bluuebunny/crossref_metadata_2025 huggingface dataset:
The silage yield potential of hybrid ryegrass over a 5‐year period in Northern Ireland relative to other ryegrasses and timothy
Authors: Gilliland T. J. , Mann R. L.
Published: March 2003

The yield and persistency of grass species within a managed sward are a major consideration when determining species mixtures for either long‐term or short‐term sward management systems. Perennial ryegrass is lower yielding but more persistent than Italian ryegrass. Hybrid ryegrass, an interspecies cross between perennial and Italian ryegrass, may be higher yielding than perennial ryegrass and more persistent than Italian ryegrass. Therefore, the yield and persistency of hybrid ryegrass was investigated in Northern Ireland in five experiments, each harvested over five consecutive years, and compared with that of Italian ryegrass, perennial ryegrass and timothy. The performance of the five grass species were in the expected order; Italian ryegrass was higher yielding than hybrid ryegrass, which was higher than perennial ryegrass, with timothy the lowest, whereas perennial ryegrass and timothy had significantly higher sward densities than the hybrid and Italian ryegrasses. In addition, it was found that the rate of decline in yield and sward density with age was the same for all species. Consequently, this study indicated that the higher yielding Italian and hybrid ryegrasses could continue to out‐perform perennial ryegrass for 5 years, opening the possibility of more extensive farming use of these species, particularly in Northern Ireland.
The effect of different additives on the fermentation quality, aerobic stability and in vitro digestibility of pea/wheat bi‐crop silages containing contrasting pea to wheat ratios
Authors: Adesogan A. T. , Salawu M. B.
Published: March 2003

Studies were conducted to compare the effects of using two microbial inoculants, a sulphite salt‐based additive, formic acid and quebracho tannins, on the fermentation quality, nutritive value and aerobic stability of pea/wheat bi‐crop silages. Spring peas (Pisum sativum var. Magnus) and spring wheat (Triticum aestivum var. Axona) were drilled together at rates that gave high (HP/W; 3:1) or low (LP/W; 1:3) pea to wheat ratios. The peas and wheat were harvested at the yellow wrinkled pods and late milk/early dough maturity stage, respectively, and conserved in 1·5‐kg polyethylene bag, laboratory silos. The bi‐crops were conserved without treatment (control) or treated with either of two lactic acid bacteria‐based inoculants [Lactobacillus buchneri; applied at 105 colony‐forming units (CFU) g–1 fresh weight (FW) or Lactobacillus plantarum (applied at 106 CFU g–1 FW)], sulphite salts (applied at the rate of 1 ml sulphite solution kg–1 FW), quebracho tannins (applied at 16 g kg–1 FW) and formic acid (applied at 2·5 g kg–1 FW). Six replicates were made for each treatment, and the silos were opened after 112 days of ensilage. The level of peas in the bi‐crop influenced the effectiveness of the additives. With the exception of sulphite salts, all the additives significantly reduced the soluble nitrogen (N) and ammonia‐N concentrations of all the silages. The ratio of lactic acid to acetic acid was generally lower in the LP/W silages than in the HP/W silages, and the additive treatments only increased the in vitro digestible organic matter in dry matter of the LP/W silages. Of all the additives evaluated, formic acid resulted in the least aerobic spoilage in HP/W bi‐crop silages. However, in the LP/W bi‐crops, additive treatment was not necessary for ensuring aerobic stability.
A randomized study comparing levonorgestrel intrauterine system (LNG IUS) and transcervical resection of the endometrium (TCRE) in the treatment of menorrhagia: preliminary results
Authors: Kittelsen Nina , Istre Olav
Published: March 2003

Objective

To identify the effect of the levonorgestrel coil (Mirena; LNG IUS) vs. transcervical resection of the endometrium (TCRE) for treatment of menorrhagia.

Design

A randomized study of 60 patients performed at a gynaecological clinic specializing in operative hysteroscopy.

Results

24 patients in the LNG IUS group and 29 patients in the TCRE group completed 20 months of follow up. In the TCRE group one patient refused to continue after the result of randomization. Reasons for discontinuation in the LNG IUS group included abdominal pain (2), acne (1) and bleeding or continuous spotting (3). The bleeding intensity was assessed using the PBAC score and was reduced in both groups, from 418 to 42 in the LNG IUS group, and from 378 to 6.6 in the TCRE group.

Conclusion

Both methods have a dramatic effect on bleeding intensity and furthermore the LNG IUS is reversible and has no operative hazards or side‐effects.
Trocar injuries during laparoscopic gynaecological surgery. Report from the French Society of Gynaecological Laparoscopy
Authors: Marret, Henri , Harchaoui, Yahia , Chapron, Charles , Lansac Jacques , Pierre Fabrice
Published: March 2003

Objective

To review laparoscopic complications resulting from trocar insertions and to define their risk factors.

Methods

The French register of laparoscopic complications was reviewed for this study.

Results

A total of 47 complications due to trocar insertions were recorded between 1994 and 1997: 29 vascular injuries (18 parietal vascular injuries), 12 bowel injuries, three bladder perforations and three incisional hernias were noted in this survey. Regardless of the operator, the indication for laparoscopy or the type of trocar used, some patients seem to be more at risk for complications at laparoscopic surgery: 72% of the studied group had undergone previous abdominal surgery and 54% were overweight; and in 30% infringement of the recognized safety rules for trocar insertion was the main cause of injury. Laparotomy was needed for these complications in 64% of all cases, and in 90% of cases if vascular injuries of the abdominal wall were not included. Laparotomy for repair of the injury was delayed in 21% of cases, and it was done by the same surgeon who performed the laparoscopic procedure in 83%.

