bluuebunny/crossref_metadata_2025 huggingface dataset:
Free Air CO2 Enrichment of potato (Solanum tuberosum, L.): design and performance of the CO2‐fumigation system
Authors: MIGLIETTA F. , LANINI M. , BINDI M. , MAGLIULO V.
Published: November 2003

Free Air CO2 Enrichment (FACE) systems are used to fumigate unconfined field plots with CO2. As these installations can treat a sufficiently large area without interfering with natural climatic conditions, they are considered important tools for global change research worldwide. However, there is general consensus that elevated capital costs of existing FACE systems as well as high running costs may prevent their application at the required level of scale. A new and small FACE system that was designed to reduce both capital costs and CO2 use, is described in this paper. Due to its intermediate size (8 m diameter) between the smaller Mini‐FACE systems that were developed in Italy and the larger systems designed by the Brookhaven National Laboratory in the USA, it was named Mid‐FACE. The Mid‐FACE was at first developed as a prototype and then used to enrich field grown potato crops in a CO2 concentration gradient experimental design. Technical details of a Mid‐FACE prototype and of the operational set‐up are presented in this paper together with performance data in terms of temporal and spatial control of CO2 concentrations within the experimental area.
Water vapour fluxes and their impact under elevated CO2 in a C4‐tallgrass prairie
Authors: OWENSBY CLENTON , HAM JAY , KNAPP ALAN , BREMER DALE , AUEN LISA
Published: November 2003

We measured leaf‐level stomatal conductance, xylem pressure potential, and stomate number and size as well as whole plant sap flow and canopy‐level water vapour fluxes in a C4‐tallgrass prairie in Kansas exposed to ambient and elevated CO2. Stomatal conductance was reduced by as much as 50% under elevated CO2 compared to ambient. In addition, there was a reduction in stomate number of the C4 grass, Andropogon gerardii Vitman, and the C3 dicot herb, Salvia pitcheri Torr., under elevated CO2 compared to ambient. The result was an improved water status for plants exposed to elevated CO2 which was reflected by a less negative xylem pressure potential compared to plants exposed to ambient CO2. Sap flow rates were 20 to 30% lower for plants exposed to elevated CO2 than for those exposed to ambient CO2. At the canopy level, evapotranspiration was reduced by 22% under elevated CO2. The reduced water use by the plant canopy under elevated CO2 extended the photosynthetically‐active period when water became limiting in the ecosystem. The result was an increased above‐ and belowground biomass production in years when water stress was frequent.
Experimentally increased soil temperature causes release of nitrogen at a boreal forest catchment in southern Norway
Authors: LÜKEWILLE ANKE , WRIGHT RICHARD
Published: November 2003

Boreal forest ecosystems are sensitive to global warming, caused by increasing emissions of CO2 and other greenhouse gases. Assessment of the biological response to future climate change is based mainly on large‐scale models. Whole‐ecosystem experiments provide one of the few available tools by which ecosystem response can be measured and with which global models can be evaluated. Boreal ecosystem response to global change may be manifest by alterations in nitrogen (N) dynamics, as N is often the growth limiting nutrient. The CLIMEX (Climate Change Experiment) project entails catchment‐scale manipulations of CO2 (to 560 ppmv) and temperature (by + 3 to + 5 °C) to whole forest ecosystems in southern Norway. Soil temperature is increased at 400‐m2 EGIL catchment by means of electric cables placed on the soil surface. Soil warming at EGIL catchment caused an increase in nitrate and ammonium concentrations in runoff in the first year of treatment. We hypothesize that higher temperature increased N release by mineralization. Whether these responses are only transient will be shown by additional years’ treatment.
The influence of elevated CO2 on species phenology, growth and reproduction in a Mediterranean old‐field community
Authors: NAVAS MARIE‐LAURE , SONIE LAURETTE , RICHARTE JEAN , ROY JACQUES
Published: November 2003

We studied the effects on the phenology, growth and reproduction of 19 Mediterranean species, of elevating the atmospheric CO2 concentration ([CO2]) to twice‐ambient. Intact monoliths were taken from an old‐field and put, during a six month growing season, into growth chambers in which external climatic conditions were mimicked and [CO2] was regulated. Fruit set time was significantly changed in six species under elevated [CO2] and leaf and branch senescence accelerated in most species. Grasses had fewer leaves and legumes were more branched at peak production under elevated [CO2] than under ambient. Plant seed number was not significantly changed under elevated [CO2], whereas the reproductive effort of grasses was significantly depressed. Reproductive and vegetative characteristics showed related responses to [CO2], as species with enhanced biomass had a hastened fruit set time, a higher number of fruits per plant and a higher reproductive biomass under elevated [CO2] than under ambient conditions, while species with depressed biomass had a delayed fruit set time, a lower number of fruits per plant and a lower reproductive biomass. Our results also show a high interspecific variability in [CO2] response, but some trends emerged at the family level: the production of vegetative and reproductive modules were depressed in grasses and slightly stimulated in legumes.
Wildlife and climate change: assessing the sensitivity of selected species to simulated doubling of atmospheric CO2
Authors: JOHNSTON KEVIN , SCHMITZ OSWALD
Published: November 2003

