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Biomedical subjects

J Keckstein

Publications and source records attributed to J Keckstein.

35 records · Page 2Linked to original sources
PubMed1994

Endoscopic Nd:YAG Laser Coagulation of Intramural Endometriosis of the Bladder

Treatment of intramural endometriosis of the bladder using the Nd:YAG laser is described. An operative cystoscope fitted with a 600 µ fibre is introduced into the bladder. At a power setting of 50 W, superficial coagulation of the visible lesion is performed. The coagulation technique corresponds to that used for the treatment of superficial bladder carcinomas. Three patients were managed in this way. In all patients dysuria and hematuria either significantly decreased or disappeared altogether. No intraoperative complications were observed. This new technique appears to be superior to surgical excision techniques, especially in cases where the lesion is situated on the roof of the bladder. Further studies need to be conducted to compare results obtained from this technique with those of the CO2 laser or excision technique.

Journal Article↗
PubMed1994

Laparoscopic Myomectomy: Sonographic Follow-Up and Second-Look Laparoscopy for the Evaluation of a New Technique

Between 1988 and 1993, 100 women underwent laparoscopic myomectomy in the Department of Obstetrics and Gynecology of the University of Ulm. Indications varied, although most myomectomies were done for fertility enhancement or preservation. Closure of the incision, especially with an open uterine cavity, was done in two or three layers. Several technical limitations specific to laparoscopic surgery impair complete and satisfactory closure of the myomectomy incision. In this study we evaluate the new technique by sonographic control and second-look laparoscopy. In 22 cases second-look laparoscopy was undertaken to assess post-operative adhesion formation and to effect adhesiolysis. The rate of adhesion formation was 28%, depending on site, size, and number of myomas. Adhesion formation was significantly higher (p<0:005) in myomas located on the posterior wall. The density of adhesions did not vary significantly. In 22 cases sonography was done preoperatively, one day after the operation and 6 weeks postoperatively to compare wound healing, depending on myoma site and size. In 74% of cases an intramural hematoma of varying size was observed. By the third control, 6 weeks later, an irregular hypodense area was seen in only 8%. This study demonstrates that laparoscopic myomectomy entails the risks of postoperative adhesion formation and impaired wound healing, including intramural hematoma. So far no data are available showing a correlation between these risks and post-operative infertility or higher incidence of uterine rupture.

Journal Article↗
PubMed1994

Laparoscopic Treatment of Distal Tubal Occlusion-Reocclusion and Pregnancy Rate

There is still controversy about the question of which approach is best to treat tubal infertility: microsurgery, laparoscopic treatment, or in vitro fertilization. Our study comprised 161 patients with distal tubal occlusion. Various instruments (argon laser, CO2 laser, Nd:YAG laser, monopolar electrical needle, scissors) were used for laparoscopic salpingostomy, and a variety of techniques applied for tubal wall eversion (flowering technique according to Bruhat with and without suturing, suturing alone, or no eversion at all). Thirty-seven women with a total of 63 laparoscopically treated tubes were followed over a period of 2-72 months. Tubal patency was 38.9%. The reocclusion rate correlated with severity of tubal wall pathology and state of reduction of the tubal mucosa. After laser treatment tubal patency proved to be higher (41.1%) compared with treatment with conventional instruments. The Argon laser scored best results. The majority of patent tubes in the follow-up were found in the cohort with "perfect" and "good" eversion (95.8%), whereas none of the tubes where eversion was classed "insufficient" remained patent. The technique according to Bruhat without the use of additional suturing yielded better results regarding tubal patency (66.6%) than the other eversion methods described (33.4%). The pregnancy rate could be assessed in 81 out of 161 laparoscopically treated cases. A total of 19 patients (23.3%) became pregnant. In 9.8% pregnancy was intrauterine and in 13.5% extrauterine. The highest intrauterine and lowest extrauterine pregnancy rate was seen in the group with "mild" distal tubal occlusion (according to AFS classification). In 84.2% of women who had conceived postoperatively, tubal wall eversion had been done by the Bruhat technique without suturing. Taking into account tubal wall pathology, tubal patency, eversion techniques, and rate of intrauterine pregnancies, it can be concluded that patients with thin-walled tubes allowing "perfect" or "good" eversion will benefit most from laparoscopic salpingostomy.

