Combined cervical and vaginal reconstruction with prefabricated pudendal thigh flap in a case with cervical and vaginal agenesis (MURCS syndrome): a new and original technique.

In the presence of functional endometrium, in addition to the construction of anatomically, functionally normal and sensitive neovagina and cervix, the preservation of the uterus for future possible pregnancies must also be considered as the main goal in this process. So far, hysterectomy was the general treatment modality in such cases. For maintaining cervical patency, there were no reports in the literature related to cervical prefabrication using flaps. In this report we present a case with cervical and vaginal agenesis (MURCS syndrome). In this case combined cervical and vaginal reconstructions were successfully performed by using bilateral pudendal thigh flaps; a real-like cervix and cervical canal had been previously prefabricated on the distal part of one of the pudendal thigh flaps. Sensitivity and function were both preserved and maintained at the end of this operation.

Acute abdomen in a case with noncommunicating rudimentary horn and unicornuate uterus.

Unicornuate uterus with a rudimentary horn is the rarest congenital anatomic anomaly of the female genital system, causing many obstetrical and gynecologic complications. The frequency of this pathology is approximately 1/100 000. A rudimentary horn usually develops following insufficient development of mullerian ducts. These patients present with dysmenorrhea, dyspareunia, and chronic pelvic pain because of endometriosis and rarely with acute abdominal symptoms following distention and torsion of the noncommunicating rudimentary horn. The case of a patient referred for acute abdomen after distention of a noncommunicating rudimentary horn is presented herein.

Priming effect of misoprostol on estrogen pretreated cervix in postmenopausal women.

Misoprostol, which is a prostaglandin E1 analogue, is effectively used in cervical priming in women both for labor induction and for gynecological procedures. Although its efficacy is well documented in reproductive age women, during postmenopausal period this efficacy is limited probably due to estrogen deficit. Our objective is to evaluate if estrogen deficit in postmenopausal women is important for the effect of misoprostol on cervical ripening before diagnostic procedures. In this study, 45 patients were randomly allocated to estrogen or placebo group. The study group received local estrogen cream and other group received chlindamycine phosphate cream as placebo. The patients were given oral misoprostol 24 and 12 hours before the procedure for uterine cavity evaluation. Cervix was dilated by using Heagar dilator up to 6 mm. Data were analyzed by Student t-test, Mann-Whitney's U-test, chi-square test and paired samples t-test where appropriate. Basal cervical widths for the estrogen and placebo groups were 4.4 +/- 0.7 and 3.7 +/- 0.7 mm, respectively (p < 0.01). Mean time required for dilatation of cervix was 44.4 +/- 16.2 seconds for the estrogen group and 61.4 +/- 18.3 seconds for the placebo group (p < 0.01). As a conclusion, misoprostol treatment alone is not effective to get cervical priming in postmenopausal women, and as shown in our study, pretreatment with local estrogen overcome the failure. To get a beneficial effect of misoprostol on cervical ripening, estrogenic activity is necessary and when pretreated with local estrogen, misoprostol ameliorates cervical priming in postmenopausal women.

Maternal and fetal plasma adenosine deaminase, xanthine oxidase and malondialdehyde levels in pre-eclampsia.

The aim of this study was to evaluate maternal-fetal plasma adenosine deaminase, xanthine oxidase (ADA, XO) activity and malondialdehyde (MDA) levels and the relationship between them in pre-eclampsia. Maternal and umbilical cord whole blood samples were taken from 29 pre-eclamptic and 33 normal pregnants. The plasma ADA, XO activities as well as MDA levels were assayed by spectrophotometric methods. MDA levels and ADA, XO activities were found to be higher in maternal and fetal plasma in pre-eclamptics than in normal pregnancy. The differences were statistically significant between groups (p < 0.05). Increased maternal-fetal plasma XO and ADA activities, as a marker of immunological disorder, may be related to the pathogenesis of pre-eclampsia. In addition, increased MDA levels may be a reflection of increased oxidative stress in pre-eclamptics and their fetuses.