bluuebunny/crossref_metadata_2025 huggingface dataset:
Bite horizons and dimensions for cattle grazing herbage to high levels of depletion
Authors: Ungar  , Ravid
Published: March 2003

A simple model of depletion by a grazing ruminant was tested at high depletion levels and for different sizes of feeding station. The model divides an initially uniform sward profile into grazing horizons, dependent on bite depth, and assumes a constant within‐horizon bite area.

Two grazing experiments were conducted using cattle. Uniform areas of oats and alfalfa herbage were grazed individually to a high level of depletion (≈150 bites m–2). Feeding station areas were 0·16, 0·30 and 0·53 m2. Initial sward heights were 10 and 20 cm in oats and 20 cm in alfalfa. Size of area did not significantly affect the observed number of bites removed per square metre, the mean residual herbage height or mass, or the proportion of each grazing horizon depleted, derived from the frequency distribution of residual heights. The mean residual height for all treatment combinations could be explained by assuming a ‘take half’ rule for mean bite depth, and allowing for the derived proportion of the area of each grazing horizon depleted.

A simple bite placement simulator was used to generate, for a single grazing horizon and for a given maximum potential area of a bite, the expected relationship among mean effective area of a bite, the proportion of the area of the horizon grazed and the number of bites removed per unit area. The simulator mimics a loosely systematic grazing style. The observed bite numbers and the derived proportions of grazing horizon depleted can be reconciled if the within‐horizon mean effective bite area is not constant but declines as predicted by the bite placement simulator. The implications for the shape of the gain function within a feeding station are discussed.
Nutritional quality of semi‐arid grassland in western Spain over a 10‐year period: changes in chemical composition of grasses, legumes and forbs
Authors: Vázquez‐de‐Aldana  , García‐Ciudad  , Pérez‐Corona  , García‐Criado
Published: March 2003

From 1987 to 1996, the nutritional quality of the main botanical components (grasses, legumes and forbs) in semi‐arid grasslands in the dehesa ecosystem in western Spain was analysed. Herbage samples were collected at the end of spring, in 30 locations, at two different topographic positions (upper and lower slope zones). Herbage mass over 2 cm and proportion of botanical components were estimated and samples were analysed for crude protein, neutral‐detergent fibre (NDF), hemicellulose, cellulose, lignin and in vitro dry matter digestibility (DMD). Analysis of variance revealed a significant effect of sampling year on the herbage mass, proportion of botanical components and their nutritional quality. The three botanical groups, grasses, legumes and forbs, followed similar year‐to‐year trends in their crude protein, cellulose and lignin contents and in vitro DMD. Herbage mass was not significantly related to any meteorological variables, suggesting that interannual variation in biomass production of botanically complex pastures cannot be explained by a single factor. However, annual precipitation was significantly related to the proportion of the botanical group that was dominant at each slope zone: grasses in the lower zone and forbs in the upper zone. In the upper zone, spring precipitation explained part of the interannual variation in the NDF, cellulose, lignin contents and in vitro DMD of the botanical components.
The effect of accumulation period and harvest date in spring on dry‐matter yield and forage quality in mixed swards containing Lolium spp. and Trifolium subterraneum in Western Australia
Authors: Callow M. N. , Baker J. E. , Hough G. M.
Published: March 2003

The object of this study was to determine the effect of closing date and date of harvest for conservation (accumulation period), on dry‐matter (DM) yield and forage quality of annual pasture in Western Australia. The field study comprised 48 plots, 2 m × 2 m, sown with either annual ryegrass (Lolium rigidum Gaud.) or Italian ryegrass (L. multiflorum Lam.), and mixed with subterranean clover (Trifolium subterraneum L.). Defoliation of swards until the end of winter was at the three leaves tiller–1 stage. In spring, once stem nodal development had commenced, swards were defoliated every 3–4 weeks. Swards were defoliated either twice with three leaves tiller–1 (accumulation period 1 commenced on 15 August); twice with three leaves tiller–1 and then once after 4 weeks (accumulation period 2 commenced on 11 September); twice with three leaves tiller–1 and then twice after 4‐week intervals (accumulation period 3 commenced on 9 October) or; twice with 3 leaves tiller–1 and then twice after 4‐week intervals and then once after 3 weeks (accumulation period 4 commenced on 30 October). From the commencement of the accumulation period, tiller density, DM yield and forage quality were determined weekly for up to 10 weeks.

There was a positive quadratic association between DM yield and days after the commencement of the accumulation period. Yields were maximized from accumulation period 1 with 5·3, 6·6 and 9·5 t DM ha–1, and growth rates were 140, 128 and 145 kg DM ha–1 d–1, for Wimmera annual ryegrass and Richmond and Concord cultivars of Italian ryegrass respectively. In contrast, in vitro dry‐matter digestibility (IVDMD) and crude protein (CP) content were negatively associated with days after the commencement of the accumulation period, and initial values were greater than 0·80 and 180 g kg DM–1 for IVDMD and CP content respectively. The rate of decline in IVDMD d–1 for Wimmera annual ryegrass was 0·005, 0·019 and 0·012 d–1 for accumulation periods 1, 2 and 3, respectively, while for Italian ryegrass cultivars Richmond was 0·015, 0·011, 0·02 and 0·012 d–1 and Concord was 0·014, 0·009, 0·013 and 0·01 d–1, for the 4 accumulation periods respectively.

