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Biomedical subjects

L Mettler

Publications and source records attributed to L Mettler.

At least 55 records · Page 3Linked to original sources
PubMed1994

Histologic features of the CISH procedure.

STUDY OBJECTIVE: To evaluate the classic intrafascial SEMM (serrated-edge macromorcellated) hysterectomy (CISH) performed by pelviscopy and by laparotomy, and determine the histologic features of the procedures. DESIGN: The first 253 women who required hysterectomy were assigned to undergo the procedure by pelviscopy or laparotomy based on uterine size. PATIENTS: One hundred fifty-two women underwent CISH by pelviscopy and 101 by laparotomy. INTERVENTIONS: Between September 1991 and December 1993, the patients underwent the two procedures. Uterine leiomyomas with menstrual disorders and pressure symptoms were the principal indications (61%). MEASUREMENTS AND MAIN RESULTS: Histologic findings were in agreement with indications for the procedures. Leiomyomas and leiomyomas with adenomyosis were the most frequent findings. Histologic analysis revealed that the squamocolumnar transformation zone was totally removed in all cases, and all cervical glands were excised in 92%. CONCLUSION: Cervical dysplasia is not a contraindication to CISH, but emphasizes the importance of adequate preoperative screening. This is a conservative operation that my protect against some cervical cancers.

Adult↗
PubMed1994

Pelviscopic Therapy of Adnexal Tumors

Minimally invasive surgery after careful presurgical screening represents an accepted method of treatment for adnexal masses. Between 1990 and 1994, 1032 adnexal tumors were treated by ovarian cystectomy, ovarectomy, adnexectomy, and salpingectomy via pelviscopy. Ten borderline cancers were managed by placing the ovaries into tissue collection bags. In four cases of a preoperatively undetected ovarian cancer, the surgical procedure was changed to laparotomy. Compared with 325 laparotomies performed for ovarian malignancy in the same period of time, the surgical advantages of pelviscopy become evident.

Journal Article↗
PubMed1994

[Treatment of endometriosis with the GnRH agonist buserelin (Suprecur): a multicenter study].

A phase III multicentre study was carried out with the GnRH agonist buserelin (Suprecur) at five university institutions (Dept. of Obstetrics and Gynaecology of Essen, Kiel, Tübingen, Münster and Erlangen) to evaluate the effect of Buserelin (3 x 300 micrograms daily intranasal) on endometriosis for a period of 6 months. Endometriosis was verified by light microscopy in all cases. The data of 430 patients could be evaluated. The extent of the endometriotic lesions was studied before the start and at the end of therapy. The mean age of the patients was 30 +/- 5 years. For 300 patients (66.4%) sterility was a main problem. Previous treatment for endometriosis consisted of operation in 20.5%, treatment with danazol in 16.8% and treatment with gestagens in 11.6% of the patients. Under treatment FSH changed from 11.0 +/- 31.4 mIU/ml to 7.0 +/- 5.6 mIU/ml at the end of therapy; LH from 11.1 +/- 12.9 mIU/ml to 7.4 +/- 7.3 mIU/ml; estradiol from 113.9 +/- 89.0 to 35.9 +/- 60.3 pg/ml and progesterone from 7.2 +/- 11.2 ng/ml to 0.8 +/- 1.4 ng/ml. The effect on endometriosis was judged according to the revised American Fertility Society score (rAFS 1985). The changes of the rAFS-score stages were as follows (before/after therapy): Stage 0: 0%/42.8%; stage I: 43.5%/38.5%; stage II: 31.1%/11.2%; stage III: 18.1%/2.2%; stage IV: 6.3%/0.2%. The total mean AFS-stage changed from 1.9 to 0.7. The frequency of clinical symptoms improved (before/after therapy): dysmenorrhoea 65.0%/11.2%; pelvic pain 48.2%/14.1%; pain at the time of gynaelogical examination 40.0%/9.7%.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Intranasal↗
PubMed1993

Amplification of c-myc but not of c-erbB-2 is associated with high proliferative capacity in breast cancer.

