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Institute
- Medizin (5293) (remove)
The question of athrepsia
(1911)
Emil Sioli †
(1923)
1. Electron micrographs of ultra-thin sections of Staphylococcus aureus and Micrococcus lysodeikticus in Vestopal as embedding medium disclose a multiplicity of DNA containing threads with varying interparticular distances.
2. The diameter of these threads is about one tenth of the average optimal section thickness.
3. This section thickness inevitably is implicated in the visualization of the internal distances between the threads as well as in some common trends in the DNA pool, a fact that has to be accounted for in the analysis of the macromolecules.
4. By spreading lysozyme protoplasts of M. lysodeikticus on a water-air interface in a Langmuir trough and by transferring this surface layer to carbon supported Formvar films, two-dimensional systems can be demonstrated which as a thread of constant width comprise the total DNA content of one microorganism each.
5. Such a macromolecular system shows equally shaped, coiled loops in a peripheral zone and many crossings towards the center. Branching of threads never has been observed so far.
From this evidence we conlude:
a) Intracellular DNA in these bacteria seems to exist in one pool as a “woolen ball” which is centered in the cytoplasm as a more or less dense object.
b) This “woolen ball“ embodies the total amount of DNA most probably as one single threadlike unit.
6. Partial destruction of the thread system of protoplasts will result upon changing optimal spreading conditions.
7. The same kind of destruction is shown upon isolation of the DNA from protoplasts, the length of the threads being an inverse function of the number of precipitation steps showing purification.
The norepinephrine content of adipose tissue is shown to be very different in various animal species and different sites of origin, ranging from 0.03-1.4 μg/g. Adipose tissue also contains considerable amounts of serotonin (0.01-1.04 μg/g) and histamine (0.1-13.6 μ/g). Changes in the norepinephrine content of adipose tissue after the injection of either reserpine analogues or monoamine oxidase inhibitors followed a pattern similar to that found in the heart and brain, indicating that the storage mechanism in these organs is basically the same. In contrast to norepinephrine, serotonin in adipose tissue is rather resistant toward depletion by reserpine. Adipose tissue also contains monoamine oxidase and catechol-O-methyl-transferase activity, which are usually highest in tissues also rich in norepinephrine.
A new NAD⊕-isomer was prepared, in which the ᴅ-ribose of the adenosine moiety was sub stituted by the enantiomeric ʟ-ribose. As compared to nicotinamide-adenine-dinucleotide (NAD⊕) and NADH the coenzyme isomer (ᴅ,ʟ)-NAD⊕ and its dihydroform (ᴅ,ʟ)-NADH are far less tightly bound to lactate dehydrogenase and alcohol dehydrogenase from horse liver. In the presence of the second substrate (ᴅ,ʟ)-NAD⊕ and (ᴅ,ʟ)-NADH act as hydrogen acceptor and hydrogen donator, respectively, with lactate dehydrogenase and alcohol dehydrogenases from horse liver and yeast. Compared to NAD⊕ and NADH the Michaelis constants are always increased, the catalytic constants (V/Et) were found to be decreased except for the dihydroform reacting with alcohol dehydrogenase from liver.
Sulfhydryl Groups, Methylmercury Containing Inactivator, Coenzyme Analogue Nicotinamide-(S-methylmercury-thioinosine) dinucleotide was formed by reaction of nicotin amide-(6-thiopurine) dinucleotide with methylmercury chloride. The compound exhibits coenzyme properties in the test with LDH (Km=1.5 × 10-4 м , Vmax=12500) and LADH (Km=1.7 × 10-4 м, Vmax=27) and inactivates YADH and GAPDH. From incubations with LDH and LADH the mercury containing coenzyme could be regained by column chromatography. The compound seems to be qualified for the X-ray structure analysis of the coenzyme-enzyme complex for some dehyrogenases based on the proportion of the heavy metal.
