bluuebunny/crossref_metadata_2025 huggingface dataset:
Photosynthetic responses of Mojave Desert shrubs to free air CO2 enrichment are greatest during wet years
Authors: Naumburg Elke , Housman David C. , Huxman Travis E. , Charlet Therese N. , Loik Michael E. , Smith Stanley D.
Published: March 2003

It has been suggested that desert vegetation will show the strongest response to rising atmospheric carbon dioxide due to strong water limitations in these systems that may be ameliorated by both photosynthetic enhancements and reductions in stomatal conductance. Here, we report the long‐term effect of 55 Pa atmospheric CO2 on photosynthesis and stomatal conductance for three Mojave Desert shrubs of differing leaf phenology (Ambrosia dumosa—drought‐deciduous, Krameria erecta—winter‐deciduous, Larrea tridentata—evergreen). The shrubs were growing in an undisturbed ecosystem fumigated using FACE technology and were measured over a four‐year period that included both above and below‐average precipitation. Daily integrated photosynthesis (Aday) was significantly enhanced by elevated CO2 for all three species, although Krameria erecta showed the greatest enhancements (63% vs. 32% for the other species) enhancements were constant throughout the entire measurement period. Only one species, Larrea tridentata, decreased stomatal conductance by 25–50% in response to elevated CO2, and then only at the onset of the summer dry season and following late summer convective precipitation. Similarly, reductions in the maximum carboxylation rate of Rubisco were limited to Larrea during spring. These results suggest that the elevated CO2 response of desert vegetation is a function of complex interactions between species functional types and prevailing environmental conditions. Elevated CO2 did not extend the active growing season into the summer dry season because of overall negligible stomatal conductance responses that did not result in significant water conservation. Overall, we expect the greatest response of desert vegetation during years with above‐average precipitation when the active growing season is not limited to ∼2 months and, consequently, the effects of increased photosynthesis can accumulate over a biologically significant time period.
Soil carbon stores in Nordic well‐drained forest soils—relationships with climate and texture class
Authors: CALLESEN I. , LISKI J. , RAULUND‐RASMUSSEN K. , OLSSON M. T. , TAU‐STRAND L. , VESTERDAL L. , WESTMAN C. J.
Published: March 2003

Soil organic carbon (SOC) pools in forest floors and mineral soil to a depth of 100 cm were determined in 234 well‐drained Nordic forest soils from latitude 55–68???°‐N, and longitude 6–28???°‐E. The data were compiled in a database of Nordic forest soils, from literature, and sources of validated data the authors had access to. The SOC pool increased with both mean annual temperature (MAT) and mean annual precipitation (MAP), and the increase with MAT was more pronounced for coarse‐textured soils than for medium‐textured soils. Soil organic carbon in fine‐textured soils was not correlated with MAT and MAP. Differences between texture classes were mainly due to different carbon stores in the upper 40 cm of the mineral soil and in the forest floor. The emphasis on well‐drained soils eliminated the impact of hampered decomposition in hydromorphic soils. Large carbon accumulation in such soils probably explains the negative relationship between SOC and temperature reported in other studies. The increase in SOC with temperature and precipitation is interpreted as an indirect effect of higher net primary production.
Net changes in regional woody vegetation cover and carbon storage in Texas Drylands, 1937–1999
Authors: ASNER GREGORY P. , ARCHER STEVE , HUGHES R. FLINT , ANSLEY R. JAMES , WESSMAN CAROL A.
Published: March 2003

Although local increases in woody plant cover have been documented in arid and semiarid ecosystems worldwide, there have been few long‐term, large‐scale analyses of changes in woody plant cover and aboveground carbon (C) stocks. We used historical aerial photography, contemporary Landsat satellite data, field observations, and image analysis techniques to assess spatially specific changes in woody vegetation cover and aboveground C stocks between 1937 and 1999 in a 400‐km2 region of northern Texas, USA. Changes in land cover were then related to topo‐edaphic setting and historical land‐use practices. Mechanical or chemical brush management occurred over much of the region in the 1940–1950s. Rangelands not targeted for brush management experienced woody cover increases of up to 500% in 63 years. Areas managed with herbicides, mechanical treatments or fire exhibited a wide range of woody cover changes relative to 1937 (−75% to + 280%), depending on soil type and time since last management action. At the integrated regional scale, there was a net 30% increase in woody plant cover over the 63‐year period. Regional increases were greatest in riparian corridors (33%) and shallow clay uplands (26%) and least on upland clay loams (15%). Allometric relationships between canopy cover and aboveground biomass were used to estimate net aboveground C storage changes in upland (nonriparian) portions of regional landscapes. Carbon stocks increased from 380 g C m−2 in 1937 to 500 g C m−2 in 1999, a 32% net increase across the 400 km2 region over the 63‐year period. These plant C storage change estimates are highly conservative in that they did not include the substantial increases in woody plant cover observed within riparian landscape elements. Results are discussed in terms of implications for ‘carbon accounting’ and the global C cycle.
Analysis of the nutritive value of timothy grown with varying N nutrition
Authors: Bélanger G. , McQueen R.E.
Published: March 2003