Proliferative capacity provides an independent prognostic marker of progression in breast cancer. Little is known about the molecular mechanisms influencing the cell division rate in mammary carcinomas. In order to address this issue, the copy numbers of c-erbB-2 (HER/neu) and c-myc protooncogenes that have been shown to be amplified in aggressive types of cancers were determined in 60 mammary carcinomas and related to the proliferation rate. The proliferative activity was determined by labeling of the proliferation-associated nuclear antigen which is defined by the recently described monoclonal antibody Ki-S1. Approximately one-third of samples under investigation displayed a Ki-S1 labeling index exceeding 30%. In this subgroup, amplification of c-myc was found in 52.6%, whereas in the remaining cases, 26.1% exhibited an enhanced copy number of c-myc (P < 0.025). By contrast, c-erbB-2 amplification was not found to be associated with a higher proliferation index. Except for one case of invasive lobular carcinoma, both protooncogenes exhibited regular copy numbers in the low proliferation subgroup (< 20%; P < 0.03). We conclude from our findings that c-myc amplification may be one of the molecular causes underlying the highly proliferating phenotype of mammary carcinoma, known to be associated with an unfavorable clinical course.

Base Sequence↗
PubMed1993

[Value of endoscopic ovarian surgery--critical analysis of 626 pelviscopically operated ovarian cysts at the Kiel University Gynecologic Clinic 1990-1991].

During 1990-1991, 626 cystic ovarian tumours measuring > 3 cm diameter were treated endoscopically at the Department of Obstetrics and Gynaecology at the University of Kiel. In 97 patients, either ovariectomy or adnexectomy, and in 529 cases, an ovarian cyst enucleation was performed. In every case, we considered clinical laboratory, pre-examinations as well as a vaginal ultrasound examination to be of extreme importance for our decision. In 1990, we changed 18 times from pelviscopy to laparotomy and in 1991 7 times under the visual impression of an ovarian malignant tumour. The diagnosis was verified 8 times in 1990 and 3 times in 1991. 10 times in 1990 and 4 times in 1991, the patients were laparotomised with benign ovarian tumours, whose form and motility did not indicate laparotomy at the beginning. No case of ovarian cancer was endoscopically biopsied in 1990-1991. Details on the treatment of patients, their brief hospitalisation period and quick reintegration into family and professional life speak for the applied operation technique.

Biopsy↗
PubMed1993

Ovarian surgery via pelviscopy.

A retrospective study of operative pelviscopy was undertaken at the Department of Obstetrics and Gynecology at the Christian-Albrechts-University of Kiel to review the spectrum of ovarian surgery performed from 1987 to 1989. The purpose of this study was to assess the scope of surgery (cystectomies, ovariolysis, ovarian biopsy and cyst puncture), and to identify any advantages or disadvantages associated with the procedure.

Biopsy↗
PubMed1992

Macrophage- and lymphocyte-subtypes in the endometrium during different phases of the ovarian cycle.

The presence of immunocompetetive cells in the endometrium during the proliferative and secretory phase of the ovarian cycle is demonstrated on the light and electron microscopic level using monoclonal antibodies (MoAb). Subtypes of monocytes, macrophages and T-lymphocytes appear during the different phases in variable extent and different localization. Some subpopulations of the monocyte/macrophage system and T-helper lymphocytes increase in number on day 21/22. Our observations indicate that cells with bone marrow origin take part in functional events of the endometrium during the ovarian cycle.

Antibodies, Monoclonal↗
PubMed1992

Experience with leuprorelin acetate depot in the treatment of fibroids: a German multicentre study.

Between October 1988 and October 1990 in a noncomparative multicentre study, 114 patients were treated for uterine fibroids with the gonadotrophin-releasing hormone (Gn-RH) agonist, leuprorelin acetate depot. The mean age of the women was 33 years and 55.3% of them had a history of infertility. After confirmation of the diagnosis by ultrasound and/or operation, treatment began between day 1 and 3 of the cycle with leuprorelin acetate depot 3.75 mg subcutaneously. Therapy was carried out for a total of 6 months with one injection every 4 weeks. Treatment was paralleled by measurements of endocrine and metabolic parameters, estimation of myoma and uterine size by ultrasound and self-reporting of the patients of drug-related complaints. Four of the 114 women did not complete the whole treatment, two of them because of general side effects, one because of carcinophobia and unsatisfactory regression of the myoma and the last one for unspecified reasons. During treatment, a mean reduction of the uterine volume of about 67% was observed, in conjunction with shrinkage of the myoma in 92.1% of cases (mean decrease of 56% of the fibroids) with a large interindividual difference. Maximal diminution of uterine and fibroid size had been nearly completely reached within the first 12 weeks of therapy. After 4 weeks of the Gn-RH agonist depot most of the patients had achieved postmenopausal status, which continued throughout the remaining 20 weeks of treatment. In accordance with this finding, the majority of general side effects was due to the hypo-oestrogenic endocrine status. Liver and lipid metabolism was almost unaffected, although increasing calcium and alkaline phosphatase serum levels as well as an increased urinary calcium/creatinine ratio demonstrated an increased metabolic turnover of the bone. Haemoglobin concentrations, however, increased in those cases with fibroid-related anaemia. Thus the slow-release form of leuprorelin acetate is an adjunct to myomectomy especially in those women in whom family planning is not yet completed.

