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L Mettler

Publications and source records attributed to L Mettler.

At least 19 recordsLinked to original sources
PubMed2006

Ectopic pregnancy treatment by laparoscopy, a short glimpse.

Ectopic pregnancy is a life-threatening emergency, the incidence of which is increasing globally. There are a number of factors predisposing to this condition; today, the most common of these is salpingitis. Due to advancements in diagnostic technology it is possible to diagnose this condition early and thus try to achieve a favourable outcome for the patient. Treatment options in the form of medical and surgical modalities are widely available. As minimally invasive therapy techniques are rapidly advancing, laparoscopic treatment has become the most popular and preferred method for treating ectopic pregnancy. Both salpingotomy as well as salpingectomy can be performed through the laparoscope. This paper gives a short glimpse at the predisposing factors and the diagnostic investigations available for ectopic pregnancy and an insight into its laparoscopic treatment. It also reviews the pregnancy outcome and laparoscopic treatment of cases at the Department of Obstetrics and Gynaecology, Campus Kiel, University Hospitals Schleswig-Holstein.

Female↗
PubMed2005

Is granulocyte colony-stimulating factor level predictive for human IVF outcome?

BACKGROUND: We investigated granulocyte colony-stimulating factor (G-CSF) in human reproduction. METHODS: From a total sample of 93 patients, we analysed in group 1 (n = 82) the level of G-CSF and estradiol (E(2)) in serum and follicular fluid (FF) on day of follicular puncture (FP). Furthermore, in response to ovarian stimulation, G-CSF levels in serum were compared between low (n = 11), moderate (n = 53) and high (n = 18) response patients. In group 2 (n = 23) serum for G-CSF assessment was collected throughout menstrual cycle until gestation. Group 3 (n = 11) patients with endometriosis were assessed for G-CSF in serum and FF on day of FP without further differentiation. RESULTS: G-CSF in FF was higher than in serum (P < 0.01). G-CSF in serum increased from low through moderate to high response (P < 0.001); pregnancy rates were 0, 24.5 and 33.5% respectively. G-CSF in serum increased throughout stimulation, reached a peak with ovulation induction (P = 0.01) and decreased until embryo transfer (P=0.001). G-CSF level only in pregnant patients (n = 11) increased from embryo transfer to implantation to gestation (P = 0.005). In endometriosis patients G-CSF in serum and FF was lower than in non-endometriosis patients (P < or = 0.03) and corresponded with low response patients. CONCLUSIONS: G-CSF is involved in follicle development and may be a predictor of IVF outcome.

Adult↗
PubMed2005

Laparoscopic hysterectomy: challenges and limitations.

Twenty years after the first description of vaginal hysterectomy with laparoscopic assistance by Kurt Semm in 1984 (1), and 16 years after the publication of the so-called laparoscopically assisted vaginal hysterectomy (LAVH) by Harry Reich in 1989 (2), it is time to review and evaluate the real benefits of laparoscopic hysterectomy. Although laparoscopic surgery is well accepted by gynaecologists worldwide for the treatment of certain gynaecological conditions, laparoscopic hysterectomy in Germany, and probably worldwide, is still only performed by a few specialists. Highly skilled surgical techniques, longer operating time and expensive technology are suggested to be the deterring factors. Laparoscopic hysterectomy, in its different forms, is an attractive and safe procedure for the management of benign gynaecological conditions and many authorities recommend its use on a larger extent. On the other hand, in our opinion, the use of laparoscopic hysterectomy for oncological indications is still controversial. Extensive experience of over 15 years, of the first author, in practising and teaching various forms laparoscopic hysterectomy, namely, laparoscopically assisted vaginal hysterectomy (LAVH), total laparoscopic hysterectomy (TLH), classic intrafascial supracervical hysterectomy (CISH) and laparoscopic supracervical hysterectomy (LSH), has led us to the firm conclusion that these techniques are advantageous to patients if performed for the appropriate indication. In particular, subtotal or supracervical hysterectomy, with the cervix remaining in its place, is associated with fewer complications and a very favourable outcome for the patient. Radical laparoscopic vaginal hysterectomy (RLVH), the last variant in our exposé, is only successful in an expert's hands. The surgical techniques of these varieties of laparoscopic hysterectomies will be described and illustrated in detail in this paper.

Journal Article↗
PubMed2004

Perioperative levels of interleukin-1beta and interleukin-6 in women with breast cancer.