Conclusions

To reduce the risk of trocar injuries, surgeons must be careful and must respect the rules for safe trocar insertion, particularly when there is a history of previous surgery. ‘Open laparoscopy’ may be useful in facilitating a laparoscopic procedure which is as safe as possible, but the technique is not yet validated. Laparoscopists must inform the patient concerning the risk of laparotomy becoming necessary should trocar injury occur. Other clinicians should participate in recording complications in registers, similar to that of the French Society of Gynaecological Laparoscopy, to accumulate valuable information concerning trocar injuries.
Diagnosis and treatment of abnormal uterine bleeding in postmenopausal patients using hormone replacement therapy
Authors: Maia Jr Hugo , Maltez Amelia , Oliveira Maita , Calmon Luis C. , Coutinho Elsimar M.
Published: March 2003

Objective

To investigate the cause of uterine bleeding in menopausal patients using hormone replacement therapy (HRT), and the efficacy of resectoscopic surgery for treatment of irregular vaginal bleeding caused by benign uterine pathology in such patients.

Design

Retrospective case series.

Setting

Endoscopy unit of a private urban hospital.

Subjects

143 patients receiving HRT and with irregular vaginal bleeding, examined between January 1994 and December 1997.

Interventions

All the patients were evaluated using transvaginal sonography, hysteroscopy and endometrial biopsies. A total of 87 patients with polyps, myomas or an atrophic uterine cavity underwent polypectomy (n = 64) and myomectomy (n = 19) in association with endometrial resection (n = 87).

Results

Endometrial polyps and submucous myomas were the most frequent cause of uterine bleeding in postmenopausal women using HRT. These conditions could be treated effectively using the resectoscope. The failure rate of resectoscopic surgery for focal lesions in patients receiving HRT was 6%. Adenomyosis and recurrence of endometrial polyps were the most frequent reasons for treatment failure and resumption of vaginal bleeding.

Conclusion

Uterine bleeding caused by endometrial polyps and submucous myomas in menopausal patients using HRT can be effectively treated with the resectoscope.
Implantation endometrioma at port site after laparoscopic abdominal supracervical hysterectomy
Authors: Wilson Hayley , Shaxted Edward J.
Published: March 2003

Objective

To report three instances of implantation endometriomas occurring after laparoscopic subtotal hysterectomy.

Subjects

Three patients who developed implantation endometriomas at the site of insertion of the morcellator used in laparoscopic subtotal hysterectomy are described. At one hospital this occurred in two patients out of 54, giving an incidence of 4%.

Conclusion

Implantation endometriosis may be a risk associated with morcellation of the uterus at laparoscopic subtotal hysterectomy.
Outpatient hysteroscopy: indications and hysteroscopic findings in pre‐ and postmenopausal patients
Authors: Decloedt Jan F. , Fenton David W.
Published: March 2003

Objectives

We present a large series of outpatient hysteroscopies in order to assess the feasibility of the procedure, the incidence of abnormal findings in pre‐ and postmenopausal patients and to define a lower age limit for hysteroscopic investigation of patients presenting with abnormal uterine bleeding (AUB).

Setting

The Endoscopy Clinic of the Rotherham District General Hospital, Rotherham, UK.

Subjects

665 patients with a mean age of 47  years. Only patients presenting with abnormal uterine bleeding were included in the study.

Interventions

673 outpatient hysteroscopies were carried out; 469 (69%) procedures were done in premenopausal and 204 (31%) in postmenopausal patients. All procedures were done under local anaesthesia with 4‐mm rigid hysteroscopes with a 30° objective, using video endoscopy.

Results

The failure rate was only 6%, i.e. 2.4% in the premenopausal and 11% in the postmenopausal group. The incidence of intrauterine pathology was similar in those patients presenting with intermenstrual bleeding (33%), those presenting with postcoital bleeding (39%), and in those over the age of 40 who presented with menorrhagia (32%). In younger patients (<40 years) with menorrhagia abnormal hysteroscopic findings were seen in 21%, but these were found in only 4% of patients under the age of 30. The lesions in the patients under the age of 40 were mainly uterine fibroids, which can be easily missed using traditional endometrial sampling alone. Uterine fibroids seem to be the commonest lesion in premenopausal patients. Endometrial polyps and endometrial cancer have a peak incidence in patients over the age of 50.

Conclusions

Outpatient hysteroscopy is a feasible technique in pre‐ and postmenopausal patients. The high incidence of pathology in post‐ and premenopausal patients with abnormal uterine bleeding justifies its use in all patients presenting with postmenopausal, intermenstrual and postcoital bleeding, and in patients with menorrhagia over the age of 30.
‘Classic’ laparoscopic entry in a university hospital: a series of 8324 cases
Authors: Dubuisson Jean Bernard , Chapron Charles , Decuypère Fouzia , De Spirlet Marina
Published: March 2003

Objective

To evaluate the complications of ‘classic’ laparoscopic entry in a university tertiary care centre.

Design

An analysis of the complications of classic laparoscopic entry for diagnostic and operative laparoscopies. We considered a consecutive series of 8324 cases with the same entry technique: CO2 insufflation, followed by insertion of the umbilical trocar and subsequent placement of accessory trocars under direct vizualization.

Subjects

Between November 1 1992 and December 31 1998, 8324 patients underwent laparoscopies. The 978 diagnostic laparoscopies (11.75%) and 7346 operative laparoscopies (88.25%) were performed by 14 experienced gynaecological surgeons or by trained surgeons under the supervision of one of the experienced surgeons.