Nitrogen fertilization affect growth and yield of timothy (Phleum Pratense L.), but there are conflicting report on its effect on nutritive value. Two experiments were conducted to describe changes in nutritive value of field‐grown timothy fertilized with four rates of N fertilizer during spring and summer growth cycles, and to analyse relationships between parameters of nutritive value and the leaf to weight ratio (LWR). Early in the regrowth cycles when the harvestabe shoot biomass was approximately 200 g dry matter (DM) m−2 and under non‐limiting N and water conditions, the in vitro true digestibility (IVTD) of DM was greater in spring than in summer because the concentration of neutral‐detergent fibre (NDF) was lower and its in vitro cell wall digestibility (IVCWD) was greater. However, the rates of decline in IVTD and IVCWD and the rate of increase in NDF were greater in spring than in summer. Nitrogen deficiency decresed IVTD and IVCWD, and increased NDF concentration early in the regrowth cycles. Nitrogen deficiency, however, reduced the rate of change in the three parameters of nutritive value. By the end of growth cycles, IVTD was 59 and 42 g kg−1 DM greater when no N was applied than with non‐limiting N conditions in spring and summer respectively. When no N was applied, the IVCWD was 76 and 52 g kg−1 NDF greater, whereas the NDF concentration was 35 and 42 g kg−1 DM less than under non‐limiting N conditions in spring and summer respectively. The N deficiency increased the proportion of leaves in the biomass, which can explain for the most part the positve effect of the N deficiency on the nutritive value of timothy. This positive effect of the N deficiency on nutritive value though the proportion of leaves in the biomass, however, was reduced by the negative effect of N deficiency on the nutritive value of leaves or stems or both.
The effects of the inclusion of either maize silage, fermented whole crop wheat or ure‐treated whole crop wheat in a diet based on a high‐quality grass silage on the performance of dairy cows
Authors: Hameleers A.
Published: March 2003

Sixteen multiparous Holstein/Friesian cows were used to examine the effect on food intake and milk production of replacing 40% of the dry matter (DM) of first cut perennial ryegrass silage (G) with either maize silage (M), fermented (F) or urea‐treated (U) wheat whole crop silage. In addition to the forage mixtures, the animals received 5.25 kg DM d −1 of a standard concentrate and 1.75 kg DM d −1 of soya bean meal. The experiment consisted of four periods, each of 4 weeks duration, in a Latin square design. The grass silage used was of high quality with an estimated metabolizable energy (ME) content of 11.4 MJ kg −1 DM and in vitro digestibility of 748 g kg −1 DM. DM intake was significantly increased (s.e.d. = 0.364, P < 0.01) with the inclusion of M, F and U. The resulting total DM intakes were 17.6, 18.4, 19.2 and 20.1 kg d −1 for treatments G, M, F and U respectively. None of the animal production variables was significantly affected by the treatments. Milk yield was 27.4, 26.4, 27.1 and 26.9 kg d −1 for treatments G, M, F and U respectively. Milk fat content was 48.9, 46.9, 49.0 and 48.1 g kg −1, and milk protein content was 34.1, 33.6, 34.0 and 34.3 g kg −1 for treatments G, M, F and U respectively. The results show that partly (40%) replacing a high‐quality grass silage with forage maize, fermented whole crop wheat or urea‐treated whole crop wheat will increase DM intake in dairy cows but is not accompanied by an increase in animal performance and therefore will result in decreased efficiency of forage DM utilization.
Effects of crop properties, weather conditions and mechanical treatments on the wilting rate of dipliod and tetraploid Italian ryegrass for silage
Authors: Borreani G. , Tabacco E.
Published: March 2003

The relationship between rate of water loss of Italian ryegrass (Lolium multiflorum) and crop properties, weather conditions and mechanical treatments were studied on a field scale, as was the importance of the variables and their combined effects on influencing the wilting process.

Eleven forage‐drying experiments were performed between 1992 and 1994 on diploid and tetraploid cultivars cut at different growth stages, ranging from early elongation to flowering, under environmentally variable conditions. The rate of drying was measured until a moisture content of 1 g water g−1 dry matter (DM) (500 g kg−1) was reached, or for a maximum of 2 days by calculating the rate of water loss from two consecutive hourly weights of swath portions placed on trays. Multiple regression analysis was used to correlate the drying rate (k) with crop properties and with meteorological and mechanical treatment variables.

The interaction between potential evapotranspiration (ET0) and the moisture content of grass at cutting (Mgrass appeared to be the most important variable, from the twenty‐one tested, in influencing K. This variable shows that the same quantity of energy available for evaportaion acts in different ways when the water content of the crop at cutting differs. The rate of water loss is also influenced by the Mgrass itself, surgacae density of the swath, tedding and the weather conditions on the first day of drying.

The value of Mgrass at cutting is greatly greatly dependent on crop maturity and ploidy. The tetraploid cultivars, with a higher inital moisture content, lost water more slowly than diploid cultivars did. Because the date of cutting cannot be delayed, owing to the decline in nutrive value, it is helpful to select for cultivars with low moisture contents at cutting, as well as applying mechanical treatment (spreading and tedding), in order to keep the wilting period as short as possible.

