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W Michels

Publications and source records attributed to W Michels.

At least 19 recordsLinked to original sources
PubMed2004

Learning laparoscopic-assisted hysterectomy.

OBJECTIVE: The aim of this study was to evaluate the factors considered for proficiency and to estimate the number of procedures needed to achieve competence in laparoscopic-assisted vaginal hysterectomy in a teaching hospital. METHODS: The length of the learning curve, duration of surgery, change of hemoglobin (in grams per liter), conversion rate, and intra- and postoperative complications were evaluated. Cases were analyzed according to the order for the individual surgeon. RESULTS: Thirty-three surgeons performed 929 laparoscopic-assisted vaginal hysterectomies during the study period. Analyzing the duration of surgery and rate of complications, we decided on a cutoff of 30 cases. Eight surgeons with more than 30 cases performed 668 laparoscopic-assisted vaginal hysterectomies. Their initial 30 cases (group A, the first 30 cases) were compared with their subsequent cases (group B, cases 31 and after). Patient age, body mass index, and uterine weight did not differ between the groups. The intraoperative complication rate dropped from 4.2% to 0.5% (P =.001), hemoglobin drop decreased from -0.8 +/- 0.9 g/L to -0.5 +/- 1.0 g/L (P =.002), and postoperative complications dropped from 12.9% to 7.0% (P =.017). The duration of surgery was also shorter (148.8 +/- 45.4 minutes versus 125.1 +/- 46.5 minutes), but this difference was taken from the results of 1 surgeon. CONCLUSION: A learning experience of 30 laparoscopic-assisted vaginal hysterectomies was necessary in our institution to reach a low level of complications. Duration of the surgical procedure was not an adequate study endpoint to assess a learning effect.

Adult↗
PubMed2004

Laparoscopic coagulation of the uterine blood supply in laparoscopic-assisted vaginal hysterectomy is associated with less blood loss.

BACKGROUND: Does laparoscopic coagulation of the uterine blood supply decrease blood loss compared with transvaginal ligature of the uterine vessels? METHODS: Intra- and postoperative data of 446 patients undergoing laparoscopic-assisted vaginal hysterectomy at the Department of Gynecology, University of Jena, between 1998 and 2001 were analysed. In 213 patients the uterine blood supply was transected laparoscopically at the origin of the uterine vessels (LAVH type II) and in 233 patients (LAVH type I) transvaginally. RESULTS: Patients in both groups were comparable with respect to median age, Quetelet index, and parity. The drop of hemoglobin between the preoperative day and postoperative day 3 was 0.8 mmol/l or 0.6 mmol/l for LAVH type I without or with BSO vs 0.3 mmol/l or 0.4 mmol/l for LAVH type II without or with BSO (p = 0.001), respectively. Median operative time was similar for both techniques: LAVH type I 136 min or with BSO 128 min vs LAVH type II 126 min or with BSO 131 min. The weight of the removed uteri was significantly lower in LAVH type I vs type II (220 vs 270 grams), but similar when LAVH was combined with BSO (160 vs 178 grams). The rate of intraoperative complications was 2.2% vs 0.9% between LAVH type I or II (n.s.), but 9% vs 3.3% for overall postoperative complications (p = 0.01). CONCLUSIONS: Laparoscopic coagulation of the uterine blood supply at the origin of uterine vessels is a safe technique which minimizes blood loss in LAVH. In patients with a low preoperative hemoglobin value this technique is indicated.

Adult↗
PubMed2001

Prospective randomized comparison of laparoscopic-assisted vaginal hysterectomy (LAVH) with abdominal hysterectomy (AH) for the treatment of the uterus weighing >200 g.

BACKGROUND: Laparoscopic-assisted vaginal hysterectomy (LAVH) can be used for the vaginal removal of large uteri (200 g), which are conventionally treated with an abdominal approach (AH). METHODS: Forty-eight women with a sonographically estimated uterine weight of >200 g were prospectively randomized to undergo either LAVH (n = 28) or AH (n = 20). RESULTS: The median uterus weight was 334 g for LAVH vs 428 g for AH (not significant). The median operative time (133 vs 132 min) and duration of recuperation (42 vs 42 days) were similar. LAVH was associated with significantly less intraoperative blood loss (median, 200 vs 600 ml; p < 0.05), a lower pain index at postoperative day 4 (median [who scale], 0 VS 5; P < 0.05), a lower decrease in hemoglobin (median,-0.6 VS -1.55 MG/DL; P < 0.05), and a lower decrease in hematocrit (median, -0.03% VS -0.07%; P < 0.05). There were no significant differences in the frequency of postoperative complications (14.3% for LAVH VS 30% for AH). Although all LAVH patients who answered the questionnaire said they would undergo the same procedure again, only 45% of the AH group were satisfied (P < 0.05). CONCLUSION: For the treatment of uteri >200 g, LAVH has several advantages over AH: lower postoperative morbidity, quicker short-term recuperation, and better patient acceptance.

