Biomedical subjects

C Altgassen

Publications and source records attributed to C Altgassen.

6 recordsLinked to original sources

PubMed2006

Complications in laparoscopic myomectomy.

BACKGROUND: An increasing number of patients with fibroids wish to retain their uterus without improving fertility. We evaluated the rate of complications in our teaching hospital and its association with patients' age. METHODS: Chart records of 351 patients were evaluated according to patients' age. RESULTS: A total of 654 fibroids were removed. Mean size of fibroids was 5.3 cm; mean duration of surgery was 113.2 min. Blood transfusion was necessary in one patient. The intraoperative complication rate was 2.6% and postoperative complications occurred in 5.7% of patients. Sonographic evaluation showed a hyperechogenic scar in 29.2%. A total of 57.1% pregnancies ended in term infants. No uterine rupture was reported. As a sign of contentment, 87% of patients would choose the same procedure again. Indication for myomectomy in elder women was more often associated with uncertain sonographic findings due to intraligamentary localization. CONCLUSION: Morbidity was low. Age had no impact. Laparoscopic myomectomy can be offered to all women.

Adult↗

PubMed2006

[Fluorescence diagnosis and photodynamic therapy with 5-aminolevulinic acid induced protoporphyrin IX in gynecology: an overview].

Fluorescence diagnosis and photodynamic therapy with 5-aminolevulinic acid induced protoporphyrin IX are promising new options in the diagnosis and therapy of diseases in a wide spectrum of medical disciplines such as urology, dermatology, gastroenterology, surgery, neurosurgery and gynecology. The techniques are based on the application of the heme biomolecule precursor 5-aminolevulinic acid which induces the endogenous accumulation of the photosensitizer protoporphyrin IX in designated tissues. After external excitation with blue light a strong red fluorescence can be initiated particularly in tumorous tissues. In gynecology many studies have been performed evaluating the usefulness of fluorescence based detection of cervical dysplasias, breast cancer, endometrial diseases, ovarian cancer and endometriosis. This work aims on the principles of fluorescence detection as an important tool in biomedical optical imaging and its current status in gynecology.

Aminolevulinic Acid↗

PubMed2006

Patients' satisfaction with laparoscopic myomectomy.

BACKGROUND: Laparoscopic myomectomy offers a uterus-conserving alternative to hysterectomy for patients suffering from symptomatic myomas. The following study aimed to examine clinically relevant aspects of perceived satisfaction following laparoscopic myomectomy. METHOD: 191 women completed a 17-item questionnaire on retrospective satisfaction with their choice for the operation and with the surgical outcome (e.g., "all myomas were removed", "termination of discomfort"). A comparison was performed using questionnaire data, patients' demographical data and surgical records (e.g., duration of surgery). RESULTS: Women who trusted in their decision for the surgical procedure revealed better surgical outcome and greater satisfaction with the treatment process than those who were insecure with their choice. Age did not influence the patients' perceived satisfaction. In anticipation of the surgical outcome, patients placed stronger emphasis on tissue preservation than on their wish for a child or on the termination of discomfort. CONCLUSIONS: The high overall level of satisfaction and positive outcome in various age groups contradicts current recommendations against laparoscopic myomectomy for women over 40 years of age.

Adult↗

PubMed2004

The value of uterine artery Doppler ultrasound in the prediction of severe complications in a risk population.