Main outcome measures

Peri‐ and postoperative complications of laparoscopic entry were assessed and analysed.

Results

Laparoscopic entry complications occured in 10 cases out of 8324 laparoscopies (0.12%). These included six vascular injuries, three bowel perforations and one bladder complication. No death occurred and no blood transfusions were required. No adverse consequences were observed in five cases. A laparotomy was performed in four cases and in one instance the laparotomy was delayed.

Conclusion

The complication rate of classic laparoscopic entry was quite low in our experience. These results suggest that no modifications to the technique for classic laparoscopic entry are needed.
A successful pregnancy following trachelectomy and laparoscopic pelvic lymphadenectomy for cervical carcinoma
Authors: Burnham Annabelle , Venkitaraman Uma , Street Patricia
Published: March 2003

Design

Case report.

Method

A young patient had stage Ibi cervical carcinoma. She was treated with trachelectomy and laparoscopic pelvic lymphadenectomy. Two years later she achieved a successful third trimester pregnancy, and was delivered by elective Caesarean section at 37 weeks.

Conclusion

A cervical suture had been inserted at trachelectomy, and this was considered to be a significant contributing factor to the success of this pregnancy.
Peritonitis of undetermined aetiology following laparoscopic surgery
Authors: Wong Yat‐May , Cheong Ying‐Ching , Li Tin‐Chiu , Stoddard Christopher
Published: March 2003

We present an unusual case of peritonitis of undetermined aetiology following a simple laparoscopic surgical procedure. This patient presented with a clinical picture similar to bowel injury after laparoscopic surgery. However, no trauma to the bowel could be found despite a diligent search. Instead, purulent turbid material was seen in the peritoneal cavity with no evidence of faecal material. The patient responded very well to antibiotic treatment, without any long‐term sequelae. The value of prophylactic antibiotics in laparoscopic surgery is discussed.
Bizarre leiomyoma: a rare form of atypical leiomyoma
Authors: Hviid Ulla R. , Sørensen Søren S.
Published: March 2003

Objective

Selective operative hysteroscopy is today the preferred treatment for symptomatic submucous uterine fibromas. The correct pathological diagnosis is important, especially in premalignant conditions.

Setting

A case report is presented concerning the discrimination between bizarre leiomyoma and leiomyosarcoma in a woman with persistent menstrual periods who was treated by means of endometrial resection.

Results and Conclusion

Atypical leiomyomas of the uterus have been considered to be benign, but some have malignant potential and special attention is needed in such cases, especially in light of the rapid development of conservative salvage surgery.
Randomized controlled trial of postoperative pain and activity following microlaparoscopy and standard laparoscopy
Authors: Burmeister Lynn , Tsaltas Jim , Griffiths Andrew , Goodchild Colin , Mamers Pam , Healy David L.
Published: March 2003

Objective

To compare postoperative pain and recovery of patients undergoing surgery with the 2‐mm microlaparosope and the 10‐mm standard laparoscope.

Design

A double‐blind prospective randomized clinical study to assess pain.

Setting

Monash Medical Centre Women's Health Program, Melbourne, Australia.

Subjects

29 women of reproductive age (24–45 years) undergoing diagnostic procedures for fertility were randomly allocated to either microlaparoscopy (ML) or standard laparoscopy (SL).

Interventions

Of these patients 13 received a microlaparoscopy and 16 received standard laparoscopy. All patients agreed to complete the self‐administered Short‐Form McGill Pain Questionnaire (SF‐MPQ), immediately after surgery before any analgesia and at 48 h after surgery, in order to assess pain and recovery.

Main outcome measures

Pain intensity and recovery time for patients undergoing microlaparoscopy were compared with those for standard laparoscopy.

Results

There was no significant difference between the two groups when the affective, sensory and visual analogue scale (VAS) pain scores, immediately after recovery and at 48 h, were compared. However there was a significant difference in the time to return to normal activity as perceived by the patients, with the ML group scoring a quicker return to normal activity (mean ± SD, 3.6 ± 3.6 compared with the SL group (7.1 ± 3.3) (P = 0.01). This was despite a significant difference in operating times between the two groups. The mean operating time for the ML group was 22.6 min (95% confidence interval (CI) 18.8–26.5), compared with a mean for the SL group of 16.4 min (95% CI, 13.9–18.8) (P = 0.01). The ML group required no narcotic postoperative analgesia.

Conclusion

There was no significant difference in pain scores between groups in whom the microlaparoscope or the standard laparoscope were used. However the microlaparoscopy group experienced a quicker post‐surgical recovery, required less analgesia and were more satisfied with their scar.
Cervical cancer metastasis on the surgical wound: not a new feature and not specific to laparoscopy. Report of two cases and review of the literature
Authors: Paraskevaidis Evangelos , Papadimitriou Dimitrios , Koliopoulos George , Dalkalitsis Nikolaos , Fotiou Stylianos , Lolis Dimitrios , Kitchener Henry
Published: March 2003

Objective

The appearance of cervical cancer metastases on the abdominal wall is unusual and almost always indicates an extremely poor prognosis. More specifically however, metastases on the surgical wound or trocar insertion site are extremely rare while their pathophysiology and clinical significance remain controversial. This study presents two cases and attempts to clarify the pathophysiology and suggest clinical strategies. A literature review is also presented.

Setting

Department of Gynecology, Ioannina University Hospital, Ioannina, Greece.