It is recommended that annual and Italian ryegrass pastures be harvested between 10% and 20% inflorescence emergence when IVDMD will exceed 0·70 regardless of cultivar and/or defoliation practice prior to the commencement of the accumulation period.
Extensification of grassland use in the Welsh uplands: sheep performance in years 1–6
Authors: Fothergill M. , Davies D. A. , Morgan C. T.
Published: March 2003

An experiment was established in 1991 on a 25‐year‐old perennial ryegrass/bent (Lolium perenne L./Agrostiscapillaris L.)‐dominated pasture in Wales to study the effects of reducing nutrient inputs to previously fertilized upland pasture. The effects of the removal of applications of (1) N (denoted by CaPK) (2) N, P and K (Ca) and (3) N, P, K, and Ca (Nil) were compared with a treatment which received applications of all four nutrients (CaPKN) over a 6‐year period (1991–96) in a randomized block design replicated three times. The experiment was managed under a continuous variable stocking regime (ewes and lambs until weaning and ewes thereafter) maintaining a sward surface height of 4·0 cm throughout the grazing season. Although individual liveweight gain of the lambs was unaffected by the treatments, there was a significant reduction (P < 0·05) in total lamb liveweight gain, ewe stocking rate and length of grazing season as a result of the withdrawal of nutrients. Over the 6 years total lamb liveweight gain was reduced by 17%, 32% and 45% and ewe stocking rate by 21%, 36% and 49% on treatments CaPK, Ca and Nil, respectively, compared with treatment CaPKN. The effect of withdrawing nutrient inputs on ewe stocking rate was progressive and by 1996 the Nil input treatment displayed a 63% reduction compared with the CaPKN treatment and this was also coupled with a 21‐day reduction in length of the grazing season. During the post‐weaning period, ewes from the Nil input treatment recorded a liveweight loss in 1995 and only a modest liveweight gain in 1996. This coupled with significantly lower body condition scores (P < 0·01) of these ewes in the autumn indicated that the Nil input treatment could lead to reductions in reproductive performance.
Effects of grazing by sheep or cattle on sward structure and subsequent performance of weaned lambs
Authors: Wright I. A. , Jones J. R. , Parsons A. J.
Published: March 2003

The study was designed to test the hypothesis that grazing management in early season could alter sward structure to facilitate greater animal performance during critical periods. The effects of grazing a mixed perennial ryegrass/white clover sward at different sward surface heights, by cattle or sheep, in early season on sward composition and structure, and on the performance of weaned lambs when they subsequently grazed these swards in late season were determined. In two consecutive years, from mid‐May until mid‐July, replicate plots (three plots per treatment) were grazed by either suckler cows and calves or ewes and lambs at 4 or 8 cm sward surface heights (Phase 1). From mid‐August (Year 1) or early August (Year 2), weaned lambs continuously grazed, for a period of 36 d (Year 1) or 43 d (Year 2) (Phase 2), the same swards maintained at 4 cm (treatment 4–4), 8 cm (treatment 8–8) or swards which had been allowed to increase from 4 to 8 cm (treatment 4–8). Grazing by both cattle and sheep at a sward surface height of 4 cm compared with 8 cm in Phase 1 resulted in a higher (P < 0·001) number of vegetative grass tillers per m2 in Phase 2, although the effect was more pronounced after grazing by sheep. Sheep grazing at 8 cm in Phase 1 produced a higher number of reproductive tillers per m2 and a greater mass of reproductive stem (P < 0·001) than the other treatment combinations. The mass of white clover lamina was higher under cattle grazing (P < 0·05), especially on the 8‐cm treatment, and white clover accounted for a greater proportion of the herbage mass. These effects had mainly disappeared by the end of Phase 2. On the 4–4 and 8–8 sward height treatments the liveweight gain of the weaned lambs was higher (P < 0·05) on the swards previously grazed by cattle than those grazed by sheep. The proportion of white clover in the diet and the herbage intake also tended to be higher when the weaned lambs followed cattle. However, there was no difference in liveweight gain, proportion of white clover in the diet or herbage intake between swards previously grazed by cattle or sheep on the 4–8 sward height treatment. It is concluded that grazing grass/white clover swards by cattle compared with sheep for the first half of the grazing season resulted in less reproductive grass stem and a slightly higher white clover content in the sward, but these effects are transient and disappear from the sward by the end of the grazing season. They can also be eliminated by a short period of rest from grazing in mid‐season. Nevertheless these changes in sward structure can increase the performance of weaned lambs when they graze these swards in late season.
Effect of herbage mass per unit area and conditioning treatment on herbage drying rate
Authors: Frost J. P. , Binnie R. C.
Published: March 2003

