bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laparoscopic extirpation of bilateral rudimentary horns in a patient with a variant of Mayer–Rokitansky–Kuster–Hauser syndrome
Authors: Dokmeci Fulya , Atabekoglu Cem S. , Berker Bulent , Sonmezer Murat , Kabukcu Cihan 
Published: June 2003

ABSTRACTObjective To report a case of laparoscopic resection of bilateral rudimentary horns in a patient with a variant of Mayer–Rokitansky–Kuster–Hauser (MRKH) syndrome.Methods The clinical records of the patient were reviewed.Results Laparoscopy was undertaken in our patient for diagnosis of suspicious adnexal masses which had been observed on ultrasound examination. Laparoscopy disclosed two Müllerian remnants (bilateral rudimentary horns) on each pelvic sidewall and a simple paraovarian cyst 3–4 cm in size. These remnants did not communicate with each other and cervical agenesis was identified. It was decided to undertake bilateral laparoscopic horn resection since our patient complained of a cyclic pelvic pain and suspicious endometriotic implants on the right ovary and fallopian tube were observed; this was performed without complication. The resected horns and paraovarian cyst were removed by use of an endobag with extension of the left 5‐mm trocar incision. The patient was completely free of symptoms at the 1‐ and 6‐months follow‐up examinations.Conclusion Laparoscopic resection was used safely for the treatment of a variant of MRKH syndrome with bilateral rudimentary horns.
Hysterectomy: towards an overnight stay
Authors: Trehan A.K. 
Published: June 2003

ABSTRACTObjective To review the introduction of an overnight stay laparoscopically assisted vaginal hysterectomy (LAVH) service in a district general hospital.Design A retrospective study.Setting Dewsbury District Hospital is a 478‐bedded district general hospital with 14 gynaecological inpatient beds, serving a population of 165 000.Data collection Included in the study were 265 consecutive patients who underwent LAVH, performed by one consultant between September 1995 and September 2000. These patients were unsuitable for vaginal hysterectomy according to conventional (British) criteria and in the past would be have been offered abdominal hysterectomy. The names of the patients were obtained from the hospital register. All operative notes were abstracted and data collected independently by junior medical staff working in the department.Results Postoperative stay was analysed for consecutive groups of 50 patients. Initially the median postoperative stay was 2 nights but by the last cohort, nine out of 10 patients were going home after only 1 night's postoperative stay. None of the patients were readmitted or suffered complications as a result of this policy. Among the patients, 4.5% suffered one or more complications (most were minor). No patient suffered visceral injury. Patients had full surgical recovery by 6 weeks after operation except for a few who developed granulation tissue which needed topical treatment.Conclusion In experienced hands LAVH has few complications, and it is acceptable and safe to discharge patients home after an overnight hospital stay provided strict guidelines are followed.
Haematosalpinx and haematometra as long‐term complications of balloon endometrial ablation
Authors: Sinha P. , Pachydakis A. , Konamme S.P. , Auld B. 
Published: June 2003

ABSTRACTObjective To report the case histories of two patients who presented with haematometra and haematosalpinx 18 and 24 months after endometrial ablation.Design This is a retrospective case note analysis.Subjects A 51‐year‐old woman, who had undergone endometrial ablation 18 months previously, presented with acute abdominal pain. She was known to be taking continuous combined hormone replacement therapy. Pelvic ultrasound scan showed a large cystic mass, and diagnostic laparoscopy revealed a right haematosalpinx. She underwent right salpingectomy and was pain‐free after the operation. A 48‐year‐old woman presented with lower abdominal pain 2 years after endometrial balloon ablation. The ultrasound scan of the pelvis showed a haematometra (4.4 × 2.6 × 3.3 cm). She underwent examination under anaesthesia (EUA), dilation and drainage of the haematometra. A few weeks later she had a recurrence and underwent hysterectomy.Conclusion As more ablation procedures are performed, more delayed complications will arise.
Colouterine fistula as a complication of colonic diverticulitis: a conservative approach
Authors: Al Azzam Mo’iad , Cassidy Laura , Thomas Millicent 
Published: June 2003

