Biomedical subjects
Publications and source records attributed to R Burmucic.
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130 total hysteroscopic resections of the endometrium (RE) were performed at the Department of Gynecology and Obstetrics of the Deutschlandsberg Hospital from August 1, 1992 to May 31, 1997. 115 patients (88.5%) suffered from distinctive therapy-resistant uterine bleeding in terms of hypermenorrhea and menorrhagia, frequently combined with poly- and dysmenorrhea. 15 (11.5%) women who had previously been operated for breast cancer developed--during continuous treatment with tamoxifen--endometrial hyperplasia or polyps on which RE was performed after a hysteroscopic biopsy or resection had been carried out in a second setting. The operation showed that 98 out of 115 patients (85.2%) had pathologic anomalous uteri which were the organic cause of the uterine bleeding. Only 17 women (14.8%) suffered from dysfunctional uterine bleeding (12 cases) or from iatrogenically reduced coagulability (5 cases). The majority of the women (106 cases = 81.5%) were older than 40 (average 46.9 +/- 6.21 years). All RE were performed under inhalation anesthesia whereby the complete uterine cavity up to the inner orifice of the uterus was resected with the resectoscope loop. 92 out of 130 patients (70.8%) underwent a hysteroscopy or a dilatation and curettage before the RE. 77 patients (66.9%) received pretreatment with drugs to reduce the endometrium. 15 women (13.0%) underwent a laparoscopic tubal sterilization in the same setting. Finally, the results of 107 patients were analyzed excluding dropouts and patients who had undergone continuous treatment with tamoxifen and those who had an observation time of less than 6 months. After an observation period of 6-58 months, the success rate was 84.1%. For treatment of relapses 7 second resections were performed, whereby in 1 patient with a further uterine bleeding the uterus had to be extirpated. Nine of the 10 remaining patients had a hysterectomy, 1 patient refused any further treatment. The total hysterectomy rate was 12.2%. Basically, RE is absolutely practicable as far as the treatment of abnormal uterine bleeding is concerned, since hysterectomy can be avoided in a number of cases. Satisfactory long-term results, however, can only be achieved if indication and operation technique are of high quality. A problem which has not yet been solved is the indication and treatment of proliferating adenomyosis uteri interna.
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Within recent years female sterilization has gained a place of great importance as an effective contraceptive method. Nowadays sterilization is hardly subject to any formal restrictions, but is solely the responsibility of the woman concerned, the couple or the physician. The indications for sterilization may be divided into two main groups, namely for medical indications and family planning. Sterilization is carried out on the uterus or tubes. Today the method of choice is laparoscopic tubal sterilization. The most frequently used procedure and the safest way of tubal occlusion is bipolar electrocoagulation of the entire isthmic tubal portions without additional section of the tubes. The complication rate in laparoscopic tubal sterilization depends on the type of anaesthesia, on the skill of the operator and on patient risk factors such as obesity etc. Minor intraoperative complications are of little importance since they are easily remedied during laparoscopy. Severe complications are rare, but have to be corrected immediately by laparotomy. Pregnancies on account of failure in sterilization procedure may be due to the occlusion technique, the lack of experience of the operator, the timing of sterilization and the observation period. Altogether 2372 laparoscopic tubal sterilizations were performed at the University Department of Obstetrics and Gynaecology in Graz between January 1st, 1975 and December 31st, 1985. During these eleven years a specific technique has been developed, whereby standard methods were simplified and improved. No intrauterine cannula for mobilizing the uterus is applied to avoid infection or perforation. The preferred "single-puncture technique" offers many advantages over the older "double-puncture technique", since fewer instruments are needed and the operation is less time-consuming, eliminating the danger of a second puncture. Moreover, the procedure is easier to perform and the cosmetic result better. In high-risk patients, especially the extremely obese, the laparoscopic technique has been improved by a special method of introducing the trocar.
Between February 1978 and December 1985 53 women with lost intrauterine devices (IUD) were treated. To exclude unrecognized expulsion and to locate the device sonography was primarily employed. In 90.6% of cases a correct diagnosis was established. Only in 9.4% of cases a plain X-ray of the abdomen was necessary because sonography was not diagnostic. In 47 patients (88.7%) the IUD could be located by hysteroscopy and was removed. Using biopsy forceps or curette. Of the remaining 6 cases there were 4 with perforation and intraabdominal dislocation, 1 spontaneous expulsion in the interval between diagnosis and admission to the hospital and 1 case of endometrial incrustation which escaped hysteroscopic diagnosis.