Calcification, Collagen Membrane, Ca/P Ratio Dependence Spontaneous calcification of a membrane made of native collagen has been investigated. The method permits independent variation of calcium and phosphate concentrations. With increasing phosphate concentration the precipitation of calcium-phosphate on the collogen occurs at a conspicuously lower calcium concentration as with a number of other membranes.
Membrane-Phloretin Interaction, Infrared Raman, ESR Spectroscopy The transport inhibitor phloretin was bound to human red cell membrane and the concomitant structural changes were observed by spectroscopic methods. By the spin labeling method a decrease in fluidity of the membrane was found at 1 and 10 |iM concentrations of the reagent. This result was obtained with the 2-(3-Carboxypropyl)-4,4-dimethyl-2-tridecyl-3-oxazolidinyloxyl, and the 2-(14-Carboxytetradecyl)-2-ethyl-4,4-dimethyl-3-oxazolidinyloxyl lipid spin labels. Infrared spectroscopy of modified membranes revealed an intensity increase of the POO~ band at about 1250 cm-1. Moreover, a shift of the peak at 1050 cm -1 to 1100 cm-1 was observed in the presence of phloretin. Raman spectroscopy of the membranes did not contradict the results found with infrared and ESR spectroscopy: In the phloretin modified membrane we observed a lack of the band at 1085 cm-1, which leads to suggest that the POO" and/or C-C regions are less fluid. Changes of the extracted red cell membrane lipids were less characteristic, and the results differed from those found in red cell membrane.
1-anilino-naphthalene-8-sulfonate (ANS) fluorescence measurements have revealed that red blood cell membrane of the Rhnull type undergoes a transition at about 16 degrees C. In contrast, viscosity measurements of the extracted membrane lipids showed the usually observed transition at about 18 degrees C. Lower values of titratable sulfhydryl (SH) groups were observed in Rhnull membrane using 5,5'-dithiobis-(2-nitro-benzoic-acid) (Nbs2). In contrast, disulfide bonds in Rhnull membrane were estimated to be about 3 times the value of the controls. Spin labeling experiments using 2-(3-carboxypropyl)-4, 4 dimethyl-2-tridecyl 3-oxazolidinyloxyl were carried out with phospholipase A2 modified membranes. The mobile part of the spectra was significantly increased on the Rhnull membrane. In the presence of D-glucose, infrared spectrometry showed a larger reduction of the intensity of the POO-band in Rhnull membrane. In contrast to controls, binding of the reagent diethylpyrocarbonate resulted in no significant changes of the Rhnull membrane as determined by electron spin resonance (ESR) measurements. D-glucose transport activity was found to be at the upper level of a group of Rh positive and Rh negative persons. It is suggested that the intensity of the polar protein-lipid interaction is reduced in Rhnull membrane.
pH-titrations with NADH show two ionizable groups in mitochondrial and cytoplasmic malate dehydrogenase, the first with a pKa in the range 6.8 -8.3 for the mitochondrial and 6.4-7.8 for the cytoplasmic enzyme, the second with a lower limit at 10.2 resp. 11. Comparison with bis-(dihydronicotinamide)-dinucleotide and dihydronicotina-mide-ribosyl-P2-ribose-pyrophosphate instead of NADH indicates that the second alkaline ionization is caused by a residue placed near the adenine binding site of the active centre of the two isoenzymes. Binding studies with NADH and NAD+ give evidence for the participation of a group in the mitochondrial enzyme with pKa 6.8, deprotonation of which is necessary for detectable association of NAD+. In contrast the fixation of NAD+ to the cytoplasmic enzyme is independent of pH.
Studies on the transport of anions and zwitterions of acidic amino acids in Streptomyces hydrogenans
(1983)
n Streptomyces hydrogenans, acidic amino acfds are taken up either as anions by a specific transport system or as zwitterions via a nonspecific one. Variations in the zwitterion concentration caused by changes in pH influence the uptake and exchange diffusion by the nonspecific system. Differences in pH-optima for ʟ-glutamate and ʟ-aspartate transport are due to the different pK2-values of these amino acids. The anion transport by the specific system is accompanied by a short hyperpolarization of the membrane potential followed by a secondary influx of potassium ions into the cells.
