Rene Wenzl - Academia.edu (original) (raw)
Papers by Rene Wenzl
Geburtshilfe Und Frauenheilkunde, Jun 1, 2020
Expert Opinion on Pharmacotherapy, Mar 1, 2022
INTRODUCTION Endometriosis is a benign disease, characterized by a wide range of symptoms and dif... more INTRODUCTION Endometriosis is a benign disease, characterized by a wide range of symptoms and different degrees of severity, which is why therapy should be individually adapted to the patient's needs. Over the years, a lot of research has gone into finding new therapeutic approaches for this enigmatic disease. AREAS COVERED This review presents the latest advances in pharmacological management of endometriosis and is solely focused on studies published from 2010 to 2021. EXPERT OPINION Clinicians and researchers are constantly searching for new therapeutic strategies for endometriosis patients. As there are well-established treatments, however, any new medication should fulfill at least one of the three criteria: increased efficacy, comparable efficacy but a better safety profile, or treatments that have a lack of accompanying contraceptive effects that are seen in most endometriosis treatments. While some new substances show promising results, further studies are needed to demonstrate the fulfillment of one of the above-mentioned criteria.
Gynecological Surgery, Nov 13, 2011
Laparoscopy is one of the most common surgical procedures in gynecologic medicine. Major complica... more Laparoscopy is one of the most common surgical procedures in gynecologic medicine. Major complications associated with gynecologic laparoscopy are relatively rare, with up to 50% related to laparoscopic entry. Several entry techniques have been developed, all of which aim to provide a safe and easy entry to the abdominal cavity. In this article, we aim to review the available evidence on laparoscopic entry techniques in gynecologic surgery. We found no evidence that the Hasson (open) technique is superior to the Veress needle entry, the preferred method of most gynecologists all over the world. When entering the abdomen using the Veress needle, an intraperitoneal pressure <10 mmHg is a reliable predictor of correct intraperitoneal placement. Entry at Palmer's point (left upper quadrant laparoscopy) is recommended for patients with suspected or known periumbilical adhesions, or a history or presence of umbilical hernia, or after three failed insufflation attempts at the umbilicus. Recently published trials suggest that direct trocar entry, especially when using optical trocar systems, might be superior to both the Hasson open technique and the Veress needle entry to avoid extraperitoneal insufflation and failed entry. Moreover, blood loss can be reduced and the mean entry time shortened. Laparoscopic entry techniques are still a controversial topic in gynecologic surgery. Many studies are underpowered in order to assess the risk for rare but lifethreatening complications. In conclusion, there is no solid evidence proving the superiority of any method of laparoscopic entry.
Fertility and Sterility, Nov 1, 2022
Journal of Clinical Medicine, Aug 14, 2019
To evaluate the incidence of endometriosis in polycystic ovary syndrome (PCOS) patients who did n... more To evaluate the incidence of endometriosis in polycystic ovary syndrome (PCOS) patients who did not present with any endometriosis symptoms and underwent laparoscopic ovarian drilling (LOD) for clomiphene citrate (CC) resistance, 225 and 630 women with CC-resistant PCOS without classic endometriosis symptoms were included in a retrospective study and a meta-analysis, respectively. All women underwent LOD. The main outcome parameter was the prevalence of incidental endometriosis. Laparoscopy revealed endometriosis in 38/225 (16.9%) women (revised American Fertility Society (rAFS) stage I: 33/38, 86.8%; rAFS stage II: 5/38, 13.2%). When women with CC-resistant PCOS without endometriosis were compared, lower body mass index (BMI) and lower 25-hydroxy-vitamin D levels were associated with the presence of endometriosis at laparoscopy (odds ratios (OR): 0.872, 95% confidence intervals (95%CI): 0.792-0.960; p = 0.005 and OR: 0.980, 95%CI: 0.962-0.999; p = 0.036; respectively). The inclusion criteria for the meta-analysis were fulfilled by 4/230 reports about LOD. After correction for study heterogeneity, the pooled prevalence of incidental endometriosis was 7.7% in women with CC-resistant PCOS. In conclusion, the rate of incidental endometriosis in women with CC-resistant PCOS might reflect the prevalence of asymptomatic endometriosis. All cases were affected by minimal or mild disease. Since the literature lacks reports on associated clinical outcomes, the relevance of this entity in such patients should be the subject of further studies.
