bluuebunny/crossref_metadata_2025_split huggingface dataset:
Who should have outpatient hysteroscopy?
Authors: Cutner A. , Erian J. 
Published: November 2003

Objective To determine criteria by which patients may be selected as suitable for outpatient hysteroscopy. Design Patients undergoing outpatient hysteroscopy filled in visual analogue scales to assess their pain/discomfort during different parts of the procedure. Setting Outpatient hysteroscopy clinic in a district general hospital.
Subjects All women referred for outpatient hysteroscopy. Main outcome measure Degree of discomfort/pain as determined from visual analogue scores. Results Age had no effect on acceptability of the procedure. A previous vaginal delivery had an effect on pain/discomfort at insertion of the hysteroscope. Carbon dioxide was less painful than saline, and anxiety before the procedure only had a very small effect. However pain/discomfort at insertion of the speculum had the greatest predictive value with regards to discomfort both during and after the procedure. Conclusions In our study we have demonstrated that those women who found the speculum insertion particularly uncomfortable were more likely to find all parts of the procedure painful. It is this group of women who should be considered for investigation under general anaesthetic. They can be identified at the referral stage removing unnecessary distress for the patient and possible wasted investigation time for the operator.
Does the use of pneumoperitoneum and disposable trocars prevent bowel injury at laparoscopy? A randomized experimental study in the rabbit
Authors: Lanvin D. , Elhage A. , Querleu D. 
Published: November 2003

Objectives The purpose of this experimental study was twofold. The first aim was to compare the incidence of bowel injury after prior insufflation using the Veress needle versus direct trocar insertion, and the second aim was to compare bowel injury with the use of disposable versus reusable trocars, in animals with or without prior abdominal surgery.
Design A total of 80 mature New Zealand rabbits (2400–3000 g) were randomly assigned to one of two experimental groups, with (n=40) or without (n=40) prior standardized peritoneal trauma. In each group, four subgroups (n=10 each) were constituted by randomly assigning the animals to initial insufflation using the Veress needle or direct trocar insertion and/or to reusable or disposable trocar insertion. Each animal underwent five trocar insertions. The number of bowel injuries was assessed by laparotomy.
Results As expected, the presence of experimentally induced abdominal wall adhesions significantly increased (P=0.0001) the incidence of bowel injury. When abdominal wall adhesions were present, the number of perforations was lower if initial insufflation had been performed compared with those in whom direct trocar insertion was carried out (P=0.03). There was no statistical difference in the rate of injury between disposable and reusable trocars when abdominal wall adhesions were present. However, in those without abdominal wall adhesions, the use of disposable trocars significantly decreased (P=0.04) the risk of bowel injury.
Conclusions The presence of abdominal wall adhesions increased the rate of bowel injury at laparoscopy. In the cases with prior abdominal surgery and abdominal wall adhesions, initial insufflation was safer than direct trocar insertion, but the use of disposable trocars did not improve the safety of the procedure. In the absence of prior abdominal surgery, initial insufflation using the Veress needle did not prevent bowel injury; however, in this group the use of disposable trocars proved safer than the use of reusable trocars.
A new laparoscopic approach for enterocoele repair
Authors: Lam A. , Rosen D. 
Published: November 2003

ObjectiveA thorough understanding of the anatomy of the defective rectovaginal septum and vaginal supports is necessary for adequate corrective surgery. We describe a new technique for laparoscopic enterocoele repair.MethodBetween February 1995 and April 1996, 40 consecutive patients underwent laparoscopic dissection and enterocoele repair. Surgery was succesfully completed in all cases.ResultsAverage time of surgery was 35 min (range 15–60) and the average length of inpatient stay was 2.2 days (1–7). One complication (bladder perforation) was repaired laparoscopically, and all patients were able to return to normal activities within 1–2 weeks.ConclusionThis paper provides details of a promising new technique for laparoscopic repair of enterocoele, which has been shown to be effective in this first cohort of patients. Larger numbers and longer follow‐up will be required to fully establish the place of this technique.
Flexible hysteroscopy: an outpatient evaluation in abnormal uterine bleeding
Authors: Coats P. M. , Haines P. , Kent A. S. H. 
Published: November 2003