Adult↗
PubMed2001

Laparoscopic-assisted vaginal versus abdominal surgery in patients with endometrial cancer--a prospective randomized trial.

OBJECTIVE: We compared a laparoscopic-vaginal approach with the conventional abdominal approach for treatment of patients with endometrial cancer. METHOD: Between July 1995 and August 1999, 70 patients with endometrial cancer FIGO stage I-III were randomized to laparoscopic-assisted simple or radical vaginal hysterectomy or simple or radical abdominal hysterectomy with or without lymph node dissection. RESULTS: Thirty-seven patients were treated in the laparoscopic versus 33 patients in the laparotomy group. Lymph node dissection was performed in 25 patients by laparoscopy and in 24 patients by laparotomy. Blood loss and transfusion rates were significantly lower in the laparoscopic group. Yield of pelvic and para-aortic lymph nodes, duration of surgery, and incidence of postoperative complications were similar for both groups. Overall and recurrence-free survival did not differ significantly for both groups. CONCLUSION: The laparoscopic-vaginal approach for treatment of endometrial cancer is associated with lower perioperative morbidity compared with the conventional abdominal approach.

Aged↗
PubMed2001

Influence of two low-dose oral contraceptives on pulsatile gonadotropin secretion.

In this study, we investigated the influence of two combined oral contraceptives on pituitary gonadotropin secretion and their pulsatile characteristics. The contraceptives compared were 30 micrograms ethinyl estradiol plus 125 micrograms levonorgestrel; and 20 micrograms ethinyl estradiol plus 150 micrograms desogestrel. In 13 healthy normocyclic women, hormonal patterns were obtained in the early follicular phase (EFP) and mid-luteal phase (MLP) of an ovulatory control cycle, and on day 5/6 and day 20/21 of the first treatment cycle during a 12-hour period of continuous blood sampling. On the fifth day of treatment, both combinations had significantly suppressed the mean levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). The LH pulse frequency of the treatment cycle was significantly inhibited in comparison with the EFP of the control cycle. While increased LH pulse amplitudes were observed on treatment day 5 for both combinations, only the effects of the levonorgestrel-containing combination were found to be significant. In all volunteers, ovulation was reliably inhibited during the treatment cycle, which was indicated by very low progesterone levels. Estradiol secretion was also suppressed on treatment day 21. It is concluded that: (1) the pulsatile character of gonadotropin secretion is maintained at a low level during treatment with low-dose contraceptives; (2) the effects of the monophasic combinations on gonadotropin pulsatility do not seem to depend on the amount of ethinyl estradiol they contain.

Adult↗
PubMed2000

Comparison of written reports of mammography, sonography and magnetic resonance mammography for preoperative evaluation of breast lesions, with special emphasis on magnetic resonance mammography.

Patients with abnormal breast findings (n = 413) were examined by mammography, sonography and magnetic resonance (MR) mammography; 185 invasive cancers, 38 carcinoma in situ and 254 benign tumours were confirmed histologically. Sensitivity for mammography was 83.7%, for sonography it was 89.1% and for MR mammography it was 94.6% for invasive cancers. In 42 patients with multifocal invasive cancers, multifocality had been detected by mammography and sonography in 26.2%, and by MR mammography in 66.7%. In nine patients with multicentric cancers, detection rates were 55.5, 55.5 and 88.8%, respectively. Carcinoma in situ was diagnosed by mammography in 78.9% and by MR mammography in 68.4% of patients. Combination of all three diagnostic methods lead to the best results for detection of invasive cancer and multifocal disease. However, sensitivity of mammography and sonography combined was identical to that of MR mammography (i.e., 94.6%).

Breast Neoplasms↗
PubMed2000

Establishing a new technique of laparoscopic pelvic and para-aortic lymphadenectomy.

