bluuebunny/crossref_metadata_2025_split huggingface dataset:
No difference found in survival using carbon dioxide laparoscopy, helium laparoscopy, or laparotomy in an adenocarcinoma nude mouse model
Authors: Narducci Fabrice , Lanvin Dominique , Occelli Bruno , Miannay Emmanuel , Danet Sandrine , Querleu Denis 
Published: March 2003

ObjectiveTo evaluate the impact of surgical approach on tumour growth and survival of xenografted nude mice.Materials and methods237 mice which had received 106 SKOV‐3 (human ovarian adenocarcinoma) cells subcutaneously and intraperitoneally, were anaesthetized for 60 min. The animals were randomly allocated to one of four groups: control group (n = 57), laparotomy (n = 61), CO2 laparoscopy (n = 62), or He laparoscopy (n = 57).ResultsScar tumour grafts were found in 83.6% in the laparotomy group and in 64.5% in the group which underwent CO2 laparoscopy (P = 0.02). No significant differences were observed between any of the groups in relation to subcutaneous tumour volume at day 30 (P = 0.95), the intraperitoneal tumour volume (P = 0.70), the frequency of peritoneal carcinomatosis (P = 0.55), mesocolic and submesocolic tumour location (P = 0.52) or diaphragmatic metastases (P = 0.97). Moreover, no effect was found on the period of survival of the animals (P = 0.83). The average duration of survival was 63.4 ± 18.2 days (control), 64.2 ± 13.2 (laparotomy), 65.2 ± 16.9 (CO2) and 64.9 ± 16.5 (helium).ConclusionIn the model used, CO2 laparoscopy is not associated with increased risk of tumour dissemination, scar implantation or death.
Adelaide laparoscopic hysterectomy audit (1991–1998): realistic complication rates!
Authors: O'shea Robert T. , Petrucco Oswald , Gordon Simon , Seman Elvis 
Published: March 2003

ObjectiveTo review complications of laparoscopic hysterectomy occurring in a citywide population of approximately 1 million people.DesignAll laparoscopic hysterectomy cases were analysed retrospectively independently of the surgeons involved.SettingAll private and public hospitals (n = 19) in metropolitan Adelaide, South Australia.Subjects1904 patients over the period 1991–98.InterventionsThe majority of cases involved a combined laparoscopic and vaginal approach with a proportion of total laparoscopic hysterectomies (n = 33). Surgical techniques involved both staples and diathermy.Main outcome measuresRates of major complications such as haemorrhage, haematoma formation, laparotomy and urinary tract injury.ResultsSignificant haemorrhage occurred in 3.7% (n = 70) of cases with a haematoma incidence of 3.2% (n = 60). Laparotomy rates reduced from 5% (1991–93) to 1.7% (1996–98) with an overall incidence of 3.4% (n = 64). Overall urinary tract injury rates remained constant over the survey period, i.e. 3.3% (1991–93) vs. 3.1% (1996–98). However there was a significant reduction in ureteral damage but this was countered by an increasing cystotomy rate.ConclusionsLaparotomy rates were comparable to those in published data but reduced significantly over the audit period. The incidence of haematoma formation was significantly greater than that in published data, but reduced over the period 1991–98. Urinary tract damage and haemorrhage exceeded expectations. This audit once again has suggested that the true rate of major complications with laparoscopic hysterectomy is higher than the literature suggests.
Early experience with the vaginoscopic approach to outpatient microhysteroscopy
Authors: Okeahialam Majella G. , Jones Sian E. , O'Donovan Peter 
Published: March 2003

ObjectiveTo assess the outcome of the vaginoscopic approach to outpatient microhysteroscopy using a 2.5‐mm semi‐rigid hysteroscope without using a speculum, tenaculum or analgesia.Design A prospective observational study.Setting Outpatient hysteroscopy unit of a large district general hospital.Subjects 24 women referred to the outpatient hysteroscopy unit with abnormal uterine bleeding.Results A total of 24 women had vaginoscopic outpatient microhysteroscopy. Of the procedures, 20 (83.4%) were successful using the technique and four (16.6%) failed procedures occurred. Pain was not encountered during the procedure.Conclusion Outpatient hysteroscopy with a semi‐rigid 2.5‐mm microhysteroscope using the vaginoscopic approach is a well‐tolerated and successful technique for the evaluation of abnormal genital tract bleeding.
Do not catheterize the bladder at operative laparoscopy
Authors: Miskry Tariq , Cumbis Athanasios , Apostolidis Petros , Eleftheriou Marios , Magos Adam 
Published: March 2003

