PubMed Health⌕ Search

Biomedical subjects

H A Hirsch

Publications and source records attributed to H A Hirsch.

At least 19 recordsLinked to original sources
PubMed1992

[Perforation of surgical gloves in gynecologic operations and abdominal Cesarean section].

The aim of the study was to determine the incidence of glove perforation during gynaecological operations and Caesarean section, and to assess the value of double gloving. For this purpose the surgical gloves used in 415 procedures were tested for perforations by the water leak test. For laparotomy and breast surgery, two pairs of gloves (brand A) were worn; for vaginal and other surgery, only a single pair of thicker gloves (brand B) was used. As controls, 75 pairs of unused gloves of each brand were tested. This revealed 6 (4%) perforations in brand A gloves and 2 (1.3%) perforations in brand B gloves. Most perforations (20-40%) occurred during hysterectomy, Caesarean section, and other types of laparotomy. The gloves worn by the scrub nurse or technician were most often perforated (43.5% after vaginal hysterectomy), followed by the surgeon's gloves (29% after laparotomy). Perforations were most often located at the tip of the index finger (16.8%) and thumb (16.2%) of the nondominant hand. If two pairs of gloves were worn, and perforation occurred, only 26.7% had perforations at identical sites on the outer and inner gloves. Consequently, since three quarters of the perforations were limited to the outer glove, double gloving reduced the risk of exposure to blood by a factor of 4. The results of this study support the recommendation that two pairs of gloves be worn, at least during major surgical procedures and Caesarean section. Furthermore, the alternative operative techniques and methods of handling surgical instruments proposed for reducing the incidence of glove perforation should be tested.

Cesarean Section↗
PubMed1991

Delivery of very premature infants: does the caesarean section rate relate to mortality, morbidity, or long-term outcome?

A retrospective analysis of obstetric factors influencing mortality and morbidity of very premature infants (1500 g, less than or equal to 32 weeks' gestation) was undertaken. The study included 275 such infants born in the Department of Obstetrics of the University of Tübingen during the period January 1977 to June 1987. The caesarean section rate of very preterm infants increased from 28% during the period 1977-1982 to 87% during the period 1982-1987 (P less than 0.005), accompanied by an increase in survival rate from 63% to 70%. The improvement in survival rate was statistically significant for the group with birth weight 751-1000 g (P less than 0.01). The overall mortality rate was 31% after caesarean section and 36% after vaginal delivery. Amongst the causes of death of the non-survivors, acidosis was more frequent and amniotic infection syndrome less frequent in the infants delivered vaginally than in those delivered abdominally. The proportion of children with normal development at two years of age was significantly (P less than 0.02) greater amongst those born in 1982-1987 than in those born in 1977-1981. The interpretation of these findings is by no means clear but must include the hypothesis that the increased caesarean section rate may be incidental and in no way related to the improved outcome.

Acidosis↗
PubMed1990

[Fertility following tubal pregnancy: comparison of tube-saving surgery and salpingectomy].

391 patients were operated during 1980 to 1987 at the Department of Gynaecology of the University of Tübingen for extrauterine pregnancy. A questionnaire was circulated to inquire, how many of these women wanted to become pregnant again. 176 answered positively, the return quota being 82%. After surgery, performed to preserve the Fallopian tubes, 64% of these patients had an intrauterine pregnancy, compared with only 41% after salpingectomy or segmental resection without anastomosis. In women without the characteristic factors which reduce fertility, such as primary sterility, surgery concerning sterility or refertilization, or other kinds of abdominal surgery, a greater proportion of intrauterine pregnancies was seen after surgery preserving the Fallopian tubes (79%), than in women with the above mentioned risk factors (53%). The incidence of repeat extrauterine pregnancies was approximately equal after Fallopian tube-preserving surgery and after salpingectomy (20% and 18%, respectively).

Adult↗
PubMed1990

[Prevention of HIV infections in surgical gynecology and obstetrics].

In professionally conditioned HIV infections of medical personnel, blood has so far been the only source of infection that is of any importance. Hence, measures to prevent such infections must primarily aim at avoiding any contact with blood from HIV-infected patients. Since the HIV status of the patients and possibly alos other infections transmitted by blood (hepatitis) are often unknown, the following protective measures must be applied in all patients as a matter of routine. Fundamentally, gloves must always be worn when coming into contact with blood, body fluids, mucosa and non-intact skin. In operative procedures and deliveries, barrier methods must be employed to protect the eyes, nose, mouth and skin, as well as technical procedures during surgery and organisational measures to prevent any possible injuries or lesions caused by operative interventions and to reduce the number of persons exposed to risk. So far, needle pricks have been the most frequent mode of infection. Hence, used cannules should be treated with utmost care; do not return them into their protective cover but throw them directly into solid waste containers. After contamination, blood and other body fluids should be eliminated immediately. In case of massive contamination with material containing HIV, chemoprophylaxis should be given careful consideration.

