Long-term follow-up of sphincterotomy in the treatment of autonomic dysreflexia.

Autonomic dysreflexia (AD) is a syndrome affecting a majority of patients with high spinal cord lesions. An association between AD and detrusor-sphincter dyssynergia (DSD) is often seen. Between 1980 and 1988 we performed 51 transurethral sphincterotomies in 38 patients. Twelve of these patients underwent procedures primarily for the prevention of AD related to bladder distension. This study presents their long-term follow-up. One patient was lost to follow-up secondary to unrelated death; the remaining 11 patients were followed on average 117.5 months (94-154) after the initial operative procedure. Repeat sphincterotomy was required in 9 of 11 patients (82%). Six (66%) of these were performed within 24 months. One patient (11%) required delayed sphincterotomy greater than 100 months from the initial procedure. Overall, sphincterotomy was successful in controlling symptoms of AD in 10 of 11 (91%) patients. No major complications were recorded. Sphincterotomy is a safe and effective treatment for AD associated with DSD, however long-term urologic follow-up and management are necessary.

Conifer seedling nursery worker exposure to glyphosate.

This study addresses the measurements of glyphosate exposure received by 14 workers employed at two tree nurseries. The applicators, weeders, and scouts monitored all wore normal work clothing, which for applicators was a protective suit, rubber gloves and boots. Measurements were made of the glyphosate that was dislodged from conifer seedlings during water rinses taken twice weekly from May through August. Only 1 of these 78 dislodgeable residue samples were positive for glyphosate. Nine cotton gauze patches were attached to the clothing of each worker one day per week during this same period. Hand washes were taken on the same day that patches were worn. Most patches and hand washes from applicators and weeders contained measurable amounts of glyphosate. Analyses of individual patches showed that the body portions receiving the highest exposure were ankles and thighs. For scouts only 1 of 23 hand washes contained glyphosate. To provide a measure of the exposure occurring via all exposure routes (dermal, ingestion, and inhalation) an analysis was made of the total urine excreted. For most workers a daily total urine collection was made for 12 consecutive weeks. Urine analysis, the biological monitoring tool used to assess the total amount absorbed via all avenues, did not reveal any positive samples. The lower limit of method validation for glyphosate in the urine samples was 0.01 micrograms/ml. High rainfall, or irrigation as needed, in conjunction with normal field dissipation avenues and worker training were cited as contributing factors for the low amounts of glyphosate exposure found.(ABSTRACT TRUNCATED AT 250 WORDS)