bluuebunny/crossref_metadata_2025 huggingface dataset:
Should children be screened to undergo early treatment for otitis media with effusion? A systematic review of randomized trials
Authors: Butler C. C. , Van Der Linden M. K. , MacMillan H. L. , Van Der Wouden J. C.
Published: November 2003

Background  Otitis media with effusion (OME) is the most common cause of acquired hearing loss in childhood and has been associated with delayed language development and behavioural problems. Some have argued that children should be screened and treated early if found to have clinically important OME. The aim of this review was to assess evidence from randomized controlled trials about the effectiveness of screening and treating children with clinically important OME in the first 4 years of their life. The primary outcome was language development.

Methods  We searched the Cochrane Controlled Trials Register, MEDLINE and EMBASE and reference lists of all included studies in February 2003. We also contacted the first authors of the studies included in this review. Search terms included otitis media; otitis media with effusion; glue ear; OME; screen; children; treatment; language; and behaviour. Data extraction and methodological quality assessment were performed by at least two of us for each study independently, using methods described in the Cochrane Collaboration Handbook.

Results  From the three included randomized controlled trials evaluating interventions among children with OME identified through screening, we found no evidence of clinically important benefit in language development.

Conclusions  The identified randomized trials do not show an important benefit on language development from screening the general population of asymptomatic children in the first 4 years of life to undergo early treatment for OME. Screening asymptomatic children in the first 4 years of life for OME is not recommended.
Changes in feeding behaviour of the larvae of the damselfly Enallagma cyathigerum in response to stimuli from predators
Authors: KOPERSKI PAWEŁ
Published: November 2003

1. The feeding rates, diet composition and diel periodicity in feeding activity among larvae of the damselfly Enallagma cyathigerum Charp., exposed to chemical, visual and mechanical stimuli from the predators Ranatra linearis (L.), Notonecta glauca L. and Rutilus rutilus (L.) were investigated.

2. In response to chemical cues produced by all the predator species, larvae reduced their rate of feeding significantly (especially on large, sedentary prey).

3. Small larvae reacted more strongly than large ones to the kairomone produced by N. glauca.

4. The fish kairomone induced a reduction in feeding activity during daylight hours only. This reaction was more intense than the reaction to non‐chemical cues.

5. Observed predator‐induced changes in diet composition, caused directly by reduced activity during feeding, are discussed as an antipredator behaviour of damselfly larvae.
Trends in fishing indices for the thread herring fishery in northwest Mexico
Authors: RUIZ‐LUNA A. , JACOB‐CERVANTES M. , ESPARZA‐HARO A.
Published: November 2003

The initial success of the thread herring fishery in Sinaloa was followed by an increase in the mean fleet capacity, from 50 t in 1972 to 185 t in 1993. However, the efficiency (a measure of the storage utilization by a vessel), the fishing power and catch‐per‐unit‐effort (CPUE), did not increase proportionally. Efficiency showed a declining trend with the vessel’s size, and the CPUE stabilized at around 50 t vessel–1. To standardize the CPUE, a General Linear Model (GLM) incorporating fishing seasons and vessel categories was used. This model showed that the fishing power increased with time, but the differences among vessel categories were lower, ranging from 1–1.14. This model also explained 75.3% of the variation in catch rate. Analysis of the fishing indices trends suggested a reduction of the mean vessel size as the best way to improve the fishery management.
Influence of the flooding regime on the nutritional state and juvenile recruitment of the curimba, Prochilodus scrofa, Steindachner, in upper Paraná River, Brazil
Authors: GOMES L.C. , AGOSTINHO A.A.
Published: November 2003

The relationship between the flooding pattern of the Paraná river floodplain and the nutritional state and juvenile growth of the curimba, Prochilodus scrofa Steindachner, over three years and its recruitment to the Itaipu reservoir fish stocks over six years were analysed. Seasonal and annual variation in the condition factor and visceral‐somatic relationship were positively influenced by high water levels. A similar effect was found for growth during the second year of life. Recruitment success was found to be related to the occurrence of floods in summer and autumn. The importance of the annual floods to the availability of food, refuges and survival of P. scrofa are discussed in relation to the operation of the upstream dams.
Does fisheries management reflect societal values? Contingent Valuation evidence for the River Murray
Authors: BAKER D.L. , PIERCE B.E.
Published: November 2003

Non‐use value is likely to be a significant component of the total societal value of a fishery, but is rarely quantified and is not explicitly considered in most management structures. Contingent Valuation Methodology (Willingness‐to‐Pay approach) was employed to obtain estimates of the value of the lower River Murray fishery recreational and non‐consumptive sectors relative to the commercial sector. Respective estimates of $A9.6 m, $A45.2 m and $A1.1 m per annum indicate the importance of considering non‐use values in fisheries management. A parallel Willingness‐to‐Accept approach provided estimates of fishery value 8–15 times greater than the Willingness‐to‐Pay estimates. Analysis of the independent variables (age, sex, location of home residence, whether or not the respondent was a recreational angler and whether or not the respondent was a recreational angler on the River Murray) relative to the dependent Willingness‐to‐Pay estimates, revealed that the only significant explanatory variable was whether the respondent fished recreationally in this fishery. It is argued that management structure should first reflect societal values before the effectiveness of management strategies or individual mechanisms can be meaningfully assessed.
Patterns of population variability in marine fish stocks
Authors: SPENCER PAUL D. , COLLIE JEREMY S.
Published: November 2003