Subjects

Two cases of patients presenting with cervical cancer who developed metastasis on the surgical wound or a laparoscopy trocar insertion site are described.

Results

Apart from the two cases encountered by the authors, nine more have been reported. Five out of the total of 11 cases had metastasis on a laparoscopy trocar insertion site and the rest on the surgical wound. Nine out of the 11 women had been treated at an early stage (IB). In five patients the metastasis on the wound or the trocar site was the only one at the time of the diagnosis. A marked delay in the diagnosis of metastasis was noted in many cases.

Conclusions

Possible mechanisms for development of metastasis on the wound or the trocar site are analysed. Metastasis on the surgical wound is not always associated with laparoscopy. Careful haemostasis, avoidance of haematoma formation, careful handling of tissues especially in laparoscopy and the extension of radiotherapy fields to include the wound or trocar sites might prevent the development of metastasis. Alertness on the part of surgeons is advised, in order to ensure immediate diagnosis and wide excision of these metastases, as they are often the only site of relapse.
A Scottish audit of laparoscopically assisted vaginal hysterectomy
Authors: Brechin Susan , Farquharson David M. , Hawthorn Robert , Davis Jonathan , Fisher Peter , Philips William , Lumsden Mary A.
Published: March 2003

Objective 

To evaluate the use of laparoscopically assisted vaginal hysterectomy (LAVH) by a cross‐section of gynaecologists in Scotland.

Design 

A prospective registration of cases of LAVH carried out by gynaecologists. Case‐note review was also performed in selected hospitals.

Setting 

13 hospitals in seven Scottish Health Boards.

Subjects 

Women undergoing an LAVH.

Results 

505 LAVHs were reported between April 1994 and March 1996. Of these, 463 (91.7%) were successfully carried out laparoscopically. The uptake of laparoscopic surgery in Scotland overall is low, with a handful of surgeons performing the majority of procedures. Patient satisfaction with the procedure was high. Complication rates were high at 18.2% but this was mostly on account of postoperative infection. Only 34% of surgeons had any formal training in laparoscopic techniques, but this had increased to 55% by the end of the audit.

Conclusions 

Complication rates in the present study were higher than those reported by expert laparoscopic surgeons, but perhaps reflect more accurately those expected from a cross‐section of gynaecologists in current practice.
Surgical pelvic neuroablation for chronic pelvic pain: a systematic review
Authors: Johnson Neil , Wilson Michelle , Farquhar Cindy
Published: March 2003

Objective

To determine, from the best available evidence, the effectiveness of surgical pelvic neuroablative techniques as treatment for primary and secondary dysmenorrhoea.

Design

Systematic review of randomized controlled trials (RCTs).

Subjects

Women with primary or secondary dysmenorrhoea.

Interventions

Surgical neuroablative techniques including uterine nerve ablation and presacral neurectomy.

Main outcome measures

Pain relief (both short‐ and long‐term) and adverse effects.

Results

Laparoscopic uterine nerve ablation (LUNA) has been shown by one small study to be effective for primary dysmenorrhoea up to 12 months. A larger study showed no significant difference between LUNA and laparoscopic presacral neurectomy (LPSN) in pain relief for primary dysmenorrhoea up to 6 months, but LPSN was significantly more effective beyond 6 months. For dysmenorrhoea secondary to endometriosis, two trials found no significant difference in pain relief afforded by LUNA plus conservative laparoscopic surgery for endometriosis vs. conservative laparoscopic surgery alone. Presacral neurectomy (PSN) plus conservative surgery for endometriosis at laparotomy vs. conservative surgery for endometriosis at laparotomy showed no significant difference in overall pain relief, although there was a significant difference in relief of midline abdominal pain. Adverse events overall were significantly more common following PSN; these included constipation, urinary urgency, painless labour and one case necessitating a laparotomy for presacral haematoma 2 days after PSN.

Conclusions

There is insufficient evidence to recommend the use of surgical pelvic neuroablation in the management of dysmenorrhoea, regardless of cause. Further scientifically rigorous RCTs should be undertaken.
Endometriotic ovarian cysts: the case for ablative laparoscopic surgery
Authors: Jones Kevin D. , Sutton Christopher
Published: March 2003

To present a synopsis of the evidence supporting ablative laparoscopic surgery for endometriotic cysts.

Review article.

Endometriotic cysts can be managed laparoscopically by stripping, and excising or ablation of the capsule.

The clinical outcome of each technique in terms of cyst recurrence, pregnancy rates, pain relief and patient satisfaction are broadly similar, but this may reflect study design and in particular, the variable follow up periods, and methods used to document outcome measures. There are concerns that excision may result in post operative adhesion formation and damage to the underlying oocytes which may impair fertility, produce chronic pain, and premature menopause. These concerns arise from the postulated aetiology and pathogenesis of ovarian endometriomas.

There is no clear evidence to suggest that one minimal access surgical technique is superior to another for the management of endometriotic cysts. However, ablation of the capsule is a theoretically superior technique, with no demonstrable disadvantages.
Microwave endometrial ablation: does endometrial thickness or the medium for preoperative hysteroscopy affect the depth of ablation?
Authors: Wallage Sarah , Cooper Kevin G. , Miller Ian
Published: March 2003

Objectives To determine the depth of tissue necrosis following microwave endometrial ablation (MEA) after perioperative saline hysteroscopy, and to determine the effects of varying endometrial thickness on depth and regularity of necrosis after gas hysteroscopy.