ObjectiveTo investigate the value of including flexible hysteroscopy as an investigative procedure as part of a one‐stop outpatient clinic for the investigation of abnormal uterine bleeding.DesignA prospective study comparing the information obtained at outpatient hysteroscopy with that detected by gynaecological examination and undirected endometrial biopsy. Transvaginal ultrasound was used as an adjunct to these investigations and no formal comparison was made per se between this and hysteroscopy.SettingThe Abnormal Uterine Bleeding (AUB) Clinic, The Royal Surrey County Hospital, Guildford 1991–1996.SubjectsThese were 1022 women (age range 18–86 years) referred by their general practitioners because of abnormal uterine bleeding. No other referral criteria, such as age, were enforced.Main outcome measuresIncidence of benign and malignant gynaecological pathology.ResultsThe true failure rate where hysteroscopy was indicated and attempted was 2.7%. No significant pathology was identified in any patient under the age of 25 years. The incidence of confirmed malignancy was 6.84 per 1000. The percentage of the total pathology identified by hysteroscopy alone, in the age group 35–39 years, was 37 out of 65 abnormalities (56.9%). This was significantly greater than in the age group 25–34 years (P = 0.017), where 16 out of 47 abnormalities (34.0%) were identified. There was no significant difference between the 35–39 and the 40–89‐years age group (P = 0.078) in which hysteroscopy identified 224 out of 494 abnormalities (45.3%).ConclusionFlexible hysteroscopy applied on an outpatient basis is a simple and safe investigation, acceptable to patients, which greatly enhances the detection and characterization of intrauterine pathology allowing appropriately directed treatment options. In our series the incidence of intrauterine adhesions was 1.5%, endometrial polyps 13.7%, and submucous fibroids 14.6%. We would recommend that: hysteroscopy should not be performed on women under 25 years of age; outpatient hysteroscopy should be offered as a first‐line investigation to all women over the age of 35 years presenting with abnormal uterine bleeding.
Surgical trauma and metabolic changes induced by surgical laparoscopy versus laparotomy
Authors: Volz J. , Ko¨ster S. , Leweling H. 
Published: November 2003

Objective The aim of the research was to compare local and systemic reactions of the body to laparotomy and laparoscopy.
Design In a prospective randomized study the operative trauma and metabolic changes in 40 patients were investigated and compared in laparoscopy and laparotomy.
Main outcome measures Metabolic changes were registered by indirect calorimetry. In order to quantify intraperitoneal trauma, short‐term and medium‐term pH measurements of the peritoneal surface were made.
Results In the case of laparoscopy a severe intraoperative chemical acidosis occurred that disappeared a short time after operation. As a result, a short‐term increase of metabolic rate was observed. Following laparotomy an increase in metabolic acidosis was registered during the first postoperative hours and had not returned to normal after 24 h. A prolonged catabolism lasted over 48 h.
Conclusion In patients undergoing laparotomy the intraperitoneal trauma is more marked than in laparoscopy. Long‐term metabolic intra‐abdominal acidosis with resulting catabolism may cause increased impairment of the organism.
The use of glycine‐ethanol irrigating fluid for the early detection of fluid absorption during endometrial resection
Authors: Hall J. M. , Tingey W. R. , Gillmer M. D. G. 
Published: November 2003

Objective To evaluate the use of 1.5% glycine with 1% ethanol as a marker to detect fluid absorption during endometrial resection.
Design Prospective study.
Setting Department of Obstetrics and Gynaecology, Wycombe General Hospital, High Wycombe, UK.
Subjects 60 women having an endometrial resection for menorrhagia under general anaesthesia.
Intervention 1.5% glycine and 1% ethanol solution for irrigation.
Main outcome measures Breath ethanol concentration preoperatively, at 5‐min intervals during endometrial resection and 30 and 60 min postoperatively as measured by a hand‐held breath alcohol meter. Blood ethanol concentration, urea and electrolytes and serum ammonia were analysed at the start and the end of the procedure, and at 30 and 60 min postoperatively.
Results There was a strong positive correlation (rs=0.93, P<0.000001) between the breath ethanol concentration at the end of the procedure and the total fluid absorbed. Breath ethanol measurements were able to detect absorption of 130 ml or more. Blood ethanol measurements showed the breath ethanol measurements to be reliable. There were no adverse effects attributable to the alcohol. The fall in serum sodium from the start of the operation to the end was the most useful biochemical marker of fluid absorption (rs=0.86, P<0.000001). The rise in serum ammonia from the start of the endometrial resection to the end correlated relatively poorly with fluid absorption (rs=0.44, P=0.00058) and there was no correlation between the ammonia level at the end of the procedure and fluid absorption (rs=0.06, P=0.64).
Conclusions 1.5% glycine with 1% ethanol solution provides a safe, effective and noninvasive screening test for the detection of fluid absorption during endometrial resection.
Vaginal misoprostol for cervical dilatation before operative office hysteroscopy
Authors: Atay V. , Duru N. K. , Pabuc¸cu R. , Ergu¨n A. , Tokac¸ G. , Aydin B. A. 
Published: November 2003