Reproductive Biology and Endocrinology, Jul 22, 2015
Background: Epithelial to mesenchymal transition (EMT) is a process in which epithelial cells los... more Background: Epithelial to mesenchymal transition (EMT) is a process in which epithelial cells lose polarity and cell-to-cell contacts and acquire the migratory and invasive abilities of mesenchymal cells. These abilities are thought to be prerequisites for the establishment of endometriotic lesions. A hallmark of EMT is the functional loss of E-cadherin (CDH1) expression in epithelial cells. TWIST1, a transcription factor that represses E-cadherin transcription, is among the EMT inducers. SNAIL, a zinc-finger transcription factor, and its close relative SLUG have similar properties to TWIST1 and are thus also EMT inducers. MYC, which is upregulated by estrogens in the uterus by an estrogen response cis-acting element (ERE) in its promoter, is associated with proliferation in endometriosis. The role of EMT and proliferation in the pathogenesis of endometriosis was evaluated by analyzing TWIST1, CDH1 and MYC expression. Methods: CDH1, TWIST1, SNAIL and SLUG mRNA expression was analyzed by qRT-PCR from 47 controls and 74 patients with endometriosis. Approximately 42 ectopic and 62 eutopic endometrial tissues, of which 30 were matched samples, were collected during the same surgical procedure. We evaluated TWIST1 and MYC protein expression by immunohistochemistry (IHC) in the epithelial and stromal tissue of 69 eutopic and 90 ectopic endometrium samples, of which 49 matched samples were analyzed from the same patient. Concordant expression of TWIST1/ SNAIL/SLUG and CDH1 but also of TWIST1 and MYC was analyzed. Results: We found that TWIST1, SNAIL and SLUG are overexpressed (p < 0.001, p = 0.016 and p < 0.001) in endometriosis, while CDH1 expression was concordantly reduced in these samples (p < 0.001). Similar to TWIST1, the epithelial expression of MYC was also significantly enhanced in ectopic endometrium compared to eutopic tissues (p = 0.008). We found exclusive expression of either TWIST1 or MYC in the same samples (p = 0.003). Conclusions: Epithelial TWIST1 is overexpressed in endometriosis and may contribute to the formation of endometriotic lesions by inducing epithelial to mesenchymal transition, as CDH1 was reduced in ectopic lesions. We found exclusive expression of either TWIST1 or MYC in the same samples, indicating that EMT and proliferation contribute independently of each other to the formation of endometriotic lesions.
