Comment on “Surgical treatment of ovarian endometriomas: state of the art?”

13 11 2012

To the Editor:

We read with interest the recent review conducted by Jadoul et al. (1) on the surgical treatment of ovarian endometriomas. The authors stress, as we do, that laparoscopic cystectomy for ovarian endometriomas may be difficult, and that a meticulous surgical technique should be used. The stripping technique, similar to that used for other benign cysts, cannot be used for this situation as it may induce severe bleeding and damage to the ovary (2, 3, 4). As we published before, the authors suggest that whenever the plane is adequately exposed, the surgeon may identify “arrows” on the surface of the cyst wall. These “arrows” help the surgeon to identify the correct cleavage plane. Indeed, a precise cut on the top of the arrow will present a safe and bloodless plane close to the cyst wall and away from the normal ovarian tissue, which should be preserved as much as possible. Read the rest of this entry »

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Comment on “Effect of cigarette smoking on human oviductal ciliation and ciliogenesis”

5 11 2012

To the Editor:

Defects in motile cilia are associated with several human diseases (1), so understanding the regulatory mechanisms of cilia function in the disease stage is of great importance. The results of a retrospective cohort study on the effect of cigarette smoke exposure on ciliation and ciliogenesis in human oviductal epithelium in vivo are currently in press in Fertility and Sterility ( Pier et al., 2012). From a methodological standpoint, the quality of the evidence presented appears to be the best that is currently available on this topic in oviduct-related scientific research. However, some considerations in this study require attention.

In the experiments of Pier et al., no significant differences in cilia-specific protein expression or ciliogenesis-related transcription factor regulation were observed between the two groups of patients with or without smoking. Thus, the authors conclude that “cigarette smoking does not seem to result in quantitative differences in the density of ciliation nor expression of ciliogenesis factors.” The pathogenic mechanisms underlying cigarette smoking in human oviductal cells, however, is still not well understood. To my understanding, the paper only provides a snapshot of cilia-specific gene and protein expression profiles in the oviducts of women following chronic exposure to cigarette smoke. The effects of biomedical interventions on a biological system, however, are normally measured by steady-state or time-course experiments. Thus this study cannot exploit and describe the dynamic mechanisms of tubal gene and/or protein regulation affected by cigarette smoke exposure. The failure to detect differences in the expression of cilia-specific molecules in women with or without chronic cigarette smoke exposure may be due to (a) a length of time after cigarette smoke exposure that is not favorable to the processes of ciliation and ciliogenesis or (b) indirect effects of cigarette smoking, or both. I suggest that an in vitro experiment could address this issue for establishment of a cause-and-effect relationship between cigarette smoke exposure and ciliation and ciliogenesis factor expression in human tubal ciliated cells. Read the rest of this entry »