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J Keckstein

Publications and source records attributed to J Keckstein.

At least 19 recordsLinked to original sources
PubMed2006

[First abdominal access in gynecological laparoscopy: which method to utilize?].

The choice of the technique to enter the peritoneal cavity, during a laparoscopy, depends on a lot of variables which hinder a standardized method and, actually, it appears impossible to show, with certainty, the best method to choose for the first abdominal access in gynecological laparoscopy. The preference for one or another technique depends on the operator experience, school and speciality of the surgeon, laparoscopical upgrading and the work environment; many surgical techniques are not yet used due the limits and fears of some surgeons to change the preference in first access approaching and for the lack of operating versatility by a method or another one. A review of the scientific literature, underlines that the major problems during the first laparoscopical abdominal access are two, vascular and intestinal and their percentage is variable. In this paper we describe the large range of methods for open and closed laparoscopy and for direct access, that permit to perform a first abdominal laparoscopical access, and their major possible problems.

Abdominal Wall↗
PubMed2006

Malignant mixed Müllerian tumor with heterologous component arising in the fallopian tube--a case report.

Primary malignant mixed Müllerian tumors (MMMTs) of the fallopian tube are rarities in gynecologic oncology with only 26 cases of MMMTs with a heterologous component reported thus far. We report a case of FIGO Stage II primary MMMT of the fallopian tube with a heterologous tumor portion in an 80-year-old woman presenting with abdominal discomfort at the time of primary diagnosis. After performance of total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy follow-up examination three months postoperatively did not show signs of disease recurrence. The patient finally presented six months after the initial diagnosis with extensive intraabdominal metastasis and died several days thereafter. The present report supports the aggressive nature of these neoplasms. The efficacy of chemotherapy and radiation remains to be defined in future studies.

Aged, 80 and over↗
PubMed2005

Interleukin 1alpha and tissue-lytic matrix metalloproteinase-1 are elevated in ectopic endometrium of patients with endometriosis.

BACKGROUND: Matrix metalloproteinases (MMP) play an essential role in tissue remodelling and menstruation and appear to be regulated by cytokines such as interleukin-1alpha (IL-1alpha). In order to investigate their role in the pathogenesis of endometriosis, the aim of the present study was to compare the protein localization of matrix metalloproteinase-1 (MMP-1) and of its main stimulatory cytokine IL-1alpha in eutopic and dystopic endometrium of patients with endometriosis. METHODS: MMP-1 and IL-1alpha protein localization was analysed retrospectively in paired paraffin-embedded tissue biopsies obtained simultaneously from the endometrial cavity and from endometrial lesions of 37 patients with peritoneal or ovarian endometriosis and in cycling endometria from 37 women without endometriosis. Protein localization was demonstrated by immunohistochemistry; antibody specificity was confirmed by western blot analysis. RESULTS: MMP-1 and IL-1alpha protein staining in women suffering from endometriosis was significantly more pronounced in endometriotic lesions than in eutopic endometrium. This held true for both epithelial MMP-1 and IL-1alpha staining (P < 0.006 and P < 0.001), and for stromal MMP-1 and IL-1alpha staining (P < 0.001 and P < 0.001). Furthermore, stromal MMP-1 and IL-1alpha were significantly co-expressed in dystopic endometriotic tissue (P = 0.045). Endometrial MMP-1 and IL-1alpha protein expression pattern in eutopic endometrium from women suffering from endometriosis, however, did not differ significantly from the pattern seen in healthy women. CONCLUSIONS: The increased expression of both matrix-degrading MMP-1 and its major stimulatory cytokine IL-1alpha in endometriotic lesions and the selective co-expression in the stroma of endometriotic foci clearly suggests their involvement in the pathogenic mechanisms leading to local invasion and tissue destruction.

Adult↗
PubMed2005

[Matrix metalloproteinases and their role in menstruation and endometriosis].

