bluuebunny/crossref_metadata_2025 huggingface dataset:
The effects of frequency of cutting and cultivar on the period of leaf expansion in white clover grown in mixed swards
Authors: Fengrui Li
Published: March 2003

The period of leaf expansion in white clover (Trifolium repens) grown with perennial ryegrass (Lolium perenne) in mixed swards and the relationship between the period of leaf expansion and leaf appearance rate were examined in a field experiment in The Netherlands in which two cutting frequencies (low and high) and three white clover cultivars (Alice, Retor and Gwenda) were used. A significant positive correlation existed between the period of leaf expansion and leaf appearance rate under a low frequency of cutting, indicating that a longer cutting interval might allow the expression of cultivar and environmental differences in both leaf expansion and leaf appearance rate. In most cases, frequent cutting tended to shorten the period of leaf expansion, which may be an important cause of lower dry‐matter yield in the high frequency of cutting treatment. The large‐leaved cv. Alice had a significantly longer period of leaf expansion than the other cultivars under frequent cutting in autumn. This might partly account for the mixtures with Alice having a greater proportion of white clover than the mixtures with Retor and Gwenda in autumn. Some of the variation between low‐ and high‐frequency cutting treatments in the period of leaf expansion could be explained by mean and minimum temperatures (38% and 15% respectively).
The response of Whitegrass [Cortaderia pilosa (D’Urv.) Hack.] to nitrogen nutrition
Authors: Wilson F. E. A. , Harvey B. M. R. , McAdam J. H. , Walton D. W. H.
Published: March 2003

To investigate the potential for increasing Falkland Island Whitegrass [Cortaderia pilosa (D’Urv.) Hack.] pasture production through application of nitrogen (N) fertilizer, two hydroponic experiments were conducted. First, 5 mg l–1 N was supplied to plants as nitrate (NO3–), urea [CO (NH2)2], ammonium (NH4+), or a nine parts NH4+: one part NO3– mixture. At harvest, plants grown in a NO3– medium had about half the biomass of plants grown in a NH4+ medium. In the second experiment plants were supplied with 1, 3, 10, 30 or 100 mg l–1 NH4+‐N. Plants at 1 and 3 mg l–1 N had the largest biomass of young root and the lowest shoot–root ratios. Leaf extension rate was low in the 1 mg l–1 N treatment. Plants given 10 mg l–1 N had the greatest proportion of green shoot material but little root growth; while those at 100 mg l–1 N produced very little shoot and root biomass. Preferential assimilation of NH4+‐N and a low N requirement make Whitegrass well adapted to dominating vegetation on much of the Falkland Islands.
The effect of small gaps in California annual grassland on above‐ground biomass production
Authors: Fehmi J. S. , Laca E. A. , Rice K. J.
Published: March 2003

Small gaps and clumped species distributions are common in grasslands. In California annual grasslands, patches of Lolium multiflorum Lam. and Bromus hordeaceus L. are often separated by gaps. These gaps potentially limit the productivity and associated resource use of these grasslands. The effect that differences in spatial aggregation, gap distribution and species mixing on 20‐cm‐diameter plots has on overall forage production by these two grasses was tested. There were three levels of aggregation: whole plots planted; half planted/half empty; two opposing quarters planted/two empty. Each species was planted in each distribution, and they were combined as mixed, half L. multiflorum/half B. hordeaceus and two quarters L. multiflorum/two quarters B. hordeaceus (nine treatments). Plant aggregation had no significant effect on above‐ground production of whole plots, but individual tillers near gaps were significantly larger than others. Plasticity in the growth of individual annual grasses effectively buffered against variation in average productivity resulting from variations in plant distribution. There were significant (P < 0·001) differences in forage production as a result of the species the plots contained. Plots containing only L. multiflorum produced 4053 kg of dry matter (DM) ha–1, B. hordeaceus plots produced 2448 kg of DM ha–1, and plots containing both species produced 4712 kg of DM ha–1. At small scales, spatial distribution was less important than species composition in determining annual grassland productivity.
Modelling net photosynthetic rate of field‐grown cocksfoot leaves under different nitrogen, water and temperature regimes
Authors: Peri P. L. , Moot D. J. , McNeil D. L. , Varella A. C. , Lucas R. J.
Published: March 2003

A simple multiplicative model using temperature, foliage nitrogen (N) concentration and water status was developed to predict the maximum photosynthetic rate (Pmax) of field‐grown cocksfoot (Dactylis glomerata L.) leaves when none, one, two or all the factors were limiting. The highest Pmax was 27·4 μmol CO2 m–2 s−1 in non‐limited conditions, which was defined as the standardized Pmax value dimensionless (Pmaxs=1). Pmaxs increased 0·058 units per °C from 10°C to the optimum range (19–23°C) (Pmaxs=1) and then declined 0·077 units of Pmaxs per °C from 23 to 31°C. Pmaxs=1 was also measured from 59 to 52 g N kg−1 dry matter (DM) foliage N. Pmaxs then decreased at the rate of 0·115 units per 10 g N kg−1 DM from 52 to 26 g N kg−1 DM, and 0·409 units of Pmaxs per 10 g N kg−1 DM from 26 to 15 g N kg−1 DM. For predawn leaf water potential (ψlp), Pmaxs=1 was measured from −0·1 to −1·2 bar but declined linearly at a rate of 0·078 units per bar of ψlp from −1·2 to −14·0 bar because of a linear decrease in stomatal conductance. An interaction between low N content (≤20 g N kg−1 DM) and high temperature (>23°C) was also detected. Together, this multiplicative model accounted for 0·82 of the variation in Pmaxs.
A note on ensiling safflower forage
Authors: Weinberg Z. G. , Ashbell G. , Hen Y. , Leshem Y. , Landau Y. S. , Brukental I.
Published: March 2003

