bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of Thoracic Outlet Syndrome: Long‐term Results
Authors: Athanassiadi Kalliopi , Kalavrouziotis Georgios , Karydakis Kleanthis , Bellenis Ion
Published: October 2003

Thoracic outlet syndrome (TOS) refers to a complex of symptoms in the upper extremity caused by compression of the neural and vascular structures at some point between the interscalene triangle and the inferior border of the axilla. A review of our experience in treating this controversial syndrome is presented. Between 1989 and 1997 a series of 23 patients (5 men, 18 women) were operated on for TOS. The average age of the patients was 26.4 years (range 17–60 years). All patients complained of pain typically in the shoulder and proximal upper extremity with radiation to the neck, and most had paresthesias and numbness in the forearm and hand. Their symptoms had been present for 8 months to 9 years (mean 2.6 years). All were evaluated by history, physical examination, radiographs of the chest and cervical spine, electromyography, and nerve conduction studies; computed tomography, magnetic resonance imaging, angiography, and myelography were conducted selectively. When TOS was suspected, a cooperative concept was utilized employing the aid of the neurologist, orthopedist, and occasionally a cardiologist. The initial treatment was physical therapy for a minimum of 6 weeks. If no relief occurred they underwent surgery. In all patients in the present series the first rib was removed through a transaxillary approach. A cervical rib was also removed in four cases. Postoperatively, they were evaluated by questionnaire and reexamination. Nineteen (82.6%) had complete relief, and four had partial relief of symptoms. Complications included pneumothorax and temporary brachial paralysis in one case each. We concluded that careful selection of patients for surgery can yield satisfactory results, and a coordinated team of thoracic surgeons, neurologists, and physical therapists is important for management of these patients.
Surgical Management of Duodenal Leiomyomas
Authors: Rice David C. , Bakaeen Faisal , Farley David R. , Unni K. Krishnan , van Heerden Jon A.
Published: October 2003

Duodenal leiomyomas are rare neoplasms and when present are usually asymptomatic. There are, however, isolated case reports of such leiomyomas giving rise to complications including gastrointestinal hemorrhage and obstruction. The purpose of this study was to review the surgical experience with duodenal leiomyomas at a large tertiary referral center. A retrospective review was performed of all patients with histologically proven duodenal leiomyomas encountered from 1975 to 1995. Twelve patients with surgically treated duodenal leiomyomas were identified. There were eight men and four women with a mean age of 57 years (range 20–73 years) at diagnosis. Anemia was the presenting sign in 10 patients (83%). The mean hemoglobin level at presentation was 10.8 ± 2.67 g/dl. Other presenting signs included melena (n= 5) and epigastric tenderness (n= 4). No patient had obstructive symptoms. Upper endoscopy visualized the lesion in 9 of 10 patients, but endoscopic biopsy provided an accurate histologic diagnosis in only two of six patients biopsied. All resected specimens underwent frozen section and permanent histopathologic analysis. Local excision was performed in eight patients, as benignancy was anticipated at surgical exploration and frozen section findings. Two patients underwent segmental duodenal resection with primary end‐to‐end anastomosis, and two patients underwent a Whipple procedure. There was no perioperative mortality. Morbidity was minimal. There was no tumor recurrence during a median follow‐up of 8.4 years. Gastrointestinal blood loss is the most common complication of duodenal leiomyomas requiring surgical intervention. Small symptomatic leiomyomas with benign features may be safely treated with local excision.
Fluorodeoxyglucose positron emission tomography for detection of recurrent or metastatic breast cancer
Authors: Kim Tae‐Seon , Moon Woo Kyung , Lee Dong‐Soo , Chung June‐Key , Lee Myung Chul , Youn Yeo‐Kyu , Oh Seung Keun , Choe Kuk Jin , Noh Dong‐Young
Published: October 2003

Fluorodeoxyglucose‐positron emission tomography (FDG‐PET) is a noninvasive imaging technique capable of identifying primary tumors and metastases with high sensitivity and accuracy. The aim of this study was to evaluate the diagnostic accuracy of whole‐body FDG‐PET imaging for the detection of recurrent or metastatic breast cancer after surgery. Whole‐body FDG‐PET imaging was performed on 27 patients with suspected recurrent breast carcinoma. PET images were evaluated qualitatively for each patient and lesion. FDG‐PET scans showed that there were 61 reference sites of malignant or benign lesions in 27 patients. In a patient‐based analysis, FDG‐PET scans correctly identified 16 of 17 patients with recurrent or metastatic disease and 8 of 10 without recurrence, resulting in a sensitivity, specificity, and accuracy of 94%, 80%, and 89%, respectively. In a lesion‐based analysis, FDG‐PET scans correctly identified 46 of 48 lesion sites with recurrent or metastatic disease and 11 of 13 without recurrence. The overall sensitivity, specificity, and accuracy for all lesion sites were 96%, 85%, and 93%, respectively. FDG‐PET scans revealed unsuspected recurrent or metastatic diseases in 8 of 27 (30%) of patients and 11 of 20 (55%) distant metastatic lesions. In 13 patients treatment was altered by the outcome of the PET scan. We concluded that whole‐body FDG‐PET scan is a useful diagnostic imaging modality for detecting recurrent or metastatic breast carcinoma in patients suspected of having recurrent disease after primary surgery.
Improved Survival with Early Fluid Resuscitation Following Hemorrhagic Shock
Authors: Santibanez‐Gallerani Alberto S. , Barber Annabel E. , Williams Shelley J. , Zhao Yan , Shires G. Tom
Published: October 2003

