Treatment of urinary stress incontinence. Use of dermal graft in the sling procedure.

Use of dermal graft for a urethral sling in treating urinary stress incontinence is described. This tissue has potential advantages of availability, strength, and freedom from side effects.

Adenosquamous-cell carcinoma of the ovary: report of a case with positive peritoneal fluid cytology.

Cytologic examination of peritoneal fluid showed only malignant squamous cells, without revealing adenocarcinomatous cell components, in a patient who had an endometrioid adenosquamous-cell carcinoma of the ovary. Histologic examination of the ovary demonstrated diffuse squamous-cell carcinoma with rare foci of endometrioid and abortive malignant glands, as well as isolated mucin-positive cells. The cytologic differential diagnosis of malignant squamous cells in peritoneal fluid and the pathogenesis of squamous-cell carcinoma of the ovary are discussed.

Maternal weight and fetal injury at birth: data deriving from medico-legal research.

The relationships among maternal weight, gestational weight gain, fetal birth weight and birth injuries have been investigated in connection with 62 cases of shoulder dystocia that involved permanent impairment of the newborn or neonatal demise. A high prevalence of > 13.5 kgs. gestational weight increase between the first and last office visits (62%) obesity expressed as > or = 87 kg. body weight at term (64.1%) and > or = 4000 gm. birth weight (80%) was found in this group of patients. The results indicate that the relationship between excessive maternal and fetal body weights and shoulder dystocia related fetal or neonatal impairment is closer than previous studies have suggested. These results underline the importance of appropriate and intensive nutritional counselling of the mother throughout pregnancy, noting that arrest of the shoulders is only one of those obstetric complications that are closely related to maternal obesity. The findings underline the usefulness of medico-legal reviews in clinical research.

Artificial double vagina in association with Rokitansky syndrome.

A case of Rokitansky syndrome is described where the typical anomalies of the entity were associated with cribriform hymen. The appearance of the external genitalia led to an erroneous diagnosis of complete vaginal agenesis and to surgical creation of an artificial vagina by the McIndoe technique at the patient's age of 19. She had a satisfactory sexual life subsequently. Ten years following the surgery, routine examination revealed that the patient had an essentially normal vagina with a blind upper ending. Prior to this, she and her husband had been unaware of the fact that their marital relations were conducted through her natural vagina during the years of their sexual activities.

Fetal risk in hyperextension of the fetal head in breech presentation.

An evaluation of the possible etiologic factors in hyperextension of the fetal head in breech presentation and a discussion of management are presented. Our seven cases plus a review of the literature led to the conclusion that hyperextension of the aftercoming head is a dangerous malpresentation that should not be underestimated. For this reason, we strongly suggest an x-ray of all breech presentations in early labor, not only to evaluate pelvic adequacy but also to determine the attitude of the head. In persistent hyperextension, cesarean section is the management of choice.