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Biomedical subjects

K Semm

Publications and source records attributed to K Semm.

At least 37 records · Page 2Linked to original sources
PubMed1989

[Sonographic diagnosis of amniotic band syndrome].

A case is reported of sonographic diagnosis of ADAM-complex (amniotic band syndrome) in the 19th week of gestation of an otherwise healthy pregnancy. The ultrasonic investigation showed absence of bony structures in the skull area a direct connection to the placenta. The intra-cerebral structures showed no abnormalities. Aminocentesis demonstrated normal chromosomal analysis and an alpha-fetoprotein value was within normal limits. The acetylcholinesterase examination was negative. Following prostaglandin induction, a spontaneous delivery of a 230 g freshly dead fetus occurred, the latter exhibiting a broadly-based amniotic band connection between skull and placenta.

Adult↗
PubMed1989

[Adenomatous hyperplasia--hysterectomy or drug therapy?].

Adenomatous hyperplasia of the endometrium requires either gestagen treatment or hysterectomy, depending on the patient's age and grade of hyperplasia. 51 patients, in whom adenomatous hyperplasia of grade I-III had been ascertained by curettage, were hysterectomized not more than 4 weeks following diagnosis at the Kiel University Clinic of Obstetrics and Gynecology during the years 1985-1989. Only few of the patients received hormone treatment. For all grades of hyperplasia, histological findings from curettage and hysterectomy were identical in only 40% of the cases. In patients older than 40 years, 54% of 13 patients with adenomatous hyperplasia grade III in the curettage specimen had already developed a well differentiated adenocarcinoma, which was detected in the extirpated uterus. In our opinion, when adenomatous hyperplasia of grade II or III is present in a curettage specimen in the age group over 40 years women, hysterectomy should be recommended. For younger women and for adenomatous hyperplasia grade I, we recommend individual therapy.

Adenoma↗
PubMed1989

Incidence of adhesions in the true pelvis after pelviscopic operative treatment of tubal pregnancy.

33 patients with tubal pregnancies, who had been treated by pelviscopy with organ preservation between 1978 until the beginning of 1988 have had follow-up examinations from within 4 months to 2 years after their first operation. In 15 (45%) of these 33 patients we found adhesions in the true pelvis on initial pelviscopy; these adhesions were lysed in all cases. During a second inspection of the abdominal cavity-either by laparotomy (Cesarean section; 4 patients) or by repelviscopy (29 patients)-mainly avascular, filmy adhesions on one or both adnexae were found in 17 cases (52%). The pelviscopic treatment of ectopic pregnancy does not completely prevent the development of postoperative adhesions. The concomitant pelviscopic adhesiolysis during the treatment of ectopic pregnancy reduces the degree of severity of the recurring adhesions.

Adnexal Diseases↗
PubMed1989

Delivery of breech presentation infants at term. An analysis of 304 breech-deliveries.

304 breech presentation infants greater than or equal to 2.500 g were delivered at the University Women's Clinic, Kiel, between 1984 and 1987. Only 2 of the vaginally delivered infants died; both had severe malformations sonographically diagnosed prior to delivery. The umbilical cord arterial PH was found to be significantly (p less than 0.001) higher in infants delivered per Caesarean Section as compared to those vaginally delivered. The same ratio was found in a control group of vaginally delivered infants compared to sectioned infants in the vertex presentation. In 13.3% of cases post primary section and in 14.4% of cases post vaginal delivery from breech presentation we found an apgar of less than or equal to 7 one minute post-partum. The transfer rate to a paediatric unit of vaginally delivered infants (7.2%) appeared to be double that of the infants delivered per Caesarean Section (3.6%). However, the indication for transferral is principally independent of the mode of delivery. Taking the 3-12fold increased maternal mortality rate post section as compared to vaginal delivery into consideration, a vaginal delivery of a breech presentation infant at term appears to be justifiable under certain presuppositions: exclusion of cranio-pelvic disproportion, and normal progression of labour. The indication for secondary Caesarean Section should be generously applied in cases of a suspicious C.T.G. and a slow progression of labour.

Breech Presentation↗
PubMed1989

The frequency distribution of various pelviscopic (laparoscopic) operations, including complications rates--statistics of the Federal Republic of Germany in the years 1983-1985.

