bluuebunny/crossref_metadata_2025_split huggingface dataset:
A successful pregnancy following trachelectomy and laparoscopic pelvic lymphadenectomy for cervical carcinoma
Authors: Burnham Annabelle , Venkitaraman Uma , Street Patricia 
Published: March 2003

DesignCase report.MethodA young patient had stage Ibi cervical carcinoma. She was treated with trachelectomy and laparoscopic pelvic lymphadenectomy. Two years later she achieved a successful third trimester pregnancy, and was delivered by elective Caesarean section at 37 weeks.ConclusionA cervical suture had been inserted at trachelectomy, and this was considered to be a significant contributing factor to the success of this pregnancy.
Bizarre leiomyoma: a rare form of atypical leiomyoma
Authors: Hviid Ulla R. , Sørensen Søren S. 
Published: March 2003

ObjectiveSelective operative hysteroscopy is today the preferred treatment for symptomatic submucous uterine fibromas. The correct pathological diagnosis is important, especially in premalignant conditions.SettingA case report is presented concerning the discrimination between bizarre leiomyoma and leiomyosarcoma in a woman with persistent menstrual periods who was treated by means of endometrial resection.Results and ConclusionAtypical leiomyomas of the uterus have been considered to be benign, but some have malignant potential and special attention is needed in such cases, especially in light of the rapid development of conservative salvage surgery.
Randomized controlled trial of postoperative pain and activity following microlaparoscopy and standard laparoscopy
Authors: Burmeister Lynn , Tsaltas Jim , Griffiths Andrew , Goodchild Colin , Mamers Pam , Healy David L. 
Published: March 2003

ObjectiveTo compare postoperative pain and recovery of patients undergoing surgery with the 2‐mm microlaparosope and the 10‐mm standard laparoscope.DesignA double‐blind prospective randomized clinical study to assess pain.SettingMonash Medical Centre Women's Health Program, Melbourne, Australia.Subjects29 women of reproductive age (24–45 years) undergoing diagnostic procedures for fertility were randomly allocated to either microlaparoscopy (ML) or standard laparoscopy (SL).InterventionsOf these patients 13 received a microlaparoscopy and 16 received standard laparoscopy. All patients agreed to complete the self‐administered Short‐Form McGill Pain Questionnaire (SF‐MPQ), immediately after surgery before any analgesia and at 48 h after surgery, in order to assess pain and recovery.Main outcome measuresPain intensity and recovery time for patients undergoing microlaparoscopy were compared with those for standard laparoscopy.ResultsThere was no significant difference between the two groups when the affective, sensory and visual analogue scale (VAS) pain scores, immediately after recovery and at 48 h, were compared. However there was a significant difference in the time to return to normal activity as perceived by the patients, with the ML group scoring a quicker return to normal activity (mean ± SD, 3.6 ± 3.6 compared with the SL group (7.1 ± 3.3) (P = 0.01). This was despite a significant difference in operating times between the two groups. The mean operating time for the ML group was 22.6 min (95% confidence interval (CI) 18.8–26.5), compared with a mean for the SL group of 16.4 min (95% CI, 13.9–18.8) (P = 0.01). The ML group required no narcotic postoperative analgesia.ConclusionThere was no significant difference in pain scores between groups in whom the microlaparoscope or the standard laparoscope were used. However the microlaparoscopy group experienced a quicker post‐surgical recovery, required less analgesia and were more satisfied with their scar.
Cervical cancer metastasis on the surgical wound: not a new feature and not specific to laparoscopy. Report of two cases and review of the literature
Authors: Paraskevaidis Evangelos , Papadimitriou Dimitrios , Koliopoulos George , Dalkalitsis Nikolaos , Fotiou Stylianos , Lolis Dimitrios , Kitchener Henry 
Published: March 2003

