bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparing vaginal and coelioscopic total or subtotal hysterectomies: prospective multicentre study including 82 patients
Authors: Jugnet Nathalie , Cosson Michel , Wattiez Armand , Donnez Jacques , Buick Valerie , Mage Gerard , Querleu Demis 
Published: March 2003

Three surgical units were involved in a prospective comparative study: the Pavillon Paul Gellé in Roubaix, France for vaginal hysterectomies; the Hôtel Dieu Polyclinic in Clermont‐Ferrand, France for total percoelioscopic hysterectomies; and the Saint‐Luc Clinic in Brussels, Belgium for subtotal percoelioscopic hysterectomies.The inclusion criteria were age (38–55 years old), the patients were either not menopausal or else they had received alternative therapies for menopause, and had mild uterine pathology with or without castration signs, but without pelvic pain. The vaginal or coelioscopic approach had to be practicable. Those patients with psychiatric histories, or with prolapses or stress incontinence which demanded surgery were excluded. Contraindications to any of the approaches (uterine volume larger than umbilicus, major previous pelvic surgery, severe endometriosis and virginity) were also considered to be exclusion criteria. A total of 82 patients who had undergone 31 vaginal hysterectomies, 31 total coelioscopic hysterectomies and 20 subtotal coelioscopic hysterectomies were followed up 1 year after the operation.The population characteristics in the three groups were similar. Operating times were 70.8 min for vaginal hysterectomies (VH), 67.6 min for total percoelioscopic hysterectomies (TPCH) and 111.5 min for subtotal percoelioscopic hysterectomies (SPCH). The mean hospital stay was comparable in the three groups. The mean uterine weight was 225 g for the VH group, 281 g for the TPCH and 206.5 g for the SPCH group (P was not significant). The pain evaluation scales used by the patients during their hospital stay did not show any significant difference between the three groups. The mean times before patients could walk, return to work or resume sexual intercourse showed no significant differences between the groups. Mild urinary signs were reported in the mid‐term without any significant difference. Physical activity improved in 38.7% of the patients who had undergone VH, in 46.6% who had undergone TPCH and in 60% who had undergone SPCH (P not significant). Those patients who had undergone SPCH resumed satisfactory sexual intercourse significantly earlier (P = 0.0002). Intercourse was not significantly modified in the three groups. Quality of life was generally and significantly improved for 80.6%, 96.5% and 70%, respectively, of the patients in the VH, TPCH and SPCH groups.Although some surgical teams are still reluctant to practise coelioscopic hysterectomies, all three hysterectomy types were finally demonstrated to be equivalent in this study. They were proved to be feasible even in patients with a large uterus. Operating times are no longer unfavourable factors when coelioscopies are performed by highly skilled surgeons.
Mesh erosion into the bladder following laparoscopic colposuspension
Authors: Paley Judith , Doyle Mark , Parr Nigel 
Published: March 2003

A previously unreported finding of polypropylene mesh erosion into the bladder two years after laparoscopic colposuspension.As with the vagina, synthetic mesh can erode into the bladder following urogynaecological sling procedures. Previous surgery may be a risk factor. Recurrent urinary tract infection or persistent haematuria following such a procedure should raise suspicion of mesh erosion.
Transcervical endometrial resection in 197 women. Hysterectomy rate and associated risk factors after a 5–8‐year follow‐up period
Authors: Panoskaltsis Theodore A. , Bassett Paul A. , Frappell Jonathan M. 
Published: March 2003