Exploited marine fish and invertebrate stocks fluctuate in a myriad of complex patterns, exhibiting variability on interannual, decadal, and longer time scales. To characterize various patterns of variation, time series of catch, catch per unit effort, or biomass from 30 stocks were examined with a variety of statistical methods including autocorrelation analysis and Lowess smoothing. A hierarchical cluster analysis classified the stocks into six identifiable groups: steady‐state; low‐variation, low‐frequency; cyclic; irregular; high‐variation, high‐frequency; and spasmodic. The observed patterns are consistent with life history traits; for example, stocks with high variability are generally small, pelagic species whereas low‐variability stocks are generally slow‐growing, demersal fish. Each of the six general patterns of variability can be produced from a simple multiple‐equilibrium population model by varying the intrinsic rate of population growth, and the time scale and amplitude of environmental variability. Suitable management policies depend on the type of variation observed, and the vast majority of stocks examined do not correspond to the steady‐state assumptions of classical fisheries models. For example, management of spasmodic stocks may alternate between periods of active exploitation and periods of rebuilding, a process enhanced by the existence of alternative fisheries.
Feeding by larval cod in different water‐masses on Western Bank, Scotian Shelf
Authors: McLAREN I. A. , AVENDAÑO PATRICIA , TAGGART C. T. , LOCHMANN S. E.
Published: November 2003

Gut contents were obtained from 1406 cod larvae from 94 stations in seven water masses related to a gyre around Western Bank, Scotian Shelf, 22 November–16 December 1992. Initial samples were from: well‐mixed water over the bank crest (CW); a surrounding convergent FRONT; relatively cold, fresh water (CFW) largely east of CW; warmer, salty water (WSW) west of CW and FRONT. After a storm on 3–6 December, samples were from CW and CFW displaced south‐east on the bank and, after further winds 11–12 December, from CW displaced north‐west off the bank. Zooplankton biomass (300–333 μm mesh, mostly Calanus copepodids) did not differ among water masses, but larval concentrations were significantly higher in FRONT than elsewhere. The small‐copepod diets of larvae varied among water masses, partly attributable to larval growth during the sampling period. Numbers of prey in guts, and indices of fullness and digestion, varied among water masses. More reliably, after ANCOVAs significant independent variables were: overwhelmingly time of day (maximum prey numbers and fullness at ∼19:00) and larval size; water mass; weaker interactions of the above among themselves and with sample depth and date; a very weak negative turbulence‐index effect on gut prey numbers in depth‐stratified samples. After ANCOVAs, larvae from prestorm CW had significantly higher prey numbers and fullness than did those from FRONT, WSW, and CFW. Larvae in CFW were significantly fuller when sampled closer to sites of former CW after the storm. Although numbers of prey in larvae advected off the bank in CW decreased significantly, prey averaged larger, so that gut fullness did not decrease. We conclude that larvae were best fed in the `centre' of the Western Bank gyre, but not greatly affected by subsequent displacement off the bank.
Amphibian species richness and distribution in relation to pond water chemistry in south‐western Ontario, Canada
Authors: HECNAR STEPHEN , M’CLOSKEY ROBERT
Published: November 2003

1. We assessed the patterns of amphibian species richness and distribution in relation to water chemistry over a large geographical area in 1992–94.

2. Thirteen amphibian species were observed at 180 ponds, with mean species richness 3.5 ± 0.13 species per pond (range zero to nine). Water samples were collected from 143 ponds, analysed for fifteen chemical variables, and further analysed by multivariate statistical techniques.

3. Water in the study area was hard, alkaline and well‐buffered against pH change, and most ponds were eutrophic. Amphibian species richness was negatively correlated with five chemical variables (chloride, conductivity, magnesium, total hardness, turbidity).

4. Principle components analysis reduced the data set to four chemical components that explained 65.4% of the variance in the original variables. Principle component scores were retained for use in further multivariate tests. Multiple regression accounted for only 19.0% of the variance in amphibian species richness. Discriminant function analysis (DFA) was used to determine if water chemistry variables discriminated among species, but it was only able to classify 17.5% of cases correctly. DFA was also used to determine if water chemistry distinguished between used and unused sites for individual species. DFA was moderately successful, classifying 61–77% of cases correctly.

5. General water chemistry appears to play only a minor part in affecting amphibian species richness in south‐western, Ontario. However, chemical variables may be helpful to distinguish between used and unused sites for some species.
Habitat partitioning in riverine macrophyte communities
Authors: FRENCH TODD , CHAMBERS PATRICIA
Published: November 2003

1. Habitat partitioning has been extensively studied in terrestrial plant communities. By comparison, few studies have examined habitat partitioning in riverine macrophyte communities. Riverine environments are often highly heterogeneous with respect to current speed, depth, bottom sediment fertility and other biologically important properties. Thus, the potential for habitat partitioning in riverine macrophyte communities is great.

2. The objective of this study was to investigate how, or if, macrophyte species are differentially distributed with respect to abiotic gradients in a large river in central British Columbia, Canada.

3. A survey of macrophyte biomass and associated measures of current speed, depth and sediment texture showed that coexistence occurred both with and without habitat partitioning.

