bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laparoscopic dissection of intact ovarian dermoid cysts: evaluation of a simple technique
Authors: Remorgida V. , Anserini P. , Magnasco A. , Capitanio G.L. 
Published: November 2003

Objective to evaluate a simple laparoscopic technique for dissecting ovarian dermoid cysts without any risks of puncture and spillage.
Design Open clinical study.
Setting University hospital.
Subjects 10 premenopausal women with unilateral dermoid cysts operated between October 1993 and November 1994.
Interventions Laparoscopic technique based on: (a) creation of a cleavage plane between the cyst and the ovary by fluid injection with a laparoscopic injection needle; (b) dissection of the cyst by a combination of water, scissors and gravity without direct traction on the cyst (c) vaginal extraction by a specific device after cyst placement inside a laparoscopic bag.
Results Mean cyst diameter was 6 cm (range 3–10). Mean operating time was 105 min (range 50–160). All patients were discharged 24 h after surgery. The dermoid cysts were dissected intact from the ovary and extracted without spillage from the abdominal cavity in all cases.
Conclusions Using a careful technique, it is possible to prevent rupture and spillage of dermoid cysts during laparoscopic surgery.
Postoperative pain and postoperative recovery following respective laparoscopy: no relation to the intra‐abdominal surgical procedure
Authors: Mais V. , Ajossa S. , Guerriero S. , Peiretti R.F. , Serri F. , Melis G.B. 
Published: November 2003

Objective To investigate whether different resective procedures might be related to different intensities of postoperative pain and different subjective recovery times following laparoscopic surgery
Interventions A total of 60 patients underwent laparoscopic myomectomy, 60 patients underwent laparascopic excision of endometriomas, and 60 patients underwent laparoscopic enucleation of non‐endometriotic adnexal cysts.
Measures The intensity of postoperative pain was assessed by completion of a visual analogue scale on the day of surgery and 1, 2, and 3 days postoperatively, and the results of the three groups were compared. We also compared the proportions of patients who were analgesic free on day 2, discharged from hospital within 3 days, and feeling fully recuperated on day 15.
Results No differences were found among the three groups of patients.
Conclusions Both the intensity of postoperative pain and the length of convalescence following resective laparoscopy do not seem to depend on the intra‐abdominal surgical procedure.
THE EFFECT OF SORBITOL–MANNITOL ABSORPTION ON SERUM SODIUM CONCENTRATION DURING HYSTEROSCOPIC SURGERY
Authors: Barisic D. , Wamsteker K. , Strelec M. , Cvrk L. , Babic D. 
Published: November 2003

Objective To evaluate the effect on serum electrolyte concentrations of sorbitol–mannitol absorption during hysteroscopic surgery.
Design The volume of sorbitol–mannitol retained during hysteroscopic surgery and the difference between the preoperative and the postoperative serum sodium concentrations were measured and analysed for correlation.
Setting A university‐based hospital.
Subjects These were 40 consecutive patients undergoing hysteroscopic resection of submucous fibroid or uterine septum, using a 9‐mm continuous flow resectoscope with loop or needle electrode for high‐frequency cutting and coagulation and a 4% sorbitol–mannitol solution for uterine irrigation.
Results The mean volume of infused sorbitol–mannitol solution was 5435 ± 720 ml (mean ± SEM), with a mean fluid deficit of 718 ± 120 ml. The fall in serum sodium concentration correlated positively with the sorbitol–mannitol deficit (r=0.79, P<0.001), and with the total volume of infused sorbitol–mannitol (r=0.45, P<0.01). In 26 patients the sorbitol–mannitol deficit was less than 1000 ml, and in 14 patients it was equal to or higher than 1000 ml. The group with a fluid deficit exceeding 1000 ml had a significantly (P<0.001) higher fall in serum sodium concentration. Type I or type II fibroid patients retained a significantly (P< 0.001) higher volume of sorbitol–mannitol and had a significantly (P<0.005) higher fall in serum sodium concentration than the group of patients who had a septum or a type 0 fibroid resected. The two patients with a type II fibroid resected retained 2000 ml and 3800 ml of sorbitol–mannitol solution. One of them had symptoms of water intoxication and dilutional hyponatraemia, with cerebral and pulmonary oedema, and the other had signs of early pulmonary oedema. Both patients were successfully managed.
Conclusions The fall in serum sodium concentration is positively correlated to the sorbitol–mannitol deficit. Type II fibroid patients are at the highest risk of excessive fluid intravasation and consequent dilutional hyponatraemia. A routine postoperative measurement of serum sodium concentration when fluid deficit exceeds 1000 ml is recommended.
DIAGNOSIS AND THERAPY OF ADNEXAL MASSES IN POSTMENOPAUSAL WOMEN: A PROSPECTIVE STUDY
Authors: Hesseling M , De Wilde R.L. 
Published: November 2003