Abstract The ensiling characteristics of safflower (Carthamus tinctorius) wilted to 290 and 411 g dry matter (DM) kg−1 fresh material were studied in 1·5 l glass jars. The experiment included a control and the application of Lactobacillus plantarum at 3·3 × 105 colony‐forming units (cfu) per g of crop. After 60 days of ensiling, the pH of safflower silages was 4·6 and 4·0 in the control and inoculated silages respectively, with corresponding values for lactic acid, the major fermentation product, of 20 and 45 g kg−1 DM. The silages from the anaerobic jars were stable upon aerobic exposure. It is concluded the safflower silage has potential as an alternative fodder in semiarid regions.
Forage yield and persistency of Trifolium repens × Trifolium nigrescens hybrids when sown with a perennial ryegrass companion
Authors: Marshall A. H. , Williams T. A. , Powell H. G. , Abberton M. T. , Michaelson‐Yeates T. P. T.
Published: March 2003

Abstract Introgression of reproductive traits from ball clover (Trifolium nigrescens Viv.) into white clover (Trifolium repens L.) is one breeding strategy to improve seed yields of T. repens that must be achieved without sacrificing agronomic performance and persistency. The yield and persistency of hybrids between white clover and the annual, profuse flowering species T. nigrescens were compared under a cutting regime over three harvest years. The hybrids included the F1 and the backcross (BC) 1, 2 and 3 generations produced using T. repens as the recurrent parent. Parental species and hybrids were sown with a perennial ryegrass companion; clover and perennial ryegrass dry‐matter (DM) yield and the proportion of clover present were measured over the growing season. In the third harvest year, a portion of each plot was grazed. Differences were observed between T. nigrescens, the F1 and the backcross hybrids and T. repens. In the first and second harvest years, clover DM yield, the proportion of clover present and total DM yield of the backcross hybrids were similar to T. repens, whereas that of the T. nigrescens and the F1 hybrid were negligible. No significant difference in perennial ryegrass production was observed between the parental species and the hybrids when grown, respectively, in combination with these species and hybrids. In the third harvest year, clover DM yield and the proportion of clover present with the BC3 was lower than with T. repens. Throughout the growing season the DM production of T. repens and the backcross hybrids was similar. In the third harvest year, under cutting, DM yield of T. repens was greatest and that of the BC3 lowest, but under grazing, the yields of the BC1 and BC3 were greater than T. repens and the BC2. The implication of these results for the future development of these hybrids is discussed.
Effects of simulated grazing on growth and persistence of Artemisia frigida in a semiarid sandy rangeland
Authors: Li F. R. , Zhao A. F. , Zhou H. Y. , Zhang T. H. , Zhao X.
Published: March 2003

Abstract To assess the tolerance of fringed sagewort (Artemisia frigida Willd.) to grazing in semiarid sandy rangeland, forty‐five fringed sagewort plants of similar size were chosen randomly from sandy rangeland and divided into three cohorts (fifteen plants per cohort) that were subjected to simulated grazing management in 1998. Plants were cut in spring on 24 April and again in summer on 26 July at either 2–3 cm (severe), or at5–6 cm (moderate), or uncut to serve as the control. Plant responses to intensity of cutting were monitored over two consecutive years differing substantially in the amount and seasonal distribution of rainfall. Cutting in spring (moderate or severe) did not influence plant height, average canopy diameter, the number of branches, and specific branching density measured in July 1998. Moderate cutting in summer reduced plant height compared with the uncut treatment but did not influence other plant growth variables in September 1998. However, severe cutting in summer during the reproductive stage strongly reduced plant height, canopy size, the number of branches, individual shoot weight and specific branching density in September 1998 compared with moderate and no cutting and its negative impacts on the growth of this species were evident in the following year. Severe cutting in spring significantly increased the number of flowering shoots, whereas cutting in summer (at either level) reduced the capacity of fringed sagewort to produce flowering shoots. Also, the negative impact of summer cutting on seed production continued in the following year. The production of plant biomass was similar in the three treatments in 1998, but it was significantly lower in cut than uncut plants in 1999. The reduced biomass was due to a decline in plant height, canopy size, number of branches and specific branching density. Compared with the uncut plants, the cut plants tended to allocate a greater proportion of their biomass to vegetative shoots and leaves than to flowering shoots in 1998; in 1999, although cutting treatments had ceased, the cut plants still allocated a greater proportion of new biomass to vegetative shoots and less to flowering shoots, but a similar proportion to leaves.
Incarcerated hernia after laparoscopic‐assisted vaginal hysterectomy: a cautionary tale
Authors: Chan Norman
Published: March 2003

Objective

To report a case of an incarcerated hernia after laparoscopic surgery. To review the literature in order to discuss the risk factors for and prevention of incarcerated hernias at laparoscopic trocar wounds.

Case report

The patient developed an incarcerated hernia through a 12‐mm laparoscopic trocar wound and small bowel obstruction following a laparoscopic‐assisted vaginal hysterectomy. She required a laparotomy to reduce the hernia.