Fertility and Sterility, Aug 1, 2023
Einleitung: Die Entfernung der weiblichen Brust ist neben der Entfernung der primaren Geschlechts... more Einleitung: Die Entfernung der weiblichen Brust ist neben der Entfernung der primaren Geschlechtsorgane der wichtigste Schritt zur Geschlechtsangleichung bei Frau zu Mann (FzM) Transexuellen. Je nach Grose der Brust und des Hautmantels stehen fur die Entfernung der Brust die quer[for full text, please go to the a.m. URL]
Gynakologe, Aug 1, 2004
Zusammenfassung Die Endometriose ist eine benigne, östrogenabhängige, vererbbare Erkrankung, wobe... more Zusammenfassung Die Endometriose ist eine benigne, östrogenabhängige, vererbbare Erkrankung, wobei jedoch der genaue Vererbungsmodus unklar ist. Das erhöhte Risiko für Endometriose in der Verwandtschaft (5–8% bei Verwandten 1. Grades) weist auf einen polygenen Mechanismus hin. Das polygene Modell ist dadurch definiert, dass die Entstehung einer Erkrankung durch einen kumulativen Effekt von mehreren Genen beeinflusst wird. Für das polygene Modell sprechen das
PubMed, 1993
To date, investigators have relied on hysterosalpingography, hysterosalpingoscintigraphy, and lap... more To date, investigators have relied on hysterosalpingography, hysterosalpingoscintigraphy, and laparoscopic chromopertubation for the diagnosis of tubal disease causing infertility. With the development of the "linear everting catheter" system it may now be possible to evaluate the tubal lumen and to diagnose changes in the tubal wall or the tubal mucosa by direct visualization. This paper describes our initial clinical experience with 14 women who underwent evaluation for infertility. The new catheter system allowed both inspection of the tubal ostium without cervical dilation or concomitant hysteroscopy and virtually atraumatic access to the tube by means of an endoscope measuring half a millimeter in diameter and a magnification of 40. Given adequate experience with this technique it may also be performed in an outpatient setting. Ultimately, tuboscopy may come to play a major part in the diagnosis of sterility. Other potential applications of this new technology are the tubal transfer of embryos, intratubal insemination and the conservative treatment of tubal pregnancy.
Archives of Gynecology and Obstetrics, 1995
We report on a tubal pregnancy treated with prostaglandin F2a locally. Falloposcopy two years aft... more We report on a tubal pregnancy treated with prostaglandin F2a locally. Falloposcopy two years afterwards showed multiple, non obstructive adhesions of the tubal epithelium.
Cellular physiology and biochemistry : international journal of experimental cellular physiology, biochemistry, and pharmacology, 2015
Autophagy is of importance in the regulation of cell differentiation and senescence in podocytes.... more Autophagy is of importance in the regulation of cell differentiation and senescence in podocytes. It is possible that derangement of autophagy under different pathological conditions activates or enhances Epithelial-to-Mesenchymal Transition (EMT) in podocytes, resulting in glomerular sclerosis. To test this hypothesis, the present study produced lysosome dysfunction by inhibition of the vacuolar H(+)-ATPase (V-ATPase) to test whether deficiency of autophagic flux leads to enhancement of EMT in podocytes. By Western blot and confocal analysis, lysosome inhibition using a V-ATPase inhibitor or its siRNA was found to markedly decreases the epithelial markers (P-cadherin and ZO-1) and increases the mesenchymal markers (FSP-1 and α-SMA). This enhancement was accompanied by deficient autophagic flux, as demonstrated by marked increases in LC3B-II and p62/Sequestosome 1. However, inhibition of autophagosome formation using spaudin-1 significantly attenuated both enhancement of EMT and def...
Cells, Feb 4, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Fertility and Sterility, Feb 1, 2022
OBJECTIVE To provide a video tutorial on myomectomy via mini-laparotomy in women with large uteri... more OBJECTIVE To provide a video tutorial on myomectomy via mini-laparotomy in women with large uterine fibroids. DESIGN Stepwise demonstration of the technique with narrated video footage. SETTING Uterine fibroids represent the most common benign gynecologic disease, and myomectomy is a frequent reproductive surgery aiming to preserve or improve fertility. Abdominal and laparoscopic myomectomy are common treatments, but over the last decades, laparoscopy has become the preferred surgical approach because it provides significant advantages, such as shorter recovery time and a lower overall risk of complications. However, removal of large fibroids by laparoscopy is often technically challenging or even impossible. PATIENT(S) A 29-year-old woman presenting with urinary frequency and lower abdominal pressure due to a 14-cm diameter FIGO type 4 uterine fibroid in the anterior uterine wall. INTERVENTION(S) Myomectomy via mini-laparotomy using a 4-cm transverse skin incision and morcellation with a scalpel using an atraumatic circular self-retaining wound retractor. MAIN OUTCOME MEASURE(S) Mini-laparotomy represents a safe and simple approach combining the benefits of laparoscopy, such as reduced postoperative pain, reduced morbidity, and shorter hospitalization time, and the benefits of laparotomy, such as shorter duration of surgery, cost-effectiveness, and no need for advanced laparoscopic skills. RESULT(S) Mini-laparotomy can provide preferable cosmesis compared with alternative approaches. CONCLUSION(S) Mini-laparotomy represents an alternative minimally-invasive approach for large uterine fibroids, resulting in good overall outcome and no need for special surgical skills or equipment including power-morcellators. With this video, we aim to expedite the clinical learning curve of this technique and believe that selected patients desiring fertility could benefit from its application on a broader scale in the future.