A validated drying model can be useful for operational purposes to understand the drying process and to assess technological choices for forage drying.
Acoustic measurement of intake and grazing behaviour of cattle
Authors: Laca  , WallisDeVries
Published: March 2003

Acoustic analysis of grazing behaviour was found to allow accurate identification of chewing and biting, and estimation of intake by cattle. Four steers grazed six types of turves, three were short (14, 16 and 20 cm tall), leafy turves from mowed Setaria lutescens with high application of N fertilizer, and three were tall (36, 49 and 62 cm tall), mature turves from uncut areas with low application of N fertilizer. Each animal grazed ten bites from each turf type while behaviour was videotaped and grazing sounds were recorded with a wireless microphone taped to the animal’s forehead. The intake was measured by the difference in pre‐ and post‐grazing turf weight, corrected for water loss. Chews and bites differed in acoustic characteristics, with bites producing more output in the 3–8 kHz frequency band. Discriminant analysis of the acoustic characteristics correctly classified chews and bites with 94% accuracy. Intake was predicted with a high degree of accuracy by total energy flux density (fJ m–2) in chewing sounds (EFDC), EFDC per chew and average intensity of chewing sound in the 1–2 and 2–3 kHz bands (R2=0·90, CV=3·6%). Although bite mass ranged from 1·37 to 4·50 g, EFDC per g of intake (CV=0·015) was not affected by treatments or animals. Chewing sounds carried more information about intake than biting sounds and chews per bite. Analysis of grazing sounds has the potential to overcome many of the problems associated with the measurement of grazing intake.
The effects of intravenous administration of amino acids and glucose on the milk production of dairy cows consuming diets based on grass silage
Authors: Kim  , Choung  , Chamberlain
Published: March 2003

Two experiments, using intravenous infusion of nutrients, were carried out with the aim of separating milk production responses due to the provision of amino acids as precursors of milk protein synthesis from those due to the provision of amino acids as glucose precursors. Diets were based on grass silage of restricted fermentation and barley‐based supplements because it has been suggested that these diets might provide insufficient glucose precursors to meet the needs of lactose synthesis. The silages used in the experiments were of similar lactic acid contents [62 and 63 g kg–1 dry matter (DM)] but of different water‐soluble carbohydrate (WSC) contents (206 and 20 g kg–1 DM in Experiments 1 and 2 respectively). In Experiment 1, four dairy cows were given the following treatments in a 4 × 4 Latin square arrangement with periods of 10 d: (1) basal diet (Basal), (2) Basal plus jugular infusion of 182 g d–1 of amino acids simulating casein (TAA), (3) Basal plus 101 g d–1 of essential amino acids (EAA), being the essential amino acid component of the TAA treatment and (4) Basal plus 101 g d–1 of essential amino acids plus 50 g d–1 of glucose (EAA + G), being the glucose equivalent of the non‐essential amino acid component of treatment TAA. All infusions increased (P < 0·05) the concentration of milk protein compared with Basal but only for TAA was the increase in the yield of milk protein statistically significant (P < 0·05), amounting to 68 g d–1. Both TAA and EAA reduced (P < 0·05) the concentration of milk fat. There was no difference between EAA and EAA + G treatments.

In Experiment 2, five dairy cows were given the following treatments in a 5 × 5 Latin square design with periods of 7 d: (1) basal diet (Basal), (2) Basal plus 182 g d–1 of amino acids simulating casein (TAA), (3) Basal plus 182 g d–1 of non‐essential amino acids as in casein (NEAA), (4) Basal plus 100 g d–1 of glucose (G100) and (5) basal plus 230 g d–1 of glucose (G230). G100 supplied the glucose equivalent of NEAA whereas G230 supplied the caloric equivalent of NEAA. Again, only for TAA was the increase in yield of milk protein statistically significant (P < 0·05), amounting to 83 g d–1. Neither glucose treatment caused any statistically significant (P > 0·05) effect on the yield of milk protein nor the yield of milk lactose.

It is concluded that, in both experiments, the primary nutritional limitation on milk protein output was the supply of amino acids as precursors of milk protein, there being no evidence to support a primary limitation due to glucose supply.
The influence of trichome density on the drying rate of alfalfa forage
Authors: Lenssen A. W. , Banfield J. D. , Cash S. D.
Published: March 2003

Trichomes decrease water loss in some plant species, but their influence on water loss from alfalfa (Medicago sativaL.) forage is unknown. A study was conducted which measured the water loss from field‐grown, harvested forage of three erect, glandular‐haired alfalfa germplasms, KS161, KS210 and KS224, the eglandular ‘Arc’ cultivar and the ‘Kenland’ cultivar of red clover (Trifolium pratenseL.). Harvests were taken once in 1995 and 1997, and four times in 1996. Plant height, phenological stage, upper and lower stem diameters, leaf:stem ratio and apical stem densities of simple, procumbent glandular and erect glandular trichomes were determined. The drying rate constants of the forage were calculated by a combination of parametric and non‐parametric modelling techniques. The harvest × germplasm interaction was significant for all parameters measured. The density of erect glandular hairs varied among entries for all harvests, while the drying rate of harvested forage differed among entries for three of the six harvests. Correlations between densities of erect glandular hairs and drying rate constants were generally low and non‐significant, except for one harvest. Erect glandular hairs, at the densities measured in this study, generally did not influence drying rates of alfalfa forage. However, density of total trichomes was significantly and negatively correlated with drying rate for all alfalfa entries. The diameter of the stem had the greatest negative impact on drying rate.
Determination of microbial protein in perennial ryegrass silage
Authors: Driehuis F. , Van Wikselaar P. G.
Published: March 2003

