bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of plastic mulch, sowing date and cultivar on the yield and maturity of forage maize grown under marginal climatic conditions in Northern Ireland
Authors: Easson  , Fearnehough
Published: March 2003

The effects of growing forage maize (Zea mays) with or without plastic mulching treatments on the dry‐matter (DM) yield, cob yield, DM content and starch content was investigated in Northern Ireland in 1996 and 1997. Cultivars differing in maturity characteristics were sown in spring at a range of dates in three replicated plot experiments and were used to compare the effects of two plastic mulches and an untreated control: one plastic mulch completely covered the rows (floating); the other had holes punched in the plastic, through which the plants grew (punch). Between April and October in 1996 and 1997, the Ontario heat units (OU) received were above average at 2489 and 2660 respectively; in those years without plastic mulches, the earliest maturing cultivar, Melody, yielded 11·0 and 13·6 t DM ha–1, with dry‐matter contents of 214 and 215 g kg–1 respectively. Mean daily increases in soil and air temperature under plastic mulches of up to 6°C and 11°C, respectively, were closely related to solar radiation. Under plastic mulches, 15% fewer OU were required to reach silking, and 33% more OU were available between silking and harvest. Meaned over three experiments, two years and three cultivars, plastic mulches, when compared with the unmulched control, increased maize yield from 12·0 to 14·7 t DM ha–1, cob yield from 3·7 to 6·8 t DM ha–1, dry‐matter content from 230 to 270 g kg–1 and starch content from 198 to 272 g kg–1. The effect of plastic mulch on the maturation of the crop was greatest at earlier sowings. In 1997, plants from an early sowing date (10 April) that had recently emerged through the punch plastic mulch were damaged by frost, whereas those in the floating plastic mulch plots were unaffected. When the floating plastic mulch was left on after the six‐ to eight‐leaf stage of the first‐early maize cultivar Hudson, the plants were physically damaged and the yield reduced, but DM and starch contents continued to increase. The increases in yield and dry‐matter content under the plastic mulch were greater in Diamant (second‐early cultivar) than in Melody (first‐early cultivar). It was concluded that, under marginal climatic conditions, plastic mulches ought to be used to improve the reliability of early cultivars rather than growing later maturing cultivars.
Dynamics of perennial ryegrass and white clover in sown swards in NW Greece
Authors: Thanopoulos R. , Marriott C. A. , Sidiras N.
Published: March 2003

Seasonal dynamics of white clover and perennial ryegrass were examined in sown perennial ryegrass/white clover swards subject to a 2 × 2 factorial treatment combination of defoliation (rotational grazing by sheep and cutting) and nitrogen fertilizer application (0 and 40 kg N ha–1 year–1) in NW Greece. Sward surface height and percentage cover were measured before and after five defoliation periods in 1996 within permanent microplots (30 × 30 cm, divided into nine cells) in which white clover was either initially present or absent. Both white clover and perennial ryegrass achieved maximum height and cover in April–May. Defoliation treatment and whether white clover was present initially significantly affected height and cover of both species. Total plant cover was similar prior to all defoliation periods except in July, a time of drought. Cover of perennial ryegrass was greater where white clover was initially absent, but total plant cover was greater in microplots containing white clover and the extent of the differences varied during the year. In contrast, N fertilizer application had little effect on species cover, other than small reductions in white clover cover. When white clover was present in April, it was found in virtually every microplot cell until July, but if it was absent in April there was little colonization of the microplot.
Genetic shifts in smooth bromegrass under grazing: changes in nutritional value and preference for surviving vs. original genotypes
Authors: Falkner L. K. , Casler M. D.
Published: March 2003

Genetic shifts in plant morphology and reproductive characters under grazing may potentially affect nutritive value and preference. This research was conducted to determine the response of smooth bromegrass (Bromus inermis Leyss.) populations to long‐term grazing. Genotypes from five populations of smooth bromegrass that survived 9 years of grazing were compared with genotypes of each population grown from original seed. Plant height was measured and biomass estimated for each genotype, before and after grazing by sheep, in order to assess preference. Genotypes were also tested for nutritive value. The selective effect of competition during establishment and maintenance under grazing was accompanied by genetic shifts in smooth bromegrass plants in these pastures. Survivors had greater plant biomass despite having a decrease in plant height of up to 5%. Preference for survivors, quantified as percentage consumption by sheep, was up to 3% units less than for original populations. The nutritive value of survivors was similar to that of original populations, except for one population, which had a lower neutral‐detergent fibre among the survivors after grazing.
Sulphur concentration of soils and plants and its requirement for ruminants in the Inner Mongolia steppe of China
Authors: Wang S. P. , Wang Y. F. , Chen Z. Z. , Schnug E. , Haneklaus S.
Published: March 2003

The sulphur status of four soils and 122 forage plants from the Inner Mongolia steppe was determined. The organic sulphur concentration ranged from 17 μg g–1 in the 0·2–0·4 m soil layer to 397 μg g–1 in the topsoil. The mean sulphate‐S concentrations were <10 μg g–1; greater concentrations were found only in the chernozem soil. Biomass‐S accounted for 0·018–0·028 of total S in four soils. Three‐quarters of plant samples examined had <1·6 g kg–1 S, and >0·80 of them had an N:S ratio >14:1. More than 0·80 of the plants were deficient in S. There was a close relationship between plant‐available soil sulphur concentrations and total plant sulphur concentrations. It was concluded that sulphur deficiency is widespread in the Inner Mongolia steppe and that sulphur fertilizer requirements should be evaluated.
Increased concentration of water‐soluble carbohydrate in perennial ryegrass (Lolium perenne L.): milk production from late‐lactation dairy cows
Authors: Miller L. A. , Moorby J. M. , Davies D. R. , Humphreys M. O. , Scollan N. D. , MacRae J. C. , Theodorou M. K.
Published: March 2003