Journal of The Society for Gynecologic Investigation, 2003
Acta Obstetricia et Gynecologica Scandinavica, 1994
This case report is about a 23‐year‐old female patient who underwent heart transplantation becaus... more This case report is about a 23‐year‐old female patient who underwent heart transplantation because of dilatative cardiomyopathy. Four months after transplantation she conceived. Thirteen months postoperatively, the patient had spontaneous vaginal delivery and gave birth to a child in good physical condition.
Fertility and Sterility, Dec 1, 2016
Objective: To provide a review of the literature regarding this technique as well as a step-by-st... more Objective: To provide a review of the literature regarding this technique as well as a step-by-step description with the goal of increasing its use as a safe surgical option. Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is characterized by vaginal agenesis and a variety of mullerian duct anomalies. To date, a variety of procedures have been described for creating a neovagina, but the best treatment remains debated. The Wharton-Sheares-George method, a minimally invasive surgical approach for the creation of a neovagina, is remarkably simple to perform. Design: Surgical video tutorial. Setting: University hospital and referral center for pediatric and adolescent gynecology. Patient(s): A 20-year-old woman with MRKH syndrome who underwent Wharton-Sheares-George neovaginoplasty. Intervention(s): With the Wharton-Sheares-George neovaginoplasty the rudimentary m€ ullerian ducts are dilated incrementally by pushing Hegar dilators in the direction of the pelvic axis, and the resulting median raphe is then intersected using diathermy. Subsequently a vaginal mold is inserted into the newly created cavity and held in position by two sutures. Main Outcome Measure(s): Discussion of the surgical steps according to the Wharton-Sheares-George method and review of the anatomic and functional results. Results: Reviewing the existing literature shows that a mean vaginal length and width of 8.3 and 3.3 cm, respectively, can be achieved, and so far no major intraoperative or postoperative complications or prolapse of the neovagina has been reported. Patients can achieve a high degree of general well-being as well as sexual and psychosocial functioning. However, as with most other methods, the presented method requires diligent patient compliance due to the lifelong need to actively avoid contraction of the neovagina. Also, as revealed by vaginal cultures and biopsies, the neovaginas remarkably resemble natural vaginas with regard to type of bacterial colonization and structure of epithelium. The process of spontaneous epithelialization of the neovagina is not fully understood, but has been observed to begin at the vaginal orifice and take several months to reach the apex. This leads to the assumption that the nonkeratinizing, stratified squamous epithelium originates from the preexisting vaginal epithelium of the vaginal dimple and migrates in a cranial direction. Alternatively, epithelialization might arise from pluripotent stem cells located in the obliterated m€ ullerian ducts. Conclusion(s): The creation of a neovagina using the Wharton-Sheares-George method does not require allogenic or autologous transplants, nor does it require traction devices or specialized surgical equipment. Furthermore, the procedure is comparatively simple to perform and easy to learn. By following our step-by-step description of this technique, surgeons can offer a minimally invasive, quick, and safe surgical option that provides long-term results that are both functionally and anatomically satisfying. We believe that this technique represents a valuable alternative for the creation of a neovagina in patients with MRKH syndrome and thus should be investigated on a broader scale in the future. (Fertil Steril Ò 2016;106:e20-1. Ó2016 by American Society for Reproductive Medicine.
