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Biomedical subjects

M Korell

Publications and source records attributed to M Korell.

At least 37 records · Page 2Linked to original sources
PubMed1995

Conservative treatment of endometrial cancer permitting subsequent triplet pregnancy.

We report on a 28-year-old woman who received conservative treatment of endometrial carcinoma by curettage and progestins. After regression of endometrial lesions the patient's infertility was treated by gamete intrafallopian transfer (GIFT). Intact triplet pregnancy was diagnosed 3 weeks later. The patient was delivered of three infants by caesarean section following premature rupture of membranes at 30 weeks of gestation. Subsequent standard treatment of endometrial cancer by abdominal hysterectomy and bilateral salpingo-oophorectomy after 4 weeks revealed no clinical or histological evidence of persistent carcinoma. One year after surgery the patient remained without evidence of disease. We believe that individualized cancer therapy may be safely performed in carefully selected cases.

Adult↗
PubMed1995

[Dynamic stability of the glenohumeral joint. A biomechanical study].

Stability of the glenohumeral joint with an anterior, posterior and inferior displacement force of 50 Newton was measured in a dynamic shoulder model. Controlled hydrodynamic actuator forces were applied to the deltoid muscle and to the rotator cuff in seven anatomic specimens. During elevation of the arm, the position of the humerus was measured with a six-degree-of-freedom ultrasonic sensor device. The rotational center of the humeral head was used as reference point for translation. A displacement force of 50N led to significant humeral head displacement anteriorly and posteriorly, but not inferiorly. A 50% reduction of rotator cuff forces increased anterior displacement by 46% and posterior displacement by 31%. Venting of the glenohumeral joint space and of the subacromial bursa resulted in a 50% increase of anterior displacement, a 19% increase of posterior displacement and in significant inferior displacement. This study demonstrates that, in addition to passive stabilizers and negative intraarticular pressure, rotator cuff force significantly contributes to stabilization of the glenohumeral joint during arm motion. Muscle strength and coordination should gain more emphasis in the diagnosis and treatment of shoulder instability.

Adult↗
PubMed1995

[The synergistic effect of delta-aminolevulinic acid and photodynamic laser therapy based on an in vitro model of the ATP tumor chemosensitivity test].

Photodynamic laser therapy (PDT) is under prospective clinical evaluation in gynecology. We used the ATP tumorchemosensitivity assay to detect the efficacy of delta-aminolevulinic acid (ALA) in combination with PDT. Two invasive cervical cancer cell lines were used, C33 and SIHA. The cell-damaging effect was quantified by measuring the intracellular ATP content. The 50% inhibitory concentration of ALA was 760 microM in the cell line C33 and 500 microM in the cell line SIHA. The combination of ALA incubation and PDT was synergistic in both cell lines. After in vitro experiments with this method, the combination is now used in a clinical phase II study. PDT after topical ALA application promises to become a possible alternative for the treatment of preinvasive and invasive malignancies in gynecology.

Adenosine Triphosphate↗
PubMed1995

[Use of photodynamic laser therapy in gynecology].

OBJECTIVE: Dysplasia of the vulva and uterine cervix are often multicentric, tend to recur and have mostly to be treated by surgical procedures. The photodynamic laser therapy (PDT) may be an alternative, which selectively destroys neoplastic tissue after topical delta-aminolevulinic acid (ALA) used as a photosensitizer. METHODS: We measured the distribution of fluorescence in dysplastic and nondysplastic tissue after topical application of ALA in 27 patients with dysplasia. In 3 vulvar and 2 cervical dysplasias, PDT was performed. RESULTS: We could show a selective enrichment of endogenous porphyrins in dysplastic tissues, whereas benign tissue showed no fluorescence. The fluorescence was limited to the mucosa. The heterogeneous fluorescence pattern was influenced by the duration of ALA application. In the treated patients, cytological and clinical parameters showed improvement after use of PDT. The longest recurrence-free interval from treatment up to date is 15 months (range 3-15 months). CONCLUSIONS: After first results of penetration studies and clinical follow-up, PDT after topical ALA application seems to be a good alternative to surgical procedures in dysplastic changes of the genital tract.

Adult↗
PubMed1995

[Possibilities and limits of endoscopic fallopian tube surgery].