Eight multiparous Holstein–Friesian dairy cows in late lactation were used to investigate the potential of using perennial ryegrass with a high concentration of water‐soluble carbohydrate (WSC) to increase the efficiency of milk production. After a pretreatment period on a common pasture, the cows were each given ad libitum access to one of two varieties of zero‐grazed grass continuously for 3 weeks. Treatments were: high sugar (HS), an experimental perennial ryegrass variety bred to contain high concentrations of WSC; or control, a standard variety of perennial ryegrass (cv. AberElan) containing typical concentrations of WSC. The two grass varieties were matched in terms of heading date. All animals also received 4 kg day–1 standard dairy concentrate. Grass dry matter (DM) intake was not significantly different between treatments (11·6 vs. 10·7 kg DM day–1; s.e.d. 0·95 for HS and control diets respectively), although DM digestibility was higher on the HS diet (0·71 vs. 0·64 g g–1 DM; s.e.d. 0·23; P < 0·01) leading to higher digestible DM intakes for that diet. Milk yield from animals offered the HS diet was higher (15·3 vs. 12·6 kg day–1; s.e.d. 0·87; P < 0·05) and, although milk constituent concentrations were unaffected by treatment, milk protein yields were significantly increased on the HS diet. The partitioning of feed N was significantly affected by diet, with more N from the HS diet being used for milk production (0·30 vs. 0·23 g milk N g–1 feed N; s.e.d. 0·012; P < 0·01) and less being excreted in urine (0·25 vs. 0·35; s.e.d. 0·020; P < 0·01). In a separate experiment, using the same grasses harvested earlier in the season, the fractional rate of DM degradation, measured by in situ and gas production techniques, was higher for the HS grass than for the control. It is concluded that increased digestible DM intakes of the HS grass led to increased milk yields, whereas increased efficiency of utilization of the HS grass in the rumen resulted in the more efficient use of feed N for milk production and reduced N excretion.
The implications of controlling grazed sward height for the operation and productivity of upland sheep systems in the UK. 5. The effect of stocking rate and reduced levels of nitrogen fertilizer
Authors: Sibbald A. R. , Maxwell T. J. , Dalziel A. J. I. , Agnew R. D. M.
Published: March 2003

The implications for UK upland sheep systems of reducing nitrogen fertilizer application to perennial ryegrass/white clover swards were studied over 3 years. Sward height (3·5–5·5 cm) was controlled for ewes with lambs until weaning using surplus pasture areas for silage; thereafter, ewes and weaned lambs were grazed on separate areas, and sward height was controlled by adjusting the size of the areas grazed and using surplus pasture areas for silage if necessary. Combinations from three stocking rates [10, 6 and 4 ewes ha−1 on the total area (grazed and ensiled)] and four nitrogen fertilizer levels (150, 100, 50 and 0 kg ha−1) provided six treatments that were replicated three times. Average white clover content was negatively correlated with level of nitrogen fertilizer. The proportion of white clover in the swards increased over the duration of the experiment. Control of sward height and the contribution from white clover resulted in similar levels of lamb liveweight gain on all treatments. All treatments provided adequate winter fodder as silage. It is concluded that the application of nitrogen fertilizer can be reduced or removed from upland sheep pastures without compromising individual animal performance provided that white clover content and sward height are maintained. Resting pastures from grazing by changing ensiled and grazed areas from year to year sustained white clover content over a 3‐year period.
Advanced analysis of dry‐weight‐rank data to discriminate direct and indirect interactions between white clover and grasses in a multi‐species pasture under a range of management strategies
Authors: Schulte R. P. O. , Neuteboom J. H.
Published: March 2003

Infestations of pastures by species, such as creeping bentgrass (Agrostis stolonifera), may compromise the white clover (Trifolium repens) content in perennial ryegrass (Lolium perenne) mixtures. However, the interactions between white clover and species other than perennial ryegrass are not well understood. Strategies to prevent creeping bentgrass infestations require an understanding of its interactions with white clover, as the exclusion of white clover from infested pastures could be the result of either direct interaction or niche‐differentiation in response to management. A methodology is presented which enables the segregation of the effects of direct interaction and niche‐differentiation, based on existing dry‐weight‐rank measurements of a number of experimental pastures, subjected to a range of management strategies.

Only between the two management extremities, i.e. permanent cutting of silage and lax grazing for long periods, did niche‐differentiation occur between white clover and creeping bentgrass. The white clover content was enhanced under the cutting regime, whereas lax grazing for long periods stimulated the content of creeping bentgrass. White clover was actively excluded from creeping‐bentgrass‐dominated patches by direct interaction, whereas it showed a high compatibility with perennial ryegrass. This direct interaction presents challenges to the prevention of creeping bentgrass by management, as creeping bentgrass and white clover showed nearly identical requirements in terms of environmental conditions and grassland management.
The long‐term effects on upland sheep production in the UK of a change to extensive management
Authors: Barthram G. T. , Marriott C. A. , Common T. G. , Bolton G. R.
Published: March 2003

Extensification (a reduction in fertilizer inputs and stocking rate of grassland) is seen as one way of increasing the conservation value and of reducing the environmental impact of upland sheep production in the UK, but little is known about the consequences of such a change. This study determines the changes in animal production over ten years following the introduction of four extensive grazing management strategies to perennial ryegrass/white clover pastures at two upland sites. Fertilizer‐free treatments were maintained with sward heights of: 4 cm (treatment 4/4U) or 8 cm (8/8U) during the whole of the grazing year, 4 cm during summer and 8 cm during autumn (4/8U) and 8 cm during summer and 4 cm during autumn (8/4U). A control treatment that received 140 kg N ha−1 year−1 was also maintained with a sward surface height of 4 cm (4/4F). Scottish Blackface sheep grazed all treatments.

