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K Wamsteker

Publications and source records attributed to K Wamsteker.

16 recordsLinked to original sources
PubMed1999

Long-term results of hysteroscopic myomectomy for abnormal uterine bleeding.

OBJECTIVE: To analyze the efficacy of transcervical resection of submucous myomas and to identify prognostic factors for long-term results. METHODS: Two-hundred eighty-five women were treated with transcervical resection of submucous myomas without endometrial ablation. In case of incomplete resection a repeat procedure was offered. Long-term follow-up was obtained. Recurrence was defined as the need for further surgery. The relation of several variables with the outcome was analyzed using Cox proportional hazard regression analysis. RESULTS: Seventeen cases (6%) were lost to follow-up. The median follow-up was 46 months (range 1-104 months); for cases without recurrence median follow-up was 42 months (range 16-104 months). Forty-one (14.5%) patients had repeat surgery. An independent prognostic value of uterine size (P < .001) and number of submucous myomas (P < .001) for recurrence was noted. Twenty of 41 patients who had repeat surgery subsequently had a hysterectomy. None of the variables investigated predicted the need for hysterectomy. The surgery-free percentage of 165 patients with normal sized uteri and not more than two myomas was 94.3% (standard error +/- 1.8%) at 2 years and 90.3% (+/- 3.0%) at 5 years. CONCLUSION: Transcervical resection of submucous myomas is a safe and effective treatment for patients with a normal sized uterus and not more than two myomas. It is an acceptable alternative for selected other patients. The need for a combined endometrial ablation is questionable. Transcervical resection of submucous myomas will give patients a high chance of averting further surgery and should modify the way patients are counseled.

Adult↗
PubMed1998

[Secondary amenorrhea due to intrauterine adhesions: Asherman's syndrome].

Three women aged 35, 33 and 40 years had secondary amenorrhoea and monthly recurring abdominal pains after curettage for blood loss after a pregnancy. Hysteroscopy revealed intrauterine adhesions. The symptoms disappeared largely or completely after synechiolysis, introduction of an IUD and oestrogen treatment. Changes in the menstrual cycle, infertility or recurrent abortions starting after a puerperal or postabortum curettage should cause the physician to suspect intrauterine adhesions. For the diagnosis hysteroscopy is the method of choice and hysterography should be added for preoperative assessment and classification. Blind procedures for rupturing the adhesions should not be performed because of the risk of perforation and creating false routes.

Abdominal Pain↗
PubMed1997

An analysis of fluid loss during transcervical resection of submucous myomas.

OBJECTIVE: To determine the contribution of several variables to fluid loss during transcervical resection of submucous myomas. DESIGN: An observational study using multiple linear regression analyses. SETTING: A university-affiliated training hospital and a university department of clinical epidemiology and biostatistics. PATIENT(S): Patients with submucous myomas. INTERVENTION(S): Transcervical resection of submucous myomas and monitoring of fluid loss. MAIN OUTCOME MEASURE(S): Patient age, uterine enlargement, treatment with GnRH analogues or 8-ornithine-vasopressin, type of anesthesia, number of myomas, intramural extension of the myoma (type of myoma), and operating time were tested as variables. RESULT(S): Only intramural extension of the myoma and operating time were obviously related to fluid loss. For the other variables, such a relation was weak at best. The relation between fluid loss and operating time was not modified by any of the other variables. CONCLUSION(S): Because fluid loss is an important limiting factor in the transcervical resection of submucous myomas, special attention should be paid to reduction of the operating time and preoperative assessment of the intramural extension of the myoma to guide appropriate patient selection.

Adult↗
PubMed1997

Is dilatation and curettage obsolete for diagnosing intrauterine disorders in premenopausal patients with persistent abnormal uterine bleeding?

BACKGROUND: To determine the predictive value of dilatation and curettage (D&C) for diagnosing intrauterine disorders in patients with persistent abnormal uterine bleeding. METHODS: An observational descriptive study was performed in a large university-affiliated teaching hospital. The suspicion of intrauterine disorders described in theater-reports involving D&C was compared with the hysteroscopical findings in 131 premenopausal patients with persistent complaints of abnormal uterine bleeding who were referred by other gynecologists within six months after D&C. Pre-test probability (prevalence), post-test probabilities (predictive values) and likelihood-ratio's were calculated. RESULTS: The pre-test probability for all intrauterine disorders was 0.49. The post-test probabilities for a 'suspect' and a 'not suspect' D&C were 0.61 and 0.46 respectively with an overlap of confidence-intervals. The corresponding likelihood-ratio's were 1.69 and 0.87 respectively. CONCLUSIONS: D&C findings were of no value in the prediction of the presence or absence of intrauterine disorders in this population with persistent complaints.