Objective To assess the efficacy of misoprostol as an adjunct for easy cervical dilatation before operative office hysteroscopy under local anaesthesia.
Design Randomized, placebo‐controlled clinical trial.
Setting Tertiary centre for treatment of infertility.
Subjects Patients undergoing hysteroscopy, for simultaneous diagnostic and operative indications such as uterine septae, synechiae, submucous myomas, endometrial polyps and lost intrauterine devices, were included into the study
Intervention 43 cases were randomized to misoprostol (n=22) and placebo (n=21) groups. The drug was administered vaginally 4 h before hysteroscopy. Hysteroscopy was performed under local anaesthesia in an examination room as an office procedure.
Main outcome measures Rapid and easy dilatation, decreased pain, decreased incidence of cervical haemorrhage, laceration and uterine perforation.
Results In the misoprostol group, a 7‐mm hysteroscopic sheath passed easily without dilatation in 20 (91%) cases while it passed easily without dilatation in six (28%) of the placebo group (P<0.001). The average dilatation time for groups was 1.6 and 2.8 minutes respectively (P<0.05). Mean dilatation pain scores for the misoprostol and placebo groups were 5.1 and 9.3, respectively (P<0.05). Cervical bleeding was noted in two cases in the misoprostol group and laceration of the cervix was noted in three cases. In the placebo group there were eight cases each of both bleeding and laceration.
Conclusion Application of misoprostol does provide a safe, painless and effective means of cervical dilatation by chemical, rather than mechanical forces, and reduces complications such as cervical bleeding, laceration and uterine perforation.
Intestinal metaplasia subtyping: evaluation of Gomori's aldehyde fuchsin for routine diagnostic use
Authors: SHAH K.A. , DEACON A.J. , DUNSCOMBE P. , PRICE A.B. 
Published: November 2003

Aims:Intestinal metaplasia (IM) has been implicated in the pathogenesis of gastro‐oesophageal carcinoma, but because of its common occurrence, its specificity for use in cancer surveillance is low. IM subtypes characterized by mucin phenotype have been studied to try and improve specificity.Methods and results:On balance, type III IM seems the most promising for use in gastric cancer surveillance. The situation is problematic at the gastro‐oesophageal junction where the normal occurrence of acidic mucins raises doubt on the value of subtyping. High iron diamine–Alcian blue combination (HID‐AB) is commonly used for IM subtyping, but its potential toxicity and long staining period (up to 24 hours) precludes widespread clinical use. This study has compared the sulphomucin staining ability of Gomori's aldehyde fuchsin–Alcian blue combination (GAF‐AB) against HID‐AB for identifying and subtyping IM in gastric and oesophageal biopsies.Conclusions:Compared to HID‐AB, a sensitivity of 85%, a specificity of 100% and a staining time of less than 30 minutes, shows this stain to be a simple and effective technique for identifying and subtyping IM in routine laboratories.
Expression of stratified epithelial‐type cytokeratins in hyalinizing trabecular adenomas supports their relationship with papillary carcinomas of the thyroid
Authors: FONSECA E. , NESLAND J.M. , SOBRINHO‐SIMÕES M. 
Published: November 2003

Aim:To evaluate the cytokeratin pattern of expression of hyalinizing trabecular adenomas and to verify whether or not these tumours, that share morphological features with papillary carcinomas, present the stratified epithelial‐type cytokeratins commonly found in ordinary papillary carcinomas.Methods and results:This study consisted of the immunohistochemical detection of simple and stratified epithelial type cytokeratin filaments in a series of six hyalinizing trabecular adenomas, three papillary carcinomas with a trabecular growth pattern and two carcinomas combining hyalinizing trabecular and papillary patterns. Simple epithelial‐type cytokeratins 7, 8, 18 and 19 were found in every case. Expression of the stratified epithelial‐type cytokeratins 1, 5/6 and/or 13 was detected in four hyalinizing trabecular adenomas.Conclusion:Based on this, as well as on the cytological features and on the frequent co‐occurrence of hyalinizing trabecular adenoma and papillary carcinoma, we suggest that the former lesion may be considered a peculiar encapsulated variant of papillary carcinoma.
Pancreatic tissue in a lateral cervical cyst attached to the thyroid gland—a presumed foregut remnant
Authors: LANGLOIS N.E.I. , KRUKOWSKI Z.H. , MILLER I.D. 
Published: November 2003