ObjectiveBladder catheterization at operative laparoscopy is currently routine, although this may be associated with an increased risk of urinary tract infection and urethral trauma. We wanted to establish whether non‐catheterization is practical or whether it results in problems with operative view or postoperative urinary retention.DesignProspective study with historical controls.SettingMinimal‐access surgery unit at a tertiary referral centre.Subjects40 consecutive women undergoing operative gynaecological laparoscopy.InterventionsPatients were only catheterized intraoperatively if bladder filling interfered with surgery, or postoperatively if they failed to pass urine within 6 h. The rate of urinary infection was compared with 40 historical controls who were routinely catheterized.ResultsThere were no cases of intraoperative bladder trauma. In total, five patients (12.5%) required a urinary catheter, three intraoperatively and two postoperatively. The likelihood of catheterization was significantly associated with an operating time >100 min (P < 0.01). One woman (2.5%), who was not catheterized had positive urine microbiology findings compared with five (12.5%) in the control group (P = 0.2). Although this was not statistically significant, this was not the main aim of our study. In fact, a total of 160 patients would be required to confirm a reduction in infection by 10%.ConclusionsBladder catheterization should not be routine prior to operative laparoscopy. Not only can most procedures be completed without catheterization, but it is likely that the risk of urinary infection would be reduced and there would be cost savings to the hospital.
Adhesion prevention in the surgical treatment of pelvic endometriosis
Authors: Canis M. , Botchorishvili R. , Tamburro S. , Safi A. , Wattiez A. , Mage G. , Pouly J. L. , Bruhat M. A. 
Published: March 2003

ObjectiveTo review and to discuss the current approaches which may be proposed to prevent adhesions in the surgical management of pelvic endometriosis.MethodsThe current literature was reviewed using a Medline search and data from the Cochrane Library.Results and conclusionsAlthough not demonstrated in adequately designed prospective randomized trials, laparoscopy is considered to be less adhesiogenic than laparotomy. Adhesion re‐formation is still a major problem after laparoscopy. The use of barrier agents, such as Interceed, or solutions such as Intergel should be considered in patients treated for moderate or severe endometriosis. Although effective, these products are not substitutes for a good surgical technique. As the treatment of adhesions is difficult, every effort should be made to prevent adhesion formation. To prevent severe postoperative adhesion formation, the following rules are proposed. Laparotomy should be avoided whenever possible. When the surgical treatment appears too difficult, a preoperative medical treatment may be used to delay the treatment, to facilitate the procedure, and to avoid a laparotomy. Laparoscopic procedures should be performed according to the principles of microsurgery which have been demonstrated to reduce adhesion formation at laparotomy.
Ambulatory endoscopic treatment of symptomatic benign endometrial polyps: a feasibility study
Authors: Clark T. Justin , Godwin Jan , Khan Khalid S. , Gupta Janesh K. 
Published: March 2003

ABSTRACTObjectiveTo determine the feasibility (potential efficacy and cost‐effectiveness) of ambulatory endoscopic polypectomy in the treatment of symptomatic endometrial polyps.DesignCohort study comparing ambulatory (intervention group) with inpatient treatment (control group).Methods58 women with symptomatic intrauterine polyps were identified on outpatient hysteroscopy. The experimental group underwent outpatient endoscopic polypectomy using a bipolar intrauterine system (31/58, 53%) and the control group underwent traditional inpatient polypectomy under general anaesthesia (27/58, 47%). The main outcomes compared between the two treatment groups were: uterine bleeding symptoms; patient satisfaction; quality of life (EuroQol); time off work, and use of health service resources at 6 months.Results18/31 (58%) women treated as outpatients and 16/27 (59%) women treated as inpatients returned completed outcome questionnaires. There was no difference in the effectiveness of outpatient endoscopic polypectomy compared with inpatient treatment, in terms of improvement of abnormal uterine bleeding (11/12 (92%) vs. 13/14 (93%);P = 1.0); patient satisfaction (14/18 (78%) vs. 14/16 (88%);P = 0.7) and quality of life measured by EuroQol (median score 1.0 vs. 0.93;P = 0.1). Patients who underwent inpatient therapy did however, visit their general practitioner more frequently than those who received outpatient therapy (20 visits vs. seven visits, respectively;P = 0.005). The mean cost of outpatient treatment was 37% less than that of inpatient therapy (£490 vs. £781;P = 0.0001).ConclusionAmbulatory endoscopic therapy for symptomatic endometrial polyps appears to be efficacious and cost‐effective. The launch of a randomized controlled trial to confirm these provisional results seems feasible.
Acquired von Willebrand syndrome – report of 10 cases and review of the literature
Authors: Nitu‐Whalley  , Lee  
Published: March 2003