The 3rd German pelviscopic (laparoscopic) statistics include in all 207,823 laparoscopies from 310 general hospitals and 41,644 laparoscopies from 121 private clinics. The response rate was 39% for the hospitals and 59.3% for the clinics. In the hospitals 429 serious complications occurred and in the clinics 63, which is a complication rate of 1.97%. In 415 cases (1.66%) a laparotomy was required. The most frequent serious complication was an injury of the intestinal organs, caused by the Veress-needle or the Trocar. Another serious complication was an injury of a major blood-vessel, as well as haemorrhages from salpinges on dissected Omentum. For sterilization 87.7% of the hospitals and clinics used the bipolar HF-technique; 32.4% used Endocoagulation according to Semm. In 8.3% of the cases, the monopolar high frequency method was applied. After sterilisation in the hospitals, intra- and extra-uterine pregnancies occurred in 2.8% while in the private clinics this figure was 3.3%. The intra- or extra-uterine pregnancies occurred mainly after sterilisation by the bipolar HF-technique or after Clip-sterilisation. 46.1% of the investigated hospitals and 36.4% of the private clinics intend to increase the indication of the endoscopic operations.

Female↗
PubMed1989

[Endoscopy and sonography change a specialty: exemplified by gynecology].

Pelviscopy, a surgical technique employing new apparatuses and instruments, has replaced the classic laparotomy in gynecology in over 75% of cases. According to an organ-oriented surgical catalogue, pelviscopic surgery has proven to be successful in the treatment of ectopic pregnancy (nearly 100%), ovarian cyst enucleation, oophorectomy, and myoma enucleation. In cases of extensive bowel and omental adhesiolysis, pain-free status is achieved in 60%. Second-look and repelviscopy enhance the success rate of adhesiolysis. The results achieved in Kiel have been statistically proven in over 15,000 peliviscopies.

Appendectomy↗
PubMed1988

Ovulation induction for in-vitro-fertilization and embryo transfer applying decapeptyl (DTRP-6 LH/RH) in combination with HMG or FSH.

47 patients out of the IVF-program of the Department of Obstetrics and Gynecology University of Kiel, who demonstrated in previous stimulation cycles premature LH surges, were treated in two modalities with a down regulation applying the GnRN-analogue decapeptyl (DTRP-6 LH/RH) and a concomitant HMG- or FSH-stimulation. The down-regulation was started after ovulation up to a negative LH/RH test followed by a concomitant gonadotropin stimulation in group 1. In group 2 a parallel treatment with decapeptyl and HMG or FSH was performed from day 2 of the cycle. 10 husbands of the punctured patients had pathological sperm. In both groups 6 patients were discarded from of the stimulation protocol as their oestradiol responses were not adequate, sperm contamination was detected late in one case, and in one patient a premature LH surge occurred once again. In 36 patients vaginal follicular punctures were performed. With respect to pregnancies group 1 revealed a much higher pregnancy rate than group 2. It seemed better to start the down-regulation with the GnRH-analogue decapeptyl in the luteal phase of the previous cycle. The treatment with decapeptyl should not only be applied in patients with previous LH surges but also in order to establish a synchronous follicular maturation in ovulating patients treated for in-vitro fertilization, or gamete-intra-Falloppian-tube-transfer.

Adult↗
PubMed1988

Local infiltration of ornithine 8-vasopressin (POR 8) as a vasoconstrictive agent in surgical pelviscopy (applied to myoma enucleation, salpingotomy in cases of tubal pregnancy and peripheral salpingostomy).

For better hemostasis in cases of operative pelviscopy in 60 patients Ornithine-8 Pitressin (POR 8) was applied locally as a vasoconstrictive agent in quantities of up to 50 ml at a concentration of 0.05 IU/ml. From the broad spectrum of indications for operative pelviscopy, the following procedures employing local application of a 5% POR 8 solution to produce intraoperative ischemia are described: Myoma enucleation, longitudinal salpingotomy with conception product extraction in the conservative treatment of a tubal pregnancy, ovarian cystectomy and salpingostomy. The tolerance was optimal no side effects were observed.

Endoscopy↗
PubMed1988

[Pelviscopic treatment of abscess-forming inflammations of the pelvis].

