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Biomedical subjects

K Semm

Publications and source records attributed to K Semm.

At least 127 records · Page 7Linked to original sources
PubMed1982

There is no place in gynecological endoscopy for unipolar of bipolar high-frequency current.

In 1981 we showed that there is a clear relationship between the extent of destruction of the vascular and nervous systems within the mesosalpinx, and the occurrence of menstrual disorders, and menopausal symptoms. Depending upon the individual sterilization technique, varying portions of the tubes are destroyed and considerable in jury is done to extensive parts of the mesosalpinx. Since two-thirds of the ovarian blood supply passes through the tubal branch of the uterine artery, after destruction of large areas of the mesosalpinx, a marked disturbance of ovarian metabolism must be expected. Using a patient questionnaire, we investigated the effects of the unipolar high frequency current method and the endo-coagulation procedure with respect to late complications. In the years following high-frequency sterilization (in a total of 258 women) 23 women (8.9) were hysterectomized; in the endocoagulation group only 9 patients (2.3%) underwent hysterectomy, primarily for recurrent therapy-resistent menometrorrhagia. Of the women sterilized by the unipolar HF- technique (total number 258) 20 (7.8%) required post-operative curettage 1-3 times while only 8 patients (2.1%) of the endocoagulation group required such a procedure. We found that 79 patients of the HF-group (30.9%) exhibited menstrual disorders compared with only 45 women 11.7% in the endocoagulation group.

Electrocoagulation↗
PubMed1982

Comparison of fluid hysteroscopy and CO2 hysteroscopy.

A total of 247 women were subjected to liquid and CO2-hysteroscopy used as adjuncts in the screening of bleeding abnormalities in reproductive and post-menopausal groups. A point system of scoring proved quite useful. Using CO2-hysteroscopy the percentage of the detected malignancies corresponded to the percentages obtained by curettage in the age group of these patients. In liquid hysteroscopy, a group already suspicious for malignancy yielded a higher percentage of malignancies detected than normally expected. In post-menopausal women 41.7% of the cases examined wer malignant. The nine point scoring system used in liquid hysteroscopy correlated well with the histological findings. Both hysteroscopic techniques have their application and both are complementary, since they can be used for different indications in the visualization of the uterine cavity.

Carbon Dioxide↗
PubMed1982

[Pretreatment of carcinoma in situ and microcarcinoma of the cervix by conization and endocoagulation (author's transl)].

65 microcarcinomas and 189 Ca. in situ-cases were diagnosed by cone biopsy in the Department of Gynaecology and Obstetrics of the University in Kiel in the periods 1973-1976 and 1977-1980. During the first period the haemostasis of the conization crater was obtained by the conventional techniques. In 38% (microcarcinoma) and 30% (Ca. in situ) of the cases the excised uterus was free of pathological epithelium. Since 1977 we have used simple coagulation of the wound area, with endocoagulation-technique according to Semm. In the second group (1977-1980), 73% (microcarcinoma) and 45% (Ca. in situ) were histologically normal, and only one case showed remaining microcarcinoma in the excised uterus. In individual cases--such as during pregnancy or where the patient still desires to have children--the Ca. in situ with not free margins, can be treated simply with a secondary coagulation of the wound crater.

Carcinoma in Situ↗
PubMed1982

An initial comparison of coagulation techniques of sterilization.

For nearly 50 years reports have been published on laparoscopic sterilization techniques. However, the different procedures vary greatly with regard to the extent of the tube destroyed and the magnitude of damage to the mesosalpinx. In 1981 we proved that a clear relationship exists between the extent of destruction of the circulation and nervous system within the mesosalpinx and the occurrence of menstrual disorders as well as menopausal symptoms. Because two-thirds of the ovarian blood supply passes through the ramus tubarius of the ateria uterina, after destruction of larger areas of the mesosalpinx striking disturbances within the ovarian metabolism must be expected. With numerous animal experiments we are currently studying the expansion of the coagulated area following the use of mono- and bipolar high-frequency current, endocoagulation and CO2 laser coagulation. With the aid of conventional histologic techniques, in addition to enzyme histochemical and electron microscopic examinations, attempts are being made not only to determine the extent of the destroyed zone but also to gain additional information on damage of the vascular and nervous systems of the tubes and ovaries. Although these studies have not yet been completed, it is possible at this time to state that the unipolar high-frequency coagulation technique, because of its tremendous primary and secondary complications, should not be used for laparoscopic female sterilization.

