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Biomedical subjects

K Semm

Publications and source records attributed to K Semm.

At least 145 records · Page 8Linked to original sources
PubMed1980

[The post-laparoscopic pain syndrome (author's syndrome)].

Following laparoscopy 18.5% of 200 patients had sub-phrenic pain on the day of operation and 28% had shoulder pain. During the night following the operation or on the first post-operative day 30.5% of the 200 patients had sub-phrenic pain and 54.5% had shoulder pain. A total of 63% of the patients had shoulder pain and 37.5% of the patients had sub-phrenic pain. 31.5% of the patients had a combination of both types of pain. Most of the sub-diaphragmatic pain was on the right side. In 93% of all patients the post-operative radiological investigation of the chest showed subphrenic gas. The remaining gas was aspirated and measured by infrared spectroscopy. All the remaining gas was carbon dioxide. The previously suggested absorption rates for carbon dioxide are probably too high. The transition of anaesthetic gas (e.g. N2O) through the peritoneum into the abdominal cavity as suggested by Hodgson, McClelland, and Newton was not detected in these measurements. The most likely cause of the post-laparoscopic pain syndrome is the effect of the volume of the remaining gas of the phrenic nerve.

Absorption↗
PubMed1980

[Bacteriological examinations of liquid drawn from the pouch of Douglas (author's transl)].

The article reports on bacteriological examinations of 510 samples of liquid drawn from the pouch of Douglas (excavatio rectouterina) during pelviscopy in patients not displaying any signs of inflammation. Bacterial populations were found in 270 samples (= 52.9%). The results are subdivided according to aerobic and anaerobic types of pathogens and their incidence.

Ascitic Fluid↗
PubMed1980

Leucospermia and male fertility.

The evaluation of smears of normozoospermic men showed a clear leucospermia in 15% of the patients. There was a slight motility inhibition of the spermatozoa and head-to-head agglutination in the direct surroundings of the leucocytes. Phagocytosis of sperm heads by granulocytes was also evident. Leucospermia was due to prostatis, epididymitis, autoimmune reaction, or the presence of anerobic bacteria which have not been detected by the routing procedures. In twenty percent of all the females examined the aspirates of Douglas pouch contained anerobic bacteria and increased frequency of granulocytes.

Female↗
PubMed1980

[Clinical aspects relating to extragenital endometriosis (author's transl)].

Endometriosis was recorded from 26 per cent of more than 5,800 pelviscopic checks at the Department of Gynaecology and Obstetrics of the University of Kiel, according to a comprehensive statistical record covering a period between 1971 and 1979. Sterility patients ranked high on the list; they accounted for 51 per cent. -Systematic examinations were performed on a more stringently selected group of 611 patients, over the last two-and-a-half years. They were similar to studies conducted by Scott and Te Linde as well as by Meigs. Extragenital endometriosis was diagnosed in 26.2 per cent of the latter cases. -Clinically measurable symptoms were recorded from not more than about 50 per cent of those patients. -Treatment should always be given on the basis of one definitely established therapeutic scheme. Three-step treatment, including pelviscopy followed by six-months antigonadotrophin treatment and, finally, by re-pelviscopy with correction of the tube factor, has proved to be extremely successful for sterility patients. Larger manipulations on the tubes should be preceded by complete elimination of extragenital endometriosis to prevent fimbrial reclosure after a few months.

Adult↗
PubMed1979

Treatment of female infertility due to tubal obstruction by operative laparoscopy.

