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Biomedical subjects

K Semm

Publications and source records attributed to K Semm.

At least 37 records · Page 2Linked to original sources
PubMed1994

Management of patients with persistent beta-hCG values following laparoscopic surgical and local drug treatment for ectopic pregnancy.

OBJECTIVES: To show that the beta-human chorionic gonadotropin (hCG) decline following tubal-preserving techniques for ectopic pregnancy (EP) can take a longer course than currently believed, indicating expectant management; and to define the indications for a second-look laparoscopy if beta-hCG persists. METHODS: Three hundred thirty-seven patients treated for EP were retrospectively reviewed. In order to define the 'normal' beta-hCG decline following tubal-preserving techniques we acquired a Kaplan-Meier curve for 98 patients treated by laparoscopic linear salpingotomy, the main method performed for EP (253 patients). The Mann-Whitney U-test served as a statistical test. The patient population requiring a second-look laparoscopy for proliferating trophoblastic remnants is described. RESULTS: Twenty-eight patients (8.3%) required a second-look laparoscopy (acute abdominal pain and sonographically suspect findings combined with increasing beta-hCG values). The majority (15 patients) underwent a preceding laparoscopic linear salpingotomy (6.5% unresolved cases). The relative beta-hCG values differed significantly from the unresolved group compared to the group with resolved EP starting at postoperative day 2 (P < 0.01). A maximal beta-hCG decline period of 77 days postoperatively was observed. CONCLUSIONS: Patients with slowly declining beta-hCG levels following tubal-preserving techniques for EP can be managed expectantly. Increasing beta-hCG values combined with abdominal pain and sonographically suspect observations indicate a second-look laparoscopy.

Chorionic Gonadotropin↗
PubMed1994

Histologic features of the CISH procedure.

STUDY OBJECTIVE: To evaluate the classic intrafascial SEMM (serrated-edge macromorcellated) hysterectomy (CISH) performed by pelviscopy and by laparotomy, and determine the histologic features of the procedures. DESIGN: The first 253 women who required hysterectomy were assigned to undergo the procedure by pelviscopy or laparotomy based on uterine size. PATIENTS: One hundred fifty-two women underwent CISH by pelviscopy and 101 by laparotomy. INTERVENTIONS: Between September 1991 and December 1993, the patients underwent the two procedures. Uterine leiomyomas with menstrual disorders and pressure symptoms were the principal indications (61%). MEASUREMENTS AND MAIN RESULTS: Histologic findings were in agreement with indications for the procedures. Leiomyomas and leiomyomas with adenomyosis were the most frequent findings. Histologic analysis revealed that the squamocolumnar transformation zone was totally removed in all cases, and all cervical glands were excised in 92%. CONCLUSION: Cervical dysplasia is not a contraindication to CISH, but emphasizes the importance of adequate preoperative screening. This is a conservative operation that my protect against some cervical cancers.

Adult↗
PubMed1994

[Pain reduction after pelvi/-laparoscopic interventions by insufflation of CO2 gas at body temperature (Flow-Therme)].

Intraabdominal pain, shoulder pain and tachycardia are observed after pelviscopic interventions. Recent publications blame this on hypothermia caused by the CO2 gas used. The authors discuss in detail the physics of the problems connected with the heating of CO2 gas. The heating of carbon dioxide gas to 37 degrees C in the heating tube of the WISAP-Flow-Therme will not only reduce intra-operative hypothermia (down to 28 degrees C intra-abdominally and 34 degrees C in the rectum) but also the occurrence of tachycardia (reduced by 40% to 11%). Heating will also result in reduced CO2 consumption, which is also of ecological significance. As a result of the overall improvement of the female patients' perception of pain there is a significant reduction in postoperative palliative medication required by 31%. The physical laws and data permit fitting the WISAP Universal Flow Therme to all commercially available CO2 gas insufflators. The rinse water, as an additional factor causing hypothermia, should be preheated to 40 degrees C (WISAP water bath).