We explored, using computer simulations, the sensitivity of four mammal species (elk, Cervus canadensis; white‐tailed deer, Odocoileus virginianus; Columbian ground squirrel, Spermophilus columbianus; and chipmunk, Tamias striatus) within the continental USA to the effect of anticipated levels of global climate change brought about by a doubling of atmospheric CO2. Sensitivity to the direct effects of climate change were evaluated using a climate‐space approach to delineate the range of thermal conditions tolerable by each species. Sensitivity to indirect effects were evaluated by quantifying the association of each species to the current vegetation distribution within the continental USA and using this association to assess whether wildlife species distributions might shift in response to vegetation shifts under climate change. Results indicate that altered thermal conditions alone should have little or no effect on the wildlife species’ distributions as physiological tolerance to heat load would allow them to survive. Analyses of the effects of vegetation change indicate that deer and chipmunks should retain their current distributions and possibly expand westward in the USA. For Elk and ground squirrels, there is a possibility that their current distributions would shrink and there is little possibility that each species would spread to new regions. This work emphasizes that the distributions of the four mammalian species are likely to be influenced more by vegetation changes than by thermal conditions. Future efforts to understand the effects of global change on wildlife species should focus on animal–habitat and climate–vegetation linkages.
Detection of methanogens and methanotrophs in natural environments
Authors: RITCHIE D.A. , EDWARDS C. , McDONALD I. R. , MURRELL J. C.
Published: November 2003

The role of methane as a greenhouse gas and the contribution of bacteria to the production (methanogenesis) and destruction (methane oxidation) of methane is described. Using experimental approaches based on DNA sequences identifying either methanogen‐specific or methanotroph‐specific gene sequences methods were developed to broaden the detection and identification of methane metabolizing bacteria in natural environments. These methods were focused on blanket bog peat but are suitable for other environments. In addition to group specific 16S rRNA DNA sequences, specific functional gene probes based on methane coenzyme reductase sequences for methanogens and methane monooxygenase sequences for methanotrophs, were developed. These sequences were used in PCR‐based protocols to detect and amplify specific gene sequences from the total DNA isolated from transverse sections of blanket bog peat. This permitted the analysis of the vertical distribution of methanogen and methanotroph populations, discrimination between different sub‐sets of these populations, and the identification of novel organisms not previously detected by culture‐based methods.
Methane emission from Texas rice paddy soils. 2. Seasonal contribution of rice biomass production to CH4 emission
Authors: HUANG YAO , SASS RONALD , FISHER FRANK
Published: November 2003

Measurements focused on seasonal contribution of rice productivity to methane emission were made in three experiments conducted in Texas flooded paddy soils during 1994 and 1995 growing seasons. A total of five rice cultivars representing two distinct groups in methane emission were involved. Over a 10‐week period after permanent flooding, total seasonal methane emission was positively correlated with rice above‐ground biomass (r2 = 0.845, n = 11). A very strong dependence of daily methane emission on above‐ground vegetative biomass (r2 = 0.887, n = 93) and on root biomass (r2 = 0.816, n = 33) was also observed. Calculation from three developmental periods (vegetative, reproductive and ripening) of rice plant indicated that more than 75% of total seasonal methane was emitted during the last 5‐week period in concert with reproductive and ripening stages, while rice biomass production during the same period amounted to ≈ 50% of the seasonal total. According to the correlation of cumulative methane emission with above‐ground biomass increment between every two‐week interval (r2 = 0.490, n = 93, P = 0.000), the carbon released as methane is approximately equivalent to 3% and 4.5% of photosynthetically fixed carbon in the biomass for low and high emission cultivars, respectively. A further investigation showed that these fractions are related to plant growth and development. The carbon ratio of methane emitted to net photosynthetic production during vegetative, reproductive, and ripening periods averaged 0.9%, 3.6% and 7.9%, respectively, for low emission cultivars, and 2.0%, 5.0% and 8.3%, respectively, for high emission cultivars. Moreover, the ratio was strongly dependent on plant biomass, resulting inr2 values from 0.775 to 0.907.
Nitric oxide production in agricultural soils
Authors: DRURY C.F.
Published: November 2003

Numerous papers on nitric oxide have been published covering various aspects ranging from its solution and gas‐phase chemistry, biochemical and physiological functions and atmospheric processes. This review emphasizes recent developments in the literature relating to NO/NOx production in agricultural soils. We have tried to minimize overlap with other recent and relevant review articles. Emission measurements that have been made since 1992 are tabulated and discussed in terms of variability, fertilization effects, and advances made in monitoring fluxes. We describe attempts made by a number of authors to utilize ecological markers such as aeration, water, ammonium, nitrate content, etc. in order to distinguish between nitrification and denitrification as the primary source of production and/or consumption in natural field situations. This may allow a rational accounting for the high spatial and temporal variability observed, and the formulation of reliable predictive models. Factors such as diffusion, oxygen, water, and carbon (content and quality) that regulate or significantly influence production, consumption and emission are discussed. Finally some important implications of recent research relating to nitrification and denitrification is presented showing the chemical oxidation of NO which could occur when the acetylene inhibition technique is used.
Satellite inventory of human settlements using nocturnal radiation emissions: a contribution for the global toolchest
Authors: ELVIDGE CHRISTOPHER , BAUGH KIMBERLY , HOBSON VINITA , KIHN ERIC , KROEHL HERBERT , DAVIS ETHAN , COCERO DAVID
Published: November 2003

