bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laparoscopic surgery vs. laparotomy management for infertile patients with ovarian endometrioma
Authors: Sawada Tomio , Ohara Satoshi , Kawakami Seiji 
Published: March 2003

ObjectiveTo determine the usefulness of laparoscopic surgery compared with laparotomy for conservative surgical treatment of patients with ovarian endometrioma.DesignNon‐randomized retrospective study.SettingInfertility unit at the Fujita Health University Hospital, Aichi, Japan.SubjectsA total of 78 infertile patients with endometrial cysts treated during a 5‐year period.InterventionsConservative surgical treatment by means of laparoscopic surgery (n = 32) or laparotomy (n = 46) with follow up over 24 months. Each group was subdivided according to revised American Fertility Society (r‐AFS) score into two subgroups: those with early‐stage endometrioma (score < 16) and those with advanced‐stage endometrioma (score ≥ 16).Main outcome measuresData for operating time, endometrioma size, r‐AFS score and pregnancy outcome were compared between both groups and subgroups.ResultsFor the patients with advanced‐stage endometrioma, the operating time was significantly longer for the laparoscopic group (154.0 ± 71.1 min; mean ± SD), compared with the laparotomy group (102.0 ± 37.8 min) even though the sizes of the removed endometrioma were similar (laparoscopic group 5.4 ± 2.2 cm, laparotomy group 7.1 ± 3.1 cm). Again for patients with advanced endometrioma, the mean time interval to subsequent pregnancy outcome following conservative surgery was significantly shorter in the laparoscopic group (206.4 ± 168.2 days) than in the laparotomy group (510.2 ± 338.3 days),ConclusionsLaparoscopic removal of advanced‐stage ovarian endometriomas seems as effective as laparotomy in terms of pregnancy outcome, but takes a slightly longer operating time compared with laparotomy. The laparoscopic approach has the advantage of a shorter time to pregnancy after surgery. Laparoscopic surgery is the recommended approach for infertile patients with ovarian endometrioma for better postoperative fertility.
Laparoscopic resection of a uterine horn following a pregnancy and rupture at 30 weeks' gestation
Authors: Jones Kevin , Keckstein Jorg , Sutton Christopher 
Published: March 2003

Objective To report the case history of a patient who underwent a laparoscopic resection of a rudimentary uterine horn following a pregnancy and rupture at 30 weeks' gestation.MethodsThe clinical records of the patient were reviewed.ResultsThe clinical and radiological findings demonstrated a unicornuate uterus, without a patent connection between the rudimentary uterine horn, and the cervix. The patient's first pregnancy occurred in the rudimentary uterine horn which ruptured at 30 weeks' gestation. A haematometra developed 17 months after an emergency Caesarean section, and she subsequently underwent a laparoscopic resection of the rudimentary uterine horn.ConclusionThis case report describes a minimal access procedure being carried out to treat a congenital anomaly of the uterus following a major obstetric complication.
Laparoscopic treatment of a subfascial haematoma following a Pfannenstiel laparotomy
Authors: Schreurs Annick M. A. R. , Bijnens Bernadette , Vanacker Bernard , Koninckx Philippe R. 
Published: March 2003

Objective To report the laparoscopic treatment of abdominal wall haematomas and to review the literature spanning 1976–99.Design Case report and Medline search using Winspirrs as search engine.Report A 50‐year‐old patient, with a large abdominal wall haematoma following an abdominal hysterectomy by Pfannenstiel incision, was treated by laparoscopy. Following CO2 insufflation and trocar insertion at the umbilicus, the diagnosis of a haematoma was confirmed by the bulging parietal peritoneum. Using an operative laparoscope, the peritoneum was entered close to the umbilicus and a haematoma of 750 ml was aspirated. Thorough examination did not reveal any remaining active bleeding. Clinical recuperation was spectacular and the patient was discharged 2 days later.Review Abdominal wall haematoma following Pfannenstiel incision is a rare complication, with reported incidences of 5%. The clinical diagnosis can be confirmed by ultrasound and computed tomographic (CT) scan, with sensitivities of 71% and 100%, respectively. Surgical treatment is limited to large haematomas because of secondary wound healing problems.Conclusion Since the laparoscopic treatment of wall haematomas is so easy and straightforward, we suggest that broadening the indications for surgery can be considered. This could moreover lead to a revision of the diagnostic accuracy of ultrasound and CT scan for smaller haematomas.
Arcus taurinus: the ‘mother and father’ of all LUNAs
Authors: Jones Kevin D. , Sutton Christopher 
Published: March 2003