Body Temperature Regulation↗
PubMed1994

[Prenatal diagnosis of severe stenosis of the ductus arteriosus Botalli in a twin pregnancy].

Premature ductus arteriosus stenosis is a rare cardiovascular disease, which has a poor prognosis. The case presented was detected even in early pregnancy and was progressed rapidly to the stage of severe foetal heart failure. The patient was first seen at 20 weeks of gestation with one of the foetuses of a twin pregnancy, showing signs of cardiac decompensation and advanced hydrops fetalis universalis. Obstruction of the ductus arteriosus may result from maternal tocolysis treatment with prostaglandin synthetase inhibitors, such as indomethacin or maternal salicylate or in conjunction with foetal post maturity.

Adult↗
PubMed1994

[Lung metastasis after pelviscopic salpingectomy in therapy of tubal pregnancy].

UNLABELLED: A 34-year old VI gravida, II para underwent a pelviscopic salpingectomy of the left fallopian tube for treatment of a repeated ectopic pregnancy. Histology revealed an invasive hydatidiform mole. The declining beta-hCG titers after surgery were not further controlled. Seven months later a secondary amenorrhoea occurred again; beta-hCG levels increased steadily. We could not obtain trophoblastic tissue by operative pelvis-copy (excision of the tubal stump on the left side and tubal sterilisation on the right side) nor by curettage of the uterine cave. A lesion of the lung was interpreted as a metastatic lesion following malignant transformation of the invasive hydatidiform mole and disappeared under cytotoxic therapy containing methotrexate with an uneventful follow-up period of now 4 years. RECOMMENDATION: In order not to overlook the presence of persistent trophoblastic tissue and the possible development of a choriocarcinoma, beta-hCG serum titers should be measured until they disappear, following the surgical therapy of an ectopic pregnancy.

Adult↗
PubMed1994

Histopathological aspects of pelviscopic hysterectomy. Investigation of histological giant sections and morphometry to confirm a new application of minimally invasive surgery.

The present study attempts to confirm the effectiveness of a new method of pelviscopic hysterectomy which maintains the pelvic floor integrity comparable to that in a supracervical uterus amputation. A major advantage of this procedure is that the central portion of the cervix and transformation zone is punched out using a special resection tool for the purpose of removing any potential source of cancer. Thirty-four specimens resected by pelviscopic hysterectomy were investigated using histological giant and serial sections. Morphometrical analysis was performed using MOP-AMO2 (Kontron Instruments). The transitional zone and cervical glands were excised completely with an average security distance of 1.5 cm to the resection margins. No mesonephric remnants were found which might serve as a possible source of adenocarcinoma. Our study confirms that the application of this new technique of pelviscopic hysterectomy is not limited by the development of stump carcinoma while also possessing the additional advantage of maintaining pelvic floor integrity.

Adult↗
PubMed1993

[Pelviscopic treatment of female sterility].

In 1988 and 1989 176 patients underwent pelviscopy at the Kiel University Hospital of Gynaecology for primary or secondary sterility of at least 12 months duration. 120 patients (68%) filled in a questionnaire on the therapeutic results after 2 to 3 years. Following peripheral salpingostomy in 18 patient, an intrauterine pregnancy developed in 22% of these cases, while an ectopic pregnancy occurred in 11% of the cases. After fimbrioplasty in 37 cases, the intrauterine pregnancy rate amounted to 43%, whereas the rate was 50% following salpingoovariolysis. 4 patients with a subserous or intramural myoma, measuring 2.5 to 8 cm in diameter, but no other pathological signs of disturbed fertility, became pregnant after enucleation of the myoma. 2 patients delivered at full term, the other two miscarried. 5 out of a total of 10 patients became pregnant after endometriosis foci had been coagulated or endometriomas enucleated. In these cases, the adnexa did not require additional surgical treatment. Pelviscopy revealed an untreatable intratubal block in 9 cases. 10 patients could not be included in the study, either because of a successful in vitro fertilisation or a pregnancy following heterologous insemination or because a hysterectomy or tubectomy had been performed in the meantime. In cases, where inspection under magnification had shown at least one non-pathological adnexa and tubal patency of at least one of the tubes, 35% of the patients conceived after pelviscopy and chromopertubation within the follow-up period. The therapeutic action of the chromopertubation and the psychological effect of finding no pathological signs during the genital examination remains speculative.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Value of endoscopic ovarian surgery--critical analysis of 626 pelviscopically operated ovarian cysts at the Kiel University Gynecologic Clinic 1990-1991].

