bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effects of intravenous administration of amino acids and glucose on the milk production of dairy cows consuming diets based on grass silage
Authors: Kim  , Choung  , Chamberlain  
Published: March 2003

Two experiments, using intravenous infusion of nutrients, were carried out with the aim of separating milk production responses due to the provision of amino acids as precursors of milk protein synthesis from those due to the provision of amino acids as glucose precursors. Diets were based on grass silage of restricted fermentation and barley‐based supplements because it has been suggested that these diets might provide insufficient glucose precursors to meet the needs of lactose synthesis. The silages used in the experiments were of similar lactic acid contents [62 and 63 g kg–1 dry matter (DM)] but of different water‐soluble carbohydrate (WSC) contents (206 and 20 g kg–1 DM in Experiments 1 and 2 respectively). In Experiment 1, four dairy cows were given the following treatments in a 4 × 4 Latin square arrangement with periods of 10 d: (1) basal diet (Basal), (2) Basal plus jugular infusion of 182 g d–1 of amino acids simulating casein (TAA), (3) Basal plus 101 g d–1 of essential amino acids (EAA), being the essential amino acid component of the TAA treatment and (4) Basal plus 101 g d–1 of essential amino acids plus 50 g d–1 of glucose (EAA + G), being the glucose equivalent of the non‐essential amino acid component of treatment TAA. All infusions increased (P < 0·05) the concentration of milk protein compared with Basal but only for TAA was the increase in the yield of milk protein statistically significant (P < 0·05), amounting to 68 g d–1. Both TAA and EAA reduced (P < 0·05) the concentration of milk fat. There was no difference between EAA and EAA + G treatments.In Experiment 2, five dairy cows were given the following treatments in a 5 × 5 Latin square design with periods of 7 d: (1) basal diet (Basal), (2) Basal plus 182 g d–1 of amino acids simulating casein (TAA), (3) Basal plus 182 g d–1 of non‐essential amino acids as in casein (NEAA), (4) Basal plus 100 g d–1 of glucose (G100) and (5) basal plus 230 g d–1 of glucose (G230). G100 supplied the glucose equivalent of NEAA whereas G230 supplied the caloric equivalent of NEAA. Again, only for TAA was the increase in yield of milk protein statistically significant (P < 0·05), amounting to 83 g d–1. Neither glucose treatment caused any statistically significant (P > 0·05) effect on the yield of milk protein nor the yield of milk lactose.It is concluded that, in both experiments, the primary nutritional limitation on milk protein output was the supply of amino acids as precursors of milk protein, there being no evidence to support a primary limitation due to glucose supply.
Effects of reduced time on pasture caused by prolonged walking on behaviour and production of Mpwapwa Zebu cattle
Authors: Jung J. , Yngvesson J. , Jensen P. 
Published: March 2003

AbstractIn many African countries, cattle are often allowed to graze only during the daytime and the daily walk to pasture limits time for foraging. Two groups of cattle were allowed access to pasture for 9 h or 5 h associated with a daily walk of 0·5 h or 4·5 h respectively. Each treatment period lasted for 14 days in a cross‐over design. Observations of behaviour were carried out for 8 days in each treatment period. When only 5 h were allowed at pasture, the animals grazed less (0·61 vs. 0·66 of time) compared with the first 5 h of the 9 h treatment. The average daily milk yield was 323 g (0·078) higher when 9 h were allowed on pasture (P < 0·05 during the second week of treatments). There were no differences in milk yield after the end of the treatments. The daily liveweight gain was 250 g higher when the animals were on pasture for 9 h. These differences could be due to the limited time on pasture or to energy requirements for the walk to pasture. It is concluded that increasing the walking time and reducing time on pasture may compromise animal welfare and performance under the experimental conditions, i.e. on poor quality pastures in a warm humid climate where the main period at pasture is in the middle of the day.
A prospective randomized scanning electron microscopy study on the effect of a pneumoperitoneum on tumour cell implantation in nude mice
Authors: Köster, Stefanie , Volz Joachim , De Wilde Rudi 
Published: March 2003