Objectives This prospective study was conducted to examine the safety and efficacy of the operative laparoscopic management of adnexal masses in the postmenopause and to define the limits of this procedure.
Main outcome measure The parameter chosen for testing the preoperative diagnostic model was the laparoscopic operation of a malignant ovarian tumour.
Design This hospital‐based study included 265 consecutive postmenopausal patients with adnexal masses. After preoperative pelvic examination, transvaginal/abdominal ultrasound and determination of the tumour marker CA 125, primary laparoscopy was performed in 69.4% (group A) and primary laparotomy in 30.6% (group B). In 4.2% the patients were converted to laparotomy following diagnostic endoscopy (group Ab); in 65.2% the operative laparoscopic adnectomy was completed (group Aa).
Results In the total sample, 81.1% of the tumours were classified as definitely benign, 3.8% showed borderline changes and 15.1% were malignant. The malignancy rate in group A was 3.8% with 2.2% in group Ab, and in group B it was 53.1%. Complications occured in 1.9% of cases, without statistically significant differences between the two groups.
Conclusion By combining pelvic examination, transvaginal/abdominal ultrasound, determination of the tumour marker CA 125, and adequate intraoperative evaluation during laparoscopy, the risk of laparoscopic operation of a malignant adnexal tumour can be reduced to a minimum. After carefully weighing up the benefits and risks, we consider a laparoscopic approach to be justified in a selected patient population in the postmenopause, provided the team has sufficient experience in the preoperative assessment of adnexal masses.
Survey of training in minimal access surgery in the West Midlands region of the UK
Authors: Chin K. , Newton J. 
Published: November 2003

Objective To assess the status of trainees in the West Midlands, UK, their minimal access surgery (MAS) operative experience, level of supervision, complications experienced, and mode of training in MAS.
Design Postal survey utilizing a structured questionnaire.
Setting Gynaecology units throughout the West Midlands.
Subjects A total of 167 gynaecology trainees.
Main outcome measures Types of complications related to level of supervision and mode of training.
Results The response rate was 72% (n = 120). Only 25% of these trainees had attended a formal training course. Of the trainees, 36% and 26% had encountered laparoscopic and hysteroscopic complications, respectively, in their total experience. Bowel injury was four times more likely to have been caused by those who were unsupervised and almost three times more likely to have been caused by those who had not been on a formal training course (P < 0.005).
Conclusion This study supports the strong link between supervision, appropriate training and complications in MAS and stresses the crucial role of the supervisor and the need for formal training.
Pregnancy outcome following endometrial ablation
Authors: Edwards A. , Tippett C. , Lawrence M. , Tsaltas J. 
Published: November 2003

Objective We report a case of successful outcome in a pregnancy following endometrial ablation. We also review the 10 previous reported pregnancies following this procedure and try to suggest guidelines for the management of this condition, based upon the cases reported to date and by drawing from the clinicopathologically related condition Asherman's syndrome.
Outcome The case reported in this paper had a successful outcome with minimal intervention. The patient became pregnant following an ablation that had achieved excellent symptom relief of her menorrhagia.
Conclusion Although our case had a succesful outcome with minimal intervention, ideally pregnancy following endometrial ablation should be avoided. Pregnancies following endometrial ablation should continue to be reported to allow the establishment of a database to ascertain the real risk of pregnancy and third‐stage problems. This will assist practitioners with management and in counselling their patients.
HYSTEROSCOPY: A MILESTONE IN GYNAECOLOGY
Authors: Gaglione R. , Cinque B. , Paparatti L. , Pistilli E. 
Published: November 2003

