Biomedical subjects
Publications and source records attributed to L W Popp.
A summary of the original descriptions of the Authors who gave the name to the syndrome characterized by absence of uterus and vagina is presented. Through these original descriptions a complete view of the development in gynecology over the last 150 years is offered.
OBJECTIVES: The potential of the combined use of vaginosonography and serum beta-hCG levels for early diagnosis of intrauterine and ectopic pregnancies (5-7 weeks postmenstrual) was investigated in a multicentric study. METHODS: Three hundred and forty-nine patients underwent vaginosonographic examination and determination of serum beta-hCG. When the first examination failed in establishing a precise diagnosis, repeat examinations were performed on alternate days. RESULTS: During the first 3 weeks after the missed menses, vaginosonography can detect practically all viable intrauterine pregnancies, half of the nonviable intrauterine and viable ectopic pregnancies, and one quarter of nonviable ectopic pregnancies, respectively. It was not possible to differentiate intrauterine and ectopic pregnancies by serum beta-hCG levels. CONCLUSIONS: Vaginosonographic screening, ideally at 2 weeks after the missed menses, permits detection, localization, and dating in 80%-90% of suspected pregnancies.
OBJECTIVE: Management of early ectopic pregnancy was investigated in a multicenter, prospective study. METHODS: Serum beta-hCG levels were monitored after therapy and correlated to the type of management, gestational age, and initial serum beta-hCG levels in 119 patients with ectopic pregnancies detected at 5-7 postmenstrual weeks. RESULTS: Salpingectomy was performed in 16 patients. No post-operative complications were reported. After conservative laparoscopic surgery of 51 ectopic pregnancies, 9 (18%) had delayed decrease or an increase of serum beta-hCG levels. Re-operations were performed in 4 (7%) patients. Similar findings were noted in 2/6 patients after conservative operations performed by laparotomy. Intrachorionic injection treatment was successful in 17/18 ectopic pregnancies, and expectant management in 7/8 patients with initial serum beta-hCG levels below 250 mIU/ml. CONCLUSIONS: Persistence of trophoblastic activity is a potential complication of conservative surgical treatment of ectopic pregnancy. A detailed diagnosis as early as 6-7 post-menstrual weeks may be the key for future non-surgical management of ectopic pregnancy.
In 298 patients we evaluated criteria of peri- and post-operative quality of life. 222 patients underwent pelviscopic surgery and 76 patients underwent laparotomy. The parameters of convalescence used were: the duration of hospital stay and disablement, the duration and intensity of post-operative discomfort, and the number of consultations in a physician's office after discharge from hospital. Our results show, that minimal access endoscopic surgery can reduce the impairment in the peri- and post-operative quality of life.
OBJECTIVE: Differentiation of benign and malignant cystic adnexal masses by analysis of cyst fluid was investigated. STUDY DESIGN: Eighty-one cystic adnexal lesions of 80 patients were punctured intraoperatively or after surgical removal. Color of the cyst fluid, cytology, concentrations of steroid hormones (estradiol, progesterone, testosterone), and tumor markers (CEA, CA 125, CA 15-3) were correlated to histology. RESULTS: Color of cyst fluid was not reliable in the differential diagnosis of cystic adnexal masses. Cytology missed four out of seven malignant tumors. One mucinous cystadenoma was cytologically suspicious for malignancy. The combination of negative cytology, low tumor marker levels, and estradiol levels higher than 1000 pg/ml may support the diagnosis of a 'functional' cyst. Elevated CEA levels may be suspicious for all mucinous and malignant lesions. CONCLUSION: Analysis of cyst fluid could not accurately discriminate between benign or malignant tumors.