The microbial matter fraction was determined in perennial ryegrass silages of different dry‐matter (DM) contents, ensiled with or without Lactobacillus plantarum. 15N‐Leucine and the bacterial cell wall constituent diaminopimelic acid (DAPA) were used as markers for microbial‐N. Perennial ryegrass crops with DM contents of 202, 280 or 366 g kg−1 fresh weight were ensiled in laboratory‐scale silos and stored for 3 to 4 months. At different times after ensiling, silages were analysed and microbial fractions were isolated. Microbial‐N concentration determined with 15N‐leucine reached a maximum during the first week of ensilage. It remained unchanged thereafter, except in silage with a DM content of 280 g kg−1 in which it decreased (P < 0·01) by 32% during storage. After 3 to 4 months ensilage, microbial‐N concentration varied from ≈0·3 to ≈1·7 g kg−1 DM. A negative relationship was observed between microbial‐N concentration and silage DM content. Inoculation resulted in an approximately twofold increase (P < 0·001) in microbial‐N concentration. Microbial‐N concentrations determined with DAPA were 1·14–2·07 times higher than those determined with 15N‐leucine. However, 19–35% of the DAPA in silage occurred in a soluble form, indicating that this fraction of DAPA was not associated with intact bacteria.
Effects of reduced time on pasture caused by prolonged walking on behaviour and production of Mpwapwa Zebu cattle
Authors: Jung J. , Yngvesson J. , Jensen P.
Published: March 2003

In many African countries, cattle are often allowed to graze only during the daytime and the daily walk to pasture limits time for foraging. Two groups of cattle were allowed access to pasture for 9 h or 5 h associated with a daily walk of 0·5 h or 4·5 h respectively. Each treatment period lasted for 14 days in a cross‐over design. Observations of behaviour were carried out for 8 days in each treatment period. When only 5 h were allowed at pasture, the animals grazed less (0·61 vs. 0·66 of time) compared with the first 5 h of the 9 h treatment. The average daily milk yield was 323 g (0·078) higher when 9 h were allowed on pasture (P < 0·05 during the second week of treatments). There were no differences in milk yield after the end of the treatments. The daily liveweight gain was 250 g higher when the animals were on pasture for 9 h. These differences could be due to the limited time on pasture or to energy requirements for the walk to pasture. It is concluded that increasing the walking time and reducing time on pasture may compromise animal welfare and performance under the experimental conditions, i.e. on poor quality pastures in a warm humid climate where the main period at pasture is in the middle of the day.
A prospective randomized scanning electron microscopy study on the effect of a pneumoperitoneum on tumour cell implantation in nude mice
Authors: Köster, Stefanie , Volz Joachim , De Wilde Rudi
Published: March 2003

Objective

The aim of the study was to examine the influence of a CO2 pneumoperitoneum on intraperitoneal tumour cell implantation and on survival in the event of intra‐abdominal spread of tumour cells during laparoscopy in nude mice.

Design

6‐week‐old nude mice were stratified into three groups of 47 animals each. A CO2 pneumoperitoneum was induced by a microhysteroflator with an intraperitoneal pressure of 8 mmHg for 60 min in group 1 and 100 000 cells of a malignant mesothelioma, suspended in 2 ml of Ringer solution were injected intraperitoneally. Group 2 received an identical tumour cell load after laparotomy by midline incision. In the control group 3 tumour cells were injected only. After 1, 2, 6, 12, 24, 48, 72 and 96 h respectively four animals were killed and the entire peritoneum in all animals was examined by scanning electron microscopy. The survival time of the remaining 15 animals served as controlling arm.

Results

In group 1, scanning electron microscopy showed that within 1 h mesothelial cells had become cuboidal, detached and condensed. The basement membrane was partly denuded. After 2 h this initial reaction reached its peak; tumour cells attached to the free basement membrane. None of those changes was seen in groups 2 and 3. It appears, that in group 1 intraperitoneal metastases were promoted by the CO2 pneumoperitoneum. The survival rate of group 1 was significantly reduced compared with that of group 2 and 3.

Conclusion

We conclude that the technique of CO2 pneumoperitoneum promotes intraperitoneal tumour cell implantation and growth in nude mice.
Hysteroscopic investigation of bleeding in women receiving tibolone: a case–control study
Authors: Ramsay Jane E. , Calder Anne L. , Mackay Hart David , Habiba  , Akkad  , Al Azzawi Farook
Published: March 2003

Objective

To compare the hysteroscopic findings and endometrial histology in women presenting with bleeding while receiving tibolone and in those with spontaneous postmenopausal bleeding (PMB).

Design

A retrospective review over a period of 1 year.

Setting

Outpatient hysteroscopy clinics and day surgical units, Stobhill NHS Trust, Glasgow and Leicester Royal Infirmary NHS Trust.

Subjects

A total of 74 women referred for investigation of abnormal uterine bleeding; in 37 the bleeding was spontaneous and the other 37 were receiving tibolone. The average age in both groups was 55.7 years.

Results

Of those bleeding while receiving tibolone, 38% were found to have intra‐uterine abnormalities on panoramic hysteroscopy, compared with 22% in the PMB group (P = 0.3). Attempted endometrial sampling was unsuccessful in 46% overall. There were atrophic histological findings in 89% of the tibolone group. There was a greater prevalence of positive findings, i.e. proliferative histology and simple and atypical hyperplasia, in the PMB group (P = 0.0018).