[4-(3-Bromoacetylpyridinio)-butyl]adenosine pyrophosphate as a structural analog of NAD+ reacts covalently with the sulfhydryl groups of thiopropyl agarose. 10-20 μmol can be bound to 1 ml gel. Stabilization of the insoluble coenzym e is attained by treatment with sodium boro hydride (NaBH4). This complex when applied to column chromatography, allow s the separation of various dehydrogenases as a result of their different complex stability coefficients. Alcohol dehydrogenase from liver, lactate dehydrogenase, and adenylate kinase, which all bind to the ADP-analog residues of the gel matrix, can thus be separated by different salt gradients. Alcohol dehydrogenase from yeast, however, does not form a complex and can easily be eluted from the column with phosphate buffer. Glyceraldehyde-3 phosphate and aldehyde dehydrogenases can be eluted by the addition of NAD+ or NADH to the buffer. The uncharged 1,4-dihydropyridin ring of the reduced coenzyme produces a more stable complex with the dehydrogenases than the oxidized form.
The recently developed stereospecific sodium salt glycosylation procedure has been successfully applied to the synthesis of the β-ᴅ-2′-deoxyribofuranosides of benzimidazole, 5,6-dihalogeno benzimidazoles, and some 2-substituted analogues in high yield. The 5,6-dibromo analogue was obtained by bromination of the parent nucleoside. These have all been characterized by spectroscopic methods, including 1H NMR, which permitted analyses of their solution conformations and comparison with those of the corresponding ribofuranosides. Some biological aspects, including preliminary results on cytotoxicity and antiviral activity, are briefly considered.
By means of differential thermoanalysis, the miscibility of the main polar tetraether lipid of Thermoplasma acidophilum with two ester lipids, dipalmitoyl phosphatidylcholine and dipalmitoyl phosphatidylglycerol, resp., in the presence of excess water was studied. It is shown that with increasing fraction of tetraether lipid in the mixture, the transition range of dipalmitoyl phosphatidylcholine is broadened and the temperature of the maximum heat flow (Tm) is shifted to lower temperatures; furthermore, the enthaply change (ΔH) of the transition declines. Similar results were obtained with mixtures of tetraether lipid with dipalmitoyl phosphatidylglycerol. It is therefore concluded that the main polar tetraether lipid of Thermoplasma acidophilum , which essentially forms monomolecular layers, is able to form stable common phases with bilayer-forming ester lipids. Miscibility of the tetraether lipid with dipalmitoyl phosphatidylglycerol, which are both monovalent anions at neutral pH, is also observed in the presence of high proton or calcium ion concentrations.
(±)-Aeroplysinin-1, an optically active 1.2-dihydroarene-1.2-diol. was isolated from the marine sponges Verongia aerophoba (+-isomer) and lanthella ardis (--isomer). For the experiments presented we used the +-isomer from Verongia aerophoba. Here we describe the hitherto unknown biological and pharmacological property of this compound to display pronounced anticancer activity against L5178y mouse lymphoma cells (ED50: 0.5 μm). Friend erythroleukemia cells (ED50: 0.7μm) , human mamma carcinoma cells (ED50: 0.3μm) and human colon carcinoma cells (ED50: 3.0 μm) in vitro. Furthermore, aeroplysinin caused a preferential inhibition of [3H]thymidine (dThd) incorporation rates in L5178y mouse lymphoma cells if compared with murine spleen lymphocytes in vitro. At concentrations between 1.1 and 28.5 μm, the [3H]dThd incorporation rates in L5178y cells were suppressed to 28% -0% but only to 78% -18% in murine spleen lymphocytes. The same differential effect in vitro was found with the following epithelial cells: 14.70 μm of the compound were required to inhibit normal human fibroblasts to 50% , but only 2.9 μm in the assays with human malign keratinocytes or malignant melanoma cells to observe the same inhibitory effect. Moreover, aeroplysinin-1 displayed antileukemic activity in vivo using the L5178y cell/NMRI mouse system; administered at a dose of 50 mg/kg for five consecutive days, the T/C (% ) value was determined to be 338. Preliminary toxicology studies revealed an acute LD50 of 202 mg/kg and a subacute LD50 of 150 mg/kg. Aeroplysinin-1 is neither a direct mutagen nor a premutagen in the umu/Salmonella typhimurium test system.