Recent studies have questioned the benefits of early fluid resuscitation in hemorrhagic shock. The purpose of the current study is to evaluate the effects of early fluid resuscitation (HSE) (15 minutes), delayed fluid resuscitation (HSD) (60 minutes), and no fluid resuscitation (HSU) on cytokine levels, hepatic resting membrane potential (Em), renal function, and mortality. Eighty male Sprague‐Dawley rats (350–450 g) were hemorrhaged 35% of their total blood volume and then received 40, 80, or 100 ml of crystalloid per kilogram as intravenous fluids (IVFs). The implementation of HSE resulted in stabilization of the Em (−29 mV), which was significantly different from that seen with HSD or HSU (−24 and −29 mV, respectively). The timing of resuscitation did not affect the elevation of tumor necrosis factor (TNFα) levels. The interleukin‐6 (IL‐6) levels for the HSE group were 81, 101, and 274 pg/ml for 40, 80, and 100 ml/kg, respectively. In contrast, HSD group IL‐6 levels were 440, 566, and 632 pg/ml for 40, 80, and 100 ml/kg (p < 0.0001). IL‐6 levels for the HSU group was 427 pg/ml, which was significantly different from that of the HSE group (p < 0.05). Urine output was present in 58% of the HSE rats but only 24% in the HSD rats and 0% of the HSU rats. Mortality was 11% for HSE, 58% for HSD, and 50% for HSU rats. Despite the recent studies questioning the benefits of early fluid resuscitation, these data show marked improvement in hepatic stability, the presence of urine output, decreased IL‐6 levels, and significantly lower mortality when IVFs were given early after hemorrhagic shock. Furthermore, excessive fluid resuscitation (100 ml/kg) resulted in an increased inflammatory cytokine level and mortality and may account for the controversy.
Difference in Patterns of Met Expression in Papillary Thyroid Carcinomas and Nonneoplastic Thyroid Tissue
Authors: Fluge Øystein , Haugen Dagny R.F. , Lillehaug Johan R. , Varhaug Jan E.
Published: October 2003

Met protein is a tyrosine kinase receptor for hepatocyte growth factor (HGF). c‐Met has morphogenic, mitogenic, and motogenic properties and is overexpressed in many solid tumors. We studied c‐met mRNA and protein expression in papillary thyroid carcinomas and nonneoplastic thyroid tissue. The c‐met mRNA was detected in all biopsies by reverse transcriptase‐polymerase chain reaction and by hybridization of complex cDNA probes to a c‐met‐specific DNA fragment in a dot blot array. Immunohistochemistry on fresh frozen biopsies showed Met protein localized along the basal cell membrane of normal thyrocytes in 32 of 35 nonneoplastic thyroid tissue specimens, sometimes associated with weak cytoplasmic reactivity but without apical cell membrane staining. In papillary carcinomas an increased Met protein expression was seen, comprising a cytoplasmic (33 of 49) and apical cell membrane (24 of 49) immunoreactivity, whereas only 1 of 49 biopsies showed basal cell membrane staining. A 145‐kDa Met‐specific band was detected by Western immunoblotting on protein extracts from papillary carcinomas. The tight junction protein zona occludens‐1 (ZO‐1), studied by immunohistochemistry, was weakly expressed along the apical cell membrane in 10 nonneoplastic biopsies. In contrast, increased and cytoplasmic/apical membranous ZO‐1 immunostaining was seen in 11 of 15 papillary carcinomas. Nuclear ZO‐1 staining was present in a few papillary carcinomas with partial dedifferentiation. The concomitant overexpression and subcellular redistribution of Met and ZO‐1 proteins indicate a change in cell polarity in papillary carcinomas compared to nonneoplastic thyroid tissue. These observations may reflect an important feature of the tumorigenesis of papillary thyroid carcinomas. No significant association was found between semiquantitative immunohistochemical assessment of Met protein and clinical parameters in papillary carcinoma patients.
Calcium ions as a factor of cell—cell cooperation in hepatocyte cultures
Authors: Brodsky Vsevolod Y. , Zvezdina Natalia D. , Nechaeva Natalia V. , Avdonin Pavel V. , Novikova Tatjana E. , Gvasava Inessa G. , Fateeva Valentina I. , Malchenko Ludmila A.
Published: October 2003

Ultradian protein synthesis rhythm was used as a marker of cell cooperation in synchronous dense and non‐synchronous sparse hepatocyte cultures. Phenylephrine (2 μM, 2 min), an α 1‐adrenoreceptor agonist, which exerts [Ca2+]cytelevation from intracellular stores, affected protein synthesis rhythm in sparse cultures, i.e. initiated cooperative activity of the cells. The same effect was produced by 2,5‐di(tertiary‐butyl)‐1,4‐benzohydroquinone (10 μM, 2 min), which increases [Ca2+]cytby a non‐receptor pathway. Pretreatment of dense cultures with the intracellular calcium chelator, 1,2‐bis (2‐aminophenoxy) ethane‐N,N,N′,N′‐ tetraacetic acid (acetoxymethyl) ester (BAPTA‐AM) at 10–20 μM for, 30–60 min resulted in loss of the rhythm of protein synthesis, i.e. loss of cooperative activity between the cells. The medium conditioned by control dense cultures initiated rhythm in sparse cultures, whereas the conditioned medium of cultures pretreated with BAPTA‐AM did not. [Ca2+]cytincrease is known to occur with monosialoganglioside GM1 treatment. By ELISA estimation, the GM1 content in 3 h conditioned medium was similar in control dense cultures to that in cultures pretreated with BAPTA‐AM. Bearing in mind data on the Ca2+‐dependence of vesicle formation and shedding, the conditioned medium was separated by 150,000 g centrifugation to supernatant containing monomers and micelles, and a pellet containing vesicular form of gangliosides. Only the latter initiated cooperative activity of the cells of sparse cultures. These cultures were also synchronized by GM1‐containing liposomes at lower concentrations than added free GM1, 0.0003 and 0.06 μM respectively. Thus, GM1 and calcium are both involved in cell—cell synchronization. Activation of gangliosides, including GM1 and elevation of [Ca2+]cyt, is known to lead to changes of protein kinase activity and protein phosphorylation resulting in modulation of oscillations in protein metabolism.
A multilevel analysis of factors affecting pocket probing depth in patients responding differently to periodontal treatment
Authors: Axtelius B. , Söderfeldt B. , Attström R.
Published: October 2003