AIM: The aim of this prospective study was to assess the role of uterine artery color Doppler waveform analysis in the prediction of adverse pregnancy outcome such as preeclampsia, intrauterine growth retardation, placental abruption or a combination of outcome parameters in risk pregnancies (n=52). METHODS: Various uterine artery Doppler ultrasound parameters (resistance index (RI)>0.58, RI>0.7 and uni/bilateral or bilateral notching) were tested. The mean time of delivery was 37+1 weeks' gestation. Six newborns (12%) were delivered before 34 weeks of gestation. The mean birth weight was 2,910 g. Dystrophic fetuses (<10% percentile) were registered in 7 cases (13%). In 11 of the 52 women (21%) a cesarean section was performed because of abnormal fetal heart recording. RESULTS: Preeclampsia was diagnosed in 4 cases (8%). In 4 cases (8%) an intrauterine fetal death was diagnosed. Placental abruption did not occur. The sensitivity of notching for the prediction of preeclampsia and for the prediction of a severe pregnancy complication was 75 and 69% with relative risks of 2.7 and 2.0. The sensitivity of notching in the uterine arteries for developing an intrauterine growth retardation (IUGR) was 71% with a relative risk of 2.2. The sensitivity of RI>0.58 in the uterine arteries for developing an IUGR was 67% with a relative risk of 5.4. The sensitivity of RI>0.58 for the prediction of preeclampsia, of intrauterine death and for the prediction of a severe pregnancy complication was 50, 75 and 80% with relative risks of 2.7, 8.1 and 10.9 respectively. CONCLUSION: The results of this study suggest that Doppler ultrasound of the uterine artery in the second trimester of gestation is a useful method to predict abnormal outcomes in risk pregnancies, with high negative predictive values.

Adult↗

PubMed2004

Learning laparoscopic-assisted hysterectomy.

OBJECTIVE: The aim of this study was to evaluate the factors considered for proficiency and to estimate the number of procedures needed to achieve competence in laparoscopic-assisted vaginal hysterectomy in a teaching hospital. METHODS: The length of the learning curve, duration of surgery, change of hemoglobin (in grams per liter), conversion rate, and intra- and postoperative complications were evaluated. Cases were analyzed according to the order for the individual surgeon. RESULTS: Thirty-three surgeons performed 929 laparoscopic-assisted vaginal hysterectomies during the study period. Analyzing the duration of surgery and rate of complications, we decided on a cutoff of 30 cases. Eight surgeons with more than 30 cases performed 668 laparoscopic-assisted vaginal hysterectomies. Their initial 30 cases (group A, the first 30 cases) were compared with their subsequent cases (group B, cases 31 and after). Patient age, body mass index, and uterine weight did not differ between the groups. The intraoperative complication rate dropped from 4.2% to 0.5% (P =.001), hemoglobin drop decreased from -0.8 +/- 0.9 g/L to -0.5 +/- 1.0 g/L (P =.002), and postoperative complications dropped from 12.9% to 7.0% (P =.017). The duration of surgery was also shorter (148.8 +/- 45.4 minutes versus 125.1 +/- 46.5 minutes), but this difference was taken from the results of 1 surgeon. CONCLUSION: A learning experience of 30 laparoscopic-assisted vaginal hysterectomies was necessary in our institution to reach a low level of complications. Duration of the surgical procedure was not an adequate study endpoint to assess a learning effect.

Adult↗

PubMed2000

Establishing a new technique of laparoscopic pelvic and para-aortic lymphadenectomy.

OBJECTIVE: To assess the number of operations necessary to develop and standardize a laparoscopic approach to pelvic and para-aortic lymphadenectomy, with radicality and number of complications as quality markers. METHODS: Over 4 years, 108 women had complete laparoscopic pelvic and para-aortic lymphadenectomies combined with laparoscopy-assisted radical vaginal hysterectomies for primary therapy of cervical cancer. Complete data and videotapes were available for 99 women. Operating time and radicality for specific anatomic subareas were measured by review of video documentation and histologic lymph node counts. Intra- and postoperative complications were recorded prospectively. To analyze the progress of surgery, we compared two groups of women, one operated on at the beginning of our study (early group, subjects 6-35) and one operated on in the final period of the study (late group, subjects 79-108). RESULTS: The operating time for pelvic and para-aortic lymphadenectomy increased constantly. Comparing the early and late groups for para-aortic lymphadenectomy, there was an increase in mean operating time (34.8 versus 73.2 minutes; P < .001) and mean histologic lymph node yield (5.1 versus 10.6; P < .001). For pelvic lymphadenectomy, mean operating time increased slightly (60.7 versus 69.7 minutes; not significant) but mean histologic lymph node count decreased over time (24.3 versus 21.0; not significant). Retrospective evaluation of videotapes showed that the radicality of lymphadenectomy improved continuously in all evaluated subareas. CONCLUSION: Establishment of a protocol for para-aortic and pelvic lymphadenectomy took 100 operations. Video documentation was a more reliable indicator of progress in technical performance than were histologic lymph node counts.

Adult↗