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Differences in rates of apoptosis after hypoxia in human peritoneal and adhesion fibroblasts
August 2001, Vol. 8, No. 3 Supplement The Journal of the American Association of Gynecologic Laparoscopists
202. Differences in Rates of Apoptosis after Hypoxia in Human Peritoneal and Adhesion Fibroblasts GM Saed, B Boytchev, K Collins, MP Diamond. Wayne State University School of Medicine, Detroit, Michigan.
Measurements and Main Results. A 43-year-old woman with history of surgery experienced nonspecific abdominal symptoms. Physical examination showed a smooth, round, mobile abdominal mass occupying the pouch of Douglas and fight pelvic cavity. Ultrasound revealed an intraperitoneal, echo-free, multichambered structure, 25 • 10 • 5 cm, apparently arising from the right ovary. At laparoscopy a mesenteric cyst was located in the pelvic cavity inside the meso of the descending colon and sigma. The cyst was punctured to collect its fluid for cytology and completely removed without bowel resection. To prevent recurrence, we performed complete resection. There were no intraoperative or postoperative complications. Histopathologic examination revealed a singlelayered mesothelial coat. Conclusion. Mesenteric cysts are rare, benign, intraabdominal lesions without typical clinical findings. Treatment is indicated if they become symptomatic due to enlargement, and they can be successfully managed by laparoscopy. Clinical history and sonographic appearance may be misleading.
Objective. To test the hypothesis that tissue hypoxia resulting from injury during surgery lowers the rate of apoptosis of peritoneal fibroblasts during peritoneal healing. Measurements and Main Results. Peritoneal fibroblasts remain in the proliferative stage and do not die through apoptosis, and therefore continue to produce extracellular molecules, resulting in adhesion development. We obtained fibroblast primary cultures from normal peritoneal and adhesion tissues of the same patient. They were cultured under normal and hypoxic conditions for 24 hours before evaluation of apoptosis by the Tunel assay. Tunel assay measures the fragmented DNA of apoptotic cells by incorporating fluorescein12-dUTP at 3-OH DNA ends using the enzyme terminal deoxynucleotidyl traaasferase. Fluorescein-labeled DNA was visualized directly by fluorescence microscopy and quantified by flow cytometry (FACS). Hypoxia resulted in an increase in the rate of apoptosis in peritoneal fibroblasts but decreased apoptosis of adhesion fibroblasts. Analysis of FACS showed that apoptosis was higher in fibroblast of normal peritoneum (MFC 18.32) than adhesions (MFC 14.11) of the same patients in response to hypoxia treatment. Conclusion. Our data suggest that adhesion fibroblasts respond to hypoxia by decreasing their rate of apoptosis, which contributes to reformation of peritoneal adhesions.
201. Running Suture for Laparoscopic Myomectomy A Rossetti, O Sizzi, P Paparella. Columbus Hospital of Rome, Rome, Italy. Objective. To show advantages and disadvantages of a rurming suture for laparoscopic myomectomy. Measurements and Main Results. In 10 women, laparoscopic myomectomy was performed with interrupted, simple, or more frequently cross-stitches tied intracorporeally using 1 or 0 polyglactin. In 10 other patients, a rurming suture was applied first in the deeper plane starting from the apex of the myomectomy scar to the base, continuing along the more superficial plane from base to apex. The suture was tied intracorporeally with the tail of the running suture. The rurming suture allowed a 30% reduction of suturing time compared with traditional suture. The surgeon has to deal with a very long suture, however, which can be cumbersome and disorienting in a narrow field. Good team coordination is necessary because the assistant has to hold the running suture without being in the way of the operator. Power Doppler sonographic examination 30 days after the procedure showed good healing of the myomectomy scar. Conclusion. Reapproximation of margins of the myomectomy scar using this new suturing technique seems to be sturdy and thorough.
203. Thermoablation of the Endometrium R Sagiv, A Oebby, M Glezerman, A Golan. E. Wolfson Medical Center, Holon, Israel. Objective. To assess the efficacy and safety of thermoablation. Measurements and Main Results. After ultrasound examination, diagnostic hysteroscopy, and endometrial sampling, 73 women underwent thermoablation for severe menorrhagia and were followed for 6 to 40 months. The endometrium was destroyed by thermal energy applied by a balloon introduced transcervically by different methods. All procedures were performed in an ambulatory setting with sedation or analgesia only, and patients were discharged after 3
$61
202. Differences in Rates of Apoptosis after Hypoxia in Human Peritoneal and Adhesion Fibroblasts GM Saed, B Boytchev, K Collins, MP Diamond. Wayne State University School of Medicine, Detroit, Michigan.