ObjectiveThe appearance of cervical cancer metastases on the abdominal wall is unusual and almost always indicates an extremely poor prognosis. More specifically however, metastases on the surgical wound or trocar insertion site are extremely rare while their pathophysiology and clinical significance remain controversial. This study presents two cases and attempts to clarify the pathophysiology and suggest clinical strategies. A literature review is also presented.SettingDepartment of Gynecology, Ioannina University Hospital, Ioannina, Greece.SubjectsTwo cases of patients presenting with cervical cancer who developed metastasis on the surgical wound or a laparoscopy trocar insertion site are described.ResultsApart from the two cases encountered by the authors, nine more have been reported. Five out of the total of 11 cases had metastasis on a laparoscopy trocar insertion site and the rest on the surgical wound. Nine out of the 11 women had been treated at an early stage (IB). In five patients the metastasis on the wound or the trocar site was the only one at the time of the diagnosis. A marked delay in the diagnosis of metastasis was noted in many cases.ConclusionsPossible mechanisms for development of metastasis on the wound or the trocar site are analysed. Metastasis on the surgical wound is not always associated with laparoscopy. Careful haemostasis, avoidance of haematoma formation, careful handling of tissues especially in laparoscopy and the extension of radiotherapy fields to include the wound or trocar sites might prevent the development of metastasis. Alertness on the part of surgeons is advised, in order to ensure immediate diagnosis and wide excision of these metastases, as they are often the only site of relapse.
A Scottish audit of laparoscopically assisted vaginal hysterectomy
Authors: Brechin Susan , Farquharson David M. , Hawthorn Robert , Davis Jonathan , Fisher Peter , Philips William , Lumsden Mary A. 
Published: March 2003

Objective  To evaluate the use of laparoscopically assisted vaginal hysterectomy (LAVH) by a cross‐section of gynaecologists in Scotland. Design  A prospective registration of cases of LAVH carried out by gynaecologists. Case‐note review was also performed in selected hospitals. Setting  13 hospitals in seven Scottish Health Boards. Subjects  Women undergoing an LAVH. Results  505 LAVHs were reported between April 1994 and March 1996. Of these, 463 (91.7%) were successfully carried out laparoscopically. The uptake of laparoscopic surgery in Scotland overall is low, with a handful of surgeons performing the majority of procedures. Patient satisfaction with the procedure was high. Complication rates were high at 18.2% but this was mostly on account of postoperative infection. Only 34% of surgeons had any formal training in laparoscopic techniques, but this had increased to 55% by the end of the audit. Conclusions  Complication rates in the present study were higher than those reported by expert laparoscopic surgeons, but perhaps reflect more accurately those expected from a cross‐section of gynaecologists in current practice.
Surgical pelvic neuroablation for chronic pelvic pain: a systematic review
Authors: Johnson Neil , Wilson Michelle , Farquhar Cindy 
Published: March 2003

ObjectiveTo determine, from the best available evidence, the effectiveness of surgical pelvic neuroablative techniques as treatment for primary and secondary dysmenorrhoea.DesignSystematic review of randomized controlled trials (RCTs).SubjectsWomen with primary or secondary dysmenorrhoea.InterventionsSurgical neuroablative techniques including uterine nerve ablation and presacral neurectomy.Main outcome measuresPain relief (both short‐ and long‐term) and adverse effects.ResultsLaparoscopic uterine nerve ablation (LUNA) has been shown by one small study to be effective for primary dysmenorrhoea up to 12 months. A larger study showed no significant difference between LUNA and laparoscopic presacral neurectomy (LPSN) in pain relief for primary dysmenorrhoea up to 6 months, but LPSN was significantly more effective beyond 6 months. For dysmenorrhoea secondary to endometriosis, two trials found no significant difference in pain relief afforded by LUNA plus conservative laparoscopic surgery for endometriosis vs. conservative laparoscopic surgery alone. Presacral neurectomy (PSN) plus conservative surgery for endometriosis at laparotomy vs. conservative surgery for endometriosis at laparotomy showed no significant difference in overall pain relief, although there was a significant difference in relief of midline abdominal pain. Adverse events overall were significantly more common following PSN; these included constipation, urinary urgency, painless labour and one case necessitating a laparotomy for presacral haematoma 2 days after PSN.ConclusionsThere is insufficient evidence to recommend the use of surgical pelvic neuroablation in the management of dysmenorrhoea, regardless of cause. Further scientifically rigorous RCTs should be undertaken.
Endometriotic ovarian cysts: the case for ablative laparoscopic surgery
Authors: Jones Kevin D. , Sutton Christopher 
Published: March 2003