Time series data from the Defense Meteorological Satellite Program (DMSP) Operational Linescan System (OLS) have been used to derive georeferenced inventories of human settlements for Europe, North and South America, and Asia. The visible band of the OLS is intensified at night, permitting detection of nocturnal visible‐near infrared emissions from cities, towns, and villages. The time series analysis makes it possible to eliminate ephemeral VNIR emission sources such as fire and to normalize for differences in the number of cloud‐free observations. An examination of the area lit (km2) for 52 countries indicates the OLS derived products may be used to perform the spatial apportionment of population and energy related greenhouse gas emissions.
The effects of pressure and stage of ensilage on the mechanical properties and effluent production potential of grass silage
Authors: O'Donnell C. , Williams A. G. , Biddlestone A. J.
Published: November 2003

Direct‐cut grass silage was ensiled without compression in laboratory silos for 0–75 d. On occasions during this period, the silage was subjected to creep compression tests at three pressure levels for a period of 5 h and effluent production was measured. Precision‐chopped Italian ryegrass (Lolium multiflorum) was ensiled in the first experiment, whereas flail‐harvested perennial ryegrass (Lolium perenne) was ensiled in the second. Pressure levels were 11·3, 16·9 and 22·5 kPa for Experiment 1 and 5·7, 11·3 and 16·9 kPa for Experiment 2. Moisture contents of the ensiled herbage were 815 and 856 g kg−1 for Experiments 1 and 2 respectively. The consolidation of the grass silage was described by a Burgers body model. Effluent production was more closely related to strain than to compressibility. Linear regression equations for the relationship between strain and effluent production are presented. There was a significant positive linear relationship between pressure and effluent production at each silo opening time in both experiments. The time course of effluent production was fitted to a negative exponential curve. The time that elapsed before effluent release in each experiment was a function of both pressure and time after ensilage. The results of the experiments were compared with the predictions of two models of effluent production. Reasonable agreement between predicted and actual effluent production could be obtained provided the measured material parameters were used and immediate saturation of the forage was assumed. Using the models highlighted the need for a better understanding of saturation development in the silage.
Regrowth, morphology and persistence of Grasslands Puna chicory (Cichorium intybus L.) in response to grazing frequency and intensity
Authors: Li G. D. , Kemp P. D. , Hodgson J.
Published: November 2003

Effects of different grazing frequencies and intensities on herbage production (on both a unit pasture and individual plant basis) and on persistence of chicory (Cichorium intybus L. cv. Grasslands Puna) were studied at Palmerston North, New Zealand (latitude 40°23′S) from November 1994 to November 1995. Three experiments were conducted on the same chicory stand, sown on 12 May 1994. The main grazing experiment had two grazing intensities, hard‐lax grazing (50‐ to 100‐mm stem stubble to mid‐January, and thereafter 100‐ to 150‐mm stem stubble) and lax grazing (100‐ to 150‐mm stem stubble), and three grazing frequencies (1‐, 2‐ or 4‐week intervals). A subsidiary plant survival experiment compared the survival of 120 marked plants in ungrazed and grazed treatments. A late autumn grazing experiment examined the effects on plant persistence in the following spring. The greatest herbage mass (leaf + stem) resulted from the 4‐week grazing frequency [9640 ± 874 kg dry matter (DM) ha−1], in which stem mass was reasonably low (1270 ± 410 kg DM ha−1), but was significantly higher in the 4‐week grazing frequency than 1‐ and 2‐week grazing frequencies (P < 0·01). Grazing intensity had no significant effect except on the average stem mass of individual plants when the hard‐lax intensity gave a lower stem mass (P < 0·01). There were no interactions between grazing frequency and intensity in herbage mass. Plant density declined by 35% over the growing season with the decline unaffected by grazing intensity or frequency during the season. Grazing in late autumn resulted in approximately 27% less plants the following spring. It was concluded that grazing management through the growing season cannot be used to improve persistence without compromising leaf growth rate, but that avoidance of grazing late autumn will improve the persistence of chicory.
A comparison of diploid and tetraploid perennial ryegrass and tetraploid ryegrass/white clover swards under continuous sheep stocking at controlled sward heights. 3. Sward characteristics and animal output, years 4–8
Authors: Vipond J. E. , Swift G. , Cleland A. T. , Fitzsimons J. , Hunter E. A.
Published: November 2003

Results for years 4–8 of a long‐term grazing experiment on swards of a diploid perennial ryegrass (Lolium perenne), var. Contender (D swards), a tetraploid ryegrass, var. Condesa (T swards) and Condesa with S184 white clover (Trifolium repens) (TC swards), direct sown in May 1987, are presented. The swards were continuously stocked with sheep from 1988 to 1990, as previously reported, and for a further 5 years, 1991–95, at a target sward surface height (SSH) of 4–6 cm. Control of sward height was successfully achieved by variable stocking, except in 1993 when paddocks were set stocked and the resulting mean SSH was 9·3 cm. Grass swards received on average 160 kg N ha−1 year−1; grass/clover swards were mainly not fertilized with N with the exception that they were given 30 kg N ha−1 as a remedial mid‐summer application during a period of low herbage mass on offer in 1994 and 1995.