Geburtshilfe Und Frauenheilkunde, Jun 1, 2020
Expert Opinion on Pharmacotherapy, Mar 1, 2022
INTRODUCTION Endometriosis is a benign disease, characterized by a wide range of symptoms and dif... more INTRODUCTION Endometriosis is a benign disease, characterized by a wide range of symptoms and different degrees of severity, which is why therapy should be individually adapted to the patient's needs. Over the years, a lot of research has gone into finding new therapeutic approaches for this enigmatic disease. AREAS COVERED This review presents the latest advances in pharmacological management of endometriosis and is solely focused on studies published from 2010 to 2021. EXPERT OPINION Clinicians and researchers are constantly searching for new therapeutic strategies for endometriosis patients. As there are well-established treatments, however, any new medication should fulfill at least one of the three criteria: increased efficacy, comparable efficacy but a better safety profile, or treatments that have a lack of accompanying contraceptive effects that are seen in most endometriosis treatments. While some new substances show promising results, further studies are needed to demonstrate the fulfillment of one of the above-mentioned criteria.
Gynecological Surgery, Nov 13, 2011
Laparoscopy is one of the most common surgical procedures in gynecologic medicine. Major complica... more Laparoscopy is one of the most common surgical procedures in gynecologic medicine. Major complications associated with gynecologic laparoscopy are relatively rare, with up to 50% related to laparoscopic entry. Several entry techniques have been developed, all of which aim to provide a safe and easy entry to the abdominal cavity. In this article, we aim to review the available evidence on laparoscopic entry techniques in gynecologic surgery. We found no evidence that the Hasson (open) technique is superior to the Veress needle entry, the preferred method of most gynecologists all over the world. When entering the abdomen using the Veress needle, an intraperitoneal pressure <10 mmHg is a reliable predictor of correct intraperitoneal placement. Entry at Palmer's point (left upper quadrant laparoscopy) is recommended for patients with suspected or known periumbilical adhesions, or a history or presence of umbilical hernia, or after three failed insufflation attempts at the umbilicus. Recently published trials suggest that direct trocar entry, especially when using optical trocar systems, might be superior to both the Hasson open technique and the Veress needle entry to avoid extraperitoneal insufflation and failed entry. Moreover, blood loss can be reduced and the mean entry time shortened. Laparoscopic entry techniques are still a controversial topic in gynecologic surgery. Many studies are underpowered in order to assess the risk for rare but lifethreatening complications. In conclusion, there is no solid evidence proving the superiority of any method of laparoscopic entry.
Fertility and Sterility, Nov 1, 2022
Journal of Clinical Medicine, Aug 14, 2019
To evaluate the incidence of endometriosis in polycystic ovary syndrome (PCOS) patients who did n... more To evaluate the incidence of endometriosis in polycystic ovary syndrome (PCOS) patients who did not present with any endometriosis symptoms and underwent laparoscopic ovarian drilling (LOD) for clomiphene citrate (CC) resistance, 225 and 630 women with CC-resistant PCOS without classic endometriosis symptoms were included in a retrospective study and a meta-analysis, respectively. All women underwent LOD. The main outcome parameter was the prevalence of incidental endometriosis. Laparoscopy revealed endometriosis in 38/225 (16.9%) women (revised American Fertility Society (rAFS) stage I: 33/38, 86.8%; rAFS stage II: 5/38, 13.2%). When women with CC-resistant PCOS without endometriosis were compared, lower body mass index (BMI) and lower 25-hydroxy-vitamin D levels were associated with the presence of endometriosis at laparoscopy (odds ratios (OR): 0.872, 95% confidence intervals (95%CI): 0.792-0.960; p = 0.005 and OR: 0.980, 95%CI: 0.962-0.999; p = 0.036; respectively). The inclusion criteria for the meta-analysis were fulfilled by 4/230 reports about LOD. After correction for study heterogeneity, the pooled prevalence of incidental endometriosis was 7.7% in women with CC-resistant PCOS. In conclusion, the rate of incidental endometriosis in women with CC-resistant PCOS might reflect the prevalence of asymptomatic endometriosis. All cases were affected by minimal or mild disease. Since the literature lacks reports on associated clinical outcomes, the relevance of this entity in such patients should be the subject of further studies.