The rates of drying of herbage, cut from perennial ryegrass (Lolium perenne L.) – dominant swards and subjected to different treatments, were investigated under field conditions by changes in weight of herbage in wire mesh trays in 1995 and 1996. A series of replicated factorial experiments studied the effects, in different combinations, of intensity of conditioning achieved by passing the cut herbage through a laboratory‐scale macerator zero (0C), once (1C), three (3C) or six (6C) times; weight of herbage per unit area equivalent to 450, 675 and 900 g dry matter (DM) m−2. In one experiment, pressing the herbage to form a mat was incorporated into the experimental design. A further experiment investigated the effect of varying the proportion of conditioned herbage in the herbage mass from 0·00, 0·25, 0·50, 0·75 and 1·00 on drying rate. On each occasion the trays plus herbage were weighed at hourly intervals over an ≈6‐h period and the DM content of the herbage estimated from the change in weight. On all occasions, conditioning and weight of herbage per unit area significantly (P < 0·001) influenced herbage drying rate. Lowering the weight per unit area of both unconditioned and conditioned herbage increased the rate of moisture loss. Unconditioned herbage at the equivalent of a herbage mass of 450 g DM m−2 had a total moisture loss that was on average 1·5–1·8 times greater than unconditioned herbage at the equivalent of a herbage mass of 900 g DM m−2. Similarly, conditioned herbage at the equivalent of a herbage mass of 450 g DM m−2 had a total moisture loss that was 1·8–2·3 times greater than unconditioned herbage at the equivalent of a herbage mass of 900 g DM m−2. Increasing the level of conditioning produced a non‐linear response in rate of moisture loss, consequently 3 passes through the macerator produced >0·95 of the total moisture loss that was produced by 6 passes through the macerator. Increasing the proportion of conditioned herbage in the herbage mass increased rate of moisture loss and consequently final DM content (P < 0·001) although there was little effect from increasing the proportion of conditioned herbage above 0·75. The effects of conditioning and weight of herbage per unit area treatments on total nitrogen , water‐soluble carbohydrate and acid‐detergent fibre concentration of the herbage were small.
Relationships between the yield of perennial ryegrass and of small‐leaved white clover under cutting or continuous grazing by sheep
Authors: Williams T. A. , Abberton M. T. , Thornley W. , Rhodes I.
Published: March 2003

Seven varieties or advanced breeding lines of white clover (Trifolium repens L.), all of small leaf size, were grown separately in mixtures with perennial ryegrass (Lolium perenne L.) in an experiment encompassing three harvest years. Harvestable dry‐matter (DM) yield measurements were taken of these mixtures and of perennial ryegrass monocultures under two management regimes: cutting and continuous sheep grazing. Considerable differences were observed in the harvestable DM yields of white clover, perennial ryegrass and total yields of the mixtures between plots containing different white clover varieties. White clover yields were generally higher under cutting, and perennial ryegrass yields were higher under grazing. The difference between perennial ryegrass yield in monoculture and in mixture was variable. In the second harvest year, a significant interaction effect was seen between management and white clover variety for white clover yield but not for perennial ryegrass yield. The relationship between clover yield and grass yield differed between the two management regimes. Under cutting, a negative correlation was observed, indicative of competitive effects. However, under grazing, no such correlation was seen. Possible mechanisms underlying these outcomes are discussed.
The liveweight gain of Limousin × Friesian heifers grazing perennial ryegrass/white clover swards of different clover content and the effects of their grazing on sward botanical composition
Authors: Yarrow N. H. , Penning P. D.
Published: March 2003

An experiment was carried out in 1992 and 1993 to examine the effect of white clover content of perennial ryegrass/white clover swards on the performance of Limousin × Friesian heifers. Swards with low (L), medium (M) and high (H) white clover contents were established and managed by continuous variable stocking. A compressed sward height of 5·5 cm was maintained using a buffer fence to vary plot areas, with herbage surplus to grazing requirements cut, removed and yields measured. The mean white clover proportions for treatments L, M and H were 0·02, 0·19 and 0·18 in 1992 and 0·13, 0·16 and 0·31 in 1993 respectively. White clover contents of the swards reached a maximum in August and September, and differences between treatments diminished. There was no significant difference between treatments in the content of white clover in the swards in autumn 1993.

Liveweight gains of heifers increased asymptotically with increasing white clover content of the sward. Below a white clover herbage mass of 300 kg DM ha–1, there was little effect on liveweight gain, which was 0·70 kg day–1 over the grazing season. Between 400 and 450 kg DM ha–1 white clover, liveweight gains were 0·85–0·90 kg day–1. While clover content of the sward did not significantly affect utilized metabolizable energy output; the mean output over the grazing season in the two years from liveweight gain and herbage yield was 78 GJ ha–1. It is suggested that, using this grazing system, white clover reached an equilibrium with a mean herbage mass of about 400 kg DM ha–1 over the grazing season.
Intake, liveweight gain and feed preference by steers fed combinations of lucerne and Westerwolds ryegrass silages
Authors: Charmley E.
Published: March 2003

Nutritive value and voluntary intake of legumes are generally considered to be higher than those of grasses when ensiled at similar digestibility, although high levels of soluble protein can result in low N utilization by animals and high losses to the environment. The objectives of this experiment were to describe the optimum combination of Westerwolds ryegrass (Lolium multiflorum Lam. cv. Aubade) and lucerne (Medicago sativa L. cv. AC Caribou) silages to maximize liveweight gain of steers fed silage, determine chemical components that are important and ascertain whether steers selected the optimum mixture when given a choice. Both silages contained similar concentrations of dry matter (DM), acid‐detergent fibre (ADF) and organic acids, but lucerne silage had higher concentrations of N, soluble‐N and ammonia‐N. Westerwolds ryegrass silage contained more neutral‐detergent fibre (NDF). In a 12‐week experiment, voluntary intake by Hereford steers was not influenced when the proportion of the two silages was changed from 1 to 0 in 0·25 increments. However, liveweight gain and feed efficiency increased linearly (P < 0·001) as the proportion of ryegrass silage fed was increased. When preconditioned to either of the two silages, steers showed a significant preference for ryegrass over lucerne (P < 0·05). When conditioned to a mixture of both silages, no preference was elicited. It is suggested that extensive solubilization and deamination of protein in the lucerne silage may have caused the preference for Westerwolds ryegrass silage and the higher liveweight gains on diets containing higher proportions of Westerwolds ryegrass silage.
Incorporating grazing behaviour measurements in models to predict herbage intake by grazing dairy cows
Authors: Rook A. J. , Yarrow N. H.
Published: March 2003