4. Coexistence in the absence of habitat partitioning was depicted by Potamogeton gramineus, Potamogeton berchtoldii, Myriophyllum exalbescens, Callitriche hermaphroditica and Potamogeton pectinatus such that they had a minimum and average niche overlap (NO) of 65% and 84%, respectively, for all measured abiotic variables. Similarly, the spatial niche of E. canadensis was close to that of Ceratophyllum demersum and M. exalbescens.

5. While several taxa seemed to occupy the same spatial niche, some taxa were distinguished from one another in terms of the types of microhabitats they utilized. Mosses, for example, were often the only occupants of sites having current speeds greater than 0.6 m s–1 and substrates of bare rock. Ranunculus aquatilis was most abundant at sites having current speeds between 0.4 and 0.6 m s–1 whereas most other taxa were restricted to slower waters. Habitat partitioning across depth contours, which occurred between several taxa, was most evident between P. pectinatus and C. demersum

(NO = 17%), C. hermaphroditica and C. demersum (NO = 3%), C. demersum and

P. richardsonii (NO = 19%) and C. hermaphroditica and E. canadensis (NO = 29%).
Predicting the outcome of trophic manipulation in lakes—a comment on Harris (1994)
Authors: SARNELLE ORLANDO
Published: November 2003

1. Harris (Freshwater Biology, 32, 143–160, 1994) asserts that while empirical modelling of lake ecosystem properties has yielded general predictions and useful explanations, research into the effects of food‐web interactions has not. I provide an explicit example of a useful, quantitative prediction gleaned from experiments on food‐web effects—the relationship between total phosphorus and the magnitude of response of algal biomass.

2. I further argue that Harris errs in asserting that food‐web effects will be ineffective in eutrophic lakes. This error stems from a misconception about the relevance of ecosystem behaviour in unmanipulated systems for predictions of how an ecosystem will respond to manipulation. I cite empirical evidence demonstrating that, contrary to Harris’s contention, the response of algal biomass to a change in food‐web structure increases as lakes are enriched.
Ceratophyllum demersum hampers phytoplankton development in some small Norwegian lakes over a wide range of phosphorus concentrations and geographical latitude
Authors: MJELDE MARIT , FAAFENG BJØRN
Published: November 2003

1. Data on submerged and floating‐leafed macrophytes, phytoplankton, nutrients (N, P) and calcium were collected from twenty‐four small lakes ( 1 km2) over a wide range of latitudes in Norway. The majority of the investigated lakes were mesotrophic or eutrophic, and most of the lakes were markedly affected by diffuse and point‐source runoff from agriculture. According to their macrophyte species composition, the majority of the lakes can be classified as Potamogeton lakes or Chara lakes, or a combination of these.

2. This study is consistent with the ‘two alternative stable states’ hypothesis. We observed clearwater lakes with dense macrophyte cover over a wider range of total P concentration than has been reported previously: from 30 to more than 700 mg P m–3. The clearwater state was only observed in lakes with mean depths of less than 1.9 m.

3. Most clear lakes with high cover of submerged vegetation showed indications of N limitation.

4. In this study nearly all the macrophyte‐dominated lakes with P concentrations above 30 mg m–3 had dense stands of Ceratophyllum demersum (L.). This indicates that Ceratophyllum may also play an important role in stabilizing and maintaining a clearwater state at high P concentrations.
Excretion of heptadecene‐1 into lake water by swarms of Polyphemus pediculus (Crustacea)
Authors: WENDEL THOMAS , JÜTTNER FRIEDRICH
Published: November 2003

1. In the littoral zone of a mesotrophic freshwater lake (Lake Selent, Northern Germany) much higher concentrations of heptadecene‐1 were found within a swarm of Polyphemus pediculus than in lake water at some distance from the swarm. Polyphemus collected in the field produced large amounts of heptadecene‐1 when exposed to osmotic shock. Other volatile compounds were not detected.

2. Heptadecene‐1 could be involved in the formation, maintenance and recognition of swarms of Polyphemus. It is the first report of the release of a volatile organic compound from a freshwater crustacean.
Phenotypic plasticity of Daphnia life history traits: the roles of predation, food level and toxic cyanobacteria
Authors: WALLS M.
Published: November 2003

1. We studied the life history responses of Daphnia pulex under different biotic conditions. In a factorially designed experiment, we tested the impacts of water conditioned by the invertebrate predator Chaoborus, low and high food level (10 000 and 100 000 Scenedesmus cells ml–1), and exposure to toxic Microcystis (5000 cells ml–1) on twelve D. pulex clones originating from different habitats. Our aim was to compare the phenotypic plasticity of different clones, and to study the interactions among biotic factors.

2. Individuals cultured in Chaoborus‐conditioned water started to reproduce at a larger size than individuals cultured in water not conditioned by the predators. We found interactions between food level and Chaoborus‐conditioned water on age at first reproduction and total offspring number. In addition, the impact of the Chaoborus treatment on the size at first reproduction was reduced by Microcystis exposure.

3. Clonal differences were found in the degree of phenotypic plasticity of different life history traits. However, there was no obvious connection between the original habitat of the clone and the degree of plasticity.
PAT1, an evolutionarily conserved acetyltransferase homologue, is required for multiple steps in the cell cycle
Authors: Lin Rueyling , Allis C. David , Elledge Stephen J.
Published: November 2003

Background: Acetylation has been implicated in many biological processes. Mutations in N‐terminal acetyltransferases have been shown to cause a variety of phenotypes in Saccharomyces cerevisiae including activation of heterochromatin, inability to enter G0, and lethality. Histone acetylation has been shown to play a role in transcription regulation, histone deposition and histone displacement during spermatogenesis, although no known histone acetyltransferase is essential.

