bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adenomyosis and endometrial ablation
Authors: Neis Klaus J. , Brandner Percy 
Published: March 2003

Objective To present a synopsis concerning adenomyosis uteri interna with respect to endometrial ablation. The definition of adenomyosis, different diagnostic methods and their effectiveness, as well as the influence of adenomyosis on the outcome after endometrial ablation, are discussed. Design Review. Setting Obstetrics and gynaecology clinic of an academic teaching university hospital. Results Depending on which definition is used, the incidence of adenomyosis varies between 8 and 61%. The term ‘adenomyosis’ should be restricted to those cases with a deeper ingrowth of glands, as only these show clinical symptoms. Adenomyosis can not be diagnosed or excluded with certainty by either sonography, diagnostic hysteroscopy, or dilation and curettage. Needle biopsies of the myometrium show low accuracy and are difficult to obtain. Hysteroscopic resection of myometrium detects some cases of adenomyosis, but misses the majority. In patients undergoing hysterectomy after unsuccessful endometrial ablation, incidence rates of 75–100% for adenomyosis were reported. Thus adenomyosis might be a principal reason for treatment failure. As there is no safe means of excluding adenomyotic foci, adenomyosis can be assumed in patients with an enlarged uterus and marked dysmenorrhoea. Conclusion Patients with dysmenorrhoea and uteri >10 cm show a high incidence of adenomyosis. Because of an increased risk of failure, these patients should be excluded from endometrial ablation.
The laparoscopic Deschamps needle: revival of an old concept
Authors: Brölmann Hans A. M. , Bremer Gérard L. 
Published: March 2003

Background  In laparoscopic surgery there are several appropriate ways of securing uterine or ovarian vessels. The costs of stapling are high. Bipolar coagulation is a cheap and useful technique; however, it carries a risk of inadvertent heat conduction to neighbouring organs. Ligating the uterine pedicle may be a reasonable alternative, but stitching with a sharp needle may damage large arteries and can cause uncontrollable haemorrhage. Instrument In view of this, a laparoscopic needle similar to the Deschamps needle (with a blunt, articulating tip and a distal eye) has been developed. The needle is loaded with any regular suturing material. The instrument is introduced through an operation port of 5 mm or more. After the tissue that is to be transsected has been perforated by the Deschamps needle, a second needle‐holder is introduced and both ends of the suture are pulled outside the abdomen. The knot is tied, using a Clarke knot‐pusher. A total of four extra‐abdominal throws strengthen the final knot. The threads are then cut. Results  In a 24‐month period we tested the device in 50 patients, who underwent a laparoscopically assisted vaginal hysterectomy (LAVH). In all patients the uterine vessels were ligated by Deschamps suturing; in seven the ovarian vessels were also ligated using this technique. Conclusion  Suturing with the Deschamps needle is easy to learn, and is fast, effective and inexpensive.
Wound dehiscence at a 7‐mm port site closed with tissue adhesive
Authors: Abbott Jason , Phillips Graham 
Published: March 2003

Objective  To describe the herniation of omentum through a 7‐mm suprapubic port site, which had been closed with tissue adhesive, following laparoscopic sterilization, requiring repair under general anaesthetic. Setting  Minimal access gynaecological surgery unit in a district general hospital. Subject  A 26‐year‐old multiparous woman who presented with abdominal pain and an omental herniation through her suprapubic port site. Intervention  The patient required repeat laparoscopy and digital reduction of the hernia with formal repair of the rectus sheath defect. Conclusion  This case of herniation through a midline 7‐mm port site may have implications for the closure of wounds at laparoscopy. Most gynaecologists do not formally close the rectus sheath at laparoscopic sterilization; however, with the possibility of visceral herniation and vascular compromise, this practice may change in the future. It is not clear whether the tissue adhesive had a role in this complication.
Laparoscopic ultrasonography in the management of ectopic pregnancy: is there a possible role?
Authors: Ahmed Ahmed A. , Lumb Michael R. , Williamson John G. 
Published: March 2003

Objective  Ectopic pregnancy is a potentially serious condition. The standard methods of diagnosis include estimation of the beta subunit of human chorionic gonadotrophin (β‐hCG), transvaginal ultrasonography (TVUS), and laparoscopy. Diagnostic laparoscopy yields up to 2% false‐positive and 4.5% false‐negative results with potentially serious consequences. Two cases where the technique of laparoscopic ultrasonography was used in the diagnosis of unruptured ectopic pregnancies are described. Subjects  Laparoscopic ultrasonography was used in cases of suspected ectopic pregnancy to confirm the diagnosis. A 60° convex array probe with multifrequency (5, 6.5 and 7.5 MHz) and a radius of curvature of 20 mm was used. The probe was introduced through a 10‐mm port. Results  The laparoscopic ultrasound probe could clearly detect early ectopic pregnancy. This technique is also superior to transvaginal ultrasonography in identifying an early intrauterine pregnancy. Conclusion  Our results suggest that laparoscopic ultrasonography may assist in the diagnosis of ectopic pregnancy when the findings at laparoscopy are uncertain.
The importance of histological diagnosis in patients with chronic pelvic pain and laparoscopic evidence of endometriosis
Authors: Shafik Amina , Ratcliffe Norman , Wright Jeremy T. 
Published: March 2003