Conclusion

Small bowel herniation following laparoscopic surgery is rare. As laparoscopic operations become more complicated, the risk of bowel herniation also increases. Awareness of this condition may prompt prevention, earlier diagnosis and treatment.
Reality of pelvic lymphadenectomy by laparoscopic surgery
Authors: Mettler Liselotte M. , Bidzinski Marins B. , Morawski Andrej M. , Zielinski Jan Z.
Published: March 2003

Objective

Pelvic lymphadenectomy, as part of the surgical management in many gynaecological malignancies, has so far been performed by laparotomy. Laparoscopy offers a new surgical route for lymphadenectomy. Although numerous papers report on laparoscopic lymphadenectomy, the adequacy at each centre has to be proven. If indicated, the surgery can be combined with laparoscopic‐assisted vaginal hysterectomy.

Design

A retrospective clinical study.

Setting

Over a period of 2 years, 50 laparoscopic pelvic lymphadenectomies and laparoscopic‐assisted vaginal hysterectomies, as total and radical hysterectomies, were performed at the Department of Obstetrics and Gynecology, University of Kiel, Germany and at the Oncological Center in Warsaw, Poland. The lymphadenectomy strategies were identical in all cases, the aim being primarily a lymph node sampling. A transperitoneal route was chosen. A total of 36 cases of endometrial cancer stage I, treated by laparoscopy, were compared with 20 cases of total hysterectomy by laparotomy.

Results

From the 50 patients treated for cervical cancer, borderline ovarian lesions and endometrial cancer stage I, the average number of removed lymph nodes was 14. The aim of these operations was primarily lymph node sampling. No intra‐operative complications were observed. The operation time varied from 2 to a maximum of 4 h. The blood loss did not exceed 250 ml for any case. In three patients tumour metastases were found in 1–3 lymph nodes.

Conclusion

As no symptoms indicating a disadvantage owing to the laparoscopic path of the lymphadenectomy were encountered, laparoscopic lymphadenectomy was found to be a feasible operation, giving identical surgical results but saving the patients a laparotomy. The vaginal hysterectomy, together with a laparoscopic lymphadenectomy, gives the patient a better quality of life within the extensive treatment of genital cancer. The organ itself, that is the uterus with parametrial surroundings and adnexae can be obtained as radically as by laparotomy.
Laparoscopic para‐aortic lymphadenectomy in advanced cervical carcinoma: the Taiwan experience. II
Authors: Chu Kiu‐Kwong , Chang Shuenn‐Dyh , Soong Yung‐Kuei
Published: March 2003

Objectives

To present the Taiwanese experience of para‐aortic lymphadenectomy by laparoscopy in the pretreatment surgical staging of advanced cervical cancer and evaluate the benefits of these procedures.

Design

Patients were prospectively evaluated for different treatment modalities and the results were analysed.

Setting

The Chang Gung Memorial Hospital, Keelung Center.

Subjects

43 consecutive, eligible patients with advanced cervical cancer, operated upon and followed up for at least 20 months, were included in this study.

Interventions

Right‐ and left‐sided para‐aortic lymphadenectomies by laparoscopy were performed. Two groups of patients were delineated, for different treatment modalities. Patients with negative para‐aortic lymph nodes were treated with whole‐pelvic irradiation only; patients with proven para‐aortic lymph node metastasis in surgical staging were treated concurrently with chemotherapy.

Main outcome measures

The 2‐year survival rates for patients with metastasis (receiving concurrent chemotherapy) and without metastasis (receiving irradiation only).

Results

On average, 10.8 lymph nodes were retrieved from both sides of the aorta. The operating time for the procedure ranged from 53 to 138 min, with an average of 93.5 min. After a median follow up of 36.8 months, the progression‐free interval for all patients was 6–55 months (median 26 months). The 2‐year survival rates for patients with metastasis and without metastasis were 68% and 85.5%, respectively.

Conclusions

Laparoscopic para‐aortic lymphadenectomy was an efficient and feasible surgical staging procedure for the pretreatment evaluation of advanced carcinoma of the uterine cervix, and made possible a better choice of treatment modality by the clinician.
Early evaluation of an electromechanical morcellator for laparoscopic supracervical hysterectomy
Authors: Daniell James F. , Channell Calvin , Lindsay James , Staggs Stephen , Henry Traci
Published: March 2003

Objective

To evaluate the effectiveness, safety, and cost effectiveness of electromechanical morcellation of the uterus and adnexae to enhance laparoscopic supracervical hysterectomy (LSH).

Design

41 consecutive LSH procedures with and without adnectomy were reviewed. An electromechanical morcellator was used in each procedure to accomplish laparoscopic removal of the uterus and adnexae.

Setting

A private gynaecological practice in a full service hospital.

Interventions

LSH.

Results

The mean uterine weight was 146 g (60–569 g). The mean operating time was 94 min (60–225 min). The time for morcellation was available in 19 cases by reviewing videotape; the average morcellation time was 11.8 min (4–23 min). Average blood loss was 125 ml (20–600 ml), with one case of late postoperative bleeding requiring operative intervention. The average cost for the procedure was $7998 ($6989–$11 581). All patients were discharged within 48 h of the time of admission, and 36 patients were discharged within 23 h from the time of admission.

