Search PubMed⌕ Search

Biomedical subjects

A Hettenbach

Publications and source records attributed to A Hettenbach.

At least 19 recordsLinked to original sources
PubMed1995

Is laparotomy for staging early ovarian cancer an absolute necessity?

STUDY OBJECTIVE: To demonstrate that palpation of the omentum, mesentery, and intestine can be omitted from the laparoscopic staging of stage I carcinoma of the ovary. DESIGN: Retrospective analysis of 223 women with stages III and IV ovarian cancer treated by laparotomy. SETTING: Gynecological Oncology Clinic, M. Sklodowska-Curie Memorial Cancer Institute of Oncology, Warsaw, Poland. INTERVENTIONS: Observation of macroscopic spread of tumor to areas accessible to laparoscopic inspection versus spread to areas inaccessible to laparoscopic evaluation. MEASUREMENTS AND MAIN RESULTS: Macroscopically detectable disease in the areas easily accessible to laparoscopic inspection was present in all cases of metastases to the mesentery, omentum, or intestine. CONCLUSION: The diagnosis of FIGO stage I ovarian cancer can be made with confidence if laparoscopic inspection of certain areas reveals no evidence of metastases.

Adnexa Uteri↗
PubMed1994

[New perspectives in color ultrasound in breast diagnosis].

In recent years, ultrasound has become established as part of the diagnostic evaluation of breast tumours. Not replacing, but complementing mammography, ultrasonic investigations increasingly represent a sensitive means of early diagnosis. Thermography, on the other hand, has proved of relatively little value and doesn't play a significant role today. Lately, Colour Doppler sonography has been used for differentiating tumour-associated blood supply patterns--however, sensitivity and specificity were not as high as initially expected. Colour spectrum analysis of local findings in comparison to the remaining glandular tissue, however, seems to be a promising method in the differentiation of ultrasound findings of uncertain tumour status. A fibroadenoma shows no significantly different colour density as compared to surrounding tissue. In carcinoma, on the other hand, one regularly finds a hyperintensive zone with sharp margins. In 70 patients, who had breast tumours, we attempted the differentiation of benign and malignant findings with the help of colour spectrum analysis. Postoperatively, these results were validated by histology. With the exception of one mesenchymal tumour, the Doppler diagnosis was identical to the histopathological findings.

Breast↗
PubMed1994

[Laparoscopic treatment of ovarian tumors in menopausal women].

OBJECTIVE: The authors report their experiences in the laparoscopical therapy of ovarian tumours with 94 postmenopausal women. STUDY DESIGN: The patients were treated in the Department of Gynecology at Göppingen Medical Center from March 1, 1992 until December 31, 1993. Tumour marker CA 125 was not within normal limits (< 35 U/ml) in all patients. Preoperatively all findings were verified by ultrasound examination. In some cases, cysts were single-chambered, smooth-bounded or without endovegetations. Choice therapy has been bilateral adnectomy without opening the ovarian cyst and without trauma to the ovary capsula. Adnectomy was performed by bipolar coagulation and sharp preparation. In every case the specimen was positioned intact in a "Lap-Sac" and then removed via second puncture. In case of ultrasonographic or laparoscopic-macroscopic conspicuous findings an obligatory fast microscopic random sample was performed. RESULTS: In one case the microscopic test sample revealed carcinoma of the ovary--the operation was terminated by standard laparotomy. No other cases showed signs of malignancy. There were no peri- or postoperative complications. The average operation lasted 35 min (20-80 min), all operations were performed without significant blood-loss. Usually the patients were discharged at the 4th to 6th postoperative day. CONCLUSION: This operation-technique guaranteed "oncological aseptic" results at any time of operation. Therefore you can waive the standard laparotomy for the benefit of laparoscopy in many elderly patients even with suspicious findings.

Adenoma↗
PubMed1993

Studies on placental transfer of celiprolol.

The maternofetal transfer of the beta 1-selective adrenergic antagonist celiprolol has been studied in four hypertensive pregnant women. Fetal plasma concentrations were about 25-50% of the levels found on the maternal side. There was no significant difference between the plasma concentrations of the two enantiomers in the child. Therefore, in further investigations only the racemate needs to be determined.

Celiprolol↗
PubMed1991

[Value of vaginal ultrasonography in noninvasive assessment of the endometrium of the postmenopausal uterus].

The endometrial carcinoma shows an increasing incidence and represents today the most frequent malignoma of the female pelvis. Until now all techniques of detection of this carcinoma or its precursors are invasive and thus are not suitable for screening investigations. Vaginosonography, as the first non-invasive diagnostic method, now supplies knowledge about the state of the endometrium. At the Gynaecological Department of the University of Homburg/Saar, West Germany, 221 patients had been preoperatively subjected to vaginosonography before they underwent surgery. Sonographical and histological findings corresponded in atrophic endometrium in 82%, in regular, perimenopausal endometrium in 91%, in endometrial polyps and hyperplasia of the endometrium in 56%, and in endometrial carcinoma in 79%. With regard to the detection of endometrial cancer, a specificity of 96%, a sensitivity of 93%, a positive predictive value of 79% and an accuracy of 96% were established. Thus, according to our experience, vaginosonography represents a valid, non-invasive diagnostical method as a suitable instrument for screening the endometrium.