Journal Article↗
PubMed1993

[Experiences with colpocoeliotomia posterior within the scope of surgical laparoscopies].

Laparoscopically performed culdotomy is a safe and easy procedure to remove enucleated myomas or benign ovarian pathological structure. So far, we have not seen any culdotomy-related complications in a group of 19 patients treated in this way. All wounds healed by primary intention. Operating time exceeded the norm by 10 to 30 minutes. The use of an endobag in connection with culdotomy, effectively facilitates removal of dermoids and myomas.

Colposcopes↗
PubMed1993

Effects of ovarian surgery on the dopaminergic and opioidergic control of gonadotropin and prolactin secretion in women with polycystic ovarian disease.

Ovarian surgery has been demonstrated as an effective means to establish regular menstrual cycles and resumption of ovulation in patients with polycystic ovarian disease (PCO). We questioned whether such reinstitution of menstrual cyclicity may be associated with changes in the opioidergic and dopaminergic activity known to be aberrant in these women. Opioidergic and dopaminergic tone was therefore assessed in patients with PCO before and after ovarian laser vaporization (n = 4) or classical ovarian wedge resection (n = 4). Blood samples for the determination of luteinizing hormone (LH), follicle stimulating hormone (FSH) and prolactin were frequently obtained following opioidergic and/or dopaminergic antagonism affected by naloxone (4 mg i.v.) or metoclopramide (10 mg i.v.). In response to either surgical approach, circulating LH levels decreased (p < 0.01), while FSH concentrations remained unaltered. Further, LH and FSH concentrations did not noticeably change following challenges with naloxone or metoclopramide: this applied to conditions before and after ovarian surgery. Prolactin release in response to metoclopramide was markedly (p < 0.01) higher following ovarian surgery than before. Thus, both ovarian laser surgery and classical wedge resection can effectively restore normal menstrual cyclicity in PCO patients, although they failed to alter opioidergic and dopaminergic activity. Dopaminergic inhibition of prolactin secretion was further enhanced after ovarian surgery. These observations suggest that different modes of ovarian surgery are effective in influencing central gonadal control, but that the central opioidergic and dopaminergic control of gonadotropin and prolactin secretion remains unaffected by ovarian surgery in PCO women, even when menstrual cyclicity is resumed.

Adult↗
PubMed1992

[Spontaneous rupture of the liver in HELLP syndrome].

Spontaneous hepatic rupture in pregnancy is a rare, but dangerous complication of acute or progressing pre-eclampsia. Pain in the right upper quadrant is the most important clinical symptom and should prompt immediate laboratory evaluation (transaminase, coagulation profile, platelet count, red and white blood count). If the diagnosis of HELLP syndrome is confirmed, close supervision in an intensive care unit is mandatory. The danger of pre- or postpartal open hepatic rupture must be considered. Pain in the right upper abdomen and signs of abdominal mass bleeding occurring within a HELLP syndrome are important evidence for hepatic rupture. Immediate ultrasonic examination may verify the tentative diagnosis. The usual therapy is then laparotomy with attempted surgical haemorrhage control. A conservative clinical haemorrhage control attempt is possible in exceptional cases only. Patients developing a HELLP syndrome although otherwise in seemingly perfect health, require closely meshed monitoring to exclude hepatic rupture.

Adult↗
PubMed1991

The impact of ovarian laser surgery on the gonadotrophin secretion in women with polycystic ovarian disease.

