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Biomedical subjects

K Semm

Publications and source records attributed to K Semm.

At least 109 records · Page 6Linked to original sources
PubMed1984

[Endoscopic methods in gastroenterology and gynecology. Completion of diagnostic pelviscopy by endoscopic abdominal surgery].

Diseases affecting the female reproductive organs often raise differential-diagnostic problems in the field of gastroenterology. Diagnostic pelviscopy represents the most reliable means for the diagnostic clarification of alterations of the adnexa, appendicitis irritable colon, genital endometriosis etc. Today, 10 years after its development this technique, which usefully supplements the x-ray and ultrasonic examination, has advanced so far that immediately after the diagnostic procedure, surgical therapy follows in a high percentage of cases during the same procedure. Thus in Kiel surgical pelviscopy replaces today till 50% of the classic laparotomies (e.g. adhaesiolysis, adnexectomy, myoma-enucleation, coagulation of endometriotic spots, appendectomy, fimbrioplasty, salpingostomy etc.). As a result not only is the duration of ectopic diseases considerably shortened but also the hospitalization time and in particular the time of convalescence is also reduced to a minimum.

Appendectomy↗
PubMed1984

In vitro fertilization and embryo replacement at the Department of Obstetrics and Gynecology, University of Kiel, F.R.G.

From July 1982 until September 1983, 194 pelviscopies were performed in Kiel (phase I). The patients were stimulated either with Clomid/human menopausal gonadotropin hMG)/human chorionic gonadotropin (hCG) or with Clomid/hCG or hMG/hCG alone. Follicular maturation was monitored by ultrasonography and the daily measured E2 and luteinizing hormone (LH) response. Surgic therapeutical pelviscopy with follicular puncture followed 36 hr after hCG application. Oocytes were incubated in either Ham's F-10 or Menezo B2 medium in an automatically gas-controlled exsiccator. Forty-eight hours after insemination normal-looking four- to eight-cell embryos were replaced into the uterine cavity. Oocytes were successfully collected in 87.4% of the patients, with an average of 2.2 oocytes per patient. Eighteen pregnancies resulted of 101 embryo replacements. The overall pregnancy rate was 16.2% per replacement and 9.3% per pelviscopy. Undivided oocytes and polyploid embryos were analyzed cytogenetically. From October 1983 to October 1984 the overall pregnancy rate after 144 pelviscopies and 88 embryo replacements (phase II) improved to 23.9% per replacement and 14.6% per pelviscopy.

Blastocyst↗
PubMed1984

Various coagulation techniques tested in a rabbit model. Results of morphological and endocrinological studies.

CO2- pelviscopies or laparotomies were performed in 370 New Zealand white rabbits and were followed by coagulation of the distal uterine horns with unipolar, bipolar, endo- or CO2-laser coagulation. After 1, 2, 4, 8 or 12 weeks laparotomy was carried out and, following macroscopic description, photo documentation and measurement of the destroyed region, the uterine horns were excised. In addition to the normal histological and electromicroscopic evaluation, 5 mu thick cryostat sections were screened for the presence of nine different enzymes. Attempts were made not only to determine the extent of the destroyed zone, but also to obtain additional information on damage to the vascular and nervous systems of the tubes and ovaries. Progesterone levels were determined in 49 New Zealand rabbits before and after stimulation with 50 I.U. HCG i.v. We were able to show that there is a definite correlation between the type of coagulation technique and the extent of the destruction zone. The average progesterone levels of the animals coagulated using the monopolar high-frequency technique, were significantly lower than the hormone levels in the endocoagulation, bipolar or control group.

Animals↗
PubMed1984

[Pregnancy and birth of monozygous female twins following in vitro fertilization and embryo transfer].

The rate of identical twins after in vitro fertilisation and embryo replacement is higher than after physiological conception. The present paper reports on the first delivery of twins (identical twins) after in vitro fertilisation and embryo replacement. The in vitro fertilisation and embryo replacement of one 4-cell stage resulted in a twin pregnancy. The difficult pregnancy, early delivery and intense perinatal care of the children deserves special consideration. In addition the paper gives a survey on the present number of deliveries after in vitro fertilisation and embryo replacement given at the 3rd World Congress on In Vitro Fertilisation and Embryo Transfer at Helsinki in May 1984.