OBJECTIVE: Proinflammatory cytokines, such as Interleukin-1beta and Interleukin-6, are known to play an important biological role in trauma, sepsis and malignant disease. Surgery can modulate the immune system, especially in patients with malignant diseases, by influencing the serum levels of Interleukin-1beta and Interleukin-6. It is known that cytokine levels depend on the grade of tissue injury. We have investigated the serum levels of Interleukin-1beta and Interleukin-6 during the perioperative period in women with breast cancer undergoing simple mastectomy or segmental resection. The aim of the study was to analyse whether breast cancer surgery influences cytokine expression in the peripheral blood and whether the concentrations of the measured interleukines differ according to the surgical method. METHODS: Blood samples of 45 women with breast cancer (Stage I and II) undergoing simple mastectomy (n = 16) or segmental resection (n = 29) were collected at six different times: before (T1), during (T2), three hours after (T3), one day after (T4), three days (T5) and five days after (T6) surgery. The serum levels of Interleukin-1beta and Interleukin-6 were measured by ELISA. RESULTS: In both groups Interleukin-1beta serum concentrations (p < 0.05) increased significantly on the first day after surgery. On the third day after surgery the concentrations of Interleukin-1b decreased to the preoperative level. A significant difference in Interleukin-1beta concentrations as a consequence of the surgical method was not detectable. Changes in the serum levels of Interleukin-6 within the measurement period were not observed. CONCLUSIONS: Surgery in patients with breast cancer leads to increased Interleukin-1beta serum levels on the first postoperative day. It has been shown that elevated Interleukin-1beta and Interleukin-6 levels are correlated with a high rate of recurrence. Therefore, this may be of consequence to patients with malignant diseases. The method of surgery for both types, however, had no influence on the peripheral cytokine expression. Therefore, a nearly equal influence on the immune system can be stated.

Adult↗
PubMed2004

Correlation of endoscopic interpretation of endometriosis with histological verification.

INTRODUCTION: In this study we correlate the laparoscopic findings of endometriosis with the histological confirmation of the disease over a period of two years. MATERIALS AND METHODS: One hundred and sixty-four laparoscopies performed at the Department of Gynecology & Obstetrics, University of Kiel, over a two-year period were reviewed for laparoscopic findings and histological confirmation of endometriosis. RESULTS: The majority of patients suspected of endometriosis at laparoscopy were confirmed by histological examination, i.e. 138 out of 164 patients (84.1%). CONCLUSION: Laparoscopy is the easiest diagnostic tool for the diagnosis of endometriosis which can be confirmed by histological examination.

Adult↗
PubMed2003

Prospective clinical trial of SprayGel as a barrier to adhesion formation: an interim analysis.

STUDY OBJECTIVE: To evaluate SprayGel, a new sprayable adhesion barrier developed for laparoscopic and open pelvic and abdominal surgical procedures. DESIGN: Prospective, randomized, controlled, multicenter trial (Canadian Task Force classification I). SETTING: University clinic and private clinic. PATIENTS: Forty-five women, 24 randomized to treatment and 21 to control group. INTERVENTIONS: Open or laparoscopic myomectomy with and without application of SprayGel, followed by second-look laparoscopy (SLL) to evaluate postoperative adhesions. MEASUREMENTS AND MAIN RESULTS: Application of SprayGel was fast and easy. On average, 10 weeks after surgery, 18 treated patients (75%) and 13 (61.9%) controls had SLL. That procedure showed 5 (27.8%) of 18 treatment patients to be adhesion free versus 1 (7.7%) of 13 controls (p = 0.163). Patients randomized to SprayGel were 3.6 times more likely to be adhesion free than controls. Mean tenacity scores were significantly lower than in controls (0.5 vs. 1.7), a difference of 0.9 (95% CI 0.3, 1.5, p = 0.003) or 47% (95% CI 17%, 77%) less. Mean adhesion area was reduced in the treatment group (4.1 vs. 5.6) but not significant (p = 0.6747, 95% CI-5.4, 8.4). No adverse events regarding application of SprayGel were seen. CONCLUSION: SprayGel was effective in reducing postoperative adhesion severity, and showed a trend toward reducing frequency and extent of adhesions after laparoscopic and open myomectomy. Further studies are necessary to confirm the promising results of this interim analysis.

Adhesives↗
PubMed2003

Pelvic adhesions: laparoscopic approach.

