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Biomedical subjects

K Bühler

Publications and source records attributed to K Bühler.

At least 19 recordsLinked to original sources
PubMed1996

A computer based, temperature controlled bipolar electrocoagulation system.

OBJECTIVE: To reduce complications during electrocoagulation particularly injury of other organs, a computer based, temperature controlled bipolar coagulation system has been developed. Under this system temperature in the tissue is kept between 60 degrees C and 95 degrees C during coagulation. A real time graphic display provides the surgeon with an actual temperature at the tip of the forceps during coagulation. STUDY DESIGN: Rabbit uterine horns were coagulated at 90 degrees C and were examined histologically and histochemically at 6 weeks after coagulation. RESULTS: Electrocoagulation at 90 degrees C induced a total loss of LDH activity in the tissue. Lumen of the uterus was completely occluded when examined 6 weeks later. CONCLUSION: This system with low temperature is sufficient for homogenous coagulation of the tissue.

Animals↗
PubMed1996

[Results of long-term follow-up in treatment of endometriosis with the GnRH agonist leuprorelin acetate depot (Enantone-Gyn monthly depot)].

In a previous study 198 patients with histologically confirmed endometriosis underwent a "three-step" therapy, where surgical removal of endometriosis implants was followed by a 6 months treatment with 3.75 mg leuprorelinacetate depot as monthly subcutaneous injections and a second look laparoscopy with removal of residuals. In the following report long-term follow-up data generated in 112 of the above 198 patients on the post-treatment effect in respect to symptoms and pregnancy outcome in infertility are reported. For this purpose a special questionnaire was used. The follow-up period was up to 60 months with a median time of 33.5 months. Out of 112 patients 91 complained of infertility. 43 out of these 91 (47.3 %) became pregnant during the follow-up period, resulting in 55 pregnancies and 36 newborns. More than half of these patients conceived spontaneously, whereas in the rest stimulation programs became necessary. Recurrence of dysmenorrhoea, dyspareunia and pelvic pain was defined as recurrence of disease. During the follow-up period 70/112 (62.5 %) of the patients complained recurrence of symptoms with median first onset at 11 months. In two third symptoms were still less severe than at admission and classified as mild and moderate. The r-AFS score at first and second look laparoscopy did not differ in patients with and without recurrence of disease (p = 0.311 and 0.750). Only 28.6 % (20/70) of patients required an additional medical or surgical treatment. A subgroup of 51 patients could be evaluated in respect to quality of life and improvement of subjective conditions. Regain of quality of life and improvement of subjective conditions were reported in 54.9 % (28/51) and 52.9 % (27/51) respectively. The study results suggest that although the physiological effects of leuprorelin acetate treatment as suppression of ovarian function is rapidly reversible, the therapeutic effects linger, as evidenced by ongoing reduction of symptoms from baseline, leaving many patients asymptomatic or much improved longer than 1 year after treatment has ended. Besides long term relief and/or sustained reduction in symptom severity, the high pregnancy rate in infertility, as well as regain of quality of life and well being favour this therapeutic approach in endometriosis.

Adult↗
PubMed1995

Electrocauterization in rats of experimentally induced endometriosis at a low temperature.

Endometriosis was induced in 40 mature female rats by means of transplantation of endometrium on the peritoneum near the ovary. Three weeks later, all the rats were laparotomized and they were randomized into four groups according to treatment; an untreated group and three groups with electrocauterization at different temperatures. Three weeks after these treatments, they were again subjected to laparotomy and the implants were examined for their size, histology and lactate dehydrogenase (LDH) activity. In the untreated group, the size of the implants was increased significantly. Electrocauterization at a high temperature (about 300 degrees C) was enough to destroy all the endometriosis and no LDH activity was observed. Electrocauterization at a low temperature (70 or 85 degrees C) with newly developed bipolar forceps also revealed complete remission of endometriosis and there was no LDH activity in all the transplantation sites examined. These results indicate that the electrocauterization of endometriosis at a low temperature is safe and as effective as that at a high temperature.

Animals↗
PubMed1994

[Treatment of endometriosis with the GnRH agonist buserelin (Suprecur): a multicenter study].