ObjectiveThis paper reviews the surgical management of pelvic pain due to endometriosis, and describes a new operation, the so called ‘arcus taurinus procedure’.BackgroundIn 1954, Joseph Doyle from Massachusetts described the procedure of paracervical uterine denervation by transection of the uterosacral ligaments. He carried out this procedure in an attempt to interrupt the pain fibres contained in the cervical division of the Lee–Frankenhauser plexus. In the 1980s, the pioneers of minimal access surgery began to perform Doyle's operation laparoscopically. However, randomized controlled trials have shown that this procedure does not confer any additional benefit to ablation or excision of endomtriotic tissue, and the operation has been recently been refined. The uterosacral ligaments are now completely excised or ablated, a crater between the ligaments is formed, and the rectovaginal septum opened. This more extensive operation has been called an ‘arcus taurinus’, or ‘bull’s horn' procedure. These procedures were initially intended to relieve pain by denervating the pelvis. However, cytoreduction of endometriosis also relieves pain, and the uterosacral ligaments and rectovaginal septum can be infiltrated with endometriosis that may not be macroscopically visible.ConclusionTherefore, it is likely that the relief of painful pelvic symptoms is due to a combination of denervation, and cytoreduction of endometriosis. In this context, the arcus taurinus procedure is truly ‘the mother and father’ of all laparoscopic uterine nerve ablations.
Auditing complications of laparoscopy in a major tertiary hospital in Australia
Authors: Erian Mark M. S. , Goh Judith T. W. , Coglan Margaret 
Published: March 2003

To review complications in both diagnostic and operative laparoscopic procedures at a university‐affiliated major teaching hospital and to assess possible risk factors for complications.A retrospective review of all laparoscopic procedures at the Royal Women's Hospital Brisbane, Australia, from 1990 to 1997 inclusive. A non‐medical or nursing independent assessor reviewed charts. Data were collected on a standard form. Incomplete charts were excluded from analysis.There was a total of 1505 procedures. Analysis was based on 1435 complete data records. The overall complication rate was 2.86% with infection (1.3%) being the most common. The rate of gastrointestinal injury was 0.14%. Compared with women who had diagnostic laparoscopies, a higher rate of complication was found in women who had undergone operative laparoscopic procedures. However, this difference did not reach statistical significance. The complication rate was unrelated to seniority of the surgeon.Complications can occur in any laparoscopic procedure. Regular reviews, especially in teaching hospitals, will provide feedback to clinicians to improve quality of care.
A partially randomized patient preference trial of microwave endometrial ablation using local anaesthesia and intravenous sedation or general anaesthesia: a pilot study
Authors: Bain Christine , Cooper Kevin G. , Parkin David E. 
Published: March 2003

To ascertain whether microwave endometrial ablation under local anaesthesia is feasible in unselected women.A partially randomized patient preference pilot study.A large teaching hospital in North‐east Scotland.98 women who were referred and suitable for endometrial ablation and who agreed to participate after informed consent had been given.Women were randomly allocated to receive general or local anaesthesia for microwave endometrial ablation, or if they had a strong preference they were allocated to their chosen anaesthesia. All procedures were performed in the theatre setting and on a day case basis.Acceptability and satisfaction were primarily assessed in each group using validated tools. Operating times, failure under local anaesthesia, postoperative analgesia and postoperative discharge times were also recorded.Microwave endometrial ablation under local anaesthesia was feasible in 75% of unselected women. Acceptability was higher in those who chose local anaesthesia.Local anaesthesia should be offered to women undergoing microwave endometrial ablation and a randomized controlled trial is a feasible option for assessing prognostic factors and satisfaction.
Complications of hysteroscopy
Authors: Motashaw Nargesh D. , Dave Svati 
Published: March 2003