Adult↗
PubMed1984

Improvement of the rosette inhibition assay for the detection of early pregnancy factor in humans using the monoclonal antibody, anti-human-Lyt-3.

The detection of early pregnancy factor (EPF) is a controversial subject. The findings of independent groups attempting to confirm the phenomenon of EPF have been quite variable. The present article gives details of an improved rosette inhibition assay using a monoclonal antibody (anti-human-Lyt-3), instead of an anti-lymphocyte serum (ALS), in order to increase reproducibility. Results are calculated for the first time in terms of absolute monoclonal anti-Lyt-3 concentrations. It is suggested that results be expressed as the Rosette Inhibition Antibody Concentration (RIAC) or the more accurate extrapolated 25% Rosette Inhibition Antibody Concentration (25% RIAC), in place of the previously used Rosette Inhibition Titer (RIT), when monoclonal antibodies are used. Following a 1.5 h incubation period the mean 25% RIAC for pregnant serum was 15.9 +/- 4.0 ng/ml and for control serum 48.0 +/- 12.7 ng anti-Lyt-3/ml. The improved method described should enable different groups to establish the test and compare results.

Animals↗
PubMed1983

[Endoscopic intraabdominal surgery in gynecology].

Modern technique leads to abdominal surgery under "miniature" conditions. The combination of electrically monitored pneumaperitoneum, cold light optic, new mini-instruments, the newly developed hemostatic procedure "endocoagulation" (the patient is not in contact with the electrical current) and intraabdominal ligation techniques allows a new spectrum of operative procedures to be performed in gynecology. The following endoscopic gynecological operations have become routine: adhesions, ovario- and fimbriolysis, sharp and blunt opening of the ampulla tubae (sterility-operations), enucleation of pedunculated subserous myomas, conservative and radical tubal therapy of ectopic pregnancy, ovarian biopsy, ovarian cyst enucleation, ovarectomy ("3-sling-technique"), coagulation of endometriosis, tubal ligation. As examples of non typical gynecological operations in general surgery, omental adhaesiolysis, lysis of bowel adhesions and appendectomy can be mentioned. These new operative techniques have been developed in more than 10,000 pelviscopies. They stand for laparotomy in up to 80% of all cases in tubal and ovarian surgery. The complication rate lies in the area of 2%. Hospitalization has diminished by more than 50%, the period of reconvalescence by more than 75%.

Adnexa Uteri↗
PubMed1983

CIN and preclinical cervical carcinoma. A study of morbidity trends over a 10-year period.

Between 1971 and 1980 1312 cone biopsies were performed at the Department of Gynecology and Obstetrics, Kiel. Comparing the two intervals from 1971 to 1975 and 1976 to 1980 the number of cases with dysplasia and Carcinoma in situ significantly rose in the last 5 years in patients 16-30 years of age. Amongst other reasons for this increase, on the basis of our investigation, the regular gynecological examination in combination with the prescription of the ovulation inhibitors seems to be responsible. The average age of patients (36-44 years) undergoing cone biopsy for the first time decreased in the period between 1971 and 1980 (approx. 8 years). The excision of carcinoma in situ in women under 30 years of age mostly showed margins free of pathological epithelium. With increasing age the cases of not free margins increased to 70%. For the hemostasis of the conization crater up to 1977, the conventional suture technique was applied, since 1977 cone coagulation probe according to Semm was used. In this group (1977-1980) treated with coagulation after cone biopsy, 45% of the cases with carcinoma in situ not free margins had histologically normal epithelium of the extirpated uterus. In patients with the desire for a child or in pregnant women a secondary coagulation of the wound crater is achieved to preserve the uterus.

Adolescent↗
PubMed1983

Endoscopic appendectomy.