Objective  To assess the accuracy of laparoscopic diagnosis of pelvic endometriosis by histological evaluation of biopsies excised from pelvic peritoneal lesions suspicious for endometriosis in patients with chronic pelvic pain. Setting  Centre for Endometriosis and Pelvic Pain, St Peter's Hospital, Chertsey, UK, between October 1997 and October 1998. Subjects  62 patients with the presenting complaint of chronic pelvic pain. These patients were included in the study irrespective of previous pelvic surgery or the earlier diagnosis of pelvic endometriosis. Intervention  Laparoscopic assessment and excision of peritoneal lesions suspicious for endometriosis. Excision biopsy of all suspected endometriotic lesions was laparoscopically performed using a sculpted tip Nd: YAG laser fibre. All procedures were undertaken under the direct supervision of the same senior laparoscopic surgeon. No major complication was encountered. The biopsies obtained were labelled according to the anatomical site and histologically examined by light microscopy for the presence of endometriosis. Results  We took 1–6 biopsies per patient and the total number of biopsies obtained was 150. Biopsies from three patients among the 62 were unsuitable for histological evaluation and were excluded from the study. In 43 patients (73%) there was histological confirmation of endometriosis in all or some of their biopsies. In all the biopsies from 14 patients (24%) there was no evidence of endometriosis, their biopsies comprising other tissues such as fibro‐fatty, fibrovascular and fibromuscular tissues. In two patients (3%) all their biopsies showed endosalpingiosis only. The commonest anatomical sites of pelvic peritoneal endometriotic lesions were the uterosacral ligaments, the pouch of Douglas, the medial broad ligaments, the intestinal serosa, and the ovarian fossae, respectively. Conclusions  The diagnosis of pelvic endometriosis in patients with chronic pelvic pain should be supported by excision biopsy and histological assessment, as the laparoscopic diagnosis is not always accurate. This would direct the clinician to the possible aetiology of the chronic pelvic pain and is of great value in counselling and planning future management for the patients.
Hysterectomy techniques and their effect on the blood markers of thrombogenicity
Authors: Singer Iain O. , Pringle Stewart , Tait R. Campbell , Moore Karen , Alexander Claire , Hawthorn Robert 
Published: March 2003

ObjectiveThe use of laparoscopic surgery appears to reduce patient trauma and permits earlier discharge. However, the operation may be longer and the overall effect on coagulation and the risk of thrombosis is not clear.DesignWe compared the effect on coagulation activation markers (thrombin–antithrombin, prothrombin fragments 1+2 and d‐dimers) and factors (protein C, antithrombin, fibrinogen and activated protein C resistance) of laparoscopic and open abdominal hysterectomy in 39 women for the week following surgery. Some of these are well‐recognised markers of thrombotic risk.ResultsWe found no evidence to suggest that laparoscopic hysterectomy has a more favourable prothrombotic profile. There were no major differences between the surgical options.ConclusionsLaparoscopic hysterectomy should be subject to the same rigour of thromboprophylaxis as open abdominal hysterectomy. We did find evidence of a prolonged prothrombotic state beyond the normal period of thromboprophylaxis in both groups.
Laparoscopic‐assisted vaginal hysterectomy for benign uterine pathologies: could this be the first‐line treatment?
Authors: Şimşek Tayup , Karakuş Cemil , Karaveli Şeyda , Trak Bilal 
Published: March 2003

Hysterectomy is traditionally performed by the abdominal route, and is frequently done for benign uterine pathologies. Laparoscopic procedures have been used widely because of advances in technological development and increased laparoscopic experience. We therefore wished to evaluate the role of laparoscopic hysterectomy in comparison with traditional abdominal hysterectomy. A prospective study.Department of Obstetrics and Gynaecology, Akdeniz University School of Medicine, Turkey.We recorded details from all patients between 1998 and 2000 with indications for hysterectomy on account of benign uterine pathologies. Both types of hysterectomy were performed throughout this period. The operating times, complications and analgesia dosage were compared.In all 84 patients underwent hysterectomy. Of these patients, 38 (45.2%) had laparoscopic‐assisted vaginal hysterectomy, 34 (40.4%) had total abdominal and 12 (14.2%) had vaginal hysterectomy. Laparoscopic hysterectomy showed the advantages of shorter hospital stay, less analgesic medication and earlier postoperative recovery. Laparoscopic hysterectomy, with the advantages of laparoscopic surgery, was the preferable approach to hysterectomy for benign uterine pathology in this series. It can replace traditional hysterectomy in patients who are suitable for laparoscopic surgery.
Long‐term success after open and laparoscopic colposuspension: a case–control study
Authors: Dietz Hans P. , Wilson Peter D. 
Published: March 2003