Aim:To report the previously undescribed occurrence of a lateral neck cyst, attached to the thyroid gland, containing pancreatic tissue.Methods and results:A 41‐year‐old man presented with a recurrent cystic lesion of the thyroid. At thyroidectomy cystic masses containing mucinous material were present in the neck, and there was a nodular lesion attached to the lower pole of the thyroid. Histological examination of the latter lesion revealed an epithelial lined cyst, with pancreatic tissue (exocrine and endocrine) in addition to fat, fibrous tissue, muscle and cartilage in the wall.Conclusions:The possible origin of this structure is discussed, with the conclusion being that it most likely represents a foregut remnant.
Rhabdomyomatosis of the newborn lung unassociated with other malformations
Authors: HARDISSON D. , GARCÍA‐JIMÉNEZ J.A. , JIMÉNEZ‐HEFFERNAN J.A. , NISTAL M. 
Published: November 2003

Aims:To describe a case of rhabdomyomatosis of the lung unassociated with other external or visceral malformations in a newborn infant.Methods and results:A 26 weeks' gestation newborn male with no relevant medical or family history presented a well‐circumscribed solid area in the posterior mediastinum occupying the upper lobe of the right lung. The possibility of neuroblastoma or an extralobar pulmonary sequestration were excluded after laboratory and arteriographic studies. No visceral anomalies were found. At the age of 9 months the patient underwent a partial lobectomy, and he is free of disease 39 months after surgery. Histological examination demonstrated the presence of numerous bundles of striated fibres arranged haphazardly in the pulmonary interstitium in a background of a type‐II congenital cystic adenomatoid malformation‐like morphology of the resected lung.Conclusion:The presence of striated muscle fibres in the lung not necessarily represents a lethal congenital malformation. As this case shows, rhabdomyomatosis of the lung can affect a single pulmonary lobe, and resection of the affected lung parenchyma may be curative. It is important for pathologists to be aware of this entity, although it is exceptional, and to include it in the differential diagnosis of pulmonary masses in the newborn lung.
Down‐regulation of CD95 (Fas/Apo‐1) in the epithelia of adenovirus‐infected appendices
Authors: LAROUSSERIE F. , BERREBI D. , FLORENTIN A. , DE LAGAUSIE P. , AIGRAIN Y. , PEUCHMAUR M. 
Published: November 2003

Aims:Adenoviral inclusions are commonly seen in appendices from infants with intussusception. They are associated with focal epithelial budding and less frequently with epithelial shedding. These morphological changes could depend on the opposing effects of adenoviral gene products on CD95‐mediated apoptosis.Methods and results:Appendices from intussusceptions with viral inclusions (n = 4) and normal appendices (n = 10) were studied by immunochemistry with anti‐adenovirus, anti‐CD95 and anti‐HLA‐DR antibodies. Apoptosis was studied by the TUNEL method. The mucosa of normal appendices contained no adenoviral protein. CD95 was present in all epithelial cells except Paneth cells. HLA‐DR was absent in epithelial cells and apoptosis was seen only in germinal centres and in a few surface epithelial cells. The epithelium of appendices from intussusceptions contained nuclear inclusions labelled with anti‐adenovirus antibody, always found in the epithelial buds. The epithelial CD95 pattern was drastically altered in adenovirus‐infected appendices. CD95 was absent from the budding foci. In these foci, HLA‐DR was overexpressed. There was also increased epithelial apoptosis in areas remote from those lacking CD95 antigen.Conclusions:The appearance of epithelial budding or shedding in appendices from intussusception could be due to focal in situ differences in the expression of adenoviral genes.
T‐cell intravascular lymphomatosis (angiotropic large cell lymphoma): association with Epstein–Barr viral infection
Authors: AU W.Y. , SHEK W.H. , NICHOLLS J. , TSE K.M. , TODD D. , KWONG Y.L. 
Published: November 2003