Acquired von Willebrand syndrome (AvWS) is a rare bleeding disorder with clinical and laboratory features closely resembling hereditary von Willebrand disease (vWD), arising in previously haemostatically normal individuals.We present a retrospective review of 10 cases with AvWS diagnosed over 17 years. The severity of the bleeding tendency varied from mild to severe forms. Multimers electrophoresis showed that 8/10 patients had a normal pattern similar to type 1 vWD, 1/10 had a type 2A vWD pattern (with absence of high and intermediate molecular weight multimers) and 1/10  had a type 3 vWD pattern. An inhibitor screen was performed in 6/10 patients and autoantibodies against von Willebrand factor were found in only two cases. The underlying cause/associated conditions were identified in 8/10 patients. Treatment of the bleeding diathesis was successfully achieved with desmopressin or clotting factor concentrates. Resolution of underlying hypothyroidism (in two cases) and multiple myeloma (in one case) led to normalization of the coagulation parameters.The report on this cohort of 10 patients with AvWS illustrates the complexity of AvWS and its multifactorial aetiology.A brief review of the recent literature on AvWS is also presented, with emphasis on the current opinions in pathogenesis and treatment.Acquired von Willebrand syndrome (AvWS) is an acquired bleeding disorder, characterized by a phenotype similar to the inherited von Willebrand disease (vWD), with a prolonged bleeding time and low plasma levels of factor VIII – von Willebrand factor (vWF) measurements. It occurs in patients with no family history of vWD, who present with recent onset of bleeding symptoms. AvWS appears to be associated mainly with lymphoproliferative disorders, immunological conditions and neoplasia.AvWS is a rare condition and it is difficult to conduct prospective studies, therefore it is important to document the experience with such cases. The aim of this paper is first, to report 10 cases of AvWS identified at our Haemophilia Centre during the past 17 years. Second, to present a brief review of the recent literature on AvWS – outlining the salient features, associated disorders, mechanisms of acquisition and the available options of treatment.
Treatment of patients with inhibitors: cost issues
Authors: Goudemand  
Published: March 2003

The management of bleeding episodes and surgery in haemophilia patients who develop inhibitors is specially difficult and also has major impact on therapeutic costs. We assessed the costs of coagulation factors in noninhibitor haemophilia A and B patients (0 Inh; n=103), patients with low responding inhibitors (LR; n=24), patients with high responding inhibitors (HR; n=17) in our centre between 1988 and 1998 during two periods: 1988–1995 and 1996–1998, before and after the introduction of recombinant factor VIIa in France (1996). From 1988 to 1995 the mean annual cost of 0 inh and LR patients was
43 234 and
49 422, respectively, with more than 90% as home treatment, whereas the mean cost of HR patients was
56 262 (1.3 time more than 0 Inh), half of this cost being related to treatment administered in hospital. From 1996 to 1998, the mean cost of HR patients was
186 482, approximately three times more than that of 0 Inh (
59 887) and LR patients (
54 226) with half of the cost due to treatment administered in hospital. So rFVIIa seems to exert a major economic effect on both the cost of home treatment and treatment administered in hospital. It must be pointed out that particularly severe bleeding episodes were effectively treated with rFVIIa during this period and that rFVIIa allowed surgery to be undertaken: including two elective orthopaedic surgeries. So there is no doubt that rFVIIa offers new perspectives in the therapeutic management of HR patients, but creates a new economic situation which needs further evaluation.image
Risk of variant Creuzfeldt–Jakob disease from factor concentrates: current perspectives
Authors: FARRUGIA A. 
Published: March 2003