Conclusion

The absence of neoplasia, on endometrial sampling and panoramic hysteroscopy, is reassuring with regard to the management of women who are bleeding while receiving tibolone. However, investigations must be performed and these should always include hysteroscopy. With no tissue specimen obtained on endometrial sampling in 50% of those investigated, hysteroscopy is necessary to confirm normal endometrium and to identify intra‐uterine abnormalities; the latter were present in over one‐third of the tibolone group. The similar findings in the PMB group were also reassuring.
Management of uterine fibroids with goserelin acetate alone or goserelin acetate plus endometrial resection
Authors: Rees Margaret , Chamberlain Paul , Gillmer Michael
Published: March 2003

Objectives 

To determine the extent of fibroid regrowth and the need for additional interventions following treatment with either goserelin alone or goserelin plus endometrial resection in women with fibroids.

Design 

An open, randomized controlled trial with two treatment arms.

Setting 

Women's Centre, John Radcliffe Hospital, Oxford, UK

Subjects 

Women with fibroids whose uterine size exceeded 12 weeks of gestation (255–345 ml), but was less than 16 weeks' gestation (425–575 ml).

Interventions 

Goserelin acetate alone and goserelin acetate plus endometrial resection.

Main outcome measures 

Extent of fibroid regrowth and need for additional medical and surgical interventions over 12 months.

Results 

There were fewer medical and surgical interventions in the women randomly allocated to goserelin and endometrial resection than in the goserelin‐alone group (8.3% and 33%, respectively).

Conclusions 

These results suggest that goserelin allows the use of endometrial resection in patients with fibroids, who would otherwise have been treated by hysterectomy.
Cosmesis and patient satisfaction following laparoscopy
Authors: Ramsden Clive , Jivraj Shehnaaz
Published: March 2003

Objective

To determine complication rates and patient satisfaction with closure techniques following laparoscopic surgery.

Design

Prospective observational study.

Setting

Day Surgery Centre, Rotherham District General Hospital, Rotherham, England.

Materials and methods

187 patients undergoing elective laparoscopic surgery were recruited. Various wound closure techniques were used. The degree of wound bleeding, discomfort and discharge occurring 1, 2 and 6 weeks following surgery was assessed. A subsequent study identified the exact location of the scar by means of photograph and sought a final assessment of patient satisfaction with cosmesis. The distance of the scar from the centre of the umbilicus was correlated with the patient satisfaction score on an analogue scale.

Results

Significant complications were associated with wound closure at laparoscopy. The highest rate of discomfort was associated with a subcuticular method. Umbilical discharge was seen with both the subcuticular and interrupted method when the sutures were left in situ. This was present even 6 weeks following the procedure. The lowest complication rate was associated with those cases where the wound was left unsutured. Patient satisfaction with the laparoscopic incision was greatest when the incision was made totally within the umbilicus.

Conclusion

Careful consideration should be given to the suture technique employed, to reduce wound complication following laparoscopy. Leaving the wound unsutured should be considered as an acceptable alternative. Interrupted sutures should be removed within a week of surgery to reduce the incidence of discharge. To achieve the best cosmetic result, a vertical incision, made as central to the umbilicus as possible, should be employed.
The way forward in the surgical management of endometriosis – from a third world perspective
Authors: Clarke Henry Courtenay
Published: March 2003

Diagnosis

When symptoms of pelvic pain, dyspareunia or pelvic mass present, diagnosis of endometriosis is confirmed by laparoscopy. Vaginorectal examination and a sponge forceps pushed upward in the fornix help to delineate the extent of the disease. However, in many third world countries diagnosis is seldom confirmed early by laparoscopy, but later at the time of surgery when a complication has arisen.

Treatment

Excision is indicated, for minor or moderate disease, or direct ablation of superficial implants with complete excision of endometrial cyst walls, and can involve an oöphorectomy. In some parts of the world this may be performed by means of laparoscopy by a gynaecologist if available, but seldom by a general surgeon. Advanced disease requires complete excision of endometriosis with restoration of normal pelvic anatomy. This requires a highly skilled and experienced gynaecological laparoscopist of whom, worldwide, there are about 10. For the surgeon with little prior skill or experience and with no assistant or consultant, where there is severe pain associated with bleeding, anaemia, malnutrition, no transfusion available, and no chance for second surgery, laparotomy with hysterectomy and bilateral salpingo‐oöphorectomy is the operation of choice. This will change in the future with adequate training in operative laparoscopy and cheaper technology.

Results

Even in advanced disease with cul de sac occlusion, complete excision of endometriosis by operative laparoscopy, by skilled and experienced surgeons in large centres, gives results which are particularly good with regard to partial or complete absence of pain, as well as significant improvement in fertility.

Conclusion

Today, this surgical management of advanced endometriosis is available only for the rich few. In the future, pelvic pain and infertility centres will provide advanced training for increased numbers of gynaecological laparoscopists who will be capable of completing surgery for severe endometriosis with supporting groups such as colorectal and urological surgeons, reproductive medical specialists, basic scientists and counselling and support services.
Adhesion prevention: state of the art
Authors: Al‐Musawi D. , Thompson J. N.
Published: March 2003

Objective

To evaluate current and prospective methods of adhesion prevention.

Design

Review of published experimental and clinical studies of adhesion formation and prevention.

Main outcome measures

Reduction in de novo adhesions and adhesion re‐formation; cost to health care systems.