ABSTRACTObjective To identify the hysterectomy rate and associated factors following transcervical resection of the endometrium (TCRE).Design Prospective observational study over an 8‐year period.Setting Endoscopic Unit and Medical Audit Department, Derriford Hospital, Plymouth, UK.Sample The first 197 women to undergo TCRE for menstrual disorders under the care of the senior author (J.M.F.).Interventions Hysteroscopic endometrial resection and rollerball ablation.Main outcome measure Hysterectomy rate.Results All women were followed up from a minimum of 5 to a maximum of 8 years. The mean age was 41 years (range 24–56). The procedure was abandoned in three cases. There were no deaths. Immediate complications occurred in 5% of patients (including five uterine perforations and one case of deep venous thrombosis). No serious fluid overload sequelae occurred. There was one case of atypical endometrial hyperplasia, but no cancer was found. At the end of the study (median follow up of 72 months), survival analysis showed that the hysterectomy rate because of persistent menstrual complaints was 25%. Five hysterectomies were done because of uterine perforation at the time of TCRE and four for unrelated reasons. Multivariate analysis identified only blood loss at TCRE as an independent risk factor for hysterectomy. Other operative variables (age, surgeon, size of uterus, presence of fibroids, volume of glycine used, operating time, synchronous laparoscopic sterilization, and repeat TCRE) had no effect on the hysterectomy risk.Conclusions Our results indicate that women who are offered a TCRE should be warned that they have a one‐in‐four risk of subsequently having a hysterectomy for persistent menstrual complaints. However, TCRE is a quick, safe operation with minimal operative morbidity. A repeat TCRE and the presence of fibroids did not increase the risk of hysterectomy in this group of women.
Intraoperative transmission of blood‐borne disease in Haemophilia
Authors: Rodriguez‐Merchan  
Published: March 2003

Because HIV and hepatitis B and C infection can be transmitted by exposure to infected blood or blood components, orthopaedists are at risk for HIV and hepatitis infection during surgical procedures. Thus, care must be taken to protect themselves from transmission of HIV and the hepatitis virus. The following precautions are recommended: double latex gloves, changed hourly, or a combination of cloth and latex gloves, enclosed hood and face‐masks and operative isolator with umbilical‐cord aspirator; knee‐length impermeable gowns of high‐count polyester weave or plastic‐lined nonwoven spun‐lace polyester; a combination of shoe‐covers that provide waterproof coverage as high as the knee; and disposable drapes.If a member of the operating team is inadvertently pricked or cut, the wound should be washed immediately with iodine, soap and water. If the injured person has been immunized for the hepatitis B (and has adequate titres), or is positive for hepatitis B surface antigen or antibody, no further treatment is necessary. Otherwise, two doses of hepatitis B immune globulin should be given, 5 mL immediately and 5 mL after 1 month.Because HIV infection can be transmitted by exposure to infected blood, orthopaedic surgeons are also at risk for HIV infection. Prospective studies suggest that this risk is very low; nevertheless, health‐care workers need to adhere rigorously to the aforementioned infection‐control precautions to minimize the risk of exposure to blood.
On the safety of synoviorthesis in haemophilia
Authors: Fernandez‐palazzi F. , Caviglia H. 
Published: March 2003

One of the best procedures to prevent haem‐arthrosis has been radioactive synovectomy (synoviorthesis). Since the first report of radioactive synovectomy in haemophilia of Ahlberg in 1971 [1], many centres adopted this procedure as the one of choice, through fibrosing the synovial membrane, prevent further haemarthrosis.Since 1976 we have performed 104 such radioactive synoviorthesis in 97 patients, age ranging from 6 to 40 years with a mean of 10 years. Sixty‐five of these patients were under 12 years of age. The knees were injected in 61 cases, elbow in 26 cases, ankles in 14 cases and shoulders in three cases. The clinical results of this procedure show 80% of excellent results with no further bleeding. In case of failure, a new injection can be given in the same joint at a 6‐month interval, or an injection for the same purpose in other joint. One of the criticisms against this method is the possible chromosomal damage induced by the radioactive material.In our centre, four studies have been carried out in order to see whether these changes, when they occur, are everlasting; all have demonstrated that chromosomal changes are reversible. The radioactive material used in the two first studies was Gold‐189 (189Au). In 1978, 354 metaphases were studied with 61 ruptures, 17.23% (nonpremalign) and six structural changes, considered premalign (1.69%). Any number below 2% is considered not to be dangerous. A further study was done in 1982, in the same group of patients with a result of 21 ruptures (3.34%) and no structural changes. This demonstrated that the possible premalign changes disappeared with time. A third study was performed in a series of 13 patients that sustained radioactive synoviorthesis with Rhenium‐186 (186Re) in November 1991. For comparison, we carried out a chromosomal study just before and 6 months after the radioactive material injection. The results confirmed that changes that could be linked to the radiation, appeared equally in nonirradiated patients, and those changes due to the radiation disappear with time, never reaching the dangerous zone of 2%. In the group treated with186Re we studied an additional number of 130 metaphases with identical results and no structural changes. In a study on patients where90Y was the radiocolloid, no premalign change was found before or after the synoviorthesis. It seems, in view of these results, that radioactive synovectomy is safe and gives great benefits to the haemophilic patients.
Hepatitis G virus in clotting factor concentrates
Authors: Alonso‐Rubiano E. , Gerber M. , Friedman P. , Hodges S. , Leissinger C. 
Published: March 2003