To present a synopsis of the evidence supporting ablative laparoscopic surgery for endometriotic cysts.Review article.Endometriotic cysts can be managed laparoscopically by stripping, and excising or ablation of the capsule.The clinical outcome of each technique in terms of cyst recurrence, pregnancy rates, pain relief and patient satisfaction are broadly similar, but this may reflect study design and in particular, the variable follow up periods, and methods used to document outcome measures. There are concerns that excision may result in post operative adhesion formation and damage to the underlying oocytes which may impair fertility, produce chronic pain, and premature menopause. These concerns arise from the postulated aetiology and pathogenesis of ovarian endometriomas.There is no clear evidence to suggest that one minimal access surgical technique is superior to another for the management of endometriotic cysts. However, ablation of the capsule is a theoretically superior technique, with no demonstrable disadvantages.
Microwave endometrial ablation: does endometrial thickness or the medium for preoperative hysteroscopy affect the depth of ablation?
Authors: Wallage Sarah , Cooper Kevin G. , Miller Ian 
Published: March 2003

ABSTRACTObjectives To determine the depth of tissue necrosis following microwave endometrial ablation (MEA) after perioperative saline hysteroscopy, and to determine the effects of varying endometrial thickness on depth and regularity of necrosis after gas hysteroscopy.Subjects 15 premenopausal women undergoing hysterectomy for dysfunctional uterine bleeding at Aberdeen Royal Infirmary.Methods Endometrial thickness was measured by transvaginal ultrasound scanning. After cervical dilation a hysteroscopy was performed with carbon dioxide or saline before proceeding to MEA and then hysterectomy. A vital stain was used to assess the depth and regularity of endomyometrial necrosis in the excised uterus.Results The nitroblue tetrazolium stain was a simple and effective way of demonstrating the depth of necrosis. In this small study, saline hysteroscopy led to cornual sparing in some cases. There was no clear effect of endometrial thickness up to 8 mm with gas hysteroscopy.Conclusions Saline hysteroscopy may affect the clinical outcome of MEA. Aspiration of residual saline may minimize any negative effect. The depth and regularity of necrosis did not seem to be affected by endometrial thicknesses of up to 8 mm after gas hysteroscopy. It seems reasonable to proceed to a clinical trial to assess the outcome of postmenstrual MEA without hormonal endometrial preparation.
Scientific visits to the Åland Islands
Authors: Blombäck M. 
Published: March 2003

Three research trips performed by the Stockholm teams in 1957, 1977, and 1992 are described in this paper.At the 1957 visit we showed that the family members of the original family and a few others, as described by von Willebrand, had the same coagulation defects as the Swedish patients with von Willebrand’s disease (vWD) (prolonged bleeding time, low FVIII levels and a normal platelet factor 3) and that fraction I‐0 normalized the defect.At the 1977 visit we showed that the bleeding disorder described in many papers by von Willebrand and collaborators over the years could be divided into four different forms: the pure vWD; two platelet function defects, i.e. a pure cyclooxygenase defect (no platelet aggregation at addition of arachidonic acid solely); an aspirin‐like defect, generally called a cyclooxygenase defect; and a mix between vWD and the cyclooxygenase defect.At the 1992 visit members of four families with genuine vWD (including the original family) of the Åland Islands were screened for mutations of the ‘hot spot’ regions, exons 18, 28, 32, 43 and 45, of the von Willebrand factor (vWF) gene found in Sweden. One cytosine deletion in exon 18 was detected in all the families. Linkage analysis and genealogical studies suggest that the deletion in these families probably has a common origin also with the Swedish patients. Apart from the deletion in exon 18, two close transitions G→A at S1263 and C→T at P1266 in exon 28 on the same chromosome, were identified in one individual, who married into the original family, and his two children. These mutations are probably due to a recombination between the vWF gene and its pseudogene, since both transitions are also present in the same location in the pseudogene.
Virucidal heat‐treatment of single plasma units: a potential approach for developing countries
Authors: Goubran H. A. , Burnouf T. , Radosevich M. 
Published: March 2003

