Influence of Modern Stormwater Management Practices on Transport of Road Salt to Surface Waters.

Application of road salts in regions with colder climates is leading to ground and surface water contamination. However, we know little about how modern stormwater management practices affect the movement of road salt through urban watersheds. We investigated groundwater contamination and transport of road salts at two stormwater ponds in Baltimore County, Maryland. In association with the ponds, we documented a plume of contaminated groundwater that resulted in Cl- loadings to the adjacent stream of 6574 to 40 008 kg Cl- per winter, depending on winter snowfall. We also monitored Na+ and Cl- ion concentrations and the temporal dynamics of conductivity at a range of stream sites in watersheds with and without stormwater management ponds. Streams draining watersheds with stormwater ponds had consistently higher conductivities and Cl- concentrations during base flow conditions and often exhibited greater peaks in Cl- and conductivity associated with winter storms and subsequent melting events, despite the degree of watershed development. Our results indicate that modern stormwater management practices are not protecting surface waters from road salt contamination and suggest they create contaminated plumes of groundwater that deliver Cl- and Na+ to streams throughout the year.

Findings from a 10-year follow-up of bone mineral density in competitive perimenopausal runners.

OBJECTIVE: To evaluate bone mineral density (BMD) in perimenopausal competitive runners with long-term follow-up. STUDY DESIGN: Fifteen master female runners between 40 and 50 years old who ran at least 20 miles per week were evaluated. BMD was measured by dual-energy x-ray absorptiometry (DEXA) at baseline and at the 10-year follow-up. RESULTS: The median age was 46 and median miles run per week, 25. At baseline, after a median of 11 years of competitive running, hip BMD was above peak bone mass (T-score = 0.8) and that of age-matched controls (Z-score = 1.6), while lumbar spine BMD was below peak bone mass (T-score = -0.8) and equal to that of age-matched controls (Z-score = -0.1). At the 10-year follow-up, hip BMD fell below peak bone mass (T-score = -0.2, p = 0.0004) but was still above that of age-matched controls (Z-score = 0.5, p = 0.002), while there was little change in lumbar spine BMD. CONCLUSION: Competitive running prior to the perimenopausal period seems to be associated with improved hip BMD. However, continued competitive running during the perimenopausal period is not associated with prevention of a perimenopausal hip BMD decline. In contrast, competitive running had little effect on peri-menopausal lumbar spine BMD.

Feasibility of the Maylard transverse incision for ovarian cancer cytoreductive surgery.

The vast majority of abdominal incisions used in gynecologic surgery are either transverse or vertical midline. The advantages of a vertical midline incision are considered to be rapid abdominal entry and increased exposure to the abdomen and pelvis. The advantages of transverse incisions are purported to be cosmesis, decreased postoperative pain, decreased hernia rate, decreased abdominal adhesions, and fewer postoperative pulmonary complications. The Maylard incision is a transverse incision that combines the advantages of a transverse incision with improved pelvic and abdominal exposure. We wanted to evaluate the feasibility of the Maylard incision to provide adequate abdominal and pelvic exposure in women with advanced ovarian cancer undergoing cytoreductive surgery and to evaluate the extent of anterior abdominal wall adhesions at secondary cytoreductive surgery. In our experience, it appears that the Maylard incision provides adequate exposure to perform ovarian cytoreductive surgery. It appears that there are minimal anterior abdominal adhesions after cytoreductive surgery through a Maylard incision.

A laparoscopic bipolar cutting forceps can assist in a case of difficult vaginal hysterectomy.

A vaginal approach to hysterectomy can become challenging when visualization is limited by poor or absent uterine descent, obesity, or other factors that make an approach to the uterine pedicles difficult. When factors occur that make application or visualization of conventional vaginal instruments difficult, using an instrument designed for laparoscopic application, with its thin, elongated shape, may permit continuation of a vaginal approach. In such a case, a Gyrus bipolar laparoscopic cutting forceps was used for coagulation and transection of the uterine pedicles during a vaginal hysterectomy. This represents a way to expand on traditional techniques for completion of difficult vaginal hysterectomy, which may be used concurrently. Surgical techniques that more easily and safely permit completion of hysterectomy by the vaginal approach can improve outcomes for all.