A phase III multicentre study was carried out with the GnRH agonist buserelin (Suprecur) at five university institutions (Dept. of Obstetrics and Gynaecology of Essen, Kiel, Tübingen, Münster and Erlangen) to evaluate the effect of Buserelin (3 x 300 micrograms daily intranasal) on endometriosis for a period of 6 months. Endometriosis was verified by light microscopy in all cases. The data of 430 patients could be evaluated. The extent of the endometriotic lesions was studied before the start and at the end of therapy. The mean age of the patients was 30 +/- 5 years. For 300 patients (66.4%) sterility was a main problem. Previous treatment for endometriosis consisted of operation in 20.5%, treatment with danazol in 16.8% and treatment with gestagens in 11.6% of the patients. Under treatment FSH changed from 11.0 +/- 31.4 mIU/ml to 7.0 +/- 5.6 mIU/ml at the end of therapy; LH from 11.1 +/- 12.9 mIU/ml to 7.4 +/- 7.3 mIU/ml; estradiol from 113.9 +/- 89.0 to 35.9 +/- 60.3 pg/ml and progesterone from 7.2 +/- 11.2 ng/ml to 0.8 +/- 1.4 ng/ml. The effect on endometriosis was judged according to the revised American Fertility Society score (rAFS 1985). The changes of the rAFS-score stages were as follows (before/after therapy): Stage 0: 0%/42.8%; stage I: 43.5%/38.5%; stage II: 31.1%/11.2%; stage III: 18.1%/2.2%; stage IV: 6.3%/0.2%. The total mean AFS-stage changed from 1.9 to 0.7. The frequency of clinical symptoms improved (before/after therapy): dysmenorrhoea 65.0%/11.2%; pelvic pain 48.2%/14.1%; pain at the time of gynaelogical examination 40.0%/9.7%.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Intranasal↗
PubMed1994

[Treatment of endometriosis with the GnRH agonist leuprorelin acetate depot (Enatone-Gyn monthly depot): a multicenter study].

In an open, non-randomized prospective phase-III-study the clinical and endocrine efficacy as well as the safety of leuprorelin acetate depot (Enantone-Gyn Monats-Depot) were investigated. The therapeutic results of 198 patients, gathered from 5 university institutions and two city hospitals, are reported. Endometriosis was classified by the revised American Fertility Society score (r-AFS) before and at the end of treatment. Serum levels of LH, FSH, prolactin, estradiol, progesterone, androstenedione, testosterone and leuprorelin acetate were determined by radioimmunoassay. The mean total r-AFS score changed as follows: before surgical intervention during first-look laparoscopy 21 +/- 24 at the end of first-look laparoscopy 15 +/- 19 at the end of the GnRH-treatment 8 +/- 14 During leuprorelin acetate treatment the r-AFS stages changed as follows: [table; see text] Using the scoring system 85.2% of the patients improved. Relief of dysmenorrhoea could be achieved in 95.4%, relief of dyspareunia in 64% and of pelvic pain in 69.4% of patients. Baseline hormone levels dropped sharply during treatment. [table; see text] Androstenedione, testosterone, blood pressure, body weight, haematological parameters, liver enzymes, creatinine, electrolytes and HDL-/LDL-cholesterin remained more or less unchanged. Side effects being hot flushes, sweating, sleeplessness, headache, nausea, depression and vaginal dryness were due to estradiol deprivation. In 135 patients resumption of menstruation occurred in 95.6% within the first three months post-treatment. 23 patients of whom 21 were judged as infertile, became pregnant immediately after treatment was finished. The study results confirm the efficacy of leuprorelin acetate depot in the treatment of even advanced stages of endometriosis.

Adolescent↗
PubMed1993

[Treatment of endometriosis with the GnRH analog triptorelin with special reference to the effect on bone density].

27 patients of the department of gynecology and obstetrics of the university of Essen received a six month therapy with the GnRH-analogon triptorelin because of endometriosis diagnosed by laparoscopy. All the patients experienced not only a significant improvement in their subjective symptoms but also in their rAFS-score which was used to classify the severity of the endometriosis of our patients. We could also show that no patient experienced any severe side effects under the therapy and those side effects such as hot flushes or sweating, which appeared, were almost tolerated very well by the patients. None of the patients did leave the study because of the side effects. We were also able to demonstrate that under the therapy there was no significant loss of the bone density. The introduction of the GnRH-analogon triptorelin is therefore a major step forward in the effective therapy of patients suffering from endometriosis.