ABSTRACTColouterine fistula is a rare complication of diverticular disease. Few cases have been reported in the literature. A wide spectrum of presentations may accompany this entity. In our experience it simulated uterine perforation at time of surgery. Diagnosis was confirmed by histopathology. Surgery has been suggested to be the treatment of choice in this situation, with resection of the colon as the main step; hysterectomy is mandatory to extirpate the sinus of infection. We undertook a conservative approach in this patient and did a simple repair of the colon. Hysterectomy was carried out. We believe that this would be a safe alternative to resection of the colon.
Laparoscopic management of ectopic pregnancy by trainees in Wales
Authors: Myerson Nicholas A. , Pugh David H.O. 
Published: June 2003

ABSTRACTObjective To discover whether trainees in Wales are able to manage ectopic pregnancy using laparoscopic techniques, and to identify factors preventing trainees from acquiring and using these skills.Design Postal questionnaires.Setting Wales deanery of the Royal College of Obstetricians and Gynaecologists.Subjects All specialist registrars in obstetrics and gynaecology.Results Two surveys were completed. The initial survey in January 2000 had a response rate of 91% and found that 38% of trainees could independently manage an ectopic pregnancy laparoscopically. A more detailed survey in January 2002 with an 87% response rate found that 21% of trainees were able to manage an ectopic pregnancy laparoscopically. However, only 7% of specialist registrars in years 1–3 of training could do so. The main reasons why trainees could not manage ectopic pregnancies laparoscopically were lack of practical experience coupled with a lack of consultant supervision.Conclusions Over 2 years, there was a decrease in the number of trainees able to manage an ectopic pregnancy using laparoscopic techniques. This has important implications both for training and service provision.
Semi‐open direct trocar insertion method for induction of pneumoperitoneum at laparoscopy
Authors: Volpi Eugenio , Sismondi Piero 
Published: June 2003

ABSTRACTBackground and objective Different techniques have been previously described for the induction of pneumoperitoneum to start laparoscopy. This is the first description of a technique of semi‐open direct trocar insertion in which the peritoneum is first opened and a trocar is then directly inserted without insufflation.Patients and methods The technique was tested in 184 (89.3%) out of 206 patients who underwent laparoscopy at our institution over a 1‐year period. In 22 patients, closed entry through Palmer's upper quadrant with a Veress needle was used. An incision was made at the deepest point of the umbilical scar down to the peritoneal membrane which was entered to a depth of 1–2 mm. Direct trocar insertion was then performed.Results Direct trocar insertion was successful in 171 (92.9%) patients at the first attempt, and in 183 out of 184 (99.4%) by the third attempt. The approach was changed to upper quadrant entry in only one patient. The technique was faster and easier than upper quadrant entry. No major complication was observed.Conclusions Semi‐open direct trocar insertion can be performed safely in the starting phase of laparoscopy.
Laparoscopic surgery and adhesiolysis
Authors: Mettler L. , Schollmeyer T. , Kotdawala P. , Zavala A. , Moharram A.E. 
Published: June 2003

ABSTRACTObjectives To evaluate the degree of adhesion formation at laparoscopic surgery in different patient groups.Design A retrospective study using the American Fertility Society's Adhesion Scoring Method and the MCASM (More Comprehensive Adhesion Scoring Method).Subjects The 465 patients with adhesions among 2124 patients who underwent laparoscopy.Results Details of the 465 cases of adhesiolysis are given. In subgroup 1 (n = 34) there were no pre‐existing adhesions. All 34 patients were assessed for adhesion occurrence at a second‐look laparoscopy after 6–8 weeks; 29.4% were found to have no adhesions and 70.6% of patients had significant or mild adhesions. A more comprehensive adhesion scoring method (MCASM) was found to be more objective in the assessment of adhesions; however, it was difficult to record in an easily readable manner. In subgroup 2, 21 patients who had undergone previous surgery for adhesiolysis were operated upon again, and 24% revealed an increased adhesion score, 57% the same adhesion score and 19% a reduced adhesion score at second‐look laparoscopy.Conclusions The new data confirmed our previous knowledge: to avoid adhesions one must avoid surgery. If surgery has to be performed, laparoscopic surgery causes fewer adhesions than laparotomy.
Laparoscopic extracorporeal cystectomy in the management of large dermoid cysts
Authors: Sönmezer Murat , Güngör Mete , Cengiz Bora , Ortaç Fırat 
Published: June 2003