The advent in recent years of safe endocoagulation (thermocoagulation within the abdomen) has permitted operative laparoscopic treatment of the tubal factor in infertility in selected cases. This paper reviews the results of operative laparoscopy in 223 cases treated for infertility between 1971 and 1976. Tubal occlusion was present in 133 patients before surgical intervention. Following operative laparoscopy, tubal patency was demonstrated in 67% on testing at the time of operation and in 12% at the first postoperative hydrotubation. In only 21% of cases was tubal patency not achieved by these methods. Those cases requiring isthmic salpingostomy, ampullary or isthmic-tubal implantation, or end-to-end anastomosis were further treated by laparotomy and microsurgery. Ninety cases of pelvic endometriosis were treated by a combination treatment of thermocoagulation, ovarian cyst resection, and the antigonadotropin agent, danazol. Ovariolysis, salpingolysis, fimbrioplasty, and salpingostomy can easily be performed using operative laparoscopy as the method of choice with a minimum of complications, shortened hospitalization time (2 days), and the potential for a repeat procedure or a follow-up laparotomy should this be necessary. The pregnancy rate following laparoscopic treatment for the correction of distal tubal occlusion was 30.5% and for endometriosis genitalis externa, 40%. These rates compare favorably with the rates following procedures involving laparotomy and microsurgery for correction of similar lesions.

Adult↗
PubMed1979

New methods of pelviscopy (gynecologic laparoscopy) for myomectomy, ovariectomy, tubectomy and adnectomy.

The development of suitable instruments for perfect grasping, cutting, sucking, ligating and of a new system of performing hemostasis by endocoagulation through a 7--11 mm phi trocar-sheath enables us to initiate effective endoscopical intraabdominal surgery. New surgical techniques are being investigated on greater than 2.000 cases of surgical pelviscopic interventions which were performed between 1973--1976. Since 1977 we have extended the endoscopical intraabdominal surgery as follows: Myomectomy (subserous), adnectomy, ovarian-cyst-resection, cystomectomy, tubectomy in case of tubal pregnancy. In 115 cases no intra- or postoperative complications have occurred. Normal postsurgical healing procedure could be checked on 18 re-pelviscopies and on 2 later laparotomies. The new technical equipment has opened us together with special surgical procedures a new era of gynecologic surgery.

Adnexa Uteri↗
PubMed1979

Statistical survey of gynecological laparoscopy/pelviscopy in Germany till 1977.

By mailing, 1.365 questionnaires to gynecologists, 265,900 laparoscopies/pelviscopies were reported in 682 questionnaires (49.2%) by anonymous answer. These had been performed by 380 gynecologists (hospitals) between 1949 and 1977 in Germany. 302 gynecologists who answered the questionnaires (44.2%) are not using the endoscopic technique. Till the end of 1977 in Germany monopolar high-frequency current was used in 52%, bipolar high-frequency current was used in 42%, and modern endocoagulation was used in 25% for the purposes of hemostasis. 240 hospitals (63%) are mainly using pelviscopes of 5--8 mm diameter, 124 hospitals (33%) are using laparoscopes of 11 mm diameter. All together 949 (3.56%) complications had occurred which necessitated 690 laparotomies (2.59%). Cause of these complications were damages to vessels and burns by high-frequency current. 24 (0,09%) deaths were reported which had occurred during or following the intervention, that is one death for 11,000 pelviscopies. Mortality due to this method can be itemized as follows: 13 deaths (0.09%) in 140,977 (53%) diagnostical laparoscopies/pelviscopies, 3 deaths (0.08%) in 37,639 (14.2%) diagnostical-operative pelviscopies, 8 deaths (0.09%) in 87,284 (32.8%) sterilizations. Since 1974, however, the mortality rate is smaller than 1 : 100,000. Since 1973 every year 30,000 to 35,000 pelviscopies were registered in Germany; no deaths in 1974, 1976 and 1977.

Electrocoagulation↗
PubMed1979

[Regeneration of the Fallopian tubes following sterilization (author's transl)].

After any trauma to the fallopian tubes by a sterilizing operation, pregnancy occurs. If the sterilizing procedure was by high frequency current coagulation, large areas of the fallopian tube must be destroyed down into the mesosalpinx in order to avoid the preprogrammed recanalization tendency of the muellerian duct. Fertilization has occurred in recanalized fallopian tubes which only showed a cubic epithelium. Extensive destruction of the fallopian tube is today not justifiable because of the possibility of interference with the ovarian blood supply and subsequent hormonal damage. At present the safest method of female sterilization is by tissue coagulation of segment of the fallopian tube at 100 centigrade and division of the coagulated portion. In 1000 cases there were no pregnancies.