ObjectiveThe aim of the study was to examine the influence of a CO2 pneumoperitoneum on intraperitoneal tumour cell implantation and on survival in the event of intra‐abdominal spread of tumour cells during laparoscopy in nude mice.Design6‐week‐old nude mice were stratified into three groups of 47 animals each. A CO2 pneumoperitoneum was induced by a microhysteroflator with an intraperitoneal pressure of 8 mmHg for 60 min in group 1 and 100 000 cells of a malignant mesothelioma, suspended in 2 ml of Ringer solution were injected intraperitoneally. Group 2 received an identical tumour cell load after laparotomy by midline incision. In the control group 3 tumour cells were injected only. After 1, 2, 6, 12, 24, 48, 72 and 96 h respectively four animals were killed and the entire peritoneum in all animals was examined by scanning electron microscopy. The survival time of the remaining 15 animals served as controlling arm.ResultsIn group 1, scanning electron microscopy showed that within 1 h mesothelial cells had become cuboidal, detached and condensed. The basement membrane was partly denuded. After 2 h this initial reaction reached its peak; tumour cells attached to the free basement membrane. None of those changes was seen in groups 2 and 3. It appears, that in group 1 intraperitoneal metastases were promoted by the CO2 pneumoperitoneum. The survival rate of group 1 was significantly reduced compared with that of group 2 and 3.ConclusionWe conclude that the technique of CO2 pneumoperitoneum promotes intraperitoneal tumour cell implantation and growth in nude mice.
Hysteroscopic investigation of bleeding in women receiving tibolone: a case–control study
Authors: Ramsay Jane E. , Calder Anne L. , Mackay Hart David , Habiba  , Akkad  , Al Azzawi Farook 
Published: March 2003

ObjectiveTo compare the hysteroscopic findings and endometrial histology in women presenting with bleeding while receiving tibolone and in those with spontaneous postmenopausal bleeding (PMB).DesignA retrospective review over a period of 1 year.SettingOutpatient hysteroscopy clinics and day surgical units, Stobhill NHS Trust, Glasgow and Leicester Royal Infirmary NHS Trust.SubjectsA total of 74 women referred for investigation of abnormal uterine bleeding; in 37 the bleeding was spontaneous and the other 37 were receiving tibolone. The average age in both groups was 55.7 years.ResultsOf those bleeding while receiving tibolone, 38% were found to have intra‐uterine abnormalities on panoramic hysteroscopy, compared with 22% in the PMB group (P = 0.3). Attempted endometrial sampling was unsuccessful in 46% overall. There were atrophic histological findings in 89% of the tibolone group. There was a greater prevalence of positive findings, i.e. proliferative histology and simple and atypical hyperplasia, in the PMB group (P = 0.0018).ConclusionThe absence of neoplasia, on endometrial sampling and panoramic hysteroscopy, is reassuring with regard to the management of women who are bleeding while receiving tibolone. However, investigations must be performed and these should always include hysteroscopy. With no tissue specimen obtained on endometrial sampling in 50% of those investigated, hysteroscopy is necessary to confirm normal endometrium and to identify intra‐uterine abnormalities; the latter were present in over one‐third of the tibolone group. The similar findings in the PMB group were also reassuring.
Management of uterine fibroids with goserelin acetate alone or goserelin acetate plus endometrial resection
Authors: Rees Margaret , Chamberlain Paul , Gillmer Michael 
Published: March 2003

Objectives To determine the extent of fibroid regrowth and the need for additional interventions following treatment with either goserelin alone or goserelin plus endometrial resection in women with fibroids.Design An open, randomized controlled trial with two treatment arms.Setting Women's Centre, John Radcliffe Hospital, Oxford, UKSubjects Women with fibroids whose uterine size exceeded 12 weeks of gestation (255–345 ml), but was less than 16 weeks' gestation (425–575 ml).Interventions Goserelin acetate alone and goserelin acetate plus endometrial resection.Main outcome measures Extent of fibroid regrowth and need for additional medical and surgical interventions over 12 months.Results There were fewer medical and surgical interventions in the women randomly allocated to goserelin and endometrial resection than in the goserelin‐alone group (8.3% and 33%, respectively).Conclusions These results suggest that goserelin allows the use of endometrial resection in patients with fibroids, who would otherwise have been treated by hysterectomy.
Cosmesis and patient satisfaction following laparoscopy
Authors: Ramsden Clive , Jivraj Shehnaaz 
Published: March 2003