ABSTRACTObjective To evaluate the results of the surgical management of large dermoid cysts by laparoscopic extracorporeal cystectomy.Design The results of the surgical management by laparoscopic extracorporeal cystectomy of large (≥8 cm) dermoid cysts in 21 women, were evaluated in a retrospectively designed study.Setting Ankara University School of Medicine, Obstetrics and Gynaecology Clinic.Intervention After the cyst had been aspirated and decompressed, it was pulled out through the trocar site, the 10‐mm suprapubic trocar incision having been enlarged to 25 mm. The aim of this was better identification of functional ovarian tissue and extracorporeal completion of cystectomy. The remaining ovarian tissue, that appeared to be functional, was pushed back into the peritoneal cavity. The duration of hospitalization, operating time, intraoperative blood loss and postoperative morbidity were evaluated.Results All of the large cysts were managed successfully by laparoscopic extracorporeal cystectomy. The mean age of the patients was 28.5 ± 4.9 years (range 21–37). The mean diameter of the cysts was 11.2 ± 2.7 cm (range 8–17 cm), the mean operation time was 65.8 ± 13.9 min (range 45–95 min), and the mean duration of hospitalization was 1.8 ± 0.7 days (range 1–3 days). Average blood loss was less than 35 ml. Despite considerable efforts to keep leakage of cyst contents to a minimum, this did occur to some extent and was managed successfully by copious lavage in all patients. None of the patients developed postoperative morbidity associated with chemical peritonitis.Conclusion Laparoscopic extracorporeal cystectomy is a safe and effective technique in the management of large dermoid cysts. Functional ovarian tissue could be well identified and preserved by direct visualization.
A European survey of the complications of a uterine thermal balloon ablation system in 5800 women
Authors: Rogerson Lynne , Duffy Sean 
Published: June 2003

ABSTRACTObjective To study the nature and incidence of complications, and the ease of use associated with a uterine thermal balloon system.Design An anonymous postal questionnaire with no follow up for non‐responders.Setting European survey throughout the UK, France, Switzerland and the Netherlands.Sample All users of the ThermaChoice uterine thermal balloon system in the countries stated.Main outcome measures These were the number of procedures performed by respondents throughout Europe; the nature and incidence of intraoperative and postoperative complications, and the perceived ease of use and safety of the thermal balloon system.Results 446 questionnaires were mailed, and there were 149 responses (33.4%). From the returned questionnaires it is possible to report on an estimated 5859 procedures performed throughout Europe. In this series, there were 14 reported intraoperative complications (0.24%), two emergency procedures, and a total of 230 postoperative complications (3.92%). This gives an overall complication rate of 4.16%.Conclusions This survey found that the ThermaChoice system is widely used throughout Europe. Although the methodology of this retrospective study has limitations, it has shown that the system has an excellent safety record, and notably that the complication rate appears to be lower than that observed for traditional ablation techniques as reported in the MISTLETOE study. Clinicians employing this system perceive it to be very safe and easy to use compared with traditional transcervical resection of endometrium. For the future, it is important to prospectively collect this data in order to gain the same information for the second‐generation devices, as is available for the ‘gold standard’ techniques for endometrial ablation.
The effect of home‐use fluoride gels on glass–ionomer, compomer and composite resin restorations
Authors: Dionysopoulos P. , Gerasimou P. , Tolidis K. 
Published: June 2003

summary  The purpose of this study was to investigate the resistance to dissolution by two home‐use fluoride gels on the surface integrity of glass–ionomer, resin modified glass–ionomer, compomer and composite resin restorations. Class V cavities prepared in extracted teeth were restored with a glass–ionomer (Fuji II), a resin modified glass–ionomer (Vitremenr), two compomers (Dyract and F‐2000) and a composite resin (Z‐100).Groups of five specimens of each material were treated for 24 h with one of the following: (i) distilled water, (ii) neutral fluoride gel and (iii) acidulated phosphate fluoride (APF) gel.Surface degradation of the restorations was studied using standard electron microscopy (SEM), rated according to specific criteria and statistically analysed by the Wilcoxon test (rank sums).Acidulated phosphate fluoride was found to have a significant effect on all examined materials, while minimal effects resulted from the neutral fluoride gel compared with the control group. The effect of home‐use fluoride gels on glass–ionomer, compomer and composite resin restorations.
Characterization of RAT, an autolysis regulator in Staphylococcus aureus
Authors: Ingavale S. S. , Van Wamel W. , Cheung A. L. 
Published: June 2003