A retrospective study using the American Fertility Society's Adhesion Scoring Method and the MCASM (More Comprehensive Adhesion Scoring Method) and a prospective, randomized, controlled, multicenter trial (Canadian Task Force Classification I) were conducted. Of 2124 cases operated by laparoscopy, 465 patients had adhesions. Fifty-one female patients underwent open or laparoscopic myomectomy procedures with vs. without application of SprayGel adhesion barrier prevention, followed by second-look laparoscopy to evaluate postoperative adhesions. Details of the 465 cases of adhesiolysis are given. In subgroup 1 (n = 34) there were no preexisting adhesions. All 34 patients were assessed at a second-look laparoscopy for adhesion occurrence after 6-8 weeks; 29.4% were found to have no adhesions and 70.6% of patients had significant or mild adhesions. In subgroup 2, 21 patients who had undergone previous surgery for adhesiolysis were operated upon again, and 24% revealed an increased adhesion score, 57% the same adhesion score, and 19% a reduced adhesion score at second-look laparoscopy. Out of 51 patients enrolled, 45 were randomized to either treatment (n = 24) or control (n = 21). Three to sixteen weeks following surgery, 18 of 24 treatment patients (75%) and 13 of 21 controls (61.9%) had second-look laparoscopies (SLL). SLL showed 5 of 18 treatment patients (27.8%) were adhesion free vs. 1 in 13 of controls (7.7%). Patients randomized to SprayGel treatment were 3.6 times more likely to be adhesion free than patients randomized to control. Compared to the initial surgery, the severity score showed a 22% reduction in the treated group vs. a 39% increase in the control group, and a 12% reduction of adhesion area in the treated group vs. a 37% increase in the control group at SLL. New data confirmed previous knowledge: To avoid adhesions you must avoid surgery. If surgery has to be performed, laparoscopic surgery causes fewer adhesions than laparotomy. SprayGel was shown to be effective in reducing postoperative adhesions after laparoscopic and open myomectomy. Application of this adhesion barrier prevention system is fast, easy, and safe. Further studies are needed to confirm the promising results of this interim analysis.

Adult↗
PubMed2003

[Effect of estradiol and progesterone on production of macrophage colony-stimulating factor by human granulosa cells in vitro].

OBJECTIVE: To investigate the effect of estradiol (E(2)) and progesterone (P) on macrophage colony-stimulating factor (M-CSF) production by human luteinized granulosa cells in vitro. METHODS: Human luteinized granulosa cells were isolated from follicular fluid of superovulated infertile patients undergoing intracytoplasmatic sperm injection (ICSI). Luteinized granulosa cells were cultured with HAM's F-10 medium with various concentrations of E(2) or P (0, 1 x 10(-7), 1 x 10(-6), 1 x 10(-5), 1 x 10(-4), 1 x 10(-3) mol/L). Media were removed at 72 h after culture. M-CSF in media was measured by a solid phase enzyme-linked immunosorbant assay (ELISA) and estradiol and progesterone in media were measured by enzyme immunoassays (EIA). RESULTS: The basic concentration of M-CSF in cultivated granulosa cells without E(2) stimulation was low (47 +/- 15 ng/L). However, E(2) at concentrations of 1 x 10(-6) - 1 x 10(-3) mol/L caused a significant increase of M-CSF secretion by luteinized granulosa cells in a dose-dependent mode (2.3, 4.5, 6.9, 7.9 times higher than the basic level, respectively) (P < 0.05). E(2) at a concentration of 1 x 10(-7) mol/L, however, did not stimulate the production of M-CSF (P > 0.05). P at concentrations of 1 x 10(-7) - 1 x 10(-3) mol/L showed no effect on M-CSF production by luteinized granulosa cells (P > 0.05). CONCLUSIONS: Estradiol can stimulate M-CSF production by luteinized granulosa cells in vitro in a dose-dependent mode, on the other hand P cannot induce M-CSF production by luteinized granulosa cells. The mechanism of estradiol regulating follicular development may partially via M-CSF/receptor pathway.

Adult↗
PubMed2001

Pelviscopic reversal of tubal sterilization with the one- to two-stitch technique.