OBJECTIVE: To assess the number of operations necessary to develop and standardize a laparoscopic approach to pelvic and para-aortic lymphadenectomy, with radicality and number of complications as quality markers. METHODS: Over 4 years, 108 women had complete laparoscopic pelvic and para-aortic lymphadenectomies combined with laparoscopy-assisted radical vaginal hysterectomies for primary therapy of cervical cancer. Complete data and videotapes were available for 99 women. Operating time and radicality for specific anatomic subareas were measured by review of video documentation and histologic lymph node counts. Intra- and postoperative complications were recorded prospectively. To analyze the progress of surgery, we compared two groups of women, one operated on at the beginning of our study (early group, subjects 6-35) and one operated on in the final period of the study (late group, subjects 79-108). RESULTS: The operating time for pelvic and para-aortic lymphadenectomy increased constantly. Comparing the early and late groups for para-aortic lymphadenectomy, there was an increase in mean operating time (34.8 versus 73.2 minutes; P < .001) and mean histologic lymph node yield (5.1 versus 10.6; P < .001). For pelvic lymphadenectomy, mean operating time increased slightly (60.7 versus 69.7 minutes; not significant) but mean histologic lymph node count decreased over time (24.3 versus 21.0; not significant). Retrospective evaluation of videotapes showed that the radicality of lymphadenectomy improved continuously in all evaluated subareas. CONCLUSION: Establishment of a protocol for para-aortic and pelvic lymphadenectomy took 100 operations. Video documentation was a more reliable indicator of progress in technical performance than were histologic lymph node counts.

Adult↗
PubMed1998

Human papillomavirus detection in cervical intraepithelial neoplasia by the second-generation hybrid capture microplate test, comparing two different cervical specimen collection methods.

BACKGROUND: The second generation Hybrid Capture microplate-based human papillomavirus (HPV) test (HC II) was examined to determine its sensitivity for identification of cervical intraepithelial neoplasia (CIN) by two different cervical specimen collection methods. OBJECTIVES: A cohort of 115 women with a mean age of 34.6 years (SD 9.1), referred to colposcopy with a history of abnormal cytology, was studied to compare HPV prevalence and viral load in low grade CIN vs. high grade CIN. STUDY DESIGN: Prior to the application of acetic acid, cervical specimens were obtained by either method 1 or 2, as follows: method 1: A cotton-tipped swab was applied to the ectocervix and endocervix for a Papanicolaou (Pap) smear. Next, a special cone-shaped cervical brush was applied to the endocervix, the ectocervix, and to the posterior vaginal vault and suspended in 1.0 ml of transport medium for HPV testing. Method 2: a Pap smear was taken with a cyto standard cylindrical cytology brush from the endocervix, and ectocervix, and the remaining cells were suspended in 3 ml phosphate-buffered saline (PBS) for HPV testing. Next, a Dacron-tipped swab was used to take a specimen from the ectocervix and posterior fornix and suspended in the same PBS solution.

Adult↗
PubMed1997

[Levels of antioxidants after cesarean section and administration of Multibionta N, Inzolen and selenase].

PATIENTS AND METHOD: In 29 women with the necessity to terminate pregnancy via Cesarean section, lipid peroxidation and antioxidative state were investigated before and 24 hours after the surgical intervention as well as after substitution of antioxidants and trace elements. RESULTS: The results indicate that administration of antioxidants protects at least partially from consequences of surgically induced oxidative burden.

Antioxidants↗
PubMed1997

Laparoscopically assisted vaginal hysterectomy as an alternative to abdominal hysterectomy in patients with fibroids.

OBJECTIVE: Introduction of laparoscopically assisted vaginal hysterectomy (LAVH) was evaluated for its usefulness to replace abdominal hysterectomy in fibroids. STUDY DESIGN: A total of 240 women with a mean age of 46.7 years underwent hysterectomy over a period of one year. The technique of LAVH was introduced starting in the second quarter of the study period. Clinical data of 60 patients undergoing either LAVH or abdominal hysterectomy for fibroids were compared in a cross-sectional study by chi 2- and t-test. RESULTS: A comparison between the first and the last quarter of the study period showed that the rate of abdominal hysterectomies decreased from 66% to 12%, whereas LAVH increased from 0 to 40% (p < 0.05). The rate of vaginal hysterectomies remained between 34% and 48%. Compared to abdominal hysterectomy, LAVH operating time was about 1/3 longer, hospital stay was shorter (3 days), and LAVH proved more cost-effective than abdominal hysterectomy (significance of all differences: p < 0.05). CONCLUSIONS: LAVH is a valid alternative to abdominal hysterectomy in fibroids.

Adult↗
PubMed1997

Peroxidative and glutathione status in uterus and placenta after normal and pathological pregnancy.