Lactate dehydrogenase from pig heart is inactivated by the NAD+ -analog P1-N6-(4-azidophenylethyl)adenosine-P2-[4-(3-azidopyridinio)butyl]diphosphate (6) upon irradiation with UV light of wavelengths in the range from 300 to 380 nm. The decrease in enzyme activity can be prevented by the addition of NAD+ and oxalate. The modified enzyme shows a reduced binding capacity for its coenzyme as compared to native lactate dehydrogenase. The amount of incorporated coenzyme is deduced from the ribose content of inactivated enzyme. Tryptic digestion of the modified protein and separation of the peptides by HPLC yields 5 ribose-containing fractions. One of them, fraction 6 6 , is split by treatment with nucleotide pyrophosphatase into two subfractions, 63 and 58. Only subfraction 63 contains ribose. Whereas peptide 58 shows a UV absorption spectrum similar to that of 4-(3-aminopyridinio)-butyl phosphate (3). Amino acid analyses of the peptides indicate that the inactivator forms covalent bonds with different parts of the protein: Peptide 63 is characterized by a great portion of hydrophobic amino acids whereas peptide 58 shows a high degree of hydrophilicity.
In the course of the odontogenesis of bovine incisors several clearly distinguishable phosphohydrolase activities are observed in the pulp and in dental hard tissues. Using various substrates and inhibitors, unspecific alkaline phosphatase, two isoenzymes of acid phosphatase, Ca2+-activated ATPase and inorganic pyrophosphatase are characterized. The enzymatic activity of alkaline phosphatase in pulp and hard tissues is significantly high at the beginning of dentine and enamel mineralization. The specific activity of this enzyme decreases quite fast with the beginning of root formation, then more slowly, until it reaches a constant final value. Histochemical studies show that during mineralization the maximum of alkaline phosphatase activity is in the subodontoblasts. Lower enzyme concentrations are found in the stratum intermedium and in the outer enamel epithelium during that process.
The specific activities of ATPase, acid phosphatases and pyrophosphatase show little temporal variation during tooth development, but they also appear in a characteristic spatial pattern in the dental tissues.
Nitric oxide causes ADP-ribosylation and inhibition of glyceraldehyde-3-phosphate dehydrogenase
(1992)
Nitric oxide and nitric oxide-generating agents like 3-morpholinosydnonimine (SIN-1) stimulate the mono-ADP-ribosylation of a cytosolic, 39-kDa protein in various tissues. This protein was purified from human platelet cytosol by conventional and fast protein liquid chromatography techniques. N-terminal sequence analysis identified the isolated protein as the glycolytic enzyme glyceraldehyde-3-phosphate dehydrogenase (GAPDH). Nitric oxide stimulates the auto-ADP-ribosylation of GAPDH in a time and concentration-dependent manner with maximal effects after about 60 min. Associated with ADP-ribosylation is a loss of enzymatic activity. NAD(+)-free enzyme is not inhibited by SIN-1, indicating the absolute requirement of NAD+ as the substrate of the ADP-ribosylation reaction. Inhibition of the glycolytic enzyme GAPDH may be relevant as a cytotoxic effect of NO complementary to its inhibitory actions on iron-sulfur enzymes like aconitase and electron transport proteins of the respiratory chain.
A comparison of different APTT-reagents, heparin-sensitivity and detection of mild coagulopathies
(1992)
The activated partial thromboplastin time (aPTT) is widely used to detect coagulation abnormalities or to monitor heparin treatment.