The 4/4F treatment carried the greatest number of animals (3746 grazing days ha−1 year−1); the 4/4U and the 8/8U treatments carried 0·73 and 0·43 of this number respectively. The number on the 4/8U treatment was similar to that on the 4/4U while the 8/4U treatment carried 1·41 of that on the 8/8U treatment (0·61 of 4/4F). Mean individual animal performance was greatest on the 8 cm swards and tended to be lowest on the 4/4F treatment. However, the 4/4F treatment produced the greatest live weight of lamb (623 kg ha−1 year−1) with the 4/4U producing 0·77, and the 8/8U producing 0·55, of this amount. Although there was year‐to‐year variation in agricultural output, it was concluded that the lower levels of sheep production that result from a change to extensive systems of grazing management can be maintained for at least 10 years.
Use of regrowth for forage in crops of timothy (Phleum pratense L.) cv. Grindstad grown for seed in Norway
Authors: Havstad L. T. , Aamlid T. S.
Published: March 2003

Six experiments were carried out in two climatically different regions in south‐east Norway in order to compare different procedures for autumn management and use of regrowth in seed crops of timothy (Phleum pratense L.) cv. Grindstad. The experiments were laid out after seed harvest in mid‐August in crops with a stubble height of 5 cm (two experiments) or 12–15 cm (four experiments). Cutting to 5 cm on 15 September or 15 October, with or without an application of 50 kg N ha−1 immediately after seed harvest, and with or without an additional application of 30 kg N ha−1 after cutting, were compared with an uncut and unfertilized control treatment. As a main effect,autumn cutting increased seed yield in the subsequent year in only one experiment; this was laid out in a 13 cm stubble on a fertile soil near the coast. In the remaining five experiments seed yields were unaffected byautumn management regardless of climate or stubble height. Autumn cutting and N application increased the number of seedheads in two experiments, but this was offset by a drop in other seed yield components.

On average for two cutting dates and for plots receiving an application of 50 kg N ha−1 after seed harvest, the dry matter (DM) was 1430 kg ha−1 on an inland site with 12–15 cm stubble, 1400 kg ha−1 on a coastal site with 5 cm stubble and 2460 kg ha−1 for two coastal sites with 12–15 cm stubble. Whereas forage yield and quality were fairly stable from the first to the second cut at the inland site, the yield of DM increased, but the crude protein and energy concentrations decreased from 15 September to 15 October at the coastal sites. It is concluded that the stubble and regrowth in seed crops of timothy cv. Grindstad can be harvested for forage without any effect on seed yield in the next year.
Laparoscopic vs. laparotomic ovarian cystectomy in reproductive age women: an economic evaluation
Authors: Damiani  , Campo  , Dargenio  , Garcea
Published: March 2003

Objective

This study was carried out to assess both the efficacy and the economic advantages of two different surgical techniques in the treatment of ovarian cysts in women of reproductive age.

Design

A prospective randomized clinical study.

Setting

Endocrinological Gynaecology Department of the Catholic University of S. Cuore, Rome.

Subjects

These were 68 women of reproductive age (16–39 years) who were hospitalized for ovarian cysts which had persisted for at least 3 months, or who were noted to have an increase in ovarian volume detected by consecutive ultrasound investigations.

Interventions

Of these patients, 34 received laparotomic treatment using a Pfannewstiel incision and traditional techniques. The other 34 patients underwent a laparoscopic stripping of the capsule of the cyst with no sutures on the ovary.

Results

The two techniques showed similar levels of safety and efficacy. The comparison of direct and indirect costs for the two procedures showed an average total cost of $4940 for laparotomic surgery and $3543 for laparoscopy.

Conclusions

The present study demonstrates that ovarian cysts can be as well treated using laparoscopic access as with laparotomy, but with an average cost reduction of 28% for the former.
The laparoscopic management of ovarian carcinoma: preliminary observations and suggested protocols
Authors: Kadar Nicholas
Published: March 2003

The laparoscopic management of seven women with primary ovarian cancer is described. One had stage I disease, four had stage IIIB and IIIC disease, and two were restaged after suboptimal primary operations. Both patients who were restaged had aortic lymph node metastasis. All patients were left with either no residual or minimal residual disease. The mean anaesthetic time was 4.25 h, the average blood loss 542 ml, the median hospital stay 3 days, and there were no surgical complications. Five patients received chemotherapy prior to discharge. The laparoscopic management of ovarian cancer is discussed in the light of this necessarily anecdotal experience, and the widely held view that laparoscopic surgery is contraindicated in women with suspected ovarian cancer is shown to be untenable. Protocols for the laparoscopic management of patients with early and advanced stage disease are outlined and discussed.
Combined ovarian and uterine pregnancy
Authors: Astner Alois , Henrich Johann A. , Jonat Walter , Mettler Liselotte
Published: March 2003

Objective

We report a case of combined ovarian and intrauterine pregnancy successfully treated by pelviscopy after spontaneous abortion of the intrauterine pregnancy. We discuss the frequency, pathogenic aspects, diagnostic management and therapeutic possibilities of such a rare type of ectopic pregnancy.