Animals↗
PubMed1982

[Devitalization and haemostasis by thermal destruction--results of enzyme-histochemical and histological examination of oviduct specimens, following tissue coagulation by means of endocoagulation or high-frequency current (author's transl)].

Semm's technique of endocoagulation has been used by the authors for haemostasis in endoscopic abdominal surgery at the Department of Gynecology and Obstetrics, University of Kiel since 1973. --Enzyme-histochemical and histological tests, all based on endocoagulation or high-frequency current procedures, were applied to 100 human fallopian tubes. Fifteen of them remained uncoagulated and were used for comparison. --Membrane ATPase, 5-nucleotidase, cytochrome-C-oxydase, and other essential enzymes in cellular metabolism were inactivated by temperatures in excess of 57 degrees C. These enzymes, consequently, were no longer detectable from enzyme-histochemical preparations, whereas active tissue regions, those which still contained vital cells, were stained black to brown. --Negative enzyme reactions occurred in response to a coagulation forceps temperature of 120 degrees C, when applied not less than 20 seconds. Residual enzyme activities were still recordable from certain tubal areas, when forceps temperatures below 120 degrees C had been used. In such cases coagulation was insufficient, particularly in the inner layers of tubes (epithelium, mucosa). Temperatures above 130 degrees C and coagulation lengths of more than 20 seconds proved to be unnecessary, since no improvement in results was thus achievable. Temperatures of 140 degrees C and more have changed coagulated tissue into "adhesive" and make it stick to the coagulation forceps. Instrument withdrawal can in such cases cause bleeding rather than the desired haemostatic effect.

5'-Nucleotidase↗
PubMed1982

[CO2 laser coagulation of benign changes of the portio vaginalis in comparison with the endocoagulation technic (Semm's method)].

The CO2-COHERENT laser was therapeutically used by the authors on 31 cases of extensive erythroplakia associated with recurrent and therapy-resistant fluor formation and on cases of highly vascularised transformation zones with contact bleeding. The benign nature of the findings first had been established by repetitive Pap smears and thorough colposcopic examination. The authors suggest that for the time being the CO2 laser is not suitable yet for the treatment of dysplasia or carcinoma in situ, since no material for histological testing is obtainable from that therapeutic approach, and the presence of microcarcinoma with invasive growth cannot be ruled out with absolute safety. CO2 laser treatment was undertaken without hospitalisation of patients, just as endocoagulation of the vaginal portio was carried out on an outpatient basis. Postoperative follow-up checks have been made one, three, and six weeks as well as three and six months from treatment. The therapeutic results obtained from CO2 laser therapy were compared with those recorded from patients who had undergone endocoagulation of the vaginal portio, with the view to checking the advantages claimed for laser therapy in the literature [1, 4, 11, 12, 23, 24], such as no need for anaesthesia, effective destruction of much of the pathological tissue, high-accuracy identification of tissue for destruction by means of colposcopy, low rate of postoperative complications, soon healing, and good haemostatic action. All these advantages were found to be obtainable just as well from the technique of endocoagulation without the need for the great amount of technical input and equipment definitely required for laser therapy [16, 18, 19, 20, 21].

Adult↗
PubMed1981

[First results of in vitro fertilization in the human (author's transl)].

In vitro fertilization was studied in human egg cells obtained by laparoscopy. In 1979 our studies included 65 women with long term infertility and proven tubal factor infertility. The primary diagnostic laparoscopy established disease of uterus, tubes and ovaries and was used to correct pathology. Lysis of adhesions was used to make aspiration of a spontaneous mature follicle for in vitro fertilization easier. The aspiration laparoscopy was performed after stimulation with HMG and HPG. Our prerequisite was the presence of at least one ovary with ovulatory cycles. In almost all cases the ovaries wer accessible only following lysis of ovarian and tubal adhesions. Aspiration of the follicle was successful in 55 of the patients stimulated with HMG/HCG. In 10 cases no follicle for aspiration was available. In 21 cases one egg cell was found. In 11 cases more than one egg cell was found. The maximum was 8 egg cells in one patient. In 34 patients only cumulus cells were aspirated following stimulation. Under the in vitro fertilization conditions described in this paper it was possible to obtain twice a pro-nucleus formation, twice the two cell and twice the four cell stage following conjugation with sperm of the partner. Of the 47 patients with a tubal occlusion, 30 were isthmic or utero-isthmic and 17 tubal occlusions were peripheral. In 15 patients chromo-tubation showed recanalization.