The demonstration of iatrogenic transmission of Creuzfeldt–Jakob disease (CJD) through therapeutic interventions led to substantial concerns in communities requiring blood products in the 1980s and 1990s. These concerns led some regulatory authorities to adopt a very precautionary approach and require recall of plasma products, including factor concentrates, which included donors at risk of CJD. The FDA's approach on recall contributed to a substantial lack of plasma products on the world market in the mid‐ to late 1990s. Growing epidemiological evidence of non‐transmission of CJD to humans through blood, as well as demonstration of the plasma fractionation system's ability to eliminate CJD‐type agents, led the FDA to rescind its measures for product recall in 1998.Although no evidence exists that the variant strain of CJD (vCJD) will behave any differently to the classic strain (cCJD) of the disease during fractionation, indications that higher levels of the strain may be present in the blood in vCJD, as well as the uncertainty regarding the epidemiology of the disease, has led to a new round of precautionary measures aimed at minimizing vCJD risk. Currently, the traditional approach to product safety through appropriate donor selection, screening using laboratory tests and systematic pathogen elimination is not completely possible for addressing the risk of vCJD. The only definite risk factor for vCJD is residence in a country where meat products from cattle with bovine spongiform encephalopathy (BSE) have been consumed; currently this is predominantly the United Kingdom but the appearance of BSE in other European countries has stimulated non‐European regulatory authorities to defer blood donors from most of Europe. There is currently no screening test available for vCJD. Plasma fractionation techniques fortuitously appear to eliminate substantial amounts of vCJD like agents but only one pathogen eliminating technique, nanofiltration, has been proposed for specifically eliminating vCJD‐like agents.Despite the current uncertainty, it is possible to be cautiously optimistic regarding the safety of factor concentrates from the risk of vCJD. An accumulating body of evidence suggests that it is unlikely that the plasma pool from countries with moderate BSE epidemics will contain sufficient levels of vCJD agent to lead to an infective final product. Nevertheless, the development of a blood screening test and more dedicated elimination methods are high priorities for the blood industry as it faces this new threat. The community of blood product users, including people with haemophilia, need to be in a position to make an informed choice regarding the risk of this new agent. Such a choice needs to take into account the alternatives to plasma product therapy such as recombinant concentrates and the risks to product supply ensuing from an excessive reliance on one form of product.
Inhibitor development and FVIII gene mutation analysis in a pediatric cohort treated with sucrose formulated, full‐length recombinant Factor VIII
Authors: Kreuz W. , Leissinger C , Oldenburg J , Lusher J , Kelleher J , Gorina E , Kellermann E , Larson P ,   the International rFVIII‐FS Study Group
Published: March 2003

Treatment of previously untreated patients (PUPs) and minimally treated patients (MTPs) with severe hemophilia A using FVIII concentrates is complicated by FVIII inhibitor formation in ∼30% of patients. The incidence of FVIII inhibitors was determined in a prospective clinical trial of sucrose‐formulated full‐length recombinant FVIII (rFVIII‐FS, KOGENATE® Bayer; Kogenate® FS) in pediatric patients.Methods:  PUPs and MTPs (=4 exposure days‐EDs) with hemophilia A (<2% FVIII) were enrolled from 19 EU and 13 US centers. Sixty patients were evaluable for inhibitor formation (EU, 31; US, 29). Patients were tested regularly with the Nijmegen‐modified Bethesda assay (negative, ≤0.6 BU; Low Titer, >0.6‐5 BU; High Titer, >5 BU).Results:  In the EU cohort (31 Caucasian), 4 patients developed inhibitors (3 Low; 1 High). Five high titer inhibitors developed in the US cohort (17 Caucasian; 5 Black; 7 Other). Median EDs at inhibitor detection was 8 [range, 3‐16], and at study end 1 EU and 4 US patients had <20 EDs. The incidence of inhibitors in patients achieving 20 ED was 16.4% (9/55).Conclusions:  The rate of inhibitor formation in pediatric patients with severe hemophilia A treated with rFVIII‐FS is consistent with that observed with plasma‐derived and other recombinant FVIII products. Major gene disruptions were observed in all inhibitor patients.
Value of magnetic resonance imaging for the diagnosis and follow‐up of haemophilic arthropathy
Authors: Dobón M. , Lucía J. F. , Aguilar C. , Mayayo E. , Roca M. , Solano V. , Peña A. , Giralt M. , Ferrández A. 
Published: March 2003