Cesarean Section↗
PubMed1990

[Prevention of vaginal prolapse in hysterectomy by suspension of the vaginal stump].

For prophylaxis of enterocele and of prolapse of the vagina following hysterectomy, the vaginal stump is fixed in at-risk patients to the sacro-uterine ligaments (known as McCall's suture) or to the sacro-spinal ligament (Amreich-Richter method). We report on the indications and results obtained in 101 sacro-spinal fixations and 211 McCall sutures in vaginal hysterectomy and 118 McCall sutures in abdominal hysterectomy. From 1975 to 1981 sacro-spinal fixation was only occasionally employed in prophylaxis of enterocele. After introduction of the McCall suture in 1982, the use of this method has been steadily increasing and has largely replaced sacrospinal fixation for prophylactic purposes. Nevertheless we are still using this often in cases of total prolapse, since in that situation, the fixation of the vaginal stump to the sacrouterine ligaments (in most cases weakly developed) is insufficient and does not offer enough support. Of a total of 350 McCall sutures performed to date, postrenal anuria occurred twice after kinking of the ureters, a typical complication that requires removal of the McCall suture. In a total of 174 sacro-spinal fixations of the vaginal stump for prophylactic or therapeutic indications, pronounced intraoperative haemorrhage took place in about 5% of the cases, whereas in one case, there was an abscess formation due to an infected haematoma. Technical details on both methods and on avoiding complications are discussed.

Female↗
PubMed1989

Effect of cesarean section on outcome in high- and low-risk very preterm infants.

The effect of mode of delivery on the survival and morbidity of 24- to 32-week infants (500-1500 g) was studied in 262 consecutive deliveries. The study population was divided into high-risk (e.g., hypertension) and low-risk (e.g., incompetence of the cervix) groups by evaluation of risk factors. 194 very preterm newborn were classified as high risk and 68 as low risk. In both groups the perinatal outcome of vaginal delivery and cesarean section delivery was compared. Cesarean section was associated with a highly significantly improved survival rate in the high-risk group, but was not associated with differences in fetal outcome in the low-risk group. The results of this study do not support primary cesarean section as the method of delivery for all very preterm fetuses.

Adult↗
PubMed1989

[Results of organ-saving therapy in tubal pregnancy].

Worldwide, the incidence of nonruptured tubal pregnancy has increased, and so has the feasibility of conservative management of this condition. Following conservative surgery the rate of intrauterine pregnancy is significantly higher than after salpingectomy. The rate of ectopic pregnancy has not (or hardly) increased. For a surgeon skilled in this technique, the laparoscopic approach has advantages because it avoids laparotomy. For the time being, medical treatment of ectopic pregnancy with methotrexate, prostaglandins, and antiprogesterone should be confined to clinical studies. For nonviable, nonruptured tubal pregnancy with decreasing HCG titers expectant management seems possible; following conservative treatment, monitoring of HCG until it becomes undetectable is mandatory.

Female↗
PubMed1989

[Comparison of the results of preoperative studies with imaging procedures with the surgical status of ovarian cancer].

Optimal cytoreductive surgery of ovarian cancer is based on the preoperative diagnosis and assessment of tumour spread. Of 147 patients who underwent staging laparotomy at the Department of Gynaecology of the University of Tübingen, intraoperative staging was compared retrospectively with the results of sonography, computed tomography, double-contrast enema and urography. Ultrasound and computed tomography were comparable concerning accuracy of the diagnosis in 86 and 79% of the cases, respectively. Combined application of both methods resulted in an accuracy of 90%. Involvement of colon was diagnosed by double-contrast enema in only 41% of the cases in which enterotomy had to be performed. Involvement of bladder and ureter was observed in 80% of the cases by intravenous urography. According to our results abdominal ultrasound and urography should be performed in patients with palpable pelvic masses. The application of computed tomography as an additional method is indicated in patients with tumour classified as benign by sonographic examination. Double-contrast enema is of limited value in the diagnosis of colon involvement.

Adolescent↗
PubMed1989

Clinical evaluation of terconazole. European experience.

Terconazole is a new topical antifungal agent that differs structurally and functionally from the imidazoles. European clinical trials were conducted to determine (1) the lowest effective dose for a given treatment period, (2) which formulation should be tested further, and (3) how terconazole compares with other topical antifungal agents in terms of safety and efficacy. The results of dose-response studies demonstrated that 80- and 240-mg suppositories and 0.4% cream were the most effective formulations. Data from multicenter studies of pregnant and nonpregnant women in Belgium and Luxembourg indicate that the efficacy of terconazole cream is superior to that of miconazole nitrate cream and clotrimazole cream. Terconazole cream is also more effective than clotrimazole cream in terms of lower relapse rates.

Administration, Topical↗
PubMed1988

[Laparoscopic findings in suspected adnexitis].

