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Biomedical subjects

E Dreher

Publications and source records attributed to E Dreher.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Diagnosis and biopsy of nonpalpable breast lesions].

In a retrospective analysis we reviewed 117 needle-localized biopsies of nonpalpable breast lesions in 115 women from the senologic outpatient clinic at the Women's Hospital of the University of Berne. In a logistic regression analysis, the age of the patient, the presence of grouped and irregular microcalcifications as well as the presence of a stellate lesion in mammography correlated closely with the diagnosis of breast cancer. The prevalence of malignant lesions, which was equal to the rate of preoperative correctly diagnosed malignancy in this group, was 22.2%.

Adult↗
PubMed1996

Treatment of human papillomavirus-associated vulvar disease with the CO2-laser. Physical and histological aspects with use of a new scanning device, the SwiftLase.

The CO2-laser has a successful record in treatment of extensive, refractory vulvar condylomas and vulvar intraepithelial neoplasia. A prerequisite for optimal use of the laser is careful preoperative diagnosis and optimized surgical technique based upon the exact knowledge of the interaction process between laser radiation and tissue. Using a new CO2-laser scanning device, the Sharplan Swift-Lase, this in-vivo study analyses the effects of CO2-laser parameters [average power density (PD), beam size and exposure time] on vulvar skin to determine optimum laser settings. Our histomorphometric analyses reveal a minimal skin destruction (ablation depth 40 microns, extent of irreversible thermal damage 80 microns to 120 microns) after application of the CO2-laser energy with the SwiftLase using a PD of 1000 W/cm2 with a beam size of 1 mm diameter. Previous CO2-laser application techniques required low PD (200 W/cm2 to 750 W/cm2) and a larger beam size (1.5 mm to 2 mm) moving over the epithelial surface as fast as possible to obtain a precise skin destruction. The SwiftLase allows the laser beam to be moved slowly with a beam size of 1 mm and significantly higher PD (up to 5000 W/cm2). These advantageous application conditions guarantee precise, homogeneous vulvar skin treatments with minimal thermal damage to the surrounding normal skin. The SwiftLase enables a less experienced colposcopists to perform vulvar CO2-laser surgery.

Carcinoma in Situ↗
PubMed1995

Curative treatment of clinical stage II endometrial carcinoma.

In a retrospective study of 54 patients we compared three treatment policies of clinical stage II endometrial carcinoma: One group of patients (n = 29) was surgically staged with histological examination made at surgery and treated by abdominal total hysterectomy with bilateral salpingo-oophorectomy. In case of cervical infiltration by tumour, a pelvic node sampling was added. The second group was treated by radical hysterectomy (n = 9) and the third group of patients (n = 16) was treated by abdominal total hysterectomy with bilateral oophorectomy only. The median follow-up time was 68 months. The overall five year-survival was 64%. The overall five year-survival rates according to surgical procedure were not significantly different. The survival curves were significantly different from each other as were those according to surgical stage and age. In a multivariant analysis stage, grading and age proved to have an independent relation with the survival rate whereas type of surgical procedure, depth of myometrial infiltration and type of radiotherapy had no influence on survival. Intraoperative histological staging allows adaption of treatment to the true stage, thus minimising treatment-related morbidity.

Adult↗
PubMed1995

Production of endometrial placental protein 14 and prolactin by cultured endometrial explants after collagenase and freeze/thaw treatment, and in response to progesterone.