Mean white clover content of the swards fell from 18·2% of herbage dry‐matter (DM) in 1992 to 8·5% in 1993, whereas stolon lengths fell from 120 to 58 m m−2. A return to lower sward heights in 1994–95 resulted in an increase in white clover content to 12·8% by the final sampling in August 1995. Perennial ryegrass content of the grass swards remained high throughout (mean 96·7% in 1995). Perennial ryegrass tiller densities recorded in August 1991, 1993 and 1994 showed consistently significant (P < 0·001) sward differences (3‐year mean 16 600, 13 700 and 10 100 perennial ryegrass tillers m−2 for the D, T and TC swards). In 1994, the year after lax grazing, a low perennial ryegrass tiller density (9100 m−2) and low white clover content (mean 4·3%) in the TC swards resulted in a much lower herbage bulk density than in the grass swards (April–July means 72, 94 and 44 kg OM ha−1 cm−1 for the D, T and TC swards). There was a consistent 40 g d−1 increase in lamb liveweight gain on the TC swards over the T swards, except in 1994. In that year there was a reduction in lamb liveweight gain of 33 g d−1 on the TC swards and a significant increase in ewe liveweight loss (117 g d−1) associated with low herbage bulk density despite optimal sward height. Lamb output (kg liveweight ha−1) on TC swards reflected white clover content, falling from a similar output to that produced from grass given 160 kg N ha−1, at 18% white clover DM content, down to 60% of grass + N swards with around 5% clover. A 6% greater output from the T than the D swards was achieved mainly through higher stocking rate. The experiment demonstrated a rapid, loss in white clover under lax grazing, and showed that the relationship between performance and sward height is also dependent on herbage density. High lamb output from a grass/clover sward was only achieved when the clover content was maintained at 15–20% of the herbage DM.
Fatal infection following transvaginal fibroid resection
Authors: Jørgensen J.C. , Pelle J. , Philipsen T.
Published: November 2003

An endometrial ablation and a hysteroscopic fibroid resection were performed in a 44‐year‐old healthy woman because of metrorrhagia. The surgery was uncomplicated except for a 1000‐ml fluid deficit. Prophylactic antibiotics were not given. Less than 15h after surgery signs of sepsis and disseminated intravascular coagulation developed. Despite being given adequate antibiotic and supportive treatment the patient deteriorated and died 72h after the primary surgery. The question of prophylactic antibiotics is raised and their use is recommended. The importance of regarding a transvaginal endometrial ablation and fibroid resection as an alternative to hysterectomy and not as a suitable treatment for a low‐grade menstrual disorder is stressed. A call is made for publication of all serious and unexpected complications in connection with transvaginal hysteroscopic operations.
Is it worth taking a biopsy of the normal‐looking endometrium?
Authors: Badawy A. , Ash A. , Nagele F. , O'Connor H. , Davis A. , Magos A. L.
Published: November 2003

Objectives To determine whether it is necessary to supplement the finding of a normal hysteroscopic appearance at diagnostic hysteroscopy with endometrial biopsy in the investigation of women with abnormal uterine bleeding.

Design Observational study.

Setting An undergraduate teaching hospital.

Subjects The endometrial biopsy reports of 756 patients aged 19–77 years old with abnormal uterine bleeding, who were found to have a normal hysteroscopy, were used. A normal hysteroscopic appearance was defined as: (a) normally shaped uterine cavity, (b) normal‐looking, homogeneous‐appearing endometrium, and (c) absence of focal lesions such as submucous myoma and polyps. An enlarged endometrial cavity, atrophic endometrium, and polypoid secretory‐appearing endometrium were all considered normal.

Results Endometrial histology was normal in 97.5% of cases (n = 737). Abnormalities found included chronic endometritis (n = 17) and low‐risk hyperplasia (n = 2). No age‐ or symptom‐related differences were seen any of the histological findings, and no cases of malignancy or atypical hyperplasia were detected.

Conclusion The visual diagnosis at panoramic hysteroscopy is reliable when performed properly and according to strict criteria of what is normal. It seem unnecessary to obtain tissue for pathological examination when the hysteroscopic view is within normal limits, but biopsy should still be obtained if the uterine cavity appears in any way abnormal.
From laparotomy to pelviscopic intrafascial hysterectomy
Authors: Mettler L. , Lutzewitch N. , Dewitz T. , Remmert K. , Semm K.
Published: November 2003

Objective This study is intended to clarify the significance of different types of intrafascial hysterectomies in comparison to classical hysterectomy techniques in cases of benign uterine disorders.

Design A comparison of six types of hysterectomy, performed for benign indications, as transabdominal, vaginal or intrafascial hysterectomy which were carried out in our Department of Obstetrics and Gynecology between 1993 and 1994.

Subject and intervention 368 women who underwent hysterectomies for benign disorders at the University of Kiel. Of these, 58.7% were performed either by pelviscopic or by laparotomic classic intrafascial supracervical hysterectomy (CISH). Of the remaining, 14.8% were performed by abdominal hysterectomy, 13.6% by intrafascial vaginal hysterectomy (IVH), 12.2% by vaginal hysterectomy (VH), and only 0.05% by laparoscopic‐assisted vaginal hysterectomy (LAVH).