Abstract. 3 distinct levels are involved in the periodontal inflammatory process: site, tooth, and individual. By focusing attention on the levels in the population, multilevel or hierarchical modelling (MLM) enables the researcher to understand where and how the effects at the levels involved are occurring. The aim of this paper is therefore to analyse the progression of periodontal disease using analytical models that consider the level hierarchy. 22 patients with periodontitis, in previous reports described as either non‐responsive or responsive to periodontal treatment, were investigated. In the multilevel modelling method (MLM), the site pocket probing depth (PPD) is summarised in 3 parameters: the overall mean, the between‐individual variance, and the within‐individual, between‐site variance. The model can readily be extended to include independent variables for sites, teeth and individuals. If these variables are important determinants of PPD, their inclusion in the model will lead to a reduction in residual variances between sites, teeth and individuals. The PPDs were used for construction of a PPD change variable (cPPD). This variable, together with the final registrations of PPD (fPPD) alone, were used as dependent variables in the MLM. Independent predictor variables, 12 on site‐level, 3 on tooth‐level, and 19 on individual‐level, were constructed. The total number of sites assessed was 2236 distributed on 559 teeth in 22 subjects. Initially, a fixed, fully unconditional model (models A and E) was assessed, where no predictor variables were specified at any level. Different random‐intercept models (B‐D, F‐H) were then calculated where the independent variables were inserted in blocks relating to each level. The variance components at all 3 levels were significantly larger than zero. This indicates that MLM is recommended for analysing the present data. The inserted predictors showed 100% sensitivity relating to the subject‐level variance. Subsequent testing of the patient with disease or at high risk of disease would have to focus on diagnostic tests aimed at the individual teeth and sites. These tests would need to have a balance of sensitivity and specificity. Thus, by using multilevel modelling, the theoretical understanding of important factors in the pathogenesis of periodontitis is stimulated.
A comparative study of the Philips HP 735, Braun/Oral B D7 and the Oral B 35 Advantage toothbrushes
Authors: Heasman P. A. , Stacey F. , Heasman L. , Sellers P. , Macgregor I. D. M. , Kelly P. J.
Published: October 2003

Abstract. The aim of this 3‐group, 3‐treatment, single‐blind, parallel group study was to evaluate and compare the efficacies of the Philips/Jordan HP 735 powered toothbrush, the Braun/Oral B D7 powered toothbrush and the Oral B Advantage B35 manual toothbrush in a cohort of 75 young adults (18–25 years). Following an appointment for screening, full mouth mean (±sd) modified Turesky plaque index (PI) and Löe & Silness gingival index (GI) were recorded at baseline. After 24 h abstinence from all oral hygiene measures, PI was recorded and each subject was given one of the test brushes with detailed instructions for use. The subject then brushed under supervision for 90 s, during which time mean (±sd) toothbrushing forces (TBF) were recorded. PI were recorded immediately after supervised brushing and the subjects were then discharged for 6 weeks to use the allocated toothbrush at home. After 6 weeks, PI, GI and TBF were again recorded. Comparisons between the brushing groups for all parameters, at baseline, 24 h and 6 weeks were tested using ANCOVA. There were no significant differences for PI and GI between groups at baseline, or for PI following supervised brushing at 24 h. After 6 weeks subjects using the powered brushes had lower mean PI (±sd) scores than those using manual brushes but the differences were significant only at interproximal sites; HP 735 1.44 (0.52), D7 1.44 (0.53), B35 1.75 (0.51) (p=0.05). At 6 weeks, mean (±sd) GI were; HP 735 1.49 (0.21), D7 1.61 (0.21), B35 1.64 (0.22) (p=0.033). Mean GI scores for the HP 735 group were similar at baseline and at 6 weeks although for the other brushes, the GI scores actually increased over this period. Mean (±sd) TBF (grammes/force) at baseline and 6 weeks respectively for the brushes were; HP 735 233 (205), D7 159 (58), B35 279 (122) (p=0.026): HP 735 194 (86), D7 141 (57), B35 297 (113) (p=0.0001). The within‐group variability for the HP 735 TBF reduced considerably over 6 weeks, a likely consequence of the click‐force threshold feature of this brush.
Some effects of periodontal therapy on local and systemic immunological parameters
Authors: Berglundh T. , Liljenberg B. , Lindhe J.
Published: October 2003