Adult↗
PubMed1991

[Slit drainage versus Redon drainage in a clinical comparison--initial experiences with a new kind of wound drainage system].

In a prospective, randomised study we compared the clinical properties of the established Redon drain with a new type of drain called "slit drain". Both types of drains were examined regarding the amount of drained fluid, the time elapsing until removal of the drain, the frequency of occlusion of the lumen as well as the patient's pain and the required force at extraction of the drain. The statistical analysis showed both drains to have equal abilities in draining of fluid if they were used under vacuum conditions. If used as nonsuction drains, the new device was able to drain more fluid than the established type of drain (p less than 0.05). Statistically relevant advantages of the slit drain were seen in a lower rate of obstruction of the lumen, a higher amount of drained fluid (as non-suction device) as well as an easier and less painful extraction.

Breast Neoplasms↗
PubMed1989

[The "other induction"--experiences and consequences in 281 deliveries following intravaginal administration of PGE2 tablets].

186 patients have been included prospectively in a study, aimed at analysing the course of birth after induction with 3 mg PGE2-tablets given intravaginally. These data are compared with those gained from a retrospective analysis of 95 patients using a dose of 2 mg. The total of the births within our clinic in 1986/87 functions as controls. Although in every case there has been an urgent need for the termination of pregnancy and there have been also unfavourable cervix findings in the 3 mg group, no differences could be observed in comparison to the control group concerning duration of cervical dilatation and expulsion, as well as foetal outcome parameters. When comparing the 2 mg and 3 mg groups, a certain superiority of the 3 mg dosage could be noted, leading to the opinion, that trial dosages of less than 3 mg should be abandoned. C-section rate was lowest and spontaneous birth rate was highest in the 3 mg group as compared to the 2 mg and the control groups. Permanent CTG-monitoring was not necessary. CTG-controls after 2 and 6 hours proved to be sufficient. Uterine hyperstimulation occurred in 2.1% of cases in both groups. In every case, prompt antagonization by means of high dose betamimetic therapy could be achieved. Due to reducing maternal and foetal side effects, the maximal mobility of the mother after tablet application, as well as, for the smooth congruence of cervical ripening and labour induction, the clinical use of the 3 mg tablet is a modern alternative to the classic oxytocin induction.

Administration, Intravaginal↗
PubMed1989

[Fenoterol-induced lung edema during anesthesia in cesarean section].

Indications for anaesthetics and the beta-mimetic fenoterol, which is used to inhibit uterine contraction, are of interest for the anaesthesiologist because these drugs can be life-threatening. For this reason a case is presented showing the cardiopulmonary side effects connected with anaesthesia for Cesarean section. Detailed knowledge of the pharmacodynamics of this tocolytic is imperative to prevent avoidable errors during administration of anaesthesia.

Adult↗
PubMed1987

[Effect and side effects of oral morphine, lormetazepam and placebos as premedication].

In 60 patients undergoing a curettage in thiopentone induced inhalation anaesthesia with enflurane and N2O/O2 = 2:1, the effects of oral premedication (2 h before anaesthesia) with 30 mg morphine (MST 30) (n = 21), 1 mg lormetazepam (Noctamid) (n = 19) and placebo (n = 21) on psychological (anxiety, depression and asthenia), physiological (blood pressure, heart and respiratory rate) and pain parameters (visual analogue scale, analgesic consumption) were investigated. The study design was single blind, randomized. Before premedication the three groups did not differ in one parameter and so were comparable. MST 30 had a significantly better anxiolytic, Lormetazepam a significantly better antidepressive effect than the compared substance. There were no differences in blood pressure and heart rate. In contrast to lormetazepam and placebo after MST 30 there was no increase in the respiratory rate which can be explained by the anxiolytic stress reducing effect. There was no difference in peri- and intraoperative pain parameters, probably due to the type of surgery. Nausea and vomiting occurred more frequently after MST 30, but there was no significance. A higher rate was probably prevented by the application of transdermal scopolamine the day before surgery. The indication of analgesics (opiates) for premedication is discussed taking the controversy into account. The results of this study show that oral morphine (MST 30) has an anxiolytic effect, one of the most important effects a premedication should have. Further studies should investigate in which types of surgery the analgesic effect of MST 30 is peri- and intraoperatively relevant, so that advantages compared to e.g. Flunitrazepam, Midazolam or Lormetazepam in a higher dosage could be expected.

Administration, Oral↗
PubMed1987

[Conization of the uterine cervix. A study of 900 cases].

In the years 1968 till 1982, 900 conisations of uterine cervix were performed, 90% of which were diagnostic interventions. During the follow-up period, the mean age of the patients with carcinoma in situ decreased 4 years, the mean age from patients with microcarcinoma 3.2 years. In 64% the conisation was carried out due to a positive or suspekt smear. Conisations, performed during pregnancy, were not associated with any additional complications for mother or child. Taking a big conus resulted more often in a total extirpation of the neoplastic changes, without increasing the complication rate. The average hospital stay was 8.7 days. It was only prolonged in patients with secondary hemorrhage. 33% of all neoplastic changes were extirpated totally. In 85% of the women who had follow-up only after incomplete extirpation of the neoplasia by conisation, there was no recurrence. The rest did show the neoplasia again, often in a more serious way. The overall complication-rate was 7.4%.