Adolescent↗
PubMed1996

Endometrial ablation using a distensible multielectrode balloon.

The VestaBlate system uses a multielectrode intrauterine balloon as a device to create effective and safe endometrial ablation (EA). The surface of the distensible balloon is impregnated with thermistors and thin, platelike electrodes. It is designed to deliver low-power electroenergy to the endometrium. Unlike the resectoscope techniques that require nonelectrolytic fluids for uterine distention, moving electrodes at high power outputs, and other variables that are operator dependent, the VestaBlate is computer controlled using a standard type electrosurgical generator. A respiratory enzyme stain, nitroblue tetrazoleum, was used to determine the extent and depth of tissue necrosis to a myometrial depth of 2 to 4 mm with uniform destruction of tissue with power setting at 45 W for a 4-minute application of energy. Sixty-nine patients have been treated, with 45 followed for at least 3 to 9 months. The amenorrhea rate is 40%; the oligomenorhea-hypomenorrhea rate is 49%.

Electrodes↗
PubMed1995

A prospective comparison of transvaginal ultrasonography and diagnostic hysteroscopy in the evaluation of patients with abnormal uterine bleeding: clinical implications.

OBJECTIVE: We determined the diagnostic value of transvaginal ultrasonography for endometrial and intrauterine abnormalities in patients with abnormal uterine bleeding. STUDY DESIGN: Between June 1, 1992, and June 1, 1993, 279 consecutive patients underwent transvaginal ultrasonography. Findings were compared with the final diagnosis established by diagnostic hysteroscopy and histologic examination. RESULTS: Transvaginal ultrasonography demonstrated a sensitivity of 0.96 and a specificity of 0.89. With a pretest probability (prevalence) of 0.42, this resulted in posttest probabilities of 0.03 in the case of a normal sonogram and 0.87 for an abnormal sonogram. The corresponding likelihood ratios were 0.04 and 9.09, respectively. CONCLUSION: Transvaginal ultrasonography seems to be an effective procedure to exclude endometrial and intrauterine abnormalities. Its use could be implemented as a routine first-step procedure in patients with abnormal uterine bleeding, and it selects those in need of further diagnostic evaluation in the case of an abnormal or inconclusive sonogram.

Adolescent↗
PubMed1993

Transcervical hysteroscopic resection of submucous fibroids for abnormal uterine bleeding: results regarding the degree of intramural extension.

OBJECTIVE: To examine the results of transcervical resection of submucous fibroids in relation to the degree of intramural extension. METHODS: A prospective 3-year observational study was performed of transcervical resection of submucous fibroids for abnormal uterine bleeding. The mean follow-up was 20 months (range 10-34). Fifty-one patients with a mean age of 38 years (range 23-55) were treated with transcervical resection after classification according to the degree of intramural extension of the submucous fibroids. The intention was to perform complete resection, established at control hysteroscopy. A repeat procedure was performed in cases of incomplete resection unless the patient denied further hysteroscopic treatment. Outcome measures were control of bleeding, subsequent surgery, number of procedures, number of complete resections, and number of recurrences. RESULTS: Bleeding was controlled in 48 (94.1%) of all patients after final resection. Hysterectomy was performed in three patients (5.9%) because of persistent complaints: in two cases after incomplete resection and in one case after complete resection. Three patients were lost to follow-up. Of the remaining 45 patients (42 with complete and three with incomplete final resection), three (6.7%) had a recurrence (one after complete and two after incomplete final resection). With more extensive intramural involvement, the chance to achieve complete resection decreased and the mean number of procedures to achieve complete resection increased. CONCLUSIONS: Complete resection improves the long-term results of transcervical resection of submucous fibroids for control of abnormal uterine bleeding. Transcervical resection of submucous fibroids with more than 50% intramural extension should be performed only in selected cases, as complete resection usually necessitates repeat procedures.

Adult↗
PubMed1992

[Hysteroscopy].

Explore the source record for details and available documents.

Biopsy↗
PubMed1989

Documentation in laparoscopic surgery.