OBJECTIVE: Investigation of methods for maintaining functional endometrial explants in culture after cryopreservation with or without previous enzymatic dispersion of stromal cells and epithelial glands. Such a standardized culture system is a requirement for the development of a non-invasive bioassay for embryo quality in in vitro fertilization programs, a method that will eventually measure endometrial response to embryo conditioned media. METHOD: Culture of mid-luteal phase endometrial biopsies, in the presence of [35S]methionine, with or without prior collagenase treatment and/or storage in liquid nitrogen in the presence of dimethyl sulfoxide. Determination of released de novo synthesized total protein by trichloroacetic acid precipitation of culture media. Measurement, after culture in absence and presence of progesterone, of prolactin and placental protein 14 (PP14) production by sensitive non-isotopic immunoassays. RESULTS: Production of prolactin, but not PP14, was increased by 200 nmol/l progesterone, 2-8-fold after 4 days and 1.5-700-fold after 7 days in culture. After limited collagenase treatment (but without separation of stromal cells from glands), both marker protein productions were similar compared to untreated explants; however, there was no significant stimulation of prolactin by progesterone. After freezing and thawing, production was markedly reduced, particularly from explants frozen following collagenase treatment. CONCLUSIONS: Both stromal and glandular viability are maintained after collagenase treatment but the response to progesterone is lost. Cryopreservation reduced prolactin and PP14 production in subsequent culture. Therefore, novel freezing protocols should be developed which preserve both endometrial structure and function.

Collagenases↗
PubMed1994

Effects of various laser types and beam transmission methods on female organ tissue in the pig: an in vitro study.

The purpose of this in vitro study was to investigate and compare effects of various laser types (CO2, Argon, Erbium:YAG, Erbium:YSGG, and Holmium:YAG) and laser beam transmission methods (optical lens and flexible fiber) on ovarian and uterine tissue of the pig. The Erbium laser radiation was transmitted through Zirconium fluoride fibers (ZrF4). To circumvent the low mechanical stability of these fibers, we developed a special microlens system, which refocuses the radiation and protects the distal end from damage. Tissue lesions were performed with 1 and 5 joule. Histologic analysis of acute Er:YAG laser lesions reveal precise cutting effects with a minimal thermal damage zone of 40 microns and a high damage resistance of the fiber microlens systems. The extent of thermal damage caused by the Erbium:YSGG and CO2 laser is about two times larger, whereas the Argon and Holmium laser tissue lesions show a damage of the surrounding tissue of 200-300 microns. This study suggests that for precise cutting and coagulation, Erbium and Holmium lasers transmitted via our modified fiber tip may render the use of these lasers possible in a wide range of laparoscopic surgery applications.

Animals↗
PubMed1994

Long-term results after Burch colposuspension.

OBJECTIVE: Our purpose was to review the long-term (5 to 10 years) clinical and urodynamic outcome in patients with stress urinary incontinence after Burch colposuspension. STUDY DESIGN: A follow-up of 87 women with stress urinary incontinence who had a Burch colposuspension between 1979 and 1985 at the Department of Obstetrics and Gynecology, University of Berne, was performed by clinical and urodynamic reevaluation of the patients. RESULTS: Stress incontinence was cured in 81.6% of patients. The cure rate was not significantly related to age, hormonal status, body weight, or previous surgical procedures for incontinence. Burch colposuspension stabilized the urethrovesical junction. Urodynamic measurement at follow-up compared with the preoperative evaluation showed in the cured group a significant increase in (1) the functional urethral length at rest and at stress, (2) maximum urethral closure pressure at stress, and (3) pressure transmission. On the contrary, in unsuccessful operations none of the recorded parameters had improved. Women with failed surgery had significantly lower preoperative maximum urethral closure pressures at rest and at stress, lower continence areas, smaller functional urethral lengths at stress, smaller length to peak pressures, and lower index values of urethral relaxation at stress. The procedure had a low operative and postoperative morbidity, with no significant disturbance of voiding function noted at 5 to 10 years' follow-up. CONCLUSIONS: Our results with the Burch colposuspension showed a high success rate at 5 to 10 years' follow-up. The high cure rate and low operative and postoperative morbidity were related to careful preoperative selection.

Adult↗
PubMed1993

Lasers in endoscopic surgery.

Lasers provide the endoscopic surgeon with a sophisticated tool for high precision cutting, destruction of tissue and coagulation. The laser allows efficient and time-saving operating techniques. Various laser systems emitting at different wavelengths are available. The absorption of the laser is determined by the tissue properties, such as water content or pigmentation, and varies strongly with the wavelength. Each laser offers advantages for the treatment of specific disorders. Further data from clinical studies are required to evaluate whether the advantages found in experimental studies are of significance in clinical use.