Between 1976 and 1985 laparoscopy was performed on a total of 768 patients in whom adnexitis was suspected. In accordance with conventional usage they were initially designated as "acute" and "chronic" cases of adnexitis on the basis of clinical criteria. The tentative diagnosis of an active infection was confirmed by laparoscopy in 62.7% of the patients with the clinically acute form and 14.5% of those with "chronic" adnexitis. Although high temperature, leukocytosis, and an increased ESR were more common among patients with laparoscopically confirmed adnexitis, high levels of inflammatory reaction were also found in patients with other conditions. In 164 patients (21%) no pathological findings were found in the genital and abdominal regions. The results confirm the importance of laparoscopy in the diagnosis of adnexitis.

Adult↗
PubMed1988

[Incidence and significance of pathogen detection in Douglas fluid in non-inflammatory genital diseases].

Between 1976 and 1986 the secretions from the pouch of Douglas of 1,219 patients with non-inflammatory genital diseases were microbiologically studied. Microorganisms were detected in 3.4%. In the majority of cases they were physiological skin organisms, with a count of less than 10 per ml of Douglas fluid. These findings support the view, that secondary contamination of the specimens occurred during removal, transportation, or laboratory processing.

Bacteria↗
PubMed1988

[Maternal morbidity following cesarean section: effect of infection control and preventive use of antibiotics].

1. Between 1976 and 1986, data were collected prospectively by a nurse specializing in hygiene on postoperative infections in the 3508 low cervical cesarean sections carried out at the University Gynecological Clinic in Tübingen. Over the past four years, this has also included data on noninfectious complications. During this 11-year period, the rate of sections rose from 10.3% to 18.2%. 2. During the first seven years, in which only hygienic, organizational, and surgical measures were used to prevent infection, the rate of patients with postoperative infections decreased from 28.2% to 11.9% (-58%), while the rate of feverish standard morbidity decreased from 27.2% to 9.7% (-64%). 3. Over the past four years, in which 60% of the patients received a perioperative antibiotics prophylaxis consisting of three doses of a cephalosporin, the number of patients with infections has decreased further to 8.6% (-28%), and the number of those with feverish morbidity to 3.7% (-62%). Over the total period, the reduction in the named parameters was 70% and 86%. 4. The most frequent infections were urinary tract infections (mainly cases of asymptomatic bacteriuria), infections of the abdominal wound, and endomyometritis and phlebitis of the arm owing to intravenous applications. Only the reductions in the number of cases of bacteriuria (-77%), wound infections (-72%), and endomyometritis (-73%) reached statistic significance. 5. As a result of antibiotics prophylaxis, the rate of infections in the case of primary section decreased from 15.3% to 9.0%, and in the case of secondary section from 15.1% to 8.2%; feverish standard morbidity decreased from 9.1% to 3.5% and from 9.4% to 4.9%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

[Maternal morbidity following cesarean section. Comparison of isthmo-corpus longitudinal section and isthmian transverse section in premature labor].

In an increasing number of cases of the Caesarean delivery of small premature babies (length of gestation less than 32 weeks or an estimated weight of less than 1501 g) between April 1983 and March 1987, the uterus was opened by an isthmo-corporeal longitudinal section if the lower uterine segment appeared too narrow for a gentle delivery via an isthmian transverse incision. A comparison of 67 Caesarean deliveries of this type with 116 Caesarean deliveries of the same small premature babies using an isthmian transverse incision did not reveal any difference with regard to postoperative infections, feverish standard morbidity, or other noninfectious complications. In comparison with Caesarean deliveries of older babies, the Caesarean deliveries of small premature babies had significantly more infectious and noninfectious complications, such as cases of phlebitis of the arm owing to intravenous application (2.7% as against 1.0%), posthemorrhaging and hematomas (3.8% as against 0.8%), and blood transfusions (3.3% as against 0.8%). The number of infectious complications was significantly reduced by a perioperative antibiotics prophylaxis. The question of late complications as a result of the isthmo-corporeal longitudinal section, especially the danger of rupture of the uterine scar in the event of a subsequent vaginal delivery, has not yet been resolved.

Birth Weight↗
PubMed1988

[Fetal outcome following cesarean section in premature labor. Isthmocorpus longitudinal section or isthmian transverse section?].

Little is known about the comparative safety of the isthmocorporal versus the low transverse uterine incision for Caesarean delivery of the very low birthweight infant. To address this question, the fetal outcome of 59 deliveries by isthmocorporal incision and 76 by low transverse incision were analysed. The incidences of a 5-min-Apgar score of 6 or lower and UA-pH were not significantly different. No correlation was evident between early intraventricular hemorrhage and type of incision. The number of neonatal deaths weighing less than 1000 g associated with vertical incision (27%) was lower than that associated with the low transverse incision (47%). Nevertheless the difference was not statistically significant. The decision for the type of incision should be made intraoperatively by an experienced surgeon. This factor is probably more important than the choice of a particular incision.

Apgar Score↗