Technological developments have increased tremendously the possibilities for the application of image documentation techniques in gynaecological laparoscopy. Increased quality of optical endoscopes, powerful light sources, highly sensitive photographic films and miniature electronic video cameras have largely removed the barriers to efficient documentation. This equipment is no longer considered to be only for 'hobbyists', but has become an essential part of diagnostic and surgical laparoscopy. Future developments can only increase its applications further.

Diagnostic Imaging↗
PubMed1987

Sonographic investigation of the uterus during artificial uterine cavity distention.

The improvement of sonographic examination of the uterus during artificial uterine cavity distention was studied in 30 consecutive patients in whom a hysteroscopy was indicated. In 10 of 21 patients with a normal sonographic appearence of the uterus, after filling the uterine cavity with Hyskon, various pathologic conditions became visible. In 5 of 9 patients with abnormal sonographic appearance of the uterus, the procedure enabled a more precise diagnosis concerning localization of abnormal echoes in the uterus. The advantage of this method was clearly demonstrated in cases of central echogenic structures, congenital uterine anomalies, myoma's, synechiae, and corpora aliena.

Dextrans↗
PubMed1985

Evaluation of 24 patients with IUD-related problems: hysteroscopic findings.

The clinical and diagnostic findings in 24 patients with IUD-related abnormal uterine bleeding or missing IUDs have been evaluated with special reference to hysteroscopy. For the IUD-related abnormal uterine bleeding no gross uterine or tissue pathology has been revealed except for chronic inflammatory reaction of the endometrium. In half of the cases the IUD showed embedment, displacement within the uterine cavity or migration into the uterine wall, which may be a possible cause of the IUD-related abnormal uterine bleeding. For the detection and removal of IUDs with missing strings, partially embedded and perforated IUDs or retained broken parts of it, the hysteroscopic procedure appeared to be invaluable and in our opinion should be the method of choice.

Adult↗
PubMed1976

Indication of increase of the lecithin/sphingomyelin (L/S) ratio in lung fluid of lambs maternally treated with metabolite VIII of Bisolvon.

Metabolite VIII of Bisolvon (Met. VIII) was administered to six pregnant ewes (i.m. daily 5 or 10 mg/kg for 7-9 days). The treatment was started at the 116th/117th or 117th/118th day of gestation and in one case the drug was given to the fetus (i.v. 2 mg/ml/h). Fetal lung fluid obtained from chronically implanted catheters was used for the estimation of the lecithin/sphingomyelin ratio. The maternal treatment with Met. VIII resulted in a significantly increased growth of the L/S ratio compared to the control group (n=4). In three lambs a sharp increase of the L/S ratio was noticed during the last days of Met. VIII treatment. The time gap between first treatment and noticeable effect was 6-8 days. It is postulated that the noticed increase of L/S ratio is the consequence of Met. VIII treatment and very unlikely the result of a release of glucocorticoticoids.

Ambroxol↗
PubMedDate not supplied

Thermoregulated radiofrequency endometrial ablation.

OBJECTIVE: To test the hypothesis that treating dysfunctional uterine bleeding by automated application of electrothermal energy to the uterine cavity, with precise regional control, might yield results equivalent to those reported for hysteroscopically directed laser and electrosurgical endometrial ablations. MATERIALS AND METHODS: Patients with life style compromising menorrhagia, referred to six gynecologic surgical centers for hysterectomy or endometrial ablation, were admitted to the study if they had normal cervical cytology, a benign endometrial biopsy, no defined cause for their bleeding, and consented to participate in the evaluation of a newly developed Vesta DUB Treatment System. The device consists of a silicone-inflatable electrode carrier to be inserted into the uterine cavity and a controller to monitor and distribute current from a matched electrosurgical generator. Treatment involved a 3-minute or shorter warm-up period and a 4-minute treatment phase. RESULTS: Three- to 24-month follow-up data were available for 187 patients, with a mean follow-up of 14.8 months. The amenorrhea rate was 38%. Bleeding was reduced in 95% of patients. Actuarially, 88 +/- 3% of patients should expect to be free of menorrhagia, dissatisfaction, or need for a second procedure out to 24 months. CONCLUSIONS: The unique regional feed-back control offered by this system causes thorough, evenly distributed, thermal destruction 4-5 mm into the myometrium that reduces bleeding with durability equivalent to published reports of hysteroscopic endometrial ablation.

Adult↗