bluuebunny/crossref_metadata_2025_split huggingface dataset:
The reclamation of bracken‐dominated pastures in Bulgaria using asulam and fertilizers
Authors: Petrov P. , Marrs R. H. 
Published: March 2003

Bracken (Pteridium aquilinum) is a major weed of considerable economic concern in upland pastures in Bulgaria and elsewhere in Europe. Between 1993 and 1998, a field experiment was carried out to test methods for restoring productive meadows. Initially, spraying asulam (4·8 kg a.i. ha−1) was used to control the bracken on the site; this was achieved in terms of reduced frond densities and a higher level of grassland establishment. This grassland was dominated by Vicia cassubica and the perennial grasses Agrostis vulgaris, Dactylis glomerata, Festuca rubra, Holcus lanatus and Poa pratensis.After 2 years, a fertilizer addition experiment was started with four treatments (no fertilizer; addition of phosphorus; addition of nitrogen and phosphorus; addition of nitrogen, phosphorus and potassium. The phosphorus and potassium fertilizers were applied annually in the early spring at 80 kg of P ha−1 year−1 and 50 kg of K ha−1 year−1, and nitrogen was added at the start of grass growth at 60 kg of N ha−1 year−1. At the same time, a twice‐yearly hay‐cutting regime was implemented. Fertilizer addition increased both the quantity and the quality of the resulting grassland. The herbage dry matter was increased by at least a factor of two depending on fertilizer combination, and there was an increase in grass and legume cover and a decrease in both weed cover and bracken recovery. However, although bracken recovery was inversely related to grassland production, there was a consistent increase in bracken density across all treatments between 1997 and 1998, suggesting that increasing herbage biomass merely delays bracken recovery. The implications of these findings are discussed.
Comparison between medical treatment by GnRH analogue (goserelin) and conservative surgery by laparoscopic diathermy for the management of endometriosis
Authors: Hefni Mohamed A. , Apoola Ade , Omran  
Published: March 2003

ObjectiveTo compare the effectiveness of medical treatment of endometriosis with conservative surgical treatment, either alone or combined with medical treatment.DesignCase‐controlled, prospective observational clinical study.SettingGynaecology Department at Benenden Hospital, Kent, UK.Patients98 women proven laparoscopically to have endometriosis which was staged using the Revised American Fertility Society Classification (rAFS).InterventionsThe first group underwent medical treatment with the GnRH analogue, goserelin (3.6 mg depot) and the second group was treated using laparoscopic diathermy. Some members of the second group who had endometriomas and stage IV endometriosis (AFS classification) also had GnRH analogue in addition to laparoscopic diathermy. There was no statistically significant difference between the age, parity and severity of symptoms of the groups.Main outcome measuresVariations in patient‐reported symptoms, physician‐recorded clinical examination and in second‐look laparoscopic findings, in each group, 6 months after treatment completion.ResultsTreatment with laparoscopic diathermy, either alone or in combination with GnRH analogue, was associated with a significantly better outcome, as assessed by a self‐report of marked improvement in symptom score or cure, compared with treatment with GnRH analogue alone (relative risk 2.36, 95% confidence interval (CI) 1.38–4.02). The surgical treatment group were also 2.52 times more likely to show either marked improvement or cure, as judged by clinical assessment, than the group of patients who received GnRH analogue alone (relative risk 2.52, 95% CI 1.54–4.14). There was an improvement or cure in 71% of patients in the surgical group, when assessed laparoscopically at follow up, compared with 49% in the medical group.ConclusionThe results showed that patients with endometriosis receiving conservative surgery, either alone or in combination with GnRH analogue, were at least two times more likely to have either marked improvement or cure, as assessed by patient‐reported symptoms and clinical findings at 6‐month follow up, than those who received GnRH analogue alone.
A prospective randomized double‐blind placebo‐controlled study of local anaesthetic injected through the hysteroscope for outpatient hysteroscopy and endometrial biopsy
Authors: Costello Michael F. , Horrowitz Stephen D. , Williamson Margaret 
Published: March 2003