ABSTRACTObjective A decade after its development, laparoscopic colposuspension remains a controversial alternative to open colposuspension in the treatment of female genuine stress incontinence. Results from the few published randomized controlled trials vary considerably. The authors therefore intended to define long‐term subjective and objective results in their own patient population.Design Clinical retrospective case–control trial.Setting Urogynaecology service of a tertiary hospital.Subjects 50 patients seen on average 3.3 years after laparoscopic colposuspension, matched with 50 women who had been followed up on average 3.4 years after open colposuspension.Intervention Standardized interview, translabial ultrasound imaging.Main outcome measures Incidence of urinary tract symptoms, bladder neck elevation and mobility, trigonal deformation, funnelling.Results Stress and urge incontinence were non‐significantly more common after open colposuspension, with significantly less frequency and nocturia in the laparoscopic group (P = 0.02). Significantly more patients were completely asymptomatic after laparoscopic colposuspension (P = 0.03). On ultrasound imaging, open colposuspension appeared to more commonly result in permanent distortion of the trigone (P = 0.02), with significantly less bladder neck descent on Valsalva manoeuvre (P = 0.005). These parameters were independent of follow‐up time.Conclusion It appears that, in the population assessed here, laparoscopic colposuspension seems to offer at least equivalent results when compared with open colposuspension.
Safe entry during laparoscopy: a prospective audit in a district general hospital
Authors: Jones Kevin D. , Fan Alfred , Sutton Christopher 
Published: March 2003

ABSTRACTObjectives To audit the implementation of a consensus guideline on safe entry during laparoscopy.Design A prospective clinical study in a district general hospital, with a special interest in laparoscopic surgery for endometriosis.Subjects and setting All patients undergoing a gynaecological laparoscopy at The Royal Surrey County Hospital between 1 February 2000 and 31 January 2001. Surgeons completed a standard form at the time of the procedure, and these were cross‐checked with patient discharge summaries, case notes and the hospital automated records.Results At 12 months, the database included 470 patients. The Veress needle was inserted at the umbilicus in 458 (97.4%) of patients (343 at the base of the umbilicus and 115 subumbilically), and at Palmer's point in nine (1.9%), and in one patient access was gained through an open method. A suprapubic insertion was used in two patients. A gas pressure of 25 mmHg was used to establish a pneumoperitoneum in 299 patients (63.6%), and a volume technique was used in 167 patients (35.5%). All laparoscopies performed on the professional unit (C.S.) complied with the Middlesbrough guidelines. There were 23 (4.5%) complications related to the laparoscopy. Extraperitoneal insufflation occurred in 14 patients, and omental emphysema in four patients. A bowel injury occurred in two patients (0.42%), and uterine perforation in another two patients (0.42%). One procedure (0.21%) was converted to a laparotomy because of bleeding during treatment of an ectopic pregnancy. There were no vascular injuries, and no injuries occurred as a result of operative laparoscopic surgery.Conclusion Apart from laparoscopies performed on the professional unit (C.S.), a large number of procedures did not comply with the recommendations of the Middlesbrough consensus, following implementation of the consensus guidelines.
Female adnexal tumour of probable Wolffian origin
Authors: Kim Kyong Jin , Jeong Dong Ki , Jang Byeung Woo , Lee Sung Ki , Kim Yoon Mi , Min Seong Ki , Nam Sang Lyun 
Published: March 2003

ABSTRACTObjective  Case report of unusual clinical and histological consequence of a female adnexal tumour of probable Wolffian origin (FATWO).Subject  A 31‐year‐old woman with a 6 cm diameter adnexal tumour.Interventions  The tumour was located within the leaves of the Fallopian tube. Excision was done using two atraumatic grasping forceps and bipolar coagulation.Result  The duration of the operation was 70 min. Histological examination confirmed a FATWO.Conclusion  FATWO may be low‐grade malignancies. The patient should be followed up regularly.
von Willebrand disease: an update in the Åland islandsSummary of a Nordic Symposium on von Willebrand disease, 24–25 September 1998, Mariehamn, Åland
Authors: Berntorp E. , Ingerslev J. , Schulman S. 
Published: March 2003