Many commercial aPTT-reagents are available which contain different phospholipid reagents and activators. In the present study 3 aPTT-reagents (aPTT-D, Instrumentation Laboratory, Neothromtin, Behring, PTTa, Boehringer) were compared using a computerized centrifugal analyzer. One aPTT-reagent (Pathromtin, Behring) was tested on a semiautomated coagulometer. Instrument precision was evaluated using aPTT-D as reagent.
Comparative tests were performed on plasma samples of 40 healthy donors, 3 patients with mild von Willebrand's disease (vWd), W patients with heaemophilia or subhaemophilia A, 1 patient with subhaemophilia A and vWd, 8 patients treated with subcutaneous injection of unfractionated heparin (UFH) and 14 patients treated with subcutaneous injection of a low molecular weight heparin (LMWH).
aPTT-D was the most sensitive reagent to detect mild vWd while Pathromtin detected none of these defects. In patients with heamophilia A and subhaemophilia A aPTT-D, Neothromtin and PTTa detected the abnormality in nearly all tested samples while Pathromtin was less sensitive.
Patients treated with subcutaneously applied UFH or LMWH often had a prolonged aPTTt especially when aPTT-D and Neothromtin were used as reagents.
Herpes simplex virus type 2 (HSV-2) is the main cause of herpes genitalis, a recurrent sexually transmitted disease. By the use of routine Serologie methods (complement fixation test, enzyme immunoassay), virus carriers are difficult to identify because of strong antibody cross reactions with antigens of HSV-1 which is ubiquitously spread throughout the population. We introduce a microtechnique Western blot system loaded with HSV-1 and HSV-2 type-specific and common antigens on separated nitrocellulose strips. By the simultaneous evaluation of Immunologie reactions with both strips, the occurrence of HSV-2 specific antibodies can be sensitively detected in serum specimens containing antibodies to HSV-1. A total of 158 serum specimens were analyzed and the results obtained by Western blot were compared to those of a screening ELISA and virus isolation performed with smears of herpes lesions.
An agreement of 97.9 % was assessed between Western blot and virus isolation to detect an HSV-1 and HSV-2 infection. Less specific serologic results were produced by the screening ELISA on HSV-2 antibodies which correlated in 85.4 % (41/48) with virus isolation and typing. Concerning HSV-2 antibody testing, Western blot and ELISA showed an overall agreement in 89.8 % of the sera investigated.
As shown by our data, the HSV type specific Western blot proved to be a specific, reproducible and standardized technique. It can be utilized for both sero-epidemiological surveys and determination of the HSV immune status.
New reactive coenzyme analogues for affinity labeling of NAD+ and NADP+ dependent dehydrogenases
(1995)
Reactive coenzyme analogues ω-(3-diazoniumpyridinium)alkyl adenosine diphosphate were prepared by reaction of ω-(3-aminopyridinium)alkyl adenosine diphosphate with nitrous acid. In these compounds the nicotinamide ribose is substituted by hydrocarbon chains of varied lengths (n-ethyl to n-pentyl). The diazonium compounds are very unstable and decompose rapidly at room temperature. They show a better stability at 0 °C. L actate and alcohol dehydrogenase do not react with any of the analogues. Glyceraldehyde-3-phosphate dehydrogenase reacts rapidly with the diazonium pentyl compound. Decreasing the length of the alkyl chain significantly decreases the inactivation velocity. 3α,20β-Hydroxysteroid dehydrogenase reacts at 0 °C with the ethyl homologue and slowly with the propyl compound. The butyl-and pentyl analogues do not inactivate at 0 °C. Tests with 14C -labeled 2-(3-diazoniumpyridinium)ethyl adenosine diphosphate show that complete loss of enzyme activity results after incorporation of 2 moles of inactivator into 1 mole of tetrameric enzyme. 4-(3-Acetylpyridinium)butyl 2 ′-phospho-adenosine diphosphate, a structural analogue of NADP +, was prepared by condensation of adenosine-2,3-cyclophospho-5′-phosphomorpholidate with (3-acetylpyridinium)butyl phosphate, followed by hydrolysis of the cyclic phosphoric acid ester with 2 ′:3′-cyclonucleotide-3′-phosphodiesterase. Because of the redox potential (-315 mV) and the distance between the pyridinium and phosphate groups, this analogue is a hydrogen acceptor and its reduced form a hydrogen donor in tests with alcohol dehyd rogenase from Thermoanaerobium brockii. The reduced form of the coenzyme analogue also is a hydrogen donor with glutathione reductase. With other NADP +-dependent dehydrogenases the com pound has been show n to be a competitive inhibitor against the natural coenzyme. The acetyl group reacts with bromine to form the bromoacetyl group. This reactive bromoacetyl analogue is a specific active-site directed irreversible inhibitor of isocitrate dehydrogenase.