Measurements and Main Results. A 43-year-old woman with history of surgery experienced nonspecific abdominal symptoms. Physical examination showed a smooth, round, mobile abdominal mass occupying the pouch of Douglas and fight pelvic cavity. Ultrasound revealed an intraperitoneal, echo-free, multichambered structure, 25 • 10 • 5 cm, apparently arising from the right ovary. At laparoscopy a mesenteric cyst was located in the pelvic cavity inside the meso of the descending colon and sigma. The cyst was punctured to collect its fluid for cytology and completely removed without bowel resection. To prevent recurrence, we performed complete resection. There were no intraoperative or postoperative complications. Histopathologic examination revealed a singlelayered mesothelial coat. Conclusion. Mesenteric cysts are rare, benign, intraabdominal lesions without typical clinical findings. Treatment is indicated if they become symptomatic due to enlargement, and they can be successfully managed by laparoscopy. Clinical history and sonographic appearance may be misleading.
Objective. To test the hypothesis that tissue hypoxia resulting from injury during surgery lowers the rate of apoptosis of peritoneal fibroblasts during peritoneal healing. Measurements and Main Results. Peritoneal fibroblasts remain in the proliferative stage and do not die through apoptosis, and therefore continue to produce extracellular molecules, resulting in adhesion development. We obtained fibroblast primary cultures from normal peritoneal and adhesion tissues of the same patient. They were cultured under normal and hypoxic conditions for 24 hours before evaluation of apoptosis by the Tunel assay. Tunel assay measures the fragmented DNA of apoptotic cells by incorporating fluorescein12-dUTP at 3-OH DNA ends using the enzyme terminal deoxynucleotidyl traaasferase. Fluorescein-labeled DNA was visualized directly by fluorescence microscopy and quantified by flow cytometry (FACS). Hypoxia resulted in an increase in the rate of apoptosis in peritoneal fibroblasts but decreased apoptosis of adhesion fibroblasts. Analysis of FACS showed that apoptosis was higher in fibroblast of normal peritoneum (MFC 18.32) than adhesions (MFC 14.11) of the same patients in response to hypoxia treatment. Conclusion. Our data suggest that adhesion fibroblasts respond to hypoxia by decreasing their rate of apoptosis, which contributes to reformation of peritoneal adhesions.
201. Running Suture for Laparoscopic Myomectomy A Rossetti, O Sizzi, P Paparella. Columbus Hospital of Rome, Rome, Italy. Objective. To show advantages and disadvantages of a rurming suture for laparoscopic myomectomy. Measurements and Main Results. In 10 women, laparoscopic myomectomy was performed with interrupted, simple, or more frequently cross-stitches tied intracorporeally using 1 or 0 polyglactin. In 10 other patients, a rurming suture was applied first in the deeper plane starting from the apex of the myomectomy scar to the base, continuing along the more superficial plane from base to apex. The suture was tied intracorporeally with the tail of the running suture. The rurming suture allowed a 30% reduction of suturing time compared with traditional suture. The surgeon has to deal with a very long suture, however, which can be cumbersome and disorienting in a narrow field. Good team coordination is necessary because the assistant has to hold the running suture without being in the way of the operator. Power Doppler sonographic examination 30 days after the procedure showed good healing of the myomectomy scar. Conclusion. Reapproximation of margins of the myomectomy scar using this new suturing technique seems to be sturdy and thorough.
203. Thermoablation of the Endometrium R Sagiv, A Oebby, M Glezerman, A Golan. E. Wolfson Medical Center, Holon, Israel. Objective. To assess the efficacy and safety of thermoablation. Measurements and Main Results. After ultrasound examination, diagnostic hysteroscopy, and endometrial sampling, 73 women underwent thermoablation for severe menorrhagia and were followed for 6 to 40 months. The endometrium was destroyed by thermal energy applied by a balloon introduced transcervically by different methods. All procedures were performed in an ambulatory setting with sedation or analgesia only, and patients were discharged after 3
$61