The gluteal fold fascio-cutaneous flap for reconstruction after radical excision of primary vulvar cancers.

OBJECTIVES: Reconstructive surgery plays an important role in cosmetic and functional results of major excisional surgery performed as a treatment for invasive vulvar cancer. Traditional techniques -- gracilis myocutaneous o rectus abdominis flaps -- have several limits. We describe here a different surgical approach that we have used since 1998 in an effort to obtain better results in vulvar reconstruction. METHODS: From January 1998 to June 2007, thirty three patients who underwent excisional radical surgery for invasive vulvar tumors, were treated with vulvar reconstruction using the gluteal fold fascio-cutaneous local flap. Flaps were designed along the gluteal fold in adequate length and size. They were oval or triangular in shape depending on the defect they were supposed to cover. The flaps -- which always included the fascial layer -- were raised up to identify a perforator branch of the internal pudendal artery and then harvested as an island flap to achieve better mobility. RESULTS: We had no major complications, only two patients presented marginal necrosis and eight patients experienced significant seromas. Advantages over the alternative techniques included reduced dimensions of scars, absence of flap liponecrosis, no need of modifying patient's position on the surgical table, and very limited blood loss. CONCLUSIONS: We conclude that gluteal fold flap offers excellent cosmetic and functional results with a low complication rate. Therefore we support the gluteal fold flap as a valid surgical option whenever reconstruction is needed after radical excision of vulvar neoplasms.

A false visualization of ureteral jet with Doppler sonography during transvaginal evaluation of ureterocele.

A case of ureterocele diagnosed by an experimental trial using transvaginal ultrasound is reported. Color Doppler sonography revealed a jet flowing from the ureterocele into bladder. The radionuclide renal scan revealed a right duplex system, a ureterocele of the upper moiety and its functional obstruction. If the upper moiety was obstructed, where was the ureteral jet from? We can suppose that the jet visualized was flowing from the ureteral meatus of the lower moiety, positioned behind the ureterocele, and not from the ureterocele itself. In the light of this case, a urinary obstruction could not be excluded only on the basis of Doppler sonographic findings. In conclusion, a diagnostic work-up using only transvaginal ultrasound is insufficient to adeguately analyse the anatomy and function of the urinary system, especially when there are anatomy malformations.

The management of severe vaginal obstruction from genital chronic graft-versus-host disease: diagnosis, surgical technique and follow-up.

AIM: Chronic graft-versus-host disease (GVHD) is one of the most important systemic late-onset complications of haematopoietic stem cell transplantation. Gynaecological manifestations are considered relatively rare, and involve lower genital tract skin and mucosa, causing vulvar scarring, vaginal stenosis, affecting the patients' sexual life, and leading to more serious complications as haematocolpos, haematometra and abscesses. Genital GVHD can be treated with topical therapy when mild to moderate disease is present. Surgery is indicated in advanced and complicated cases to restore normal anatomy. The aim of this study is to propose a standard approach for the management of such condition when medical therapy is not effective. METHODS: From May 2000 to January 2002, 8 patients suffering from genital chronic GVHD were operated in our institution. We describe clinical and sonographic presurgical assessment, simple or ultrasonographic guided surgical technique, postsurgical treatment and follow-up. RESULTS: Surgery was completely successful in restoring genital anatomy in all the cases. Mean follow-up was of 17 months (6 to 38 months). Two patients early discontinued the postsurgical treatment. At 1 month complete vaginal patency was found in 6 cases, weak partial adhesions in 1 case, while 1 patient refused follow-up. Eventually, complete vaginal patency was maintained in 2 cases, and partial adhesions were found in 5 cases. CONCLUSIONS: The combined use of clinical examination and endosonography provides a precise assessment of the level of the obstruction. The surgical technique here described is feasible and successful in restoring normal anatomy, while long term results seem related to the compliance towards the postsurgical treatment.

Pilot study on lipocalin expression into extracellular fluids of women in fertile age.