Conclusions

LSH is a safe and effective method of managing patients who lack cervical pathology or pelvic relaxation. Electromechanical morcellation can enhance the performance of LSH by decreasing operating time.
Use of laparoscopic surgery for the treatment of ectopic pregnancy in the UK: a national survey
Authors: Saidi Samir A. , Butler‐Manuel Simon A. , Powell Martin C.
Published: March 2003

Objective

Laparoscopic surgery may be considered the gold standard in the management of ectopic pregnancy (EP), yet the technique may not be widely available in the UK. The aim of the study was to investigate its availability.

Method

A postal questionnaire was sent to all 1420 practising consultant gynaecologists registered with the Royal College of Obstetricians and Gynaecologists.

Results

772 consultants responded (55%). At only 13% of hospitals was laparoscopic surgery performed routinely (defined as >75% of cases) for EP. In 43% of hospitals a laparoscopic service for EP was available (>25% of cases managed laparoscopically). Teaching hospitals were significantly more likely than non‐teaching hospitals to have a laparoscopic service available (72 vs. 32%, P < 0.001), and to use the technique routinely (27 vs. 7%, P < 0.001). The main reasons cited for not routinely managing EP using laparoscopic surgery were lack of training of seniors (83% of respondents) and of juniors (86%). Factors significantly associated with provision of a laparoscopic service were the ready availability of consultants in theatre and of juniors trained in the technique. Surgery is still the most common form of treatment for EP, with less than 4% of hospitals routinely using medical treatment as first‐line therapy.

Conclusion

Laparoscopic surgery for ectopic pregnancy is still not available to the majority of British women. The development of training programmes in the technique is a priority.
Laparoscopic treatment of ectopic pregnancy after total vaginal hysterectomy
Authors: Köster Stefanie , Volz Joachim , Melchert Frank
Published: March 2003

Objective

To present an unusual case of extrauterine pregnancy after vaginal hysterectomy.

Subject

A 38‐year‐old patient presented with increasing lower abdominal pain having had a vaginal hysterectomy for myoma 8 weeks previously. A pregnancy test was positive.

Interventions

An immediate operative laparoscopy revealed approximately 2.5 l of blood in the abdomen and a ruptured left tube. A large fetus was found floating freely in the abdomen. The tube was dissected by bipolar coagulation and removed completely, with the product of conception, by Endobag.
The laparoscopic approach of the transabdominal cerclage of the uterine cervix in case of cervical incompetence
Authors: Brölmann Henricus A. M. , Oei Swan G.
Published: March 2003

Cervical incompetence is characterized by painless cervical dilation in the second or early in the third trimester, with prolapse or ballooning of membranes in the vagina and expulsion of an immature fetus. Unless effectively treated, this sequence tends to recur at each pregnancy. Usually a ‘purse‐string’ cerclage as described by McDonald, using a vaginal approach, is effective. If the cervix is too short for this or even absent, a transabdominal cervicoisthmic cerclage (TCC) is indicated. After TCC an eventual pregnancy always culminates in a Caesarean section, as the cerclage cannot be removed vaginally. This is, in fact, the main drawback of this technique.

Objective

To present the laparoscopic approach to TCC.

Case history

The patient was a 34‐year‐old woman with a history of cervical intraepithelial neoplasia and electrosurgical excision of the transformation zone. The pregnancy following this operation ended with an immature delivery, which was attributed to cervical incompetence. Before the next pregnancy, TCC using a laparoscopic approach was carried out. Using one 12‐mm port and two 5‐mm ports, the cervix was laparoscopically freed from the bladder. The avascular space between the ascending and descending branch of the uterine artery was penetrated and a Mersilene band was guided through, just above the level of the sacrouterine ligaments and tied. The operation lasted 40 minutes and the patient was discharged from the hospital, in a good state of health, the next day. Some months later she had an uneventful pregnancy, and a healthy but growth‐retarded son, weighing 1890 g, was delivered by Caesarean section at 37 weeks of gestational age.

Conclusion

The laparoscopic approach to TCC was successful. The growth retardation in the subsequent pregnancy seemed coincidental. The laparoscopic approach is to be preferred for a planned TCC.
Conservative treatment of rectovaginal fistula after laparoscopic treatment of rectovaginal adenomyotic nodule
Authors: Anaf Vincent , De Groote Alexandre , Simon Philippe , Nakadi Issam El
Published: March 2003

Objective

To report a case of successful conservative treatment of a single rectovaginal fistula occurring after laparoscopic treatment for rectovaginal adenomyosis.

Setting

Gynaecology department at a university hospital.

Subject

A young healthy patient who presented with a high rectovaginal fistula (RVF) 3 weeks after laparoscopic resection of a rectovaginal adenomyotic nodule.

Intervention

The patient was treated medically under parenteral nutrition over a period of 18 days, along with a fluid diet and oral intake of loperamide hydrochloride 2 mg three times daily for the first week, and a fibre‐rich regimen during the rest of the hospital stay.

Results

Gastrograffin enema controls showed the closure of the fistula track after 18 days of treatment, when the patient had already been asymptomatic for 4 days.

Conclusion

High RVF are considered to rarely heal under medical therapy. Nevertheless in non‐septic healthy patients with an RVF of small diameter and few symptoms, medical treatment may be attempted under close clinical and biological monitoring. RVF must be considered as a rare but possible complication of rectovaginal adenomyosis surgery. Great care must be taken when dissecting, manipulating or coagulating on the anterior rectal wall which is most usually involved in adenomyosis. Other adapted surgical alternatives must be considered in the case of failure of this conservative medical treatment.
Convalescence after laparoscopically assisted vaginal hysterectomy
Authors: Fahy Una , Watkins Karen , Duffin Stephanie , Kirwan Philip H.
Published: March 2003

Objective

To compare convalescence in women following laparoscopically assisted vaginal hysterectomy and following total abdominal hysterectomy.