Subject

A 25‐year‐old primigravida, who had conceived after ovarian stimulation with clomiphene, came to our hospital 3 weeks after curettage of the uterine cavity for an incomplete abortion. An ovarian pregnancy was suspected on transvaginal sonography and this diagnosis was confirmed histologically after pelviscopic treatment.

Conclusion

Minimally invasive diagnostic and therapeutic management of ectopic pregnancy in early pregnancy should be employed for confirmation of the diagnosis of such a rare combination of intrauterine and ovarian pregnancy. We propose that our surgical management has a high degree of safety for the patient and involves lower hospitalization costs.
Torsion of a Filshie clip presenting as an acute abdomen
Authors: Ong Nicole C. S. , Higgins John R. , Tan Jeffrey H.‐J.
Published: March 2003

An acute abdomen is a common diagnostic problem for physicians. A case is presented in which a Filshie clip had undergone torsion resulting in the presentation of an acute abdomen. This unusual complication should be considered in patients who present with abdominal pain following laparoscopic sterilization using Filshie clips.
Patient recovery after laparoscopic colposuspension
Authors: Cutner Alfred , Rymer Janice
Published: March 2003

Objective

This short report aims to examine patient recovery after laparoscopic colposuspension.

Method

Assessment of patient recovery after a laparoscopic colposuspension.

Results

We found that return to activity was faster than that which would normally be expected after an open abdominal procedure.

Conclusion

We feel that the data presented should encourage further research into the role of laparoscopic surgery for genuine stress incontinence.
A case report of vaginal injury with peritoneal perforation from a water‐jet accident: the first report of treatment by laparoscopic operation
Authors: Ishihara Yuki , Nabuchi Kaoru , Fukumoto Yumiko , Inoue Hiromi
Published: March 2003

Objective

To describe a unique case of vaginal injury with peritoneal perforation from a water‐jet accident that was treated by laparoscopic assisted operation.

Subject

A woman was transferred to our unit with a vaginal laceration caused by impact of water flow to the perineum after falling off of the back seat of a Jet‐ski. A part of the appendix epiploica was seen in the vagina.

Interventions

In this particular case, by using a laparoscope and washing and draining the pelvic cavity, it was confirmed by the surgeon that there was no intestinal injury despite part of the colon having entered the vagina. The perforated vaginal wound was sutured transvaginally while draining the abdominal cavity. Compared with what would have been the case with laparotomy, the patient's need for pain killers and her recovery time were greatly reduced.

Conclusions

Patients with vaginal lacerations are often encountered in the emergency room. In treatment it is necessary to stop the bleeding and prevent infection. In the case of vaginal perforation, it is also important to check for intestinal or pelvic injury. Usually, open surgery is performed for these reasons. However, the authors managed to treat the woman using a laparoscopically assisted approach, and therefore the treatment was minimally invasive.
Peritoneal seeding following hysteroscopic diagnosis of cervical adenocarcinoma
Authors: Wilson Hayley , Duncan Alistair
Published: March 2003

Objectives

The purpose of this case report is to highlight the need for caution when investigating postmenopausal bleeding.

Design

A retrospective analysis of the management of a case of postmenopausal bleeding.

Setting

Northampton District General Hospital, UK.

Subject

The patient was a 77‐year‐old woman with two episodes of unexpected bleeding whilst on continuous combined hormone‐replacement therapy.

Interventions

After diagnostic hysteroscopy and curettage, a total abdominal hysterectomy and bilateral salpingo‐oöphorectomywas performed.

Results

Histological diagnosis revealed a stage 1A2 adenocarcinoma of the cervix and peritoneal washings taken at the time of hysterectomy were found to contain adenocarcinoma cells.

Conclusions

These include advocating the use of hysteroscopy and directed curettage for the investigation of abnormal uterine bleeding, but with some caution as hysteroscopy may be associated with peritoneal seeding of carcinomatous cells. Cervical, ovarian and fallopian tube carcinomas should be also considered as possible causes of postmenopausal bleeding.
Audit of a new one‐stop menstrual disorder service
Authors: Uhiara Joseph E. , Dwarakanath Linga S. , Newton John R.
Published: March 2003

Objective

To evaluate the outcomes of a one‐stop menstrual disorder clinic and to determine its acceptability to patients.

Design

A two‐part audit including a retrospective analysis of data from patients' records, and a prospective study of patients' views of the service.

Setting

The Birmingham Women's Hospital, Birmingham, UK.

Subjects and methods

Audit I involved a manual and computer‐assisted search of the records of patients who attended between 1 May and 31 October, 1996, for data collection and retrospective analysis. Audit II was based on the replies to anonymous printed questionnaires, completed after the consultation, by patients who attended the clinic between 1 January and 31 March 1997.