Adult↗
PubMed1993

[Perioperative preventive use of antibiotics in breast surgery: clindamycin vs. cefuroxime].

149 patients scheduled for breast surgery with an identified risk for infection received either 1.2 g Clindamycin (n = 79) or 1.5 g Cefuroxim given intravenously in a prospectively randomized fashion at induction of anaesthesia. Both drugs were well tolerated by all study patients. Postoperative fever was seen in one woman in the Clindamycin group vs. two women in the Cefuroxim group (n.s.). Serum and tissue levels measured 30 minutes after administration were within the therapeutic range for both antimicrobial substances.

Adult↗
PubMed1993

[Cefuroxime and cefoxitin in perioperative preventive use of antibiotics. A randomized study].

In a prospectively randomized study 243 patients scheduled for gynaecologic surgery received either 2 g Cefoxitin or 1.5 g Cefuroxim at induction of anaesthesia. Both drugs were well tolerated by all study patients. Post-operative fever was seen in seven women in the Cefuroxim group (n = 121) vs. three women in the Cefoxitin group (n.s., x2-test). Wound infection occurred in two women in each group. In result Cefuroxim probably can be recommended as an alternative replacing Cefoxitin in prophylaxis, so Cefoxitin can be reserved as potent antimicrobial substance for therapy of gynaecologic infections.

Adult↗
PubMed1992

Treatment of endometriosis with leuprorelin acetate depot: a German multicentre study.

During the past decade, the development of various gonadotrophin-releasing hormone (Gn-RH) agonists, which induce reversible hypo-oestrogenism has opened a new area in the medical management of endometriosis. In an open, multicentre phase III study, the efficacy, tolerance and safety of the Gn-RH agonist leuprorelin acetate were tested. The preliminary results of 104 women treated in seven German centres are presented. Pelvic endometriosis was diagnosed by laparoscopy and classified according to the American Fertility Society scoring system: 33% of patients had minimal, 22% mild, 28% moderate and 8% severe endometriosis and in 9% no pathological results were obtained. The patients' mean age was 30 +/- 6 years and 66 had infertility problems. Treatment was started within the first 3 days of the menstrual cycle and consisted of a subcutaneous injection of leuprorelin acetate 3.75 mg, repeated once monthly over 24 weeks. A follow-up period of 12 months after the last injection has been completed in 70 patients, including a second laparoscopy. At all visits, symptoms were evaluated, physical examinations performed, and blood samples collected for haematological screening, serum chemistry determinations and measurement of the gonadotrophins oestradiol and progesterone and leuprorelin acetate. The median score at laparoscopy fell from 12 before operation to 8 after operation and 2 after treatment with leuprorelin acetate. Of the total number of patients, 89% had improvements in their endometriosis, 8% a deterioration and 3% no change. Patients reported improvement in the following: dysmenorrhoea 93%, dyspareunia 62% and pelvic pain 70%. However, all women complained of at least one of the following symptoms: hot flushes 86%, sleep disturbance 62%, sweating 61%, headache 41%, nausea 32% and depression 20%. Fifty-five percent of patients reported additional side effects such as vaginal dryness, fatigue and lower abdominal pain. After the third injection, amenorrhoea persisted in 94% of the women. Four weeks after the first leuprorelin acetate injection median concentrations of oestradiol fell from 45 pg/ml to 11 pg/ml, follicle-stimulating hormone from 7 U/L to 3 U/L and luteinising hormone from 5 U/L to 1 U/L and remained almost unchanged over the observation period. During the 6 months' treatment, laboratory parameters showed no significant deviations from normal; only total cholesterol, high-density lipoprotein cholesterol and alkaline phosphatase increased. Treatment results were judged as good and satisfactory in 82% and 11% of cases, respectively. On the basis of this study, it can be concluded that leuprorelin acetate treatment is safe, well tolerated and effective in the medical management of endometriosis and endometriosis-related complaints.

Adult↗
PubMed1992

Influence on hormone levels, lipid metabolism and reversibility of endocrinological changes after leuprorelin acetate depot therapy.

The effect of leuprorelin acetate depot on the endocrine system and on lipid metabolism was evaluated in a multicentre, noncomparative study. During the first month of treatment, suppression of serum oestradiol levels to below 20 pg/ml was achieved and luteinising hormone and follicle-stimulating hormone levels were reduced to less than 50% of pretreatment values. A negative influence on lipid metabolism was not recorded. The high-density lipoprotein/low-density lipoprotein ratio did not change during therapy. Resumption of menstruation occurred within a mean period of 3 months after the last leuprorelin acetate depot injection.