SummaryIn trying to identify genetic loci involved in the regulation of cap5 genes in Staphylococcus aureus, we isolated a transposon mutant that exhibited a growth defect, enhanced autolysis and increased sensitivity to Triton X‐100 and penicillin, attributable in part to increased murein hydrolase activity. Analysis of the chromosomal sequence flanking the transposon insertion site revealed that the gene disrupted in the mutant encodes an open reading frame of 147 amino acids. We named this gene rat, which stands for regulator of autolytic activity. Sequence analysis indicated that Rat is homologous to the MarR and, to a lesser extent, the SarA protein families. Mutations in rat resulted in decreased expression of known autolytic regulators lytSR, lrgAB and arlRS. Gel shift studies indicated that Rat binds to the lytRS and arlRS promoters, thus confirming Rat as a DNA‐binding protein to these known repressors of autolytic activity. As anticipated, rat appears to be a negative regulator of autolysin genes including lytM and lytN. These data suggest that the rat gene product is an important regulator of autolytic activity in S. aureus.
Haemophore‐mediated signal transduction across the bacterial cell envelope in Serratia marcescens: the inducer and the transported substrate are different molecules
Authors: Rossi Maria‐Silvia , Paquelin Annick , Ghigo Jean Marc , Wandersman Cécile 
Published: June 2003

SummaryNumerous bacteria are able to use free and haemoprotein‐bound haem as iron sources because of the action of small secreted proteins called haemophores. Haemophores have very high affinity for haem, and can therefore extract haem from the haem‐carrier proteins and deliver it to the cells by means of specific cell surface receptors. Haem is then taken up and the empty haemophores are recycled. Here, we report a study of the regulation of the Serratia marcescens has operon which is involved in haemophore‐dependent haem acquisition. We characterized two genes encoding proteins homologous to specific ECF sigma and antisigma factors. We showed that they regulate the synthesis of the haemophore‐specific outer membrane receptor, HasR, by a signal transduction mechanism similar to the siderophore surface‐signalling systems. We also showed the essential role of HasR itself in this process. Using haem‐loaded and haem‐free haemophore, we identified the stimulus for the HasR‐mediated signal transduction as being the binding of the haem‐loaded haemophore to HasR. Thus, unlike siderophore‐uptake systems, in which the signalling molecule is the transported substrate itself, in the haemophore‐dependent haem uptake system the inducer and the transported substrate are different compounds.
Membrane‐specific targeting of green fluorescent protein by the Tat pathway in the cyanobacterium Synechocystis PCC6803
Authors: Spence Edward , Sarcina Mary , Ray Nicola , Møller Simon Geir , Mullineaux Conrad W. , Robinson Colin 
Published: June 2003

SummaryThe transport and sorting of extracytoplasmic proteins in cyanobacteria is made complex by the presence of a highly differentiated membrane system. Proteins destined for the periplasm and thylakoid lumen are initially transported by Sec‐ and Tat‐type pathways but little is known of the mechanisms that ultimately direct them to the correct destinations. We have generated a Synechocystis PCC6803 transformant that expresses a fusion protein comprising the Tat‐specific targeting signal of Escherichia coli TorA linked to green fluorescent protein (GFP). Immunoblotting indicates the presence of mature‐size GFP but no precursor form, demonstrating that efficient translocation has taken place. Confocal microscopy and immunogold electron microscopy reveal GFP to be almost exclusively located in the periplasm, with almost no protein evident in the thylakoid network. These data point to the operation of highly effective sorting pathways for soluble proteins in this cyanobacterium. The observed sorting of the GFP suggests that either (a) the Tat apparatus is located only in the plasma membrane or (b) the TorA‐GFP is targeted across either membrane but the GFP is subsequently directed to the periplasm, perhaps by a default sorting pathway to this compartment.
The kinetic properties of the carboxy terminal domain of the Bacillus licheniformis 749/I BlaR penicillin‐receptor shed a new light on the derepression of β‐lactamase synthesis
Authors: Duval Valérie , Swinnen Marc , Lepage Sophie , Brans Alain , Granier Benoît , Franssen Christine , Frère Jean‐Marie , Joris Bernard 
Published: June 2003