Design

A prospective comparative study.

Subjects

72 women who underwent hysterectomy.

Main outcome measure

Physical functioning score according to the SF‐36 Health Status Questionnaire at, 1 and 6 weeks postoperatively.

Results

The physical functioning scores were similar, both preoperatively and at 1 week after the operation, in women who had laparoscopically assisted vaginal hysterectomy (n = 35) and in those who had conventional total abdominal hysterectomy (n = 37). However 6 weeks after operation, women who had undergone laparoscopically assisted vaginal hysterectomy had significantly higher physical functioning scores (26, range 19–30 vs. 22, range 14–30; P = 0.041), and significantly less reduction in physical functioning score relative to baseline than the conventional hysterectomy group (3% vs 13%; P = 0.031).

Conclusion

Women appear to recover more quickly after laparoscopically assisted vaginal hysterectomy than after total abdominal hysterectomy.
Complete resection of adnexal masses with endobag extraction: the risk of involuntary tumour rupture
Authors: Kühn Thorsten , Mangold Raphael , Santjohanser Claudia , Heuser Thomas , Hock Sebastian , Zippel Heinz‐Herbert , Kreienberg Rolf
Published: March 2003

Objective

In a prospective study we analysed the frequency of intraoperative capsule rupture among 161 ovarian tumours operated on endoscopically, using total removal of the adnexa with protected retrieval.

Subjects and methods

Between June 1993 and September 1997 we carried out endoscopic surgery on 161 consecutive patients, presenting with ovarian tumours up to 10 cm in diameter, and assumed to have an increased risk for malignancy on the basis of menopausal status, sonography findings or endoscopic evaluation. The risk of tumour rupture was related to the different phases of the operation (resection and extraction) and to the presence and location of intra‐abdominal adhesions.

Results

Malignancies were found in 6.83% of the patients. Capsule rupture occurred in 13 cases (8%). There was no instance of malignant cell spillage because of intraoperative capsule rupture. The statistical probability of malignant cell dissemination was 0.55% in our series. During resection, rupture of suspicious but not malignant tumours occurred in six cases (3.7%). The probability of spilling cyst contents was closely associated with the presence and the location of intra‐abdominal adhesions, the highest spillage rate (16.6%) being found in tumours with adhesions to intestine. During extraction, contamination on account of bag rupture occurred in seven cases (4.3%).

Conclusion

Using adequate endoscopic resection and removal techniques, suspicious ovarian tumours under 10 cm in diameter can be operated on endoscopically with a low risk of tumour rupture.
Endoscopic surgery and diagnosis in infertility management and assisted reproductive techniques
Authors: Mencaglia Luca
Published: March 2003

Objective

To describe the role of diagnostic laparoscopy, salpingoscopy, surgical laparoscopy, and diagnostic and surgical hysteroscopy in infertile patients, with special attention to techniques of assisted reproduction.

Design

A personal review.

Setting

The Regional Center for Ambulatory Surgery and Infertility, Florence, Italy.

Subjects

Infertile patients undergoing assisted reproduction procedures.

Interventions

Diagnostic laparoscopy, salpingoscopy, surgical laparoscopy, diagnostic and surgical hysteroscopy.

Main outcome measures and results

Diagnostic laparoscopy was considered mandatory in infertile patients when there was suspected tubal, ovarian or peritoneal disease interfering with the capacity to reproduce. The value of other methods as alternatives to laparoscopy and dye insufflation in the management of infertile patients was also evaluated. Salpingoscopy was also reviewed, with the conclusion that this technique is very important in the infertility work up because it allows a prognosis concerning the possibility of conception according to the status of the mucosal folds. Diagnostic hysteroscopy was evaluated. This technique is an extremely reliable outpatient procedure in infertility diagnosis and it allows savings in health costs, even though, unfortunately, it is not yet widely used. The indications for and results of hysteroscopic surgery were also reviewed. Hysteroscopic operations, compared with traditional surgery, involve reduced risk, shortened hospitalization, reduced costs and better results. Considering endoscopic techniques in relation to assisted reproduction, the importance of laparoscopy and hysteroscopy in the selection and preparation of infertile patients was evaluated. However, the direct involvement of endoscopic techniques in gamete retrieval and transfer was considered to give inconsistent results.

Conclusion

There are clear advantages in using endoscopic surgical techniques, and many traditional surgical approaches can be replaced by operative laparoscopy and hysteroscopy. Considering assisted reproduction and endoscopic techniques, we should emphasize the importance of laparoscopy and hysteroscopy in the selection and preparation of infertile patients.
Laparoscopic uterine nerve ablation: a survey of gynaecological practice in the UK
Authors: Daniels Jane , Gray Richard , Khan Khalid S. , Gupta Janesh K.
Published: March 2003

Objective

To determine the current use of and the indications for laparoscopic uterine nerve ablation (LUNA) in the UK, and to establish practitioners' views regarding the desirability of a controlled clinical trial to assess the efficacy of LUNA.

Setting

Gynaecologists associated with the British Society of Gynecological Endoscopy.