Results

Surgical technique influences adhesion formation. Laparoscopy reduces incisional and de novo adhesion formation. Pharmacological methods of adhesion prevention have not been adopted clinically. Three membrane barriers (two bioresorbable) are available to reduce adhesions. Liquid gels and solutions may have a role in non‐site‐specific adhesion prevention. New methods of adhesion prevention are being developed. Epidemiological studies show a large workload and health care cost associated with adhesion‐related disease.

Conclusion

Adhesion prevention is now possible using a variety of adhesion barriers in membrane and liquid/gel form. These may prove cost‐effective in reducing adhesion‐related disease. New products will soon be available.
Laparoscopic management of benign adnexal masses: experience in a developing country
Authors: Darwish Atef M. , Amin Ahmad F. , AbdelAleem Mahmoud A. , Youssef Mohamad A.
Published: March 2003

Objective

To compare the efficacy, cost‐effectiveness, and possible complications of operative laparoscopy with laparotomy for treating benign adnexal cystic tumours at a unit in a developing country.

Design

A prospective comparative study.

Setting

Gynaecologic Endoscopy Unit, Assiut University Hospital, Assiut, Egypt.

Subjects

91 women of childbearing age with a clinical, biochemical and transvaginal sonographic diagnosis of benign adnexal cystic tumour.

Interventions

71 patients were allocated to one of two groups according to management approach. The laparoscopy group (A) included 37 patients while the laparotomy group (B) included 34 patients.

Main outcome measures

For each patient, the operating time, intra‐ and postoperative complications, postoperative pain and duration of hospital stay were recorded.

Results

The operating time was significantly shorter in group A (47.8 ± 28.3 min) than in group B (64.9 ± 19.2 min). Intraoperative uncontrolled bleeding occurred in one patient in group A. Postoperative pain was significantly less in group A than in group B (P < 0.001). Postoperative febrile morbidity developed in 12.2% and 31.6% of patients in groups A and B, respectively. The duration of postoperative hospital stay was significantly shorter among patients in group A (49.5 ± 42.6 h) than in group B (124.8 ± 40.9 h) (P < 0.001). Postoperative complications included wound infections: one case in group A and three in group B.

Conclusions

Laparoscopic management of benign cystic adnexal masses is a fast and safe procedure with minimal intra‐ and postoperative complications compared with laparotomy. Its use in developing countries with limited resources is cost‐effective, given appropriate selection of cases and experienced endoscopists.
Gas embolism during VersaPoint hysteroscopic myomectomy
Authors: Hunter David C. , Cooper David W. , Phillips Graham
Published: March 2003

To describe a case of gas embolism in association with VersaPoint hysteroscopic myomectomy.

A 40‐year‐old woman with menorrhagia secondary to uterine fibroids.

Hysteroscopic VersaPoint spring endometrial ablation and submucous myomectomy under general anaesthetic with saline as the distension medium. Intraoperatively an acute and profound drop in the patient's end‐tidal carbon dioxide and oxygen saturation suggested gas embolism and the procedure was abandoned. The origin of the gas responsible for the embolism is uncertain.

The VersaPoint spring for endometrial ablation and submucous myomectomy requires further evaluation. Factors which may have contributed to the gas embolism are discussed.
Laparoscopic excision of primary pelvic hydatid cyst presenting as an adnexal mass
Authors: Dilbaz Serdar , Çalışkan Eray , Oguzer Kamber , Ertem Asuman , Gelisen Orhan , Haberal Ali
Published: March 2003

To report a case of primary pelvic hydatid cyst presenting as an adnexal mass and having undergone a laparoscopic excision

The clinical records of the patient were reviewed.

The clinical and radiological findings demonstrated a right adnexal 5x6x5 cm unilocular cystic mass. Laparoscopic dissection of the dense adhesions between the mass, the right ovary and the omentum were performed. Laparoscopic excision of the mass was performed without rupturing the cyst and placing it in a bag. Histological examination confirmed the hydatid disease. Neither complications nor recurrence was observed during the follow up.

Laparoscopy is used safely for treatment of pelvic haydatid cysts after taking measures to prevent intra‐abdominal spillage.
Routine cystoscopy after laparoscopically assisted hysterectomy: what's the point?
Authors: Seman Elvis I. , O'Shea Robert T. , Gordon Simon , Miller John
Published: March 2003

To define the role of routine cystoscopy following laparoscopically assisted hysterectomy in the early detection of ureteric injuries.

A retrospective observational study based on casenote review.

A consecutive series of 436 women who underwent routine video cystoscopy after intrafascial laparoscopically assisted hysterectomy, with or without bilateral salpingo‐oöphorectomy.

In 436 cystoscope evaluations, six cases aroused suspicion of a ureteric injury. Subsequent evaluation confirmed injury in two of these cases. A further two cases were not suspected on cystoscopic grounds but were detected in the early postoperative period. One ureteric injury was associated with endoscopic staples, two with electrosurgery and one with the harmonic scalpel. The staple injury was suspected clinically during the operative procedure; the remainder were not.

Routine cystoscopy at intrafascial laparoscopically assisted hysterectomy has not contributed to the early diagnosis and treatment of ureteric injuries sustained with the authors' current technique. Thus cystoscopy ought to be done selectively according to clinical intraoperative concern. The distal pelvic ureter should be routinely inspected for dilatation, via peritoneal windows, at the end of the hysterectomy. Every endogynaecologist should review their data on cystoscopy and ureteric injuries associated with laparoscopically assisted hysterectomy to ascertain whether cystoscopy is justifiable in their practice, and whether surgical techniques need to be modified to enhance ureteric protection.
Hydrothermal ablation: assessment of a new simple method for treatment of uncontrolled menorrhagia
Authors: Hefni Mohamed A. , El‐Toukhy Tarek , Nagy Charles , Mahadevan Subramanian , Davies Angharad E.
Published: March 2003

Objective Assessment of the safety and efficacy of hydrothermal ablation (HTA) in the treatment of therapy‐resistant menorrhagia.

