Evaluation of a new virtual-reality training simulator for hysteroscopy.

BACKGROUND: To determine realism and training capacity of HystSim, a new virtual-reality simulator for the training of hysteroscopic interventions. METHODS: Sixty-two gynaecological surgeons with various levels of expertise were interviewed at the 13(th) Practical Course in Gynaecologic Endoscopy in Davos, Switzerland. All participants received a 20-min hands-on training on the simulator and filled out a four-page questionnaire. Twenty-three questions with respect to the realism of the simulation and the training capacity were answered on a seven-point Likert scale along with 11 agree-disagree statements concerning the HystSim training in general. RESULTS: Twenty-six participants had performed more than 50 hysteroscopies ("experts") and 36 equal to or fewer than 50 ("novices"). Four of 60 (6.6%) responding participants judged the overall impression as "7--absolutely realistic", 40 (66.6%) as "6--realistic", and 16 (26.6%) as "5--somewhat realistic". Novices (6.48; 95% confidence interval [CI] 6.28-6.7) rated the overall training capacity significantly higher than experts (6.08; 95% CI 5.85-6.3), however, high-grade acceptance was found in both groups. In response to the statements, 95.2% believe that HystSim allows procedural training of diagnostic and therapeutic hysteroscopy, and 85.5% suggest that HystSim training should be offered to all novices before performing surgery on real patients. CONCLUSION: Face validity has been established for a new hysteroscopic surgery simulator. Potential trainees and trainers assess it to be a realistic and useful tool for the training of hysteroscopy. Further systematic validation studies are needed to clarify how this system can be optimally integrated into the gynaecological curriculum.

[The validity of chemotherapy in the treatment of endometrial cancer]. / Der Stellenwert der Chemotherapie in der Therapie des Endometriumkarzinoms.

Endometrial cancer is a heterogeneous tumour with two types which can be distinguished clinically, histologically and pathogenetically:the classical endometrioid cancer (type 1) with a good prognosis and the aggressive histological type 2 with a poor prognosis and early metastatic spread. The most active cytotoxic drugs in advanced or metastatic endometrial cancer are the anthracyclines, the platinum salts and the taxanes. In most studies, combination chemotherapy is superior to monotherapy in terms of response rates. In the last few years there is growing evidence that chemotherapy can prolong overall survival in metastatic endometrial cancer and that adjuvant chemotherapy can reduce recurrence rates in high-risk situations.

2,3,7,8-Tetrachlorodibenzo-p-dioxin increases glycodelin gene and protein expression in human endometrium.

CONTEXT: Glycodelin (GdA) is an immunosuppressive endometrial glycoprotein critical for embryonic implantation and pregnancy establishment. OBJECTIVE: The aim of the present study was to examine the effect of dioxin [2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)] on GdA production in human endometrial cells. DESIGN: Controlled endometrial explant (EE) and cell cultures were used in this study. SETTING: Work was conducted at university hospital research laboratories in Bern, Switzerland, and in San Francisco, California. PATIENTS: Ovulatory women provided endometrial biopsies in the proliferative or secretory phase. INTERVENTION(S): EEs and cells were cultured without and with TCDD. MAIN OUTCOME MEASURE(S): GdA protein and gene expression were quantified. RESULTS: A 2.5-fold increase in GdA production was demonstrated in EEs treated with 10 nm TCDD for 9 d. Fluorography revealed a 3- to 4-fold increase in new GdA biosynthesis and secretion in TCDD-treated endometrial epithelial cells. Because the action of dioxin is mediated by the aryl hydrocarbon receptor (AhR), we ascertained that primary epithelial and Ishikawa cells express AhR. Dose responses to TCDD and expressed AhR were established in transiently transfected Ishikawa cells using luciferase fusion vectors containing 1.0 kb of 5' flanking DNA relative to the GdA transcriptional start site but not when shorter promoter constructs were used. A dioxin response element was mapped to nucleotides -539 to -533 of the gene promoter and verified by site-directed mutagenesis. CONCLUSIONS: We demonstrated a direct AhR-mediated effect of dioxin on GdA gene transcription and protein secretion that might influence human female fertility.