ObjectiveTo determine complication rates and patient satisfaction with closure techniques following laparoscopic surgery.DesignProspective observational study.SettingDay Surgery Centre, Rotherham District General Hospital, Rotherham, England.Materials and methods187 patients undergoing elective laparoscopic surgery were recruited. Various wound closure techniques were used. The degree of wound bleeding, discomfort and discharge occurring 1, 2 and 6 weeks following surgery was assessed. A subsequent study identified the exact location of the scar by means of photograph and sought a final assessment of patient satisfaction with cosmesis. The distance of the scar from the centre of the umbilicus was correlated with the patient satisfaction score on an analogue scale.ResultsSignificant complications were associated with wound closure at laparoscopy. The highest rate of discomfort was associated with a subcuticular method. Umbilical discharge was seen with both the subcuticular and interrupted method when the sutures were left in situ. This was present even 6 weeks following the procedure. The lowest complication rate was associated with those cases where the wound was left unsutured. Patient satisfaction with the laparoscopic incision was greatest when the incision was made totally within the umbilicus.ConclusionCareful consideration should be given to the suture technique employed, to reduce wound complication following laparoscopy. Leaving the wound unsutured should be considered as an acceptable alternative. Interrupted sutures should be removed within a week of surgery to reduce the incidence of discharge. To achieve the best cosmetic result, a vertical incision, made as central to the umbilicus as possible, should be employed.
The way forward in the surgical management of endometriosis – from a third world perspective
Authors: Clarke Henry Courtenay 
Published: March 2003

DiagnosisWhen symptoms of pelvic pain, dyspareunia or pelvic mass present, diagnosis of endometriosis is confirmed by laparoscopy. Vaginorectal examination and a sponge forceps pushed upward in the fornix help to delineate the extent of the disease. However, in many third world countries diagnosis is seldom confirmed early by laparoscopy, but later at the time of surgery when a complication has arisen.TreatmentExcision is indicated, for minor or moderate disease, or direct ablation of superficial implants with complete excision of endometrial cyst walls, and can involve an oöphorectomy. In some parts of the world this may be performed by means of laparoscopy by a gynaecologist if available, but seldom by a general surgeon. Advanced disease requires complete excision of endometriosis with restoration of normal pelvic anatomy. This requires a highly skilled and experienced gynaecological laparoscopist of whom, worldwide, there are about 10. For the surgeon with little prior skill or experience and with no assistant or consultant, where there is severe pain associated with bleeding, anaemia, malnutrition, no transfusion available, and no chance for second surgery, laparotomy with hysterectomy and bilateral salpingo‐oöphorectomy is the operation of choice. This will change in the future with adequate training in operative laparoscopy and cheaper technology.ResultsEven in advanced disease with cul de sac occlusion, complete excision of endometriosis by operative laparoscopy, by skilled and experienced surgeons in large centres, gives results which are particularly good with regard to partial or complete absence of pain, as well as significant improvement in fertility.ConclusionToday, this surgical management of advanced endometriosis is available only for the rich few. In the future, pelvic pain and infertility centres will provide advanced training for increased numbers of gynaecological laparoscopists who will be capable of completing surgery for severe endometriosis with supporting groups such as colorectal and urological surgeons, reproductive medical specialists, basic scientists and counselling and support services.
Adhesion prevention: state of the art
Authors: Al‐Musawi D. , Thompson J. N. 
Published: March 2003

ObjectiveTo evaluate current and prospective methods of adhesion prevention.DesignReview of published experimental and clinical studies of adhesion formation and prevention.Main outcome measuresReduction in de novo adhesions and adhesion re‐formation; cost to health care systems.ResultsSurgical technique influences adhesion formation. Laparoscopy reduces incisional and de novo adhesion formation. Pharmacological methods of adhesion prevention have not been adopted clinically. Three membrane barriers (two bioresorbable) are available to reduce adhesions. Liquid gels and solutions may have a role in non‐site‐specific adhesion prevention. New methods of adhesion prevention are being developed. Epidemiological studies show a large workload and health care cost associated with adhesion‐related disease.ConclusionAdhesion prevention is now possible using a variety of adhesion barriers in membrane and liquid/gel form. These may prove cost‐effective in reducing adhesion‐related disease. New products will soon be available.
Laparoscopic management of benign adnexal masses: experience in a developing country
Authors: Darwish Atef M. , Amin Ahmad F. , AbdelAleem Mahmoud A. , Youssef Mohamad A. 
Published: March 2003