Endometriosis is one of the most common benign proliferative disorders of the female genital tract and occurs in up to 20 % of women, leading to symptoms such as chronic pelvic pain, dyspareunia, dysmenorrhea but also sterility. Although retrograde menstruation represents a plausible explanation for the development of endometriosis, several additional factors have to contribute to the establishment, invasion and growth of endometriotic lesions since endometrial cells spilled into the peritoneal cavity can also be detected in the majority of women without evidence of disease. Within this, the ability of endometrial tissue to implant and invade the peritoneal surfaces and underlying tissues appears to be a pathogenic key mechanism for the growth of endometrium outside the uterine cavity. Matrix metalloproteinases (MMPs) constitute a group of enzymes that not only mediate physiologic tissue turnover such as endometrial breakdown at menstruation, but also have been shown to play important roles in the development of invasive and destructive diseases. The altered regulation of endometrial MMPs has therefore also been associated with the pathogenesis of endometriosis, linking the invasive potential of refluxed endometrium to the adhaesion and growth of endometriotic cells. The aim of present work is to review the role of MMPs in processes of menstruation and development of endometriosis.

Endometriosis↗
PubMed2005

[Diagnosing endometriosis].

Clinical pelvic exam, vaginal sonography, and, consequently, laparoscopic and histologic evaluation may be considered the gold standard for the diagnosis of endometriosis. Additional studies, such as cysto- and rectoscopy, rectal endosonography, and intravenous pyelogram may be useful in the individual situation. In the clinical routine, magnetic resonance imaging -- despite providing good results -- is inessential. The assessment of CA-125 -- outside clinical investigations -- is not helpful in making the diagnosis of endometriosis.

Endometriosis↗
PubMed2005

[ENZIAN-score, a classification of deep infiltrating endometriosis].

The ENZIAN-Score is presented as a new instrument to classify the deep infiltrating endometriosis. Especially the retroperitoneal part of the severe endometriosis is focussed on. In analogy to an oncological staging four different stages are pronounced. The localisation and the expansion of the endometriosis nodule was indicated to different subgroups. The still used rAFS-score is of no clinical evidence, as we pointed out in a retrospective study of our patients with severe intestinal endometriosis.

Endometrial Neoplasms↗
PubMed2005

Deep endometriosis, including intestinal involvement--the interdisciplinary approach.

Deep endometriosis is a disease which may involve all organs of the pelvis. The lesion is most often located at the backside of the uterus, involving the uterosacral ligaments and/or the rectovaginal septum. The involvement of adjacent organs, e.g. bowel, ureter, and bladder, makes an interdisciplinary approach necessary. There is a correlation between the radicalness of endometriosis resection and the postoperative improvement of complaints. In a series of 202 patients with deep endometriosis including the bowel we performed a segmental resection with anterior anastomosis including radical excision of all endometriotic lesions. The follow-up of 142 patients shows a significant improvement of pelvic pain (96%), dyschezia (88%), and dyspareunia (87%). Of 95 patients with a desire for children, 50% became pregnant. The postoperative complication rate was low. A leakage of anastomosis was seen in six cases (3%).

Journal Article↗
PubMed2004

[Laparoscopic ovariopexy--modality of ovarian endometriosis treatment].

OBJECTIVE: Case report of a successful treatment of ovarian endometriosis by laparoscopic ovariopexy in infertile women. DESIGN: Case report. SETTING: Institute for the Care of Mother and Child, Prague, Institute for Postgraduate Medical Education, Prague. RESULTS: Conservative treatment of ovarian endometriosis is often complicated by postoperative periadnexal adhaesions which may result in pelvic pain or ongoing infertility. Temporary laparoscopic ovarian suspension--ovariopexis is a very effective method in postoperative adhaesion prevention and in the treatment of ovarian endometriosis in infertile patient. We observed successful cases of laparoscopic treatment of ovarian endometriosis. CONCLUSION: Laparoscopic ovariopexis is a simple and effective method for treatment of ovarian endometriosis and prevention of extensive periadnexal adhaesions.

Adult↗
PubMed2000

Laparoscopic surgery for complex ovarian masses.