BACKGROUND: To verify the expression of neutrophil gelatinase associated lipocalin (NGAL), molecule now arising great interest because of its proposed involvement in cell-cycle regulation, acute phase response and immunomodulation, into extracellular fluids of female reproductive tract, in order to provide useful data to understand its biological functions. The data collected are purely qualitative, just meant to reveal the presence of lipocalin into the assayed fluids, and they have to be considered as preliminary for a quantitative study (in progress at the moment) based on a double antibody radioimmunoassay. METHODS: Three kinds of extracellular fluid were randomly sampled: amniotic fluid (13 samples), cervical mucus (10 samples), coloster (20 samples). The inclusion criteria concerning the selection of the donor women were: age (fertile period), healthy state and pregnancy state. All the samples underwent protein assay, electrophoresis and western blot. RESULTS: All the samples examined revealed NGAL's presence. CONCLUSIONS: The positive results of this study seem to strengthen the hypothesis related to NGAL biological functions, specifically the ones that suggest its role into cell differentiation, embryonic development and inflammation. Therefore the female reproductive tract is suggested as a new promising study object in this research field.

The accessibility of DNA to dimethylsulfate in complexes with recA protein.

recA protein coats DNA co-operatively to form filaments approximately 100 A thick, which in the presence of ATP, and more stably so in the presence of the non-hydrolyzable analog ATP gamma S, have a helical appearance with a deep cleft in the protein coat. This protein helix follows the DNA helix, to which it imparts a new helicity of 18.5 bp per turn of 97 A pitch. Here we test the accessibility of the DNA in the complex to modification by dimethylsulfate, and find that the complexed DNA is approximately 2-fold more reactive on the major groove side than it was in B-DNA (methylation of guanine N7), while it is protected approximately 2-fold on the minor groove side (methylation of adenine N3), suggesting that the protein coats the DNA along the minor groove. Furthermore, N3 of cytosine, a residue involved in base pairing, is found exposed in complexes with single strands as it is in naked single-stranded DNA, while it remains inaccessible in complexes with double strands, suggesting that the latter is not melted at this stage of the strand exchange reaction.

Torsional stress induces left-handed helical stretches in DNA of natural base sequence: circular dichroism and antibody binding.

Above a threshold of torsional stress, the c.d. spectrum of covalently closed circular DNA of natural base sequence acquires a Z-like contribution and antibodies raised against Z-DNA are bound. Mapping of the antibody binding sites by electron microscopy reveals sites which correlate with stretches enriched in alternating purine-pyrimidine sequences and GC base pairs.

The helicity of DNA in complexes with recA protein.

The RecA protein of Escherichia coli is involved in recombination (for review see ref. 1). The protein binds transiently to double-stranded DNA in the presence of ATP. In the presence of ATP gamma S, a non-hydrolysable analogue of ATP, recA-DNA complexes are stable. Duplex DNA in these complexes is stretched by a factor 1.5 (ref. 4), and the complexes appear in the electron microscope as helical filaments with a pitch of approximately 100 A and 6.2 recA units per turn covering 18.6 base pairs (bp). RecA crystals have a space group of similar helical parameters. In order to understand the function of recA, it is necessary to describe the conformation of the DNA in the recA complex. Using a topological method, the present work determines the helicity of DNA in the complex. We find that the DNA helix follows the protein helix visible in the electron microscope and has 18.6 bp per turn, which corresponds to an unwinding of the DNA double helix by 15 degrees per bp.

A tRNA gene of Xenopus laevis contains at least two sites promoting transcription.

A small cloned DNA segment previously shown to contain all genetic information for the expression of the tRNA1met gene of Xenopus laevis was cleaved into an anterior and posterior portion by Hae III restriction. Both restriction fragments were cloned in pCR1 using EcoRI linkers. Starting from these tDNA subclones, a series of new recombinants were constructed. The transcriptional activity of the cloned DNA's was tested both in an in vitro transcriptional system and by means of the oocyte injection technique. It was shown that both the 5' and 3' ends of the cloned gene unit were essential for transcription. We have developed a model for the functional organization of the tRNA1met gene. We propose that the gene contains a regulatory site situated near the 3' portion of the gene unit. For transcription to occur both in vivo and in vitro a specific initiation site near the 5' end of the gene is required.