Abstract. The aim of the present investigation was to study the effect of nonsurgical periodontal therapy on some local (gingival) and systemic host defense characteristics in subjects with advanced periodontal disease. 16 individuals with advanced periodontal disease were recruited. Following a clinical examination, the 3 deepest interproximal sites in the upper and lower premolar‐ or molar segments were selected for further analysis. Samples from the subgingival microbiota were obtained from the pocket of the selected sites and were prepared for a microbiological examination. The gingival tissue at one of the selected sites was also biopsied. Each excised soft tissue specimen was snap frozen and prepared for immunohistochemical analysis. A sample of peripheral blood was obtained from each individual and prepared for immunohistochemical analysis. Following the baseline examination, all 16 patients received periodontal therapy including oral hygiene instruction and scaling and root planing. Re‐examinations regarding the clinical parameters were performed, the subgingival microbiota harvested from the sampling sites and one gingival biopsy was collected at 12 months and 24 months, respectively, among the selected sites. Samples of peripheral blood were obtained from the subjects at the 24‐month re‐examination. It was demonstrated that non‐surgical periodontal therapy effectively reduced symptoms such as gingivitis and probing pocket depth in the subject sample and improved the overall probing attachment level. The treatment applied also markedly reduced (i) the total number of micro‐organisms present in selected gingival pockets as well as (ii) the relative proportions of A. actinomycetemcomitans, P. gingivalis and P. intermedia of the subgingival microbiota. The improved clinical condition was, in addition, accompanied by a substantial reduction in the size of the inflammatory lesion (P‐ICT) which in the soft tissue samples harvested at baseline was found to reside lateral to the pocket epithelium. Also qualitative alterations occurred in the lesions. Hence, following therapy (i) both the density of CD19 positive cells and the proportion of CD3 positive cells expressing TCR Vb genes were reduced in the P‐ICT, while (ii) the overall relative number of CD3 positive cells remained unchanged. In conclusion, non‐surgical periodontal therapy markedly changed the size and composition of the plaque associated lesion in the gingival tissue but apparently failed to affect the relative distribution of lymphocyte subsets in peripheral blood.
An in vitro assessment of the dentine lost during instrumentation using the Periosonic® system
Authors: Rees J. S. , Addy M. , Hughes J.
Published: October 2003

Abstract. This study investigated the ability of a new instrument designed for root debridement, the Periosonic®, to remove dentine compared to a hand curette and an ultrasonic scaler. The Periosonic system is a modification of the Micro‐Mega® endodontic system and uses modified files to remove plaque, calculus and tooth substance. The Periosonic® has 2 file types; the Periosonic 1 is a more aggressive file for the removal of gross supra‐ and subgingival deposits, while the Periosonic 2 is a thinner more flexible file used for the removal of subgingival deposits. 40 human dentine specimens were ground flat and baseline measurements were made using a surfometer. The specimens were divided into 4 experimental groups and each group was treated with a hand curette, ultrasonic scaler, Periosonic 1 or 2 using 12, 1‐s strokes. The specimens were remeasured blind in the surfometer. The curette removed 23.6 μm of dentine, the ultrasonic 6.8 μm, the Periosonic 1 18.8 μm and the Periosonic 2 12.5 μm. A qualitative assessment of the samples following mechanical preparation was also made. In conclusion, the Periosonic® instrument does not remove more tooth substance than a conventional curette and may be a useful addition for the debridement of root surfaces.
Plaque regrowth studies: discriminatory power of plaque index compared to plaque area
Authors: Addy M. , Renton‐Harper P. , Newcombe R.
Published: October 2003

Abstract. A large number of plaque‐scoring methods exist for the evaluation of plaque inhibition by oral hygiene agents, products or devices. The ability of such methods to discriminate between high and low plaque scores has not been compared. In this retrospective analysis, the F‐ratios for differences between treatments for plaque index and area were compared from 15, 4‐day plaque regrowth studies. F‐ratios favoured plaque index as having greater a discriminatory power compared to plaque area in 2/3 of the studies considered. It is concluded that, when appropriate, 2 scoring methods for plaque should be used, but if a choice is necessary, plaque index is likely to provide the greater discriminatory power over plaque area.
Comparison of periodontal pocket penetration by conventional and microultrasonic inserts
Authors: Clifford Lester R. , Needleman Ian G. , Chan Yoong Kian
Published: October 2003

Abstract. Recently, 'microultrasonic' instruments have been developed with the aim of improving root‐surface debridement. Whilst their reduced tip diameter and modified shape suggests that they may penetrate the periodontal pocket more easily than conventional inserts, there have been few studies investigating their efficacy. The aim of this investigation was therefore to compare the periodontal pocket penetration of a conventional ultrasonic insert (P10 insert – Dentsply) with microultrasonic inserts (Slimline FSI left and right – Dentsply). Efficacy of penetration was assessed by a modification of instrument limit. This modification permitted measurement of the linear % removal of the apical plaque border by image analysis. Debridement was carried out on randomly allocated surfaces of 30 teeth which had been treatment planned for extraction due to periodontitis. One surface on each tooth acted as an untreated control. The results of this study showed that both types of insert were able to reach and debride the apical plaque border, and at all pocket depths assessed. However no significant differences were found between the Slimline insert and the P10 tip. Trends between instruments were observed which suggest that the Slimline insert might more easily penetrate to and debride the apical plaque border in deep pockets, whereas the P10 insert might be more effective in disrupting the apical plaque border in shallow pockets. Future investigations using a larger sample size will be needed to confirm these observations.
Spontaneous uterine rupture during delivery in a patient who had previously undergone laparoscopic myomectomy
Authors: Jakiel Grzegorz , Sobstyl Małgorzata , Swatowski Dariusz
Published: October 2003

ABSTRACT Introduction  Following laparoscopic myomectomy, uterine rupture during pregnancy or delivery in the area of the scar is a very rare but dangerous complication. Individual cases of uterine rupture during pregnancy are described in the literature.

Setting  University Teaching Hospital.

Material  Casereport of uterine rupture after delivery in a patient who had previously undergone laparoscopic myomectomy. In the case presented here, the patient conceived 2 months after an 8‐cm subserous myoma with a pedicle had been laparoscopically removed.

