bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endoscopic surgery and diagnosis in infertility management and assisted reproductive techniques
Authors: Mencaglia Luca 
Published: March 2003

ObjectiveTo describe the role of diagnostic laparoscopy, salpingoscopy, surgical laparoscopy, and diagnostic and surgical hysteroscopy in infertile patients, with special attention to techniques of assisted reproduction.DesignA personal review.SettingThe Regional Center for Ambulatory Surgery and Infertility, Florence, Italy.SubjectsInfertile patients undergoing assisted reproduction procedures.InterventionsDiagnostic laparoscopy, salpingoscopy, surgical laparoscopy, diagnostic and surgical hysteroscopy.Main outcome measures and resultsDiagnostic laparoscopy was considered mandatory in infertile patients when there was suspected tubal, ovarian or peritoneal disease interfering with the capacity to reproduce. The value of other methods as alternatives to laparoscopy and dye insufflation in the management of infertile patients was also evaluated. Salpingoscopy was also reviewed, with the conclusion that this technique is very important in the infertility work up because it allows a prognosis concerning the possibility of conception according to the status of the mucosal folds. Diagnostic hysteroscopy was evaluated. This technique is an extremely reliable outpatient procedure in infertility diagnosis and it allows savings in health costs, even though, unfortunately, it is not yet widely used. The indications for and results of hysteroscopic surgery were also reviewed. Hysteroscopic operations, compared with traditional surgery, involve reduced risk, shortened hospitalization, reduced costs and better results. Considering endoscopic techniques in relation to assisted reproduction, the importance of laparoscopy and hysteroscopy in the selection and preparation of infertile patients was evaluated. However, the direct involvement of endoscopic techniques in gamete retrieval and transfer was considered to give inconsistent results.ConclusionThere are clear advantages in using endoscopic surgical techniques, and many traditional surgical approaches can be replaced by operative laparoscopy and hysteroscopy. Considering assisted reproduction and endoscopic techniques, we should emphasize the importance of laparoscopy and hysteroscopy in the selection and preparation of infertile patients.
Laparoscopic uterine nerve ablation: a survey of gynaecological practice in the UK
Authors: Daniels Jane , Gray Richard , Khan Khalid S. , Gupta Janesh K. 
Published: March 2003

ObjectiveTo determine the current use of and the indications for laparoscopic uterine nerve ablation (LUNA) in the UK, and to establish practitioners' views regarding the desirability of a controlled clinical trial to assess the efficacy of LUNA.SettingGynaecologists associated with the British Society of Gynecological Endoscopy.DesignA self‐administered structured questionnaire was posted to 457 UK gynaecologists. Their surgical practice and willingness to participate in a randomized trial were surveyed. The postal questionnaire was returned by 249 (55% response rate).ResultsThe survey indicated that 113 (45%) of the responders performed LUNA. Of these, 86 (76%) carried out LUNA for chronic pelvic pain, 72 (64%) for endometriosis, and 16 (14%) for dyspaurenia/dysmenorrhoea. Diathermy was used as the surgical tool by 66 (59%) gynaecologists and laser was used by 57 (51%). Of the 113 currently using LUNA, 91 (81%) were willing to enter patients into a proposed clinical trial of LUNA.ConclusionCurrent clinical practice regarding LUNA for pelvic pain is hung in equipoise. This means that the technique has been introduced without reliable evidence of efficacy but opinion regarding its use is not yet solidified. Hence, a rigorous randomized trial of LUNA's efficacy is urgently needed and is practicable.
Histochemical detection of c‐erb‐2 overexpression in endometrial polyps removed by hysteroscopy
Authors: Maia Hugo , Maltez Amélia , Fahel Paulo E. , Coutinho Elsimar M. 
Published: March 2003