Objective The aim is to stress the fundamental role of hysteroscopy in the diagnosis of the cause of endometrial pathologies.
Subjects and methods The results of 10 years’ experience, between December 1984 and January 1995, in the gynaecological endoscopy outpatients' unit of the Catholic University of Rome are reported. A series of 6180 women undergoing diagnostic hysteroscopy is analysed and the indications, contraindications and side‐effects of hysteroscopic examination are discussed.
Results Outpatients, mean age of 51 years (range 22–81), who underwent hysteroscopic examination had, as main indication, abnormal uterine bleeding (AUB). The differing distributions of hysteroscopic findings in pre‐ and postmenopausal women is stressed, along with the importance of focal endometrial pathologies such as polyps and submucosal myomas in premenopause, the high incidence of endometrial atrophy, and the significant occurrence of hyperplastic and neoplastic hysteroscopic findings in the postmenopause. Primary and secondary infertility are, after AUB, the second most common indications for hysteroscopic examination, and the role of malformation (septate and subseptate uterus), inflammation (intrauterine synechiae) and focal endometrial pathologies (polyps and submucosal myomas) is illustrated.
Conclusions As a result of the introduction of hysteroscopy it is now possible to preserve organs, with the slight trauma of noninvasive treatment, rather than using extirpartive surgery. In premenopausal women with AUB (n=2132) the most frequent pathologies were low‐risk hyperlasia (25.3%), submucosal myoma (24.5%) and endometrial polyps (8.3%); there were normal findings in 40.2%. There is a low incidence of high‐risk hyperplasia (0.7%) and neoplastic pathology (0.5%). In postmenopausal women with AUB there is a high incidence of atrophy (23%), whereas high‐risk hyperplasia and neoplastic pathology are five and eight times more common, respectively, in these women than in premenopausal patients.
Intraoperative autologous blood transfusion in laparoscopic surgery for ectopic pregnancy
Authors: Yamada T. , Yamashita Y. , Terai Y. , Okuda K. , Sugimoto O. 
Published: November 2003

Objective Our purpose was to evaluate the safety, efficacy and procedural difficulties of intraoperative autologous blood transfusion during laparoscopic surgery for ectopic pregnancy.
Design A retrospective study was performed.
Methods The Cell Saver, an intraoperative autologous blood salvage device, was used in laparoscopic operations on 13 patients with ectopic pregnancy, who had haemoperitoneum but good physical status without severe anaemia and hypovolaemic shock.
Results Homologous blood transfusion was not needed in any patient. The mean blood loss was 327±178 ml and the mean volume of reinfused processed blood was 288±92 ml. The haemoglobin level of reinfused processed blood was proportional to the blood loss. Neither adverse reactions to norprocedural difficulties of autotransfusion were observed.
Conclusions When laparoscopic surgery is performed for ectopic pregnancy in patients with haemoperitoneum, intraoperative autologous transfusion employing the Cell Saver is considered to be a potentially very useful technique.
Intrauterine adhesions and fertility: results of hysteroscopic treatment
Authors: Roge P. , Cravello L. , D'Ercole C. , Brousse M. , Boubli L. , Blanc B. 
Published: November 2003

ObjectiveTo assess the efficacy of hysteroscopic surgery in infertile women presenting with uterine synechiae.DesignA retrospctive audit of 52 patients.SettingUniversity hospital.SubjectsA total of 52 patients presenting with intrauterine adhesions in a context of reproductive dysfunction: infertility, 29 cases; recurrent abortions, 23 cases.InterventionsOperative hysteroscopy including section with scissors, lesion division, and electrosection.ResultsThere were 34 pregnancies in 28 patients, with 24 term deliveries and 10 abortions.ConclusionOperative hysteroscopy should be considered as the primary treatment for patients with intrauterine adhesions. Hysteroscopy allows selectivity, reproducibility with little morbidity, and preserves the surrounding endometrium. After several unsuccessful procedures, abdominal surgery could be proposed.
A prospective randomized trial of the effect of preoperative endometrial inhibition on the long‐term outcome of transcervical endometrial resection
Authors: Sowter M.C. , Bidgood K. , Richardson J.A. 
Published: November 2003

