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Biomedical subjects

K Semm

Publications and source records attributed to K Semm.

At least 19 recordsLinked to original sources
PubMed1992

Macrophage- and lymphocyte-subtypes in the endometrium during different phases of the ovarian cycle.

The presence of immunocompetetive cells in the endometrium during the proliferative and secretory phase of the ovarian cycle is demonstrated on the light and electron microscopic level using monoclonal antibodies (MoAb). Subtypes of monocytes, macrophages and T-lymphocytes appear during the different phases in variable extent and different localization. Some subpopulations of the monocyte/macrophage system and T-helper lymphocytes increase in number on day 21/22. Our observations indicate that cells with bone marrow origin take part in functional events of the endometrium during the ovarian cycle.

Antibodies, Monoclonal↗
PubMed1992

[Retrospective comparative study of the treatment of tubal pregnancy by pelviscopic surgery or prostaglandin injection].

The incidence of tubal pregnancy has been increasing in recent years. The improvement in diagnostic procedures leads to an early detection of tubal pregnancies. As a result, conservative treatment modalities are more feasible today. In this study, we compared the treatment of tubal pregnancy by means of locally applied prostaglandin with pelviscopic surgery. 75 patients with an early tubal pregnancy were included in each group. The comparison between the two groups showed, that prostaglandin treatment has a higher failure rate, than treatment by pelviscopic surgery. However, postoperative fertility indicated better results in the prostaglandin treated patients.

Adult↗
PubMed1992

[Total ablation of uterine mucosa (TUMA)--C*U*R*T* instead of endometrium ablation].

Hysteroscopic ablatio endometrii, a procedure established in gynaecology as a result of the general trend to minimal invasive surgery, is clinically not very satisfactory. A new procedure, namely, transvaginal pelviscopically monitored cervix/cavum uteri fundus punch via C*U*R*T* (Calibrated Uterine Resection Tool) enables removal of the total endothelium from the uterus. TUMM (total uterine mucosa ablation) is a synthesis of pelviscopy, excoriation by conisation, and ablatio. This procedure may be considered as the presently optimal method to avoid hysterectomy in case of special indications.

Dilatation and Curettage↗
PubMed1992

Pelviscopic treatment of ovarian cysts in premenopausal women.

Between 1984 and 1989, 773 patients less than or equal to 45 years of age, presenting with a total of 809 ovarian cysts, underwent pelviscopy at the Department of Obstetrics and Gynecology of Kiel University. In 36 cases, cysts were bilateral. 678 cysts (84%) were treated by pelviscopy alone. Organ-preserving treatment was performed in 83%, oophorectomy or adnexectomy in only 17% of cases. Two stage Ia ovarian carcinomas (0.26% of all cysts) were operated on by pelviscopy before laparotomy. Sonography is particularly important in determining whether a pelviscopic approach is appropriate. Pelviscopic procedures are unacceptable in multilocular cysts measuring greater than or equal to 7 cm in diameter with echo-dense components. Special caution is required for any cyst measuring greater than 9 cm in diameter. The risk of opening a malignant cyst must be weighed against the advantages of pelviscopic surgery: minimal physical strain, better postoperative quality of life, and organ conservation. In doubtful cases, laparotomy is recommended.

Adenocarcinoma↗
PubMed1992

Pelviscopy/laparoscopy and its complications in Germany, 1949-1988.

The fourth German pelviscopy/laparoscopy statistical report includes survey data on a total of 219,314 laparoscopies from 354 clinics and 40,892 laparoscopies from 161 private practices. Clinics' response rate was 44.7%; 98.9% of them reported performing laparoscopies; and the number of serious complications requiring laparotomy or control laparoscopy was 492 (2.2/1,000). For private practices, the comparable figures were 66%, 90.8% and 123 (3/1,000), respectively. Compared with data from the third laparoscopy statistical survey, the data show a slight increase in serious complications, most of which were mechanical lesions of blood vessels in the abdominal wall or in the mesosalpinx, followed by mechanical lesions of the intestine. As shown by the previous survey, 16.5% of the complications were burns. For tubal sterilization, bipolar techniques were still predominant; approximately equal numbers of departments used this method, with or without subsequent transsection of the tubes. Endocoagulation by the method of Semm was the second most popular procedure; the use of clips and rings was of little significance. Monopolar high-frequency (HF) current was still used with transsection by 4.1% of clinics (4.7% of private practices) and without transsection by 2.5% (5.3%). Sterilization failure rates remained the same as those previously reported (4.6/1,000 in clinics, 5.3/1,000 in private practices); the highest rates were observed after the use of monopolar HF techniques. Sixty-six percent of the clinics and 41% of the private practices reported their intention to increase the use of endoscopic operational methods.

