Postoperative voiding dysfunction is a potential complication of anti-incontinence procedures. Reported rates of urethral obstruction range from 5% to 20%. There is a lack of consensus in the literature regarding the appropriate evaluation and management of this distressing problem. A literature search was carried out using Medline (1966-2001) for postoperative voiding dysfunction. The key word urethrolysis was cross-referenced with surgical complications and stress urinary incontinence to identify all published English-language articles. The bibliographies of reviewed articles were searched manually. We also mailed a survey to the members of American Urogynecologic Society (AUGS) regarding their management of this problem. Overall, 262 members (31.4%) responded to the survey. Success rates reported in the literature between retropubic and vaginal techniques of urethrolysis are comparable, but morbidity is lower with the vaginal approach. The success rates are equivalent with (68%) or without (74%) resuspension following transvaginal urethrolysis. The incidence of postoperative SUI is acceptably low even without resuspension of the urethra (6% for both). Results of the AUGS survey reveal that most providers favor a transvaginal approach (74%) when performing urethrolysis, and they do not routinely resupport the bladder neck (82%).

Background: Leiomyomas rarely cause pseudo-Meigs syndrome. Increased levels of CA 125 often are associated with some types of malignancy. No reported case of pseudoMeigs syndrome presenting with hydropic degeneration of uterine leiomyoma and an elevated CA 125 level could be found on a MEDLINE search. Case: A 46-year-old woman presented with a pleural effusion and a pelvic mass measuring 30 ؋ ؋ ؋ 18 cm. Preoperative evaluation was remarkable for a CA 125 level of 254 U/mL. At laparotomy, the diagnosis was a benign leiomyoma with focal hyaline and extensive hydropic degeneration. Her pleural effusion resolved completely by 4 months postoperatively. Conclusion: Pseudo-Meigs syndrome can present with an elevated CA 125 level. (Obstet Gynecol 1998;92:648 -9.)

No abstract

Reduced cardiovagal baroreflex sensitivity and a peak in the incidence of cardiovascular events in the hours immediately after waking from nocturnal sleep suggest that cardiovascular control is impaired in the morning compared with other times of day. Previous research indicates that diurnal variation exists in acute blood pressure (BP) responses to exercise. However, the effect of time of day on activities such as cognitive tasks and "passive coping" physical tasks has yet to be established. Therefore, the primary aim of this study was to explore cardiovascular responses to physical and mental stressors at two times of day that have previously been associated with differing levels of cardiovascular control. In addition, the effect of the chronotype was examined to identify possible interactions between morningness/eveningness, time of day and responses to stressors. Fourteen healthy, young subjects completed a morning (08:30 h) and an afternoon (13:30 h) trial on separate days. Subjects performed a mental arithmetic task and a cold pressor test while beat-to-beat measurements of BP and heart rate were recorded continuously. Reactivity was determined using mean change scores in systolic BP, diastolic BP, mean arterial pressure, heart rate and rate-pressure product (RPP) from a period of rest recorded immediately prior to the task. There was no significant difference in cardiovascular reactivity between the morning and afternoon (p > 0.05). The time course of the responses and subsequent recovery were also consistent between the two times of day (p > 0.05). There was a significant interaction between time of day and chronotype, although this was apparent only for heart rate and RPP reactivity (p < 0.05); subjects tending towards "morningness" exhibited greater heart rate and RPP reactivity in the afternoon, and subjects tending towards "eveningness" exhibited greater heart rate and RPP reactivity in the morning. No interactions were observed between time of day and chronotype for BP reactivity (p > 0.05). Despite effects of time of day on heart rate that are dependent upon chronotype, this study suggests that BP control during mental and passive physical stress is not altered between the morning and afternoon.

BackgroundA myriad of studies have argued that tactile sensibility is underpinned exclusively by large myelinated mechanoreceptors. However, the functional significance of their slow-conducting counterparts, termed C-low threshold mechanoreceptors (C-LTMRs), remains largely unexplored. We recently showed the emergence of brush- and vibration-evoked allodynia in human hairy and glabrous skin during background muscle pain. The allodynia persisted following the preferential blockade of myelinated fibres but was abolished by the preferential blockade of cutaneous C fibres, thereby suggesting a pathway involving hairy skin C-LTMRs and their functional counterparts in glabrous skin in this phenomenon. In the present study, we tested the effects of preferential A- and C-fibre conduction blocks and pharmacological blockade of T-type calcium channel Cav3.2 (expressed selectively on small-fibre LTMRs) on monofilament detection thresholds in healthy participants by compression, low-dose intradermal anaesthesia (xylocaine 0.25 %) and selective T-channel antagonist, TTA-A2.ResultsWe found that all participants could detect monofilament contacts (as low as 1.6 mN) within the innocuous tactile range regardless of the preferential blockade of myelinated fibres. Furthermore, during the compression block no subject reported a switch in modality from touch to pain. That is, the low-force monofilament contacts were always perceived as non-painful. However, there was a small but significant elevation of monofilament thresholds (~2 mN) in the glabrous skin following the compression block. Importantly, no differences were found in the thresholds across hairy and glabrous regions while the myelinated fibres were conducting or not. The preferential blockade of C fibres in the glabrous skin (with myelinated fibres intact) also resulted in a small but significant elevation of tactile thresholds. Furthermore, the use of T-channel blocker in the glabrous skin during compression block of myelinated fibres resulted in complete abolition of monofilament sensibility within the innocuous tactile range (tested up to ~20 mN).ConclusionsThese observations suggest that C-LTMRs need not be regarded as a redundant tactile system, but appear to complement normal large-myelinated-fibre tactile function. Convergent findings in glabrous and hairy skin lend support for an underlying system of innocuous mechanoreception with Cav3.2-expressing unmyelinated fibres.