Assessment of perineal floor function: electromyography with acrylic plug surface electrodes in nulliparous women.

A new technique using acrylic plug surface electrodes was employed to record electromyographic activity in the musculature surrounding the rectum and vagina. Forty-one asymptomatic nulliparous women were tested. The group had a wide range of normal values. When eight women were chosen at random for a second testing session, intra-class correlation coefficients to compare readings between the two sessions ranged from 0.76-0.97, indicating adequate reliability. No demographic factor correlated with the voltage generated in these women.

Management of a recalcitrant periprosthetic fluid collection.

Axillofemoral bypass grafts have been in common use for more than 20 years in the treatment of severe aortoiliac occlusive disease in poor-risk patients. A persistent periprosthetic fluid collection is an unusual complication of this procedure. We describe a technique by which a tense periprosthetic collection was kept successfully decompressed by the construction of a "window" from the cavity to the peritoneum. In our hands it proved to be safely and easily performed with the patient given local anesthetics; no morbidity occurred.

Nosocomial legionellosis in surgical patients with head-and-neck cancer: implications for epidemiological reservoir and mode of transmission.

A prospective pneumonia study was conducted simultaneously on head-and-neck surgery wards at two hospitals over 2 years; one hospital had a water supply contaminated with Legionella pneumophila but no record of having had a case of legionella pneumonia, and the other had just decontaminated its water supply because of known endemic nosocomial legionellosis. Special laboratory tests for legionella were done on all cases of nosocomial pneumonia irrespective of clinical impression. Over the first 18 months, the rate of nosocomial legionellosis was 30% at the first hospital and 0% at the second. Patients who underwent laryngectomy did not acquire the disease. Hyperchlorination at the first hospital was followed by a fall (p less than 0.01) in legionella pneumonias. Thus legionella pneumonias can be overlooked if special laboratory tests are not applied routinely, and surgical patients with head-and-neck cancer may be at high risk of nosocomial legionellosis because of the potential for pulmonary aspiration of contaminated water or orophyaryngeal microflora and/or frequent manipulation of the respiratory tract. This study demonstrates the benefits of examining the environment for legionella despite the absence of documented disease.