Design

A self‐administered structured questionnaire was posted to 457 UK gynaecologists. Their surgical practice and willingness to participate in a randomized trial were surveyed. The postal questionnaire was returned by 249 (55% response rate).

Results

The survey indicated that 113 (45%) of the responders performed LUNA. Of these, 86 (76%) carried out LUNA for chronic pelvic pain, 72 (64%) for endometriosis, and 16 (14%) for dyspaurenia/dysmenorrhoea. Diathermy was used as the surgical tool by 66 (59%) gynaecologists and laser was used by 57 (51%). Of the 113 currently using LUNA, 91 (81%) were willing to enter patients into a proposed clinical trial of LUNA.

Conclusion

Current clinical practice regarding LUNA for pelvic pain is hung in equipoise. This means that the technique has been introduced without reliable evidence of efficacy but opinion regarding its use is not yet solidified. Hence, a rigorous randomized trial of LUNA's efficacy is urgently needed and is practicable.
Histochemical detection of c‐erb‐2 overexpression in endometrial polyps removed by hysteroscopy
Authors: Maia Hugo , Maltez Amélia , Fahel Paulo E. , Coutinho Elsimar M.
Published: March 2003

Objective 

To detect the presence of c‐erb‐2 over‐expression in endometrial polyps.

Setting 

Endoscopy unit of a private, urban hospital.

Subjects and methods 

20 patients with endometrial polyps and six patients with disordered proliferative endometrium underwent resectoscopic surgery. Oestrogen receptor and c‐erbB‐2 protein over‐expression were investigated in the polyp and endometrium by immunohistochemical methods.

Results 

Over‐expression of c‐erbB‐2 was detected in 83% of endometrial polyps in women of reproductive age and in 57% of polyps in women in the menopause. The use of hormone replacement therapy did not affect the percentage of polyps showing c‐erbB‐2 over‐expression. Oestrogen receptors were present in the polyps of all patients. There was no c‐erbB‐2 over‐expression in the cases of disordered proliferative endometrium.

Conclusions

Over‐expression of c‐erbB‐2 oncoprotein was detected in benign endometrial polyps in both pre‐ and postmenopausal patients. Activation of the epidermal growth factor receptor family may be involved in the mechanism of polyp growth.
Late subumbilical metastases of an occult ovarian cancer after laparoscopic cholecystectomy
Authors: Volz‐Köster Stefanie , Melchert Frank , Volz Joachim
Published: March 2003

We present a case of subumbilical tumour seeding of a cystadenocarcinoma 2 years after laparoscopic cholecystectomy. Laparotomy revealed a bilateral FIGO stage 1c cystadenocarcinoma of the ovaries with no signs of other metastases. The subumbilical tumour was the result of an inoculation of tumour cells from the previously undetected ovarian cancer during laparascopy.
Interstitial ectopic pregnancy following hysteroscopic resection of an intrauterine septum
Authors: Robson Stephen , Pozza Christopher , Kerin John F.
Published: March 2003

Objective 

To describe an interstitial pregnancy which occurred subsequent to and at the site of an hysteroscopic excision of an intrauterine septum.

Setting

University‐affiliated reproductive medicine programme.

Subject

A 32‐year‐old woman undergoing IVF treatment for infertility.

Results

The patient underwent IVF treatment after hysteroscopic resection of an intrauterine septum. Ectopic pregnancy occurred interstitially in the uterine fundus, at the site of the previous septotomy. The pregnancy was excised at laparotomy.

Conclusions

Interstitial ectopic pregnancy may represent a complication of operative hysteroscopy.
Outpatient microhysteroscopy: why does it fail?
Authors: Salha Osama , Okeahialam Majella , Jones Siân , O'Donovan Peter
Published: March 2003

Objective

To assess the failure rate of diagnostic outpatient hysteroscopy using a 2.5‐mm semirigid hysteroscope.

Design

Retrospective cohort analysis.

Setting

Outpatient hysteroscopy unit in a large district general hospital.

Sample

All patients who had a diagnostic outpatient hysteroscopy during the study period.

Main outcome measures

Hysteroscopy was considered a failure when the uterine cavity was not accessible or when the view obtained was unsatisfactory.

Results

A total of 1976 patients were seen in the direct‐access hysteroscopy unit between November 1994 and May 1999. The procedure was performed successfully in 1898 patients (96.1%) but failed in 78 patients (3.9%). Causes for failure included: cervical stenosis (n = 54; 67.9%), severe discomfort (n = 7; 8.9%), unsatisfactory view (n = 6; 2.6%), obesity (n = 5; 6.4%), large cervical polyp (n = 4; 5.1%) and vagal reaction (n = 2; 2.6%). Overall failure was more likely in postmenopausal (46/894; 5.1%) than in premenopausal patients (32/1082; 2.9%).