Objective To determine the effect of preoperative hormonal inhibition of the endometrium on the long‐term results of transcervical endometrial resection.
Design A prospective randomized trial.
Setting Gynaecology department of a district general hospital.
Subjects 77 women undergoing transcervical endometrial resection between January 1992 and December 1993 were randomized to either no endometrial preparation or pretreatment with two injections of goserelin, 3.6 mg, 4 weeks apart prior to surgery. Another 58 women who declined entry into the trial were given danazol, 800 mg per day, for 6 weeks preoperatively, and were also contacted postoperatively to assess the outcome of surgery.
Main outcome measures Postoperative menstrual loss, dysmenorrhoea, patient satisfaction and the need for any further surgery were assessed by postal or telephone questionnaire at between 12 and 33 months after surgery.
Results A significantly higher proportion of women treated preoperatively with goserelin had amenorrhoea postoperatively when compared with those who had no pretreatment (57.1 vs. 22.5%; P<0.01). Overall postoperative menstrual loss was also significantly less in the pretreatment group. The proportion of women with no postoperative dysmenorrhoea was greater in those who had received preoperative goserelin (57.1 vs. 35.0%) but did not reach significance (P=0.08). Patients treated with danazol preoperatively showed a similar but nonsignificant pattern when compared with women receiving no pretreatment. Patient satisfaction and the proportion of women subsequently having a hysterectomy was similar in each of the three groups.
Conclusions Endometrial inhibition with goserelin prior to transcervical endometrial resection results in significantly higher rates of postoperative amenorrhoea. It may also reduce postoperative dysmenorrhoea and overall postoperative menstrual loss. However, patient satisfaction and subsequent hysterectomy rate is unaffected by preoperative endometrial inhibition.
Improved cost‐effectiveness by pharmacokinetic dosing of factor VIII in prophylactic treatment of haemophilia A
Authors: CARLSSON M. , BERNTORP E. , BJÖRKMAN S. , LETHAGEN S. , LJUNG R. 
Published: November 2003

The aim of the study was to investigate the feasibility of optimizing prophylactic dosing of factor VIII by the use of individual pharmacokinetic data. Twenty‐one patients were enrolled in a randomized cross‐over study on standard dosage regimens vs. dosing according to pharmacokinetic principles. The study period was 2×6 months. Using single‐dose pharmacokinetic data for each patient, plasma factor VIII procoagulant activity (FVIII:C) curves following various doses and intervals were computer‐simulated. From these calculations, a suitable dosage was chosen. FVIII:C was also repeatedly measured during study periods. Trough levels of FVIII:C, numbers of spontaneous joint bleedings and amounts of factor concentrate used during the two study periods were compared for each patient.There was a close correlation between predicted and measured values of FVIII:C. As the half‐lives of FVIII:C in the patients varied from 7.8 to 18.3 h, it was obviously beneficial to base the dosage on individual pharmacokinetic data. Fourteen patients completed both study periods. Mean trough level of exogenous FVIII:C was raised from 0.89 (SD 0.73) U dL−1 during standard dosage to 2.2 (1.5) U dL−1 during pharmacokinetic dosage. Concomitantly, mean 6‐month consumption of factor VIII was decreased from 124 000 (SD 30 000) units to 84 000 (31 000) units. Numbers of reported bleedings were generally similar during both periods.The study demonstrates the usefulness of individual pharmacokinetics as a tool for cost‐effective utilization of factor VIII in the prophylactic treatment of haemophilia A.
Large cell neuroendocrine carcinoma of the thymus
Authors: CHETTY R. , BATITANG S. , GOVENDER D. 
Published: November 2003

Aim:We highlight the occurrence of an unusual neuroendocrine tumour, a large cell neuroendocrine carcinoma, arising from the thymus.Case details:A 68‐year‐old man with a history of cigarette smoking had a large mediastinal tumour arising from the thymus removed. Two years later the tumour recurred; it was debulked surgically but the patient died 2 months later. Histological examination of both tumour specimens revealed a tumour with an endocrine pattern, composed of large pleomorphic cells with large nuclei and prominent nucleoli. The mitotic count ranged from 19 to 26 per 10 high‐power fields and large tracks of coagulative tumour necrosis were present. The tumour cells were strongly positive for neuron‐specific enolase (NSE), chromogranin, CAM5.2 and AE1/3, with cytoplasmic dot‐like accentuation for the latter three markers. The tumour fulfilled the criteria for a diagnosis of large cell neuroendocrine carcinoma.Conclusions:Large cell neuroendocrine carcinoma should be distinguished from atypical carcinoid and small cell carcinoma. It is a distinctive neuroendocrine malignancy with a prognosis between that of atypical carcinoid and small cell carcinoma, and needs to be treated aggressively.
Thyroid carcinoma associated with familial adenomatous polyposis
Authors: CETTA F. , TOTI P. , PETRACCI M. , MONTALTO G. , DISANTO A. , LORÈ F. , FUSCO A. 
Published: November 2003