Design and setting Prospective observational study, at a minimal access unit, Kent, UK.

Subjects and methods Patients referred because of uncontrolled menorrhagia were recruited for the study between January 1999 and July 2000, provided that they had completed their family. Preoperative evaluation included examination, ultrasound scanning and endometrial sampling. Women with submucous fibroids or fibroids 5 cm or more in diameter were excluded. Endometrial suppression was induced prior to surgery with two injections of goserelin. HTA was carried out by circulating saline at 90°C for 10 min in the uterine cavity under hysteroscopic vision. Uterine serosal and intravesical temperatures were recorded. Follow up was by specially designed menstrual questionnaires at 3 and 6 months after surgery and at 6‐monthly intervals thereafter.

Outcome measures Operative and postoperative complications, temperatures recordings, changes in menstrual pattern and patient satisfaction.

Results The procedure was performed for 67 women. No operative or postoperative complications occurred. No fluid spilled through the fallopian tubes or leaked through the cervix. The mean temperature recorded was 36.8°C (± 0.4). Technical difficulty caused by failure of the HTA control unit occurred in two cases. The percentage of women reporting amenorrhoea or vaginal spotting was 57% at 1 year, 58% at 18 months and 62% at 2 years. After a mean follow‐up period of 17 months (range 12–24), 79% of patients were satisfied with the procedure. The efficacy of the procedure was not reduced in the presence of uterine fibroids.

Conclusion HTA is a safe, easy and effective method of endometrial ablation in women suffering from therapy‐resistant menorrhagia, even in the presence of uterine fibroids which did not distort the cavity.
The changing patterns of factor VIII (FVIII) and factor IX (FIX) clotting factor usage in a comprehensive care centre between 1980 and 1994
Authors: Miners  , Sabin  , Tolley  , Lee
Published: March 2003

The annual amount of clotting factor used by patients at the Royal Free Haemophilia Centre increased significantly from 4 million iu in 1980 to over 15 million iu by 1994 (P < 0.0001). In order to assess the reasons for this increase, data on concentrate usage over this period were retrospectively collected for patients who had Haemophilia or von Willebrand’s disease. Only patients who were registered exclusively at the Centre were included in the study. In total, 498 patients met the inclusion criterion. The median age of the cohort on 1 January 1980 was 21 (range < 1–69) years. During the period there were 88 births and 45 deaths. The majority of patients had Haemophilia A (55%). The median follow‐up period per patient was 2.1 (range 0–14.8) years. Despite adjusting for increases in the number of patients and changes in body weight, statistically significant increases in clotting factor usage were detected for some subgroups of patients, in particularly for those with severe Haemophilia A and B and from the late 1980s onwards, for patients with von Willebrand’s disease. Two reasons for this increase in clotting factor usage were identified as being the introduction of improved products and prophylaxis. However, the increased cost of clotting factor provision that has resulted from these changes in treatment policy should not be analysed in isolation but should be balanced off against cost decreases in other areas and against increases in the effectiveness of treatment.
Anaphylactoid reactions and nephrotic syndrome – a considerable risk during factor IX treatment in patients with haemophilia B and inhibitors: a report on the outcome in two brothers
Authors: Tengborn  , Hansson  , Fasth  , LÜbeck  , Berg  , Ljung
Published: March 2003

Anaphylaxis/anaphylactoid reactions have recently been reported after few treatments with factor IX concentrates in patients with haemophilia B at the same time as inhibitors to factor IX were demonstrated. In some of these cases nephrotic syndrome has appeared during immune tolerance induction (ITI) with high doses of factor IX concentrates. Gene deletions seem to be associated with a high risk of developing antibodies to factor IX.

This report presents two brothers with deletion of 1 bp in exon f of the factor IX gene. Both showed anaphylactoid reactions and they were desensitized using slow i.v. injections of factor IX. At the time of anaphylaxis, inhibitors of factor IX in a low titre could be demonstrated. The elder brother responded well after a short time on ITI and has no spontaneous bleedings on regular prophylaxis although in a somewhat higher dose than expected. On the other hand, in spite of comparable regimens, the younger brother has so far been resistant to ITI. Moreover, during treatment with extremely high doses of factor IX concentrate he developed nephrotic syndrome which only slowly subsided after treatment with corticosteroids and withdrawal of factor IX.
Quality of life during menstruation in patients with inherited bleeding disorders
Authors: Kadir  , Sabin  , Pollard  , Lee  , Economides
Published: March 2003

