Less vaginal cuff and pelvic infection after laparoscopic hysterectomy?
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Female↗
Biomedical subjects
W Decleer
Publications and source records attributed to W Decleer.
[Photodynamic laser therapy with antibody-bound dyes. A new procedure in therapy of gynecologic malignancies].
In the present paper, a new therapeutic concept of photodynamic laser therapy using antibody-linked dyes for the treatment of gynecological malignancies is described. So far, HPD (hematoporphyrin derivative) has been employed in this area, but is associated with toxic systemic reactions. We see a solution to this problem in the linking of a systemically non-toxic dye--known to induce photodynamic reactions while not itself being selectively accumulated within tumor cells--to an antibody directed against a selective tumor-associated antigen. The results of our study demonstrate the efficacy of this therapeutic concept as exemplified by the selective destruction of dye-labeled ovarian carcinoma cells by laser light of a defined wavelength (675 nm). The potential of this form of photodynamic therapy extends far beyond its use in ovarian carcinoma.
Antibodies, Monoclonal↗
Photodynamic laser therapy of carcinomas--effects of five different photosensitizers in the colony-forming assay.
Photodynamic therapy (PDT) with laser radiation opens a new field in the treatment of malignancies. We evaluated the phototoxic effects of five different substances for photodynamic therapy in concentrations showing no systemic toxicity. We used gynecologic tumor cells and evaluated the photodynamic effects for cell growth in a colony-forming assay. For Indigocarmin we found a reduction in the colony-forming assay compared to the control group from 87% to 66% after irradiation at 50 mumol/l and 608 nm wavelength. "IR 132" showed a reduction in the colony-forming assay from 73% to 72% 50 mumol/l (590 nm). For the incubation of the HeLa cells with 50 mumol/l of "Sulfo-Phthalocyanin" we found a reduction of the colony-forming potential from 81% to 67% (595 nm). The most strikingly differences were found for the incubation and irradiation of Methylene Blue, showing a reduction from 77% to 16% caused by a toxic effect of the substance itself (5 mumol/l, 660 nm) and "Sulfo-Aluminium-Phthalocyanin" stained cells, which shows a reduction from 86% to 17% (50 mumol/l, 675 nm). We see the possibility of a photoactivation and cell devitalisation by "Sulfo-Aluminium-Phthalocyanin" and laser radiation. A future clinical trial would seem justified.
Cell Survival↗
Endoscopic fetal surgery by excimer laser. An experimental study in premature lambs.
Fetal malformations are detected early in pregnancy by means of ultrasound challenging fetal therapy. While open fetal surgery has been preformed during preliminary clinical trials we evaluated fetoscopic therapy avoiding laparotomy and uterotomy. We used a laser fibre (900 mu) which was introduced into the uterus by an endoscope. During animal experiments in five fetal lambs with a gestational age of 120-122 days we used an excimer laser (Technolas, x) with a wave-length of 308 nm. Laser incisions were compared with the conventional cutting technique using a scapel. During histological evaluation the tissue effect was morphometricly analysed. The zone of devitalisation was characterized by pycnosis of the nuclei and in a change of cytoplasma volume. The excimer laser incisions using a frequency of 40 HZ had a mean zone of devitalisation of 50.3 +/- 4.5 mu. Using the excimer laser with a frequency of 10 HZ we found a tissue alteration of only 11.2 +/- 3.4 mu. The incisions by scapel showed a extended traumatisation with a mean tissue effect of 153.2 +/- 16.3 mu. From these results we conclude, that endoscopic surgery may be come a usefull additional tool for fetal therapy.
Animals↗
An approach to fetal surgery: endoscopic use of excimer laser.
Recent progress in the area of prenatal diagnosis by means of ultrasound forces the improvement of surgical techniques for intra-uterine fetal therapy. By the use of short, intense pulses of ultraviolet laser light (20-200 ns long) a photoablation of defined samples of biological tissue is performed with no substantial thermal side effects. The experimental set-up applied in this study included endoscopic operation on five fetal lambs. Macroscopically, a sharp edge in the incision area was observed at both prechosen laser frequencies of 10 and 40 Hz. The clinical application of pulsed ultraviolet laser systems with the characteristics of guided photoablation and atraumatic incisions avoiding thermal side-effects opens new perspectives for fetal surgery.
Animals↗
[Continuous transcutaneous PCO2 measurement and laser spectroscopy for fetal monitoring in 3d degree atrioventricular block].
Obstetrical management in case of foetal third-degree AV block has been to date mainly via primary abdominal section, the indication being partly the foetal condition and partly also unsatisfactory childbirth monitoring. The article describes a childbirth associated with AV block, monitoring being effected by continuous measurement of the transcutaneous partial carbon dioxide pressure (tcpCO2) and via laser spectroscopy. Prenatal diagnostics and indications for vaginal delivery are also described. Updated knowledge on the pathogenesis of foetal AV block is presented.
Adult↗
[Laser spectroscopy--a new procedure in fetal monitoring].
Monitors for laser spectroscopy are available as an additional tool for foetal surveillance. Using this technique, continuous and non-invasive registration of four biochemical parameters (HbO2, HbR, blood volume and cytochrome aa3) can be performed. The calculation is based on the optical density after irradiation of the biological sample with pulsed laser light in the near-infrared range (755, 805, 845, 904 nm). We evaluated the new technique in a clinical trial of 20 patients. The application of the laser sensor was performed, using a modified amnioscope. During prenatal tracings in cases with suspect CTG patterns, hypoxia was not verified. In cases without late decelerations a decrease of the cytochrome aa3 signal was observed in less than 1%. During intrapartual measurements, near-infrared signals were compared with the result of the PO2 measurement in foetal blood analysis. We found a significant correlation for HbO2 and cytochrome aa3 with a correlation coefficient of r = 0.96 respectively r = 0.94. We conclude, that laser spectroscopy will potentially be of benefit for foetal monitoring as it might provide a basis for differentiation between foetuses at risk and non-hazardous cases.