Results

Audit I: A total of 188 records (95%) were traced and audited. The mean waiting time to consultation was 5.5 weeks. The most common indication for patient referral was postmenopausal bleeding (PMB) (32.2%), followed by intermenstrual bleeding (30.5%) and menorrhagia (12.6%), a combination of which was most prevalent among women aged 41–50 years (90.7%). Out‐patient hysteroscopy was successful in 92.6% of patients. The most common pathology was an endometrial polyp. There were two cases of endometrial carcinoma. Additional procedures at a later stage under general anaesthetic were needed by 25 patients. The difference in costs over 6 months between the out‐patient one‐stop service and the traditional referral system following in‐patient treatment was £31 000. Audit II: Although nine out of every 10 patients experienced moderate discomfort, there was overwhelming patient satisfaction with all aspects of the service.

Conclusion

The one‐stop out‐patient service is successful, rapidly accessible, safe and convenient, and is more cost‐effective than the service offered through the traditional referral system. Our study also indicates that the service is applicable to other gynaecological problems, such as assessment of the endometrium as part of the investigation for infertility.
Twin pregnancy in a rudimentary uterine horn diagnosed by ultrasound and managed laparoscopically before rupture
Authors: Morgans David , Scott Fergus
Published: March 2003

Objective

To describe a case of a pregnancy in a rudimentary horn, diagnosed by ultrasound and treated entirely with laparoscopic surgery.

Subject

A 33‐year‐old multiparous patient, who had conceived after gamete intrafallopian transfer to the left fallopian tube.

Intervention

At 9 weeks' gestation, because of mild right‐sided pain, pregnancy in a right rudimentary uterine horn, surrounded by very little endometrium, was diagnosed by means of ultrasound. At laparoscopy, the diagnosis was confirmed and the main body of the uterus was separated from the rudimentary horn containing the pregnancy. The tissue was then removed via one of the abdominal ports.

Conclusion

Pregnancy in a rudimentary uterine horn diagnosed by ultrasound before rupture, can be treated using advanced laparoscopic surgery, with the associated benefits of this technique.
Simplified laparoscopic suturing: an acquired skill
Authors: Trivedi Prakash , Krishnamurthy Y. Niraj , Padhye Asima
Published: March 2003

Objective

To describe a simplified method of laparoscopic suturing for advanced or simple laparoscopic surgery by using our specially designed thread carrier, a simple knot and a special knot‐pusher, and to describe a method of making endosutures.

Design

Prospective study.

Setting

National Institute of Laser and Endoscopic Surgery, Mumbai (Bombay), and Jaslok Hospital and Research Centre, Mumbai, India.

Interventions

A simplified laparoscopic suturing technique was used in 352 laparoscopic surgery procedures, including laparoscopic hysterectomy, myomectomy, appendectomy, etc.

Results

The simplified laparoscopic suturing technique designed and used by us is a skill that can be acquired; it is associated with adequate safety, no major complications, and an easy learning curve. It is a cheap technique and not dependent on a continuous supply of ready‐made endosutures.

Conclusion

Though laparoscopic surgery has progressed rapidly, suturing techniques still remain difficult and quite often confusing. We have designed a simplified suturing technique for various laparoscopic surgery procedures, which is elegant, secure and cheap, which is easy to learn and is associated with no major complications. Our technique is predominantly extracorporeal; however, the simplification of both extracorporeal and intracorporeal suturing will be of benefit to all endoscopists.
Combined vaginal and laparoscopic sacrofixation for genital prolapse using a tacking technique: a series of 45 cases
Authors: Godin Pierre Arnaud , Nisolle Michelle , Smets Mireille , Squifflet Jean , Donnez Jacques
Published: March 2003

Objective

To determine the efficacy and the safety of a combined laparoscopic and vaginal approach to the management of genital prolapse.

Design

A retrospective case series.

Setting

Gynaecological unit of a university hospital.

Subjects

45 women with total genital, cervical or vaginal prolapse examined between November 1995 and November 1997.

Interventions

All the patients underwent a simple combined vaginal and laparoscopic technique. A polypropylene mesh was attached to the posterior part of the cervix or the vaginal vault and the body of the first sacral or fifth lumbar vertebra. A tacking device (Origin Tacker System) was used.

Results

Follow up ranged from 6 to 30 months. Combined vaginal and laparoscopic surgery was faster than laparotomy and use of the tacking technique provided an easy, quick and effective fixation of the mesh to the vertebra in all cases but one. There was one recurrence due to inappropriate fixation of the mesh to the cervix. In another case, the vault was well fixed but an enterocele appeared 1 month later and required classical vaginal management. One serious complication (sciatic nerve compression) was caused by inappropriate tacking of one coil.

Conclusion

Our results suggest that a combined vaginal and laparoscopic sacrofixation approach can be an effective and quick alternative for prolapse therapy.
Evaluation of the endometrium in abnormal uterine bleeding associated with long‐term tamoxifen use
Authors: Bakour Shagaf H. , Khan Khalid S. , Newton John R.
Published: March 2003

Objective

To evaluate the underlying endometrial pathology in breast cancer patients receiving long‐term tamoxifen and presenting with abnormal bleeding.

Design

Prospective cohort study (1996–97).

Setting

Minimal access surgical training centre in a large teaching hospital.

Methods

Outpatient ultrasound scan, hysteroscopy and endometrial sampling were carried out in 24 breast cancer patients with abnormal uterine bleeding who were receiving tamoxifen. If these outpatient procedures failed, inpatient hysteroscopy and endometrial sampling was undertaken. On diagnosis of an endometrial polyp, inpatient hysteroscopy, polypectomy and curettage were carried out.