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In a prospective study the size of 157 pelvic tumors in 101 patients was measured preoperatively by bimanual palpation and vaginosonography, and the results were compared with measurements made at operation. In 72 uterine and 85 ovarian lesions the Spearman correlation coefficients (rs) between the three maximum diameters at right angles to each other measured at operation and by bimanual palpation ranged from 0.48 to 0.78. The correlation coefficients (rs) between measurements at operation and preoperative vaginosonography ranged from 0.91 to 0.97. The size of small lesions was overestimated by bimanual palpation; 44% of tumors smaller than 5 cm in diameter were only detected by vaginosonography.
OBJECTIVE: Automatic cutting needle sampling was used for diagnosis of adenomyosis uteri. The purpose of this study was the establishment of myometrial biopsy as a clinically applicable method. STUDY DESIGN: Sensitivity and specificity of myometrial biopsy in diagnosis of uterine adenomyosis was estimated by examining 680 biopsy specimens from 68 surgically removed uteri. In 34 patients with clinical symptoms of adenomyosis uteri 70 myometrial biopsies were performed during laparoscopy, and vaginal ultrasonographically guided myometrial biopsy was performed in six patients (14 specimens) without complications. Prevention of myometrial bleeding was achieved by prophylactic injection of ornipressin into the biopsy cannula. RESULTS: The sensitivity of a single myometrial sample for diagnosing adenomyosis uteri ranged from 8% to 18.7%; specificity was 100%. CONCLUSION: Our results may encourage further investigation on the clinical use of myometrial biopsy.
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Rabbits at mid pregnancy were used as experimental models for investigating the feasibility of intrachorionic injection therapy in human ectopic pregnancy. Also, exposure of rabbit pregnancy to hyperthermia of 45 degrees C was studied. The experiments were followed by serial serum progesterone levels and by light as well as electron microscopy. Intrachorionic injection of different drugs led to demise in 92% of gestations. Application of hyperthermia to the pregnant rabbit uterus led in 94% to demise of gestations. Impairment of the reproductive functions after exposure did not occur. Injection was more effective up to day 15 of pregnancy, while hyperthermia had better results in older gestations. Morphological reactions to injection of different drugs and to hyperthermia were similar. Irreversible damage to the uterine wall was not observed. Intrachorionic injection of drugs may be a suitable treatment of human ectopic pregnancy. Application of hyperthermia may be a promising future therapy.
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A pelviscopic method for the creation of a neovagina in a case of Mayer-von Rokitansky-Kuester-Hauser syndrome is described. Only one procedure for endoscopic diagnosis and minimal access operative therapy is required. The operative trauma of the Vecchietti procedure is greatly reduced by replacing the Pfannenstiel incision by pelviscopy.
Since abdominal wall herniae derive from the abdominal cavity, they are accessible to laparoscopic diagnosis and treatment. This may be more appropriate than the conventional external approach. In five gynecological patients, scheduled for pelviscopic surgery, a coexisting inguinal hernia was endoscopically repaired. Transcutaneous aquadissection of the musculofascial defect using physiological saline solution in a syringe was easy to perform and very helpful in the endoscopic dissection of the peritoneal space. The method is described in specific detail, and recommended for application.
A new endoscopic procedure for hernioplasty is described. Operative pelviscopy technique according to Semm was used.
Vaginosonography has the potential of improving not only accurate diagnosis preceeding chorionic villus sampling but also the sampling procedure itself. The vaginosonographic diagnostic landmarks of early pregnancies are the contact area between the amnion and the chorion, the insertion of the umbilical cord, the yolk sac and the decidua-trophoblast complex. The occurrence of a "Swiss-cheese-pattern" in the latter structure is a strong hint for an unfavourable outcome of early pregnancy. Vaginosonographically guided puncture is a promising approach for chorionic villus biopsy. The punturing facilities are firmly attached to the high resolution vaginal ultrasound probe. Thus, precise ultrasound-guided puncture penetrating the vaginal skin and the uterine wall in the shortest possible distance has become possible.
This is a photographically well documented case report of endoscopic patch repair of an inguinal hernia in a female patient. The surgical steps as well as the repair materials are described in detail. Patch repair of abdominal hernias is a promising new application of minimally invasive endoscopic surgery.
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