During 1990-1991, 626 cystic ovarian tumours measuring > 3 cm diameter were treated endoscopically at the Department of Obstetrics and Gynaecology at the University of Kiel. In 97 patients, either ovariectomy or adnexectomy, and in 529 cases, an ovarian cyst enucleation was performed. In every case, we considered clinical laboratory, pre-examinations as well as a vaginal ultrasound examination to be of extreme importance for our decision. In 1990, we changed 18 times from pelviscopy to laparotomy and in 1991 7 times under the visual impression of an ovarian malignant tumour. The diagnosis was verified 8 times in 1990 and 3 times in 1991. 10 times in 1990 and 4 times in 1991, the patients were laparotomised with benign ovarian tumours, whose form and motility did not indicate laparotomy at the beginning. No case of ovarian cancer was endoscopically biopsied in 1990-1991. Details on the treatment of patients, their brief hospitalisation period and quick reintegration into family and professional life speak for the applied operation technique.

Biopsy↗
PubMed1993

[Intrafascial vaginal hysterectomy (IVH) with or without pelviscopic assistance].

During the past few years, new techniques have supplemented the vaginal and abdominal techniques of hysterectomy, namely, the pelviscopic/laparoscopic methods C*I*S*H* (Classic Intrafascial S*E*M*M* Hysterectomy, S*E*M*M* denoting Serrated Edged Macro-Morcellated) and LAVH (Laparoscopic Assisted Vaginal Hysterectomy). With C*I*S*H*, the uterus is supravaginally removed with pelviscopy and morcellated intraabdominally after having punched out the cervical glandular tissue by means of C*U*R*T* (Calibrated Uterine Resection Tool), whereas with LAVH, the uterus is peeled laparoscopically, but ultimately removed from the abdomen per vaginam. The next method to be developed from C*I*S*H* was, initially, TUMA (Total Uterine Mucosa Ablation) where the residual uterine muscle remains in situ. Following that, IVH (Intrafascial Vaginal Hysterectomy) was developed as a minimal invasive approach. After having punched out the cervical glandular tissue by means of C*U*R*T* (Calibrated Uterine Resection Tool). Hysterectomy is performed with the technique employed up to now with anterior precipitation of the uterus. The cardinal and sacrouterine ligaments, uterine arteries and the vagina remain uninjured. Since no sensitively innervated tissue is transected, this operation is postoperatively largely painless. Likewise, the innervation of the urinary bladder and rectum is not damaged and there is also no impairment of sexual feeling. The time required for the operation corresponds with that of the routine time required so far, when performing vaginal hysterectomy. Vaginal surgery is significantly facilitated by the fact, that the cervix is practically absent when the uterus is precipitated anteriorly.

Equipment Design↗
PubMed1993

Ovarian surgery via pelviscopy.

A retrospective study of operative pelviscopy was undertaken at the Department of Obstetrics and Gynecology at the Christian-Albrechts-University of Kiel to review the spectrum of ovarian surgery performed from 1987 to 1989. The purpose of this study was to assess the scope of surgery (cystectomies, ovariolysis, ovarian biopsy and cyst puncture), and to identify any advantages or disadvantages associated with the procedure.

Biopsy↗
PubMed1993

[The development of pelviscopic (laparoscopic) surgical procedures in former East Germany--statistics from 1986-1988 inclusive].

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 (2.5/1,000 in clinics, 2.8/1,000 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↗
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↗