Reproductive Biology and Endocrinology, Jul 22, 2015
Background: Epithelial to mesenchymal transition (EMT) is a process in which epithelial cells los... more Background: Epithelial to mesenchymal transition (EMT) is a process in which epithelial cells lose polarity and cell-to-cell contacts and acquire the migratory and invasive abilities of mesenchymal cells. These abilities are thought to be prerequisites for the establishment of endometriotic lesions. A hallmark of EMT is the functional loss of E-cadherin (CDH1) expression in epithelial cells. TWIST1, a transcription factor that represses E-cadherin transcription, is among the EMT inducers. SNAIL, a zinc-finger transcription factor, and its close relative SLUG have similar properties to TWIST1 and are thus also EMT inducers. MYC, which is upregulated by estrogens in the uterus by an estrogen response cis-acting element (ERE) in its promoter, is associated with proliferation in endometriosis. The role of EMT and proliferation in the pathogenesis of endometriosis was evaluated by analyzing TWIST1, CDH1 and MYC expression. Methods: CDH1, TWIST1, SNAIL and SLUG mRNA expression was analyzed by qRT-PCR from 47 controls and 74 patients with endometriosis. Approximately 42 ectopic and 62 eutopic endometrial tissues, of which 30 were matched samples, were collected during the same surgical procedure. We evaluated TWIST1 and MYC protein expression by immunohistochemistry (IHC) in the epithelial and stromal tissue of 69 eutopic and 90 ectopic endometrium samples, of which 49 matched samples were analyzed from the same patient. Concordant expression of TWIST1/ SNAIL/SLUG and CDH1 but also of TWIST1 and MYC was analyzed. Results: We found that TWIST1, SNAIL and SLUG are overexpressed (p < 0.001, p = 0.016 and p < 0.001) in endometriosis, while CDH1 expression was concordantly reduced in these samples (p < 0.001). Similar to TWIST1, the epithelial expression of MYC was also significantly enhanced in ectopic endometrium compared to eutopic tissues (p = 0.008). We found exclusive expression of either TWIST1 or MYC in the same samples (p = 0.003). Conclusions: Epithelial TWIST1 is overexpressed in endometriosis and may contribute to the formation of endometriotic lesions by inducing epithelial to mesenchymal transition, as CDH1 was reduced in ectopic lesions. We found exclusive expression of either TWIST1 or MYC in the same samples, indicating that EMT and proliferation contribute independently of each other to the formation of endometriotic lesions.
