Utero-vaginal anastomosis in women with uterine cervix atresia: long-term follow-up and reproductive performance. A study of 18 cases.

BACKGROUND: Atresia of the uterine cervix is an uncommon Müllerian anomaly. Total hysterectomy remains the classical treatment of this malformation. The purpose of this study was to evaluate functional results and reproductive performance of women who had conservative surgical procedure. METHODS AND RESULTS: The medical records of 18 patients admitted to our centre between 1969 and 1998 for the treatment of uterine cervix atresia, were reviewed. Seven women had an associated high vaginal aplasia. Fifteen women had a history of abdominal or pelvic surgery before referral, with an unsuccessful attempt at canalization in five cases. Associated pelvic endometriosis or adhesions were observed in 12 cases. The utero-vaginal anastomosis procedure was performed successfully in all cases. A secondary stenosis of the anastomosis occurred in one case and this required canalization. Median follow-up after surgery was 4.5 years. Sexual intercourse was satisfactory for the 12 patients who began sexual activity. Ten patients had a pregnancy, four of which resulted in a total of six successful spontaneous pregnancies. Of the six remaining women, five had an evident cause of infertility. CONCLUSIONS: Utero-vaginal anastomosis should be proposed in women with congenital atresia of the uterine cervix, even when it is associated with vaginal aplasia. Early diagnosis and surgery appear necessary to avoid the development of pelvic associated lesions.

[Diagnosis and treatment of intra-epithelial carcinoma of the uterine cervix. About 124 cases (author's transl)]. / Epithélioma intra-épithélial du col utérin. Diagnostic et traitement: 124 cas.

The means for diagnosis, treatment and long follow-up of intra epithelial carcinomas of the uterine cervix are assessed by the authors, about 124 cases seen at the Hotel-Dieu de Paris. The diagnosis is given by cytologic means and mostly by colposcopic examination. When the cylindro-pavimental junction (usual initial focus) is seen in totality, direct biopsies always gave an accurate diagnosis. When the junction is not seen, only a diagnostic--conisation can allow a definitive answer. Two types of surgical treatment were applied: amputation of the cervix conservative of menstrual and/or reproductive functions and, hysterectomy led by vaginal or abdominal route. The patients were followed from 1 to 16 years by the triple cytologic, Schiller test and colposcopic examination: none of them showed any recurrence either of intra-epithelial or of invasive type.

[Haemangiopericytomas of the uterus. 4 case histories (author's transl)]. / Hémangiopéricytomes de l'utérus. A propos de quatre observations.

The authors report four cases of uterine haemangiopericytoma. These vascular tumours develop at the expense of the pericytes of Zimmermann. They are very rare since only 64 cases have been reported. The haemangiopericytomas of the uterus are clear cut histologically and as far as their ultrastructure is concerned. They therefore can be clearly distinguished from other connective tissue tumours which develop in the uterus and especially in the stroma of the endometrium. They should be considered as slow growing sarcomata of the myometrium as a study of the embryogenesis of the genital tract shows. Their prognosis is guarded.

[Surgical treatment of trophoblastic diseases]. / Le traitement chirurgical des maladies du trophoblaste.

Early diagnosis of a developing hydatidiform mole gives an opportunity to evacuate this by intrauterine suction. This atraumatic procedure which is sure in its outcome has considerably lowered the indications for curettage, for hysterectomy and for hysterotomies. On the other hand, when trophoblastic disease persists chemotherapy is indicated so long as the indications are strictly grounded on biological criteria. The real indication for surgery is found when an isolated focus is resistant to medical treatment.

[On some adverse effects of diathermocoagulation of the cervix uteri (pregnancy complications excluded)]. / A propos de quelques méfaits de la diathermo-coagulation du col utérin (complications gravidiques exceptées).

Diathermocoagulation is not a therapeutical procedure devoid of risk. Its indication should take into account potential drawbacks: infection episodes, haemorrhage and, first of all, sclerosing scarrs of the chorion that can give rise to pavimentous keratosis, stencsis, synechiae, cervicale sterility. A particular complication is the development of endometriosis: exocervical in the first place but that can also involve the uterosacral ligaments, the rectovaginal septum or even the uterus or pelvis. More especially it can mask the incipient syndromes of cervical carcinoma and its prophylactic value as far as this cancer is concerned appears questionable. For all these reasons, the authors insist in the precautions that must be taken prior to diathermocoagulation of the cervix uteri and for its implementation.