Results: Studies aimed at revealing a role for histone H1 in yeast have uncovered a mutation in a putative acetyltransferase, PAT1. The mutant (pat1‐1) cells can live only in the presence of vertebrate H1. PAT1 is essential for mitotic growth in S. cerevisiae; mutant cells depleted of the Pat1p show aberrant cellular and nuclear morphology. PAT1 is required for multiple cell cycle events, including passage through Start, DNA synthesis, and proper mitosis through a microtubule‐mediated process. The S. pombe PAT1 gene was cloned by complementation and shown to exist as part of a larger protein, the unique portion of which is homologous to a second S. cerevisiae gene. pat1 mutants show a variety of mitotic defects including enhanced chromosome loss, accumulation of multiple nuclei, generation of giant cells, and displays classical cut phenotypes in which cytokinesis occurs in the absence of proper nuclear division and segregation.

Conclusion: PAT1 controls multiple processes in cell cycle progression which suggests an essential role for the acetylation of yet unknown substrate(s).
Geology and desert fieldwork in Oman
Authors: Pilcher Robin
Published: November 2003

Collecting geological data in the desert of east‐central Oman is very different from working in temperate countries. The fieldwork depends largely on traditional methods, combined with the advantage of modern aids such as the Global Positioning System and radio communication. The information gained on the ground, followed up by modern laboratory and computing techniques in the UK, is being used to shed light on the sedimentological and structural evolution of this fascinating area.
P‐to‐S conversion for a thin anisotropic zone produced by vertical fracturing
Authors: Kelly Steve , Baltensperger Paul , McMechan George A.
Published: November 2003

Point‐source synthetic seismic responses for a thin, fractured bed are generated, interpreted and processed. The synthesis is carried out for a compressional source and multicomponent surface receivers. The anisotropy considered has hexagonal symmetry, with a horizontal symmetry axis, and represents oil‐ and gas‐filled, aligned vertical fractures for a broad range of fracture densities and aspect ratios. P‐to‐S reflected conversions recorded on the horizontal geophones show both kinematic and dynamic anomalies that increase with increasing fracture density and are only weakly dependent on aspect ratio. In contrast, the vertical component P‐wave reflections provide a much poorer diagnostic of fracturing. Analytic expressions for the eigenvalues and eigenvectors of a vertically fractured system are presented, that have the same simplicity as those for transverse isotropy. New linearized expressions for mode‐converted amplitudes are developed for small angles of incidence and are used to interpret the synthetic response.
The reliability of aeroplane attitude determination using the main geomagnetic field with application to tensor VLF data analysis
Authors: Bastani M. , Pedersen L.B.
Published: November 2003

The attitude angles of an aeroplane used for geophysical measurements are necessary in order to calculate field components in a fixed reference frame. In this paper it is shown analytically how the measurement of static magnetic field components can be used to determine the attitude angles. Error analysis shows that when magnetic anomalies are small to moderate (less than 5% of the total field), the attitude angles can be determined to within a few degrees at high latitudes. For a given area the maximum error is linearly related to the magnitude of the anomaly.

The technique is illustrated on a tensor VLF data set from an area in Sweden with local magnetic anomalies less than 1% of the regional total magnetic field. Attitude errors propagated into tensor VLF transfer functions are of the same order as their random errors.
Time‐depth relationships for multilayer depth conversion
Authors: Al‐Chalabi M.
Published: November 2003

The conversion of seismic time to depth through the use of analytical functions has been a common procedure in seismic work for many decades. With the exception of recent examples dealing with the linear function, none of the published time‐depth relationships corresponding to these functions is applicable to multilayer depth conversion. The present work redresses this situation. It presents formulae applicable to multilayer depth conversion for a large number of analytical functions. The derivation is based on a procedure generally similar to that presented by Japsen (1993). Most of the functions considered date back to a publication by Kaufman in 1953 and earlier publications. A number of other functions hitherto not known in the industry are also presented.
Migration velocity analysis using a genetic algorithm
Authors: Docherty Paul , Silva Ron , Singh Satish , Song Zhong‐Min , Wood Margaret
Published: November 2003

Migration velocity analysis, a method for determining long wavelength velocity structure, is a critical step in prestack imaging. Solution of this inverse problem is made difficult by a multimodal objective function; a parameter space often vast in extent; and an evaluation procedure for candidate solutions, involving the calculation of depth‐migrated image gathers, that can be prohibitively expensive. Recognizing the global nature of the problem, we employ a genetic algorithm (GA) in the search for the optimum velocity model. In order to describe a model efficiently, regions of smooth variation are identified and sparsely parametrized. Region boundaries are obtained via map migration of events picked on the zero‐offset time section. Within a region, which may contain several reflectors, separate components describe long and short wavelength variations, eliminating from the parameter space, models with large velocity fluctuations. Vital to the success of the method is rapid model evaluation, achieved by generating image gathers only in the neighbourhood of specific reflectors. Probability of a model, which we seek to maximize, is derived from the flatness of imaged events. Except for an initial interpretation of the zero‐offset time section, our method is automatic in that it requires no picking of residual moveout on migrated gathers. Using an example data set from the North Sea, we show that it is feasible to solve for all velocity parameters in the model simultaneously: the method is global in this respect also.
The effects of pneumoperitoneum on intraperitoneal tumour implantation in nude mice
Authors: Volz J. , Köster S. , Melchert F.
Published: November 2003

Objective The aim of the study was to examine the effect of a CO2 pneumoperitoneum on the intraperitoneal growth of tumour cells.