Intervention  No symptoms suggesting uterine rupture were observed during the pregnancy. Spontaneous vaginal delivery was under way, but in the third stage of delivery the condition of the patient deteriorated and symptoms of oligaemic shock developed. A laparotomy was performed, which showed the presence of blood in the peritoneal cavity and ruptured uterine muscle in the scarred area about 5 cm.

Conclusions  In patients who have previously undergone a laparoscopic myomectomy, there is some risk of uterine muscle rupture at delivery. This is also the case where no suturing of the uterine muscle had been required.
Laparoscopic mesh colposuspension in the treatment of stress and mixed incontinence: clinical and urodynamic outcomes
Authors: Valpas Antti , Kivelä Aarre
Published: October 2003

Objective  The purpose of this study was to evaluate the results of laparoscopic mesh colposuspension as a treatment for stress incontinence and mixed incontinence.

Subjects  Data on the first 40 patients to undergo the operation at Oulu University Hospital were collected retrospectively.

Main outcome measures  The primary end‐points were quality of life (QoL) measured by using standardized questionnaires, and urodynamic findings.

Results  The subjective cure rate was 90%. There were six (15%) bladder perforations, which were successfully treated and which left no sequelae. Significant improvement was seen in QoL measurements. No significant changes were noted in urodynamic parameters.

Conclusions  The short‐term results of laparoscopic mesh colposuspension were comparable with those of open operations. Laparoscopic colposuspension significantly improved QoL scores among both stress and mixed incontinence patients and simultaneously significantly reduced associated urge symptoms. However, the high incidence of serious complications casts doubt on the acceptability of this technique.
Are women able to void to completion prior to laparoscopy?
Authors: Greenland Hugh , Granne Ingrid
Published: October 2003

Objective  To establish the amount of urinary residuals in women who are asked to void immediately prior to laparoscopy.

Design  Prospective observational study.

Setting  A district general hospital.

Subjects  A total of 97 women undergoing elective diagnostic laparoscopy.

Outcome measure  The amount of urinary residual measured at catheterization prior to laparoscopy.

Results  A total of 97 urinary residuals were measured. The average volume was 28 ml. The median volume was 15 mL. Only two women (2%) had urinary residuals above 100 ml.

Conclusions  Under appropriate conditions, the majority of women are able to void to completion prior to laparoscopy.
Hysterectomy: a personal audit of an evolving practice
Authors: East Michael
Published: October 2003

Objective  To investigate the author's evolving practice of hysterectomy with respect to the introduction of advanced laparoscopic surgical techniques.

Design  A retrospective case study.

Setting  The Oxford Clinic, St George's Hospital and Southern Cross Hospital, Christchurch, New Zealand.

Subjects  A total of 863 patients who underwent hysterectomy during the period January 1992 to May 2001.

Results  Over the study period the proportion of hysterectomies performed by laparoscopic assistance gradually increased to 100%. In addition it was observed that the short‐term complication rate of 3.5% for laparoscopically assisted vaginal hysterectomy (LAVH) was significantly lower than those for vaginal hysterectomy (13.6%, P < 0.0001) and abdominal hysterectomy (11.5%, P = 0.002). The long‐term complication of adhesions requiring adhesiolysis was higher for patients undergoing abdominal hysterectomy, at 6.1% vs. 3.1% for vaginal hysterectomy and 3.7% for LAVH, but these differences were not significant. From 1993 until the introduction of the manipuseal© technique in May 1996, there was no significant difference in operating times across the years (P = 0.32, mean 139.2 min). However the mean time declined in every succeeding year after 1996, from 137.2 min in 1996 to 75.2 in 2001 (P < 0.0001). Inpatient stay was shorter for the LAVH patients than for either vaginal hysterectomy or abdominal hysterectomy patients, especially if a day surgery unit was used.

Conclusion  LAVH is associated with less short‐term morbidity and a faster recovery rate than either abdominal hysterectomy or vaginal hysterectomy. If this is wanted, 100% of hysterectomies performed to treat benign pathology can be carried out laparoscopically when the author's method of surgery is employed. It is believed that this is the first publication to demonstrate this possibility.
Umbilical Richter's hernia: unusual early complication of gynaecological laparoscopic surgery
Authors: Edi‐Osagie Edmond
Published: October 2003

Case  A 39‐year‐old lady undergoing her fourth laparoscopy developed a 5‐cm Richter's hernia of the small bowel through the umbilical port site. Its diagnosis was difficult and this resulted in delay in treatment.

Conclusions  Post‐laparoscopy incisional hernias are uncommon, occurring mostly with ports of 10 mm and above, and at the umbilical site. Their occurrence is not influenced by the surgeon's experience. Predisposing factors include previous laparoscopies, extensive manipulation during surgery, increased intra‐abdominal pressure, obesity, use of sharp cutting‐tip trocars, rapid abdominal deflation at the end of surgery, poor port removal techniques and defective closure of the abdominal fascia. The diagnosis is often delayed because most cases present late, and treatment might be instituted along other lines. Computed tomography scans are helpful in its diagnosis and will facilitate prompt treatment to avoid the grave consequence of bowel gangrene.
Endometriotic ovarian cysts: the case for excisional laparoscopic surgery
Authors: Maouris Panos , Brett Lincoln
Published: October 2003

Objective  To review the evidence comparing laparoscopic excision with laparoscopic ablation for endometriotic cysts.

Design  Review of the current literature.

Background  Endometriotic cysts can be managed laparoscopically by stripping and excising, or by ablation.

Main outcome measures  Symptom relief, post‐procedure fertility and cyst recurrence rates.

Results  With ablative techniques, there are concerns about thermal damage to the underlying follicles, incomplete destruction of endometriotic tissue, overdiagnosis of endometriosis in cases of functional haemorrhagic cysts and missed diagnosis in cases of malignancy. The limited comparative data available demonstrate that the clinical outcomes in terms of symptom relief, pregnancy rates and cyst recurrence, are significantly better with excision when compared with ablation.