Female↗
PubMed1991

Width of thermal damage after using the YAG contact laser for cutting biological tissue: animal experimental investigation.

At the University Women's Clinic in Kiel, the YAG contact laser has been used as a cutting instrument in pelviscopic operations since 1987. When the laser cuts, it produces only a scant amount of mechanical trauma. The determining factor is the amount of thermal damage produced along the wound margins and in direct neighboring tissue. The extent of the tissue change seen in the uterus and liver parenchyma of rats and the striated muscle of rabbits after application of the YAG contact laser was demonstrated using various staining techniques and stains. Liver parenchyma proved to be the most sensitive to thermal damage. In the uterine horn, enzyme-histochemical ATPase and alkaline phosphatase demonstrations showed a significantly wider zone of thermal damage after laser incision than did hematoxylin-eosin and Goldner staining techniques. A good understanding of the extent of thermal damage is essential for atraumatic pelviscopic operations using the YAG contact laser and also for the preventing of complications.

Abdominal Muscles↗
PubMed1991

Incidence of adhesions following thermal tissue damage.

Coagulation and vaporization of tissue are techniques applied in pelviscopic surgery in order to achieve hemostasis as well as cut and destroy endometriotic implants. An animal experimental study was devised to show if there is a difference in the incidence of adhesions after vaporization of equal-sized areas of the anterior abdominal wall of the rat compared to coagulation of equal-sized areas. A similar depth of the lesions was achieved by repeating the vaporization procedure. The rate of adhesions was significantly lower (P less than 0.001, Chi2-test) post-coagulation, using a biopolar high frequency current or post-endocoagulation than post-vaporization. The surface vaporization of tissue, for example endometriotic implants, as produced by laser is to be viewed critically as regards the higher incidence of adhesions after vaporization compared with coagulation.

Abdominal Muscles↗
PubMed1991

[Pelviscopic ovarian surgery--a retrospective study of 1,016 operated cysts].

In 969 patients, we observed 1016 ovarian cysts at pelviscopy between the years 1984-89. 36 of these were non-benign. On the basis of the pre- and intraoperative findings (palpation, sonography, inspection of the cyst surface under eye-glass magnification) we treated 827 cysts exclusively by pelviscopy, 189 cysts by laparotomy. Laparotomy was preceded by pelviscopic surgery on the cyst in 94 cases. None of the pre- and intraoperative findings completely eliminated the risk of performing pelviscopic surgery on a stage Ia carcinoma; indeed, this occurred in 2% (2/1016).

Adolescent↗
PubMed1991

[Morcellement and suturing using pelviscopy--not a problem any more].

The new serrated-edge macro-morcellator (S.E. M.M.) enables the punching out of tissue cylinders up to a size of 10 x 1.5 cm diameter. If used together with a myoma drill, large holes can be punched into tumours, making them for the first time well palp-able and revolvable. With the help of needle hook bearers and an intracorporeal knotting technique it becomes possible, both to perform deep-seated sutures of muscles of the uterus, and one can use commercially available atraumatic suturing material with straight or hooked needles.

Equipment Design↗
PubMed1991

[Hysterectomy via laparotomy or pelviscopy. A new CASH method without colpotomy].