Design 6‐week‐old nude mice were stratified into four groups of 15 animals each. A CO2 pneumoperitoneum was induced by a micro‐hysteroflator with an intraperitoneal pressure of 8 mm Hg for 90 min in groups 2 and 4. Two different tumour cell lines, suspended in 2 ml of Ringer solution for homogeneous spread of the cells, were injected i.p.. The control groups 1 and 3 received the tumour cells without pneumoperitoneum.

Results The induction of a CO2 pneumoperitoneum resulted in an increased seeding rate of tumour cells and provoked a significant increase in the number and size of intra‐abdominal metastases.

Conclusion We conclude that present laparoscopic techniques should be evaluated with regard to the potential risk of intraperitoneal tumour growth in the case of malignant tumours.
Laparoscopic management of solid ovarian tumour: is it safe?
Authors: Raslan F. , Charnock F.M.
Published: November 2003

Management of solid adnexal masses remains a controversial issue. The laparoscopic approach is being used with increased frequency. A case is presented in which a large solid ovarian tumour was removed by laparoscopic oo¨phorectomy. The 6‐cm large solid ovarian tumour was freed and placed in an endo‐bag, which was removed with extreme difficulty by extending the left lateral incision to 4 cm. Extensive abdominal bruises developed postoperatively.
Trends in endometrial ablation and hysterectomy for dysfunctional uterine bleeding, in Mersey region
Authors: Bridgman S.A.
Published: November 2003

The objectives of this study were to describe the trends in National Health Service hysterectomies and endometrial ablations for dysfunctional uterine bleeding (DUB) in Mersey Regional Health Authority residents. Data were extracted from routine hospital statistics. The proportion of patients with DUB treated surgically by endometrial ablation increased from 0 to 30% between 1988/9 and 1992/3. Contrary to expectations of proponents of endometrial ablation, there was little change in the number of hysterectomies performed for DUB. Conversely the life‐chances of a Mersey woman receiving an operation for DUB increased from 6.5 to 11%. While theoretically there are several reasons for the trend of increased operative rates for DUB, a lower threshold for operation with the advent of endometrial ablation was considered most likely to be the strongest factor. It was also noted to be of concern that a novel operation was widely introduced in the UK without there being any obligation for systematic study of medium‐ and long‐term effects.
Adelaide laparoscopic hysterectomy audit (1991–1994): complications in the real world
Authors: O'Shea R. , Petrucco O.
Published: November 2003

Objective To analyse, in a unbiased manner, major complications of laparoscopic hysterectomy encountered by a citywide population of gynaecologists. Design All laparocopic hysterectomy cases were retrospectively analysed independently of the surgeons involved. Setting All private and public hospitals in metropolitan Adelaide. Subjects In total, 760 cases over the period 1991–1994. Interventions Most cases involved combined laparoscopic and vaginal approaches. In 89% of them disposable endoscopic staples were used. Main outcome measures Major complication rates such as haemorrhage, haematoma, laparotomy incidence and urinary tract injury. Results Significant haemorrhage occurred in 3% of cases (n = 23). Haematoma formation requiring intervention was 3.3% (n = 25) with an overall laparotomy rate of 5.3% (n = 40). Urinary tract injury overall totals were 2.5% (n = 19), which included ureteric laceration (0.5%) and late diagnosis (1.1%). Conclusions Haemorrhage, laceration and laparotomy rates were higher than in previously published data, but compared favourably with abdominal and vaginal hysterectomy complication rates. Urinary tract trauma was significantly raised in the study group, in comparison to published data. This study represents the first such attempt to ascertain true laparoscopic hysterectomy complication rates in a major urban setting.
Omental trophoblastic implantation following laparoscopic salpingostomy for tubal pregnancy
Authors: Wong A. Y. K. , Wong K. S. , Yu K. , Tang L.
Published: November 2003

A case is presented in which laparoscopic salpingostomy was performed for unruptured tubal pregnancy. The patient remained well with falling hCG levels until 41 days later, when she developed acute abdominal pain. Laparotomy confirmed haemoperitoneum as a result of haemorrhage from implantation of trophoblastic tissue on the omentum. This case report highlights the potential risk of residual gestational products in sites other than the fallopian tube and the fact that hCG monitoring after the initial operation may not fully guarantee complete clearance.
Cost analysis of gynaecological endoscopy
Authors: Demco L. A. , Culham B.
Published: November 2003

Objectives To determine whether gynaecological endoscopy is cost effective when compared with standard gynaecological techniques. Setting Hysterectomies, oöphorectomies, ovarian cystectomies and ectopic pregnancies were performed laparoscopically and by laparotomy at the Rockyview Hospital in Calgary, Alberta, Canada and the results were analysed. Design A total of 682 operations were assigned ‘resource intensity weight’ (RIW) and the ‘hospital cost per weight case’ was applied in order to determine the total cost if 100% of the procedures were carried out by laparotomy vs. 90% carried out laparoscopically and the remaining 10% by laparotomy. Personal experience and collaboration with other gynaecological laparoscopists indicated that at least 90%, if not more of these cases can be carried out laparoscopically. With this in mind, the financial saving to the hospital as well as potential number of inpatient beds saved were then calculated. Outcomes The cost of the 682 procedures if all had been performed by laparotomy was $1 819 286 (Canadian dollars). This compared with the cost of $519 874 when 90% of the operations were carried out laparoscopically and the remainder by laparotomy, for a saving of $1 299 412. The number of inpatient beds needed for the cases carried out by laparotomy was 10.75; potentially 7.69 of these beds are saved with 90% of the cases being carried out laparoscopically. Conclusion Endoscopic surgery is an effective method of reducing costs and the number of inpatient beds required.
Lower limb prosthetic considerations in persons with coagulopathies
Authors: HEIM M. , AZARIA M. , HEIJNEN L.
Published: November 2003