In the past decades von Willebrand disease (vWD) has, in several respects, fallen into the shadow of classical haemophilia due to all problems that have faced those dealing with congenital bleeding disorders, not least regarding blood‐borne diseases. The time has come to revisit and refocus on vWD, probably the most common bleeding disorder. Accordingly, a number of Nordic physicians and scientists working in this field organized a meeting on the ferry boat from Stockholm to Mariehamn, in the Åland islands, the home of the index families with this disease, as described by Erik von Willebrand in 1926. The objective of the meeting was to make a comprehensive survey of vWD as seen from the situation in the Nordic countries. In order to achieve all goals some scientists of note from countries outside the Nordic area were invited as well.This paper gives a summary of the symposium, mainly based on the separate papers published in this issue.
Hidden on the ward: the abuse of children in hospitals
Authors: Kendrick Andrew , Taylor Julie 
Published: March 2003

Hidden on the ward: the abuse of children in hospitals While there have been a small number of high profile cases of the abuse of children by hospital staff, there has been relatively little attention paid to the child protection issues for children staying in hospitals. Drawing on a conceptual framework from work on institutional abuse, we identify three types of abuse: physical and sexual abuse; programme abuse; and system abuse. Physical and sexual abuse can be perpetrated by medical professionals and hospital workers, it can be perpetrated by other children, or it can be perpetrated by the child’s own parent(s). Research evidence from the United States of America (USA) suggests that the rate of abuse in hospitals is higher than in the family home. Programme abuse occurs when treatment and care falls below normally accepted standards. Recently, a tragic case of programme abuse concerned the unacceptably high death rate of babies undergoing heart surgery at Bristol Royal Infirmary. System abuse is the most difficult to define but concerns the way in which child health services fail to meet the needs of children. Recent reports have highlighted inadequate services for children and young people, lack of priority given to children’s services, and geographical inequalities in the provision of services. Three crucial aspects in safeguarding children from abuse are highlighted: listening to children; the selection support and training of staff; and external systems of inspection, monitoring and standards. The recent British government agenda which has placed quality at the centre of National Health Service (NHS) developments are discussed. Only by addressing the abuse of children in hospital openly and honestly will effective child protection be possible.
Factors associated with students’ orientations to nursing
Authors: Vanhanen Liisa , Janhonen Sirpa 
Published: March 2003

Factors associated with students’ orientations to nursing This paper presents the results of a study focusing on the factors associated with orientations to nursing. Students’ orientations to nursing have not as yet been a focus of nursing research. In some other professions, however, professional orientation has been associated with learning motivation and study performance, and has been seen as a predictor of work satisfaction. In this study, students’ orientations to nursing were defined in terms of caring, nursing expertise and life orientation. The hypothesis of whether students’ pre‐educational experiences of nursing, gender, choice of nursing specialty, problems with nursing studies and intention to stay in nursing were associated with different orientations was tested. The extent to which students were orientated to caring, nursing expertise and their own life was also examined. The orientation to nursing measurement tool, which has been developed on the basis of a qualitative study, was used to collect the data. Nurse teachers collected the data from nursing students (n=184) who were studying in three different nursing programmes in Finland. Non‐parametric assessments (Mann–Whitney U‐test and Kruskal–Wallis test) of the differences between the students’ orientations were carried out. A majority of the students were highly life‐orientated, and two‐thirds had average nursing expertise or caring orientation scores. The results supported the study hypothesis of an association between students’ orientations and their gender, choice of nursing speciality, problems with nursing studies and intention to stay in nursing. However, the hypothesis of an association between students’ pre‐educational nursing experiences and orientation to nursing was not supported. The contradictions between students’ orientation to nursing and the philosophy of nursing underlying the study programme may be a source of motivational problems and dissatisfaction with nursing education. Therefore, nurse educators are challenged to discuss curriculum matters and student supervision in order to promote flexibility in planning personal study programmes.
Ecosphere, biosphere, or Gaia? What to call the global ecosystem
Authors: Huggett R. J. 
Published: March 2003

SummaryThe terms biosphere, ecosphere, and Gaia are used as names for the global ecosystem. However, each has more than one meaning. Biosphere can mean the totality of living things residing on the Earth, the space occupied by living things, or life and life‐support systems (atmosphere, hydrosphere, lithosphere, and pedosphere). Ecosphere is used as a synonym of biosphere and as a term for zones in the universe where life as we know it should be sustainable. Gaia is similar to biosphere (in the sense of life and life‐support systems) and ecosphere (in the sense of biosphere as life and life‐support systems), but, in its most extreme form, refers to the entire planet as a living entity. A case is made for avoiding the term Gaia (at least as a name for the planetary ecosystem), restricting biosphere to the totality of living things, and adopting the ecosphere as the most apt name for the global ecosystem.