Cervico-isthmic pregnancy: an extremely rare case diagnosed during labour.

This case report describes a cervico-isthmic pregnancy ending in a live vaginal birth at 37+2 weeks' gestation. The case remained undiagnosed throughout pregnancy when after a fairly normal labour a massive haemorrhage occurred. After an unsuccessful effort to control the bleeding conservatively, a total abdominal hysterectomy was carried out. During the operation the diagnosis of cervico-isthmic pregnancy was confirmed, which was in accordance with the pathology report.

Colposcopically directed biopsy findings in the young female.

STUDY OBJECTIVE: To evaluate the colposcopic findings of cervical alterations in the young sexually active female. DESIGN, SETTING, PARTICIPANTS: Colposcopic examination and follow-up of 51 young sexually active females aged 15-20 yr was conducted due to abnormal cytology or a suspicious abnormality of the cervix. The study was conducted at the Colposcopy Units of the 1(st) and 2(nd) Departments of Obstetrics and Gynecology, University of Athens, Greece. ONTERVENTIONS: Colposcopic examination, LEEP, conization. MEAN OUTCOME MEASURES: Biopsy, human papillomavirus (HPV) typing. RESULTS: Colposcopic examinations were within normal limits in 8 of 51 (15.7%) cases. Cervical alterations were related to HPV infection in 14 cases (27.4%), to cervical intraepithelial neoplasia (CIN) I in 15 (29.4%) cases, to CIN II in 13 (25.5%) cases, and to CIN III in 1 (2.0%) case. Of all CIN I cases, 8 of 15 (53.3%) were HPV positive, and HPV type 11, 16, 18, 31, 33, and 11& 16 were found. In CIN II cases, 5 of 13 (38.4%) were HPV positive, and HPV type 11, 16, 18, and 11 & 31 were found. In the CIN III case, only HPV type 16 was found. CONCLUSIONS: Our findings strongly confirm the necessity of obtaining cervicovaginal smears on all sexually active gynecologic and obstetric teenage patients. Colposcopy plays a major role in the evaluation of the cervix and in the treatment that should be given for any individual CIN lesion.

Laparoscopic treatment of hydrosalpinx: factors affecting pregnancy rate.

STUDY OBJECTIVE: To evaluate the efficacy of laparoscopic surgery in a series of women with hydrosalpinx. DESIGN: Prospective, observational study (Canadian Task Force classification II-2). Setting. University-affiliated hospital. PATIENTS: Sixty-one women undergoing bilateral neosalpingostomy and restoration of tubal ovarian anatomy laparoscopically, and followed for 24 months. INTERVENTION: Video-controlled operative laparoscopy using standard four-puncture technique. MEASUREMENTS AND MAIN RESULTS: During 24-month follow-up, cumulative intrauterine pregnancy rates at 6-month intervals were 6.8%, 13.6%, 20.5%, and 20.5% for patients with only distal tubal obstruction and 12%, 23%, 29%, and 29% for those with mild degree of tubal disease and periadnexal adhesions. Miscarriage rate for intrauterine pregnancies was zero in both groups. CONCLUSION: Operative laparoscopy seems to be an effective treatment for hydrosalpinx in terms of pregnancy outcome.

Laparoscopic gonadectomy in a patient with testicular feminization syndrome.

A laparoscopic technique is reported as an operative approach for gonadectomy in a case of testicular feminization syndrome. A 17-year-old phenotypic female presented with primary amenorrhea and was evaluated through a diagnostic protocol that included clinical, cytogenetic, and hormonal examinations. The findings supported the diagnosis of testicular feminization syndrome. The left gonad was found at the internal opening of the inguinal canal and removed laparoscopically. No gonad was found at the contralateral side. No complications occurred during the operation and the patient left the hospital the same day. A long-term hormonal replacement treatment was initiated postoperatively.

Non-Hodgkin's ovarian lymphoma during adolescence: report of two cases.

STUDY OBJECTIVE: To present two cases of non-Hodgkin's ovarian lymphoma during adolescence. DESIGN: Follow up of the patients. Report of diagnostic and therapeutic approaches. SETTING: Division of Pediatric and Adolescent Gynecology and Corrective Gynecological Surgery, University of Athens (Athens, Greece). INTERVENTIONS: Laparotomy and chemotherapy. RESULTS AND MAIN OUTCOME: Three- and five-year survival rates. CONCLUSIONS: Ovarian lymphoma constitutes a rare entity with guarded prognosis. Selective surgery and chemotherapy constitute the treatment of choice.

Myomectomy during pregnancy and caesarean section.

Myomectomy was performed on a 31 year old primigravida during the 15th week of pregnancy due to a large myoma which was 23 cm in diameter. At the 39th week of pregnancy, during the Caesarean section, eight fibroids obstructing the lower part of the uterus were removed. There were no maternal or fetal complications.

Outcome of pregnancy in women with uterine malformation: evaluation of 62 cases.

A retrospective analysis of the outcome of pregnancy in 62 women seen between 1971 and 1988, with a uterine malformation was carried out. Fifty-seven out of 62 cases with a uterine malformation conceived and there was a total of 127 pregnancies. On the other hand five women have an unexplained infertility of more than 2 years duration. The abortion rate among these 127 pregnancies was 36% premature delivery rate 22% and term delivery rate 42%. Cases with a complete septate uterus had the higher abortion rate. Metroplasty was done in three patients with a uterus bicornis and in six cases with a septate uterus. Cervical cerclage was done in 23 cases. Breech presentation was very frequent (46%). The cesarean section rate in the 81 cases whose pregnancy continued beyond the 28th week of pregnancy was 63%. Perinatal mortality rate was 37% and fetal survival rate 61%.

Second-look laparoscopy in ovarian cancer.

Forty-six patients with epithelial ovarian cancer previously treated with surgery, chemotherapy or external radiation underwent second-look laparoscopy to evaluate management. Twenty of the patients had positive laparoscopic findings and were not subjected to further laparotomy. The frequency of positive findings was related to the stage of the disease. Laparoscopic examination revealed no evidence of cancer in the remaining 26 patients. Three of the patients in this group were found to have additional disease at subsequent laparotomy. The laparoscopic procedures were not associated with major complications. Although second-look laparoscopy cannot replace repeat laparotomy, it does have a role in the follow-up of patients with ovarian cancer.