ObjectiveTo compare the efficacy, cost‐effectiveness, and possible complications of operative laparoscopy with laparotomy for treating benign adnexal cystic tumours at a unit in a developing country.DesignA prospective comparative study.SettingGynaecologic Endoscopy Unit, Assiut University Hospital, Assiut, Egypt.Subjects91 women of childbearing age with a clinical, biochemical and transvaginal sonographic diagnosis of benign adnexal cystic tumour.Interventions71 patients were allocated to one of two groups according to management approach. The laparoscopy group (A) included 37 patients while the laparotomy group (B) included 34 patients.Main outcome measuresFor each patient, the operating time, intra‐ and postoperative complications, postoperative pain and duration of hospital stay were recorded.ResultsThe operating time was significantly shorter in group A (47.8 ± 28.3 min) than in group B (64.9 ± 19.2 min). Intraoperative uncontrolled bleeding occurred in one patient in group A. Postoperative pain was significantly less in group A than in group B (P < 0.001). Postoperative febrile morbidity developed in 12.2% and 31.6% of patients in groups A and B, respectively. The duration of postoperative hospital stay was significantly shorter among patients in group A (49.5 ± 42.6 h) than in group B (124.8 ± 40.9 h) (P < 0.001). Postoperative complications included wound infections: one case in group A and three in group B.ConclusionsLaparoscopic management of benign cystic adnexal masses is a fast and safe procedure with minimal intra‐ and postoperative complications compared with laparotomy. Its use in developing countries with limited resources is cost‐effective, given appropriate selection of cases and experienced endoscopists.
Gas embolism during VersaPoint hysteroscopic myomectomy
Authors: Hunter David C. , Cooper David W. , Phillips Graham 
Published: March 2003

To describe a case of gas embolism in association with VersaPoint hysteroscopic myomectomy.A 40‐year‐old woman with menorrhagia secondary to uterine fibroids.Hysteroscopic VersaPoint spring endometrial ablation and submucous myomectomy under general anaesthetic with saline as the distension medium. Intraoperatively an acute and profound drop in the patient's end‐tidal carbon dioxide and oxygen saturation suggested gas embolism and the procedure was abandoned. The origin of the gas responsible for the embolism is uncertain.The VersaPoint spring for endometrial ablation and submucous myomectomy requires further evaluation. Factors which may have contributed to the gas embolism are discussed.
Laparoscopic excision of primary pelvic hydatid cyst presenting as an adnexal mass
Authors: Dilbaz Serdar , Çalışkan Eray , Oguzer Kamber , Ertem Asuman , Gelisen Orhan , Haberal Ali 
Published: March 2003

To report a case of primary pelvic hydatid cyst presenting as an adnexal mass and having undergone a laparoscopic excisionThe clinical records of the patient were reviewed.The clinical and radiological findings demonstrated a right adnexal 5x6x5 cm unilocular cystic mass. Laparoscopic dissection of the dense adhesions between the mass, the right ovary and the omentum were performed. Laparoscopic excision of the mass was performed without rupturing the cyst and placing it in a bag. Histological examination confirmed the hydatid disease. Neither complications nor recurrence was observed during the follow up.Laparoscopy is used safely for treatment of pelvic haydatid cysts after taking measures to prevent intra‐abdominal spillage.
Routine cystoscopy after laparoscopically assisted hysterectomy: what's the point?
Authors: Seman Elvis I. , O'Shea Robert T. , Gordon Simon , Miller John 
Published: March 2003