To review the complications of hysteroscopy.A retrospective review of the literature on hysteroscopy, to focus on some of the problems that the surgeon may face following this easy and usually safe procedure.Complications both from large series and isolated reports are included. They can be immediate, varying from an innocuous perforation of the uterus to injury to the bladder, bowel or vascular structures. Haemorrhage may be arrested by simple techniques or may require a laparotomy and hysterectomy. Problems include infection; complications of the distending medium, including CO2 and air embolism; anaesthetic complications, and thermal injuries. Delayed complications, such as haematometra, rupture of the uterus in a subsequent pregnancy and the need for a repeat procedure including hysterectomy, are other possibilities.Though hysteroscopy is a safe and easily executed procedure, it may be associated with mild or severe morbidity and even mortality.
Sacrocolpopexy for vaginal vault prolapse: a combined vaginal and laparoscopic approach
Authors: Rae David , Hawthorn Robert 
Published: March 2003

ABSTRACTObjective To report the short‐term effectiveness and safety of a combined vaginal and laparoscopic approach to sacrocolpopexy in the management of vaginal vault prolapse.Design A retrospective analysis of 22 patients.Results The mean operating time was 105 min. The only significant intraoperative complication was a rectal injury. The mean length of hospital stay was 3.18 days. Erosion of the Prolene mesh occurred in two women. The vaginal vault remained well supported in all 22 patients, over a mean follow‐up time of 12.5 months. Three women have required further surgery for a symptomatic cystocele.Conclusion A combined vaginal/laparoscopic approach to sacrocolpopexy appears to be effective and associated with a low risk of intraoperative and postoperative morbidity. Its principal advantage over a completely laparoscopic approach is in removing the technical demands of laparoscopic suturing.
Educational model for an objective assessment of operative laparoscopic skill
Authors: Mayooran Zorana , Tsaltas Jim , Rombauts Luk , Brown T. Ian H. , Lawrence Anthony S. , Fraser Kym , Healy David L. 
Published: March 2003

ABSTRACTObjective The purpose of this pilot study was to develop an assessment instrument to evaluate the level of skill of laparoscopic surgeons with regard to operative laparoscopy.Subjects A total of 16 doctors working in obstetrics and gynaecology were tested on the Monash University gynaecological laparoscopic pelvi‐trainer. Eight candidates were consultants with 9–28 years of practice in operative laparoscopy, and eight were registrars with up to 6 years of practice in operative laparoscopy. Six consultants and one registrar were from rural Australia.Design Subjects were asked to complete 10 laparoscopic tasks. Nine of these were designed to test manual dexterity skills and the correct use of laparoscopic instruments. One task tested theoretical knowledge of electrosurgery by means of four short‐answer questions. Candidates were marked on the basis of precision and speed. Heart rate measurements were taken 20 min prior to the test, at 5‐min intervals, and at the start and end of each task thereafter.Results The highest pass rate (81.25%) was recorded for task 1, i.e. setting up the endoscopic visualization system. The median time to complete this task was 168 s. No candidate could repair a severed ovarian ligament with an intracorporeal knot within 5 min. No candidate could successfully answer all four electrosurgery questions.Conclusion It is possible to objectively evaluate basic operative skills of laparoscopists by means of well‐structured tasks and marking criteria.
Current practices regarding newborn intracranial haemorrhage and obstetrical care and mode of delivery of pregnant haemophilia carriers: a survey of obstetricians, neonatologists and haematologists in the United States, on behalf of the National Hemophilia Foundation’s Medical and Scientific Advisory Council
Authors: Kulkarni  , Lusher  , Henry  , Kallen  
Published: March 2003

We undertook this survey to determine institutional practices of obstetricians, neonatologists and haematologists regarding care of pregnant haemophilia carriers and newborns with haemophilia and intracranial haemorrhage (ICH). Our purpose was also to determine whether institutions had written guidelines to manage such patients. Questionnaires were sent to 1000 obstetricians and through the Haemophilia Treatment Centres (HTC) to 180 paediatric haematologists and 180 neonatologists, each representing an institution.Twenty‐three per cent of obstetricians, 22% of neonatologists and 16% of paediatric haematologists returned completed surveys. Over 94% of the respondents had no written guidelines for management of pregnant haemophilia carriers or their newborns or for neurologic assessment of newborns. For known haemophilia carriers, 57% of the obstetricians routinely preferred vaginal delivery and 11% preferred caesarean section. Availability of perinatal services influenced prenatal management (P < 0.05). In term newborns with documented ICH, only 23% of neonatologists would evaluate for haemophilia, whereas in pre‐term newborns with ICH, this number dropped even further to 3%. For all newborns with haemophilia, 40% preferred routine administration of clotting factor concentrates (CFC) immediately following birth to offset the trauma of delivery and 89% of paediatric haematologists favoured early prophylaxis with CFC.Guidelines are needed for management of pregnant haemophilia carriers as well as newborns with haemophilia. Physicians need to be made aware that ICH may be a presenting sign of haemophilia in both term as well as pre‐term newborns, so that appropriate therapy can be instituted early in the event of a bleed.
Clinical efficacy and recovery levels of recombinant FVIIa (NovoSeven) in the treatment of intracranial haemorrhage in severe neonatal FVII deficiency
Authors: Wong  , Huang  , Miller  , Mcginty  , Whisnant  
Published: March 2003