Treatment of distal tubal occlusion by microsurgical means allows a pregnancy rate of about 30-40% per patient. The success rate directly depends on patient's age and the grade of tubal destruction and increases to 50% in younger patients. Therefore microsurgical repair still represents a sufficient alternative to IVF. The introduction of endoscopical techniques further facilitates distal tubal surgery and offers the opportunity to evaluate the grade of tubal destruction. When performed correctly based on longstanding experience pregnancy rates after endoscopical salpingostomy are similar to microsurgery via laparotomy. In contrast microsurgery by laparotomy is still the method of choice in cases of proximal tubal occlusion or reversal of tubal ligation. Furthermore laparotomy is still indicated in patients presenting with distal tubal pathology, if the endoscopical approach does not lead to a sufficient postsurgical result.

Adult↗
PubMed1994

[Dual chamber safety vacuum--initial experiences with a new suction cup].

The main problem with vacuum extraction methods, alongside the cephalhaematoma produced, is the premature separation of the suction cup under traction, since the resulting sudden change in pressure can lead to severe intra-cerebral damage to the child. To reduce the risk of vaginal operative delivery, a new double-chamber safety vacuum extractor has been developed by Hepp/King. The basic feature of this instrument is an additional chamber with a thin overlapping area, which surrounds the actual suction cup and serves as a safety vacuum. If the suction cup starts to slip, the external vacuum is released and sounds an alarm. In addition, the inner vacuum has been designed to be convex and to reduce the volume of scalp, which is sucked into the vacuum, thus reducing the size of the cephalhaematoma produced. First experiences in clinical use demonstrated the reliability of the early warning signal, if the direction of traction is false or the applied traction is too strong. The inner vacuum remains constant at 0.8 atu, so that with care, the extraction can continue without interruption. We have used the new instrument in 18 deliveries. In 15 cases, the indication was failure to progress into the second stage of labour; in one case history of retinal detachment and in two cases signs of foetal asphyxia. In all cases, the child was delivered following one or two contractions with traction, without losing the vacuum. The average weight of the newborn was 3566 g. As expected, the cephalohaematoma produced was very much smaller than usual. Further clinical trials are necessary before the value of this new instrument can be assessed.

Asphyxia Neonatorum↗
PubMed1994

Low-dose follicle stimulating hormone for ovulation induction in polycystic ovary syndrome.

In 20 patients with clinically, sonographically and endocrinologically proven polycystic ovary syndrome, ovulation induction with low doses of follicle stimulating hormone (FSH) was attempted by administration for 27 menstrual cycles. One ampule FSH was administered from day 3 onwards. If the ovarian response was inadequate after days 10-12, the daily FSH dose was increased by half an ampule until ovulation induction. Of the cycles, 55.5% were monofollicular, whereas 4 cycles had to be cancelled due to a multifollicular response or failure of ovarian stimulation. On average, 14.4 ampules was used, and human chorionic gonadotropin was given on day 16. Seven pregnancies were established, with all of them ongoing at this writing. One twin pregnancy and one triplet pregnancy occurred. Even in polycystic ovary syndrome patients, low-dose administration of FSH allows safe stimulation, with a low incidence of ovarian hyperstimulation, a high pregnancy rate and an acceptably low risk of multiple pregnancies.

Adult↗
PubMed1994

Translation of the glenohumeral joint with simulated active elevation.

Translation of the glenohumeral joint was measured with a dynamic shoulder model during elevation of the arm in 8 cadaveric specimens. Controlled hydrodynamic actuator forces were applied to the deltoid muscle and the rotator cuff through wire cables. Using a constant force ratio, the glenohumeral joint was elevated to 90 degrees. The position of the arm in all spatial orientations was measured with an ultrasonic device. Reproducibility of glenohumeral joint motion was demonstrated on the basis of 5 cycles of glenohumeral joint elevation. The rotational center of the humeral head was used as the reference point for translation. Translation during elevation of the glenohumeral joint between 20 degrees and 90 degrees averaged 9.0 mm +/- 5.2 mm superiorly and 4.4 mm +/- 1.3 mm anteriorly. Physiologic variation of muscle activity, which is not yet fully understood, was not included in the model. In vivo, translation may be diminished by coordinated activity of the rotator cuff. The presence of significant glenohumeral joint translation underlines the importance of active, muscular guidance at the shoulder. Physiologic translation must be considered in the design of total shoulder arthroplasty, in shoulder instability, and in the impingement syndrome.