STUDY OBJECTIVE: To assess the value of laparoscopy in managing complex ovarian masses. DESIGN: Retrospective, observational analysis (Canadian Task Force classification II-2). SETTING: University-based, tertiary level center for endoscopic surgery. PATIENTS: Two hundred eleven consecutive women. INTERVENTIONS: Laparoscopic surgery including ovary-preserving surgery, salpingo-oophorectomy, adhesiolysis, and pelvic lymphadenectomy. MEASUREMENTS AND MAIN RESULTS: Patients were selected on the basis of preoperative ultrasound findings. Intraoperative appearance of the tumors as well as results from frozen section examinations were compared with histologic results. Two hundred sixteen pelvic masses were benign. In 10 patients, early ovarian cancer, borderline tumors, tubal cancer, or secondary ovarian, nongynecologic pathology was managed primarily by laparoscopy and confirmed histologically. Three of these 10 women underwent standard radical open surgery within 1 week. The true nature of masses was not recognized at the time of laparoscopy in three patients with malignant findings. Patients with malignant tumors were followed for 5 years. CONCLUSION: Although most complex ovarian masses can be managed by laparoscopy, the possibility of overlooking malignancy remains, even with frozen section examination. Whether or not laparoscopy compromises clinical outcome compared with laparotomy is not fully understood. Prospective studies to address this important clinical question are urgently needed.

Adolescent↗
PubMed2000

Hysteroscopy and adenomyosis.

Adenomyosis, a disease of the myometrium, can be diagnosed by hysteroscopy. Histologic specimens removed by transcervical punch biopsies or loop resection give more information on the depth of the adenomyosis. Symptomatic superficial adenomyosis can be treated sufficiently by transcervical endometrial coagulation or resection but can lead to iatrogenic adenomyosis, which can be treated by second-look hysteroscopy. Adenomyosis may also be caused by incomplete transcervical endometrial ablation or resection. In selected cases, hysteroscopic treatment of symptomatic focal adenomyosis becomes possible.

Biopsy↗
PubMed1999

Cardiac changes in fetuses secondary to immune hemolytic anemia and their relation to hemoglobin and catecholamine concentrations in fetal blood.

OBJECTIVES: Immune hemolytic anemia in the fetus may cause cardiac decompensation and intrauterine death. Postnatally, norepinephrine (noradrenaline) is released in chronic heart failure, and may lead to myocardial hypertrophy. The aim of this study was to determine fetal cardiac changes associated with immune hemolytic anemia by means of echocardiography, and to relate them to fetal hemoglobin and norepinephrine levels. DESIGN: Thirty anemic fetuses underwent a total of 76 umbilical venous transfusions. Before the procedure, fetal echocardiography was performed, and end-diastolic myocardial wall thicknesses and ventricular dimensions together with Doppler flow patterns at the atrioventricular and semilunar valves were measured. Fetal hemoglobin, epinephrine and norepinephrine concentrations were determined before the transfusion. Statistical analysis of this prospective study comprised descriptive statistics including linear regression and correlation analyses. Two samples of measurements were compared by the Mann-Whitney U test. RESULTS: The mean hemoglobin concentration before the first transfusion was 6.9 g% at a mean gestational age of 26.8 weeks. Norepinephrine values were elevated in comparison to a reference range, and were higher than epinephrine values. The most striking echocardiographic finding was myocardial hypertrophy of all ventricular walls. Mean blood flow velocities were increased; at the left ventricle, they were negatively related to the hemoglobin concentrations, and positively to the norepinephrine values. CONCLUSIONS: Fetal myocardial hypertrophy in anemia may be the result of an augmented cardiac workload, indicated by the increased left ventricular mean velocities. This reaction reflects the redistribution of blood flow that may depend on hemoglobin and norepinephrine concentrations.

Anemia, Hemolytic, Autoimmune↗
PubMed1999

[Surgical therapy of endometriosis].

Operative treatment of endometriosis is the most important part of the therapeutic concept. It is important for the verification of the diagnosis and offers also the possibility to remove all visible lesions and to restore partially destroyed organs. Though laparotomy has many advantages, laparoscopy has developed also to a sufficient therapeutic procedure in up to 90% of all operations with endometriosis. Success rate of surgery depends on the exact preoperative diagnosis as well as on the extent of the radical operation.

Electrocoagulation↗
PubMed1996

Endoscopic surgery for mature teratoma of the ovary.