STUDY OBJECTIVE: To describe 28 pelviscopic proximal reversals of tubal sterilization. DESIGN: Cohort study (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENTS: Twenty-eight women. INTERVENTIONS: Twenty-two women underwent bilateral and six unilateral tubal end-to-end anastomosis through a catheter introduced through the working channel of a hysteroscope for a combined hysteroscopic-laparoscopic operation. MEASUREMENTS AND MAIN RESULTS: In the two-stitch technique the first stitch adapted the mesosalpinx and the second (4-0 or 6-0 material) to unite the tube muscularis. In some cases a third stitch was applied to either the muscularis or mesosalpinx. In all cases the wound was sealed with tissue col at the end of the procedure. Tubal patency was achieved in 95% of bilateral anastomoses and 100% of unilateral ones. Seventeen pregnancies (61%) were achieved within a minimum of 6 months and a maximum of 4 years. Fifteen patients (54%) had an intrauterine pregnancy with normal delivery and two (7%) had a tubal pregnancy. No abortions occurred. CONCLUSION: Laparoscopic end-to-end anastomosis is a suitable surgical alternative to tubal end-to-end anastomosis by laparotomy and has all the advantages of a laparoscopic procedure.

Adult↗
PubMed2001

Laparoscopic management of 641 adnexal tumors in Kiel, Germany.

STUDY OBJECTIVE: To evaluate the effectiveness and safety of laparoscopic and laparotomic management of ovarian tumors. DESIGN: Retrospective analysis (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENTS: Six hundred forty-one women with benign and malignant ovarian tumors. INTERVENTIONS: Laparoscopy and laparotomy. MEASUREMENTS AND MAIN RESULTS: Between January 1997 and December 1998, 493 (76.9%) ovarian tumors were treated laparoscopically and 138 (21.5%) by laparotomy. Criteria for laparotomy were high suspicion of malignancy and tumors larger than 10 cm that were technically too difficult for the laparoscopic approach. The mean size of tumors treated laparoscopically was 4.5 cm (range 1.1-11 cm) and by laparotomy 8.2 cm (range 3-20 cm). Mean operating times were 75.7 minutes (range 30-200 min) and 126 minutes (range 30-235 min), respectively, and mean blood loss was 193 ml (range 50-1200 ml) and 431 ml (range 50-2500 ml), respectively. Twelve laparoscopies were converted to laparotomy, six because of technical reasons such as severe adhesions, bleeding, or tumor size, and six for intraoperative suspicion of malignancy. Of the latter, four (66.7%) turned out to be ovarian carcinoma and two (33.3%) borderline tumors. Histologic evaluation clearly revealed predominance of functional ovarian cysts, endometriomas, and dermoid cysts in the group treated by laparoscopy, whereas ovarian carcinomas, large endometriomas, and serous cysts prevailed in the laparotomy group. CONCLUSION: With careful preoperative screening, the rate of laparoscopies for treatment of benign ovarian cysts can be increased. (J Am Assoc Gynecol Laparosc 8(1):74-82, 2001)

Adolescent↗
PubMed2001

The cystic adnexal mass: patient selection, surgical techniques and long-term follow-up.

The continuous change in the treatment and management of ovarian tumours is an excellent example of the changes that have occurred in gynaecological laparoscopic surgery. This paper evaluates the management of the adnexal mass in 2001. Second, it reviews ovarian tumours treated at the Department of Obstetrics and Gynaecology, University of Kiel, between January 1997 and December 1998, and the place of laparoscopy in the management of these lesions. Third, the review attempts to give an insight into the long-term follow-up of patients treated laparoscopically for the removal of ovarian cysts. Finally, a retrospective survey is given of the clinical pathology and prognostic features of adnexal masses operated on during pregnancy. With regard to long-term follow-up, no difference was found between laparoscopic or laparotomic treatment of ovarian tumours.

Adolescent↗
PubMed2001

Interaction of interleukin-6 on human granulosa cell steroid secretion.