Models to predict herbage intake were constructed using 168 dairy cow records from three grazing experiments. Variables included fell into three categories: animal state, sward state and animal behaviour. Linear regression models of varying complexity were obtained by removing variables from the best fitting model to reflect progressive lack of information availability on farms. Thus, behavioural variables were removed first, followed by sward surface height and milk fat concentration. Models were subject to outlier analysis and collinearity tests. Equivalent models were constructed using ridge regression to minimize collinearity problems. They were tested using 20 Holstein–Friesian dairy cows continuously stocked on a perennial ryegrass sward. A `best practice' treatment [7 cm sward surface height (SSH), 6 kg day−1 concentrate (C)] was used together with treatments of SSH5/C6, SSH7/C8, SSH7/C0 and SSH9/C6. The best model accounted for 0.37 of the variance in the estimation data and contained the following variables: concentrate intake, milk yield, milk fat concentration, days in milk, sward surface height and chewing rate while ruminating. Model performance against test data was generally poor. This was mainly because of consistent underprediction of herbage intake, caused in part by the higher average herbage intakes in the test data compared with the estimation data.
Effects of application of nitrogen fertilizer on concentrations of P, K, S, Ca, Mg, Na, Cl, Mn, Fe, Cu and Zn in perennial ryegrass/white clover pastures in south‐western Victoria, Australia
Authors: McKenzie F. R. , Jacobs J. L.
Published: March 2003

Effects of timing and rate of N fertilizer application on concentrations of P, K, S, Ca, Mg, Na, Cl, Mn, Fe, Cu and Zn in herbage from perennial ryegrass/white clover pastures were studied at two sites in south‐western Victoria, Australia. Nitrogen fertilizer (0, 15, 25, 30, 45 and 60 kg ha–1) was applied as urea in mid‐April, early May, mid‐May, early June and mid‐June 1996 to pastures grazed by dairy cows. At Site 1, N fertilizer resulted in a linear increase in P, K, S, Mg and Cl concentrations in herbage and a linear decrease in Ca concentration. For all times of application, concentrations of P, K, Ca, Mg and Cl in herbage increased by 0·0048, 0·08, −0·010, 0·0013 and 0·053 g kg–1 dry matter (DM) per kg N applied respectively. For S concentration, maximum responses occurred in mid‐May (0·012 g kg–1 DM per kg N applied). At Site 2, N fertilizer resulted in a linear increase in P, S and Na concentrations in herbage, a linear decrease in Ca concentration and a curvilinear increase in K and Cl concentration. The maximum responses for P, S and K concentrations in herbage occurred for the N application in mid‐June and were 0·015, 0·008 and 0·47 g kg–1 DM per kg N applied respectively. For Cl concentration, the maximum response occurred for the N application in early June and was 0·225 g kg–1 DM per kg N applied. Overall, applications of N fertilizer up to 60 kg ha–1 did not alter herbage mineral concentration to levels that might affect pasture growth or animal health.
Effect of breed and sward height on sheep performance and production per hectare during the spring and autumn in Northern Spain
Authors: Osoro K. , Martínez A. , Celaya R.
Published: March 2003

Abstract Effects of breed and sward surface height on ewe liveweight and body condition changes and on lamb liveweight gains during grazing in the spring and autumn were studied. The output per hectare in each season was also calculated.

A total of 112 Gallega ewes (35·6 kg live weight) and 204 Latxa ewes (47·5 kg live weight) with their lambs were used during the spring (March–June) to study the effect of five target sward heights (3·0, 4·5, 5·5, 6·5 and 8·0 cm) and the interaction with breed. In autumn (October–December) 155 Gallega and 126 Latxa ewes were used to study the effect of three target sward heights (4·0, 5·5 and 7·0 cm) and the interaction with breed. Each study was replicated twice.

A quadratic relationship was found between sward height and ewe liveweight and body condition changes and lamb liveweight gain during the spring grazing season, with the maximum individual performance being achieved at around a sward height of 6·0 cm. There were significant breed × sward height treatment interactions for ewe liveweight and body condition changes, and lamb liveweight gains. Higher liveweight gains were achieved by Latxa ewes and lambs in swards taller than 6·5 cm but they also sustained higher liveweight losses in swards shorter than 4·5 cm. Nevertheless, a higher output (liveweight gains of ewes + lambs) per hectare for a given weaning date or age was achieved by the Gallega ewes. In autumn, the relationship between liveweight change and sward height was linear, with a breed–sward height interaction similar to that observed in the spring.