Bone Density↗
PubMed1992

Plasmatic haemostasis in gonadotrophin-releasing hormone analogue therapy: effects of leuprorelin acetate depot on coagulatory and fibrinolytic activities.

The plasmatic parameters of coagulatory and fibrinolytic activity were studied in 15 patients with biopsy-proven endometriosis treated with leuprorelin acetate for 6 months. Bleeding time remained constant, indicating the absence of increased bleeding tendencies. The activity of the main inhibitor of the fibrinolytic response, plasminogen activator inhibitor, was reduced by 25%, suggesting an improvement in fibrinolytic reactivity. Plasma levels of fibrin degradation fragments were reduced by 35%, suggesting a marked reduction in the rate of fibrin generation and degradation. A simultaneous reduction in thrombin-antithrombin III complexes and prothrombin fragment 1 + 2 (-10%) indicated that this effect was induced by reduced procoagulant activity, ie, thrombin generation. These data indicate that in gonadotrophin-releasing hormone (Gn-RH) analogue therapy the basal rate of coagulatory processes is reduced. The frequency and extent of fibrin-generating and degrading processes are reduced, suggesting a beneficial effect of Gn-RH analogues on the risk of thromboembolic disease.

Antithrombin III↗
PubMed1992

Experience with leuprorelin acetate depot in the treatment of fibroids: a German multicentre study.

Between October 1988 and October 1990 in a noncomparative multicentre study, 114 patients were treated for uterine fibroids with the gonadotrophin-releasing hormone (Gn-RH) agonist, leuprorelin acetate depot. The mean age of the women was 33 years and 55.3% of them had a history of infertility. After confirmation of the diagnosis by ultrasound and/or operation, treatment began between day 1 and 3 of the cycle with leuprorelin acetate depot 3.75 mg subcutaneously. Therapy was carried out for a total of 6 months with one injection every 4 weeks. Treatment was paralleled by measurements of endocrine and metabolic parameters, estimation of myoma and uterine size by ultrasound and self-reporting of the patients of drug-related complaints. Four of the 114 women did not complete the whole treatment, two of them because of general side effects, one because of carcinophobia and unsatisfactory regression of the myoma and the last one for unspecified reasons. During treatment, a mean reduction of the uterine volume of about 67% was observed, in conjunction with shrinkage of the myoma in 92.1% of cases (mean decrease of 56% of the fibroids) with a large interindividual difference. Maximal diminution of uterine and fibroid size had been nearly completely reached within the first 12 weeks of therapy. After 4 weeks of the Gn-RH agonist depot most of the patients had achieved postmenopausal status, which continued throughout the remaining 20 weeks of treatment. In accordance with this finding, the majority of general side effects was due to the hypo-oestrogenic endocrine status. Liver and lipid metabolism was almost unaffected, although increasing calcium and alkaline phosphatase serum levels as well as an increased urinary calcium/creatinine ratio demonstrated an increased metabolic turnover of the bone. Haemoglobin concentrations, however, increased in those cases with fibroid-related anaemia. Thus the slow-release form of leuprorelin acetate is an adjunct to myomectomy especially in those women in whom family planning is not yet completed.

Adult↗
PubMed1991

[Temperature-controlled bipolar electrocoagulation].

The safety of electrocoagulation for laparoscopic surgery has been greatly improved by the introduction of the bipolar coagulation technique. But complications caused by coagulation, especially by the overheated forceps, are still reported. In order to reduce those complications, a temperature controlled bicoagulation system was developed. This system allows coagulation with lower temperatures which can be kept constant during the coagulation process. In experiments with human fallopian tubes obtained by adnexectomy and rabbit uterine horns it is shown that those lower temperatures are sufficient for homogeneous coagulation. On line monitoring of the temperature during coagulation provides the surgeon with the possibility of directly controlling the actual temperature at the tip of the forceps. The temperature curves can easily be stored in order to be able to demonstrate the particular coagulation process even after years.

Animals↗
PubMed1988

[Nuclear magnetic resonance imaging in gynecology. An evaluation of its current applications].