BACKGROUND: This study was undertaken to assess the value of laparoscopic surgery as treatment for benign mature teratomas of the ovary. METHODS: A total of 70 patients treated exclusively with laparoscopic surgery for ovarian mature teratoma were studied. The tumors were either enucleated with preservation of the ovary or removed by salpingo-oophorectomy. RESULTS: Ovary-preserving surgery was performed in 60 cases; salpingo-oophorectomy was accomplished in 10 cases. All tumors removed were histologically benign. No surgical complications were encountered throughout the series. In eight patients who underwent primary ovary-preserving surgery, a second-look laparoscopy was undertaken with virtually no pathological findings noted. CONCLUSIONS: Our findings confirm those of other authors- when performed by experienced surgeons, laparoscopic removal of ovarian mature teratomas is a safe and recommendable alternative to laparotomy. Preoperative diagnosis and intraoperative inspection of the tumor must be as thorough as possible.

Adolescent↗
PubMed1996

Removal of gonads in Y-chromosome-bearing gonadal dysgenesis and in androgen insensitivity syndrome by laparoscopic surgery.

BACKGROUND: This paper addresses the value of laparoscopic surgery for the removal of gonads in patients with Y-chromosome-bearing gonadal dysgenesis and androgen insensitivity syndrome, who are otherwise faced with a high rate of gonadal malignancy. METHODS: Three patients with Y-chromosome-bearing gonadal dysgenesis and one patient with androgen insensitivity syndrome were operated upon laparoscopically. Removal of gonads was accomplished by their mobilization and dissection from the pelvic side walls, with ligation and transection of the utero-ovarian and infundibulopelvic ligaments. RESULTS: Surgery was without complications. Histological examination of the gonads showed complete removal and absence of malignancy in each patient. Patients were discharged the day after surgery. CONCLUSIONS: The laparoscopic approach is a safe and effective alternative to laparotomy in the management of patients with Y-chromosome-bearing gonadal dysgenesis and with androgen insensitivity syndrome.

Adolescent↗
PubMed1996

Reduction of postoperative adhesion formation after laparoscopic ovarian cystectomy.

The purpose of this randomized, open-label study was to assess the efficacy of the product Interceed absorbable adhesion barrier in the prevention of adhesion formation on the ovary after laparoscopic ovarian cystectomy. A total of 25 patients requiring laparoscopic bilateral ovarian cystectomy were enrolled into this study. After removal of ovarian cysts, peri-adnexal adhesions, and peritoneal irrigants, and the attainment of meticulous haemostasis, the random assignment of one ovary for wrapping with Interceed was revealed to the surgeon. The other ovary served as the untreated control. A follow-up laparoscopy was performed 8-30 weeks after the initial procedure in 17 patients. Significantly fewer adhesions formed at the Interceed treated ovaries compared with the control (untreated) ovaries (P < 0.05). In terms of adhesion-free outcome, 76% (13/17) of Interceed treated ovaries and 35% (6/17) of control ovaries were free of adhesions. A significant reduction was observed in the area of the sutured ovaries involved with adhesions when Interceed (6%) was used, compared with controls (20%). The reduction of adhesion formation was not related to the size of the cysts at the initial procedure. No adverse events were reported by any patient during the study. In conclusion, Interceed was found to be safe and effective in reducing the incidence of postoperative adhesion formation in patients undergoing laparoscopic ovarian cystectomy.

Cellulose, Oxidized↗
PubMed1995

[Clinical and endocrine effects of laparoscopic ovarian surgery in patients with polycystic ovary syndrome].

OBJECTIVES: Is minimal invasive ovarian surgery an alternative infertility treatment for patients with polycystic ovary (PCO) syndrome? METHODOLOGY: 52 anovulatory patients with the clinical and endocrine characteristics of PCO syndrome were treated with laparoscopic Nd: YAK (n = 11) or CO2 (n = 41) laser surgery to drain atretic follicles and destroy the ovarian stroma. RESULTS: Following surgical reduction of serum androgen and estrogen levels (p < 0,01), 83% of the PCO patients ovulated spontaneously or following ovulation induction; pregnancies occurred in 38%. At re-laparoscopies, 86% of patients had no periovarian adhesions. CONCLUSIONS: Since laparoscopic laser surgery is capable of inducing profound clinical and endocrine effects, it may represents a feasible alternative for infertility treatment in PCO patients.

Adult↗