Measures Comparative data of these six surgical techniques, concerning patient characteristics, indications for operation, histological features, blood loss, operating time, hospital stay, uterine weight and postoperative analgesia, are described.

Results and conclusions Although no striking advantages of the three intrafascial supracervical hysterectomy techniques described became evident, the operating time of the new procedures was a little shorter than the conventional ones as was the postoperative convalescence time, and the techniques, although new, could compare well with to 50 years of experience with abdominal and vaginal hysterectomy.
Surgical staging in endometrial cancer stage I including laparoscopic lymphadenectomy
Authors: Mettler L.
Published: November 2003

This paper describes the techniques used with five patients with stage I endometrial cancer who had laparoscopic‐assisted vaginal hysterectomy combined with laparoscopic lymphadenectomy. Prior to the laparoscopic staging, the prerequisite histological grading with ploidy and measurement of monoclonal antibodies were carried out. All patients underwent a general check with radiography, computerized tomography, liver scan, bone scan and lymphography. The performance of lymphadenectomy in cases of stage I endometrial cancer remains a controversial subject. We believe that laparoscopic‐assisted surgical staging of stage I endometrial cancer is an attractive alternative to the traditional surgical laparotomy approach. The change from laparotomy to a laparoscopic‐assisted vaginal method allows for a similar success rate with a less invasive approach. No complications occurred in this series, and the results of our pilot study were satisfactory.
Total laparoscopic hysterectomy for benign uterine pathologies with reusable instruments: a safe, reproducible and cost‐effective procedure
Authors: Chapron C. , Dubuisson J.‐B.
Published: November 2003

With the technique of total laparoscopic hysterectomy described in this paper all the instruments are re‐usable and haemostasis is secured with bipolar coagulation. It is a safe technique whose cost is comparable to that of vaginal or abdominal hysterectomies. The routine use of disposable equipment and automatic disposable staplers for laparoscopic hysterectomies is very debatable as the considerable increase in cost is not accompanied by any benefit for patients or society.
A simple method for fascial and peritoneal repairs in operative laparoscopy
Authors: El Dosoky M.
Published: November 2003

Two complications may arise from insertion of laparoscopic cannulas. First the inferior epigastric vessels may be inadvertently injured, and second hernias may appear in the postoperative period, particularly at laterally placed port sites and especially if cannulas of 10 or 12 mm are used. The use of the Reverdin needle provides a simple and accurate method of inserting sutures deep into the anterior abdominal wall, either to secure haemorrhage from injured blood vessels or to repair port sites as prophylactic measures against hernia formation.
Extraperitoneal laparoscopic hysterectomy for the large uterus
Authors: Kadar MD N.
Published: November 2003

Objective To determine the feasibility of dividing the uterine arteries laparoscopically during extraperitoneal laparoscopic hysterectomy (ELH) for an enlarged uterus. Method Retrospective review of ELHs over a 12‐month period. Results A total of 28 women underwent ELH for a fibroid uterus. Additional procedures were performed in seven cases: pelvic lymphadenectomy (PLN) in three, pelvic and aortic lymphadenectomy (PALN) in three, and colposuspension in one. In 13 of the 28 cases the uterus weighed ≥ 500 g (mean 874 g); four weighed 750–1000 g, and three weighed > 1000 g. Considering the 13 patients where the uterus weighed > 500 g, two patients had PLN, and one had PALN in addition to a hysterectomy; the patients’ mean age was 50 years; mean anaesthetic time was 3.25 h; mean blood loss was 565 ml; mean hospital stay was 1.5 days, and two (15%) women were transfused. With respect to the uterine arteries 23/26 (88%) were divided laparoscopically; both arteries in 11 patients, one artery in one patient and neither artery in another patient. None of the women in whom both uterine arteries were divided laparoscopically was transfused, whereas both women in whom one or both uterine arteries were divided vaginally were transfused. Conclusion Both uterine arteries can be divided laparoscopically in most patients undergoing ELH for an enlarged uterus, and laparoscopic division of the uterine arteries may reduce blood loss during morcellation.
Laparoscopic management of small bowel strangulation in a first trimester pregnant patient
Authors: Bosteels J. , Delattin P. , Van Boxelaer J.P. , DeBruyn M. , Vermylen P.
Published: November 2003

We describe a case where laparoscopy allowed us to diagnose a rare complication in pregnancy, namely strangulation of small bowel after previous surgery, and to treat it properly without laparotomy. We used the open laparoscopy technique decribed by Harry Hasson in 1971.
Laparoscopic treatment of Müllerian anomalies
Authors: Busacca M. , Fedele L. , Candiani M. , Vignali M.
Published: November 2003

We describe the successful use of operative laparoscopy techniques in the treatment of a few congenital anomalies of the Müllerian genital tract. Four cases of utero‐vaginal agenesis, one case of agenesis of the cervix and upper part of the vagina, and one case of unicornuate uterus with cavitated non‐communicating rudimentary horn are reported. Besides the established role of operative hysteroscopy we support the use of operative laparoscopy in the treatment of particular Müllerian defects.
Resection of a uterine septum in early pregnancy
Authors: Raslan F. , Smarason A. K. , Gillmer M. D.
Published: November 2003

We present a case report of hysteroscopic uterine septum resection. Subsequently, the patient was found to have been pregnant at the time of successful hysteroscopic metroplasty, with delivery of normal healthy baby.
The quasi‐randomized trial: a technique for eliminating bias resulting from treatment preferences and the inability to ‘blind’
Authors: Kadar N.
Published: November 2003

Although they always lack external validity, randomized clinical trials have become the gold standard for demonstrating the effectiveness of medical therapies because of their potential to yield unbiased treatment comparisons (internal validity) among trial subjects. However, if a trial cannot be blinded and post‐randomization decisions can influence outcome, internal validity is also compromised, and the rationale for such trials becomes very unconvincing. The problem is compounded if the outcome is operator dependent, and strong physician preferences exist for different treatments, because external validity is then compromised further. Randomized trials to compare laparoscopic with vaginal or abdominal hysterectomy are paradigmatic of these problems.

