Faculty Bibliography

The process of apoptosis is responsible for normal cellular turnover in numerous tissues throughout the body. The endometrial layer of the uterus shows steroid-dependent cyclic changes in structure and function. After a proliferative and secretory phase, steroid support is withdrawn and the uterine epithelium is shed. We hypothesize that the apoptosis observed in endometrial cells following hormonal withdrawal is mediated by the Fas/Fas ligand (FasL) system. Normal endometrial cells and endometrial cancer cells were cultured in the presence of estrogen and progesterone. In order to mimic physiological hormonal changes, estrogen and progesterone were removed from the media. Apoptosis was determined by 3-[4,5-dimethylthiazol-2-yl]-2,5-dephenyl tetrazolium bromide (MTT) assay and propidium iodide staining, while Fas and FasL expression were evaluated by Western blot analysis. The endometrial cells expressed Fas and low levels of FasL. Withdrawal of estrogen and/or progesterone from the culture induced apoptosis causing an approximately 50% decrease in cell viability. This coincided with increased Fas and FasL expression. Treatment of the cells with anti-FasL antibody prevented cell death following hormonal withdrawal. Estrogen and progesterone therefore represent survival factors which hamper cell death by impeding the expression of apoptotic factors. Our results indicate that Fas-mediated apoptosis is important for endometrial cycling and suggest that dysregulation of the Fas/FasL interactions may have an important role in the development of endometrial cancer

OBJECTIVE: To evaluate what type of surgery would be more reasonable among 3 types of laparoscopic hysterectomy and to evaluate the safety of cardio-pulmonary changes on these patients during these operations. METHOD: A retrospective study was carried out in 215 women who underwent laparoscopic hysterectomy including laparoscopic-assisted vaginal hysterectomy (LAVH), laparoscopic hysterectomy (LH), total laparoscopic hysterectomy (TLH). Blood gas analysis, end-tidal CO2 levels and vital signs were checked and compared with control and preceding values. RESULTS: The average duration of operation was 102.5 min, 83.8 min and 118.3 min for LAVH (n = 97), LH (n = 75) and TLH (n = 43), respectively (p < 0.05). The average amount of bleeding was 297.5 ml, 152.3 ml and 149.2 ml for each type of hysterectomy, respectively. Hemoglobin decreased by an average of 1.6 g/100 ml, 0.9 g/100 ml and 0.8 g/100 ml, respectively. There was a lesser amount of bleeding for LH and TLH than for LAVH (p < 0.05). Profiles of blood gas analysis and expiratory CO2 varied significantly according to the operative stages under controlled anesthesia (p < 0.05), but were within the normal range. CONCLUSION: These results demonstrate that laparoscopic procedures advancing below the uterine vasculature can be considered effective for hysterectomies and that proper anesthesia can safely control the cardio-pulmonary changes during laparoscopic hysterectomy

OBJECTIVE: The purpose of this study was to evaluate whether laparoscopic separation with coagulation of the uterine arteries and uterosacral ligaments can be used in an attempt to improve the operative procedure when hysterectomy is carried out by laparoscopic and vaginal method. METHOD: A prospective study was carried out in 70 women who underwent laparoscopic hysterectomy excluding total laparoscopic hysterectomy. Laparoscopic uterine arterial separation with coagulation (include laparoscopic reperitonization) was performed after laparoscopic detachment of the bladder and resection of the broad ligament (or adnexa) in 39 cases (Group 1). Uterine artery was coagulated by bipolar electrocoagulator and separated from the uterine side wall by scissors. Endoloop tie was applied to the arterial pedicle, if bleeding occurred. Uterine arterial management was performed through the vaginal route (include vaginal reperitonization) after laparoscopic procedure which was finished at the lower part of broad ligament with bladder detachment in 31 cases (Group 2). RESULTS: The average duration of operation was 84.0 min and 101.8 min in Groups 1 and 2, respectively (p < 0.05). The average amount of bleeding was 154.8 ml and 298.4 ml in Groups 1 and 2, respectively (p < 0.05). Hemoglobin decreased in average by 0.9 g/100 ml and 1.6 g/100 ml in Groups 1 and 2, respectively (p < 0.05). CONCLUSION: These results demonstrate that laparoscopic management of uterine arterial pedicles after bladder detachment could reduce the duration of operation time and amount of bleeding in laparoscopic hysterectomy