Summary. Blood‐borne hepatitis is a well‐known complication in patients with bleeding disorders. A recently discovered parentally transmitted virus, hepatitis G [GB virus C (GBV‐C)] has an increased prevalence in patients with haemophilia. Clotting factor concentrates derived from pools of human plasma currently undergo viral inactivation techniques known to be effective against hepatitis B, C and HIV; however, the effectiveness of current purification and viral inactivation techniques against newly discovered viruses such as GBV‐C is unknown. A total of 37 vials of clotting factor concentrates manufactured in the USA from 1981 to 1995 were tested for the presence of GBV‐C virus. All samples that did not undergo a specific viral inactivation step were positive for GBV‐C. Viral inactivation techniques that did not uniformly remove GBV‐C included vapour heat treatment and dry heat treatments for less than 144 h. All samples treated by pasteurization, solvent detergent or dry heat for 144 h, were negative for the presence of GBV‐C.
Inherited bleeding disorders in Indian women with menorrhagia
Authors: Saxena R. , Gupta M. , Gupta P. K. , Kashyap R. , Choudhry V. P. , Bhargava M. 
Published: March 2003

Summary.  In order to define the prevalence of haemostatic defects in women presenting with menorrhagia in our region, the coagulation data on women bleeders investigated in the Department of Haematology, AIIMS, were analysed. A total of 337 of the 2200 menorrhagic women investigated were characterized to have an inherited bleeding disorder; 221 of these 337 women presented with menorrhagia alone while 116 also had other associated bleeding manifestations as prolonged bleeding from injury site, ecchymotic patches in the skin, epistaxis, haematomas, haemarthroses and major bleeds like intracerebral bleeding. The tests performed included bleeding time (BT), platelet count, prothrombin time (PT), prothrombin consumption index (PCI), activated partial thromboplastin time (APTT), PF3 release with adenosine diphosphate (ADP) at 0 and 20 min, total PF3 assay and platelet Aggregation studies with collagen, ADP, adrenaline, arachidonic acid and ristocetin. Coagulation factor assays, von Willebrand antigen estimation, ristocetin cofactor assay and electron microscopy were performed wherever necessary.Inherited platelet dysfunction was seen in 283 (83.9%) of the patients. Amongst these, isolated PF3 availability defect was seen in 163 (48.4%) cases. Glanzman's thrombasthenia was seen in 30 (8.9%) patients, Storage pool disease in eight (2.4%) patients, arachidonic acid pathway defect in five (1.5%) patients and Bernard–Soulier Syndrome in six (1.8%) patients. In 71 (21.1%) patients, the platelet function defect could not be classified into any specific subtypes. Inherited defects of coagulation were observed in 54 (16%) of the cases. Amongst these, von Willebrand disease (vWD) was the most frequent being seen in 40 (11.9%) of the cases. Factor XIII deficiency was seen in one (0.3%), factor X deficiency in four (1.2%), factor VII deficiency in one (0.3%) and factor XII deficiency in one (0.3%) of the patients.It is concluded that although hereditary platelet function defects constitute a large majority of women bleeders in India but among the coagulation defects, vWD is the commonest as reported from the caucasian population. It is thus suggested that in women presenting with menorrhagia, screening tests for haemostasis especially for vWD and inherited platelet function defects must be performed.
Monitoring forest degradation in tropical regions by remote sensing: some methodological issues
Authors: Lambin Eric F. 
Published: March 2003

