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Biomedical subjects

H Hepp

Publications and source records attributed to H Hepp.

At least 145 records · Page 8Linked to original sources
PubMed1989

[Differential indications for surgical technics in reproductive medicine--microsurgery, in vitro fertilization and embryo transfer, gamete intrafallopian transfer and tubal embryo transfer].

The birth of the first baby following in-vitro fertilisation and embryo transfer (IVF/ET) in 1978 and the introduction of gamete intrafallopian transfer (GIFT) in 1984 have increased the treatment modalities in operative reproductive medicine. In tubal pathology, there are besides micro-surgery now so-called additive methods available for treating infertility. With regard to the indications, there has been severe confusion, and it is therefore imperative to define special indications for IVF/ET, microsurgery and GIFT. We do not consider these treatment modalities as alternative methods. Reproductive centres should offer all these treatments to guarantee an appropriate individual programme for each couple. Therefore, knowledge of pregnancy rates is a prerequisite for the doctor. The aim of this paper is, to define the optimal therapy while taking into account the individual problems of each couple.

Embryo Transfer↗
PubMed1989

Selection of patients for IVF therapy or alternative therapy methods.

Microsurgery is the treatment of choice for most patients with a tubal factor. In-vitro fertilization--embryo transfer (IVF-ET) is performed in patients with the so-called classical indications: bilateral salpingectomy and tubal damage which is not correctable by means of microsurgery. We also discuss IVF in patients who have not conceived within 1 to 2 years following microsurgery. In women with tubal re-occlusion IVF should be performed. In patients with patent tubes following microsurgery, gamete intra-Fallopian transfer (GIFT) forms part of a controlled clinical study. More clinical experience can perhaps solve the dilemma whether it is beneficial to perform GIFT or to offer IVF primarily to these patients. In patients with andrological infertility, GIFT is offered after six unsuccessful attempts of intrauterine insemination (IUI). In long-standing infertility, GIFT is performed when IUI with ovarian stimulation fails. Patients with genital pathology (patent tubes) are treated with GIFT unless it is not technically feasible. In these cases microsurgery or IVF should be discussed.

Embryo Transfer↗
PubMed1989

Gamete intra-fallopian transfer in male sub-fertility.

Between July 1985 and July 1987, GIFT was performed in 69 out of 255 patients (87 of 333 treatment cycles) treated because of male infertility. In this group a pregnancy rate of 30% per cycle was achieved, compared to an overall pregnancy rate of 35%. Indications for GIFT include long-standing infertility that has not responded to any other method of treatment, andrological sub-fertility and various forms of genital pathology with patent tubes. These results show that the pregnancy outcome after GIFT in couples with severe male infertility is significantly lower than that following GIFT in patients with long-standing infertility. The pregnancy rates seem, however, much higher than those achieved using intrauterine insemination. In this paper, the results of treating couples with male sub-fertility by GIFT are discussed in detail.

Adult↗
PubMed1988

[Serum CA 125 values and histologic findings at the time of second-look laparotomy in ovarian cancer].

In a prospective study CA 125 serum levels of 99 patients with ovarian cancer were determined serially. 50 of 55 patients with second-look-laparotomy elevated levels initially had. We were interested in particular in the correlation between CA 125 and the histological findings at second-look operation. In 16 patients there was no residual tumor, CA 125 was in the normal range. In 34 the women tumor tissue was demonstrated; CA 125 was elevated in 14 patients, so there were 20 patients with false negative CA 125 serum levels. No false positive CA 125 values were found. In all patients with elevated tumor marker the residual tumor was histologically confirmed at second look. To verify a complete remission, a second-look operation will have to be performed in spite of a negative tumor marker, since active tumor tissue might still be present. In patients with elevated CA 125 a second-look laparotomy should be avoided at this time.

Antigens, Neoplasm↗
PubMed1988

[Prognostic factors in the indication for labor induction after previous delivery by cesarean section].

The relative importance of prognostic factors in the management of delivery after caesarean section was investigated retrospectively in 300 patients who gave birth between January 1984 and April 1986. Important factors included the parity of the patient (p less than 0.0001), the number of previous caesareans (p less than 0.001), the Bishop's Score on admission (p less than 0.005) and the indication for the previous caesarean section (p less than 0.05). On our series gestational age (p = 0.042) and estimated birthweight (n.s.) were only marginally statistically significant.

Birth Weight↗
PubMed1987

CA-125 in gynecological malignancies.