Summary. An orthopaedic assessment of the joint status of seven severe haemophiliacs (mean age 12.5 y – range 8.9–15.5) on prophylactic treatment (PT) by magnetic resonance imaging (MRI) and physical examination was carried out. Median duration of PT of these patients was 84 months (range 32–107). A locally designed MRI joint score considering seven parameters (1 – joint effusion,2 – synovial membrane thickening, 3 – haemosiderin deposits, 4 – joint cartilage injury, 5 – subchondral bone erosion, 6 – subchondral bone cysts,7 – osteonecrosis) was used (maximum score = 13 points). MRI scans were performed in 17 joints (nine ankles, seven knees and one elbow): mean MRI scores for the affected joints was 5.1. A poor consistency between physical examination and MRI findings or the real extent of joint damage was found (Cohen kappa index 0.320). MRI is a precise non‐invasive tool for the assessment of early joint cartilage and synovium pathological changes still undetectable by physical examination or conventional X‐rays in the haemophilic setting.
Canopy phenology of some mopane and miombo woodlands in eastern Zambia
Authors: Fuller Douglas O. 
Published: March 2003

SummaryMeasurements of tree canopy closure and field‐layer reflectance were made in a series of plots in protected areas of eastern Zambia as part of a multiyear study of savanna woodlands. The plots were located in the Luangwa Valley and adjacent plateaux, which contained a range of vegetation types found in southern Africa. The vegetation consisted of four broad types: 1.plateau miombo woodland; 2.valley miombo woodland; 3.scrub miombo woodland; and 4.scrub and woodland mopane. Hemispherical photographs of the tree layer provided measurements of tree canopy phenology in the different vegetation plots. The most seasonal woodland type was mopane, where tree canopy closure ranged from about 15% at the end of the dry season to just over 60% during the peak of the rains. Plateau miombo exhibited the lowest range of seasonality in the tree layer, ranging from about 40% to 60% closure over one complete seasonal cycle. Phenology of the field layer, expressed as the normalized difference vegetation index (NDVI), closely followed that of the tree layer, although the field layer senesced earlier than trees, especially in plots with relatively low tree canopy closure. The relationship between tree‐canopy closure and field‐layer NDVI was positive and statistically significant for all sites of the study area, which suggests that woody biomass and herbaceous biomass are related positively in these savanna woodland ecosystems.
Scale, succession and complexity in island biogeography: are we asking the right questions?
Authors: Whittaker Robert J. 
Published: March 2003

Abstract

This paper offers a commentary on the development of island ecological theory since the publication of MacArthur & Wilson’s equilibrium theory in the 1960s. I distinguish the simple model at the core of their Equilibrium Theory of Island Biogeography (ETIB) and the broader body of their theory, which embraces evolutionary as well as ecological patterns — all, however, within the overarching framework or assumption of equilibrium.
The basic problems with the ETIB have long been known, and its status as a ruling paradigm has been the subject of concern for more than two decades. With the development of nonequilibrium ideas in ecology, island biogeographers arguably now have viable theoretical frameworks to set alongside or around the ETIB. Four conditions are highlighted as extremes: i) dynamic equilibrium; ii) dynamic nonequilibrium; iii) ‘static’ equilibrium; and iv) ‘static’ nonequilibrium: together providing a conceptual framework for island ecological analyses.
The importance of scale is stressed and attention is drawn to Haila’s spatial‐temporal continuum as an organizational device. It is argued that the processes represented within the ETIB (and by extension, other island theories) may be prominent within only a limited portion of this continuum, while elsewhere they are generally subsumed by other dominant processes.
Colonization and ecosystem development of near‐shore islands constitute just a special case of ecological succession, and thus the development of theories of island assembly may benefit accordingly from efforts to incorporate ideas from the ecological succession literature.
The desirability of specifying answerable questions is stressed, as is the need to build a greater degree of complexity into the development of island ecological models. Notwithstanding which, it is also recognized that key advances are often brought about by simple, but bold models, of the form exemplified elsewhere in this issue.