Fertility and Sterility, Aug 1, 2023
Einleitung: Die Entfernung der weiblichen Brust ist neben der Entfernung der primaren Geschlechts... more Einleitung: Die Entfernung der weiblichen Brust ist neben der Entfernung der primaren Geschlechtsorgane der wichtigste Schritt zur Geschlechtsangleichung bei Frau zu Mann (FzM) Transexuellen. Je nach Grose der Brust und des Hautmantels stehen fur die Entfernung der Brust die quer[for full text, please go to the a.m. URL]
Gynakologe, Aug 1, 2004
Zusammenfassung Die Endometriose ist eine benigne, östrogenabhängige, vererbbare Erkrankung, wobe... more Zusammenfassung Die Endometriose ist eine benigne, östrogenabhängige, vererbbare Erkrankung, wobei jedoch der genaue Vererbungsmodus unklar ist. Das erhöhte Risiko für Endometriose in der Verwandtschaft (5–8% bei Verwandten 1. Grades) weist auf einen polygenen Mechanismus hin. Das polygene Modell ist dadurch definiert, dass die Entstehung einer Erkrankung durch einen kumulativen Effekt von mehreren Genen beeinflusst wird. Für das polygene Modell sprechen das
PubMed, 1993
To date, investigators have relied on hysterosalpingography, hysterosalpingoscintigraphy, and lap... more To date, investigators have relied on hysterosalpingography, hysterosalpingoscintigraphy, and laparoscopic chromopertubation for the diagnosis of tubal disease causing infertility. With the development of the "linear everting catheter" system it may now be possible to evaluate the tubal lumen and to diagnose changes in the tubal wall or the tubal mucosa by direct visualization. This paper describes our initial clinical experience with 14 women who underwent evaluation for infertility. The new catheter system allowed both inspection of the tubal ostium without cervical dilation or concomitant hysteroscopy and virtually atraumatic access to the tube by means of an endoscope measuring half a millimeter in diameter and a magnification of 40. Given adequate experience with this technique it may also be performed in an outpatient setting. Ultimately, tuboscopy may come to play a major part in the diagnosis of sterility. Other potential applications of this new technology are the tubal transfer of embryos, intratubal insemination and the conservative treatment of tubal pregnancy.
Archives of Gynecology and Obstetrics, 1995
We report on a tubal pregnancy treated with prostaglandin F2a locally. Falloposcopy two years aft... more We report on a tubal pregnancy treated with prostaglandin F2a locally. Falloposcopy two years afterwards showed multiple, non obstructive adhesions of the tubal epithelium.
Cellular physiology and biochemistry : international journal of experimental cellular physiology, biochemistry, and pharmacology, 2015
Autophagy is of importance in the regulation of cell differentiation and senescence in podocytes.... more Autophagy is of importance in the regulation of cell differentiation and senescence in podocytes. It is possible that derangement of autophagy under different pathological conditions activates or enhances Epithelial-to-Mesenchymal Transition (EMT) in podocytes, resulting in glomerular sclerosis. To test this hypothesis, the present study produced lysosome dysfunction by inhibition of the vacuolar H(+)-ATPase (V-ATPase) to test whether deficiency of autophagic flux leads to enhancement of EMT in podocytes. By Western blot and confocal analysis, lysosome inhibition using a V-ATPase inhibitor or its siRNA was found to markedly decreases the epithelial markers (P-cadherin and ZO-1) and increases the mesenchymal markers (FSP-1 and α-SMA). This enhancement was accompanied by deficient autophagic flux, as demonstrated by marked increases in LC3B-II and p62/Sequestosome 1. However, inhibition of autophagosome formation using spaudin-1 significantly attenuated both enhancement of EMT and def...
Cells, Feb 4, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Fertility and Sterility, Feb 1, 2022
OBJECTIVE To provide a video tutorial on myomectomy via mini-laparotomy in women with large uteri... more OBJECTIVE To provide a video tutorial on myomectomy via mini-laparotomy in women with large uterine fibroids. DESIGN Stepwise demonstration of the technique with narrated video footage. SETTING Uterine fibroids represent the most common benign gynecologic disease, and myomectomy is a frequent reproductive surgery aiming to preserve or improve fertility. Abdominal and laparoscopic myomectomy are common treatments, but over the last decades, laparoscopy has become the preferred surgical approach because it provides significant advantages, such as shorter recovery time and a lower overall risk of complications. However, removal of large fibroids by laparoscopy is often technically challenging or even impossible. PATIENT(S) A 29-year-old woman presenting with urinary frequency and lower abdominal pressure due to a 14-cm diameter FIGO type 4 uterine fibroid in the anterior uterine wall. INTERVENTION(S) Myomectomy via mini-laparotomy using a 4-cm transverse skin incision and morcellation with a scalpel using an atraumatic circular self-retaining wound retractor. MAIN OUTCOME MEASURE(S) Mini-laparotomy represents a safe and simple approach combining the benefits of laparoscopy, such as reduced postoperative pain, reduced morbidity, and shorter hospitalization time, and the benefits of laparotomy, such as shorter duration of surgery, cost-effectiveness, and no need for advanced laparoscopic skills. RESULT(S) Mini-laparotomy can provide preferable cosmesis compared with alternative approaches. CONCLUSION(S) Mini-laparotomy represents an alternative minimally-invasive approach for large uterine fibroids, resulting in good overall outcome and no need for special surgical skills or equipment including power-morcellators. With this video, we aim to expedite the clinical learning curve of this technique and believe that selected patients desiring fertility could benefit from its application on a broader scale in the future.