Objective  To detect the presence of c‐erb‐2 over‐expression in endometrial polyps. Setting  Endoscopy unit of a private, urban hospital. Subjects and methods  20 patients with endometrial polyps and six patients with disordered proliferative endometrium underwent resectoscopic surgery. Oestrogen receptor and c‐erbB‐2 protein over‐expression were investigated in the polyp and endometrium by immunohistochemical methods. Results  Over‐expression of c‐erbB‐2 was detected in 83% of endometrial polyps in women of reproductive age and in 57% of polyps in women in the menopause. The use of hormone replacement therapy did not affect the percentage of polyps showing c‐erbB‐2 over‐expression. Oestrogen receptors were present in the polyps of all patients. There was no c‐erbB‐2 over‐expression in the cases of disordered proliferative endometrium. Conclusions Over‐expression of c‐erbB‐2 oncoprotein was detected in benign endometrial polyps in both pre‐ and postmenopausal patients. Activation of the epidermal growth factor receptor family may be involved in the mechanism of polyp growth.
Late subumbilical metastases of an occult ovarian cancer after laparoscopic cholecystectomy
Authors: Volz‐Köster Stefanie , Melchert Frank , Volz Joachim 
Published: March 2003

We present a case of subumbilical tumour seeding of a cystadenocarcinoma 2 years after laparoscopic cholecystectomy. Laparotomy revealed a bilateral FIGO stage 1c cystadenocarcinoma of the ovaries with no signs of other metastases. The subumbilical tumour was the result of an inoculation of tumour cells from the previously undetected ovarian cancer during laparascopy.
Interstitial ectopic pregnancy following hysteroscopic resection of an intrauterine septum
Authors: Robson Stephen , Pozza Christopher , Kerin John F. 
Published: March 2003

Objective To describe an interstitial pregnancy which occurred subsequent to and at the site of an hysteroscopic excision of an intrauterine septum.SettingUniversity‐affiliated reproductive medicine programme.SubjectA 32‐year‐old woman undergoing IVF treatment for infertility.ResultsThe patient underwent IVF treatment after hysteroscopic resection of an intrauterine septum. Ectopic pregnancy occurred interstitially in the uterine fundus, at the site of the previous septotomy. The pregnancy was excised at laparotomy.ConclusionsInterstitial ectopic pregnancy may represent a complication of operative hysteroscopy.
Outpatient microhysteroscopy: why does it fail?
Authors: Salha Osama , Okeahialam Majella , Jones Siân , O'Donovan Peter 
Published: March 2003

ObjectiveTo assess the failure rate of diagnostic outpatient hysteroscopy using a 2.5‐mm semirigid hysteroscope.DesignRetrospective cohort analysis.SettingOutpatient hysteroscopy unit in a large district general hospital.SampleAll patients who had a diagnostic outpatient hysteroscopy during the study period.Main outcome measuresHysteroscopy was considered a failure when the uterine cavity was not accessible or when the view obtained was unsatisfactory.ResultsA total of 1976 patients were seen in the direct‐access hysteroscopy unit between November 1994 and May 1999. The procedure was performed successfully in 1898 patients (96.1%) but failed in 78 patients (3.9%). Causes for failure included: cervical stenosis (n = 54; 67.9%), severe discomfort (n = 7; 8.9%), unsatisfactory view (n = 6; 2.6%), obesity (n = 5; 6.4%), large cervical polyp (n = 4; 5.1%) and vagal reaction (n = 2; 2.6%). Overall failure was more likely in postmenopausal (46/894; 5.1%) than in premenopausal patients (32/1082; 2.9%).ConclusionsDiagnostic outpatient hysteroscopy using a 2.5‐mm semirigid hysteroscope is a simple, safe, effective and acceptable investigation. The most common reason for a failed outpatient microhysteroscopy was cervical stenosis particularly in postmenopausal women.
Quality of life following radical excision of rectovaginal endometriosis associated with complete obliteration of the posterior cul de sac
Authors: Wright Jeremy Torquil , Shafik Amina 
Published: March 2003

ObjectivesTo review the available literature and studies, both published and unpublished on the effect of radical surgery for obliterative endometriotic cul de sac disease on the quality of life.DesignReview of literature and audit studies of rectovaginal disease.SettingTwo specialist endometriosis practices, one in the United States and the other in a UK district general hospital.SubjectsPatients presenting with rectovaginal endometriosis.InterventionsRadical laparoscopic excision.Main outcome measuresReduction of pain as measured on ranked ordinal, scales and quality of life measures.ResultsRadical laparoscopic surgery for the excision of rectovaginal endometriosis is associated with a significant diminution in symptoms and an improvement in quality of life. This is particularly so for patients who rated their symptoms as severe prior to surgery.ConclusionInitial studies show promising results for radical surgery. There is however, a need for randomized controlled trials and proper audit to assess the efficacy and morbidity of this surgery.
Laparoscopic myomectomy using a modified type of reusable laparoscopic Roeder knot pusher to enhance positioning and tightening of the Roeder knot
Authors: Barišić Dubravko , Bagović Damir 
Published: March 2003