Subjects 15 premenopausal women undergoing hysterectomy for dysfunctional uterine bleeding at Aberdeen Royal Infirmary.

Methods Endometrial thickness was measured by transvaginal ultrasound scanning. After cervical dilation a hysteroscopy was performed with carbon dioxide or saline before proceeding to MEA and then hysterectomy. A vital stain was used to assess the depth and regularity of endomyometrial necrosis in the excised uterus.

Results The nitroblue tetrazolium stain was a simple and effective way of demonstrating the depth of necrosis. In this small study, saline hysteroscopy led to cornual sparing in some cases. There was no clear effect of endometrial thickness up to 8 mm with gas hysteroscopy.

Conclusions Saline hysteroscopy may affect the clinical outcome of MEA. Aspiration of residual saline may minimize any negative effect. The depth and regularity of necrosis did not seem to be affected by endometrial thicknesses of up to 8 mm after gas hysteroscopy. It seems reasonable to proceed to a clinical trial to assess the outcome of postmenstrual MEA without hormonal endometrial preparation.
Presence of human immunodeficiency virus (HIV) and T‐lymphotropic virus type I and II (HTLV‐I/II) in a Haemophiliac population in Belo Horizonte, Brazil, and correlation with additional serological results
Authors: Carneiro‐Proietti  , Lima‐Martins  , Passos  , Carmo  , Pinheiro  , Rocha  , Proietti  , Ferreira  , Rocha
Published: March 2003

The aim of this study was to determine the prevalence of human immunodeficiency virus type 1 (HIV‐1) and human T lymphotropic virus types I and II (HTLV‐I/II) infections in 226 Haemophiliac patients treated at Fundação Hemominas in Belo Horizonte, Minas Gerais State, Brazil, and to verify association with other serological results. Patients positive for HTLV‐I/II had also a neurological, heamatological and ophthalmological evaluation. Fundação Hemominas offers comprehensive care for all Haemophiliac patients in Minas Gerais. Thirty‐six (15.9%) of the 226 patients showed reactive results to HIV‐1 [ELISA, Abbott, USA, confirmed by Western blot (WB), Cambridge Biotech, USA, and/or immunofluorescence, Fiocruz, Brazil] and 16 (7.1%) had reactive sera to HTLV‐I/II (ELISA, Ortho). Eleven of these 16 (4.9%) were positive, 3/16 (1.3%) were indeterminate and 2/16 (0.9%) were negative in the HTLV WB (Cambridge Biotech). Neurological, heamatological and ophthalmological examination of 9/16 patients revealed no abnormality suggestive of HTLV disease. Of the 16 patients reactive to HTLV‐I/II ELISA test, six (37.5%) were also positive to HIV‐1 (χ2= 5.92; P= 0.01). Seropositivity for HTLV‐I/II and HIV‐1 was associated with advancing age and positive results for hepatitis C virus (HCV), Chagas’ disease (T. cruzi infection) and syphilis. No association between the presence of HTLV with type and severity of Haemophilia and hepatitis B results was detected. The prevalence of antibodies against HIV‐1 is approximately three times that of HTLV‐I/II and a patient positive for HTLV‐I/II had a significantly increased risk of being positive for HIV‐1, HCV and T. cruzi.
Alpha interferon therapy in Danish Haemophiliac patients with chronic hepatitis C: results of a randomized controlled open label study comparing two different maintenance regimens following standard interferon‐alpha‐2b treatment
Authors: Laursen  , Scheibel  , Ingerslev  , Clausen  , Wantzin  , Østergaard  , Schou  , Black  , Krogsgaard
Published: March 2003

Following a survey among all Danish Haemophiliac patients 49 HIV‐negative patients with chronic hepatitis C were offered enrollment in a randomized controlled open label study comparing two different maintenance regimens following standard interferon‐alpha‐2b treatment. Dose modifications and treatment discontinuation were based upon changes in transaminase levels. Forty‐seven patients enrolled received 3 MU of alpha interferon thrice weekly (TIW) for 3 months. Twenty‐six nonresponders had their dose increased to 6 MU TIW for an additional 3 months, while 21 responding patients continued on 3 MU TIW. At 6 months, 25 patients with a complete or a partial biochemical response were randomly allocated to either a fixed dose regimen (13 patients) (3 or 6 MU thrice weekly) or an individualized dose regimen (12 patients) tapering interferon dose from 3 or 6 MU by one‐third every 2 months if transaminases were persistently normal. The remaining 22 biochemical nonresponders were followed for an additional 6 months without further treatment. After 12 months of treatment, 18 patients (38%) had a virological response, irrespective of regimen, and seven patients (16%) had a sustained virological and biochemical response after 6 months of follow up. Overall, the individualized treatment regimen did not seem to offer any advantage over the fixed dose regimen. The response to alpha interferon treatment in Danish Haemophiliac patients with chronic hepatitis C immediately after treatment is comparable to that obtained in previous studies among nonHaemophiliacs. However, a sustained virological and biochemical response was seen in only 16% of treated patients.
Assay of factor VIII antigen (VIII:CAg) in 294 Haemophilia A patients by a new commercial ELISA using monoclonal antibodies
Authors: Girma  , Fressinaud  , Houllier  , Laurian  , Amiral  , Meyer
Published: March 2003