Sward surface heights of 4·0–4·5 cm and 4·5–5·0 cm were required to maintain live weight and body condition in spring and autumn respectively. Lamb and ewe liveweight gains per hectare decreased considerably in swards taller than 6·5 cm.
The effect of forage type and level of concentrate supplementation on the performance of spring‐calving dairy cows in early lactation
Authors: Dillon P. , Crosse S. , O'Brien B. , Mayes R. W.
Published: March 2003

Abstract In 1993 and 1994, 40 cows in early lactation in early spring were assigned randomly to four feeding treatments. One group of cows was kept indoors with access to grass silage ad libitum, plus 6 kg of concentrate daily. The other three groups had access to grass pasture (5–6 h per day in 1993 and 11–12 h per day in 1994) plus grass silage similar to that fed to the previous group while indoors plus 6, 4 or 2 kg of concentrate daily. The average daily allocations of herbage (> 3·5 cm) were 8·5 and 14·0 kg DM cow−1 day−1 in 1993 and 1994 respectively. The treatments were applied for 8 weeks (26 February to 23 April) in 1993, and 7 weeks (11 March to 29 April) in 1994. Cows with access to pasture had lower (P < 0·001) silage dry‐matter (DM) intakes and higher (P < 0·001) total forage DM intakes in both years than those kept indoors. This resulted in significantly higher yields of milk, fat, protein and lactose. Similarly, milk protein concentration was higher (P < 0·05 in 1993; P < 0·001 in 1994). There was a significant linear increase in total DM intake in both years with increased concentrate supplementation. In 1993, there was a linear increase in milk (P < 0·01), fat (P < 0·01), protein (P < 0·001) and lactose (P < 0·01) yields with increased concentrate supplementation. In 1994, only milk protein yield (P < 0·05) was increased. Concentrate supplementation had no effect on milk composition or liveweight change. Cows with access to grazed grass had higher liveweight gains (P < 0·05) than those kept indoors in both years. In 1993, increasing the energy intake increased the processing qualities of the milk produced. The results showed that access to grass pasture resulted in higher milk production, in reduced silage requirement and in reduced level of concentrate supplementation required for a given level of milk production with spring‐calving cows in early lactation compared with those kept indoors.
One hundred laparoscopic myomectomies with ultrasonic energy: surgical evaluation of a new energy source
Authors: Stringer Nelson H.
Published: March 2003

Objective

To evaluate the surgical efficiency of ultrasonic energy for laparoscopic myomectomies through review of the dissection and haemostatic capabilities of the energy source; the pregnancy results after surgery; formation of uterine fistulas and postoperative adhesions, and energy‐related difficulties and complications.

Design

Retrospective chart review.

Setting

One surgeon, and the Department of Obstetrics and Gynecology, Rush Medical College, Chicago, Illinois.

Patients

100 women with symptomatic uterine leiomyomata.

Interventions

100 consecutive laparoscopic myomectomies were performed between April 1993 and May 1997. Ultrasonic cutting and coagulation (Ultrasonic Scalpel) was used on all cases for dissection of myomas from the myometrium.

Results

The indications for surgery were: menometrorrhagia (44%), chronic pain (29%) and increasing uterine size (27%), and 99 procedures were completed laparoscopically. One procedure was converted to an open laparotomy to remove a broken needle fragment from the EndostitchTM (1% conversion rate). No energy‐related complications occurred. A total of 320 myomas were removed laparoscopically from 99 patients. Dissection and achievment of haemostasis was easy and rapid with all types of myomas. To date, 10 patients have experienced 12 pregnancies. No fistulas or uterine dehiscence have occurred. A total of 26 patients had second‐look evaluations, and 65% of these were clinically free of adhesions (grade 0 or grade 1).

Conclusions

When compared with published results of laparoscopic myomectomies performed with lasers and electrosurgical instruments, ultrasonic energy demonstrated equal dissection and haemostatic capabilities without the risks of toxic smoke, burns and thermal injuries. Ultrasonic energy is an effective energy source for laparoscopic myomectomies.
Laparoscopic surgery vs. laparotomy management for infertile patients with ovarian endometrioma
Authors: Sawada Tomio , Ohara Satoshi , Kawakami Seiji
Published: March 2003

Objective

To determine the usefulness of laparoscopic surgery compared with laparotomy for conservative surgical treatment of patients with ovarian endometrioma.

Design

Non‐randomized retrospective study.

Setting

Infertility unit at the Fujita Health University Hospital, Aichi, Japan.

Subjects

A total of 78 infertile patients with endometrial cysts treated during a 5‐year period.

Interventions

Conservative surgical treatment by means of laparoscopic surgery (n = 32) or laparotomy (n = 46) with follow up over 24 months. Each group was subdivided according to revised American Fertility Society (r‐AFS) score into two subgroups: those with early‐stage endometrioma (score < 16) and those with advanced‐stage endometrioma (score ≥ 16).

Main outcome measures

Data for operating time, endometrioma size, r‐AFS score and pregnancy outcome were compared between both groups and subgroups.

Results

For the patients with advanced‐stage endometrioma, the operating time was significantly longer for the laparoscopic group (154.0 ± 71.1 min; mean ± SD), compared with the laparotomy group (102.0 ± 37.8 min) even though the sizes of the removed endometrioma were similar (laparoscopic group 5.4 ± 2.2 cm, laparotomy group 7.1 ± 3.1 cm). Again for patients with advanced endometrioma, the mean time interval to subsequent pregnancy outcome following conservative surgery was significantly shorter in the laparoscopic group (206.4 ± 168.2 days) than in the laparotomy group (510.2 ± 338.3 days),

Conclusions

Laparoscopic removal of advanced‐stage ovarian endometriomas seems as effective as laparotomy in terms of pregnancy outcome, but takes a slightly longer operating time compared with laparotomy. The laparoscopic approach has the advantage of a shorter time to pregnancy after surgery. Laparoscopic surgery is the recommended approach for infertile patients with ovarian endometrioma for better postoperative fertility.
Laparoscopic resection of a uterine horn following a pregnancy and rupture at 30 weeks' gestation
Authors: Jones Kevin , Keckstein Jorg , Sutton Christopher
Published: March 2003

Objective 

To report the case history of a patient who underwent a laparoscopic resection of a rudimentary uterine horn following a pregnancy and rupture at 30 weeks' gestation.