To describe the technique of laparoscopic reconstruction of the uterine wall defect after laparoscopic enucleation of intramural fibroid, using a modified type of reusable laparoscopic knot pusher which enhances precise positioning and adequate tightening of the Roeder knot.A stand‐alone one‐day surgery unit.Six patients having laparoscopic enucleation of an intramural fibroid.The defect in the uterine wall was reconstructed with open surgery sutures tied extracorporeally using a Roeder knot which was slid and tightened with the knot pusher.Since the Roeder knots were slid and tightened without blockage and the uterine wall was reconstructed without postoperative intramural haematoma in all patients, the impression is that the modified type of Roeder knot pusher used on standard sutures could be a low‐price alternative to endoscopic sutures.
Is endometrial pretreatment necessary in NovaSure™ 3‐D endometrial ablation?
Authors: Cooper Jay , Brill Andrew , Fulop Tamas 
Published: March 2003

ObjectiveTo assess and compare the efficacy of NovaSure, a novel 3‐D bipolar endometrial ablation system, for women with severe menorrhagia secondary to dysfunctional uterine bleeding (DUB), with and without endometrial preparation.Study designA prospective, double‐arm, controlled, observational pilot study of 40 women undergoing endometrial ablation using the NovaSure system.Patients40 premenopausal women, of average age 44 years, with menorrhagia secondary to DUB and unresponsive to medical therapy, who had completed childbearing, with non‐distorted uterine cavities, and cornu‐to‐cornu measurement of greater than 2.5 cm.InterventionsEndometrial ablation using the 3‐D bipolar NovaSure system.Methods50% of the patients received gonadotrophin‐releasing hormone (GnRH) agonist for endometrial thinning. The remaining patients received no treatment for endometrial thinning. Pictorial blood assessment chart (PBLAC) diary sampling was used to select patients for the study, as well as to conduct the post‐treatment evaluation of menstrual blood loss and bleeding pattern (amenorrhoea, spotting, hypomenorrhea, eumenorrhoea or menorrhagia). All patients received the treatment under intravenous sedation with paracervical block.ResultsNo intraoperative complications were observed. Treatment time averaged 72 seconds. Follow up of 12 months has been completed in 29 patients. No significant difference was observed in the outcome (i.e. efficacy) of the procedure between the two groups of patients.ConclusionsPreliminary results indicate that the NovaSure system can be successfully used as an effective method of treatment for women with menorrhagia secondary to DUB. Endometrial pretreatment appears not to be necessary in global ablation performed using the NovaSure system.
Laparoscopic supracervical hysterectomy complicated by delayed vesicocervical fistula
Authors: Daniell James F. , Anderson Ted L. , Maikis Roseann 
Published: March 2003

Laparoscopically performed supracervical hysterectomy is becoming more widely accepted around the world. The objective of this case report is to describe a rare urinary tract complication associated with this operation.Case report.Referral practice for endoscopic surgery.A 35‐year‐old nulliparous woman with recurrent endometriosis and chronic pelvic pain.A laparoscopic supracervical hysterectomy with bilateral salpingo‐oöphorectomy.The patient developed a vesico‐cervical fistula 3 weeks postoperatively. After urological consultation, this was treated successfully via minilaparotomy, transvesical excision, and repair of the fistula within 36 h of diagnosis.Urinary tract fistulas can occur following laparoscopic supracervical hysterectomy. If they are diagnosed immediately and properly managed, standard repair can be successful and morbidity can be minimized.
Comparative mass of suture material involved in extracorporeal slip knots
Authors: Ind Thomas , Chou Danny 
Published: March 2003