In the United States, culdoscopy (a vaginal approach to view the abdomen) replaced laparoscopy for about 20 years, circa 1950-1970. In contrast to many of his colleagues, Hans Frangenheim of Wuppertal, Germany, was not satisfied with culdoscopy and turned to an abdominal approach. Frangenheim began publishing his experiences with gynecological laparoscopy in 1958 and stressed technical improvements. He constructed a CO2 insufflator, wrote the first book on gynecological endoscopy, and introduced "cold light" into laparoscopy. Frangenheim strongly stimulated the rise of gynecological laparoscopy in Europe in the 1960s and later.
This profile of laparoscopic pioneers between the world wars "spotlights" Heinz Kalk, a German surgeon, and John C. Ruddock, an American internist. Social, political and economic upheavals characterized the decades between World War I and World War II and, along with geographic and communication restraints, permitted the concept of laparoscopy to develop differently in separate settings.
Raoul Palmer, World War II, and transabdominal coelioscopy : laparoscopy extends into gynecology
(1997)
The traditional gap between surgeons and internists was much wider 100 years ago than nowadays. At the beginning of the twentieth century, neither group was particularly open to the idea of scholarly exchange. In this respect, both early pioneers of laparoscopy, Georg Kelling (1866–1945, a German surgeon of Dresden, and Hans Christian Jacobaeus (1879–1937), an internist from Stockholm, Sweden, were interesting exceptions...
The clinical diagnosis of neurologicaldiseases can be supported by the use of instructive, case-related reports for interpretation of CSF quantities. By using the knowledge-based System Pro.M.D.-cerebrospinal fluid diagnostics the process of clinical diagnosis can be optimized and standardized, as far as sensible. With the presentation of an exemplary case, the main features of the system are demonstrated.
Objectives: The possible etiologic relevance of occupational factors such as cadmium, cutting oils, diesel fuel and fumes, herbicides, polycyclic aromatic hydrocarbons (PAH), polychlorinated biphenyls, soot, tar, mineral oil, and solvents to prostate cancer was studied.
Methods: A case-referent study design was used to recruit 192 subjects with histologically confirmed prostate cancer and 210 referents who had prostate cancer histologically excluded either in one of two urologic practices (Hamburg and Frankfurt) or in the urological policlinic of the Frankfurt University. Data were gathered with a self-administered questionnaire and analyzed using logistic regression to control for age, region, and cigarette smoking. A job-exposure matrix was used for assigning exposure. For the calculation of dose-years, the duration of contact with specific substances was weighted by the intensity and probability of exposure according to a job-exposure matrix.
Results: The analysis of dose-years yielded a statistically significant association between occupational exposure to diesel fuel or fumes and prostate cancer (odds ratio 3.7, 95% confidence interval 1.4-9.8, for subjects exposed to more than 25 dose-years in a comparison with subjects never exposed). For the other substances, no statistically significant differences in exposure were found between the cases and referents. When only jobs with a high exposure probability were used to classify the participants as exposed, only exposure to PAH was significantly associated with prostate cancer.
Conclusion: In keeping with results from other studies, this study provides further evidence that exposure to diesel fuel or fumes - possibly mediated through PAH - may be associated with the development of prostate cancer.