Aims:Intravascular lymphomatosis (IVL) is a very rare non‐Hodgkin's lymphoma characterized by proliferation of lymphoma cells in the vascular lumina without involvement of adjacent parenchymal tissue. IVL is predominantly of B‐cell lineage, but occasional cases of T lineage IVL involving almost exclusively the skin have been described. A case of IVL that occurred initially in the epididymis of a patient with an antecedent nasopharyngeal carcinoma was studied to define the clinicopathological features associated with this unique presentation.Methods and results:This lymphoma was studied by standard histological and immunophenotyping methods. The results showed lymphoma cells confined within the blood vessels, which expressed leucocyte common antigen, and T‐cell markers CD3 and UCHL‐1. The T‐cell origin of the IVL prompted investigations for an assciation with Epstein–Barr virus infection (EBV). In‐situ hybridization with digoxigenin‐labelled anti‐sense RNA probes to EBV encoded RNA (EBER) showed strong signals in the nuclei of virtually all of the lymphoma cells.Conclusions:EBV infection of the malignant cells was demonstrated by in‐situ hybridization. This case suggests that T‐cell IVL may be another EBV related human neoplasm. This observation will need to be validated by further studies.
Mammary epidermoid inclusion cysts after wide‐core needle biopsies
Authors: DAVIES J.D. , NONNI A. , D'COSTA H.F. 
Published: November 2003

Aims:To investigate the prevalence of squamous epidermoid inclusion cysts after wide‐core needle biopsy.Methods and results:Epidermoid inclusion cysts were found in five of 17 surgical excisions (29%) after preliminary wide‐core needle biopsies in a 7‐month period. Thereafter they were not seen in 26 subsequent postwide‐core surgical excisions in a period of 6 months.Conclusions:The cysts appear to be an iatrogenic complication of wide‐core biopsy, and need morphological recognition in order to avoid confusion with spontaneous squamous metaplasia of benign or malignant breast epithelium. Longer term implications are unknown.
Intravascular lymphomatosis: a case presenting with encephalomyelitis and reactive haemophagocytic syndrome diagnosed by renal biopsy
Authors: CHENG F.Y. , TSUI W.M.S. , YEUNG W.T.C. , IP L.S. , NG C.S. 
Published: November 2003

Aims:To report an unusual instance of intravascular lymphomatosis presented with encephalomyelitis and reactive haemophagocytic syndrome. There was no skin involvement. The diagnosis was made on a renal biopsy. Methods and results: The marrow smear was air dried and stained with Diff‐Quik. The tissue sections were stained with haematoxylin and eosin, Masson trichrome, periodic acid–Schiff's reagent, Elastic van Gieson's stain, modified hexamine‐silver technique and Martius scarlet blue. Immunohistochemistry for CD45, CD20, CD45RO, Factor VIII related antigen, CD31 and CD34 was performed on paraffin‐processed tissue. The marrow smear showed active haemophagocytosis in the histiocytes. The renal biopsy showed intravascular lymphomatosis with tumour cells positive for CD45 and CD20. Conclusion: The possibility of intravascular lymphomatosis should be considered in patients with reactive haemophagocytic syndrome where the underlying cause cannot be found after thorough investigation.
Intravascular lymphomatosis: a clinicopathological study of two cases presenting as an interstitial lung disease
Authors: KO Y.H. , HAN J.H. , GO J.H. , KIM D.S. , KWON O.J. , YANG W.I. , SHIN D.H. , REE H.J. 
Published: November 2003

Aims:Intravascular lymphomatosis is an uncommon type of non‐Hodgkin's lymphoma characterized by intravascular proliferation of neoplastic lymphoid cells. Although the tumour is basically a systemic disease, eventually involving multiple organs, primary presentation in the lung is rare.Methods and results:We describe the clinicopathological features of two patients with intravascular lymphomatosis presenting in the lung. One patient complained of fever, headache and chest pain; the other, of dyspnoea on exertion and headache. Both patients showed reticulonodular density on chest radiography and decreased diffusion capacity. Lung biopsy showed features characteristic of intravascular lymphomatosis. Malignant lymphoid cells were CD30 positive T‐cells of anaplastic large cell type in one patient and B‐cells of large cell type in the other. There was a poor response to chemotherapy and both patients died of the disease within 3 months of diagnosis.Conclusions:These cases and 10 previous reports illustrate the need to include intravascular lymphomatosis in the differential diagnosis of interstitial lung disease.