The authors present a research carried out by the Universities of Essen, Tubingen (RFA) and Grenoble, France, on the use of magnetic resonance imaging (M.R.I.) in gynaecology. After clarifying our knowledge of the normal anatomy of the pelvis and of the tissular characteristics of MRI the principal indications are discussed and set out. The investigation is shown to be particularly valuable in working out the aetiology, the volume and the spread of a pelvic mass whether it is benign or malignant when it is important to be exact in finding the origin of the tumour. This research has been illustrated by analysing 35 case histories including 28 malignant tumours. A second study was carried out on 30 cases of cancer of the cervix. In this field MRI is the only test that can be carried out before therapy to give a tridimensional assessment of the size of the tumour and whether it has spread into the parametrium. The visual impressions obtained by MRI illustrate each chapter: of the gynaecological anatomy, of the pathology, in cancers of the cervix, in pelvic masses and particularly in ovarian tumours.

Female↗
PubMed1986

[Fetal monitoring sub partu in West Germany. III. Associations].

If the number of births per year at a clinic is divided by the number of available cardiotocographs, a variable is obtained, designated Q, which reflects the electronic fetal monitoring situation: the larger Q is, the more births per cardiotocograph, and the less satisfactory is the fetal monitoring situation. The smaller Q becomes, the greater the probability that every fetus can be monitored sub partu. Q has an empirical distribution pattern. The median of Q is between 139 and 215 births per year and per monitor, depending on the size of the clinic. There is a significant relationship between the monitoring value Q and the percentage frequency of cesarean and forceps deliveries: the higher the potential monitoring capacity, i.e., the smaller Q is, the higher the number of cesarean and forceps deliveries of a clinic. Intensive monitoring therefore increases the number of surgical deliveries, though no drop in the unadjusted perinatal mortality rate was observed. No association could be established between Q and the risk of fetal acidosis - possibly due to a lack of data. The conclusion drawn from these data is that the theoretical and practical training of obstetricians and midwives in cardiotocography should be further intensified.

Cesarean Section↗
PubMed1986

[Fetal monitoring sub partu in West Germany. II. Effect of clinic size and clinic type on monitoring practice].

Data from 690 clinics concerning obstetric management and intensive monitoring of the fetus sub partu were classified according to the type of hospital (e. g., municipal clinic, district hospital...) and the size of the hospital based on the number of births per year. On the basis of the annual number of births four groups (I-IV) were formed, each with 172 clinics. While the average number of surgical deliveries (cesarean, forceps, vacuum) is not related to the hospital (Table 3), it is related to the type of hospital (Table 6): the average number of cesarean deliveries is highest in university clinics (n = 24; 14.9%), and on average more forceps (6.5%) than vacuum extractions (5.7%) are performed. In all other hospitals vacuum extraction is clearly preferred (7-8%). The quotient Q of the annual number of births per CTG unit is not constant, but increases with the size of the clinic: In large hospitals (Group IV) significantly more births are monitored with a CTG unit (maximum 607, average 215), so that there is a numerical "monitoring deficit" as compared to smaller departments. The monitoring capability is numerically highest in the university clinics (Q = 147) and lowest in the academic teaching hospitals (Q = 192). The larger the clinic, the more frequently fetal blood is analyzed: the figure in large clinics is 40%. Small clinics are less familiar with this method (approx. 16%). The larger the clinic, the more often intrauterine catheters are used to measure labor; the figure rises from 7% to 29%.(ABSTRACT TRUNCATED AT 250 WORDS)

Birth Rate↗
PubMed1986

Identification and quantitation of angiotensins.

The introduction of pharmacological inhibitors of renin and angiotensin (ANG) converting enzyme in cardiovascular therapy drew new attention to the role of the renin-angiotensin system in regulating circulatory homeostasis. Accurate measurement of very low concentration of the biologically active peptides ANG II and ANG III sometimes in the presence of large amounts of inactive precursors and metabolites is needed. Active and inactive angiotensins have been measured specifically in attomolar quantities by radioimmunoassay after rapid extraction on bonded-phase silica and subsequent high-performance liquid chromatography. ANG II was found to be generated in cold plasma containing conventional inhibitors; it was concluded that renin, converting enzyme, and angiotensinases must be inhibited if physiological ANG concentrations are to be estimated. Modification of the antigen enhanced the specificity of the ANG II antisera. Monoclonal antibodies to ANG II were produced.

Angiotensin II↗