Results

Hysteroscopy revealed polyps in 17 of 24 patients (71%). Histologically, 13 polyps were benign, three polyps had hyperplasia (one simple and two complex), and one polyp was malignant. Endometrial thickness (ET) on ultrasound scan was associated with hyperplasia or cancer only at ET ≥ 10 mm.

Conclusion

In breast cancer patients receiving tamoxifen and presenting with abnormal bleeding, a high rate of pathological endometrial lesions was observed. All the polyps were diagnosed hysteroscopically but prediction of premalignant/malignant lesions, which were confirmed by histological assessment, could not be done hysteroscopically. There is a need to assess the accuracy, acceptability and cost‐effectiveness of the various tests for evaluating endometrial pathology.
Falloposcopic investigation of tube pathology: correlation with histopathological findings
Authors: Déchaud  , Serres  , Picot  , Baldet  , Hédon
Published: March 2003

Objective

To compare the results of falloposcopic and histopathological examination of diseased fallopian tubes in order to assess the diagnostic quality of falloposcopy.

Subjects

Five infertile patients with known, severe tubal pathology, which was considered to be irreversible and unsuitable for reconstructive surgery.

Interventions

Falloposcopy followed by a bilateral salpingectomy, as preparation for in vitro fertilization. Serial cuts of the different segments of the 10 tubes were then prepared for histopathological examination. The histopathological findings were compared in blind fashion to the falloposcopic results. The pathomorphological criteria for both were the luminal geometry, status of the mucosal surface, fold architecture and intraluminal findings.

Results

The sensitivity of falloposcopy was 100% for the evaluation of luminal geometry, the mucosa and fold architecture. For intraluminal pathology, the sensitivity was 75% and the specificity was 100%.

Conclusion

In cases of severe tubal pathology, falloposcopy is an accurate diagnostic examination. However, its capacity to detect intraluminal pathology needs to be improved.
The value of outpatient hysteroscopy in the management of postmenopausal bleeding: a review of 862 cases
Authors: Alexopoulos Evangelos D. , Simonis Chantal D. , Kidsley Sally , Fay Toby N.
Published: March 2003

Objective

To evaluate the efficacy, reliability and acceptability of outpatient hysteroscopy in the investigation of postmenopausal bleeding in a major teaching hospital.

Design

A retrospective descriptive study of 862 women referred with postmenopausal bleeding for outpatient hysteroscopy.

Methods

Between 1994 and 1997, 862 women were referred to the Women's Endoscopy Unit at Nottingham City Hospital for postmenopausal bleeding. Of these women, 171 were receiving hormone replacement treatment. The endocervical canal and the endometrial cavity were assessed using either a 4‐mm rigid or a 3.5‐mm flexible hysteroscope according to the preference of the operator. All hysteroscopies were performed by consultants or experienced registrars. Pipelle endometrial biopsy was taken when indicated.

Results

The mean age of patients referred with postmenopausal bleeding was 58 years. Hysteroscopy was completed successfully in 97.2% of all patients. Cervical stenosis and pain were the main reasons for failure to complete the procedure. Local anaesthesia with paracervical infiltration was used in one‐third of all patients undergoing hysteroscopy. Intrauterine polyps were the commonest finding (13.9%) while submucous fibroids were detected in 10.7%. Endometrial biopsies were taken in 34.7%. Abnormal histological findings were reported in 28 cases, including eight instances of endometrial adenocarcinoma. After hysteroscopic assessment, 81% of patients were discharged while further surgical treatment was warranted in 14.6%.

Conclusion

Outpatient hysteroscopy is a reliable, safe and well‐tolerated diagnostic procedure for investigating endometrial and endocervical pathology in patients with postmenopausal bleeding. Whenever hysteroscopic findings appear suspicious an endometrial biopsy should be taken to exclude endometrial pathology.
Laparoscopically assisted segmental sigmoid resection (LASSR) for sigmoid endometriosis
Authors: Anaf V. , Sperduto N. , Simon P. , Noel J.‐C. , El Nakadi I.
Published: March 2003

Objectives

To confirm the feasibility and safety of laparoscopically assisted segmental sigmoid resection (LASSR) for sigmoid endometriosis.

Setting

Gynaecology and surgery departments at a university hospital.

Subjects

Between August 1997 and April 1999, five patients with symptomatic sigmoid endometriosis and concomitant pelvic endometriosis underwent LASSR. During that same period laparoscopic procedures for endometriosis involving the intestinal tract included: five anterior resections of the rectum with transanal end‐to‐end anastomosis for extensive rectosigmoid endometriosis, 26 resections of rectovaginal endometriotic nodules and one appendectomy.

Interventions

These included: laparoscopic dissection of the left large bowel from its adherent neighbouring structures, incision of the lateral and medial peritoneal reflections of the mesosigmoid, incision of the left paracolic gutter, identification of the left ovarian vessels and left ureter, extracorporeal resection of the sigmoid and lateroterminal handsewn anastomosis, and laparoscopic treatment of concomitant pelvic endometriosis.

Results

Neither intra‐ nor postoperative complications occurred. The mean operating time was 210 min. Postoperative ileus lasted less than 72 h in all cases (n = 5). The mean postoperative hospital stay was 6 days. There was no recurrence of sigmoid endometriosis symptoms over follow up for a mean of 15.2 months.