ObjectiveTo determine whether the injection of local anaesthetic through the hysteroscope at outpatient hysteroscopy, with or without endometrial biopsy, will reduce abdominal pain and increase patient acceptability of the two procedures.DesignProspective randomized double‐blind placebo‐controlled study.SettingOutpatient hysteroscopy clinic, Royal Hospital for Women, Sydney, Australia.Subjects100 women undergoing outpatient hysteroscopy with or without endometrial biopsy.InterventionsRandomization into two groups: local anaesthetic (group 1) and placebo (group 2). Upon introduction of the hysteroscope into the cervical os, 5 ml of 2% plain lignocaine (group 1) or normal saline (group 2) was introduced via the channel in the hysteroscope. After 2 min, the hysteroscopy and endometrial biopsy (where indicated) were conducted in the usual manner.Main outcome measuresThe degree of pain experienced and the acceptability of the procedures were assessed using visual analogue scales.Results99 women underwent hysteroscopy (49 in group 1 and 50 in group 2) with 92 also undergoing endometrial biopsy (45 in group 1 and 47 in group 2) Both groups were homogeneous for age, parity, menopausal status and subjective pain tolerance assessment. Group 1 found both the hysteroscopy and endometrial biopsy to be less painful and more acceptable, but these differences were not statistically significant. Four subgroups were analysed: nulliparous (group A), no past vaginal delivery (group B), postmenopausal (group C), and no previous dilatation and curettage (group D). Local anaesthetic reduced the pain at hysteroscopy in groups A, B and C and at endometrial biopsy in all groups, with groups B, C, and D at endometrial biopsy reaching statistical significance (P = 0.05, 0.03, and 0.04, respectively).ConclusionsTopical intra‐uterine anaesthetic injected through the hysteroscope results in: (1) a trend towards a reduction in pain for both hysteroscopy and endometrial biopsy, and (2) a significant reduction in pain during endometrial biopsy in women who have not had a previous vaginal delivery, or dilatation and curettage, or are postmenopausal.
Laparoscopic Burch colposuspension: a minimum of 2 years' follow up and comparison with open colposuspension
Authors: Lavin Jacqueline M. , Lewis Christopher J. , Foote Andrew J. , Hosker Gordon L. , Smith Anthony R. B. 
Published: March 2003

ObjectiveTo determine whether laparoscopic colposuspension could achieve similar success rates to open colposuspension, with objective follow up at 6 months and subjective review a minimum of 2 years following surgery, and to compare the postoperative morbidity associated with the two types of procedure.DesignRetrospective review of the first 139 women to undergo laparoscopic colposuspension at St Mary's Hospital and of 52 women who had most recently undergone open colposuspension in the same hospital, for whom there was a 6‐month objective follow up.SettingSt Mary's Hospital, Manchester, UK.ResultsThere was no difference between the two groups in the incidence of intraoperative complications. Postoperative morbidity was reduced in the laparoscopic group, as were analgesic requirements, length of catheterization and postoperative stay. At 6 months, cure and improvement rates were similar between the two groups (71 and 91% with laparoscopic colposuspension vs. 67 and 89% with open colposuspension). At follow up at a minimum of 2 years, both groups had shown a decline in efficacy, but again with no significant difference between the two groups (cure rate 57.8% for the laparoscopic procedure vs. 50.0% for the open one; improvement 77.1% for the laparoscopic vs. 58.7% for the open procedure. Women who had undergone laparoscopic colposuspension returned to normal activities significantly faster and were more likely to be satisfied with the results of surgery than women who had undergone open colposuspension.ConclusionAt follow up of a minimum of 2 years, laparoscopic colposuspension appeared to have been as effective as open colposuspension in curing stress incontinence. Laparoscopic colposuspension was also associated with reduced postoperative morbidity, shorter hospitalization and earlier return to normal function.
Total laparoscopic hysterectomy with suture technique
Authors: Ho Kim Dong , Suk Chi Jeong 
Published: March 2003