Methods

The clinical records of the patient were reviewed.

Results

The clinical and radiological findings demonstrated a unicornuate uterus, without a patent connection between the rudimentary uterine horn, and the cervix. The patient's first pregnancy occurred in the rudimentary uterine horn which ruptured at 30 weeks' gestation. A haematometra developed 17 months after an emergency Caesarean section, and she subsequently underwent a laparoscopic resection of the rudimentary uterine horn.

Conclusion

This case report describes a minimal access procedure being carried out to treat a congenital anomaly of the uterus following a major obstetric complication.
Laparoscopic treatment of a subfascial haematoma following a Pfannenstiel laparotomy
Authors: Schreurs Annick M. A. R. , Bijnens Bernadette , Vanacker Bernard , Koninckx Philippe R.
Published: March 2003

Objective 

To report the laparoscopic treatment of abdominal wall haematomas and to review the literature spanning 1976–99.

Design 

Case report and Medline search using Winspirrs as search engine.

Report 

A 50‐year‐old patient, with a large abdominal wall haematoma following an abdominal hysterectomy by Pfannenstiel incision, was treated by laparoscopy. Following CO2 insufflation and trocar insertion at the umbilicus, the diagnosis of a haematoma was confirmed by the bulging parietal peritoneum. Using an operative laparoscope, the peritoneum was entered close to the umbilicus and a haematoma of 750 ml was aspirated. Thorough examination did not reveal any remaining active bleeding. Clinical recuperation was spectacular and the patient was discharged 2 days later.

Review 

Abdominal wall haematoma following Pfannenstiel incision is a rare complication, with reported incidences of 5%. The clinical diagnosis can be confirmed by ultrasound and computed tomographic (CT) scan, with sensitivities of 71% and 100%, respectively. Surgical treatment is limited to large haematomas because of secondary wound healing problems.

Conclusion 

Since the laparoscopic treatment of wall haematomas is so easy and straightforward, we suggest that broadening the indications for surgery can be considered. This could moreover lead to a revision of the diagnostic accuracy of ultrasound and CT scan for smaller haematomas.
Arcus taurinus: the ‘mother and father’ of all LUNAs
Authors: Jones Kevin D. , Sutton Christopher
Published: March 2003

Objective

This paper reviews the surgical management of pelvic pain due to endometriosis, and describes a new operation, the so called ‘arcus taurinus procedure’.

Background

In 1954, Joseph Doyle from Massachusetts described the procedure of paracervical uterine denervation by transection of the uterosacral ligaments. He carried out this procedure in an attempt to interrupt the pain fibres contained in the cervical division of the Lee–Frankenhauser plexus. In the 1980s, the pioneers of minimal access surgery began to perform Doyle's operation laparoscopically. However, randomized controlled trials have shown that this procedure does not confer any additional benefit to ablation or excision of endomtriotic tissue, and the operation has been recently been refined. The uterosacral ligaments are now completely excised or ablated, a crater between the ligaments is formed, and the rectovaginal septum opened. This more extensive operation has been called an ‘arcus taurinus’, or ‘bull’s horn' procedure. These procedures were initially intended to relieve pain by denervating the pelvis. However, cytoreduction of endometriosis also relieves pain, and the uterosacral ligaments and rectovaginal septum can be infiltrated with endometriosis that may not be macroscopically visible.

Conclusion

Therefore, it is likely that the relief of painful pelvic symptoms is due to a combination of denervation, and cytoreduction of endometriosis. In this context, the arcus taurinus procedure is truly ‘the mother and father’ of all laparoscopic uterine nerve ablations.
Auditing complications of laparoscopy in a major tertiary hospital in Australia
Authors: Erian Mark M. S. , Goh Judith T. W. , Coglan Margaret
Published: March 2003

To review complications in both diagnostic and operative laparoscopic procedures at a university‐affiliated major teaching hospital and to assess possible risk factors for complications.

A retrospective review of all laparoscopic procedures at the Royal Women's Hospital Brisbane, Australia, from 1990 to 1997 inclusive. A non‐medical or nursing independent assessor reviewed charts. Data were collected on a standard form. Incomplete charts were excluded from analysis.

There was a total of 1505 procedures. Analysis was based on 1435 complete data records. The overall complication rate was 2.86% with infection (1.3%) being the most common. The rate of gastrointestinal injury was 0.14%. Compared with women who had diagnostic laparoscopies, a higher rate of complication was found in women who had undergone operative laparoscopic procedures. However, this difference did not reach statistical significance. The complication rate was unrelated to seniority of the surgeon.

Complications can occur in any laparoscopic procedure. Regular reviews, especially in teaching hospitals, will provide feedback to clinicians to improve quality of care.
A partially randomized patient preference trial of microwave endometrial ablation using local anaesthesia and intravenous sedation or general anaesthesia: a pilot study
Authors: Bain Christine , Cooper Kevin G. , Parkin David E.
Published: March 2003

To ascertain whether microwave endometrial ablation under local anaesthesia is feasible in unselected women.

A partially randomized patient preference pilot study.