The purpose of this paper is to describe the quasi‐randomized clinical trial, a suitable method for comparing laparoscopic and conventional surgery. Blinding is always possible with this design and random treatment allocation is preserved. External validity is increased, the need for informed consent eliminated, and, by allowing physicians to perform operations for which they have a preference, recruitment is likely to be enhanced. The disadvantage of the design is that its internal validity is confounded with its external validity. However, strategies exist to ensure external validity (random selection of participants), and statistical tests of trial validity can be designed.
Peritoneal endometriosis, ovarian endometriosis and adenomyotic nodules of the rectovaginal septum: a different histopathogenesis?
Authors: Nisolle M. , Casanas‐Roux F. , Donnez J.
Published: November 2003

Morphological and morphometric data showed similarities between eutopic endometrium and red peritoneal lesions, suggesting that these lesions are the first stage of early implantation of endometrial glands and stroma. An inflammatory reaction provokes scarification and the lesions become black. The subsequent fibrosis leads to areas of white opacification which are probably inactive. Three different types of ovarian endometriosis were described: superficial haemorrhagic lesions; haemorrhagic cysts, and deeply infiltrating ovarian endometriosis. We showed that the mesothelium covering the ovary can invaginate in the ovarian cortex pushing back the primordial follicles. These mesothelial invaginations were in a continuum with endometriotic tissue, strongly suggesting the metaplasia theory as an explanation for the pathogenesis of ovarian endometriomas. Endometriotic rectovaginal nodules were histologically similar to adenomyomas, consisting of smooth muscle hyperplasia with active glandular epithelium and scanty stroma. Immunocytochemical results showed the poor differentiation and the hormonal independence of these lesions and indicated a close relationship with their mesodermal Müllerian origin.

These three types of lesions, peritoneal, ovarian and rectovaginal, must be considered as three different entities with different pathogeneses.
Laparoscopic resection of ovarian remnant after clomiphene‐assisted ultrasound localization
Authors: Orford V. P. C. , Kuhn R. J. P.
Published: November 2003

We present the case of a patient who had a residual ovarian remnant resected laparoscopically after it was localized ultrasonically following enlargement by ovarian stimulation with clomiphene.
Operative hysteroscopy procedure on an unsuspected mixed Müllerian tumour of the uterus
Authors: Benifla J. L. , Filippini F. , Darai E. , Walker‐Combrouze F. , Crequat J. , Madelenat P.
Published: November 2003

In the past few years hysteroscopy has become a useful method, improving the specificity of the diagnosis of intrauterine lesions. Today, operative hysteroscopy is commonly performed for the evaluation and treatment of benign intrauterine lesions, including postmenopausal bleeding. We present a case of rapid peritoneal and liver dissemination after operative hysteroscopy on an unsuspected mixed Müllerian tumour of the uterus. We suggest that irrigation of the endometrial cavity during the operative hysteroscopic procedure may disseminate the disease and may change the prognosis. Our case report should lead to a cautious evaluation of the indications for and limitations of the operative hysteroscopy procedure, in view of the high incidence of endometrial cancer in postmenopausal women.
Prelaparoscopic assessment of ovarian cysts in reproductive‐age women
Authors: Guerriero S. , Ajossa S. , Mais V. , Angiolucci M. , Paoletti A. M. , Lai M. P. , Risalvato A. , Melis G. B.
Published: November 2003

Ovarian cysts are a common cause of hospital admission in several countries. For this reason, and because of the increasing impact of minimal access surgery in clinical practice, a preoperative assessment that offers a reasonable degree of accuracy is necessary. While transabdominal ultrasonography has not been useful because of relatively poor resolution, the transvaginal probe increases the accuracy of ultrasonography, reducing the risk of unexpected malignancy at laparoscopy. This risk can be further reduced by thorough inspection at laparoscopy characterized by high sensitivity, and by selecting a population with a low risk of ovarian malignancy, such as women of reproductive age. Within this population, it is important to distinguish the different kinds of benign ovarian cysts. A principal ultrasonographic criterion among women of reproductive age is the persistence of the mass. Consideration of the latter feature should reduce the number of unnecessary operative laparoscopies, also reducing the number of wrong differential diagnoses. The above‐mentioned approach, associated with the use of simple ultrasonographic findings, seems to have given good reproducibility and accuracy in the differential diagnosis of ‘clear’ cysts, dermoids and endometriomas in premenopausal women. This approach should permit the preparation of suitable laparoscopic instrumentation and enable the surgeon to decide on the siting of ancillary ports, with the aim of reducing the number of unintended laparotomies and avoiding the risk of complications such as spillage in the case of unrecognized teratomas.
Operative hysteroscopy may transport endometrial cells into the peritoneal cavity: report of a prospective longitudinal study
Authors: Benifla J. L. , Darai E. , Filippini F. , Walker‐Combrouze F. , Crequat J. , Madelenat P.
Published: November 2003