ObjectiveTo evaluate the efficacy of total laparoscopic hysterectomy (TLH) with suture technique.DesignReview of hospital records of 108 women who underwent total laparoscopic hysterectomy between January 1 1994 and December 31 1996.SettingDepartment of obstetrics and gynaecology at a university teaching hospital.Subjects108 women who underwent total laparoscopic hysterectomy.InterventionsAll the hysterectomy procedures were performed in the classic manner, with scissors, grasping forceps, bipolar coagulation and suture technique as in total abdominal hysterectomy (TAH).Main outcome measures and resultsIndications, patient characteristics, associated procedures, surgical outcomes, and complications were analysed. The mean age of the patients was 44.7 ± 5.0 years. The most common surgical indication was squamous intraepithelial lesion of the cervix, including carcinoma in situ and dysplasia. The mean operating time was 173.4 ± 80.4 min, and blood loss (189 ± 105 ml) was lower than that of conventional abdominal hysterectomy. Mean uterine weight was 87.3 ± 24.3 g. None of the procedures was converted to laparotomy. There were no intraoperative complications, and a few postoperative complications were noted, specifically three out of 108 cases, comprising 2.8%. The complications included two vaginal vault infections and a febrile condition.ConclusionsOur findings suggest that total laparoscopic hysterectomy with a suture technique is feasible, cost‐effective, safer than, and a good alternative to, abdominal and vaginal hysterectomy.
Histopathology and steroid receptors in endometrial polyps of postmenopausal patients under hormone‐replacement therapy
Authors: Maia Hugo , Maltez Amelia , Calmon Luis C. , Oliveira Maita , Marques Dilson , Coutinho Elsimar M. 
Published: March 2003

ObjectiveTo study the histopathology of endometrial polyps that had developed during 6–18 months of hormone‐replacement therapy (HRT), and to determine the status of oestrogen and progesterone receptors in these lesions.DesignRetrospective study.SubjectsFifty‐five menopausal patients receiving HRT who had endometrial polyps.InterventionsPolypectomy followed by endometrial resection.ResultsEndometrial polyps have foci of hyperplasia that do not respond to progestin in menopausal patients receiving HRT. This is associated with lack of progesterone receptors in both stroma and glands. On the other hand, oestrogen receptors are expressed in endometrial polyps.ConclusionsEndometrial polyps in menopausal patients receiving HRT respond only to oestrogens but not to progestins. The unopposed oestrogenic action on polyps may favour the development of premalignant hyperplasia and carcinoma.
Management of cystic ovarian masses by laparoscopic surgery: results of 275 cases
Authors: Rasmussen Carsten , Englund Katarina , Lindblom Bo 
Published: March 2003

ObjectiveTo assess the results of operative laparoscopy in terms of operation time, postoperative care, histological diagnosis and complications.DesignRetrospective evaluation of women who had undergone laparoscopic management of cystic ovarian masses.SettingTwo Swedish university hospitals.Subjects275 women with clinically and sonographically benign cystic ovarian masses.InterventionsOperative laparoscopy under general anaesthesia was carried out in all the women. Bipolar coagulation, suture loops, suction/irrigation and various cutting instruments were used.Main outcome measures and ResultsNo major intraoperative complications occurred in this series. Minor complications included injury of the inferior epigastric artery, postoperative nausea, shoulder pain and temporary urine retention. Three patients underwent a second surgical procedure because of postoperative intra‐abdominal bleeding. The adnexal cystic masses varied in size from 2 to 12 cm (mean 5.5 cm). The mean total operation time was 54 min (range 15–200 min). The postoperative stay at the clinic ranged from 6 to 144 h (mean 23 h). Histopathological examination showed malignancy in 1.8% of the cases.ConclusionsIn this setting operative laparoscopy appears to be a safe and effective method for treating clinically and ultrasonographically benign ovarian cysts. Day surgery is possible in the majority of cases.
Endometrial cancer and fibroids: should they be managed laparoscopically?
Authors: Kadar Nicholas 
Published: March 2003