Since HIV first burst onto the scene of transfusion medicine, the quest for viral inactivation processes for plasma and plasma products has not ceased. Sophisticated methods for improving viral safety are currently used in the industrial world. However, in developing countries, with no facilities for treating plasma, nonviral‐inactivated fresh frozen plasma [FFP] continues to be used extensively, and as screening may not be optimal (or may even be absent), FFP still contributes to the spread of HIV and other infectious viruses.The feasibility of heat‐treating FFP at the liquid state, in its collection bag, was explored by testing diverse conditions of temperature and duration, in the presence of biologically compatible stabilisers. Quality of the heat‐treated plasma was evaluated by haematological, biochemical and animal assays. The efficiency of the method to inactivate viruses was validated using HIV and model viruses.The selected heating conditions are 50 °C for 3 h. The optimized combination of stabilisers is composed of 30 mM trisodium citrate, 10 g L–1L‐lysine, 12 mM calcium gluconate and 150 g L–1 sorbitol. Plasma coagulability is appropriately preserved as shown by the KCT ratio (1.4). Recovery of biological activity of most coagulation factors is higher than 70% (including fibrinogen & von Willebrand factor). Electrophoretic and immunoblotting studies did not evidence protein aggregation and/or degradation. Viral validation studies of this procedure have shown complete inactivation of HIV (> 6.6 log) in less than 1 h of treatment. A viral reduction of at least 4 log for various model viruses, including those of hepatitis A and C viruses, suggests a potential contribution of the method to diminish the risk from various blood‐borne viruses.The selected formulation appears to preserve plasma protein integrity and properties. The procedure does not require sophisticated equipment but it is mandatory to monitor it carefully to ensure quality and reproducibility. If properly controlled and standardized, this approach offers an opportunity to reduce the risk of transmission of HIV and other viruses, particularly in poor countries with a high incidence of HIV.
Weak links: ‘Rapoport's rule’ and large‐scale species richness patterns
Authors: Kerr Jeremy T. 
Published: March 2003

SummaryMany hypotheses have been proposed to explain regional species richness patterns. Among these, ‘Rapoport's rule’ has sparked considerable controversy by stating that the latitudinal gradient in species richness can be explained indirectly as a function of narrower geographic ranges for species at low latitudes. Annual climatic variability, or deviation from mean climatic conditions, has been hypothesized to moderate this phenomenon. Furthermore, taxa that avoid much of this seasonality, such as temperate zone insects that enter diapause or species that migrate, were predicted to show reduced latitudinal gradients in richness. I test the suggested link between ‘Rapoport's rule’ and species richness for two higher level insect taxa as well as for the class Mammalia. Although these taxa exhibit the well‐known latitudinal gradient in species richness, simple annual climatic variability and deviation from mean annual climatic conditions provide very poor predictions of species richness in each of them. Potential evapotranspiration, a measurement of ambient climatic energy, explains most of the observed variance in regional species richness patterns for all three taxa, consistent with the species richness‐energy hypothesis. I find no support for an indirect link between ‘Rapoport's rule’ and terrestrial species richness patterns in North America.
Mammals in South American drylands: faunal similarity and trophic structure
Authors: Ojeda Ricardo A. , Blendinger Pedro G. , Brandl Roland 
Published: March 2003

AbstractWe compared the fauna of small mammals (less than 500 g body weight) among five major South American drylands (Atacama, Altiplano, Monte, Patagonia and Caatinga) and found considerable heterogeneity and distinctiveness in species richness and composition between these biomes. From a total of 89 recorded species, 76 of them are restricted to only one of these drylands. The highland desert, or Altiplano, is the biome with the highest number of species. Despite the marked differences in the composition of the mammalian fauna, the trophic structure shows a rather consistent pattern: herbivores are the most important trophic group in all drylands. This consistency seems to be more the result of phylogenetic inertia than of similar ecological processes. Our results are compared with recent studies on desert small mammals across continents.
Species as units of analysis in ecology and biogeography: are the blind leading the blind?
Authors: Kelt Douglas A. , Brown James H. 
Published: March 2003