Conclusions  There is evidence to suggest that laparoscopic excision is superior to ablation in all the important clinical outcomes. There are also theoretical advantages of excision over ablation, with no demonstrable disadvantages.
Surgically induced hormonal, metabolic and inflammatory changes in laparoscopic hysterectomy: a comparison with abdominal hysterectomy
Authors: Holub Zdenek , Jabor Antonín , Šprongl Ludìk , Kliment Lev , Fischlová Drahomíra , Urbánek Štepán
Published: October 2003

Objective  To assess and compare surgically induced hormonal, metabolic and inflammatory changes during laparoscopic and abdominal hysterectomy.

Setting  Baby Friendly Hospital, Kladno, Postgraduate Medical Institute, Prague.

Design  77 women, with no major medical disorder but requiring hysterectomy for benign diseases, were prospectively assigned to undergo laparoscopic (n = 59) or abdominal hysterectomy (n = 18). Surgical characteristics, hospital stay and complications were analysed. Blood samples for assay of markers of tissue trauma (C‐reactive protein (CRP), interleukin‐6 (IL‐6), creatine kinase, cortisol, white blood cell count (WBC) and cystatin C) were taken preoperatively and on the first and third postoperative day.

Results  There were no differences between the two groups with regard to demographic characterics, but the mean uterine weight was 220 g in the laparoscopic hysterectomy group vs. 540 g in the abdominal hysterectomy group, (P < 0.0001). The median (interquartile range) operating time was 80 min (70–90 min) in the laparoscopic group and 105 min (80–120 min) in the abdominal group (P < 0.05). For the laparoscopic hysterectomy and abdominal hysterectomy groups, respectively, the estimated blood loss was 100 ml (95–200 ml) and 300 ml (250–2000 ml) (P < 0.0001), the median length of hospital stay was 4 days (3–4 days) and 8 days (7–10 days) (P < 0.0001), and the decline in the haemoglobin level was 0.9 and 2.45 g dl−1 on the third postoperative day (P < 0.001). Preoperative levels of biochemical markers were low in both groups. The rates of major and moderate complications were found to be low in the groups under comparison. One woman with a ureteral injury was excluded from the laparoscopic group for purposes of statistical analysis. There were significant increases in the serum concentrations of cortisol, CRP, IL‐6, creatine kinase and WBC after surgery in both groups. The laparoscopic group demonstrated a less intense stress response in terms of IL‐6 (P < 0.0001), CRP (P < 0.0001), creatine kinase (P < 0.001), cortisol (P < 0.05) and WBC (P < 0.001). Plasma concentrations of cystatin‐C decreased insignificantly during the first postoperative day.

Conclusion  Compared with abdominal hysterectomy in women with pelvic disorders, laparoscopic hysterectomy was associated with a less intense hormonal, metabolic and inflammatory reponse and a more favourable clinical outcome.
Classical intrafascial supracervical hysterectomy (CISH): laparoscopy or laparotomy?
Authors: Al Lakkany Naser S. , Badawy Ahmed M. , El Gohary Alaa , El Gharib Mohamed E.
Published: October 2003

Objectives  To compare the short‐term outcomes of Semm's classic intrafacial supracervical hysterectomy (CISH) via laparoscopy and laparotomy.

Methods  A prospective study of 43 women undergoing hysterectomy were recruited to have CISH and were allocated to either laparoscopy (18 women) or laparotomy (25 women). The study was performed in Department of Obstetrics & Gynecology, Mansoura University, Egypt.

Results  Women in both groups were matched regarding age, parity, body weight and previous abdominal surgery. There were no significant intraoperative complications in both groups operative blood loss was insignificantly more in the laparotomy group and the operative time was significantly longer in the laparoscopic group. Resumption of normal bowel function and oral feeding was significantly more rapid in the laparoscopic group. Hospital stay was significantly shorter and resumption of the normal activity was significantly more rapid in the laparoscopy group.

Conclusion  CISH represents a novel and a very smart alternative to the traditional hysterectomy. The issue of route selection is left to the operator's perference.
Transcervical endometrial resection: is it really a simple solution for a major problem?
Authors: Arslan Selcuk , Bettocchi Stephano , Van Herendael Bruno
Published: October 2003

Objectives  To determine the long‐term efficacy of transcervical resection of the endometrium (TCRE).

Design  Prospective long‐term follow‐up study.

Setting  Academic practice tertiary care setting.

Patients  116 concecutive women undergoing endometrial resection because of menorrhagia, who wished to retain the uterus.

Intervention  Hysteroscopic endometrial resection performed as a day procedure.

Main outcome measures  Long‐term assessment was on the basis of menstrual symptoms and patient satisfaction, and a questionnaire was used that included open‐ended and closed questions.

Results  116 endometrial resections were carried out. The satisfaction rate varied from 75% to 70% over 5 years. At 1 year, 40% of women were amenorrhoeic. Larger uterine size, young age and adenomyosis were factors associated with negative outcomes. After initial TCRE, 20 women required further surgery, menorrhagia being the most common indication.