We present a prospective longitudinal study, using both laparoscopy and operative hysteroscopy, which investigated the transport of endometrial cells into the peritoneal cavity. The study was carried out between 1 January 1994 and 31 December 1994 at the Department of Obstetrics and Gynaecology, Bichat‐Claude Bernard Hospital, Paris. Included in the study were 30 patients who had intrauterine lesions, diagnosed by previous hysteroscopy. All available peritoneal fluid was collected for subsequent cytological evaluation. Pre‐ and posthysteroscopy peritoneal fluid specimens were centrifuged and aliquots were smeared and stained using Papanicolau and May–Grünewald–Giemsa stains, and paraffin inclusions were prepared and stained with haematoxylin–eosin–saffron. The criterion for specimen evaluation was the presence or absence of identifiable endometrial cell material in the peritoneal fluid collected during operative hysteroscopy. Before the operative hysteroscopy procedures, cytological investigations of the peritoneal fluid showed no presence of endometrial cells. However, in the peritoneal fluid collected after the operative hysteroscopies, endometrial cells were found in seven cases (23.3%). During the latter procedure, transport of endometrial cells through the fallopian tubes can occur, and in our prospective study this was found to happen in 23.3% of cases.
Chemical synovectomy vs. radioactive synovectomy for the treatment of chronic haemophilic synovitis: a prospective short‐term study
Authors: RODRIGUEZ‐MERCHAN E. C. , CAVIGLIA H. A. , MAGALLON M. , PEREZ‐BIANCO R.
Published: November 2003

Between January 1992 and December 1994, a prospective study was performed in two centres comparing chemical synovectomy using repeated weekly injections (range, 1–17) of Rifampicin (Group R) vs. radioactive synovectomy using 1–2 injections of Yttrium‐90 (Group Y). The study was performed on 38 joints in a total of 35 haemophilic patients suffering from chronic haemophilic synovitis unresponsive to 3 months of conservative treatment (substitution therapy with the deficient coagulation factor plus a rehabilitation protocol). Group R included 18 patients with an average age of 9 years, with an average follow‐up time of 25 months. In Group R, 19 joints were treated: nine knees, four elbows and six ankles. Group Y included 17 patients with an average age of 18 years, with an average follow‐up time of 23 months. In Group Y, 19 joints were treated: 14 knees, two elbows and three ankles.

The joints were evaluated according to the frequency of bleeding episodes and the Pettersson radiographic score. On the basis of the radiographic scale at the time of the synoviortheses, the joints were categorized as stage I (0 points), stage II (1–2 points), stage III (3–7 points), stage IV (8–10 points) and stage V (11–13 points).

The overall results showed that in Group R, bleeding decreased in 12 joints, remained the same in six and worsened in one. In Group Y, bleeding decreased in 11 joints, remained the same in seven and worsened in one.

In both Groups, bleeding was controlled best if joints were in stages I and II. In stages III, IV and V, synoviorthesis should not be carried out in haemophilia because it is not effective. Use of radioactive substances in persons under the age of 9 years has been discouraged in the past and therefore only Rifampicin was used in this age group. However, in patients over 9 years of age, this study showed similar decrease of bleeding in both treatment groups. Taking into account the advantages and disadvantages of both agents, we suggest the use of Rifampicin in elbows and ankles but prefer Yttrium‐90 for the knees.
In‐vitro stability of porcine factor VIII (Hyate:C®)
Authors: WOLOSCHUK D. M. M. , RUBINGER M. , ISRAELS S. J. , HOUSTON D. S. , SCHWETZ N. , JOHNSTON J. B.
Published: November 2003

The stability of porcine factor VIII (Hyate:C®) 30 units mL–1, 15 units mL–1 and 5 units mL–1 prepared aseptically in 0.9% sodium chloride injection was studied. Solutions were stored in plastic syringes at room temperature and ambient light, and at body temperature protected from light. Samples obtained immediately after mixing and at 4, 24, 48 and 72 h were assayed for FVIII activity using a one‐stage FVIII assay. Samples were considered stable if FVIII activity did not decline more than 10% compared with baseline values.