In 10 women with disturbed pregnancies without hypertension, reduced (GSH) and oxidized glutathione (GSSG) as well as lipid peroxides as thiobarbituric acid reactive substances (TBARS) were determined in the placenta and in the uterine tissue after unexpected stress-induced Caesarian section (group II). Production of TBARS was also measured in vitro in the 9000 x g supernatant of both tissues. The results were compared with those from women after normal pregnancy and expected Caesarian section (group I). After normal pregnancy higher TBARS and lower GSH with higher GSSG/GSH ratio were found in the placenta in comparison to the uterine tissue, indicating an oxidant/antioxidant imbalance in the placenta. No statistically significant differences were shown between the parameters of groups I and II. The possible oxidant stress associated with disturbed pregnancy and subsequent unexpected Caesarian section in this study was insufficient to alter tissue levels of glutathione nor the peroxidative status of placenta and uterus.

Adult↗
PubMed1997

Serum concentrations of iodine, thyroxine (T4), triiodothyronine (T3), thyrotropin (TSH) and insulin-like growth factor 1 (IGF-1) during the last trimester of pregnancy, during labour, and in early puerperium of women with normal pregnancy or with intrauterine growth retardation (IUGR).

In women with intrauterine growth retardation (IUGR), insulin-like growth factor 1 (IGF-1) concentrations tended to reduce during the last trimester of pregnancy. Parameters of thyroid function in maternal serum were not distinctly influenced by IUGR, except for high concentrations of iodine. Triiodothyronine (T3) concentrations in cord blood of normal pregnancies was significantly lower than maternal concentrations, but was relatively high when the fetus was growth retarded. The results are discussed in connection with changes of thyroid function and changes of IGF-1 during pregnancy.

Journal Article↗
PubMed1994

[Urogynecologic follow-up after conservative therapy of stress incontinence with a vaginal cone (Femcon)].

The conservative treatment of women suffering from stress incontinence is very often highly successful. Vaginal cones (Femcon) are widely used for training the pelvic floor muscles. We investigated 60 women (mean age 50.7 years). After an exercise course with cones of 3 to 4 months, 75% of these patients reported good results with respect to pelvic floor function and stress incontinence. We found no differences between the parameters of cystometry and urethrocystometry at rest. The uroflow is also not affected. Objectively, we could only determine a statistically significant increase of the transmission ratio. This fact can be explained by the active contraction of the pelvic floor muscles, which are trained by means of the cones.

Exercise Therapy↗
PubMed1994

Preparation of instruments used in minimally invasive surgery in a washer-disinfector.

The safe sterilisation of surgical instruments presumes that one is dealing with small amounts of standardised residual contamination and in particular, that the cleaning process adheres to good manufacturing practices, taking into account the protection of the personnel. Only mechanical processes can be standardised and are suitable for the preparation of surgical instruments. The development process which the instruments used in minimally invasive surgery have undergone, along with improvements in the field of cleaning technology and disinfection, now means that preparation of instruments of this nature can be entrusted to an automatic washer/disinfector. New cleaning and disinfection methods allow the complete array of instruments, including fibreoptic light guides and lenses, to be cleaned and disinfected in one procedure.

Fiber Optic Technology↗
PubMed1992

[The diagnostic value of serum hormone parameters in hirsutism].

In 46 patients showing mild or moderate hirsutism, and 49 age-matched regularly menstruating women without symptoms the following hormone and protein serum levels were measured: Total testosterone (T), free testosterone (fT), dehydroepiandrosterone sulfate (DHEAS), androstendione (ASN), sex hormone binding globulin (SHBG), free androgen index (FAI) as expressed by the T/SHBG ratio, cortisol, Prolactin (PRL), LH/FSH ratio, 3 alpha-androstanediol glucuronide (ALG), basal and poststimulated 17-hydroxyprogesteron (17OH-P) and (in some cases) basal and poststimulated 11-deoxycortisol (S). The study was designed for exploring the diagnostic significance of these parameters and evaluating the extent to which they contribute in establishing the source of hyperandrogenism. The mean values of all but one (PRL) of the hormone and protein levels varied significantly from the controls, T, DHEAS, FAI and ALG showing the greatest differences. Most frequently elevations of T, DHEAS, and FAI values were established, the levels of which exhibited a highly significant correlation. In 96% of the hirsute women the elevation of 1 to 3 of these parameters was demonstrated. FAI was shown to be associated with a higher diagnostic accuracy than did SHBG or fT. In 9/43 patients increased values of ALG were found, which as an important metabolite of dihydrotestosterone reflects peripheral androgen activity, particularly of the skin. In every case these abnormal values were combined with elevated levels of other androgens (T, DHEAS, ASN). It is concluded from these limited data that an isolated elevation of ALG due to primary accentuation in 5 alpha-reductase is a rare or even non-existing occurrence.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Hyperplasia, Congenital↗