Journal of The Society for Gynecologic Investigation, 2003
Acta Obstetricia et Gynecologica Scandinavica, 1994
This case report is about a 23‐year‐old female patient who underwent heart transplantation becaus... more This case report is about a 23‐year‐old female patient who underwent heart transplantation because of dilatative cardiomyopathy. Four months after transplantation she conceived. Thirteen months postoperatively, the patient had spontaneous vaginal delivery and gave birth to a child in good physical condition.
Fertility and Sterility, Dec 1, 2016
Objective: To provide a review of the literature regarding this technique as well as a step-by-st... more Objective: To provide a review of the literature regarding this technique as well as a step-by-step description with the goal of increasing its use as a safe surgical option. Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is characterized by vaginal agenesis and a variety of mullerian duct anomalies. To date, a variety of procedures have been described for creating a neovagina, but the best treatment remains debated. The Wharton-Sheares-George method, a minimally invasive surgical approach for the creation of a neovagina, is remarkably simple to perform. Design: Surgical video tutorial. Setting: University hospital and referral center for pediatric and adolescent gynecology. Patient(s): A 20-year-old woman with MRKH syndrome who underwent Wharton-Sheares-George neovaginoplasty. Intervention(s): With the Wharton-Sheares-George neovaginoplasty the rudimentary m€ ullerian ducts are dilated incrementally by pushing Hegar dilators in the direction of the pelvic axis, and the resulting median raphe is then intersected using diathermy. Subsequently a vaginal mold is inserted into the newly created cavity and held in position by two sutures. Main Outcome Measure(s): Discussion of the surgical steps according to the Wharton-Sheares-George method and review of the anatomic and functional results. Results: Reviewing the existing literature shows that a mean vaginal length and width of 8.3 and 3.3 cm, respectively, can be achieved, and so far no major intraoperative or postoperative complications or prolapse of the neovagina has been reported. Patients can achieve a high degree of general well-being as well as sexual and psychosocial functioning. However, as with most other methods, the presented method requires diligent patient compliance due to the lifelong need to actively avoid contraction of the neovagina. Also, as revealed by vaginal cultures and biopsies, the neovaginas remarkably resemble natural vaginas with regard to type of bacterial colonization and structure of epithelium. The process of spontaneous epithelialization of the neovagina is not fully understood, but has been observed to begin at the vaginal orifice and take several months to reach the apex. This leads to the assumption that the nonkeratinizing, stratified squamous epithelium originates from the preexisting vaginal epithelium of the vaginal dimple and migrates in a cranial direction. Alternatively, epithelialization might arise from pluripotent stem cells located in the obliterated m€ ullerian ducts. Conclusion(s): The creation of a neovagina using the Wharton-Sheares-George method does not require allogenic or autologous transplants, nor does it require traction devices or specialized surgical equipment. Furthermore, the procedure is comparatively simple to perform and easy to learn. By following our step-by-step description of this technique, surgeons can offer a minimally invasive, quick, and safe surgical option that provides long-term results that are both functionally and anatomically satisfying. We believe that this technique represents a valuable alternative for the creation of a neovagina in patients with MRKH syndrome and thus should be investigated on a broader scale in the future. (Fertil Steril Ò 2016;106:e20-1. Ó2016 by American Society for Reproductive Medicine.