Monoclonal antibodies (MoAbs 833 and D4H1) directed against human factor VIII (FVIII) have been produced on a large scale to measure VIII:CAg by two‐site ELISA (Asserachrom VIII:CAg, Diagnostica Stago). F(ab’)2 from MoAb 833 were used for coating and bound VIII:CAg was revealed with MoAb D4H1 coupled to peroxidase. Control plasma (100 VIII:CAg U dL−1 by comparing with the International Standard) was used as reference. The assay sensitivity was 0.1 U dL−1 VIII:CAg. No apparent effect of the plasma proteins was observed provided plasma dilution was 5. Thus this ELISA allowed us to estimate VIII:CAg levels of 0.5 U dL−1 in plasma. Levels of VIII:CAg were similar to those of VIII:C (correlation coefficient r= 0.87) in plasma from normal individuals (32 cases) and in patients with von Willebrand disease of various types (30 cases). Among 294 patients with Haemophilia A (HA), 161 had severe HA (VIII:C < 1 U dL−1). Among those patients, 124 were cross‐reacting material (CRM) negative with undetectable VIII:CAg and 37 were CRM+ (VIII:CAg 1– 31 U dL−1). In 42 patients with moderate HA (VIII:C 1– 5 U dL−1), 33 were CRM reduced (VIII:CAg 0.5–8 U dL−1) and nine were CRM+ with a VIII:CAg/VIII:C ratio of 6–91 (mean 34.3). In mild HA (91 cases with VIII:C 6 U dL−1), 29 patients were classified as CRM+ (VIII:C 6–57 U dL−1, VIII:CAg 17–130 U dL−1 and VIII:CAg/VIII:C ratio 1.8–13.7 (mean 4.51)). In 62 CRM reduced patients there was a linear correlation between VIII:C (6–39 U dL−1) and VIII:CAg (2–36 U dL−1) levels (r= 0.88). In conclusion, this sensitive assay allows us to distinguish the quantitative CRM reduced and negative from the qualitative (CRM+) abnormalities in Haemophilia A.
The surgical treatment of a haeophilic pseudotumour in an extremity: a report of three cases with pathological fractures
Authors: Ishiguro  , Iwahori  , Kato  , Ito  , Kojima  , Takamatsu  , Iwata
Published: March 2003

A haeophilic pseudotumour is a rare complication of Haemophilia occurring in 1–2% of patients with a factor VIII or IX deficiency. This report presents three surgical cases of pseudotumours involved in a pathological fracture in the extremities. All cases showed a favourable post‐operative course. If the preoperative management is appropriately designed, a limb salvage operation for a pathological fracture due to a pseudotumour could be carried out successfully. Before choosing amputation of a limb, the surgeon should consider the possibility of limb salvage.
An unusual haemarthrosis in an HIV‐seronegative haemophilia A patient
Authors: MÉnart C. , Duhaut P. , Attali O. , Dechavanne M. , NÉgrier C.
Published: March 2003

We report the case of a severe haemophilia A patient with an anti‐factor VIII antibody who presented with a thigh haematoma and 1 year later with an elbow haemarthrosis infected by Salmonellaenteritidis. These two infections were treated by antibiotics. The probable origin of these infections seems to be an anal fistula. The occurrence of a septic arthritis due to Salmonella is rare, and to our knowledge has never been reported in HIV‐negative haemophilic patients. The differential diagnosis of haemarthrosis and septic arthritis in a haemophilic patient is also discussed.
Laser tissue welding: a urological surgeon's perspective
Authors: Lee C. A. , Kessler C. M. , Varon D. , Martinowitz U. , Heim M. , POPPAS D. P. , SCHERR D. S.
Published: March 2003

Summary. Laser tissue welding has proven its efficacy in the laboratory setting when compared with more traditional modalities of tissue reapproximation. In the clinical environment, several areas including urethral reconstructive surgery have shown great promise. Several technological advancements including solder development, chromophore enhancement and temperature control have improved upon the welding process and have added more precision and reproducibility to the technique. The current potential applications for laser welding in urology are numerous. On a molecular level, growth factor supplementation has certain potential in improving upon weld site healing and wound strength. Laparoscopic surgery with its need for less cumbersome modes of tissue closure is a field that will greatly benefit from the technology of laser tissue welding. Surgical specialities outside of urology are also participating in developing the field of laser welding. In particular, cardiothoracic surgery, otolaryngology, plastic surgery, neurosurgery among others, have utilized the concept of laser tissue welding. There are many areas that have potential use for laser welding that have yet to be explored. Further investigation will likely reveal more applications for this valuable technology.
How do some haemophiliacs develop inhibitors?
Authors: Lee C. A. , Kessler C. M. , Varon D. , Martinowitz U. , Heim M. , VERMYLEN J.
Published: March 2003

Summary. The purpose of this presentation is to concentrate on three issues: Is there an explanation for the large difference in reported incidence rates of inhibitor formation in haemophiliacs? Why do not all severe patients develop inhibitors? And how on the contrary do some patients with mild haemophilia develop inhibitors?
Prions and haemophilia: assessment of risk
Authors: Lee C. A. , Kessler C. M. , Varon D. , Martinowitz U. , Heim M. , EVATT B. L.
Published: March 2003

Summary. Based on information accumulated to date, it is still difficult to assess the risk of Creutzfeldt‐Jakob disease (CJD) and blood transfusion with any degree of confidence. However, it is reasonable to conclude that CJD is produced by a transmittable agent which is probably contained in low titer in the blood of infected people and animals. From the present clinical and epidemiological studies, transmission by blood or blood products appears to be a rare or non‐existent cause of current and past cases of CJD in humans. Since blood products are necessary to prevent the immediate risk of death or significant morbidity in many clinical conditions, therapeutic decisions should be made after consideration of the known risk in these situations vs the theoretical long‐term risk of the rare occurrence of CJD.
Audit of clinical management of von Willebrand disease during 1997 at a single institution and review of treatment patterns between 1980 and 1997
Authors: Nitu‐Whalley  , Miners  , Lee
Published: March 2003