Conclusions

LASSR is a feasible and safe technique which is indicated for symptomatic sigmoid endometriosis. It allows the simultaneous laparoscopic management of pelvic endometriosis. Better cosmesis is an immediately recognizable benefit of this technique. Reduced postoperative pain and shortened postoperative ileus represent presumed advantages of LASSR compared with open surgery. The use of LASSR can help to reduce the cost of the laparoscopic instrumentation that is necessary for total laparoscopic colectomy.
Complications of operative laparoscopy
Authors: Miranda Cristián S. , Carvajal Antonio R. , Escobar Paula
Published: March 2003

Objective  To assess the incidence and type of laparoscopic complications.

Design  A series of 1649 operative laparoscopies were reviewed in a retrospective study of patient records.

Setting  A tertiary care university hospital.

Interventions  Operative laparoscopy including minor procedures (minimal adhesiolysis, destruction of minimal endometriosis foci, ovarian biopsy, ovarian puncture, tubal sterilization); major laparoscopic surgery (extended adhesiolysis, tuboplasties, uterine suspension, treatment for ectopic pregnancy, salpingitis, ovarian cyst, moderate and severe endometriosis), and advanced laparoscopic surgery (hysterectomy, myomectomy, bladder neck suspension).

Results  There was one major vascular complication, two intestinal injuries, one anaesthesiological complication and two urinary tract injuries. In addition there were two minor and five postoperative complications. The overall complication rate was 13/1649 (0.8%). The major complication rate was 6/1649 (0.36%).

Conclusions  This review has been useful in helping surgeons to reduce the risk of injuries and to inform patients about possible complications. These rates were similar to those that have been previously reported.
Hysterectomy for benign uterine disease: the effect of the introduction of laparoscopic‐assisted hysterectomy on the selection of surgical access
Authors: Fernandez Hervé , Anquetil Christophe , Capella‐Allouc Sylvie , Frydman René , Gomel Victor
Published: March 2003

Objective To investigate the effect of the introduction of laparoscopic surgery on the use of traditional techniques of hysterectomy.

Design A retrospective study of hysterectomies performed for benign uterine disease, between August 1991 and July 1997.

Setting University hospital.

Subjects Patients requiring hysterectomy for benign uterine disease without prolapse or pelvic floor relaxation.

Interventions 359 hysterectomies including vaginal (n = 211), laparoscopically assisted vaginal (n = 56), and abdominal (n = 92).

Results The main indications for hysterectomy were profuse uterine bleeding and pelvic pain; uterine fibroids were a common occurrence (87%). There were no statistical differences between the mean ages of the patients in the three groups. The mean parity was significantly lower (P = 0.04) for patients undergoing abdominal hysterectomy
(AH) (1.3 ± 1.4) than for those whose surgery was either vaginal (2 ± 1.5) or laparoscopic (1.8 ± 1.6)
. Before the introduction of laparoscopic‐assisted vaginal hysterectomy (LAVH) (1989–90), the rates of vaginal hysterectomy (VH) and abdominal hysterectomy (AH) in our department were, respectively, 42% and 58%. In the initial 3 years of the study period, the rate of abdominal hysterectomy stayed stable around 30%, then dropped gradually to 18% (P < 0.05). The rate of LAVH stayed stable during the initial 4 years (between 22 and 24%) and declined thereafter to 7% (P < 0.05). The rate of VH stayed stable during the initial 4 years (between 46 and 56%) and then increased gradually to 75% (P < 0.05) and more specifically to 90% in patients who had no prior vaginal childbirth. During the last 2 years of the study there was a decrease in the use of the laparoscopic approach in favour of the vaginal route.

Conclusion In our institution the introduction of LAVH led to expected changes during the initial 3 years of the study period, producing a major decline in the rate of AH in favour of LAVH. The unexpected development during the second 3 years of the study period was a further decline in the rate of AH along with a significant decline in the rate of LAVH, both in favour of VH.
Omental evisceration through 5mm umbilical laparoscopy port site
Authors: Negri John , Kuhn Raphael
Published: March 2003

Objective To report the first adult female case of umbilical omental evisceration through a 5‐mm port site.

Subject  A woman in whom evisceration occurred 6 h after an uncomplicated laparoscopic ovarian cystectomy.

Intervention The umbilical port‐site incision was extended, the omentum reduced into the abdomen and the fascial defect closed.

Conclusions Strategies for prevention of this complication are outlined.
Endoscopic transabdominal cervical cerclage
Authors: Ind Thomas , Mason Peter
Published: March 2003

Objective To describe a case of endoscopic transabdominal cervical cerclage.

Setting St Mary’s Hospital, Paddington, London, UK.

Subject A 33‐year‐old lady with clinical cervical incompetence.

Intervention Cervical cerclage was performed with zero gauge coated polyester at the level of the internal os.

Results The duration of the operation was 50 min and was performed uneventfully. Prior to surgery the cervix admitted the largest dilator available (14 mm) without resistance. After the operation, the internal os did not admit a dilator of 9.5‐mm diameter. The patient was discharged 18 hours after completion of the procedure.

Conclusion In this instance, laparoscopic cervical cerclage proved technically easy for a surgeon trained in laparoscopic suturing methods and resulted in discharge from hospital in the morning following an afternoon procedure.
Postmenopausal endometrial tuberculosis
Authors: Agboola Adekunle Julius , Walton Stuart M. , Hoffman Jonathan
Published: March 2003

Objective We describe a case of endometrial tuberculosis where confirmatory biopsy material was obtained by selective resection. The hysteroscopic appearance of tuberculous granulomas is discussed.