SummaryKey issues related to the monitoring by remote sensing of open forest degradation in a tropical context are discussed. Degradation of forest‐cover is often a complex process, with some degree of ecological reversibility and a strong interaction with climatic fluctuations. Only a representation of land cover as a continuous field of several biophysical variables can lead to an accurate detection of forest degradation. For this purpose, repetitive measurements of spectral, spatial and temporal indicators of the land surface have to be performed. Each set of indicators brings a specific type of information on the land cover. These indicators must therefore be combined to achieve a comprehensive description of the surface processes. The detection of inter‐annual changes in landscape spatial structure is more likely to reveal long term and long lasting land‐cover changes, while spectral indicators are more sensitive to fluctuations in primary productivity associated with climatic fluctuations. Different monitoring systems may be optimal for different ecosystems. A long time series of observations is always required. The monitoring of the spatio‐temporal distribution of biomass burning may also give indications of open forest degradation.
Rainfall and topo‐edaphic influences on woody community phenology in South African savannas
Authors: Shackleton Charlie M 
Published: March 2003

AbstractWoody community phenology was studied in the central lowveld, South Africa, over a twelve month period at three sites along a rainfall gradient, with both toplands and bottomlands sampled at each site. Each month, individual plants, in replicated samples, were scored into a number of categories describing their phenological state. Position on the rainfall gradient influenced: (1) onset and magnitude of leaf emergence, (2) onset and duration of mature leaves, and (3) the proportion of leafless trees. Generally, the moist site demonstrated earlier leaf growth than the intermediate or arid sites. Emergent and mature leaves were recorded earlier, and in the case of mature leaves, retained longer. Overall, there was a lower proportion of leafless trees during the dry season at the moist site, followed by the semi‐arid site, followed by the arid site. Differences with respect to catenal position were evident for the proportion of trees in winter with mature leaves, and the proportion of trees with senescent leaves. Bottomlands had a greater proportion of trees with leaves during winter, but a lower proportion of trees recorded with senescent leaves. Both of these findings were a result of the greater proportion of evergreen species in bottomlands, as well as increased leaf retention by the deciduous species. Phenological activity of leaves was related to plant stem size. In particular, there was greater leaf retention during the dry period by small stems, relative to large stems.
Toll‐like receptors: their role in allergy and non‐allergic inflammatory disease
Authors: Sabroe I. , Parker L. C. , Wilson A. G. , Whyte M. K. B. , Dower S. K. 
Published: March 2003

SummaryThe human TLRs comprise an important and interesting group of receptors that regulate pathogen‐related responses, and play as yet uncharacterized roles in the amplication of sterile inflammation. Signalling through these receptors, which are powerfully coupled in gene transcription processes, has powerful immunostimulatory and immunomodulatory effects. Exploitation of TLR signalling will probably lead to novel effective therapies for allergic disease, in the first instance through more efficient mechanisms of immunotherapy. The likelihood of adverse consequences of such treatments, though possible, may be minimized by use of conjugated vaccines.
Granulomatous slack skin
Authors: Pai Kanthilatha ,   md, Rao Ravikala ,   md, Devadiga Rama ,   dvd, Shenoi Shrutakirthi ,   md,   dvd, Pai Sathish ,   md,   dvd
Published: March 2003