Adult↗
PubMed1991

Ectopic pregnancy treatment using pelviscopic or vaginosonographically-guided intrachorionic injection of methotrexate and POR 8.

It is believed by some that the basis of modern first-trimester pregnancy care should involve screening for ectopic pregnancy using vaginal ultrasonography. This has led to this condition being diagnosed in most cases at an earlier stage than has previously been possible. This advance in diagnostic ability has introduced the concept of conservative management for this condition. The authors describe the conservative management of nine cases of ectopic pregnancy using intrachorionic injection of either methotrexate alone or in combination with POR 8. In all cases less than 9 weeks had passed since the last menstrual period, and the ectopic pregnancies treated under ultrasound control were all thought to be viable. Five cases were treated using pelviscopy, whilst in another four the needle was guided using vaginal ultrasonography. There were no procedure-related complications. Following therapy, the women were followed up using serial levels of serum beta-hCG. In seven cases there was a gradual reduction to normal levels. There were two treatment 'failures'. In both these cases methotrexate alone, rather than in combination with POR 8, was used for injection. Although formal tests of tubal patency have not been performed in all cases, one woman in the series has since conceived and has a normal intrauterine pregnancy. It is concluded that vaginal instillation of methotrexate is an alternative treatment for early ectopic pregnancy. It should be limited to viable ectopic pregnancies whose chorionic cavities are less than 2.0 cm in diameter. A plan for the management of ectopic pregnancy is presented, involving selection for both ultrasound-guided injection and pelviscopic surgery. Laparotomy is not considered to be a treatment option in the majority of cases.

Journal Article↗
PubMed1991

Long-term treatment of atrophic vaginitis with low-dose oestradiol vaginal tablets.

Fifty-one post-menopausal women suffering from symptoms of oestrogen deficiency-derived atrophic vaginitis were treated intravaginally with two therapeutic regimens based on doses of 25 micrograms 17 beta-oestradiol (E2) in an open, controlled study. All the patients received treatment daily for 2 weeks by way of induction therapy. They were then randomly allocated to either once-weekly (17 patients) or twice-weekly (34 patients) vaginal administration for a further 50 weeks as maintenance treatment. Endometrial histopathology was evaluated before and after 1 year of treatment. The effects on symptoms and oestrogen/gonadotrophin levels were determined before and after 2, 12, 24, 36 and 52 weeks of therapy. Nine women continued twice-weekly treatment for a further year, meaning that they underwent treatment for a total period of 2 years. Endometrial biopsies were obtained after 2 years of treatment. All the pretreatment endometrial biopsies indicated an atrophic endometrium. One patient out of the 14 who completed 1 year of therapy in the group treated once weekly showed weak proliferation of the endometrium, while the other 13 had an atrophic endometrium. In the group treated twice weekly, 2 out of the 31 patients who completed the study showed weak proliferation of the endometrium. The other 29 had an atrophic endometrium. All 9 women who received treatment for 2 years had an atrophic endometrium at the end of the treatment period. The twice-weekly dosage regimen gave complete relief of symptoms in almost all patients, whereas the majority of the patients in the group treated once weekly still had mild symptoms. No adverse effects were reported.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Intravaginal↗
PubMed1991

Experience with a depot GnRH-agonist (Zoladex) in the treatment of genital endometriosis.