Conclusions

Diagnostic outpatient hysteroscopy using a 2.5‐mm semirigid hysteroscope is a simple, safe, effective and acceptable investigation. The most common reason for a failed outpatient microhysteroscopy was cervical stenosis particularly in postmenopausal women.
The concept of ‘adenomyotic disease of the retroperitoneal space’ is born
Authors: Donnez Jacques , Donnez Olivier , Squifflet Jean , Nisolle Michelle
Published: March 2003

The concept that peritoneal endometriosis, ovarian endometriosis and adenomyotic nodules of the rectovaginal septum are three different entities has been clearly demonstrated by Nisolle & Donnez in 1997. In other words, peritoneal and ovarian endometriosis are diseases of the intraperitoneal space while the adenomyotic rectovaginal nodule is a retroperitoneal disease. If we agree that the most widely accepted theory, the transplantation theory, proposed by Sampson in 1927, can explain the pathogenesis of peritoneal endometriosis, there is strong evidence of an extraperitoneal origin for the adenomyotic nodule. We suggest that the retroperitoneal space should be definitely considered to be the origin of this adenomyotic disease, and the concept of deeply infiltrating endometriosis should be finally abandoned.
Quality of life following radical excision of rectovaginal endometriosis associated with complete obliteration of the posterior cul de sac
Authors: Wright Jeremy Torquil , Shafik Amina
Published: March 2003

Objectives

To review the available literature and studies, both published and unpublished on the effect of radical surgery for obliterative endometriotic cul de sac disease on the quality of life.

Design

Review of literature and audit studies of rectovaginal disease.

Setting

Two specialist endometriosis practices, one in the United States and the other in a UK district general hospital.

Subjects

Patients presenting with rectovaginal endometriosis.

Interventions

Radical laparoscopic excision.

Main outcome measures

Reduction of pain as measured on ranked ordinal, scales and quality of life measures.

Results

Radical laparoscopic surgery for the excision of rectovaginal endometriosis is associated with a significant diminution in symptoms and an improvement in quality of life. This is particularly so for patients who rated their symptoms as severe prior to surgery.

Conclusion

Initial studies show promising results for radical surgery. There is however, a need for randomized controlled trials and proper audit to assess the efficacy and morbidity of this surgery.
Laparoscopic myomectomy using a modified type of reusable laparoscopic Roeder knot pusher to enhance positioning and tightening of the Roeder knot
Authors: Barišić Dubravko , Bagović Damir
Published: March 2003

To describe the technique of laparoscopic reconstruction of the uterine wall defect after laparoscopic enucleation of intramural fibroid, using a modified type of reusable laparoscopic knot pusher which enhances precise positioning and adequate tightening of the Roeder knot.

A stand‐alone one‐day surgery unit.

Six patients having laparoscopic enucleation of an intramural fibroid.

The defect in the uterine wall was reconstructed with open surgery sutures tied extracorporeally using a Roeder knot which was slid and tightened with the knot pusher.

Since the Roeder knots were slid and tightened without blockage and the uterine wall was reconstructed without postoperative intramural haematoma in all patients, the impression is that the modified type of Roeder knot pusher used on standard sutures could be a low‐price alternative to endoscopic sutures.
Is endometrial pretreatment necessary in NovaSure™ 3‐D endometrial ablation?
Authors: Cooper Jay , Brill Andrew , Fulop Tamas
Published: March 2003

Objective

To assess and compare the efficacy of NovaSure, a novel 3‐D bipolar endometrial ablation system, for women with severe menorrhagia secondary to dysfunctional uterine bleeding (DUB), with and without endometrial preparation.

Study design

A prospective, double‐arm, controlled, observational pilot study of 40 women undergoing endometrial ablation using the NovaSure system.

Patients

40 premenopausal women, of average age 44 years, with menorrhagia secondary to DUB and unresponsive to medical therapy, who had completed childbearing, with non‐distorted uterine cavities, and cornu‐to‐cornu measurement of greater than 2.5 cm.

Interventions

Endometrial ablation using the 3‐D bipolar NovaSure system.

Methods

50% of the patients received gonadotrophin‐releasing hormone (GnRH) agonist for endometrial thinning. The remaining patients received no treatment for endometrial thinning. Pictorial blood assessment chart (PBLAC) diary sampling was used to select patients for the study, as well as to conduct the post‐treatment evaluation of menstrual blood loss and bleeding pattern (amenorrhoea, spotting, hypomenorrhea, eumenorrhoea or menorrhagia). All patients received the treatment under intravenous sedation with paracervical block.

Results

No intraoperative complications were observed. Treatment time averaged 72 seconds. Follow up of 12 months has been completed in 29 patients. No significant difference was observed in the outcome (i.e. efficacy) of the procedure between the two groups of patients.

Conclusions

Preliminary results indicate that the NovaSure system can be successfully used as an effective method of treatment for women with menorrhagia secondary to DUB. Endometrial pretreatment appears not to be necessary in global ablation performed using the NovaSure system.
Laparoscopic supracervical hysterectomy complicated by delayed vesicocervical fistula
Authors: Daniell James F. , Anderson Ted L. , Maikis Roseann
Published: March 2003

Laparoscopically performed supracervical hysterectomy is becoming more widely accepted around the world. The objective of this case report is to describe a rare urinary tract complication associated with this operation.

Case report.

Referral practice for endoscopic surgery.

A 35‐year‐old nulliparous woman with recurrent endometriosis and chronic pelvic pain.

A laparoscopic supracervical hysterectomy with bilateral salpingo‐oöphorectomy.

The patient developed a vesico‐cervical fistula 3 weeks postoperatively. After urological consultation, this was treated successfully via minilaparotomy, transvesical excision, and repair of the fistula within 36 h of diagnosis.

Urinary tract fistulas can occur following laparoscopic supracervical hysterectomy. If they are diagnosed immediately and properly managed, standard repair can be successful and morbidity can be minimized.
Comparative mass of suture material involved in extracorporeal slip knots
Authors: Ind Thomas , Chou Danny
Published: March 2003

To compare the weights of commonly used extracorporeal slip knots.