A 32‐year‐old man presented with multiple subcutaneous swellings of 6 years' duration. A biopsy performed 6 years earlier, when the patient presented with papules and plaques, was reported as tuberculoid Hansen's disease. The patient received dapsone, but showed no improvement. The disease was progressive. The patient currently has bilateral parotid enlargement ( Fig. 1), enlarged submandibular, submental, and axillary lymph nodes, multiple subcutaneous swellings over the axillae and arms of cricket ball size, loose skin folds in the axillae (
Fig. 2) and groin, and dry, scaly, and ichthyotic skin all over the body. Clinical differential diagnoses of mycosis fungoides and cutis laxa were made. The patient was discharged on request and then was lost to follow‐up.Patient with bilateral parotid enlargementimagePatient showing loose skin folds in axillaeimageBiopsies taken from the axillary fold, right arm, and face revealed dense infiltration of the dermis and subcutis by aggregates of small lymphocytes, some exhibiting nuclear convolutions along with one or two Langhans‐type giant cells ( Fig. 3). A few giant cells showed evidence of lymphophagocytosis. Blood vessel walls were infiltrated by lymphocytes. Epidermotrophism was seen in biopsies from the arm and face (Fig. 4). There was partial loss of elastic fibers in the dermis. A histopathologic diagnosis of granulomatous slack skin (GSS) was made.Photomicrograph showing dense infiltration of the dermis and subcutis by lymphoid aggregates with one or two Langhans‐type giant cells. Epidermotropism was also noted (hematoxylin and eosin, × 10)image
‘It’s the best of two evils’: a study of patients’ perceived information needs about oral steroids for asthma
Authors: Stevenson Fiona A. , Wallace Gwen , Rivers Peter , Gerrett David 
Published: March 2003

Objectives To explore the sources of patients’ knowledge about the potential side‐effects of oral steroids prescribed to treat asthma. Methods Seventeen in‐depth interviews were conducted with patients taking prescribed oral steroid medication (prednisolone) for asthma. The interviews were transcribed verbatim and the data organized according to common themes. Results All the respondents acknowledged they had no choice but to take oral steroids but they wanted to be informed about the potential side‐effects. Respondents reported that they had not received sufficient information about side‐effects from their general practitioner (GP). Information was sought from both medical sources (pharmacists and asthma nurses) and non‐medical sources (friends and family, self‐help groups and the media) to supplement their knowledge. The conclusions drawn about the risks of taking oral steroids were also influenced by respondents’ existing beliefs. Conclusions Respondents drew upon information about oral steroids from a variety of professional and lay sources. The findings add weight to calls for doctors and patients to share their respective knowledge in consultations. Developing an understanding of the views of GPs about the provision of information about side‐effects would help to identify any perceived barriers to a more open exchange of information in the consultation.
Decision‐making role preferences and information needs: a comparison of colorectal and breast cancer
Authors: Beaver Kinta , Bogg Janet , Luker Karen A. 
Published: March 2003

Objective An exploratory study has been carried out to examine decision‐making role preferences and information needs for a sample of people with colorectal cancer (n=48). The work replicated a larger study carried out for women with breast cancer (n=150), and this paper compares and contrasts findings for both disease groups. Design A cross‐sectional design was employed, involving structured interviews. The main variables investigated were decision‐making preference (using a decisional role preference card sort), perceived decisional role and information need (using an information needs questionnaire). Results The majority (78%) of the colorectal cancer patients preferred to play a passive role in decision making, in contrast to 52% of women with breast cancer in previous work. Eighty per cent of the colorectal sample and 61% of the women with breast cancer perceived that the doctor had made treatment decisions. Priority information needs for both groups related to cure, spread of disease and treatment options. Conclusions The two most striking findings from the comparison between the two disease groups relate to the differences in decision‐making role preferences and the similarities in information needs. The process of involving people with colorectal cancer in treatment decision making warrants further investigation. The similarity in information needs of the two disease groups has implications for health care professionals providing information to people with cancer.