These newly developed endoscopic methods in gynaecology for haemostasis during surgical pelviscopy (Endocoagulation Roeder-loop ligation, endoligature, endo-suture with intra- and extracorporeal knotting) make it possible to carry out appendectomy by endoscopy for any of the following indications: Postoperative adhesion of the appendix especially in "sterility" patients, elongated appendix extending into the small pelvis, endometriosis of the appendix, subacute and chronic appendicitis. The instrument-set employed in this method permits the performance of all the usual classical operative steps (purse-string suture, and Z-suture acc. to McBurney and Sprengel). The point for resection has to be sterilized over 20-30 sec. at 212 degrees F using the crocodile forceps (endocoagulation procedure) before division and extraction of the appendix is effected.

Appendectomy↗
PubMed1983

Physical and biological considerations militating against the use of endoscopically applied high-frequency current in the abdomen.

In general surgery, high-frequency current is a routine method of producing destructive heat for hemostasis. The so-called "skin effect" prohibits any electric reactions into the human nervous or muscle tissue. When using high-frequency current in the closed abdominal cavity, the nature of the current forces is to go unpredictable ways. This fact provokes unforeseen damage (bowel, ureter, skin burns) which are method-induced and cannot be excluded even with extreme care in the handling of the high-frequency current during tubal sterilization or other endoscopic haemostasis procedures. All biological and physical data are presented that support the demand that high-frequency current must be excluded from pelviscopy e.g. laparoscopy, and a new technique called "endocoagulation" is described, which can replace the intraabdominal use of high-frequency current during pelviscopy.

Abdomen↗
PubMed1983

[Conization and hysterectomy from the viewpoint of the surgically treated woman. Results of an inquiry among 814 conized and conized-hysterectomized women].

814 questionnaires of conized and conized-hysterectomized women were evaluated according to menstruation disorders, sexual behaviour, course of pregnancy, medical check-up, carcinophobia, mentality to the operation, pains caused by the operation, and changes of womanliness. 32 percent of the conized women (less than or equal to 45 years old) gave menstruation disorders, mostly hypermenorrhea and dysmenorrhea. Course of pregnancy was not influenced by the conization. Over 80 percent of the women (less than or equal to 45 and greater than 45 years old) said their sexual life were not changed by the conization, in difference to the conized-hysterectomized women: 56 percent (greater than 45 years old) and 69 percent (less than or equal to 45 years old). Half all women were more anxious to get cervical cancer after the conization. The conized women were significantly more to a medical check-up compare to conized-hysterectomized ones. Over 80 percent would like to repeat the conization before removing the uterus. Conized-hysterectomized women felt significantly more less according to womanliness compare to conized ones. 51 percent (less than or equal to 45 years old) and only 35 percent (greater than 45 years old) said no side effects after hysterectomy. Mostly the women complained of pains of the bladder, menses-like mastodynia, and labile circulatory system. There was no significant difference according the answers about abdominal or vaginal hysterectomy with or without adnexectomy.

Adult↗
PubMed1983

Catamnestic examinations performed after the utilization of two different sterilization techniques.

By using a patient questionnaire, we checked the effects on sterilization of the unipolar high-frequency current method and the endocoagulation procedure in relation to late complications. In the years following high-frequency sterilization, 23 women (8.9%) were hysterectomized; in the endocoagulation group only 9 patients (2.3%) underwent hysterectomy, primarily because of the recurrence of therapy-resistant menometrorrhagia. Of those women sterilized by the unipolar HF technique, 20 (7.8%) required 1-3 postoperative curettages, whereas only 8 patients (2.1%) of the endocoagulation group required such an operation. We found that 79 patients of the HF group (30.9%) exhibited menstrual disorders compared to only 45 women (11.7%) in the endocoagulation collective. By disregarding those patients who had taken the pill or used an IUD prior to sterilization, the corrected rates for occurrence of menstrual irregularities were 22.5% for the HF group and 5.9% for the endocoagulation group, respectively.

Adult↗
PubMed1983

Endocrine findings in rabbits after sterilization with electrocoagulation.