Cardiotocography↗
[Laser spectroscopic assessment of induced hyperoxia--an animal experiment in lambs].
The noninvasive determination of biochemical parameters has become an important aspect of intensive care medicine. The newly developed monitors for laser reflectometry provide the possibility of spectroscopic monitoring. The equipment consists of a near-infrared data collection unit and a personal computer. The four laser diodes emit light at wavelengths of 775, 805, 845 and 904 nm. By analyzing the changes in optical density during laser irradiation of biological tissue, information is obtained about the relative changes in the concentration of hemoglobin and the blood volume. In animal experiments with ten fetal lambs we evaluated the reliability of near infrared laser spectroscopy. Fetal hyperoxia was achieved by means of an extracorporeal circuit with interposition of a membrane oxygenator (0.8 m2, Scimed). During the induced hyperoxia the laser spectroscopic tracings showed a rise in the HbO2 signal with a synchronous decrease in the HbR signal. Additionally, the spectroscopic pattern showed a characteristic initial rise in the intracerebral blood volume, which stabilized after 4 minutes. We found a significant correlation between the intermittently measured PO2 values of the arterial blood samples and the laser spectroscopic HbO2 and HbR signals (r = 0.87, and r = -0.82, respectively; p less than 0.001). Furthermore, hyperoxia was indicated by the laser system with a short lag time. We conclude that laser spectroscopy is a reliable method with a high potential for clinical routine use in intensive care, as it provides noninvasive continuous information at comparatively low costs using portable monitors.
Animals↗
[Excimer laser cold section technic for surgical gynecology].
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Animals↗
[Lung maturation during artificial placentation and mechanical lung distension].
An new method of lung maturation during artificial placentation was evaluated during a series of 15 animal experiments in premature lambs (gestational age 125-132 days). Perfusion circuit with interposition of a membrane lung was connected with the umbilical vessels. Extracorporeal CO2-removal (ECCO2-R) and apneic oxygenation were provided during lung distension. The ultramicroscopic pattern approved a maturation of the lung during the procedure showing development of lamellar bodies and surfactant secretion into the alveolar space. The biochemical analysis of the tracheal fluid showed a significant increase of both PC and PG concentrations (3.225 +/- 1.112 mg/100g to 24.228 +/- 3.36 mg/100 g respectively 0.249 +/- 0.11 mg/100 g of 0.622 +/- 0.09 mg/100 g. The biophysical function of the lung was also improved as was shown by a significant increase of the statistical compliance. We conclude that artificial placentation and lung distension might be a new mode of prophylaxis for respiratory distress syndrome in critically immature babies.
Animals↗
[The influence of umbilical cord compression on the fetal brain--an animal experiment using laser spectroscopy].
In order to evaluate the influence on the fetal brain due to compression of the umbilical cord biochemical and biophysical changes were traced during defined occlusions of 60 sec by means of NIR laser spectroscopy. Synchronously blood samples were drawn intermittently from a catheter positioned in the A. carotis and analysed for blood gases. The saturation values measured in the fetal blood correlated significantly with the dates of the HbO2 tracing of the NIR-system (r = 0.81, p less than 0.001). After induced occlusion of the umbilical cord a reproducible pattern of the NIR tracing occurred. While an immediate fall in HbO2 occurred, a synchronous rise in desaturated Hb was observed. For the changes of the cytochrome aa3 we detected a minor decrease that occurred with a lag time. Additionally there was an indication of a major change of blood volume as the total Hb content augmented during each compression. We concluded: Changes of Hb-saturation in the fetal blood are immediately indicated by NIR-laser spectroscopy. During cord occlusion of 60 sec. the intracellular oxygenation decrease only after a significant lag time and are reversible and furthermore it leads to a reproducible change of intracerebral blood volume.
Animals↗
[Endocrine parameters during artificial placentation and postnatal lung maturation].
During a experimental study in premature lamb the adaptation to a artificial placenta was evaluated by means of analysis of endocrine parameters. Performing cesarean section on day 125.-135.13 premature lambs were born and connected to a extracorporeal circuit providing CO2-Removal (ECCO2-R) during apnoic oxygenation over a period of 3 hours and 17 minutes mean duration. The intermittent analysis of 6 endocrine parameters was performed at the beginning of the experiment, after 1 hour and after 3 hours. TSH showed an statistical significant increase from a initial concentration of 0.638 +/- 0.051 microE/ml to 0.992 +/- 0.093 microE/ml after 1 hour (p 0.01). For T3 we found 0.273 +/- 0.074 nmol/l and 0.809 +/- 0.124 nmol/l. For RT3 we detected a decrease as the initial value was 4.304 +/- 0.474 ng/ml whereas after one hour we found 2.040 +/- 0.153 ng/ml. ACTH values increased from 543 +/- 109 pg/ml to 1150 +/- 194 pg/ml after 1 hour. Cortisol values increase from 39.6 +/- 7.5 ng/ml to 55.3 +/- 11.9 ng/ml. No significant change was found during the analysis of beta-endorphin concentrations. We conclude that the adaptation to artificial umbilical circulation is possible. Furthermore detected changes of endocrine parameters, namely cortisol and thyroxin levels, should provide a basis for postnatal organ maturation.
Adaptation, Physiological↗
Fibrinous tissue glue in artery anastomosis. Physiological, histological and scanning evaluation.
Twelve arterial anastomoses are performed using fibrinous tissue glue. Long term patency is controlled. Histological and scanning electron microscopical evaluation of the clot formation is performed.
Animals↗