In 1997 the UK Haemophilia Centre Directors Organization published the guidelines for diagnosis and management of von Willebrand disease (vWD). The guidelines stated that desmopressin (DDAVP) should be used in type 1 and type 2N vWD, that it might be useful in other types 2 vWD and that it is ineffective in type 3 vWD. If patients are unresponsive to DDAVP or if it is contraindicated, the treatment of choice is clotting factor concentrates (CFC). In the light of these guidelines, we audited our practice for 1997. Furthermore, we undertook a retrospective review of the changing patterns of treatment of vWD between 1980 and 1997. During 1997, 10 patients with vWD received DDAVP and another 30 patients were treated with CFC (a total of 1.2 million IU): Haemate P (Centeon, Germany) and/or 8Y (BPL, Elstree, UK). Few patients had clear contraindications to DDAVP, but several patients with type 1 and 2 vWD received CFC on the basis of age or reduced levels of von Willebrand factor – where DDAVP was considered suboptimal for adequate haemostasis. However, this assumption was made without a preliminary test dose to assess the response to DDAVP. The analysis of treatment of vWD for the past 17 years showed that cryoprecipitate was discontinued from use in the early 1990s and that both DDAVP and CFC usage has been on the increase. In conclusion, the audit illustrated a general good adherence to guidelines but it highlighted the need for a DDAVP test before using CFC.
Management of equinus contractures of the ankle in haemophilia
Authors: Ribbans W.J. , Rees J.L.
Published: March 2003

Equinus deformity has been a significant problem in haemophilia. It causes difficulties in walking and secondary problems in adjacent joints. There are a number of potential causes in haemophilia. A careful history, examination, and plain radiographs will determine the aetiology, which frequently is multifactorial. Hopefully, prophylactic factor replacement will reduce the incidence of such problems in the future. Prompt ‘on demand’ therapy will reduce the complications of articular and soft‐tissue bleeds. Physiotherapy, splints, and orthotics will usually allow a full recovery of function and comfort. Rarely, surgical intervention is required to correct articular and/or musculo‐tendinous problems. The choice of surgery depends upon the cause(s) of the deformity and should only be undertaken in experienced haemophilia units following careful counselling of the patient regarding the aims and nature of the operation and the patient’s involvement in an effective rehab‐ ilitation programme.
Scientific visits to the Åland Islands
Authors: Blombäck M.
Published: March 2003

Three research trips performed by the Stockholm teams in 1957, 1977, and 1992 are described in this paper.

At the 1957 visit we showed that the family members of the original family and a few others, as described by von Willebrand, had the same coagulation defects as the Swedish patients with von Willebrand’s disease (vWD) (prolonged bleeding time, low FVIII levels and a normal platelet factor 3) and that fraction I‐0 normalized the defect.

At the 1977 visit we showed that the bleeding disorder described in many papers by von Willebrand and collaborators over the years could be divided into four different forms: the pure vWD; two platelet function defects, i.e. a pure cyclooxygenase defect (no platelet aggregation at addition of arachidonic acid solely); an aspirin‐like defect, generally called a cyclooxygenase defect; and a mix between vWD and the cyclooxygenase defect.

At the 1992 visit members of four families with genuine vWD (including the original family) of the Åland Islands were screened for mutations of the ‘hot spot’ regions, exons 18, 28, 32, 43 and 45, of the von Willebrand factor (vWF) gene found in Sweden. One cytosine deletion in exon 18 was detected in all the families. Linkage analysis and genealogical studies suggest that the deletion in these families probably has a common origin also with the Swedish patients. Apart from the deletion in exon 18, two close transitions G→A at S1263 and C→T at P1266 in exon 28 on the same chromosome, were identified in one individual, who married into the original family, and his two children. These mutations are probably due to a recombination between the vWF gene and its pseudogene, since both transitions are also present in the same location in the pseudogene.
Haemostatic and replacement therapy in von Willebrand disease
Authors: Schulman S.
Published: March 2003

A variety of haemostatic agents can be helpful for patients with von Willebrand disease in case of bleeding. There are orally administered substances, such as tranexamic acid, oestrogens and prednisone; agents for topical or local use; and medicines for injection or infusion, including desmopressin, blood plasma products and recombinant activated factor VII. The choice depends on the type of haemorrhage, the severity of the disease, presence of inhibitors, availability and cost. Some of these aspects are reviewed here.
HAART and Mycobacterium avium complex in an HIV infected patient with severe factor VII deficiency
Authors: Girmenia  , Martino  , Mazzucconi  , Bizzoni  , Cassone
Published: March 2003