To compare the weights of commonly used extracorporeal slip knots.The weights of seven commonly used types of extracorporeal slip knots and an intracorporeally tied flat square knot were compared. In each arm of the study, 17 knots were tied around a 5‐mm jig using a laparoscopic trainer. Knots were weighed using microscales.A laboratory experiment.Weight of knot loops in milligrams.The heaviest ligature was the modified Roeder knot. The Western knot utilized less suture material than all the other knots studied. The flat square knot utilized less suture material than all the slip knots with the exception of the Western ligature.As other studies have correlated suture mass with the incidence of wound infection, a ligature with a low weight should be chosen in preference to the modified Roeder knot where possible.
Recombinant factor VIIa for patients with inhibitors to factor VIII or IX or factor VII deficiency
Authors: Scharrer  
Published: March 2003

Inhibitors to factor VIII (FVIII) or IX (FIX) in patients with haemophilia A or B create a challenging problem for the treatment of these patients. Recombinant FVIIa (rFVIIa; NovoSeven®, Novo Nordisk A/S, Bagsvaerd, Denmark) is a realistic treatment option, owing to its specific mode of action and lack of immunogenicity.This was a multicentre, open‐label, compassionate‐use trial in patients with severe haemophilia A (FVIII:C < 1%) or B (FIX:C < 1%) with inhibitors, acquired antibodies to FVIII or FIX, or FVII deficiency (FVII:C < 5%), for whom alternative therapies had failed or were contraindicated. Patients received rFVIIa treatment for life‐ or limb‐threatening bleeding episodes or for coverage during essential surgery. The mean rFVIIa dose was approximately 90 μg kg−1for haemophilia A/B and acquired inhibitor patients, and 25 μg kg−1for FVII‐deficient patients. Efficacy data for 67 treatment episodes (45 bleeding episodes, 22 surgical procedures) are presented; seven patients were treated for a concurrent serious bleeding episode and surgical procedure. At the end of treatment, rFVIIa was effective or partially effective in 85% of serious bleeding episodes. During surgery, bleeding was assessed as none or less than or equivalent to normal in 91% of surgical procedures; postoperatively, 91% of procedures were associated with no or minimal oozing.During 60 separate treatment episodes, 26 adverse events (22 nonserious, four serious) were reported in 15 patients, during 17 bleeding episodes or surgical procedures. Only 10 were considered as having a possible, probable, or unknown relationship with rFVIIa; of these, fever (n=2) and thrombophlebitis (n=3) were the most common. There was no evidence of disseminated intravascular coagulation. In conclusion, rFVIIa is an effective, well‐tolerated treatment for serious bleeding episodes and bleeding associated with surgical procedures in patients with severe haemophilia A/B with inhibitors, acquired inhibitors, or FVII deficiency.
Teaching parents advanced clinical skills
Authors: Vidler  
Published: March 2003

The management of haemophilia, in common with many other inherited, chronic disorders, has witnessed enormous advances and improvements. The quality of life enjoyed by children with haemophilia is excellent. To realize these benefits, however, expectations are placed on parents to administer intravenous treatment at home. The frequency of required treatment can be as often as alternate days.The role of implantable venous access devices has made venous access in young children at home a realistic procedure. This is a highly complex skill for the lay person to undertake, and comprehensive parental teaching and standardized written information are necessary.A teaching package has been created that commences with theoretical instruction and moves onto practical training. On‐going assessment is then carried out at regular intervals in the home environment.Not only does this package provide a formal framework for instruction, it also facilitates emotional support for both the child and parents, which can be given in a planned manner.Nurses are professionally accountable for the information and teaching they give. This package documents the process of training undertaken and standardizes the level of information given. Thereby providing reassurance to nurses that they have fulfilled the professional requirements placed on them.Currently, there is no other source of information about implantable venous access devices for the lay carer. This package could be of value in other chronic conditions that incorporate an element of intravenous home care.
Adverse events during use of intranasal desmopressin acetate for haemophilia A and von Willebrand disease: a case report and review of 40 patients
Authors: Dunn  , Powers  , Ribeiro  , Rickles  , Abshire  
Published: March 2003