Total Hysterectomy has been until non performed by extracervical "enucleation" of the fascia of the uterine corpus with amputation of the vagina. The new method leaves the extrafascial highly vascularised vascular stem, the corresponding nerves and the topography of the ureter untouched. It is limited to an intrafascial cylindriform enucleation of the cervix. The diameter of the cervical cylinder can be determined beforehand by vaginal sonography. Punching-out is effected from a new instrument C.U.R.T. (= calibrated uterine resection tool) of 10-20 mm diameter. A cervicohaemostaser provides for safe transvaginal haemostasis in the residual cervix. The transvaginal sexual sensations of the patient are not impaired due to the fact that the cardinal ligaments are preserved as well as the nerve supply of the cervical fascia. Suspension of the cervical fascia at the supporting ligaments of the uterus can be performed in an ideal manner. Pelviscopic extirpation of the uterus is done in the classical way used in abdominal hysterectomy with ligature and suture. Morcellated cylinders of 2-3 cms in diameter, of the cervix and corpus uteri and even of myomas up to the size of a child's head, will suffice for relevant histological examination. The physical stress to which the patient is exposed is about the same as in routine surgical pelviscopy. The abdominal space remains practically unopened in pelviscopic transabdominal hysterectomy. Pelviscopic transabdominal hysterectomy with and without adnexae according to the CASH technique corresponds to surgery performed with a minimum of invasiveness. It is fully sufficient as regards cancer prophylaxis with respect to cervical or endometrial cancer.

Female↗
PubMed1991

Pelviscopic surgery: a key for conserving fertility.

As a result of experience with more than 16,000 pelviscopic operative procedures performed at the Kiel University Women's Clinic from 1971 to 1988 which in this time had been adapted and used around the world, it may be said that the pelviscopic operative techniques, based completely on the laparotomy techniques which employ the microscissors, needles and suture material, is superior for many of the classical gynecological indications to operation. Minimally invasive surgery reduces hospitalization for even the most difficult cases to approximately 3 days. Convalescence is also reduced to approximately 1 week. Postoperative complaints are few, particularly when the primary exudate is removed through an abdominal drain. Late complications are practically unknown. It must be said that even the most minimal of operative procedures can produce late postoperative complaints or can be ascribed as the source of late postoperative complaints. Experiences gathered from around the world with endoscopically guided intraabdominal surgery have shown that for some gynecological procedures laparotomy is now indicated only in the rare case. The leading example of this switch can be seen in the operative treatment of the ectopic pregnancy. Following closely are operations to correct sterility such as salpingolysis, ovariolysis, fimbrioplasty, and salpingostomy. Finally pelviscopic treatment is increasing for all benign ovarian tumors, and the enucleation of myomas of up to 400 grams in weight. Endoscopically guided intraabdominal surgery also has a place in the field of general abdominal surgery--that of treatment of chronic abdominal adhesions. These procedures in the future should basically commence with endoscopic adhesiolysis, the patient having had the proper preoperative bowel preparation. Because of this minimally invasive technique the surgeon will only rarely be forced to perform laparotomy. In the case of abdominal adhesions a prerequisite for pelviscopic treatment is the visually controlled perforation of the peritoneum. Endoscopic surgery, in contrast to open laparoscopy, has a large periumbilical radius of action and produces no postoperative scars. In Kiel operative pelviscopy has replaced 80% of the classic gynecological laparotomies. The recurrence rate of adhesions is 84% with laparotomy compared with a recurrence rate of less than 40% with postendoscopic adhesiolysis. Forty to sixty percent of the patients who underwent pelviscopic adhesiolysis are complaint-free; this is a result not attained with classical abdominal surgery. Adhesiolysis per laparotomy is now limited to the emergency situation, as in the cases of ileus, for example. Endoscopically guided intraabdominal surgery has now improved the quality of life for surgical patients.

Abdomen↗
PubMed1991

Pelvic abscesses: pelviscopy or laparotomy.