A clinical syndrome represented by the association of Mycobacterium avium complex (MAC) infection with initiation of highly active antiretroviral therapy (HAART) has been recently described in patients with advanced HIV disease. HAART‐associated improvement of the immune status might convert a clinically silent MAC infection into an active mycobacterial disease. A 40‐year‐old man with severe factor VII deficiency, advanced HIV‐1 disease, a CD4 + lymphocyte count of 15 cells μL–1 (CDC stage A3) and 470,000 HIV‐RNA copies mL–1 (measurement by NASBA system) underwent standard HAART (lamivudine, stavudine and ritonavir). Two weeks after HAART onset, the patient developed enlargement of the lymph nodes throughout the mesentery and after seven weeks a rapidly enlarging mass on the left side of the neck. Culture from a needle aspirate specimen revealed MAC. His CD4 + count had increased to 97 cells μL–1 and viraemia dropped to undetectable HIV‐RNA copies. While continuing antiviral therapy, multidrug therapy for MAC infection (clarithromycin, ciprofloxacin, ethambutol, amikacin) was started with progressive improvement and cure of the neck mycobacterial infection and disappearance of the abdominal lymph nodes. HAART has been shown to offer significant clinical and laboratory benefits in terms of HIV disease with limited side‐effects in Haemophiliacs. However, the clinical manifestation of an opportunistic infection should be mentioned as a possible complication of HAART in these patients, as well as in other categories of HIV infected patients, and in patients with congenital coagulopathies.
Efficacy of a sucrose‐formulated recombinant factor VIII used for 22 surgical procedures in patients with severe haemophilia A
Authors: Scharrer I. , Brackmann H.‐H. , Sultan Y. , Abshire T. , Gazengel C. , Ragni M. , Gorina E. , Vosburgh E. , Kellermann E.
Published: March 2003

A sucrose‐formulated recombinant FVIII (rFVIII‐SF) was investigated under clinical trial conditions during surgical procedures in previously treated patients (PTPs). Fifteen PTPs with severe haemophilia A (FVIII ≤ 1%) underwent 22 surgical procedures. The procedures performed cover a spectrum from minor to major surgery. Haemostatic outcome was assessed by the investigators to be excellent in 16 procedures and good in the remaining six procedures. It is concluded that rFVIII‐SF is efficacious and safe in severe haemophilia A patients undergoing minor or major surgery.
Virucidal heat‐treatment of single plasma units: a potential approach for developing countries
Authors: Goubran H. A. , Burnouf T. , Radosevich M.
Published: March 2003

Since HIV first burst onto the scene of transfusion medicine, the quest for viral inactivation processes for plasma and plasma products has not ceased. Sophisticated methods for improving viral safety are currently used in the industrial world. However, in developing countries, with no facilities for treating plasma, nonviral‐inactivated fresh frozen plasma [FFP] continues to be used extensively, and as screening may not be optimal (or may even be absent), FFP still contributes to the spread of HIV and other infectious viruses.

The feasibility of heat‐treating FFP at the liquid state, in its collection bag, was explored by testing diverse conditions of temperature and duration, in the presence of biologically compatible stabilisers. Quality of the heat‐treated plasma was evaluated by haematological, biochemical and animal assays. The efficiency of the method to inactivate viruses was validated using HIV and model viruses.

The selected heating conditions are 50 °C for 3 h. The optimized combination of stabilisers is composed of 30 mM trisodium citrate, 10 g L–1L‐lysine, 12 mM calcium gluconate and 150 g L–1 sorbitol. Plasma coagulability is appropriately preserved as shown by the KCT ratio (1.4). Recovery of biological activity of most coagulation factors is higher than 70% (including fibrinogen & von Willebrand factor). Electrophoretic and immunoblotting studies did not evidence protein aggregation and/or degradation. Viral validation studies of this procedure have shown complete inactivation of HIV (> 6.6 log) in less than 1 h of treatment. A viral reduction of at least 4 log for various model viruses, including those of hepatitis A and C viruses, suggests a potential contribution of the method to diminish the risk from various blood‐borne viruses.

The selected formulation appears to preserve plasma protein integrity and properties. The procedure does not require sophisticated equipment but it is mandatory to monitor it carefully to ensure quality and reproducibility. If properly controlled and standardized, this approach offers an opportunity to reduce the risk of transmission of HIV and other viruses, particularly in poor countries with a high incidence of HIV.
The Malmö model for immune tolerance induction: impact of previous treatment on outcome
Authors: Carlborg E. , Astermark J. , Lethagen S. , Ljung R. , Berntorp E.
Published: March 2003

Ten patients, who had been treated according to the Malmö model for immune tolerance induction (ITI), were analysed regarding treatment with clotting factors and chemotherapy during the time period between inhibitor detection and ITI. Of the patients who were successfully rendered tolerant (n=6) all but one had received treatment with FVIII, either alone (n=1), or combined with cyclophosphamide (n=4). Of the patients who did not become tolerant, three of four had received treatment with FVIII during the inhibitor period but only one with FVIII and chemotherapy. The total amount of treatment received was in general much lower in the group that did not become tolerant. In individual cases, it appeared very clear that the inhibitor level and anamnestic response was substantially reduced prior to the ITI using the Malmö treatment model. We conclude that treatment of acute bleeds during the inhibitor period may be of importance for ITI and that the different response rates published for different immune tolerance regimens most likely do not reflect the true response rate for the respective regimen.
Long‐term evaluation of a novel surgical approach to the pseudotumour of the ilium in haemophilia: exeresis and transposition of the omentum in the residual cavity
Authors: Bellinazzo P. , Silvello L. , Caimi T. M. , Mostarda G. , Decataldo F. , Baudo F.
Published: March 2003

Pseudotumour of the ilium is a rare but severe complication in haemophiliacs. Excision is often complicated by infections, fistulation and extensive pelvic bone destruction. In 1978, the first author carried out excision of the pseudotumour with transposition of the omentum in the dead cavity to avoid recurrence. This type of surgery has been carried out in three additional patients. The long follow‐up of these four patients suggests that this procedure is feasible and curative; local bleeding, infection and fistulation did not recur and the patients remained ambulant with the aid of appropriate devices.