We report our experience with the incidence of adverse events during the use of Stimate® brand intranasal desmopressin acetate (IN DDAVP) for patients with haemophilia A (HA) or von Willebrand disease (vWD) after noting two severe adverse events in one adult patient.All patients with documented vWD (type 1 or 2 A) or haemophilia A (mild, moderate or symptomatic carrier) from the Emory Comprehensive Hemophilia Center who had IN DDAVP challenge testing or were using Stimate® for treatment of bleeding were evaluated for adverse events by patient report or nursing observation of clinical signs and symptoms.Forty patients were studied. Sixty‐eight per cent (27/40) experienced clinical signs and/or symptoms. The majority of these symptoms were mild, however several patients reported moderate to severe side‐effects and one adult patient required medical intervention for symptomatic hyponatraemia.In our experience, two‐thirds of patients tested experienced adverse signs and/or symptoms with the use of Stimate®; considerably higher than that reported from preliminary results in the literature. Young age did not correlate positively with adverse reactions. Severe adverse events requiring medical intervention were rare, however symptoms such as moderate to severe headache, nausea, vomiting and weakness may necessitate evaluation for hyponatraemia. This is the first report of symptomatic hyponatraemia in an adult patient with recommended dosing of Stimate®. Side‐effects may be minimized if patients adhere to instructions regarding fluid intake and composition while using IN DDAVP.
Intra‐articular rifamycin in haemophilic arthropathy
Authors: Radossi P. , Baggio R. , Petris U. , Biasi E. De , Risato R. , Davoli P. G. , Tagariello G. 
Published: March 2003

Summary.Synoviorthesis is the intra‐articular injection of chemical or radioactive substances able to produce fibrosis of hypertrophied synovium, which has proved effective in the treatment of chronic haemophilic synovitis. Between September 1999 and October 2001 we treated 28 outpatients (25 with haemophilia A, three with haemophilia B). Our treatment was focused on pain and functional limitation of joints. A schedule was adopted to treat each joint using intra‐articular rifamycin once a week, repeated five times. Patients were covered with factor replacement on demand. Oral analgesia was offered as required because of acute but transient painful inflammatory reaction. Their median age was 34 years (range 15–60 years). The indication for synoviorthesis was chronic synovitis characterized by recurrent haemarthroses, persistent pain and limited range of motion (ROM). Thirty‐five joints were treated with a total of 169 injections, including six joints (20%) in patients with inhibitors. In five patients two joints were treated in the same session. Thirty procedures were completed: 24 (80%) were considered effective (as excellent or good), while six were considered insufficient (20%). Pain was reduced in 96% of cases and in 70% the ROM was improved. In our experience intra‐articular infiltration with rifamycin appears to be effective in reducing joint pain and in improving the ROM. The procedure presents a low risk of bleeding, can be used for patients with inhibitors and multiple joints can be treated without any additional cost.
The safety and efficacy of B‐domain deleted recombinant factor VIII concentrate in patients with severe haemophilia A
Authors: Lusher J. M. , Lee C. A. , Kessler C. M. , Bedrosian C. L. ,   for the ReFacto Phase 3 Study Group
Published: March 2003

Summary.Background: B‐domain‐deleted recombinant factor VIII (BDDrFVIII) was developed when the B‐domain was found to be redundant for maintaining haemostasis. This allows formulation of the final product without albumin added as a stabilizer.Methods: Three multicentre clinical studies and one pharmacokinetic study were conducted in 218 patients to evaluate the safety and haemostatic efficacy of BDDrFVIII.Results: Previously treated patients (n = 113; median duration, 1711 days; median exposure days, 385; total 98 096 287 IU infused) rated 97–99% of all infusions as good or excellent efficacy. FVIII inhibitor was noted in one patient in the previously treated patient cohort after 113 exposure days. Among 101 previously untreated patients, responses to BDDrFVIII were rated as excellent or good in 92–95% of infusions (median duration, 1413 days; median exposure days, 148; total 12 636 458 IU infused). Thirty‐two previously untreated patients developed inhibitors after a median duration of 12 exposure days (range, 3–49). Sixteen of 32 (50%) patients had low levels (≤ 5 Bethesda units) and 16 had high levels of inhibitors. Inhibitors disappeared in six of 14 (43%) of the high‐level and six of eight (75%) of the low‐level patients who underwent immune tolerance induction therapy. A total of 42 patients underwent surgery and the overall efficacy of BDDrFVIII was rated as excellent or good for 99.6% of infusions.Conclusions: The results of these clinical studies indicate that BBDrFVIII is safe and effective and has haemostatic activity similar to that of full‐length FVIII concentrates.