Eighty patients with different stages of genital endometriosis were treated with Zoladex, a gonadotrophin-releasing hormone analogue in a depot formulation, injected subcutaneously every 4 weeks. The stages of endometriosis (I-IV) were classified according to the revised American Fertility Society recommendations (AFS criteria) via pelviscopy before and after 6 months of treatment. Fifty-eight second-look pelviscopies were performed with the following objective changes after (before) treatment: Stage IV 0 (3); Stage III, 2 (13); Stage II, 12 (30); Stage I, 19 (12). Twenty-five patients presented with Stage 0 after therapy and were healed. All 57 symptomatic patients showed a subjective response to Zoladex therapy with a significant decrease of the total pelvic symptom score. Thirty-eight patients with infertility wished to become pregnant and so far 16 (40%) have conceived. During therapy, the serum concentrations of luteinizing hormone, follicle stimulating hormone, estradiol and progesterone were significantly suppressed. All patients were amenorrhoeic after 1-2 injections. Restoration of ovarian function with resumption of menstruation occurred within 57-92 days after the last injection of Zoladex (1-2 months after end of treatment). Side-effects were minimal and were those expected of the hypo-oestrogenic state, such as hot flushes, vaginal dryness and decrease of libido.

Adult↗
PubMed1991

Medicosurgical approach to diagnosis and treatment of ectopic pregnancy.

Early ectopic pregnancy screening using vaginal ultrasonographic technology together with measurement of beta human chorionic gonadotropin (beta-hCG) and human chorionic somatomammotropin is possible within the first 2 weeks of the missing menses, prior to the appearance of symptoms. This article summarizes the main available treatment modalities, focusing primarily on the pelviscopic surgical tube-conserving approach and on instillation of intrachorionic drugs (methotrexate alone or in combination with ornipressin) and injection of prostaglandin F2 alpha. While the pelviscopic surgical approach can be applied in nearly all cases of ectopic pregnancy, irrespective of pregnancy duration, the pelviscopic medicosurgical approach is only appropriate for the treatment of early ectopic pregnancies until the 8th week of gestation in patients without fluid collection in the pouch of Douglas and beta-hCG values below 2000 mU/mL. The transvaginal intrachorionic drug instillation as a simple medicosurgical approach performed under ultrasonographic guidance without anesthesia remains restricted to the treatment of early viable ectopic pregnancy. A brief account of the expectant treatment of patients with nonviable ectopic pregnancy is given, underlining the prerequisites of decreasing beta-hCG values and the absence of fluid in the pouch of Douglas. Although spontaneous resorptions have been observed in a number of cases of the disease, no clear evidence is available on the reconstitution of tubal function and patency.

Chorionic Gonadotropin↗
PubMed1990

Six new monoclonal antibodies to serous, mucinous, and poorly differentiated ovarian adenocarcinomas.

Six monoclonal antibodies directed against ovarian adenocarcinoma were generated by use of 100,000 x g supernatants of Triton-X-100 solubilized extracts of ovarian serous adenocarcinoma as the antigen source. Immunoperoxidase preparation of frozen-sections and routinely processed paraffin section specimens revealed a highly restricted reactivity of these antibodies when tested with adult (n = 2) and fetal (n = 3) tissue types. Coreactivities were occasionally observed with epithelia of the kidney, mammary gland, and pancreas. One monoclonal antibody, Ki-OC I-6-2, cross-reacted only with epididymal epithelia. No coreaction occurred with normal tissue of the ovary, Fallopian tube, or uterus. All antibodies were additionally tested on 74 cases of nonovarian malignancies, 15 cases of ovarian metastases of nonovarian carcinomas, and 114 specimens of ovarian neoplasms other than carcinomas. Ki-OC I-6-2 had no cross-reactivity with these tumors except for one case of renal cell carcinoma. This monoclonal antibody recognized serous, mucinous, and poorly differentiated adenocarcinoma cell types. None of the six antibodies reacted with clear cell or endometrioid carcinoma. All were found to be of the IgG-1 subclass. The tumor antigen to which Ki-OC I-6-2 immunoreacted was estimated to have a molecular weight of 80 kilodaltons (KD).

Adult↗
PubMed1990

Pelviscopic tubal surgery: the acceptable vogue.

A retrospective analysis undertaken at the University of Kiel by the Department of Obstetrics and Gynaecology, consisted of a 3-year study of cases of tubal surgery with operative pelviscopy (laparoscopy). In the period from 1987 to 1989, 529 patients underwent selective operative laparoscopy specifically because of a tubal factor of infertility. The type of surgery performed was aimed at the conservation and salvaging of the tubes whenever possible, according to the principles of 'Minimally Invasive Surgery'.

Fallopian Tubes↗