Erich Mühe and the rejection of laparoscopic cholecystectomy (1985) : a surgeon ahead of his time
(1998)
During the early 1980s, news of Semm's laparoscopic appendectomy was rippling through German medical circles. Erich Mühe, fascinated by Semm's technique and spurred by successes of the Erlangen endoscopists, came up with the idea of laparoscopic removal of gallstones. In 1984, Mühe had already worked out the details of an operative laparoscope, the “Galloscope,” and on September 12, 1985, he carried out the first laparoscopic cholecystectomy. Later, he modified his technique and operated through a trocar sleeve. Finally, he designed an “open laparoscope” with a circular light. By March 1987, Mühe had conducted 97 endoscopic gallbladder removals. He published information about his technique at the Congress of the German Surgical Society (April 1986) and at other surgical meetings in Germany. His concept, however, was ignored. In the middle of the 1980s, the surgical community was still not prepared for the era of “minimally invasive therapy.” Erich Mühe was a surgeon ahead of his time.
In the late 1950s, Patrick C. Steptoe, a British gynecologist, established contact with Palmer of Paris and Frangenheim of Wuppertal, Germany, and studied laparoscopic technique under the tutelage of these pioneers. Despite the negative attitude among his colleagues, Steptoe soon became one of the most innovative researchers in the field of abdominal endoscopy, particularly laparoscopic sterilization. In the late 1960s, Steptoe began working with Robert Edwards, an embryologist, and launched an in-vitro fertilization project obtaining eggs by means of laparoscopy. Both researchers experienced years of frustration, disappointment, ethical and scientific criticism as well as a difficult relationship with the mass media. Finally, in July 1978, Louise Brown, the first test-tube baby, was born in England.
Like many of his colleagues in the 1950s and 1960s, Patrick Christopher Steptoe (1913-1988), a gynecologist in Oldham, Great Britain, was concerned about the number of unnecessary laparotomies. Unfortunately, the Oldham group of hospitals was not a university clinic and Steptoe had scanty opportunity to develop his own research. In the late 1950s, he searched the medical literature for an alternative form of examination and came across publications about Decker's culdoscopy, the vaginal approach to view the abdomen. Since this method was not widespread in England, Steptoe, in 1958, went to Montreal, Boston, and New York in order to observe and learn the practical use of culdoscopy. However, Steptoe left America disappointed.
Work on tubal insufflation marked the beginning of Kurt Semm's (b. 1927) scientific career. In the early 1960s, he directed his attention to the fact that, from a technical standpoint, tubal insufflation was similar to creating pneumoperitoneum. In the mid-1960s, Semm - himself a gynecologist - invested his time and financial resources and risked his university career to develop an automatic abdominal insufflation device. Later he tried it out in the Clinic for Internal Medicine. Since, at that time, the term “laparoscopy” had negative connotations associated with it, Semm formulated a new term “pelviscopy.” In 1967, Semm presented his invention to Melvin Cohen, an American pioneer of gynecological laparoscopy, at the meeting of the American Fertility Society, held in Washington.
In the 1970s, Semm developed thermocoagulation, adapted the Roeder Loop, and further invented extra- and intracoporeal endoscopic knotting to achieve endoscopic hemostasis. His numerous technical inventions, especially the electronic insufflator, allowed more complex operations to be performed laparoscopically. His technique, however, was not quickly adopted by the surgical community. When the first fully laparoscopic appendectomy was carried out by Semm in 1980, a veritable storm broke loose. In the opinion of many prominent surgeons, Semm exaggerated the problem of adhesions, and laparoscopic technique itself was regarded as very dangerous. Misunderstood by medical scientists, Semm displayed an ability to force his ideas through despite skepticism and suspicion. He realized that endoscopic surgery had tremendous potential, and promoted laparoscopic technique not only in his field of gynecology but among general surgeons as well. In 1985, Muhe, of Boblingen, Germany, used Semm's technique to remove the first gallbladder in the world laparoscopically. Three years later when Semm presented a videotape of his laparoscopic appendectomy in Baltimore, he gave impetus to McKernan and Save of Marietta. Georgia, to carry out the first laparoscopic cholecystectomy in the United States.