The weights of seven commonly used types of extracorporeal slip knots and an intracorporeally tied flat square knot were compared. In each arm of the study, 17 knots were tied around a 5‐mm jig using a laparoscopic trainer. Knots were weighed using microscales.

A laboratory experiment.

Weight of knot loops in milligrams.

The heaviest ligature was the modified Roeder knot. The Western knot utilized less suture material than all the other knots studied. The flat square knot utilized less suture material than all the slip knots with the exception of the Western ligature.

As other studies have correlated suture mass with the incidence of wound infection, a ligature with a low weight should be chosen in preference to the modified Roeder knot where possible.
Spinal epidural heamatoma in Haemophilia A
Authors: Schmitz  , Wallny  , Sommer  , Brackmann  , Schulze‐bertelsbeck  , Effenberger  , Kowalski
Published: March 2003

We report on a 27‐year‐old male Caucasian with severe Haemophilia A who presented with acute onset of neck pain with cervical nerve root irritation, due to a spinal epidural heamatoma. His past medical history revealed carrying of a moderate weight as a possible traumatic mechanism. Under immediate factor VIII replacement therapy complete remission of the symptoms was achieved within several days. The diagnosis of spinal epidural heamatoma and complete resorption was revealed by initial and follow‐up magnetic resonance imaging studies of the cervical spine. Having reviewed the literature on spinal epidural heamatoma, we present an overview of the treatment and outcome as regards Haemophilia.
Contrast venography in young Haemophiliacs with implantable central venous access devices
Authors: Medeiros  , Miller  , Rollins  , Buchanan
Published: March 2003

To assess the risk of deep vein thrombosis in Haemophiliacs with long‐term central venous catheters, we studied Haemophiliacs followed at our centre with implantable venous access devices (ports) in place for > 6 months. Medical records were reviewed for a history of catheter‐related complications. Each patient was examined for physical stigmata of thrombosis. Patency of the vessels was evaluated by contrast venography. Of 21 males with ports, 19 had factor VIII deficiency and two factor IX deficiency. Nineteen ports were evaluable (i.e. were in place for > 6 months). Seventeen patients have their original ports in place; two ports were replaced for mechanical dysfunction (1) and recurrent infection (1). Difficulty withdrawing or infusing occurred with three ports, two of which were cleared with urokinase. Physical examination was normal on all 19 patients. Venograms were performed in 13 of 19 patients. Parents of the remaining six patients refused venography because of the need for peripheral venipuncture. One patient had a small nonocclusive thrombus on the same side as his functioning catheter, and another had minimal narrowing of the subclavian vein at the site of a prior catheter. The overall prevalence of clinically relevant upper venous system thrombosis identifiable by contrast venography was zero (95% CI, 0–23%). We conclude that Haemophiliacs do not have as high a risk of thrombosis as other populations of patients with central venous catheters. The theoretical risk of thrombosis should not preclude use of central venous catheters in patients with Haemophilia.
Increased CD4‐positive monocytes in HIV‐infected haemophilic patients
Authors: Riera N. , Galassi N. , Felippo M. , Ruibal‐Ares B. , Bianco R. PÉREZ , Bracco M. DE
Published: March 2003

The monocyte–macrophage system is known to play a central role in HIV infection, and expression of CD4 on the surface of monocytes/macrophages is important, since this molecule is a key factor for the entrance of HIV into susceptible cells. In this paper we evaluated the expression of CD4 in monocytes of haemophiliac patients (He) who had been infected with HIV (HIV+ He) through transfusion of contaminated plasma concentrates. Thirty seropositive patients (HIV+ He), 10 seronegative He patients (HIV− He) and 20 voluntary normal blood donors were studied. Phenotypic evaluation of monocytes was performed by flow cytometry of peripheral blood stained with anti‐CD45, ‐CD3, ‐CD4 and ‐CD14 monoclonal antibodies. The percentage of CD4 monocytes was increased in all HIV+ patient groups, but it was highest in those belonging to Groups III and IV A of the CDC classification. Furthermore, the median of fluorescence intensity of CD4+ monocytes from individual patients was shifted to the right, indicating expression of increased numbers of CD4 molecules on the cell membrane of monocytes. This could in turn favour HIV infection and viral persistence, facilitating in vivo dissemination of the virus.
The Malmö–Klaipeda WFH twinning programme: a comparative description of the Haemophilia cohorts
Authors: Berntorp  , Astermark  , Jurgutis  , Lethagen  , Petersson
Published: March 2003

In 1994, the Malmö–Klaipeda twinning programme was approved by the World Federation of Hemophilia. One of the first steps in the collaboration has been to set up a registry of the Haemophilia patients in the Klaipeda area. In order to collect important clinical data the patients have been examined jointly by experts on Haemophilia from the two centres. Seventeen out of 25 patients with severe Haemophilia known at the Klaipeda centre were examined and compared to a matched cohort of patients from the Malmö centre. The main differences between the cohorts were that home treatment was not available to the Klaipeda patients, they received less treatment in general, had higher joint scores and more frequent bleeds. The pattern of transmission of blood‐borne virus was very similar, with a high prevalence of hepatitis C antibodies. We conclude that the twinning programme between Malmö and Klaipeda has resulted in several achievements, including training of staff and a necessary inventory of the patients. This should not only form a suitable platform for the future development of Haemophilia care in Lithuania, but could also serve as an example for liaisons between other Haemophilia centres.