The use of replacement FVII is critical to the successful treatment of life‐threatening bleeds in newborns and infants with severe FVII deficiency (<1%). However, the clinical efficacy, optimum dosage and pharmacologic recovery of rFVIIa in such children has not been studied systematically. This report is a case of an infant with severe FVII deficiency (FVII:C at 0%) and massive intracranial haemorrhage in which successful use of rFVIIa (NovoSeven) was carefully monitored. The drug was administered by intravenous bolus through a central line every 4 h at each of three dose levels: 15 μg kg–1, 22 μg kg–1 and 30 μg kg–1. FVII:C was >100% between 30 and 180 min after each infusion with mean trough levels above 25% for all three dose levels. There was no evidence of hyper‐coagulation as indicated by measurements of the platelet count,
D‐dimer, plasma protamine paracoagulant and fibrinogen levels in spite of high FVII:C concentration.In this infant, rFVIIa was well‐tolerated, maintained effective haemostasis with good clinical outcome, and produced consistent therapeutic mean trough levels above 25% FVII:C even at 15 μg kg–1 every 4 h.
Bone marrow mesenchymal cells for haemophilia A gene therapy using retroviral vectors with modified long‐terminal repeats
Authors: Van Damme A. , Chuah M. K. L. , Dell'accio F. , De Bari C. , Luyten F. , Collen D. , VandenDriessche T. 
Published: March 2003

Summary. Bone marrow (BM) cells are attractive target cells for ex vivo gene therapy of genetic diseases, including haemophilia A. However, BM‐derived haematopoietic stem/progenitor cells (HSCs) transduced with factor VIII (FVIII) retroviral vectors, failed to express FVIII in vivo. To overcome the limitations of HSCs for haemophilia gene therapy, BM‐derived mesenchymal cells were explored as alternative target cells. The BM mesenchymal cell population contains self‐renewing mesenchymal stem/progenitor cells that give rise to different mesenchymal lineages and have been used safely in phase I gene‐marking trials. Human BM mesenchymal cells were transduced in vitro with an improved retroviral vector encoding a human B‐domain deleted FVIII (hFVIIIΔB) cDNA (MND‐MFG‐hFVIIIΔB). This vector contains multiple modifications in the cis‐acting elements within the MoMLV long‐terminal repeats (LTR) that prevent the binding of repressive transcription factors. These modifications were previously shown to increase and prolong gene expression in embryonic stem (ES) cells and HSCs. Transduction of BM mesenchymal cells with the MND‐MFG‐hFVIIIΔB retroviral vector resulted in high levels of functional human FVIII in vitro, ranging between 300 ± 50 SD and 700 ± 100 SD mU per 106 cells per 24 h. Following xenografting of the transduced human BM cells into immunodeficient NOD‐SCID mice, therapeutic hFVIII levels of 12 ± 10 ng mL−1 were detected in the plasma. Polymerase chain reaction analysis demonstrated long‐term engraftment (>3 months) of the human BM mesenchymal cells. The long‐term persistence of BM mesenchymal cells in the absence of myelo‐ablative conditioning and the therapeutic FVIII levels in vivo underscore the potential usefulness of BM‐derived mesenchymal cells for haemophilia gene therapy, as opposed to BM‐derived HSCs. Despite the modifications of the MoMLV LTR, FVIII expression declined, which coincided with a decrease in FVIII mRNA transcription levels, indicating that the salutary effect of the LTR modification on transgene expression is not universally applicable to all cell types.
Suicide and self‐harm in in‐patient psychiatric units: a study of nursing issues in 31 cases
Authors: Gournay Kevin , Bowers Len 
Published: March 2003