Between 1983 to 1986, in the Department of Gynaecology & Obstetrics at the University of Kiel, 50 cases with abscess-forming pelvic inflammation were treated; 28 of these through pelviscopy, whilst laparotomy was necessary in the other 22 cases. The mean age of those patients treated through pelviscopy was significantly lower than that of those subjected to laparotomy. No significant differences were found regarding either the duration of inpatient and postoperative treatment or the duration of antibiotic therapy. In the patients subjected to laparotomy, extirpation of the inflamed organs was carried out i.e. unilateral or bilateral salpingectomy, ovariectomy with eventual hysterectomy in some cases. In the pelviscopic treatment, conservative surgery was considered and ovariectomy or salpingectomy was necessary only in small number of cases. In young women, wanting to complete their families, conservative organ-retaining pelviscopic treatment of abscess-forming pelvic inflammation is a valuable alternative to laparotomy.

Abscess↗
PubMed1988

[Distribution of the incidence of various pelviscopic (laparoscopic) surgical procedures and their complication rates. A statistical analysis in West Germany 1983 up to and including 1985].

The 3rd German pelviscopy (laparoscopy) statistics includes in all 207,823 laparoscopies from 310 clinics and 41,644 laparoscopies from 121 private practises. This is a percentage of 39% from clinics and 59.3% from private practises. There appeared 429 serious complications in the clinics and in the practises 63, which is a complication rate of 1.97%. In 415 cases (1.66%), a laparoscopy was required. The most important of the complications was injury of the intestinal organs, when putting in the Veress-needle or the optical trocar, followed by injury of the main blood vessels, as well as hemorrhages of the salpinges on detached omental fragments. Where tubal sterilization is concerned, 87.7% of the clinics ans private practises used the bipolar HF technique; 32.4% used the endocoagulation according to Semm. In 8.3% of the cases, the monopolar high frequency method was applied. After sterilization in the clinics, 2.8% intra- and extrauterine pregnancies occurred, while in the private hospitals this percentage was 3.3%. The intra- or extrauterine pregnancies occurred mainly after sterilization by the bipolar HF technique or after clip-sterilization. 46.1% of the investigated clinics and 36.4% of private practises, intend to increase the indication of endoscopic operational methods.

Cross-Sectional Studies↗
PubMed1988

[Pelviscopic adhesiolysis. Successes in the treatment of chronic abdominal pain caused by adhesions in the lower and middle abdomen].

Inspecting 200 patients with abdominal pain pelviscopically, we found adhesions and no other pathology in 62 (32%). Three groups were defined according to the extent of the adhesions. In 52 patients (84%), complete adhesiolysis was achieved pelviscopically. At discharge 3-5 days post-operatively, 38 of these patients (73%) were free from complaints; in 15%, the pain had lessened. 6 months after pelviscopy, the patients were again asked about their complaints. 39 (75%) of the patients with complete adhesiolysis answered the questionnaire. 15 (38%) were completely free from complaints after 6 months; in 8 others, the pain had lessened; in 60% of them, the abdominal pain had lasted for more than 6 months. Our results justify an attempt at complete adhesiolysis in all patients with abdominal pain, if adhesions are detected pelviscopically.

Abdomen↗
PubMed1988

[Visible control of peritoneal perforation in surgical pelviscopy].

From the inception of laparoscopy, the primary blind incision has presented an as yet unresolved risk. In "open laparoscopy", the abdomen is opened in the classic manner as though a "mini-laparotomy" were being performed. This is time-consuming, cosmetically unsatisfactory, and restricted locally. Using a newly tried-out technique, and adhering to the classic transumbilical Z-incision technique, both the muscle layer and the peritoneum beneath it are punctured under endoscopic sight. Here, the elliptically ground end of a trocar capsule slides along the epiperitoneum, until light shining through allows a growth-free site to be diagnosed. The preceding inflation of the pneuperitoneum is performed without risk by use of aspiration tests, vacuum tests, and sound tests, and simultaneous measurement of insufflation and static pressure (Semm monofil bivalent system).

Female↗
PubMed1988

[Pelviscopic treatment of tubal pregnancy].

In 1978-1985 we operated on 111 tubal pregnancies pelviscopically. In 12 cases a salpingectomy was performed, in 99 patients the tubes both remained. 17 tubal abortions were extracted, in 82 cases the pregnancy was removed by salpingotomy. One second pelviscopy and one laparotomy were required because of postoperative bleeding. In one patient, a salpingectomy became necessary because of a post-operative infection. The pregnancy rate in 45 controlled infertility patients was 53%. A recurrence of ectopic pregnancy in the same or in the other tube occurred in 11%.

Adult↗