CO2 pelviscopy or laparotomy was performed on 370 New Zealand white rabbits and followed by coagulation of the distal uterine horns with unipolar or bipolar coagulation, endocoagulation or CO2 laser coagulation. After 1, 2, 4, 8 or 12 weeks, laparotomy was done. After a macroscopic description was done, photographic documentation and measurement of the destroyed area were done, and the uterine horns were excised. In addition to the normal histologic and electron microscope evaluation, 5 microns-thick cryostat sections were screened for the presence of nine enzymes. Progesterone levels were determined in 47 rabbits before and after stimulation with 50 IU HCG administered intravenously. As we reported at the Tenth Meeting of the American Association of Gynecologic Laparoscopists in 1981, we found a definite correlation between the type of coagulation technique and the extent of the destruction. The average progesterone levels of the animals coagulated with the monopolar high-frequency technique were significantly lower than in the endocoagulation, bipolar coagulation and control groups.

Adult↗
PubMed1983

[Animal experiments, morphologic and endocrinologic studies following various coagulation technics].

CO2-pelviscopy or laparotomies were performed on 370 rabbits followed by coagulation of the distal uterine horns with unipolar, bipolar, endo-, or CO2-laser coagulation. As we could demonstrate by the following laparotomy, macroscopically with exact measuring of the destroyed region and later on by histological, histochemical and electronmicroscopic examinations, the extent of tissue destruction during coagulation of the distal uterine horns by endocoagulation or also bipolar high-frequency technique--when operated at lower coagulation currents--was significantly less compared to the destruction caused by monopolar high-frequency technique using monopolar high-frequency coagulation, extensive destruction of the uterine horns and the surrounding mesoalpingeal tissue occurred after a coagulation time of only 10 sec. With application of the bipolar coagulation technique the destruction of tissue was much more localized. - Rabbits distal uterine horns which were coagulated by CO2laser were examined by a relaparotomy 4-12 weeks later. Macroscopic, histological and enzymehistochemical studies showed that initial recanalization had occurred in 8 out of 23 cases. Utilizing the endocoagulation technique with a forceps temperature of 120 degrees C and a coagulation time of 20 sec, coagulation of the uterine horns occurred in all cases without complications. During the "Second-look" operation and the final tissue studies a complete division (of approximately 0.5 cm) of the uterine horns was evident, and it could be demonstrated, that the technique did not have any effect on the mesosalpingeal tissue. After stimulation of 49 rabbits with 50 I.U. of HCG i.v. the control group showed a clear rise in average progesterone levels of 12.69 +/- 6.02 ng/ml up to the 11th day of pseudo-pregnancy followed by gradual decrease in concentrations, returning to basal levels from day 14-25. The average progesterone levels of the two animal groups coagulated by using the monopolar high-frequency current were significantly lower than the control levels or the progesterone concentrations in the endocoagulation or bipolar group.

Animals↗
PubMed1982

Human ovum recovery via operative laparoscopy and in vitro fertilization.

Between January 1979 and December 1980, 142 laparoscopies were performed on 114 patients with long-standing tubal factor infertility. Twenty-eight were performed during spontaneous menstrual cycles, 20 following continuous human menopausal gonadotropin/human chorionic gonadotropin (hMG/hCG) therapy, and 94 following intermittent hMG/hCG stimulation. Follicular ripeness was judged by multiple criteria, which were also used to time the laparoscopy. Operative procedures were performed in all cases and follicular puncture was attempted in all but 16 subjects, where adhesions prevented access to the ovaries. In 28 spontaneous cycles, 28 follicles were punctured and 17 ova recovered; whereas in the 98 patients where ovulation was stimulated, 217 follicles were punctured and 43 ova collected. Following in vitro fertilization with the husband's spermatozoa and embryo culture, pronucleus formation, 2-cell, 4-cell, 8-cell, and 16-cell stages were observed in 18 oocytes obtained from 17 patients. Embryo transfer has, however, not yet been performed.

Clomiphene↗