To define the role of routine cystoscopy following laparoscopically assisted hysterectomy in the early detection of ureteric injuries.A retrospective observational study based on casenote review.A consecutive series of 436 women who underwent routine video cystoscopy after intrafascial laparoscopically assisted hysterectomy, with or without bilateral salpingo‐oöphorectomy.In 436 cystoscope evaluations, six cases aroused suspicion of a ureteric injury. Subsequent evaluation confirmed injury in two of these cases. A further two cases were not suspected on cystoscopic grounds but were detected in the early postoperative period. One ureteric injury was associated with endoscopic staples, two with electrosurgery and one with the harmonic scalpel. The staple injury was suspected clinically during the operative procedure; the remainder were not.Routine cystoscopy at intrafascial laparoscopically assisted hysterectomy has not contributed to the early diagnosis and treatment of ureteric injuries sustained with the authors' current technique. Thus cystoscopy ought to be done selectively according to clinical intraoperative concern. The distal pelvic ureter should be routinely inspected for dilatation, via peritoneal windows, at the end of the hysterectomy. Every endogynaecologist should review their data on cystoscopy and ureteric injuries associated with laparoscopically assisted hysterectomy to ascertain whether cystoscopy is justifiable in their practice, and whether surgical techniques need to be modified to enhance ureteric protection.
Hydrothermal ablation: assessment of a new simple method for treatment of uncontrolled menorrhagia
Authors: Hefni Mohamed A. , El‐Toukhy Tarek , Nagy Charles , Mahadevan Subramanian , Davies Angharad E. 
Published: March 2003

ABSTRACTObjective Assessment of the safety and efficacy of hydrothermal ablation (HTA) in the treatment of therapy‐resistant menorrhagia.Design and setting Prospective observational study, at a minimal access unit, Kent, UK.Subjects and methods Patients referred because of uncontrolled menorrhagia were recruited for the study between January 1999 and July 2000, provided that they had completed their family. Preoperative evaluation included examination, ultrasound scanning and endometrial sampling. Women with submucous fibroids or fibroids 5 cm or more in diameter were excluded. Endometrial suppression was induced prior to surgery with two injections of goserelin. HTA was carried out by circulating saline at 90°C for 10 min in the uterine cavity under hysteroscopic vision. Uterine serosal and intravesical temperatures were recorded. Follow up was by specially designed menstrual questionnaires at 3 and 6 months after surgery and at 6‐monthly intervals thereafter.Outcome measures Operative and postoperative complications, temperatures recordings, changes in menstrual pattern and patient satisfaction.Results The procedure was performed for 67 women. No operative or postoperative complications occurred. No fluid spilled through the fallopian tubes or leaked through the cervix. The mean temperature recorded was 36.8°C (± 0.4). Technical difficulty caused by failure of the HTA control unit occurred in two cases. The percentage of women reporting amenorrhoea or vaginal spotting was 57% at 1 year, 58% at 18 months and 62% at 2 years. After a mean follow‐up period of 17 months (range 12–24), 79% of patients were satisfied with the procedure. The efficacy of the procedure was not reduced in the presence of uterine fibroids.Conclusion HTA is a safe, easy and effective method of endometrial ablation in women suffering from therapy‐resistant menorrhagia, even in the presence of uterine fibroids which did not distort the cavity.
Anaphylactoid reactions and nephrotic syndrome – a considerable risk during factor IX treatment in patients with haemophilia B and inhibitors: a report on the outcome in two brothers
Authors: Tengborn  , Hansson  , Fasth  , LÜbeck  , Berg  , Ljung  
Published: March 2003

Anaphylaxis/anaphylactoid reactions have recently been reported after few treatments with factor IX concentrates in patients with haemophilia B at the same time as inhibitors to factor IX were demonstrated. In some of these cases nephrotic syndrome has appeared during immune tolerance induction (ITI) with high doses of factor IX concentrates. Gene deletions seem to be associated with a high risk of developing antibodies to factor IX.This report presents two brothers with deletion of 1 bp in exon f of the factor IX gene. Both showed anaphylactoid reactions and they were desensitized using slow i.v. injections of factor IX. At the time of anaphylaxis, inhibitors of factor IX in a low titre could be demonstrated. The elder brother responded well after a short time on ITI and has no spontaneous bleedings on regular prophylaxis although in a somewhat higher dose than expected. On the other hand, in spite of comparable regimens, the younger brother has so far been resistant to ITI. Moreover, during treatment with extremely high doses of factor IX concentrate he developed nephrotic syndrome which only slowly subsided after treatment with corticosteroids and withdrawal of factor IX.