In 43 healthy gravidae and 74 gravidae with a hyperemesis gravidarum between the sixth and 20th week of pregnancy the amount of chorionic gonadotropin secreted in 24-hour urine was determined. The quantity of urine secreted was the same in the two groups--919 and 917 ml, respectively. While healthy gravidae secrete 95047 Iu hCG/24 hours (mean value), the secretion among gravidae with hyperemesis gravidarum was increased by approx. 86%, at 176880 IU hCG/24 hours.
In 276 gynecological cases the ratio of anaerobic and aerobic germs was investigated. Cultures took place under criteria sufficient for anaerobic and aerobic bacteria as well. Aerobic germs were predominating (55.4%), while anaerobic germs (bacteria) were to be found in 35.5% of cases. The breakdown reveals Bacteroides in 72%. The significance of anaerobic germs (bacteria) derives both from their pathogenicity and their frequency and depends additionally on the origin of the samples. In samples derived from the cervix or the vagina it must be considered anaerobics being a normal finding having been detected in 38.5 and 40% respectively in the own material. In bartholinitis or abscess of the labia and in intrauterine devices 48,4 and 12.5% anaerobic germs are to be found. In pyosalpinx and tubo-ovarian abscess all anaerobic cultures were negative. The same was true for 80% of aerobic cultures of the same origin. These findings are most likely due to a preceding antibiotic therapy. In contrast anaerobics constantly were to be found in abscess of cul-de-sac and pyometra. These facts should be taken into consideration in selecting an appropriate antibiotic therapy.
Between January 1, 1982 and March 31, 1984, 300 patients were delivered at Graz Gynaecological Clinic who had undergone Caesarean section during their previous delivery or deliveries at the clinic. It was possible to deliver 166 patients (55.3%) of their children vaginally. The rate of spontaneous labour was as high as 91.8% in a group of 61 women who had given birth vaginally once or several times either before or since the Caesarean section. Successful vaginal delivery occurred in 73.5% or 80.6% if the indication for the previous Caesarean section was a breech presentation or a foetal distress, and in 31.7% or 30.6% of those patients whose indication for their previous Caesarean section was a cephalopelvic disproportion or a prolonged labour. The Caesarean section had to be repeated in a total of 134 parturients (44.7%). Of these, the second Caesarean section was indicated primarily (electively) in 29.1%, secondarily in 70.9%. A rupture in the area of the old Caesarean scar occurred in 5 out of 300 cases (1.7%). In four cases this was diagnosed intraoperatively, and once during post partum palpation of the uterine cavity.
A case is reported of secondary hypergonadotropic amenorrhoea following laparoscopic tubal sterilization with unipolar high-frequency current. Before the operation there had been no indication of hormonal disturbance in the 28 year-old woman. Endocrinological investigation of the patient and histological examination of the ovaries confirmed the clinical diagnosis of premature menopause. It is assumed that the ovaries had been irreversibly damaged by the coagulation procedure.
196 women underwent radical abdominal hysterectomy with pelvic lymphadenectomy for cervical cancer of the clinical stages Ib to IIb, at the University Department of Obstetrics and Gynaecology in Graz during 1977 to 1982. 51 patients without recurring cancer and without subsequent radiotherapy were followed up for functional disturbances of the efferent urinary tract. The time interval between surgery and follow-up being 6 to 60 months. Follow-up examination consisted of palpation and, in addition, specific anamnesis based on a specially designed questionnaire, determination of residual urine, control of urine culture, and urodynamic measurement. Furthermore, urethro-cystoscopy and excretion urography were performed in all patients. 21.6% of the patients were completely free from complaints. In contrast, 78.4% of the women reported more or less pronounced signs and symptoms: first of all, delayed spontaneous micturition (78.4% of the cases), and, secondly, stress incontinence (58.8%) and a reduced desire to urinate (47.1%). Enhanced amounts of residual urine were measured in 35.3% of the women, whereas significant bacteriuria occurred in 31.4% of the women. Urodynamic measurement resulted in normal intravesical pressure values in 23 women (45.1%). On the other hand, hypotonic intravesical pressure was seen in 20 patients (39.2%) and hypertonic pressure in 8 women (15.7%). In all patients micturition was disturbed both in respect of urine flow and micturition time. 41 (80.4%) urethro-cystoscopic findings and 41 intravenous pyelography were in the normal range. The complaints reported by the patients were mostly not of special significance for them, since 34 women (66.6%) were greatly satisfied with their condition. The results are described in detail and are discussed.