Adolescent↗
PubMed1987

[Midazolam and pethidine/promethazine for intramuscular premedication].

The main reason for premedication is the reduction of preoperative stress. Despite the proven fact that benzodiazepines best reduce preoperative stress, combinations of opioids and neuroleptic drugs are preferred for premedication by many on reviewing the journal Der Anaesthesist. This double-blind study was performed to investigate midazolam and meperidine/promethazine for intramuscular premedication. Method. 60 patients undergoing minor gynecological surgery were randomly assigned to receive either 5-7.5 mg midazolam or 50-75 mg meperidine and 25-50 mg promethazine intramuscularly 30-90 min before surgery. Anxiety, depression, and asthenia were assessed by the patient before and after premedication but before induction of anesthesia using visual analogue scales and a nominal scale. Sedation was assessed by an observer. Heart rate and blood pressure were the physiological stress parameters. Parameters of acceptance and side effects were registered perioperatively. Results. Midazolam had a significantly better anxiolytic and antidepressive effect. There were no differences in the other parameters except for adverse effects. Meperidine/promethazine produced significantly more side-effects than midazolam. The parameters of acceptance assessed the day after surgery were comparable. Conclusions. We conclude from these results that anesthesiologists still premedicate with meperidine/promethazine because the patients accept this premedication very well when asked the day after surgery. Nevertheless, premedication with midazolam provides significantly better anxiolytic and antidepressive effects with significantly less side-effects. Therefore, midazolam should be preferred to meperidine/promethazine for intramuscular premedication.

Adolescent↗
PubMed1986

[Effects and side effects of transdermal scopolamine for premedication in general anesthesia in elderly patients].

Transdermal scopolamine has already proved an effective premedication to prevent postoperative nausea and vomiting. In a double-blind study, the effects and above all the side effects of TTS-scopolamine (TTS-s) and TTS-placebo (TTS-p) were investigated in elderly patients (greater than 50 years), who are particularly susceptible to adverse drug reactions. The 59 (out of 61) male and female patients who could finally be evaluated had to undergo long (1-6.3 hrs.) surgical or gynaecological interventions in general anaesthesia after premedication with benzodiazepines in the evening and in the morning. The operations were performed under intubation anaesthesia induced by barbiturate (3-5 mg/kg bw) or etomidate (0.2-0.3 mg/kg bw), together with enflurane (0.5-2.5 vol.%) or isoflurane (0.5-1.5 vol.%), N2O/O2 (2:1) and fentanyl (0.05-0.45 mg). Alcuronium or vecuronium were given for relaxation, pyridostigmine/atropine was administered for antagonisation. The patient groups did not differ significantly with regard to age (mean = 65 years vs. 63 years), sex, height, weight, concomitant diseases, method and duration of operation, method and duration of anaesthesia, postoperative antagonisation and analgesia. In patients under TTS-s postoperative nausea was less intensive and of shorter duration. In contrast to 7 patients of the placebo group (p less than 0.05), no case of vomiting could be observed in the TTS-s group. The efficacy of TTS-s was significantly better than that of TTS-p. TTS-s and TTS-p were both tolerated equally well. In both groups, the most frequent side effect was dryness of the mouth, but without any significant differences between the groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Cutaneous↗
PubMed1985

[Cost-benefit studies of 2 equivalent forms of therapy in cervical cancer in the pretherapeutic T 1b stage].

Patients suffering from a collum carcinoma stage T 1b can be treated either by operation according to Wertheim and Meigs, or by radiotherapy. The results with regard to post operationem complications, five-year-survival and recidivation are equivalent in both methods. Therefore, an analysis of the indirect benefit and the costs of both therapies was performed. Surgery was superior to radiotherapy in all analysed dimensions of indirect benefit. Over and above this, expenses for an operation were 2.7 times lower than for radiotherapy.

Adult↗
PubMed1985

Carcinoma of the cervix stage T1b. A 15 years review of 256 cases.

256 patients of the years 1965-1979 who suffered from collum carcinoma stage T1b were reviewed. Most of the neoplasmas were squamous cell carcinoma (81%). By tumor screening only 21% of the carcinomas were detected. The treatment was in most of the cases a radical hysterectomy (Wertheim-Meigs). Postoperative radiotherapy was performed in cases of poor differentiated carcinoma of if lymphatic nodes had been occupied by the tumor. Thus only 43 patients had no radiotherapy. A 5 year-follow-up was possible in 151 cases. Women older than 40 year showed a better prognosis than younger women. Patients treated only by radiotherapy had a five year survival rate of 88%. No difference in prognosis was observed, if radiotherapy was additionally performed. There was no significant difference of severe complications in either forms of treatment.

Adult↗