Numerous studies have shown that a variety of cytokines are involved in the regulation of ovarian function. Interleukin-6 (IL-6), has been found in follicular fluid. In this report we show by immunocytochemical methods the localization of the extracellular domain of the IL-6-receptor and its associated signal transducer glycoprotein gp 130 on the surface of granulosa cells (GCs). The possibility that IL-6 may also influence the basal and FSH-stimulated production of estradiol (E2) and progesterone (Prog) by GCs in vitro was also investigated. GCs were obtained from infertile patients undergoing in vitro fertilization and embryo transfer treatment and cultured for 72 h or were given increasing concentrations of human recombinant IL-6 (8--128 pg/ml) in the absence or presence of FSH (96 U/ml). For the time-course studies, FSH-stimulated GCs were treated in the absence or presence of IL-6 (128 pg/ml) and supernatants were assayed at 24 h intervals (24-96 h) for E2 and Prog productions. The results show that increasing amounts of IL-6 significantly inhibit E2 production in the absence or presence of FSH vs untreated controls (P=0.025 at IL-6=128 pg/ml and P=0.016 at IL-6=16 pg/ml respectively). IL-6 also inhibited FSH-stimulated but not unstimulated Prog release (P=0.038 at IL-6=8 pg/ml). These findings suggest that IL-6 may be one of the factors that plays a local regulatory role in the course of FSH-stimulated E2 and Prog release. The time-course studies of the effect of the absence or presence of IL-6 demonstrated a significant inhibitory effect on both E2 and Prog secretion (P<0.001) by FSH-stimulated GCs. As infections of the female reproductive tract are often accompanied by elevated local IL-6 levels, this factor may be one of the links leading to endocrine reproductive dysfunction during genital infections.

Cells, Cultured↗
PubMed2000

Cetrotide confirmatory trial of cetrorelix/0.25 mg in 26 women undergoing ovarian stimulation with recombinant follicle stimulating hormones for IVF, ICSI and embryo transfer (ET).

BACKGROUND: There have been numerous double-blind, randomised, dose-finding studies of the gonadotrophin-releasing hormone (Gn-RH) antagonist Ganirelix (Org 37462) and the Gn-RH antagonist Cetrorelix. METHODS: We performed a clinical trial with 26 patients undergoing ovarian stimulation with the recombinant human follicle stimulating hormone (FSH) by applying rec. FSH in a flexible daily dose, depending on the estradiol levels of the patient, from day 3 of the cycle onwards in a controlled ovarian hyperstimulation (COH) protocol. A single dose of 0.25 mg was injected daily subcutaneously from day 7 of the cycle onwards until the day of HCG application. The recombinant FSH dose was adjusted according to ovarian response. Fifteen patients were treated for IVF and nine for ICSI. In two patients egg retrieval was not performed. Estradiol and LH levels were measured on the day of HCG application. RESULTS: The mean number of recovered oocytes in the 24 patients was 5.5. A fertilisation rate of 64% was achieved in the IVF group and 69% in the ICSI group. In Germany a maximum of three embryos per patient is permitted to be transferred. Pregnancy occurred in ten patients: 5 IVF patients and 5 ICSI patients. In this small group of IVF patients a 33% pregnancy rate per follicular puncture and a 50% pregnancy rate per embryo transfer resulted. The ICSI group showed a 55% pregnancy rate per follicular puncture and a 62% pregnancy rate per embryo transfer. CONCLUSION: Within an IVF/ET, ICSI programme the Gn-RH-antagonist Cetrorelix in combination with rec. FSH gave optimal pregnancy results.

Adult↗
PubMed2000

Nuclear grading of endometrial cancer harbors heterogenous prognostic groups as detected by proliferation activity.

OBJECTIVE: Nuclear grading, in addition to the histopathological result of every tumor, is responsible for consecutive treatment designs. Ki-S5 is the monoclonal antibody against a formalin-resistant epitope of the Ki-67 antigen and can be determined in paraffin-embedded samples. The aim of the study was a comparative analysis of the nuclear grading of endometrial cancer and the proliferation marker Ki-S5. METHODS: In 126 specimens of endometrial cancer the proliferation activity of the monoclonal antibody Ki-S5 was determined (streptavidin-biotin-complex method) in correlation to nuclear grading. In the group of grade 2, stages Ib and Ic andenocarcinomas, proliferation rates were compared to recurrence rates. RESULTS: Divergent proliferation rates resulted. Adenoacanthomas showed a relatively low proliferation rate (<28%). For the andenosquamous carcinomas the proliferation rate ranged between 28-43%. The largest group of adenocarcinomas showed proliferation rates from 5-74%. A clear dependency between increasing proliferation rates and decreasing differentiation (nuclear grading 2-3) was observed. In the small group of patients with andenocarcinomas, nuclear grading G2 stages Ib and Ic, 38 suffered no recurrence after 6-10 years. However, the six patients with proliferation rates of over 35% all suffered a recurrence. CONCLUSIONS: The results emphasize the need to differentiate G2 tumors, depending on their proliferation rate, into low risk (KiS5<35%) and high risk cases (Ki-S5>35%).

Adenocarcinoma↗