Between 1983 and 1988, we treated 66 patients with pelvic abscesses. Twenty-five patients required laparotomy and 41 underwent pelviscopy for treatment. The choice of the operative procedure, laparotomy or pelviscopy, depended on the age of the patient, the clinical presentation and the operative findings. The two collectives demonstrated no differences in the duration of hospitalization and in-patient treatment with antibiotics. A conservative, organ-preserving procedure could be performed in 80% of patients operated pelviscopically. In follow-up examinations 1-2 years after operation, 27% of the patients treated per pelviscopy complained of chronic abdominal pain as compared to 37% of those treated per laparotomy. In young patients, pelviscopic treatment of pelvic abscesses is a valuable alternative to laparotomy.

Abdominal Pain↗
PubMed1991

Pelviscopy.

Pelviscopy, along with the entire concept of minimally invasive surgery through endoscopically guided intra-abdominal surgery, has become a mainstay in gynecologic surgery. The review of instrumentation in this field includes comments on the CO2-Aqua-Purator, CO2 insufflator, round-grip instruments, electrocautery, endocoagulator, and lasers. Detailed procedural descriptions are given of visually controlled peritoneal perforation and second-look pelviscopic procedures are given in the second section, and the final section covers the role of pelviscopy in the treatment of endometriosis, polycystic ovarian syndrome, and pelvic inflammatory disease.

Endometriosis↗
PubMed1990

Pelviscopic tubal surgery: the acceptable vogue.

A retrospective analysis undertaken at the University of Kiel by the Department of Obstetrics and Gynaecology, consisted of a 3-year study of cases of tubal surgery with operative pelviscopy (laparoscopy). In the period from 1987 to 1989, 529 patients underwent selective operative laparoscopy specifically because of a tubal factor of infertility. The type of surgery performed was aimed at the conservation and salvaging of the tubes whenever possible, according to the principles of 'Minimally Invasive Surgery'.

Fallopian Tubes↗
PubMed1990

[Incidence of intra-abdominal adhesions following pelviscopy and laparotomy].

In 500 non-selected conservative pelviscopic operations the incidence of the presence of intraabdominal adhesions were compared in patients having had no previous operations, those having had a previous pelviscopy, those having had a previous pelviscopy and laparotomy, and those having had a previous laparotomy alone. The group of patients having undergone no previous operations were found to have the least amount of adhesions followed by those having undergone pelviscopy alone. The highest percentage of intraabdominal adhesions were found in the group of patients having undergone a previous laparotomy. This was also true for patients having undergone a previous pelviscopy and laparotomy. The rate of endometriosis and PID however, in this group was much lower than that of the group having undergone pelviscopy alone. Operative procedures having an equal efficacy whether performed per pelviscopy or laparotomy should therefore be performed per pelviscopy in order to reduce operative trauma and the subsequent post operative formation of adhesions.

Abdomen↗
PubMed1990

[Pelviscopic ovarian surgery. Possibilities and limitations].

In analyzing 500 consecutive pelviscopies performed at the University Women's Clinic in Kiel in 1988, 310 patients had undergone either diagnostic or operative procedures on the ovary, i.e. pelviscopy in the case of an ovarian tumor. 95.5% of all procedures could be performed per pelviscopy. 4.5% of cases required therapy per laparotomy. The pelviscopic procedures were primarily organ preserving operations associated with minimally invasive surgery, for example: Ovariolysis, ovarian cyst enucleation, coagulation of ovarian endometriotic implants, follicle puncture, parovarian cyst enucleation and, salpingo-oophorectomy. Laparotomy was indicated in the case of malignant disease, borderline tumors, large tumors, extensive adhesiolysis status post previous laparotomy, and in one case uncontrollable bleeding. The results show that today most procedures on the ovary can be performed per pelviscopy. In order to prevent a pelviscopic intervention in suspicious cases, the indication for laparotomy here must be generously applied.

Adult↗
PubMed1990

[Prenatal diagnosis of triploidy (69,XXX) in the 29th week of pregnancy with fetal death in the 37th week of pregnancy].

A case report is given on a pregnancy in the 29th week of gestation. Sonographic control showed extensive oligohydramnions, a size date discrepancy was noted, and there was no spontaneous movement of the fetus. An amniocentesis revealed triploidy as the cause. The clinical, sonographic, and hormonal data as well as the autopsy findings are discussed.

Abnormalities, Multiple↗