Most able‐bodied amputees use artificial limbs for ambulation. Special considerations are required for persons with coagulopathies because excess pressure or friction may result in soft‐tissue haemorrhages. Persons with haemophilia have multi‐articular pathologies, hence the necessity to consider carefully the use of accessory walking aids. The use of walking aids results in biomechanical forces being applied through the upper limb joints and this may cause haemarthroses.
DDI and liver tests in HIV‐1 seropositive haemophiliacs
Authors: SHOPNICK R. I. , BRETTLER D. B. , FORAND P. , McDONALD M.
Published: November 2003

Many patients with haemophilia who are HIV‐1 seropositive are co‐infected with the hepatitis C virus with variable degrees of underlying liver disease. To evaluate whether the use of the antiretroviral agent Dideoxyinosine (DDI) causes worsening of hepatic dysfunction as measured by liver enzyme tests, we reviewed our cohort of patients previously treated with monotherapy with Zidovudine (AZT) and subsequently changed to DDI. Seventeen patients (median age: 34 years, median absolute CD4 lymphocyte cell count: 86 cells μL−1) were included in this study. None had coincident use of other hepatotoxic agents. The median duration of treatment with AZT and DDI was 18 and 15 months, respectively. There was no significant change in liver function tests with the use of DDI and no development of clinical signs of hepatotoxicity. Neither duration of treatment, absolute CD4 lymphocyte cell count, pre‐existing elevation of baseline aminotransferase levels nor the use of Pneumocystis carinii prophylaxis therapy resulted in further elevation of liver function tests. Monotherapy with DDI was well tolerated in this cohort of HIV‐1‐seropositive haemophiliacs with coincident hepatitis C infection.
Virological characteristics of HCV infection in Japanese haemophiliacs
Authors: TAKAYAMA S. , TAKI M. , MEGURO T. , NISHIKAWA K. , SHIRAKI K. , YAMADA K.
Published: November 2003

It has been found that almost all haemophiliacs treated with pooled concentrates of clotting factor VIII or IX before 1985/6 have been infected with hepatitis C virus (HCV). In order to clarify the characteristics of HCV infection in Japanese haemophiliacs, we investigated the HCV genotype and HCV‐RNA level in 80 patients with haemophilia who had been confirmed to be positive by a second‐generation HCV antibody test. HCV‐RNA was detected in 60 (75.0%) individuals and various HCV genotypes were found. Although 80% (48/60) of the patients had genotype 1b, the frequency of each genotype was quite different from that in HCV‐infected non haemophiliac Japanese. Particularly, multiple HCV genotypes were observed in 27 (46.7%) patients. The mean (± SD) level of HCV‐RNA was 5.3 × 105 ±  1.1 × 106 copies mL−1. The viral load in patients with genotype 2a was significantly less common than those with genotype 1a (P= 0.0007), genotype 1b (P= 0.0009) and combined genotype 1a/1b (P= 0.0019). In patients co‐infected with human immunodeficiency virus (HIV), the HCV‐RNA level was significantly higher (P= 0.05) than in those without co‐infection. However, there was no significant difference (P= 0.25) in the HCV‐RNA level with HCV/HIV co‐infection among the 40 patients with group 1 genotypes. We conclude that this biased distribution of HCV genotypes in Japanese haemophiliacs reflects their specific mode of HCV infection. Moreover, these results suggest that super‐infection with HIV does not greatly influence the HCV load in patients with no marked immunological deterioration.
Hepatitis G virus infection in Japanese haemophiliacs
Authors: TAKAYAMA S. , MIURA T. , TAKI M.
Published: November 2003

The recently identified hepatitis G virus (HGV) (also known as GB virus‐C) has been considered as a blood‐transmissible agent. As many haemophiliacs have risk factors for infectious agents, to clarify the frequency of HGV infection is important. HGV‐RNA was investigated in 77 Japanese haemophiliacs who had been treated with nonvirus‐inactivated concentrates derived from pooled plasma. Detection of HGV‐RNA was performed with a nested RT‐PCR that recognizes the 5′‐NCR of the HGV genome. HGV‐RNA was detected in 19 (24.7%), including four (21.0%) infected with HGV alone, 12 (63.2%) co‐infected with HCV and three (15.8%) who were HBV carriers. The patients infected with HGV alone showed a normal ALT level of 18.7 ± 4.1 IU L−1. Most (36/37, 97.3%) of the patients with abnormal ALT levels had HCV‐RNA. Patients infected with HCV alone or co‐infected with HCV and HGV showed higher ALT levels of 108.8 ± 90.2 IU L−1 (n= 39) and 67.6 ± 62.6 IU L−1 (n= 11), respectively. However, there was no significant difference (P= 0.16) in ALT levels between HCV infection alone and HCV/HGV co‐infection. On the other hand, four of the patients who could be followed over 10 years showed HGV‐RNA persistently. In two who underwent liver biopsy, the histological evidence showed no definitive fibrotic and necro‐inflammatory changes. These results indicate that HGV infection has frequently occurred in haemophiliacs. It is possible that HGV infection does not cause aggressive hepatitis with elevated ALT levels, and that co‐infection with HGV may not aggravate hepatitis caused by HCV.
Clinical manifestations in 28 Italian and Iranian patients with severe factor VII deficiency
Authors: PEYVANDI F. , MANNUCCI P. M. , ASTI D. , ABDOULLAHI M. , DI ROCCO N. , SHARIFIAN R.
Published: November 2003