Subject A 62‐year‐old woman presented with breakthrough bleeding whilst on hormone replacement therapy. Endometrial biopsy obtained at diagnostic hysteroscopy showed the presence of granulomas on histological examination. At a second hysteroscopy subepithelial nodules were seen and resected. Histological examination confirmed the presence of non‐caseating epithelioid granulomas. The Heaf test was strongly positive.

Conclusion Tuberculous granulomas can be seen hysteroscopically and selective resection will provide targeted biopsy material to aid diagnosis.
A safer laparoscopic hysterectomy. Laparoscopic hysterectomy using clamps: a new concept
Authors: Sinha Rakesh Y. , Warty Neeta R. , Hegde Aparna G. , Bapaye Charulata
Published: March 2003

Objective 

To evaluate the employment of the reusable laparoscopic hysterectomy clamp, Sinha's pedicle clamp (SpeC), in addition to intracorporeal suturing and/or endoloops during laparoscopic hysterectomy.

Design 

A study of 21 laparoscopic hysterectomy procedures carried out between January 1995 and March 1996.

Interventions 

A total of 52 pedicles were secured using clamps. We used 5‐mm curved clamps (right and left), with a ratchet locking mechanism to secure the grip, for all the vascular pedicles while performing a laparoscopic hysterectomy. The pedicles were then ligated with endoloops using no. 1–0 Vicryl on a curved body needle. The clamp was then gently released as the endoligature or suture was tightened.

Conclusion 

We are convinced that using clamps for laparoscopic hysterectomy would be safer than bipolar desiccation and the use of endo‐staples and would avoid major urological and haemorrhagic complications.
Thermal balloon endometrial destruction: the outcome of treatment of 117 women followed up for a maximum period of 4 years
Authors: Friberg Britt , Ahlgren Mats
Published: March 2003

Objective

To study the long‐term results of treatment for menorrhagia involving the thermal destruction of the endometrium by means of a balloon catheter.

Design

Between August 1993 and December 1996, 117 women were treated and, in a prospective study, 116 (99%) of them were followed up with consultations and questionnaires. No pretreatment with gonadotrophin‐releasing hormone (GnRH) analogues was given.

Setting

Gynaecology department at a university hospital.

Results

There were no immediate peroperative complications. The success rate after 25 months (range 10–49) was 94%, excluding women with preoperative intracavitary changes and pretreatment ultrasonographically identified submucosal leiomyomas. Life‐table analysis showed that the probability of assessing the treatment as ‘excellent’ or ‘good’ and avoiding hysterectomy over a 49‐month period was 81%, and the probability of avoiding hysterectomy over the same time period was 85% when no exclusions were made.

Conclusions

For women with menorrhagia, who have no further wish for pregnancy, this study shows that thermal endometrial destruction by means of the balloon catheter technique is a safe type of day case procedure with a high success rate. Pretreatment examination is important in order to select women well suited for the treatment. A successful result 1 year after treatment implies a successful result in the long term.
Endometrial ablation by electroballoon coagulation: long‐term results
Authors: Gallinat Adolf , Cosgriff Ned
Published: March 2003

Objective 

To evaluate the safety and efficacy of electroballoon coagulation (Vesta™ system) for the treatment of dysfunctional uterine bleeding.

Design 

Prospective single‐arm study with continuous follow up of at least 24 months.

Setting 

Specialized free‐standing centre for gynaecological endoscopy.

Patients 

124 women suffering from menorrhagia in whom medical treatment had previously failed.

Intervention 

Vesta endometrial ablation following hysteroscopic evaluation of the uterine cavity.

Measurements and main results 

In 122 patients complete 24‐month follow‐up data were available; 52% of patients reported amenorrhea or very minimal bleeding and 34% of patients reported hypomenorrhea.

Conclusion 

The Vesta system is a safe and effective method of endometrial ablation resulting in a very high success rate as evidenced by a low complication rate and the quantitative measure of post‐treatment menstrual bleeding.
A new knot pusher for secure slip knots in laparoscopic surgery
Authors: Hutchon David J. R.
Published: March 2003

Objective

To describe a new design of knot pusher which allows secure locking of some extracorporeal slip knots during a single pass.

Design

Description of the instrument and its use with review of the literature.

Conclusion

This instrument provides an effective method of making secure slip knots in laparoscopic surgery.
An unusual case of delayed bowel trauma following uterine perforation and endometrial ablation
Authors: Jones Kevin , Anderson Harriet , Sutton Christopher
Published: March 2003

To report the case history of a patient who sustained delayed bowel trauma following uterine perforation, and endometrial ablation.

The clinical records of the patient were reviewed.

Dysfunctional uterine bleeding unresponsive to medication was diagnosed, and the patient was booked to undergo a Vesta system endometrial ablation procedure. Following insertion of the electrode‐carrying balloon, the first warm‐up phase was aborted because of an impedance error, and the second warm up failed to reach a temperature of 75 °C on all electrodes. Uterine perforation was suspected. Inspection of the uterus revealed a lateral perforation below the endocervical os. A rollerball ablation of the endometrium was then carried out under laparoscopic control. At 3 months later the patient was admitted with symptoms and signs of acute abdominal pathology. She underwent a laparotomy, and a small bowel perforation was oversewn. During the operation, malrotation of the bowel was diagnosed. The patient continued to experience menorrhagia, and subsequently underwent a hysterectomy.

This is an unusual case report of delayed bowel trauma following uterine perforation, and endometrial ablation in a patient with malrotation of the bowel.