SummaryTo study the properties of the BlaR penicillin‐receptor involved in the induction of the Bacillus licheniformisβ‐lactamase, the water‐soluble carboxy terminal domain of the protein (BlaR‐CTD) was overproduced in the periplasm of Escherichia coli JM105 and purified to protein homogeneity. Its interactions with various β‐lactam antibiotics were studied. The second‐order acylation rate constants k2/K′ ranged from 0.0017 to more than 1 µM−1s−1 and the deacylation rate constants were lower than 4 × 10−5 s−1. These values imply a rapid to very rapid formation of a stable acylated adduct. BlaR‐CTD is thus one of the most sensitive penicillin‐binding proteins presently described. In the light of these results, the kinetics of β‐lactamase induction in Bacillus licheniformis were re‐examined. When starting with a rather high cell density, a good β‐lactamase substrate such as benzylpenicillin is too sensitive to β‐lactamase‐mediated hydrolysis to allow full induction. By contrast, a poor β‐lactamase substrate (7‐aminocephalosporanic acid) can fully derepress β‐lactamase expression under conditions where interference of the antibiotic with cell growth is observed. These results suggest that acylation of the penicillin receptor is a necessary, but not sufficient, condition for full induction.
Consequences of reductive evolution for gene expression in an obligate endosymbiont
Authors: Wilcox Jennifer L. , Dunbar Helen E. , Wolfinger Russell D. , Moran Nancy A. 
Published: June 2003

SummaryThe smallest cellular genomes are found in obligate symbiotic and pathogenic bacteria living within eukaryotic hosts. In comparison with large genomes of free‐living relatives, these reduced genomes are rearranged and have lost most regulatory elements. To test whether reduced bacterial genomes incur reduced regulatory capacities, we used full‐genome microarrays to evaluate transcriptional response to environmental stress in Buchnera aphidicola, the obligate endosymbiont of aphids. The 580 genes of the B. aphidicola genome represent a subset of the 4500 genes known from the related organism, Escherichia coli. Although over 20 orthologues of E. coli heat stress (HS) genes are retained by B. aphidicola, only five were differentially expressed after near‐lethal heat stress treatments, and only modest shifts were observed. Analyses of upstream regulatory regions revealed loss or degradation of most HS (σ32) promoters. Genomic rearrangements downstream of an intact HS promoter yielded upregulation of a functionally unrelated and an inactivated gene. Reanalyses of comparable experimental array data for E. coli and Bacillus subtilis revealed that genome‐wide differential expression was significantly lower in B. aphidicola. Our demonstration of a diminished stress response validates reports of temperature sensitivity in B. aphidicola and suggests that this reduced bacterial genome exhibits transcriptional inflexibility.
The large linear plasmid pSLA2‐L of Streptomyces rochei has an unusually condensed gene organization for secondary metabolism
Authors: Mochizuki Susumu , Hiratsu Keiichiro , Suwa Masanori , Ishii Tatsuya , Sugino Fuminori , Yamada Kohei , Kinashi Haruyasu 
Published: June 2003

SummaryThe complete nucleotide sequence of the large linear plasmid pSLA2‐L in Streptomyces rochei strain 7434AN4 has been determined. pSLA2‐L was found to be 210 614 bp long with a GC content of 72.8% and carries 143 open reading frames. It is especially noteworthy that three‐quarters of the pSLA2‐L DNA is occupied by secondary metabolism‐related genes, namely two type I polyketide synthase (PKS) gene clusters for lankacidin and lankamycin, a mithramycin synthase‐like type II PKS gene cluster, a carotenoid biosynthetic gene cluster and many regulatory genes. In particular, the lankacidin PKS is unique, because it may be a mixture of modular‐ and iterative‐type PKSs and carries a fusion protein of non‐ribosomal peptide synthetase and PKS. It is also interesting that all the homologues of the afsA, arpA, adpA and strR genes in the A‐factor regulatory cascade in Streptomyces griseus were found on pSLA2‐L, and disruption of the afsA homologue caused non‐production of both lankacidin and lankamycin. These results, together with the finding of three possible replication origins at 50–63 kb from the right end, suggest that the present form of pSLA2‐L might have been generated by a series of insertions of the biosynthetic gene clusters into the left side of the original plasmid.