Electrocoagulation↗
PubMed1979

[Statistical survey on laparoscopy in gynaecology up to 1977 in the Federal Republic of Germany (author's transl)].

1385 questionaires were sent to gynaecologists in West Germany. 682 (49.2%) were answered anonymously. 302 answers (44.2%) revealed that the gynaecologists did not do endoscopy. 265.900 pelviscopies or laparoscopies were included in the statistics. The laparoscopies or pelviscopies were done from 1949--1977 by 380 gynaecologic surgeons or gynaecological departments. In Germany to the end of 1977 unipolar high frequency current was used for hemostasis in 52%, bipolar high frequency current in 42%, and modern endocoaglation in 25% of the departments. In 240 departments (63%) the five to 8 mm. pelviscope was used. In 124 department (33%) the 11 mm. laparoscope was used. In the total of the cases 949 (3.56/1000) complications occurred. These required 690 laparotomies (2.59/1000). The cause of the complications were injuries to vessels or high frequency current burns. A total of 24 (0.09/1000) deaths or 1 death per 11,000 pelviscopies was reported. The operative mortality was 13 deaths (0.09/1000) in 140,977 (53%) purely diagnostic pelviscopies or laparoscopies, 3 deaths (0.08/1000) in 37,639 (14.2%) combined diagnostic and operative pelviscopies and 8 deaths (0.09/1000) in 87,284 (32.8%) laparoscopic tubal ligations. Since 1974 the operative mortality is less than 1:100,000. Since 1973 approximately 30--35,000 pelviscopies are done yearly in West Germany.

Electrocoagulation↗
PubMed1979

Change in the classic gynecologic surgery: review of 3,300 pelviscopies in 1971-1976.

An endoscopic microsurgical technique has been developed on the basis of the development of a new technique for hemostasis (endocoagulation), which needs neither ligation nor high-frequency current, and a specific pelviscopic instrument setup for surgical therapeutic pelviscopy has been created. This new endoscopic technique, i.e., the microlaparotomy via pelviscopy, opens new methods for pelvic surgery, in particular for patients with infertility. Our data show that in 79% of tubal occlusions, patency can be achieved by pelviscopic surgery. In addition, lysis of intestinal adhesions, tubal sterilizations, endometriosis-coagulation, ovarian cyst resection, subserous myomectomy, and total oophorectomy can be performed with this newly devised procedure. Our data show that in our series of 3,300 pelviscopies, the complication rate was 1.1%, and only 0.1% necessitated laparotomy. In 55%, pelviscopy performed after previous laparotomies added very little risk. In 61%, destructive heat was utilized for hemostasis. No intra-abdominal burns occurred in the entire series of 3,300 patients. With this new method, when used for protein-coagulation to secure hemostasis, not one burn occurred.

Biopsy↗
PubMed1979

Clinical and biochemical experiences with danazol in the treatment of endometriosis in cases with female infertility.

Based on "second look" pelviscopic control in 438 cases of pelvic endometrosis, additional hormonal antigonadotrophin therapy with danazol represents the most effective treatment for endometriosis. The rationale is well explained by Dmowski and Scommegna (1976). As endocrine treatment alone cannot control severe cases of endometriosis, in recent years a combined 3-step surgical-endocrine-surgical therapy, with thermocoagulation of endometriotic foci, cyst wall resection of endometriomas and consecutive thermocoagulation has proved to be the optimal therapy for endometriosis in general and especially in cases of sterilty. While additional progestogen therapy resulted in a 60% rate of remission of the symptoms of endometriosis, danazol gave a 90% success rate in the 3-step therapy. This 3-step therapy avoids many cases of radical surgery during the reproductive age in women with endometriosis. The pregnancy rate of 312 patients treated between 1976 and 1978 with danazol amounted to 45% compared with a pregnancy rate of 32% treated with lynestrenol and laparoscopy.

Danazol↗