To evaluate the effects of ovarian surgery on the deranged episodic gonadotrophin release of women with the polycystic ovarian disease (PCOD), we studied 11 patients with the clinical and endocrinological features of PCOD before and after laparoscopic laser coagulations of ovarian surfaces and cysts. During both occasions, blood was collected at 15-min intervals for 8 h to determine LH and FSH secretory profiles and additionally for 3 h during GnRH injections (25 micrograms twice within 2 h) to assess pituitary responsiveness. Serum testosterone, androstendione and oestrogen (oestrone, oestradiol) levels were markedly reduced (P less than 0.05 or less) after surgery. Mean LH concentrations declined (P less than 0.001), while FSH levels increased (P less than 0.01) following laser treatments. The LH pulse frequencies (by Cluster analysis) did not change after ovarian surgery, but the LH pulse amplitudes were markedly reduced (P less than 0.01). Lower (P less than 0.05 or less) LH concentrations were attained in response to GnRH challenges, and the stimulated FSH release also tended to decrease after laser treatments. Thus, ovarian surgery in PCOD women resulted in reduced serum sex steroid concentrations and in divergent effects on serum LH and FSH levels. The attenuated pituitary LH responsiveness after ovarian surgery suggests action of sex steroids primarily at the pituitary site, while the increase in FSH concentrations may be attributed to other factors selectively modulating FSH release.

Adult↗
PubMed1990

The contact Nd:YAG laser: a new technique for conservation of the fallopian tube in unruptured ectopic pregnancy.

Between August 1986 and April 1988, 22 women with unruptured tubal pregnancy were treated by laparoscopy in the Department of Gynaecology and Obstetrics at the University of Ulm. Linear salpingotomy was performed using the contact Nd:YAG laser technique. The laser beam was delivered by special sapphire probes attached to a standard optical fibre for incision and coagulation. Two different shapes of sapphire probes were used. The specific laser properties and the application of vasopressin enabled treatment without any other incision instruments or coagulation agents. In one patient subsequent laparoscopy became necessary due to persisting trophoblastic tissue. Sixteen women were assessed subsequently by second-look laparoscopy or hysterosalpingography for tubal patency and possible formation of adhesions. In 14 (88%) women the tubes were patent, and in two women adhesions were seen.

Fallopian Tubes↗
PubMed1989

Laparoscopic treatment of polycystic ovarian syndrome.

Laparoscopic techniques show a number of advantages in comparison with the classic ovarian wedge resection for the treatment of PCOD. An equally high ovulation rate is achieved with less trauma, and fewer postoperative adhesions result in a higher pregnancy rate. The procedure may be done on an outpatient basis with reduced operative and recovery time. No clear advantages have so far been shown to exist for any of the available techniques, i.e. laparoscopic biopsy, electrocautery, and the four laser systems (CO2, Nd-YAG, argon, KTP). It appears, however, that the laser techniques will be the methods of choice for the future. They combine optimal precision of operation handling with maximal safety and excellent bleeding control. With laparoscopic biopsy traumatic bleedings may occur, which can occasionally be difficult to control. With electrocautery, burns due to the uncontrolled effect of electric current have been described. Optimal application of the laser techniques requires extensive personnel training and experience. The laser equipment requires considerable capital expenditure of the order of 20,000-70,000 pounds. The exact mechanism by which induction of ovulation and regular cycles are induced is yet unknown. Alteration of the ovarian surface including the underlying tissue particularly the atretic follicles leads to a significant postoperative change of the pathophysiological mechanism. The following factors are postulated to be responsible for postoperative ovulation: 1. The drainage of the follicular fluid which contains high androgen levels results in an acute reduction of the intraovarian androgen level. 2. With coagulation and/or vaporization of the atretic follicles androgen production is significantly limited. 3. This localized reduction of androgen decreases their inhibitory effect on follicular maturation. 4. Lowered androgen levels result in diminished peripheral conversion of androgen to oestrogen and decreased positive feedback on LH production. 5. The secondary reduction of ovarian inhibin permits a rise of FSH secretion which results in a normal LH:FSH ratio.