Suicide and self‐harm in in‐patient psychiatric units: a study of nursing issues in 31 cases A significant number of incidents of suicide and self‐harm occur whilst patients are in receipt of care as in‐patients. This audit comprises 31 cases which were referred to the first author for expert opinion, each case being the subject of legal action brought by patients and/or their families. The cases were referred from 31 different NHS trusts across England. All concerned suicide/serious self‐harm in people in receipt of in‐patient care. The aims of this audit were to carry out a detailed assessment of the 31 individual cases, so as to provide a nursing dimension to already established enquiries in this area and also to examine whether specific issues might be the subject of more systematic research. Further, this paper aims to provide some insights in the area of litigation, where nurses are becoming increasingly involved. The same broad approach to information‐gathering and analysis was used, comprising a systematic review of case records, trust policies, expert reports and, where appropriate, inquest transcriptions. The sample comprised 12 suicides and 19 cases of serious self‐harm. Factors associated with these events include: being male, having a dual diagnosis of mental illness and drug/alcohol abuse, and age between 21 and 30 years. Of the 12 deaths, five occurred in hospital, four by hanging and one by drowning. The audit highlighted environmental factors associated with these events which, arguably, could be simply addressed. There was a considerable variation in the content and quality of observation policy and practice. The results of this audit point to the need for further research but, above all, provide evidence requiring urgent action by the Department of Health regarding the setting of national standards.
Mangrove transgression into saltmarsh environments in south‐east Australia
Authors: Saintilan Neil , Williams Robert J. 
Published: March 2003

AbstractThe landward transgression of man‐ groves into saltmarsh environments in the estuaries of south‐east Australia over the last five decades is established as a widespread trend through a review of a number of independent studies. This process is occurring in a range of geomorphic settings, and in some cases reversing the direction of longer‐term vegetation change. Several hypotheses are advanced to explain this occurrence, including increases in rainfall, revegetation of areas cleared for agriculture, altered tidal regimes or estuary water levels, and increases in nutrient levels and sedimentation.
A history of fear: imagining deforestation in the West African dryland forests
Authors: Ribot Jesse C. 
Published: March 2003

SummaryUrban demand for woodfuels in Sudanian and Sahelian West Africa has long been assumed to contribute to permanent deforestation in dryland forests and wooded savannas. Deforestation has also long been assumed to be progressing such that these woodlands will no longer be able to provide the region's cities with fuel. Available studies of regeneration do not support the first assumption. Further, woodfuel shortages projected in the 1980s to arrive in the 1990s or early 2000s are nowhere near, while more recent projections predict supply shortages another 25 years hence. While there is deforestation from many causes, the data do not support crisis scenarios concerning woodfuels. Nonetheless, crisis scenarios and policies persist. While there may yet be deforestation due to urban woodfuel extraction, and shortages may be lurking on the horizon, the article explores some possible alternative origins of these woodfuel related deforestation and shortage fears.
New data on the history of the plateau forest of Okomu, southern Nigeria: an insight into how human disturbance has shaped the African rain forest
Authors: White LeE. J. T. , Oates JohN. F. 
Published: March 2003

SummaryThe classic 1955 and 1956 papers by Eustace Jones describe vegetation pattern, process and history in Okomu Forest, south‐western Nigeria. Jones and colleagues were puzzled to find an extensive layer of charcoal and pottery below mature mahogany forests. Based on an extensive review of historical documents and the estimated ages of dying emergent tree species, Jones suggested that the forest in Okomu had regenerated after a human population decline 200–300 years previously. We made radiocarbon measurements on samples from the layer of charcoal and pottery described by Jones. In addition, we obtained δ13C measures from a soil profile cutting through the charcoal layer. The charcoal dates to about 700–750 years BP whilst the δ13C profile showed no evidence of input of organic matter from C4 grasses. These results are discussed in the light of other recent archaeological evidence of the impact of humans on the rain forests of Africa during the last 2000–3000 years. It seems that extensive archaeological remains are hidden beneath much of the African rain forest, suggesting that human disturbance has been one of the dominant factors affecting forest structure and composition in recent millennia.