Menorrhagia is a common and major problem for patients with inherited bleeding disorders, especially vWD. Quality of life during menstruation was assessed in 99 patients with inherited bleeding disorders including vWD (n = 57), carriers of haemophilia A (n = 17), carriers of haemophilia B (n = 7) and FXI deficiency (n = 18), and comparison was performed with an age‐matched control group (n = 69). A questionnaire was used that included four main sections: (i) general health, (ii) health and daily activities, (iii) dysmenorrhea and (iv) quality of life during the menstrual period. Although patients with inherited bleeding disorders felt that their health (in general) was very good, they had significantly poorer quality of life on all the scales used than controls. Thirty‐nine per cent reported having cut down on the amount of time spent on work and other activities as a result of their menstruation; 47% felt that they accomplished less than they would like during this period, 38% felt that they were limited in the kind of work and other activities that they could do, and 40% found that it took extra effort to perform their work. Fifty‐one per cent experienced moderate, severe or very severe dysmenorrhoea. Quality of life was statistically poorer in patients with vWD, menstrual scores> 100 according to the pictorial blood assessment chart (PBAC), those who had periods ≥8 days and those who experienced flooding or passage of clots. In conclusion, menstruation has a negative effect on the quality of life in patients with inherited bleeding disorders especially in those with objectively confirmed menorrhagia.
Factor VIII immunogenicity
Authors: Lee C. A. , Kessler C. M. , Varon D. , Martinowitz U. , Heim M. , JACQUEMIN M. G. , SAINT‐REMY J.‐M. R.
Published: March 2003

Summary. The immunogenicity of factor VIII depends on the interaction of multiple parametres including host susceptibility and characteristics of the factor VIII preparations. We briefly review here the basic mechanisms by which tolerance to self is established, maintained, and possibly broken in the context of haemophilia A, with special emphasis on the severity of the disease. Reference is also made to the situation observed in healthy individuals and patients with autoantibodies to factor VIII.
Immune tolerance: a synopsis of the international experience
Authors: Lee C. A. , Kessler C. M. , Varon D. , Martinowitz U. , Heim M. , DI MICHELE D. M.
Published: March 2003

Summary. Because of the increased morbidity and cost of care associated with inhibitor development, immune tolerance therapy (ITT) is of crucial value in the care of haemophilia. The 24‐year experience with this modality, primarily in the treatment of factor VIII inhibitors, has included the use of both high and low doses of clotting factor, with and without immune modulation. Overall success rates for ITT in haemophilia A have been similar (63–83%), while median time to IT has been variable (1.2–24 months). The role of type and purity of clotting factor used remains unclear. Three immune tolerance registries have suggested the potential importance of treatment parameters such as pre‐induction inhibitor titer and daily factor dose in the prediction of successful outcome. Ultimately, prospective randomized studies of ITT are required to definitively compare therapeutic regimens with respect to efficacy, safety, and cost effectiveness.
Counselling about diagnosis and inheritance of genetic bleeding disorders: haemophilia A and B
Authors: MILLER RIVA
Published: March 2003

Genetic counselling remains an important part of comprehensive haemophilia care despite the improved outlook and quality of life for those who can obtain factor replacement concentrates. Eighty per cent of the world's population with haemophilia have limited or no treatment. It is vital that information about inheritance is made available to them. Genetic bleeding disorders impact on the daily life and psychological health not only of the affected individual, but on carriers and close family. Informed decisions about childbearing (when there is a risk of haemophilia) require knowledge about inheritance, antenatal diagnosis possibilities and consideration of selective abortion. Genetic counselling touches on sensitive issues related to childbearing, handicap and continuation of the family. Guilt, resentment and blame can be reduced if couples are enabled to gain insight into each others views and wishes in a neutral setting. Counsellors need technical knowledge, skills and clarity of purpose to carry out this task.
Bleeding problems in factor XI deficient women
Authors: Bolton‐Maggs
Published: March 2003

Factor XI deficiency affects both sexes. Some bleeding problems are specific to women, and have been overlooked in the past. Women with factor XI deficiency are prone to menorrhagia and to bleeding complications after childbirth. These may occur in women with partial deficiency, as well as in those with severe deficiency. Instrumental delivery and gynaecological surgery need careful planning in such women with close collaboration between the obstetrician and haematologist.
Carrier detection in haemophilia A families: comparison of conventional coagulation parameters with DNA polymorphism analysis – first report from India
Authors: Shetty  , Ghosh  , Pathare  , Mohanty
Published: March 2003

Linear discriminants that include data on factor VIII:C and von Willebrand factor antigen levels are well‐established tools in estimating the probability of carriership in haemophilia A families. A comparison between the conventional coagulation data, i.e. the ratio of factor VIII:C and von Willebrand factor antigen, and the DNA analysis techniques was made in 98 confirmed carriers (39 obligatory, 69 detected by gene tracking analysis) and 71 normal age matched females who did not have any history of bleeding and were not taking any drug. The lowest misclassification rate, i.e. 7% among the carriers, was seen when a cut‐off value of 0.7 was chosen. In the case of normals, all were outside this cut‐off value. Thus, it was considered as a workable reference value for classifying the carriers in haemophilia A families in our laboratory. We conclude that the optimal service for haemophilia A carrier diagnosis must include above coagulation test probabilities as well as DNA marker studies. However, it is recommended that the smaller laboratories in developing countries can benefit immensely by only establishing factor VIII:C and von Willebrand factor antigen estimation.
The economic aspects of hepatitis C – implications for haemophilia
Authors: Roberts
Published: March 2003

This paper considers the literature relating to the course of hepatitis C infection and its implications for those with haemophilia. It goes on to discuss a model that assessed the economic aspects of treating hepatitis C cases with interferon‐α, discusses recent changes in recommended treatment of hepatitis C and critically reviews the model and its application to patients with haemophilia.