Electrocoagulation↗
PubMed1977

Relationship between the prolongation of warm ischemia and the maximum available preservation period.

Fifty dog kidneys had hypothermic perfusion for 12 to 72 hours and then were transplanted. Prior to perfusion the kidneys were subjected to 15, 30, 45, and 60 minutes of warm ischemia. Fifteen minutes of warm ischemia was well tolerated (successful 72 hour preservation), but after 30 minutes successful preservation could be achieved for 24 hours only. Enzyme release and lactate formation were related to the prolongation of warm ischemia, and the highly significant concentration differences of these substances, between well functioning kidneys and those with small or no function, indicated the viability of the organ.

Animals↗
PubMed1976

[The influence of warm ischaemic time on the results of hypothermic kidney perfusion (author's transl)].

50 dog kidneys were mechanically perfused under hypothermia for between 12 and 72 h and then transplanted. Before perfusion the kidneys were subjected to 15,30,45 and 60 min of warm ischaemia: 15 min of warm ischaemia were well tolerated (successful 72-h preservation), but after 30 min preservation was successful for only 24 h. Enzyme release and lactate formation depended on the duration of warm ischaemia. Furthermore, these perfusate concentrations indicated the viability of the organ (highly significant differences between well functioning kidneys and those with little or no function.

Animals↗
PubMedDate not supplied

[Laparoscopic therapy of intestinal endometriosis and the ranking of drug treatment].

UNLABELLED: Patients with severe endometriosis involving the rectovaginal septum and bowel makes surgery necessary. The laparoscopic approach offers the possibility to perform the complete resection with minimal invasive techniques. Small lesions can be removed by full-thickness-resection. Large nodules make a segmental resection necessary. Deep lesions are resected with stapling devices. Nodules in the sigmoid ore removed by laparoscopic assisted hand-sewn anastomosis. RESULTS: Between 3/96 and 7/03 142 patients with severe endometriosis involving the bowel have been treated laparoscopically. The pre-operative complains have been reduced as following: dyschezio: 88%, dyspareunia 87%, chronic pelvic pain 96%, disturbance of sexuality 75%. The complication rate was minimal: leakage of the anastomosis n=4 (2.8%), paraproctial abscess 2 (1.4%), blood transfusion 1 (0,7 %), severe stenosis of the anastomosis 6 (4.2%). CONCLUSION: Laparoscopic approach is a safe and effective technique to treat deep infiltrating endometriosis with bowel involvement. The hormonal treatment of bowel endometriosis is used in patients with minimal symptoms. The postoperative treatment becomes necessary in incomplete operations or in patients with severe adenomyosis and infertility.

Endometriosis↗
PubMedDate not supplied

Laparoscopic creation of a neovagina: modified Vecchietti method.

A new surgical technique for the treatment of vaginal aplasia is described. It consists of a modification of Vecchietti's method, allowing laparoscopic performance of the operation. 9 patients have been treated in this way since January, 1991 with good results. No complications were seen. Being virtually atraumatic, this method requires only brief hospitalisation, which is of vital importance in view of the psychological and physical problems this particular condition entails. Results are identical, so that this technique should always take precedence over the conventional Vecchietti method.

Abnormalities, Multiple↗
PubMedDate not supplied

Laser techniques in gynaecology.

Lasers have been in use for 15 years in laparoscopic surgery. The CO2-laser in particular has become very popular in the field of gynaecology for the treatment of endometriosis and adhesions. Results achieved with the CO2-laser seem to be superior to those of conventional instruments, although only a small number of randomised prospective studies exist. Fibre lasers, such as the Nd:YAG-, KTP, and Argon-lasers combine vaporisation- and/or coagulation-effects within the same operating instrument. Time-consuming changes of instruments during the procedure are unnecessary. Nevertheless, technical problems and high costs of these laser systems on the one hand, and unfulfilled and unrealistic expectations by physicians and patients alike on the other hand hinder wide-spread use of this technique.

Endometriosis↗