A large teaching hospital in North‐east Scotland.

98 women who were referred and suitable for endometrial ablation and who agreed to participate after informed consent had been given.

Women were randomly allocated to receive general or local anaesthesia for microwave endometrial ablation, or if they had a strong preference they were allocated to their chosen anaesthesia. All procedures were performed in the theatre setting and on a day case basis.

Acceptability and satisfaction were primarily assessed in each group using validated tools. Operating times, failure under local anaesthesia, postoperative analgesia and postoperative discharge times were also recorded.

Microwave endometrial ablation under local anaesthesia was feasible in 75% of unselected women. Acceptability was higher in those who chose local anaesthesia.

Local anaesthesia should be offered to women undergoing microwave endometrial ablation and a randomized controlled trial is a feasible option for assessing prognostic factors and satisfaction.
Complications of hysteroscopy
Authors: Motashaw Nargesh D. , Dave Svati
Published: March 2003

To review the complications of hysteroscopy.

A retrospective review of the literature on hysteroscopy, to focus on some of the problems that the surgeon may face following this easy and usually safe procedure.

Complications both from large series and isolated reports are included. They can be immediate, varying from an innocuous perforation of the uterus to injury to the bladder, bowel or vascular structures. Haemorrhage may be arrested by simple techniques or may require a laparotomy and hysterectomy. Problems include infection; complications of the distending medium, including CO2 and air embolism; anaesthetic complications, and thermal injuries. Delayed complications, such as haematometra, rupture of the uterus in a subsequent pregnancy and the need for a repeat procedure including hysterectomy, are other possibilities.

Though hysteroscopy is a safe and easily executed procedure, it may be associated with mild or severe morbidity and even mortality.
Sacrocolpopexy for vaginal vault prolapse: a combined vaginal and laparoscopic approach
Authors: Rae David , Hawthorn Robert
Published: March 2003

Objective To report the short‐term effectiveness and safety of a combined vaginal and laparoscopic approach to sacrocolpopexy in the management of vaginal vault prolapse.

Design A retrospective analysis of 22 patients.

Results The mean operating time was 105 min. The only significant intraoperative complication was a rectal injury. The mean length of hospital stay was 3.18 days. Erosion of the Prolene mesh occurred in two women. The vaginal vault remained well supported in all 22 patients, over a mean follow‐up time of 12.5 months. Three women have required further surgery for a symptomatic cystocele.

Conclusion A combined vaginal/laparoscopic approach to sacrocolpopexy appears to be effective and associated with a low risk of intraoperative and postoperative morbidity. Its principal advantage over a completely laparoscopic approach is in removing the technical demands of laparoscopic suturing.
Educational model for an objective assessment of operative laparoscopic skill
Authors: Mayooran Zorana , Tsaltas Jim , Rombauts Luk , Brown T. Ian H. , Lawrence Anthony S. , Fraser Kym , Healy David L.
Published: March 2003

Objective The purpose of this pilot study was to develop an assessment instrument to evaluate the level of skill of laparoscopic surgeons with regard to operative laparoscopy.

Subjects A total of 16 doctors working in obstetrics and gynaecology were tested on the Monash University gynaecological laparoscopic pelvi‐trainer. Eight candidates were consultants with 9–28 years of practice in operative laparoscopy, and eight were registrars with up to 6 years of practice in operative laparoscopy. Six consultants and one registrar were from rural Australia.

Design Subjects were asked to complete 10 laparoscopic tasks. Nine of these were designed to test manual dexterity skills and the correct use of laparoscopic instruments. One task tested theoretical knowledge of electrosurgery by means of four short‐answer questions. Candidates were marked on the basis of precision and speed. Heart rate measurements were taken 20 min prior to the test, at 5‐min intervals, and at the start and end of each task thereafter.

Results The highest pass rate (81.25%) was recorded for task 1, i.e. setting up the endoscopic visualization system. The median time to complete this task was 168 s. No candidate could repair a severed ovarian ligament with an intracorporeal knot within 5 min. No candidate could successfully answer all four electrosurgery questions.

Conclusion It is possible to objectively evaluate basic operative skills of laparoscopists by means of well‐structured tasks and marking criteria.
Zero incidence of inhibitor development in previously treated Haemophilia A, HIV‐negative patients upon exposure to a plasma‐derived high‐purity and double viral inactivated factor VIII concentrate
Authors: Aznar  , Lorenzo  , Molina  , Haya  , Querol  , DasÍ
Published: March 2003

Thirty‐six Haemophilia A, HIV‐negative, previously treated patients were changed therapy to a high‐purity and double‐inactivated (solvent/detergent and dry‐heating) previously unused factor VIII concentrate. The mean age of these patients was 27 years at the time of the change. Twenty‐three patients were severe Haemophiliacs (FVIII:C < 0.02 IU mL−1), seven moderate (FVIII:C between 0.02 and 0.05 IU mL−1) and six mild (FVIII:C > 0.05 IU mL−1). The mean follow‐up with this single product was 16 months, with 82 accumulated exposure days and the mean consumption was 117 300 IU of FVIII corresponding to a mean of six batches per patient. No patient developed FVIII inhibitors (upper limit of the CI95: 7.98%), resulting in an incidence rate of 0/48 patient‐years (upper limit of the CI95: 77/1000 patient‐years). The change in therapy to this new factor VIII concentrate was not associated with the appearance of inhibitors.
Clinical characteristics and blood product usage in AIDS‐associated lymphoma in haemophiliacs: a case‐control study
Authors: Ragni  , Belle  , Bass  , Duerstein  , Kingsley
Published: March 2003