Midodrine, an alpha-adrenergic agent, was tested in a double-blind randomized fashion in 50 female patients suffering from stress incontinence. 61,5% of the patients receiving midodrine became completely continent, 23,1% improved and 15,4% were considered failure. The results obtained, have been statistically significant.
Antimycotic effect and compatibility of a single-dose treatment with Clotrimazole 500 mg were studied in 47 pregnant women with proven vaginal mycosis seen at the University Clinic of Obstetrics and Gynecology in Graz. Clinical and mycological controls were carried out one and five weeks after treatment was commenced. The following results were obtained after a total of 50 single-dose treatments (3 patients had a second course of 500 mg Clotrimazole 3 months after the first dose): In 39 patients (78%) complete recovery from infection was achieved, in 3 patients asymptomatic contamination was found and in 4 patients therapy was unsatisfactory. In 4 cases a recurrency was found after 5 weeks. Neither in the patients nor in their infants any side-effects of the drug could be observed.
At the Department of Gynaecology of the University of Graz laparoscopic aspirations of ovarian cysts are carried out more and more often since 1975 in order to save young women an unnecessary laparotomy. From January 1, 1975 to December 31, 1980 116 ovarian cysts were aspirated and the contents examined cytologically. Thin ovarian cysts were the main indication for aspiration since they were most likely functional cysts. Paraovarian cysts are not suitable for treatment by aspiration because of the high recurrence rate. The results are described and discussed. The recurrence rate of ovarian cysts was 11.1%.
1245 laparoscopic tubal sterilizations were performed at the University Department of Obstetrics and Gynaecology in Graz over a period of six years. The "single-puncture technique" was used. Up to November 1979 coagulation of the tubes was carried out by unipolar, and subsequently by bipolar high-frequency current. The indications were family limitation in 71.9% of cases and medical in 28.1% of cases. In most cases (70.8%) the procedure was carried out as interval sterilization. Simultaneous abortion by vacuum aspiration was performed in 28.8% of patients. The average age of patients was 33.9% years. 85.2% of women had two or more living children. Intraoperative complications occurred in 2.3% of cases. The pregnancy rate was 0.49%. The indications and the operative technique are described in detail and discussed.
40 patients with subacute pelvic inflammations were treated with the antibiotic compound sulfametrol-trimethoprim. The patients received twice a day 2 tablets with some liquid in the morning and evening. The average duration of treatment was 16.1 days. In 37 patients (92.5%) the disease could be cured completely or a distinct improvement could be achieved. In 3 cases (7.5%) the results were unsatisfactory. Side-effects were seen merely in 2 cases (sickness with allergic exanthem and diarrhea respectively).
48 patients with acute pelvic inflammatory diseases (35 cases of acute adnexitis and 13 cases of inflammatory adnexal tumours) were treated with an antibiotic combination of Ampicillin/Oxacillin and Sisomicin. As initial parenteral therapy Ampicillin/Oxacillin 3.0 g was given intravenously twice daily and additionally Sisomicin 75 or 100 mg according to the body-weight was administered intramuscular twice daily. If required a further oral treatment with 500 mg Ampicillin/Dicloxacillin capsules four times a day was carried out. The average duration of parenteral treatment was 6.3 days; together with the oral treatment the duration of antibiotic treatment was 18.5 days. In 43 patients (89.6%) the disease could be cured completely or a distinct improvement could be achieved. Only in 5 cases (10.4%) the results were unsatisfactory. As side-effects allergic reactions were observed in three cases and gastro-enteritis in one case.
At the department of obstetrics and gynaecology at the University of Graz laparoscopy in the obese women was modified. The pneumoperitoneum is introduced by placing the Verres needle through the pouch of Douglas. An umbilical incision through the fascia is made which admits the index finger of the left hand. Under control by the finger and elevation of the wound with clips the introduction of the trocar becomes safe. The technique is described in detail. The advantages and possible complications of this method are discussed and the first 25 cases reviewed.