ObjectiveTo describe techniques of morcellation without entry into the uterine cavity and discuss their use in the management of selected patients with endometrial cancer and fibroids.MethodCase series.ResultsEight patients with endometrial cancer arising in a fibroid uterus underwent laparoscopic hysterectomy, and in three cases morcellation was required. The mean uterine weight was 608 g (median 500 g). Four women had pelvic and one had pelvic plus aortic lymphadenectomy in addition to the hysterectomy. One woman had pelvic and another pelvic plus aortic lymph node metastases. The mean age, weight, and body mass index of the patients were 54.8 years, 214 lbs and 36.5, respectively. One nullliparous patient weighed 329 lbs, and another weighed 289 lbs. The mean anaesthetic time was 3.75 h, the mean estimated blood loss 770 ml, and the mean drop in haemoglobin 3.2 g/dl. The mean hospital stay was 2 days, and there were no complications although one patient was transfused.ConclusionsEndometrial cancers arising in a fibroid uterus can be treated laparoscopically in selected cases.
Laparoscopic vs. abdominal vs. vaginal hysterectomy
Authors: Mehra Sheila , Bhat Veena , Mehra Gautam 
Published: March 2003

ObjectivesTo compare vaginal, total abdominal and laparoscopically assisted vaginal hysterectomy (VH, TAH and LAVH) in terms of morbidity, operating time, blood loss, cost, hospital stay and recovery, and to compare the number of hysterectomies performed using each approach over a period of 3 years.DesignRetrospective and prospective study.SettingMoolchand K.R. Hospital (Gynaecological Endoscopic Center), New Delhi, India.SubjectsA total of 663 patients underwent hysterectomies for different indications.InterventionsPatients were assigned to either TAH (n = 312), LAVH (n = 174) or VH (n = 177), with or without salpingo‐oöphorectomy.Main outcome measuresThese included estimated blood loss, operating time, complications, hospital stay, time to return to normal work, and cost.ResultsThe estimated blood loss was significantly different with that for TAH being greater than that for LAVH or VH. The operating time for LAVH was longer than that for TAH which in turn was longer than that for VH. Complication rates (major and minor) were 31.34, 13.72 and 12.36% in TAH, LAVH and VH, respectively. The length of hospital stay was found to be least with LAVH and greatest for TAH (P = 0.001). The total costs for all three types of hysterectomy were not significantly different (P > 0.05). Women in the LAVH and VH groups recovered sooner (16.4 ± 3.4 and 18 ± 4.2 days, respectively) than those in the TAH group (30.8 ± 7.2 days; P = 0.001).ConclusionsVH is by far the most acceptable procedure in terms of lower complication rates, cost and recovery. LAVH has similar advantages, but is not a substitute for VH. However, it is strongly indicated where VH is not possible. TAH is associated with the highest patient morbidity and the longest convalescence period. Costs are similar in all three procedures.
Combined laparoscopic gynaecological and surgical procedures
Authors: Homa Tomasz , Bobrzyński Andrzej 
Published: March 2003

ObjectiveEvaluation of indications for and effectiveness of combined laparoscopic surgical and gynaecological operative procedures.DesignProspective study conducted over a 4‐year period.Patients25 patients with two coexisting diseases who underwent a single‐stage operative treatment.SettingUniversity hospital.InterventionsCombined gynaecological and surgical laparoscopic procedures performed under general anaesthesia.ResultsThe following operative procedures were performed in 25 patients: 23 cholecystectomies, 2 appendectomies, 19 cystectomies in patients with ovarian cysts, 8 myomectomies and 1 subtotal hysterectomy with adnexectomy. One patient underwent a triple procedure consisting of cholecystectomy, ovarian cyst enucleation and inguinal hernia repair. The average postoperative hospitalization time was 2 days (range 1–4).ConclusionCombined laparoscopic surgical and gynaecological operations are safe, and should be recommended as an optional strategy in the treatment of patients with two or more coexisting diseases.
Is laparoscopic hysterectomy bad for the brain?
Authors: Salonen Markku , Mäkinen Juha , Saraste Markku , Parkkola Riitta 
Published: March 2003