Aims:Thyroid carcinoma is an extracolonic manifestation that is present in about 1% to 2% of patients with familial adenomatous polyposis (FAP). Less than 100 cases have been reported in detail. We have investigated the suggestion that FAP associated thyroid carcinoma is significantly different morphologically from both papillary and follicular types and can be considered as a separate entity.Methods and results:Specimens from three patients with FAP associated thyroid tumours, all but one having single nodules, have been analysed. All three patients belonged to an extended kindred (23 siblings in four generations) who had genetic analysis and intensive screening for thyroid nodules. Seven patients had the same APC mutation at codon 1061. Pathological examination revealed a typical papillary carcinoma, encapsulated variant, in all patients, with follicular areas in one case. All thyroid specimens, in addition to histological and immunohistological examinations, were also specifically studied for activation of the RET‐PTC oncogene, that seems to be restricted to papillary thyroid carcinoma. Two of the three patients had RET‐PTC activation (PTC1 isoform).Conclusions:The findings suggest that the tumours were certainly papillary, at least in the present kindred. Further studies in different families are required for a better understanding of this peculiar tumour and of its biological behaviour.
Carcinosarcoma of the oesophagus showing neuroendocrine, squamous and glandular differentiation
Authors: ROBERTSON N.J. , RAHAMIM J. , SMITH M.E.F. 
Published: November 2003

Aim:A case of oesophageal carcinosarcoma occurring in a previously fit, 64‐year‐old man is reported.Case summary:The carcinomatous component displayed neuroendocrine, squamous and glandular differentiation; the sarcomatous component showed no specific features of differentiation. In‐situ squamous carcinoma was present in the adjacent squamous mucosa. The most superficial part of the invasive tumour consisted of carcinosarcoma with a predominant neuroendocrine epithelial component. Squamous carcinoma without an accompanying sarcomatous component occupied most of the deeper part of the tumour, suggesting outgrowth of this tumour type by a selective growth advantage.Conclusion:We speculate that further tumour growth might have led to complete replacement of the tumour by pure squamous carcinoma, and that other advanced oesophageal squamous carcinomas might have had their origin in a short‐lived carcinosarcomatous phase.
Granular cell dermatofibroma
Authors: ZELGER B.G. , STEINER H. , KUTZNER H. , RÜTTEN A. , ZELGER B. 
Published: November 2003

Aims:To describe a series of five granular cell dermatofibromas as an unusual and rare manifestation of fibrohistiocytic tissue response.Methods and results:Five granular cell dermatofibromas were collected out of 136 tumours filed as granular cell tumours. Clinically, all lesions occurred on the shoulder or back of middle‐aged adults (two women, three men), mostly with the clinical diagnosis of a fibrohistiocytic lesion. Histology revealed well‐circumscribed, dermal to subcutaneous lesions dominated by periodic acid–Schiff (PAS) positive, granular cells. Acanthosis above, as well as storiform arrangement of spindle cells, sclerotic collagen and some interspersed lymphohistiocytic infiltrate at the periphery of the lesion, indicated the fibrohistiocytic origin. Lesions showed prominent reactivity with NK1C3 (CD57), as well as for macrophage markers KiM1p and KP1 (CD68). In contrast to classic Schwannian/neurogenic granular cell tumours, granular cell dermatofibromas were S100 protein negative, but showed variable reactivity for factor XIIIa (10–50%) in 4/5, for smooth muscle specific actin (10–50%) in 2/5 and with E9 (10–30%) in 3/5 lesions. Electron microscopy in one case revealed large pools of phago‐lysosomes and variably sized glycogen granules in granular cells.Conclusion:Our series delineates granular cell dermatofibroma as a distinct clinicopathological variant of fibrohistiocytic tissue response which needs to be distinguished from other tumours with granular cell features.