CA-125 is an antigenic determinant that can be demonstrated in the majority of epithelial ovarian carcinomas. It can be measured in the serum with a radioimmunoassay by means of a monoclonal antibody. The tumor marker has a low specificity but high sensitivity for ovarian cancer, especially for serous cystadenocarcinoma. In our investigation we were interested in particular in the correlation between CA-125 and the histological findings at second-look operation. In 22 patients, second-look was performed after 6 cycles of chemotherapy, in 16 patients active tumor was demonstrated. In 6 patients with negative CA-125 values, residual tumor less than 1 cm was demonstrated. In order to verify a complete remission, a second-look operation has to be performed. No false-positive CA-125 levels were found. In all patients with elevated CA-125 serum values, residual tumor was histologically confirmed at second look.

Antigens, Neoplasm↗
PubMed1987

[Prenatal diagnosis of non-viable fetuses caused by developmental disorders--an indication for abortion for fetal reasons?].

Between October 1st 1983 and January 31st 1986 we diagnosed various anomalies on 116 foetuses at the Department of Obstetrics and Gynaecology, Klinikum Grosshadern, Munich. In 103 cases we made a correct diagnosis. This group of patients included 45 non-viable foetuses. Severe anomalies of the foetal central nervous system and lethal dwarfism were diagnosed correctly. On the other hand, antenatal diagnosis of bilateral nonfunctional kidneys and non-correctable cardiac malformations poses problems. We feel that in the case of a definitive prenatal diagnosis of an anomaly for which there is no known medical treatment and which is not compatible with life, the decision as to further procedure should be made at this stage. Before 24 weeks gestation, termination of pregnancy on foetal grounds should be discussed with the parents. Thereafter, preterm labour is preferable to the dangers of obstructed labour at term and should be conducted without foetal monitoring.

Abortion, Eugenic↗
PubMed1987

[Pathology of proximal tubal occlusion--morphologic evaluation. Results following microsurgical anastomosis].

Even today, the etiology of proximal tubal occlusion is still a controversial subject. The introduction of microsurgery in gynecology has provided a method of eliminating the main symptom of proximal tubal occlusion, i.e., sterility. Pregnancy rates of 25-30% can be achieved in overall patient collectives. Accurate histologic analyses of the specimens are essential for clinicopathological classification in three prognosis groups. For stage I patients, pregnancy rates of up to 50% (patient-related) can be achieved. Postoperative counseling can thus be differentiated on the basis of the histological results. For stage III patients the pregnancy rate is unlikely to be acceptable, even after waiting for a prolonged period of time. It has not been established whether reconstructive tubal surgery or alternative therapeutic procedures (I.V.F. and E.T.) have better chances of success in stage II. Accurate histologic analysis of the surgical specimens is an essential prerequisite for individualized sterility counseling and therapy.

Constriction, Pathologic↗
PubMed1987

[Intratubal gamete transfer--results of 219 treatment cycles in idiopathic sterility, andrologic subfertility and selected forms of genital pathology].

Gamete Intra Fallopian Transfer was performed in 175 patients in 219 treatment cycles during the period July 1985 to December 1986. This resulted in a total of 82 clinical pregnancies. Multiple pregnancy occurred in 16 cases, two of which were triplet pregnancies and one a quadruplet pregnancy. There were 16 abortions and five pregnancies were extrauterine. Besides presenting the technique of intratubal transfer of gametes, the authors give detailed information (with discussions) on pregnancy rates in idiopathic sterility, on andrological subfertility and on selected forms of genital pathology.

Adult↗
PubMed1986

[Status of obstetrical anesthesia in Germany].

A study on actual trends in obstetric analgesia and anaesthesia was conducted on data received from 385 German departments of obstetrics with a total of 267441 deliveries. On the basis of these extensive data quantitative results could be obtained about analgesic procedures for spontaneous deliveries, operative-vaginal deliveries, Caesarean sections and in cases of foetal or maternal risks. The type of analgesics and local anaesthetics used, their side effects and complications were recorded. In addition the cooperation and interaction between obstetricians and anesthesiologists in practising and monitoring obstetrical analgesia and anaesthesia are described.

Analgesia↗
PubMed1985

[Organ-saving surgery of tubal pregnancy].

Recently a number of authors have published their results of conservative treatment in tubal gestations. Numerous operative techniques have been described. This review tries to summarize the different operative approaches under special consideration of microsurgical techniques in regard to the authors experience. As a general rule conservative management of tubal gestation can be performed more extensively in the future.

Fallopian Tubes↗
PubMed1985

[Pregnancy following intrafallopian gamete transfer].

Gamete intrafallopian transfer has been performed since April 1985 in our hospital. In patients with a long history of infertility despite proved tubal patency, the follicles present at laparoscopy are aspirated. The oocytes thus obtained are introduced together with the prepared sperm via a special catheter directly into the ampulla. We would like to report on the first pregnancy for which we used this technique.

Adult↗