Hyate:C® 5 units mL–1 stored at room temperature retained FVIII activity within 90% of baseline values for at least 24 h. When stored at body temperature, FVIII activity of Hyate:C® 5 units mL–1 declined to less than 90% of baseline values within 4 h. Stability of Hyate:C® 15 units mL–1 and 30 units mL–1 stored at room temperature was retained for at least 72 h. When Hyate:C® 15 units mL–1 and 30 units mL–1 were stored at body temperature, stability was retained for 24 h. Results of this study will permit further evaluation of Hyate:C® stability when administered by ambulatory infusion pumps.
Central venous catheter infection in haemophiliacs undergoing prophylaxis or immune tolerance with clotting factor concentrate
Authors: Ragni M. V. , Hord J. D. , Blatt J.
Published: November 2003

The risk of infection in individuals with haemophilia using central vascular access devices for administration of clotting factor concentrates for prophylaxis or immune tolerance is unknown. We conducted a survey of US haemophilia treatment centres to determine the incidence and clinical characteristics of infection associated with the use of central venous catheters. Seventy (38.3%) of 183 patients using central lines developed device‐associated infection, including 30 (28.0%) on prophylaxis and 40 (52.6%) on immune tolerance, P < 0.005. Over half (54.8%) the infections occurred in those 3 years of age. Implanted/tunnelled devices (port catheters) were more likely to become infected in the first 30 days after insertion, 11 of 41 (26.8%), than external catheters (broviac/hickman), none of 29 (0%), P= 0.00003. The median time to infection from initial device placement, 124 days, varied with age, 57 days in those 2 years of age vs. 161 days in those > 2 years of age, P= 0.0008, but not with type of device or treatment. Staphylococcal infections were more common with implanted devices (ports), 30 (73.2%), than external catheters, 12 (41.4%), P < 0.01, and Gram‐negative infections were more common with external catheters, 17 (58.6%), than tunnelled devices, 7 (17.1%), P < 0.005. In summary, the rate of infection with central venous access devices in haemophiliacs is high, and alternative approaches to venous access should be explored.
Variability of the factor VIII response to DDAVP in a large kindred with mild haemophilia A
Authors: Jensen A. RavnsbÆk , Ingerslev J. , Knudsen L. , Fredberg U. , Scheibel E. a , Schwaab R.
Published: November 2003

Since 1977, desmopressin acetate (DDAVP) has established its important role in the clinical management of bleeding in milder cases of von Willebrand’s disease and haemophilia A. We present in vivo DDAVP response data from a large kindred suffering from mild haemophilia A. Levels of FVIII: C in 22 affected family members ranged from 0.11 to 0.24 IU mL−1 of FVIII: C (0.18 ± 0.04, mean ± SD), increasing to 0.22–0.92 IU mL−1 after DDAVP, giving a mean response ratio of 3.5. Response rates by various routes of administration did not differ significantly, being 3.3 for subcutaneous administration (n= 17), 3.7 for intravenous administration (n= 4) and 3.2 for intranasal spray application (n= 1). No significant correlation was found between the pretreatment level and the response rate. In three individuals, the post‐DDAVP level of FVIII:C was below 0.40 IU mL−1, the value we arbitrarily regard as the lower limit of a successful response for haemostatic efficacy suited for self‐management purposes, demonstrating that the response rate in a given member of the family cannot be predicted from previous experiences with other haemophilic members of the same subset.
Subdural haemorrhage as a predisposing factor for hyponatraemic convulsions in an infant undergoing test dose DDAVP infusion
Authors: Khadilkar V. V. , Pitcher L. A. , Cameron F. J. , Cookson J. , Hann I. M.
Published: November 2003

The infusion of desmopressin (DDAVP) is important in the investigation and treatment of selected bleeding diatheses. The potential toxicity of DDAVP is well known. In infants, hyponatraemic convulsions have been reported mostly with repeated infusions of DDAVP and rarely in the context of a single, test dose of DDAVP. We report a case of an infant with a small, resolving spontaneous subdural haematoma in whom a standard test dose infusion of DDAVP resulted in severe hyponatraemia and convulsions. Urinary arginine vasopressin analysis retrospectively identified a subclinical form of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) as a likely predisposing factor. We conclude that even in patients with normal plasma sodium levels, DDAVP testing should be performed with caution and preferably deferred where the possibility of SIADH exists.
Postpartum microneuromas of the uterine cervix
Authors: TILTMAN A.J. , DUFFIELD M.S.
Published: November 2003

The cervices of 300 hysterectomy specimens have been examined for the presence of abnormal nerves morphologically resembling traumatic neuromas. These were present in 165 uteri (55%) overall but in only two of the 48 nulliparous patients (4%), indicating a probable causation by parturition. The microneuromas could be graded. The larger, more complex lesions were associated with more extensive involvement of the cervix but not with increased parity.
Expression of the apoptosis suppressing bcl‐2 protein in transitional cell bladder tumours
Authors: LIPPONEN P.K. , AALTOMAA S. , ESKELINEN M.
Published: November 2003

The expression of bcl‐2 protein was studied by immunohistochemistry using a monoclonal antibody in 158 cases of transitional cell bladder tumours. The bcl‐2 protein was expressed in basal cells in normal transitional epithelium and 68% of the transitional cell tumours showed bcl‐2 positivity in the basal cells. The expression of bcl‐2 in basal cells was positively correlated to over‐expression of epidermal growth factor receptor in tumour cells. The expression of bcl‐2 in non‐basal cells was weak in 20% and strong in an additional 13% of tumours. The expression of bcl‐2 in non‐basal cells was positively correlated to T‐category, M‐category, grade, papillary status, DNA ploidy, S phase fraction, mitotic index, nuclear area and over‐expression of epidermal growth factor receptor. Recurrence‐free interval of Ta‐T1 tumours was related to bcl‐2 positivity in non‐basal cells. Tumours with bcl‐2 positive non‐basal cells had an unfavourable prognosis but, in multivariate analysis, expression of bcl‐2 had no independent prognostic value.