Adult↗
PubMed1993

'Blind' transvaginal gamete intra-fallopian transfer in distal tubal and peritubal pathology: an evaluation in respect to the laparoscopic approach.

Transvaginal gamete intra-Fallopian transfer (GIFT) is a new treatment modality for patients with proven tubal patency, avoiding invasive laparoscopy. In this study 79 cycles of standard laparoscopic GIFT (group 1) were analysed in comparison to 40 cycles of transvaginal intratubal gamete transfer guided by tactile sensation (group 2). GIFT in group 1 was performed for standard indications; patients with severe intra-abdominal adhesions, distal tubal pathology, peritubal adhesions or extreme obesity were included in group 2. No difference in mean age, duration of infertility, oestradiol level and number of oocytes was found. In group 1 a clinical pregnancy rate of 33% per GIFT cycle (n = 79) was achieved. The clinical pregnancy rate in group 2 was 17.5% per gamete transfer cycle. In conclusion, transvaginal GIFT offers an acceptable chance for in-vivo fertilization to patients who cannot be treated laparoscopically despite having patent tubes and who refuse in-vitro fertilization.

Adult↗
PubMed1993

Combined intra-uterine and extra-uterine pregnancy in the contralateral tube after gamete intra-fallopian transfer.

A case of combined intra-uterine and contralateral tubal pregnancy after gamete intra-Fallopian transfer (GIFT) is presented. Laparotomy with partial tubal resection was performed after tubal rupture. The intra-uterine pregnancy is still ongoing without complications. Heterotopic pregnancies are dangerous conditions for the patient and should be taken into account after transfer of multiple oocytes. To our knowledge this is the first report of a heterotopic pregnancy in the contralateral tube after GIFT.

Adult↗
PubMed1992

[Hormonal and ultrasound monitoring of early pregnancy--differential diagnosis of extrauterine pregnancy and multiple pregnancy].

In this study sonographical and hormonal findings in 63 patients with intrauterine singleton pregnancy were compared with 18 patients with multiple pregnancies and 28 patients with ectopic pregnancy. The earliest detection of the intrauterine gestational sac was obtained with a HCG level of 659 mlU/ml. The sonographical development correlated well with HCG values. There was no statistically significant correlation between gestational age and HCG. In multiple pregnancies with sonographical findings comparable to the development in singletons HCG values were remarkably elevated. A discrimination between multiple and ectopic pregnancies by sonographical and hormonal criteria cannot be performed sufficiently in a HCG zone of 1500 mlU/ml. Close sonographical and hormonal follow-up until diagnosis of the intrauterine pregnancy is necessary.

Chorionic Gonadotropin↗
PubMed1992

[Operation of acute dissecting aortic aneurysm in the 25th week of pregnancy using hypothermic extracorporeal circulation].

We report on a 24 + 2 weeks pregnant woman with Marfan's syndrome, who acutely developed a dissecting aortic aneurysm with aortic valve insufficiency. Emergency surgery was performed by using hypothermic extracorporeal circulation, whilst the aortic valve and ascending aorta were replaced by a synthetic graft. Foetal heart rates, continuously monitored by using Doppler ultrasound, were shown to be closely correlated with perfusion pressures. By applying perfusion pressures of 90-100 mmHg, we were able to maintain foetal heart rates of approximately 100/min. During the first postoperative day, the CTG was normal for gestational age and no contractions were noted. During the second postoperative night, the patient prematurely delivered a dead 820 g infant (Apgar score 0/0/0/0). In view of this case report, opportunities and problems associated with an application of extracorporeal circulation during pregnancy are discussed.

Adult↗
PubMed1991

[Current possibilities in reproduction medicine. 1. Diagnosis].

The methods employed by assisted conception, presuppose a rational diagnostic evaluation. The endocrine work-up concentrates on demonstrating adequate ovulation. Today, apart from vaginal ultrasonography, this largely means LH determination in the urine in the middle of the cycle, together with progesterone measurements in the luteal phase. Recording the basal body temperature can offer no more than an orientation. The clarification of tubal patency is ideally served by laparoscopy with pertubation. With the aid of new sonographically visible contrast media, tubal flow can also be investigated using sonography. For the male work-up, classical evaluation of the ejaculate has declined in importance. As a means of establishing a fertility prognosis, forward progression, lateral movements of the head of the sperm, and functional sperm analysis (hamster oocyte penetration test) would appear most suitable.

Fallopian Tube Patency Tests↗