Stress incontinence in women under 50: does urodynamics improve surgical outcome?

The aim of the study was to determine whether urodynamic testing improves the outcome of retropubic surgery in women aged 50 or younger. A retrospective study was undertaken of 212 women aged 50 or younger who underwent retropubic surgery at a medical school-affiliated hospital between February 1991 and July 1997. Excluded were patients with prior retropubic urethropexy and known low urethral closure pressures. The surgery was performed by one urogynecologist and two urologists. The minimal evaluation by the urogynecologist was a focused incontinence questionnaire, pelvic neurologic examination, pelvic floor grading, cough stress test, urinalysis, postvoid residual, cotton swab test and supine empty stress test. Full urodynamics consisted of uroflowmetry, subtracted cystometry, urethral closure pressure, cough leak-point pressure and cystourethroscopy. Subjective postoperative follow-up at 14 years was by annual questionnaire. The urogynecologist's patients were in group I (95 women with full urodynamic studies) and group II (36 women with minimal testing). The urologists' patients were in group III (81 women with a very minimal workup and cystourethroscopy). A review of seven variables revealed no difference between the groups. In terms of cured, improved and failed, there was also no difference in outcome. There was a difference in postoperative voiding problems (though not stress incontinence) in group III compared to group I (P= 0.005) and group II (P=0.002). Our conclusion was that all women with stress incontinence should undergo a careful minimal evaluation. In women aged 50 or younger urodynamic studies may be avoided unless there is significant stress incontinence, complex symptoms, a positive supine empty stress test, marked prolapse, or a history of prior retropubic urethropexy.

Caffeine-metabolizing capability of primary rat hepatocytes, Chinese hamster V79 cells and normal human fibroblasts in culture.

Caffeine is metabolized by primary rat hepatocytes in culture to metabolites similar to those found in rats in vivo, including 6-amino-5-[N-formylmethylamino]-1,3-dimethyluracil, one of the major caffeine metabolites produced in the rat. At a substrate-limiting level of caffeine, the rat hepatocytes metabolized 25-30% of the total added caffeine in 24 h. About 99% of the metabolites was found in the extracellular medium and rinse fractions, suggesting that on a volume basis, caffeine metabolites are in equilibrium inside and outside the cells. No detectable caffeine metabolites were produced in preparations of either Chinese hamster V79 cells, or normal human fibroblasts at caffeine concentrations from 5 microM to 5 mM. These results suggest that the varied biological effects induced by caffeine in Chinese hamster cells cannot be attributed to caffeine metabolites and further that the differential responses of Chinese hamster cells and normal human fibroblasts to caffeine are not due to qualitative or quantitative differences in caffeine metabolism in the two cell lines.

Health and environmental impacts of increased generation of coal ash and FGD sludges. Report to the Committee on Health and Ecological Effects of Increased Coal Utilization.

This paper focuses on the incremental impacts of coal ash and flue gas desulfurization (FGD) wastes associated with increased coal usage by utilities and industry under the National Energy Plan (NEP). In the paper, 1985 and 2000 are the assessment points using the baseline data taken from the Annual Environmental Analysis Report (AEAR, September 1977). In each EPA region, the potential mix of disposal options has been broadly estimated and impacts assessed therefrom. In addition, future use of advanced combustion techniques has been taken into account. The quantities of coal ash and FGD wastes depend on ash and sulfur content of the coal, emission regulations, the types of ash collection and FGD systems, and operating conditions of the systems and boiler. The disposal of these wastes is (or will be) subject to Federal and State regulations. The one key legal framework concerning environmental impact on land is the Resource Conservation and Recovery Act (RCRA). RCRA and related Federal and State laws provide a sufficient statutory basis for preventing significant adverse health and environmental impacts from coal ash and FGD waste disposal. However, much of the development and implementation of specific regulations lie ahead. FGD wastes and coal ash and FGD wastes are currently disposed of exclusively on land. The most common land disposal methods are inpoundments (ponds) and landfills, although some mine disposal is also practiced. The potential environmental impacts of this disposal are dependent on the characteristics of the disposal site, characteristics of the coal ash and FGD wastes, control method and the degree of control employed. In general, the major potential impacts are ground and surface water contamination and the "degradation" of large quantities of land. However, assuming land is available for disposal of these wastes, control technology exists for environmentally sound disposal. Because of existing increases in coal use, the possibility of significant environmental impacts, both regionally and nationally, exists regardless of whether the NEP scenario develops or not. Existing baseline data indicate that with sound control technology and successful development and implementation of existing regulatory framework, regional scale impacts are likely to be small; however, site-specific impacts could be significant and need to be evaluated on a case-by-case basis. Both Federal and privately-funded programs are developing additional data and information on disposal of FGD sludges and coal ash. Continuation of these programs will provide additional vital information in the future. However, further information in several areas if desirable: further data on levels of radionuclides and trace metals in these wastes: studies on biological impacts of trace metals; and completion of current and planned studies on disposal problems associated with advanced combustion techniques like fluid bed combustion.

Bactericidal activity of a broad-spectrum illumination source.

Several hours of exposure to Vita-Lite lamps, which have a unique spectral distribution, give significant killing of cells of Staphylococcus aureus.

Spin filter culture: the propagation of mammalian cells in suspension.

A spin filter device has been used for the propagation in vitro of cells of mnouse leukemia L1210 to densities approaching 10(8) cells per milliliter. By manipulation of flow rates, cells may be exposed to exponentially declining, drug concentrations with half-times of 1.5 hours or less, providing a more realistic parallel to in vivo drug treatment than is obtained by other culture methods.