The modern role of hysteroscopy in the care of women.
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Biomedical subjects
Publications and source records attributed to H J Lindemann.
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During a diagnostic CO2-hysteroscopy in general anesthesia, a manifest gas embolism with a resulting drop of the endexpiratory CO2 partial pressure occurred upon insertion of the instrument. By ending the procedure and through appropriate anesthesiological measures, the occurrence was brought under control and the embolism had no clinical consequences. The incidence encouraged us to reconsider the CO2-hysteroscopy examination technique. As a result, we describe an up to now neglected mechanism which may lead to air embolism in gas hysteroscopy: Similar to hysteroscopy with fluid distension, the whole system has to be purged from air by insufflating CO2 prior to examination. If this step is neglected, up to 40 cm3 of room air may be insufflated into the patient, considering a connective tubing of 200 cm length and 0.5 cm lumen. The scientific organisations as well as the endoscopic training centers and the manufacturers of hysteroflators are challenged to deal with this newly described potential cause of complications.
Hysteroscopy is rapidly becoming a common examination for every gynecologist. As an office procedure, it is one of the most valuable ways to detect intrauterine lesions. Benign and malignant changes in the endometrium can be diagnosed at an early stage, and problems in the uterine cavity that can cause sterility can be recognized and treated.
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The use of hysteroscopy has been restricted a.o. by the need for general anesthesia. This applies in particular to the pre- or post-partum period, because the hyperemic atonic uterus is easily over-inflated to a dangerous level. Over-inflation did not occur following 50 aspirotomy D & E procedures in the second trimester, using a para- and intracervical block with lidocaine 1% with adrenaline 1:200,000 only. The uterine cavity was always thoroughly evacuated in these cases in which final check suction had been performed. We recommend that postabortum hysteroscopy should be performed preferably under local anesthesia.
Basing on our research work in hysteroscopy, we used recently developed small endosonographic sounds for intrauterine and later vaginal approach, for the first time in 1981. We call this method endosonography. The equipment used so far is described, the procedure explained, and the efficacy of this new technique demonstrated via several endosonograms. The advantage to transabdominal sonography is the close contact of the ultrasound transducer with the organ to be examined. This enables the use of high frequencies with correspondingly good resolution. Finally, our own experience is discussed.
3120 patients have been sterilized by laparoscopic tubal bipolar coagulation. The operations were performed in an outpatient procedure. 0.096% severe complications during surgery were caused. The pregnancy rate was 0.06%. Our experiences and results confirm the low risk outpatient way of laparoscopic sterilization as reported in Anglo-American literature.
A survey of intra-uterine endoscopy over the last years is given showing the increased demand for hysteroscopy for diagnosis and therapy of intra-uterine diseases. Its indications include the search for unknown causes of uterine bleeding or sterility. It is also applied for various therapeutic reasons such as for example the search and removal of lost or embedded intra-uterine devices. The different methods of hysteroscopy--particularly the CO2 hysteroscopy, which we developed, are described. The new examination procedures such as for example the extensive penetration test applied in cases of sterility and others, which through the advances made in technology are now possible, are also discussed.
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Transabdominal amniocentesis and occasionally fetoscopy are used as a means of early diagnosis of fetal damage or abnormality after the 14th week of pregnancy. For medical reasons a still earlier method of diagnosis is desirable. We report about the transcervical approach- using CO2-gas-hysteroscopy to visualize the amnion sac and its contents.
Sparing termination of pregnancy with a low incidence of complications, using the drainage method in local anaesthesia, can be effected on an outpatient basis. Carticain, which is a rapidacting anaesthetic with good analgesic effect, enables practically painless dilatation of the cervical channel with subsequent evacuation, when combined with good psychological guidance of the patient. When questioned postoperatively, practically all patients were in favor of local anaesthesia. Another positive aspect, in their opinion, was the fact that they could be discharged after brief hospitalization. Furthermore, treatment on an outpatient basis is cost-saving.
By Sonography changes of the non-osseous parts of the fetal body are just as recognizable as any malformation of the skull and skeleton. We report about a severe case of double cleft formation. The prenatal diagnosis pre-determined our intranatal care and method of delivery.
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90 hysteroscopies using CO2 were performed to evaluate differences in effectiveness between the customary curettage and the suction methods in terminating pregnancy during the first trimenon. Following suction, the uterine cavity was nearly always thoroughly evacuated. Very seldom is there any residual tissue seen. On the contrary, the uterine cavity following termination by customary curettage was almost never completely evacuated. Very often rest tissue of decidua, usually chorionic, in some cases with villous structures, were found. Tissue remnants following termination by either method were removed by target biopsy or curettage and examined histologically. Having made the above observations and comparison, it must be concluded that the suction method is clearly the more advantageous. If applied correctly, it becomes unnecessary to perform curettage right after the suction.
Present-day procedures for the sterilization of women are discussed. In particular, the possibilities of inpatient and ambulant treatments and their efficacy and risks are gone into. The hypsteroscopic transuterine tubal sterilization is reported as a new method which is still in the experimental stage. If the same sucessful results are achieved as with the sterilization methods already known, its advantages would be: a short ambulant procedure; local anesthesia, therefore no risk from the anesthetic point of view; avoiding the abdominal cavity, consequently no complications involving the peritoneal space such as are usually encountered with all other sterilization procedures; low risk of morbidity; the patients are not disabled; very low cost factor.