There has been wide variation in the reported haemorrhagic manifestations of factor VII deficiency. We examined type and frequency of clinical manifestations in 28 Iranian and Italian patients with severe deficiency (factor VII coagulant activity 2% or less). The most frequent symptoms were epistaxis and menorrhagia, whereas soft tissue bleeding such as haemarthrosis and muscle haematoma was less frequent. Only 5 of 9 patient who underwent surgery without factor VII replacement therapy had postoperative bleeding severe enough to require blood transfusion. No thrombotic manifestation occurred. A factor VII functional assay based on the use of human thromboplastin was a better predictor of the bleeding tendency of these patients than a rabbit thromboplastin‐based functional assay or immunoassay. On the whole, this study shows that in severe factor VII deficiency bleeding in mucosal tracts is not uncommon. Surgery can sometimes be performed without replacement therapy and without haemorrhagic complications.
Accessory cells in physiological lymphoid tissue from the intestine: an immunohistochemical study
Authors: SARSFIELD P. , RINNE A , JONES D.B , JOHNSON P , WRIGHT D.H.
Published: November 2003

We report a study of the organization of accessory cell populations, in normal mucosal lymphoid tissue from small intestine (8 cases), large intestine (6) and appendix (9) using a panel of monoclonal antibodies and polyclonal antisera in paraffin‐embedded tissue. Two populations were identified in dome areas, one positive for acid cysteine proteinase inhibitor and HLA class II (WR18) only and the second positive for S‐100 protein, CD68, and WR18 and negative for acid cysteine proteinase inhibitor and factor XIIIa. Superficial colonic mucosal and small intestinal villous tip macrophages stained positively with CD68 and WR18 only, while deeper cryptal and submucosal populations exhibited additional positivity for factor XIIIa, but both populations were negative for acid cysteine proteinase inhibitor and S‐100 protein. Germinal centre macrophages were positive for CD68, WR18 and acid cysteine proteinase inhibitor and negative for factor XIIIa, and S‐100 protein. T zone dendritic cells included a population which stained positively for S‐100 protein, WR18 and were negative for factor XIIIa, CD68 and acid cysteine proteinase inhibitor, an immunophenotype typical of interdigitating dendritic reticulum cells. This distribution of phenotypically identifiable accessory cell subpopulations was apparent at all three sites examined. We suggest that the specialized subpopulations of dendritic cells staining for S‐100 protein and for acid cysteine proteinase inhibitor which are restricted to the dome areas, may have a potential role in the transfer of antigen across the epithelium to the germinal centres, while factor XIIIa appears to identify a tissue macrophage population with a potential role in stromal modulation distant from direct antigen challenge.
Apoptosis and proliferation in gastric carcinoma: the association with histological type
Authors: SHINOHARA T. , OHSHIMA K. , MURAYAMA H. , KIKUCHI M. , YAMASHITA Y. , SHIRAKUSA T.
Published: November 2003

We examined apoptosis in 33 gastric carcinomas using the terminal deoxynucleotydil transferase mediated dUTP‐digoxigenin nick end labelling technique (TUNEL). Of the tumours, nine were well‐differentiated, 13 moderately differentiated and 11 poorly differentiated. In addition, we also analysed MIB‐1, a cell proliferation antigen. Morphologically, apoptotic tumour cells were more frequently observed in well‐differentiated tumours. In addition, apoptotic signals of the TUNEL method were seen even in the nuclei of tumour cells which did not show apoptosis. The nick end labelling index was 51.0 ± 26.3 in the well‐differentiated and moderately differentiated tumours and 28.0 ± 18.8 in poorly differentiated tumours. The mean of apoptotic body index and nick end labelling index were both significantly higher in well‐differentiated and moderately differentiated tumours than in the poorly differentiated type (P < 0.0001, P = 0.008). The MIB‐1 labelling index and higher in poorly differentiated tumours than in the well‐differentiated or moderately differentiated tumours, and labelled cells were more numerous in the superficial region than in the middle and deep regions of tumours. No apparent correlation was found between the nick end labelling index and the MIB‐1 labelling index. The high number of apoptotic cells (the high Nick end labelling index) and low proliferation potentiality (the low MIB‐1 labelling index) in well‐differentiated gastric carcinomas may thus be related to their natural tendency to demonstrate slow growth.
The immunoexpression of bcl‐2 and p53 in Kaposi’s sarcoma
Authors: DADA M.A. , CHETTY R. , BIDDOLPH S.C. , SCHNEIDER J.W. , GATTER K.C.
Published: November 2003