Female↗
PubMed1993

Combined bilateral tubal and multiple intrauterine pregnancy after ovulation induction.

Over the last 20 years, the frequency of multiple pregnancy has increased mainly because of the introduction of exogenous pituitary gonadotropins in the treatment of sterility. The incidence of ectopic pregnancies also increased during the same period of time. This paper describes the first reported case of a simultaneous bilateral tubal and multiple intra-uterine pregnancy after ovulation induction with human gonadotropins.

Abortion, Induced↗
PubMed1993

[Evaluation of tumor extension in invasive cancer of the uterine cervix. Diagnostic evaluation of cervix cancer].

Cancer of the uterine cervix accounts for approximately 30% of deaths from malignancies in gynecology and this rate has remained unchanged for more than 40 years. The most important prognostic factor is the extent of the disease at the beginning of treatment. There is, however, a discrepancy of some 50% between clinical and postoperative staging. The aim of this study was to evaluate different diagnostic investigations leading to the preoperative classification (FIGO) of 261 patients with cervical cancer. Data of presurgical clinical and radiological examinations were compared with postoperative histopathological findings. Rectovaginal palpation and computerized tomography (CAT) both showed a positive predictive value of 60%. The performance of CAT and lymphography in the diagnosis of lymph node metastasis was poor with positive predictive values of 36.3 and 20%, respectively. In the absence of parametrial infiltration on palpation, cystoscopy and rectoscopy are superfluous since they are always normal. Urography, because of the possibility to show the topographic anatomy of the urinary tract, was justified in all cases. The value of surgical staging and more recent techniques such as sonography and magnetic resonance is discussed.

Adult↗
PubMed1992

Detection of human papillomavirus in vulvar carcinoma. A study by in situ hybridisation.

Fourty-four specimens of invasive cancers of the vulva, including 38 primary invasive squamous carcinomas, were analysed by in situ hybridisation with biotinylated HPV 6/11, 16 and 18 DNA probes. Four (9%) of the 44 carcinomas were positive for HPV DNA: three (7%) for HPV 16 DNA and one (2%) for HPV 6/11 DNA. HPV DNA was found only in squamous carcinomas. Of the 38 primary squamous carcinomas, 11% were positive (8% HPV 16, 3% HPV 6/11). The overall 5-year survival was 48.7%, 48.5% for the squamous carcinomas and 50.0% for the HPV DNA positive patients.

Adult↗
PubMed1991

Urethral isolation of Chlamydia trachomatis in women with urinary incontinence.

The overall prevalence of Chlamydia trachomatis (CT) infection in 168 patients with urinary incontinence was 7.7%. However, in patients with urethral instability CT was found significantly more often than in those with stable urethra (P less than 0.001). Clinical and urodynamic improvement followed the treatment with doxycycline in 8 out of 9 patients with urethral instability. According to our results urethral infection with CT may play an important role in the etiology of urge incontinence and urethral instability.

Adult↗
PubMed1991

[Current suture techniques in gynecology and obstetrics].

The first part addresses general principles such as foreign body reaction, strength of sutured tissues, direction of the incision, knot technique and common suture materials. It is recommended to use fine-gauge sutures, as required by tissue strength. The continuous closure of a midline vertical incision is faster than an interrupted one or a transverse incision. In the second part, different closure techniques are discussed: closure of a vertical incision of the skin, uterine closure, episiotomy and repair of the anal sphincter.

Cesarean Section↗
PubMed1991

[Laser laparoscopy in therapy of adnexa tumors].

Of 149 laser laparoscopies 50 were performed for adnexal masses. Histological evaluation revealed benign cysts in 54%, endometrioma in 24% and other benign tumors in 14%. In 2 cases, a mucinous cyst was diagnosed, in 1 case a borderline ovarian tumor and in 1 case adenocarcinoma was found. There were no complications. 10% of the patients underwent secondary laparotomy. During the observation period, 6% of the patients required operation for recurrent disease. Low complication rate, little blood loss and a short hospital stay are advantages of laparoscopic surgery.

Adult↗