Abstract Riddle & Hafner (1999) suggest that genetically differentiated lineages should be formally recognized as evolutionary significant units (ESUs) and that ESUs should replace currently recognized species as units in quantitative ecological and biogeographic analyses. Riddle & Hafner imply that if comparisons of desert rodent communities across many localities in south‐western North America by Brown & Kurzius (1987) and Kelt et al. (1996) had used ESUs rather than species, substantially different results and conclusions would have been obtained. Here we defend our use of species in these studies, and question the wisdom of formalizing the concept of ESU and applying it in most biogeographic, ecological and behavioural studies. Studies of genetic variation and description of ESUs are uneven across taxa of mammals and geographical regions, and those ESUs that have been described are often difficult or impossible to identify on the basis of the morphological traits used to distinguish currently recognized species. Consequently, most of the specimens in museum drawers, nearly all of the fossil remains, and most of the animals studied in the field or laboratory by ecologists, behaviourists and other biologists cannot be assigned to ESUs. The currently recognized species, usually described originally on the basis of morphological and biological species concepts, provide the only relatively consistent, operational taxonomic units. Results of our studies on the biogeography of desert small mammals are not seriously altered by recent subdivisions of some species into multiple ESUs.
Risk assessment for nonindigenous pests: 2. Accounting for interyear climate variability
Authors: Jarvis Claire H. , Baker Richard H. A. 
Published: March 2003

AbstractThe paper firstly discusses the importance of accounting for interyear variability when assessing the likelihood of establishment of an alien pest. The potential establishment of Colorado beetle (Leptinotarsa decemlineata) is used as an illustration within the geographical context of England and Wales. An aggregate risk index is introduced as a probabilistic representation of the likelihood that a pest might complete a single generation over a 30‐year period (1961–90). Data for individual years were used to compute, objectively, the interyear distribution of risk across the landscape. The standard deviation in area at risk (26 800 km2) was high relative to the average proportion of the landscape potentially at risk (95 700 km2). In 40% of years, the area at risk was estimated to be higher than ‘average’.Secondly, the paper demonstrates multiple indices of risk that reflect different aspects of pest risk assessment. Viewing risk from a variety of perspectives provides a means of gauging the consistency and therefore reliability of the results. This contrasts with current practice, where a single mapped output is commonly presented to decision makers. Modelling using a daily time step allowed the use of indices to investigate the long‐term probabilities of biotic and abiotic events of short duration. These indices include estimates of pest activity and flight potential.
Using conjoint analysis to elicit the views of health service users: an application to the patient health card
Authors: Ryan Mandy , McIntosh Emma , Shackley Phil 
Published: March 2003

ObjectiveTo demonstrate the application of conjoint analysis (CA) for eliciting the views of health service users.MethodsA CA study was conducted alongside a randomized controlled trial evaluating the introduction of a patient health card (PHC). The PHC was evaluated with respect to three other aspects of general practice: number of days between making a non‐urgent appointment and seeing a doctor; waiting time in reception between the time of the appointment and seeing a doctor; and whether the patient is usually seen by the doctor of their choice. A postal questionnaire was sent to 100 individuals from a general practice in Inverurie, Scotland.ResultsSeventy‐five individuals returned the questionnaire, of whom 51 answered the CA section. The PHC was the least important of the attributes considered. The number of days between making a non‐urgent appointment and seeing a doctor was considered to be the most important. A 1‐day reduction in the number of days to appointment was four and a half times more important than having a PHC; a 1‐minute reduction in waiting time in the reception area was three and a half times more important than having a PHC; and seeing a doctor of choice was over three times more important than having a PHC. Satisfaction or utility scores for different ways of providing a general practice service also indicated that priority should be given to reducing waiting time to see a doctor or reducing waiting time in reception.ConclusionsWhile the PHC is a significant and positive predictor of satisfaction in general practice, it is less important than the other three attributes considered. More generally, CA appears to be a potentially useful instrument for eliciting the views of health service users.