The aim of this study was to examine the immunohistochemical expression of p53 and bcl‐2 in Kaposi’s sarcoma and relate this with proliferation index (as measured by MIB‐1 staining) and clinicopathological subtypes. Twenty formalin‐fixed, paraffin‐embedded cases of Kaposi’s sarcoma were stained with commercially available antibodies to p53, bcl‐2 and MIB‐1, after pressure cooking antigen retrieval. All cases were strongly positive for bcl‐2 with the majority containing more than 75% positive cells. In comparison, p53 expression was less striking. Eleven cases contained less than 24% (+1) of cells staining positively. Only two cases showed greater than 75% of positive cells, and both of these latter two lesions had metastasized. The MIB‐1 staining in all cases of Kaposi’s sarcoma was strongly positive, irrespective of clinicopathological type, in keeping with the highly proliferative nature of this lesion. Thus, we have demonstrated uniformly increased expression of bcl‐2 protein in Kaposi’s sarcoma irrespective of clinicopathological subtype and MIB‐1 staining, while p53 expression is relatively less common, except in those cases which have metastasized. This may help identify those cases that will behave in a more aggressive manner. However, more cases need to be evaluated to verify this.
Mammary fibroadenoma and some phyllodes tumour stroma are composed of CD34+ fibroblasts and factor XIIIa+ dendrophages
Authors: SILVERMAN J.S. , TAMSEN A.
Published: November 2003

Fibroadenomas and mammary phyllodes tumour arise by proliferation of mammary stroma and epithelial elements. However, it is the stromal element that determines the biology of these biphasic tumours. Normal mammary stroma, like most collagenous connective tissue, contains resident populations of CD34+ dendritic interstitial cells and scattered factor XIIIa+ collagen‐associated dendrophages. Actin + myofibroblasts are usually absent from mammary stroma in non‐disease states. To determine whether CD34+ and factor XIIIa+ cells proliferate in fibroadenomas and phyllodes tumours, and to study myofibroblastic differentiation in these lesions, we examined 19 fibroadenomas in 14 patients along with five low grade and two high grade phyllodes tumours. We employed antibodies against the human progenitor cell antigen CD34, coagulation factor XIIIa and HHF‐35 actin. In three fibroadenomas and two phyllodes tumours, we used Ki‐67 antigen to study cell proliferation and oestrogen and progesterone receptors to study possible hormonal influence on stromal cells. In all fibroadenomas, CD34 strongly stained interlobular, pericanalicular and intracanalicular fibroblasts with collagenous and/or myxoid features. Four low grade phyllodes tumours also had CD34+ fibroblasts as did one high grade tumour. Actin reactivity varied and was most pronounced in six fibroadenomas resembling the so‐called cellular variant, while seven regular fibroadenomas had no actin + stromal cells and six had only focal and weak actin + stromal cells. Factor XIIIa+ cells were prominently admixed in the stroma of all tumours studied comprising from 5% to 20% in fibroadenomas and, focally, up to 50% in phyllodes tumours. Oestrogen and progesterone receptors were expressed only in glandular elements. Ki‐67 index in stromal cells was 1% to 3% in fibroadenoma, 10% to 20% in low grade, and 20% to 40% in high grade phyllodes tumour. We conclude that fibroadenomas and some phyllodes tumours are composed of CD34+ fibroblasts that show varying myxoid, collagenous or myofibroblastic differentiation. The fibroblasts are accompanied by a subset of dendritic histiocytes that express factor XIIIa. Fibroadenoma variants show prominent collagenous actin + myofibroblastic differentiation of CD34+ stromal cells, sometimes with a gradient of CD34 down‐regulation. Fine‐needle or limited stereotactic core biopsy of these biphasic tumours, if they yield only stromal cells, must be distinguished from other CD34+ stromal tumours. Increased factor XIIIa+ dendrophage populations were seen in phyllodes tumours, especially in two high grade tumours that had malignant fibrous histiocytoma‐like features, suggesting clonal evolution toward the fibrohistiocytic final pathway. Further study of CD34 and factor XIIIa + mammary stromal cells in larger numbers of phyllodes tumours might ascertain whether increasing factor XIIIa reactivity correlates with differentiation and increased tumour aggressiveness.
Rosette‐forming non‐Hodgkin's lymphomas
Authors: KOO C.H. , SHIN S.S. , BRACHO F. , JOHNSTON W.H. , RAPPAPORT H.
Published: November 2003

Homer Wright rosettes, typically found in neuroblastomas and consisting of neoplastic cells surrounding an eosinophilic fibrillary centre without a lumen, have been considered as an important finding in the differential diagnosis of small round cell tumours. Rosettes in a neoplasm involving lymph nodes or bone marrow traditionally excluded a diagnosis of malignant lymphoma. In this report, we describe three cases of malignant lymphoma (two small lymphocytic and one diffuse large cell) with pronounced rosette formation. One of the two cases of small lymphocytic lymphoma was observed in the bone marrow, the other small lymphotic lymphoma and the large cell lymphoma were in lymph nodes. The rosettes consisted of neoplastic lymphoid cells, often with participation of reactive macrophages, and ultrastructurally they had a central mass of interdigitating fibrillary cytoplasmic projections. Two cases were of B‐cell lineage and one was of T‐cell lineage. To the best of our knowledge, this is the first report of T‐cell lymphoma with rosettes. Based on these findings, it is suggested that non‐Hodgkin's lymphoma be included in the differential diagnosis of rosette‐forming round cell neoplasms.