Conclusion  Although the use of TCRE to treat menorrhagia did not avoid the need for hysterectomy in all women, for those considering hysterectomy, it was an alternative procedure that was conservative, had low morbidity and provided a good chance of avoiding the need for major surgery, especially when performed by an experienced surgeon to treat women over the age of 45.
Toll‐like receptor‐9 induced by physical trauma mediates release of cytokines following exposure to CpG motif in mouse skin
Authors: Liu Ling , Zhou Xiaohui , Shi Jianying , Xie Xin , Yuan Zhenghong
Published: October 2003

The skin plays a crucial role in defence against microbial infection via the innate immune system, but the exact cellular mechanisms of this defence are not well understood. Toll‐like receptors (TLRs), a newly recognized 10‐member family of vertebrate pattern recognition receptors (PRRs), have been identified as crucial mediators of innate immune recognition. Although both TLR2 and TLR4 have been detected in normal human skin, little is known about the expression and function of TLR9, a CpG motif receptor, in skin. In this study, reverse transcription–polymerase chain reaction and in situ hybridization analysis were used to identify TLR9 mRNA expression in mouse skin. Results showed that TLR9 mRNA was not detected in normal mouse skin, but its presence in skin could be induced by intradermal injection of either normal saline, or the bacteria‐based CpG motif in a time‐ and volume‐dependent manner. Furthermore, intradermal injection of CpG motif induced increased expression of mRNAs for proinflammatory cytokines such as interleukin (IL)‐1, IL‐6, IL‐12 and tumour necrosis factor α. This suggests that TLR9, while not present basally in skin, can be induced by physical trauma and then mediate responses to CpG motif. In conclusion, TLR9 is involved in the innate immune response in skin and that it may have a role in secondary inflammation following physical trauma such as epidermal damage or microbial infection. This role of TLR9 may help explain the previously identified enhancement of DNA immunization by CpG ODN.
Lymphocyte populations in human lymph nodes. Alterations in CD4+ CD25+ T regulatory cell phenotype and T‐cell receptor Vβ repertoire
Authors: Battaglia Alessandra , Ferrandina Gabriella , Buzzonetti Alessia , Malinconico Paolo , Legge Francesco , Salutari Vanda , Scambia Giovanni , Fattorossi Andrea
Published: October 2003

Here we provide a description of lymphocyte populations in human lymph nodes (LN) with a special emphasis on the CD4+ lymphocyte population constitutively expressing CD25 at a high level and endowed with immunoregulatory properties [T regulatory (Treg) cells]. Lymph nodes were analysed by multicolour flow cytometry in parallel with correspondent peripheral blood (PB). Immunomagnetically purified Treg cells were tested for anergy and suppressive activity in a CD3/T‐cell receptor (TCR)‐driven proliferation assay. Compared to PB, there was a reduced T/B lymphocyte ratio in LN. Both LN and PB contained a similar proportion of CD4+ lymphocytes but, conversely, CD8+ lymphocytes were less represented in PB, with a consequent increase in the ratio of CD4+/CD8+ natural killer cells were < 2% (PB range 6–22%). No significant differences existed in the frequency of the other lymphocyte subpopulations examined (naïve‐type CD4+ and CD8+ lymphocytes, activated B and CD4+ lymphocytes, and effector‐type CD8+ lymphocytes). LN and PB contained similar percentages of CD4+ lymphocytes constitutively expressing intermediate or high levels of CD25. CD4+ CD25++ cells constitutively coexpressed high levels of CD152 and were therefore identified as Treg cells. Treg cells in LN and PB differed in terms of CD45RB, HLA‐DR, CD45RO, and CD62L expression. Also the TCRVβ repertoire diverged between Treg cells from LN and PB. Similar to Treg cells from PB, Treg cells from LN were anergic and efficiently inhibited other CD4+ and CD8+ lymphocyte proliferation. This study extends the information on the diversities in lymphocyte composition between human LN and PB, and reports for the first time a description of the phenotypic and functional characteristics of Treg cells in human LN, highlighting the importance of the LN microenvironment in shaping the surface phenotype of Treg cells.
Embryonic age influences the capacity for cytokine induction in chicken thymocytes
Authors: Peters Michelle A. , Browning Glenn F. , Washington Elizabeth A. , Crabb Brendan S. , Kaiser Pete
Published: October 2003

Thymocyte responses to functional activation are of relevance to the evaluation of the efficacy of in ovo immunotherapies and vaccines in chickens. In this study we have demonstrated differences in chicken thymocyte responses according to developmental age. RNA samples from stimulated and unstimulated chicken thymocytes were assayed for messenger RNA encoding the cytokines interleukin‐1β (IL‐1β), IL‐2, interferon‐α (IFN‐α), IFN‐β, IFN‐γ and transforming growth factor‐β4 (TGF‐β4), and also components of the major histocompatibility complex (MHC), β2‐microglobulin (β2M) and the MHC class I α‐chain (MHC IA). At embryonic day 14 thymocytes were least responsive to functional activation and differences existed even between thymocyte populations at embryonic day 18 and day 1 post‐hatch. The duration of proliferation in response to stimulation was found to increase with increasing embryonic age. Mitogen stimulation of embryonic day 18 and day 1 post‐hatch thymocytes induced up‐regulation of IFN‐γ, IL‐1β and TGF‐β transcripts, and down‐regulation of IFN‐α, IFN‐β and IL‐2 transcripts, with a higher induction of IFN‐γ, IL‐1β and TGF‐β transcripts in more immature T‐cell‐receptor‐negative (TCR−) than TCR+ (TCR1+, TCR2+, or TCR3+) subsets. In contrast, in the mouse and human, both mature and immature thymocytes respond to mitogen stimulation with up‐regulation of IL‐2. Thymocytes from embryonic day 14 chicks responded to mitogen with a short burst of unsustained proliferation, and transcriptional down‐regulation of the cytokines IL‐2, IL‐1β, IFN‐α, IFN‐β and IFN‐γ. These results suggest that embryonic day 14 thymocytes are largely unresponsive to mitogen. Transcripts encoding TGF‐β and type I interferons (IFN‐α and IFN‐β) were constitutively expressed at high levels in very early thymocytes at embryonic day 14. Thymocytes at embryonic days 14 and 18 and day 1 post‐hatch responded to mitogen stimulation with up‐regulation of MHC IA transcript. The pattern of β2M transcription following mitogen stimulation was distinct from that of the globally up‐regulated MHC IA transcript, with up‐regulation of β2M transcription observed at embryonic day 18 and day 1 post‐hatch but not at embryonic day 14. In thymocyte subsets, up‐regulation of β2M transcription was found to be specific to the CD8+ TCR+ population. The balance of responses in the embryonic thymus suggests that at all stages thymocytes have a reduced capacity for activation in comparison to mature thymocyte populations.
In vivo expression of interleukin‐8, and regulated on activation, normal, T‐cell expressed, and secreted, by human germinal centre B lymphocytes
Authors: Sims‐Mourtada Jennifer C. , Guzman‐Rojas Liliana , Rangel Roberto , Nghiem Dat X. , Ullrich Stephen E. , Guret Christiane , Cain Kelly , Martinez‐Valdez Hector
Published: October 2003