Chorionic Gonadotropin↗
PubMed1981

[Ernst Gräfenberg, the life and medical accomplishments of the gynaecologist from Kiel. In honor of his 100th birthday on September 26, 1981 (author's transl)].

In honor of the 100th birthday of E. Gräfenberg born on September 26, 1981 his biography is reported. This ingenious researcher suffered heavy blows by fate. During his residency in gynaecology in Kiel, Gräfenberg published important scientific papers (for instance on Gräfenbergstheory of malignant spread) and he studied the physiology of implantation with special reference of the tryptic enzymes of the membranes. As a specialist in gynaecology Gräfenberg developed a method to prevent implantation of the egg based on his studies of implantation. His intra-uterine ring was named Gräfenberg ring. It took until two years after the death of Gräfenberg until the modification of his method of family planning was accepted throughout the world in 1959.

Female↗
PubMed1981

[Epidemiological and diagnostic analyses of 1194 cone biopsies (author's transl)].

1194 patients of the Department of Gynecology and Obstetrics of the University in Kiel were treated by cone biopsy 1971-1979. In 92 of these cases the cone biopsy was free of pathological epithelium despite positive prefindings. The part of adeno-carcinoma of the cervix was 1.2%. In two control-periods (1971-6/75 and 7/75-1979) the quantity of 16-30 year old women with dysplasia or carcinoma in situ of the cervix was high significantly increased in the last period. The prescription of ovulation inhibitors is due to this tendency as one of other important factors. The average age of patients first treated by cone biopsy decreased from 44 years to 36 in 1971 to 1979. The majority of the carcinoma in situ was completely excised by women below 30 years old. The cases of not free margins increased to 72% with advancing in years. Over the half of patients with not completely removed carcinoma in situ or micro-carcinoma there was no pathological epithelium in the followed exstirpated uterus. The reason for this behaviour may be the hemostasis with high frequency cauterization (coagulation apparates of Semm) since 1977. The number of diagnosis of the carcinoma colli uteri Ia and Ib by cone biopsy was lower in the second control-period compared to the previous period.

Adenocarcinoma↗
PubMed1981

Late complications of sterilization according to method.

By using a patient questionnaire, we checked the effects of two tubal sterilization procedures (high-frequency [HF] and endocoagulation techniques) in relation to late complications. In the years following high-frequency sterilization, 23 women (8.9%) had hysterectomies; in the endocoagulation group only 9 patients (2.3%) underwent hysterectomy. Patients sterilized by the unipolar high-frequency technique required one to three curettages in 7.8% of cases, whereas only 2.1% of the endocoagulation group required this procedure. Seventy-nine patients in the high-frequency group (30.9%) exhibited menstrual disorders as compared to only 45 (11.7%) in the other group. The combination of menstrual irregularities and menopausal complaints was found in 7.4% of the HF group, while only 2.8% of the endocoagulation group experienced these problems. Menopausal complaints only, without menstrual disorders, occurred in 4.7% and 3.9% of the women, respectively. Eighty-five percent of 330 patients sterilized by the Semm endocoagulation technique had no menstrual complaints or menopausal symptoms; in the HF group this was the case for 160 women (62%). Our results demonstrate that late postoperative complications arise less often in patients sterilized by endocoagulation.

Adult↗
PubMed1980

Technical progress in pelvic surgery via operative laparoscopy.

The development of an optimal set of instruments for perfect grasping, cutting, sucking, and ligating and of a new system to perform hemostasis by endocoaguation through a trocar sheath 7 to 11 mm in diameter permits effective laparoscopic surgery. A total of 2,000 operative laparoscopies were performed safely between 1973 and 1976. Since 1977, laparoscopic surgery has been extended to the following procedures: myomectomy (subserous), adnexectomy, ovarian cyst resection, removal of a cystoma, and tubectomy in cases of tubal pregnancy. In 82 such cases, no intraoperative or postoperative complications occurred. The normal postsurgical healing procedure has been checked during 18 second-look laparoscopies and two consecutive laparotomies. These technical advances have opened up a new era of gynecologic surgery based on operative laparoscopy.

Female↗