. coli O157 in dairy herds in Ohio (2007-2009).

Our objective was to determine the role that European starlings (Sturnus vulgaris) play in the epidemiology of Escherichia coli O157:H7 in dairy cattle. We visited 150 dairy farms in Ohio twice during summer and fall months from 2007 to 2009. Fresh faecal pats from 30 lactating cows were collected during each visit. Information on farm management and environmental variables was gathered through a questionnaire administered to the farm owner. The number of starlings observed on the farm was also recorded. Approximately 1% of dairy cattle and 24% of farms were positive for E. coli O157. Risk factors associated with the presence of E. coli O157 in faecal pats included contact between adult cattle and calves, types or number of ventilation and manure management systems and number of birds per milking cow.

The treatment of gross hematuria secondary to prostatic bleeding with finasteride.

PURPOSE: We evaluate the use of finasteride to control gross hematuria secondary to prostatic bleeding. MATERIALS AND METHODS: We reviewed retrospectively 42 patients treated with finasteride to treat gross hematuria. RESULTS: There were 28 evaluable patients who had taken finasteride for at least 6 months to control gross hematuria and hematuria ceased in 25 (91%). In 1 patient clot retention developed requiring transurethral resection of the prostate and 2 patients had 1 or more minor episodes of bleeding that resolved spontaneously. CONCLUSIONS: Finasteride appears to be an effective agent for controlling gross hematuria secondary to prostatic bleeding.

Is heparin contraindicated in pelvic lymphadenectomy and radical prostatectomy?

PURPOSE: We initiated a prospective study to verify or refute the complications of lymphocele formation and excessive blood loss associated with heparin prophylaxis in pelvic lymphadenectomy and radical prostatectomy. MATERIALS AND METHODS: A prospective study was completed on 579 men undergoing pelvic lymphadenectomy usually in association with radical prostatectomy. Patients were assigned to group 1 (given preoperative and postoperative subcutaneous heparin) and group 2 (no heparin). All patients were evaluated 2 to 3 weeks after surgery with ultrasound for pelvic lymphocele. RESULTS: There was no statistically significant difference in the number or size of pelvic lymphoceles or blood loss in group 1 versus group 2. CONCLUSIONS: The use of heparin prophylaxis to prevent thromboembolic complications in conjunction with pelvic lymphadenectomy and radical prostatectomy is not associated with increased blood loss or increased rate of lymphocele formation.

Antibiotic prophylaxis in ultrasound guided transrectal prostate biopsy.

PURPOSE: A retrospective review of a large group of transrectal ultrasound guided biopsies was performed to determine the symptomatic urinary tract infection rate associated with a consistent and defined antibiotic prophylaxis regimen. MATERIALS AND METHODS: A total of 4,439 biopsies was performed using an 18 gauge needle with ultrasound guidance. Patients were treated with 500 mg. ciprofloxacin twice daily for 8 doses beginning the day before biopsy. RESULTS: Of 5 symptomatic urinary tract infections noted 3 were complicated. CONCLUSIONS: These data demonstrate the low infection rate associated with this prophylaxis regimen.

The incidence and management of rectal injury associated with radical prostatectomy in a community based urology practice.

PURPOSE: We assessed the use of combination bowel preparation before radical prostatectomy. MATERIALS AND METHODS: We reviewed 533 radical prostatectomies performed from 1984 to 1994. All patients underwent preoperative combination bowel preparation. The incidence, management and sequelae of rectal injury were determined. The literature addressing the management of rectal injuries was reviewed. RESULTS: Rectal injury occurred in 8 patients (1.5%). Injury was recognized intraoperatively and repaired primarily in 6 cases, and repair included colostomy in 2. Injury was recognized postoperatively as recto-urinary fistula in 2 cases and initial management was conservative. No fistula closed with conservative management. There were no pelvic abscesses and no deaths. CONCLUSIONS: Combination bowel preparation permits safe closure of rectal injury at radical prostatectomy without the necessity of routine colostomy. In the event of recto-urinary fistula, conservative management is not warranted.

Once a boring task always a boring task? Interest as a self-regulatory mechanism.

A process was proposed through which individuals regulate their motivation to perform necessary but uninteresting activities over time. If committed to continuing, individuals may engage in interest-enhancing strategies that can change the activity into something more positive to perform. In Study 1 Ss performed novel tasks and generated strategies to make regular performance interesting. In Study 2 Ss actually used these strategies primarily in conditions indicating a self-regulatory attempt: The task was currently boring, there was a perceived reason to continue (alleged health benefit), and a relevant strategy was available. Strategy use was associated with a change in activity definition and greater likelihood of subsequently performing the activity. In Study 3 Ss beliefs about how to maintain motivation to perform more everyday activities emphasized the importance of regulating interest relative to other self-regulatory strategies.

Pitfalls in determination of leak point pressure.

To evaluate the influence of the technical aspects of leak point pressure measurement we performed water cystometry and determined the leak point pressure in 23 patients 5 weeks to 21 years old with neurogenic bladders. We initially assessed the influence of catheter size on the leak point pressure and determined that the measured pressure varied in direct proportion to the catheter diameter. We further evaluated the effect of the method of infusion (gravity drip versus pump) and the infusion rate on pressures measured by a transducer in an in vitro setting. Using the gravity drip infusion technique pressure measurement was adversely affected by smaller catheter size and rapid infusion rate. With the pump infusion system neither catheter size nor infusion rate adversely affected pressure measurement. We conclude that the clinical measurement of the leak point pressure during water cystometry is influenced by the catheter size, and it is dependent upon the technique and rate of infusion. We believe that standardization of the technical aspects of leak point pressure determination would provide for reproducible results and facilitate comparisons of reports among different investigators.

Planning an ambulatory care joint venture.

This article discusses ambulatory care joint ventures by hospitals and selected members of their medical staffs and emphasizes the resolution of problems in the early planning stages. Failure to follow an orderly and thoughtful planning process not only risks valuable resources of the venture partners, but also jeopardizes the working relationship between the hospital and its medical staff.