T‐cell homing within germinal centres (GCs) is required for humoral B‐cell responses. However, the mechanisms implicated in the recruitment of T cells into the GC are not completely understood. Here we show, by immunohistology, and Northern and Western blots, that in vivo human GC B lymphocytes can express CxC and CC chemokines. Moreover, B‐cell subset‐specific experiments reveal that interleukin (IL)‐8 and regulated on activation, normal, T‐cell expressed, and secreted (RANTES) are predominantly expressed by GC centroblast and centrocytes, suggesting that chemokine expression is essential at stages in which B‐lymphocytes engage in active antigen‐dependent interactions with T lymphocytes. In keeping with this hypothesis, we show that the T cells recruited into the GC correlatively express the receptors for IL‐8 and RANTES. We propose that chemokine expression is a key B‐cell function that facilitates T‐lymphocyte recruitment into the GCs and supports cognate B‐cell : T‐cell encounters. Moreover, our data are consistent with the impaired homing of T cells to secondary lymphoid organs in mice that are either deficient in CC and CxC chemokines or their receptors.
Induction of protective immunity against a Chlamydia trachomatis genital infection in three genetically distinct strains of mice
Authors: Pal Sukumar , Peterson Ellena M. , De La Maza Luis M.
Published: October 2003

To establish the feasibility of inducing a protective immune response against a chlamydial genital infection in animals with different genetic backgrounds, groups of C3H/HeN (H‐2k), BALB/c (H‐2d) and C57BL/6 (H‐2b) mice, were immunized intranasally with elementary bodies (EB) of the Chlamydia trachomatis mouse pneumonitis biovar. Following the intranasal immunization strong Chlamydia‐specific humoral and cell‐mediated immune (CMI) responses were detected in the three strains of mice. Eight weeks following immunization the animals were challenged with C. trachomatis in the genital tract. Vaginal cultures showed that the three strains of mice immunized with EB were significantly protected in comparison to the sham immunized animals. To determine the ability of this immunization protocol to protect against infertility six weeks after the genital challenge the animals were mated. Mice of the three strains immunized with EB showed significant protection as demonstrated by the number of animals that were fertile, and the number of embryos present in their uterine horns, in comparison to the sham immunized mice.
Resting CD8 T cells recognize β‐galactosidase expressed in the immune‐privileged retina and mediate autoimmune disease when activated
Authors: McPherson Scott W. , Yang Jing , Chan Chi‐Chao , Dou Chunzhi , Gregerson Dale S.
Published: October 2003

Although the expression of class II major histocompatibility complex (MHC) in retina is extremely low, it is an established fact that activated CD4 T cells, specific for retinal antigens (Ags), mediate experimental autoimmune uveoretinitis (EAU). Conversely, CD8 T cells have not been shown to recognize Ag in the retina. This study investigated whether retinal‐specific Ags are detected by class I MHC‐restricted CD8 T cells. Using a CD8 T‐cell clone (β3) specific for an immunodominant epitope of β‐galactosidase (β‐gal), local Ag recognition was shown by transfer of activated β3 cells into β‐gal transgenic (Tg) mice expressing β‐gal in the retina (hi‐arr‐β‐gal mice), or in the brain and eye (GFAP‐β‐gal mice). β‐gal‐positive photoreceptor cells were damaged in the retina of hi‐arr‐β‐gal mice, and anterior segment disease was found in the eyes of GFAP‐β‐gal mice. Ag recognition by resting CD8 T cells was also evaluated. Recovery of 5(6)‐carboxyfluorescein diacetate N‐succinimidyl ester (CFSE)‐labelled β3 cells from hi‐arr‐β‐gal mice was slightly decreased compared to recovery from B10.A mice, while recovery from GFAP‐β‐gal mice was transiently increased. Conversely, recovery of CFSE− cells increased in hi‐arr‐β‐gal mice, consistent with an Ag‐dependent response. The CFSE content of the CFSE+ population was unchanged relative to β3 cells recovered from controls. Intracellular cytokine responses of β3 cells recovered from hi‐arr‐β‐gal and GFAP‐β‐gal mice correlated with the number of cells recovered, regardless of CFSE content. Even though their production of interferon‐γ and tumour necrosis factor‐α was affected little by transfer into hi‐arr‐β‐gal recipients, the ability of β3 cells to mediate delayed‐type hypersesitivity was inhibited in hi‐arr‐β‐gal mice. These results show that resting CD8 T cells are affected by the presence of Ag that originates in retina and, when activated prior to transfer, mediate pathogenic autoimmunity against retinal and other ocular targets.