ObjectiveLaparoscopic hysterectomy gives rise to the theoretical possibility of systemic gas or debris embolization, because of the unique way in which it changes the pressure gradients at the level of the heart. We wanted to find out how great the risk might be, and whether there was a possibility of detecting patients at high risk.Subjects10 otherwise healthy patients referred to our clinic for laparoscopic hysterectomy.ResultsIn all patients there was a pressure gradient from right to left between the sides of the heart during the operation. Also in all patients, small echogenic particles were seen in the bloodstream entering the right atrium, emerging from the inferior vena cava. There were no patients with an open foramen ovale and, consequently, no right‐to‐left shunting. Cerebral magnetic resonance imaging (MRI) showed no change postoperatively compared with preoperative status.ConclusionAs the possibility of systemic embolization is increased in these patients, it is concluded that trans‐oesophageal monitoring may be useful in preventing life‐threatening incidents during laparoscopic gynaecological procedures. Judging from the MRI results, subclinical infarctions after this procedure are not frequent. With the methods used, in this small number of patients, no apparently harmful incidents were encountered.
Optical trocar systems: laparoscopic entry and its complications (a study of cases in Germany)
Authors: Mettler  , Schmidt  , Frank  , Semm  
Published: March 2003

ObjectivesTo assess the different techniques available for Veress needle and trocar entry under direct vision, and to evaluate the complications caused during laparoscopic entry, according to the German Gynaecological Endoscopic Complication Register.DesignA detailed description is given of the different trocar entry techniques under direct vision including use of the optical trocar cannula. The German Gynaecological Endoscopic Complication Register compares the data from 17 745 patients who underwent laparoscopic or hysteroscopic surgery at 15 different centres in 1997.ResultsComplications occurred in 172 (0.86%) of 20 050 endoscopic procedures; 116 of these were laparoscopic interventions (1%), and 56 were hysteroscopic interventions (0.7%). Of the 116 laparoscopic complications, 50 (43.1%) resulted from trocar entry problems. During the last 4 years no trocar or Veress needle entry lacerations have been observed at the Department of Obstetrics and Gynaecology at Kiel.ConclusionIn any surgical procedure, including laparoscopy, complications cannot be avoided; however, trocar entry lacerations can be reduced considerably if direct visualization at entry is employed.
Small‐bowel obstruction secondary to incarcerated trocar‐site hernia after laparoscopic hysterectomy: a diagnostic challenge
Authors: Fruchter Oren , Lissak Arie , Eyal Avraham , Hallak Moshe , Heinrich Avraham , Abramovici Haim 
Published: March 2003

ObjectiveTo report an unusual complication of total laparoscopic hysterectomy.SettingGynaecology Department at Carmel Medical Centre, Haifa, Israel.Subject and interventionsA 40‐year‐old woman underwent total laparoscopic hysterectomy and developed small‐bowel obstruction 3 days following the operation subsequent to incarcerated hernia through a 12‐mm laparoscopic trocar wound. The diagnosis was eventually made with the aid of abdominal computerized tomography.ConclusionAll laparoscopic surgeons should be aware of this uncommon complication of operative laparoscopy, its clinical presentation, and the imaging modalities for its diagnosis.
Laparoscopically controlled transvaginal colpoceliotomy: a technique for extraction of enucleated fibroids
Authors: Barišić Dubravko , Orešković Slavko , Dijaković Aleksandar 
Published: March 2003

Objective  To demonstrate the technique of laparoscopically controlled classic transvaginal posterior colpoceliotomy as a procedure for extraction of laparoscopically enucleated fibroids. Setting  University‐based hospital. Subjects  19 consecutive patients who underwent laparoscopic enucleation of intramural fibroids. Interventions and results  Laparoscopic myomectomy and extraction of enucleated fibroid via laparoscopically controlled transvaginal posterior colpoceliotomy was successfully performed in all 19 patients without complication. During the follow‐up period of between 3 and 25 months neither subjective nor objective postoperative sequelae were observed. Conclusions  Laparoscopically controlled transvaginal posterior colpoceliotomy is a safe, efficient and inexpensive procedure for fibroid extraction.