In order to determine risk factors associated with the development of AIDS‐associated lymphoma (AIDS‐NHL) in individuals with haemophilia, we undertook a case‐control study of 25 patients with AIDS‐NHL identified prospectively in the multicentre Hemophilia Malignancy Study (HMS) and 100 haemophilia controls with AIDS matched 1:4 by age and date of AIDS diagnosis. Clinical, laboratory and lifestyle characteristics and blood product usage during the 2 years before seroconversion and AIDS or AIDS‐NHL diagnosis were compared between cases and controls. AIDS‐NHL cases had higher haemoglobin, platelets, %CD4 and white blood count, with the latter approaching significance, 5700 μL−1 vs. 4000 μL−1, P = 0.063. The proportion of cases receiving antiretroviral treatment prior to diagnosis was similar to that of AIDS‐controls, 72% vs. 86%, but a significantly lower proportion of cases had been treated with intravenous pentamidine, 4% vs. 26%, P = 0.048. There were no differences between cases and controls in prevalence of antibody to hepatitis B or hepatitis C, HIV‐related symptoms, lifestyle characteristics, or in the type or amount of blood product usage. Thus, clinical, lifestyle characteristics, antiviral drug treatment and blood product usage appear to have little, if any, effect on the development of AIDS lymphoma in HIV(+) patients with haemophilia.
Haemophilia A gene therapy
Authors: Lee C. A. , Kessler C. M. , Varon D. , Martinowitz U. , Heim M. , CONNELLY S. , KALEKO M.
Published: March 2003

Summary. Gene therapy for haemophilia A would represent a significant improvement over the current treatment by providing prophylactic expression of FVIII and correction of the coagulation defect. Furthermore, a gene therapy protocol allowing simple, infrequent vector administration may extend haemophilia treatment to remote locations world‐wide that currently lack access to FVIII replacement therapy. Within the last half decade, significant progress has been made on the development of gene therapy for the treatment of haemophilia A. Recent achievements include high level clotting factor expression in mice, dogs, and monkeys as well as phenotypic correction in haemophiliac mice and dogs. With the efforts that are currently directed toward the improvement of gene transfer vectors and the development of technologies to enable sustained clotting factor expression, gene therapy for haemophilia A will ultimately become a reality.
State‐of‐the‐art principles and practices of medical economics
Authors: Lee C. A. , Kessler C. M. , Varon D. , Martinowitz U. , Heim M. , SCHRAMM W. , SZUCS T. D.
Published: March 2003

Summary.In an era of increasing constraints in health care expenditure, it has become necessary for the practising physician to utilise resources economically. Due to expenditure ceilings in many countries, the rational allocation of health care resources has become a central goal in health policy. Medical economics is the discipline which covers the issues of economic evaluation, policy and decision analysis and outcomes research. This paper discusses the fundamentals of this new type of research, highlighting the importance of such results in formulating health policy. Undoubtedly, medical economics will play a similar role as evidence‐based medicine and clinical epidemiology in the continuous education within the medical community. This holds specially true for costly indications such as haemophilia and other coagulation disorders.
Functional kinesiology in haemophilia, an area yet to be explored
Authors: Lee C. A. , Kessler C. M. , Varon D. , Martinowitz U. , Heim M. , HEIJNEN L. , DE KLEIJN P. , HEIM M.
Published: March 2003

Summary. In haemophilic arthropathy there is a progressive limitation of the range of motion (ROM) which may lead to disabilities in the activities of daily living (ADL). In the literature the pathology of haemophilic arthropathy is described extensively, but only one paper describing functional limitations caused by limited range of motion (LOM) in haemophilia was found. The aim of the pilot study was to estimate on theoretical grounds, how many patients with haemophilia might suffer from functional disabilities. Material: ROM of elbows, knees and ankles of 155 Haemophilia A and B patients. Methods: flexion and extension were measured with an ordinary goniometer. The ROM of joints of patients with haemophilia was compared with normal values. Results: 39 of 155 patients had a normal ROM in both elbows; 22 in one elbow; 34 patients had disabilities in ADL with both arms; 14 with one arm; 18 were able to compensate; 89 had no problems; 79 of 155 patients had a near normal ROM of both knees; 38 patients could not ride an ordinary bicycle. Conclusion: only limited data are available concerning the normal ROM needed for individual ADL. Until additional data are available, it is not possible to predict which patients will be disabled in their activities of daily living and individual counselling should be done during the yearly outpatient comprehensive care clinics. Conservative and surgical measures should be taken to ensure elbow flexion of at least 120° and knee flexion of 100° for Western societies. In Asian countries patients with haemophilia need maximum knee flexion and ankle dorsi flexion.
Safety, efficacy and lessons from continuous infusion with rFVIIa
Authors: Lee C. A. , Kessler C. M. , Varon D. , Martinowitz U. , Heim M. , SCHULMAN S. ,   rFVIIa‐CI GROUP
Published: March 2003

Summary.Continuous infusion with coagulation factor concentrates has only been widely adopted during the last decade and with recombinant activated factor VII (rFVIIa) only during the last 2 years. Still the accumulated number of days on continuous infusion with this product amounts by now to more than one year, 35 patients and 26 surgical procedures. The experience is reviewed here and compared with data from the conventional bolus dose regimen.