Neocolpopoiesis with split-thickness skin graft as a surgical treatment of vaginal agenesis: retrospective review of 201 cases.

OBJECTIVES: Our goals were to present a modified Abbe-Mcindoe technique of vaginoplasty with split-thickness skin graft and to analyze 51 years of experience in performing this procedure. STUDY DESIGN: Two hundred one women with vaginal agenesis were diagnosed and operated on by the same surgeon in 51 years (1943 through 1994). The patients' ages ranged from 14 to 41 years with an average of 20.5 years (SD 3.9 years). In most of the cases surgical intervention was performed when the patient desired to begin her sexual experience. The graft was taken from the thigh or gluteal region, followed by dissection of the urethrovesicorectal space. The access in this space was performed through two mutually perpendicular incisions (a modification of the Abbe-Mcindoe technique). A multiholed, rigid plastic mold was inserted during surgery and was replaced after 8 to 10 days with a semirigid silicone mold, which remained in place at least 6 months after operation or until the patient became sexually active. RESULTS: We retrospectively reviewed 201 cases of Mayer-Rokitansky-Küster-Hauser syndrome in which vaginoplasty was performed. The data were obtained from the personal records of Dan Alessandrescu, MD, PhD, for the 76 cases operated on between 1943 and 1967 and from the medical records in the Polizu Hospital Archive, Bucharest, Romania, for 125 cases operated on between 1968 and 1994. Overall surgical mortality was null. Intraoperative and postoperative complications consisted of two rectal perforations (1%), eight graft infections (4.0%), and 11 infections of graft-site origin (5.5%). Additional information was obtained during follow-up. Sexual satisfaction was investigated with objective (depth of constructed vagina) and subjective (ability to have sexual intercourse, presence or absence of dyspareunia, vaginal lubrication, orgasm) criteria and was analyzed on a qualitative scale. In 12 patients we performed biopsies of the neovaginal wall for histologic evaluation. CONCLUSION: Because of the simplicity, low morbidity, and high success rate, our modified Abbe-Mcindoe technique is a procedure of choice for vaginoplasty.

The measurement of the peptide hormones in saliva. 2. Chorionic gonadotropin subunits in pregnancy.

The alpha and beta subunits of the human chorionic gonadotropin (HCG) were measured during pregnancy in the saliva of a first group (no. = 23) and in the serum and saliva of a second group (no. = 25). Only ten pregnant women had normal gestation, the remaining 39 being diagnosed as miscellaneous pathologies, the threatened (or impending) abortion being the most frequent (no. = 19). The mean serum levels of alpha-HCG increase from 75.97 +/- 18.59 ng/ml (X +/- SEM) during the first trimester to 341.98 +/- 65.09 ng/ml during the third trimester of the gestation. The mean salivary concentration of the alpha HCG seems unmodified during pregnancy (approximately 10 ng/ml), but large interindividual variations were observed (limits 0.10-28.78 ng/ml) possibly due to the non-homogeneity of the investigated groups. The presence of the beta-HCG subunit in saliva could not be assessed, the great part of the values being aggregated around the sensitivity limit of the RIA technique (0.2 ng/ml). The physiological significance of the presence of the HCG and of its subunits in saliva as well as the ways to elucidate the possible selective role of the blood-saliva barrier are discussed.

LH and FSH levels in serum and cerebrospinal fluid (CSF) of human fetus.

The concentration of LH and FSH was measured in the fetal blood and cerebrospinal fluid (CSF) of 4 human fetuses between 21 and 24 weeks old. A comparison was made with 6 post menopausal females. In one fetus the serum and CSF levels of both hormones were determined after administration of 200 micrograms LRH and 400 micrograms TRH. The mean serum fetal levels of LH and FSH of 76.6 mIU/ml (range, 29.5-152.0) and 30.5 mIU/ml (range 3.1-60.3), respectively, were not significantly different from those of postmenopausal females, whereas the fetal CSF levels of these hormones were significantly higher (p less than 0.02) than those of post menopausal females. The serum to CSF ratios for the fetal LH and FSH were 4.6 +/- 1.1 and 2.4 +/- 0.61 respectively, significantly different (p less than 0.02 and p less than 0.001 respectively) from those of post menopausal females (29.1 +/- 6.6 for LH and 50.9 +/- 10.9 for FSH). In one fetus LRH did not provoke any change in circulating FSH and LH level 20 min. after administration, while a slight increase of these hormone in the CSF was observed. These data suggest that the permeability of blood-CSF barrier to gonadotropins in the fetus seems to be higher than in the adult who has no blood-CSF barrier (B--CSF--B) alterations.

Bromocriptine treatment of pituitary adenomas. Evaluation of withdrawal effect.

Forty patients wtih pituitary adenomas, i.e. 22 prolactinomas, 13 acromegalies, 5 non-secreting adenomas, were submitted to bromocriptine therapy 19.3 +/- 1.7 mg/day (mean +/- SEM) (range 7.5-40.0 mg/day) for 5 to 41 months (10.1 +/- 1.31). Remission of the tumoral mass was documented by air tomograms (PETG) or computerized tomograms (CT) in all but one prolactinomas and in 2 mixed HGH and PRL-secreting adenomas. Six empty sella syndromes (ESS) were produced, 4 of them during primary chemotherapy. Serum PRL decreased to normal in all but 3 prolactinomas, and serum HGH levels in 5 out of 13 acromegalies. Bromocriptine withdrawal was followed by a rapid increase of serum PRL into the pathological range, without a rapid reexpansion of the tumoral remnants: GT or surgical exploration of 4 cases, remitted until ESS showed a minimal evolution along 8 months after bromocriptine withdrawal. It is suggested that the antitumoral effect of bromocriptine is specific to lactotrophic cells and at least partially irreversible.

Additional antitumoral effects of bromocriptine and radiotherapy in patients with prolactinomas or acromegaly.

Thirteen patients with prolactin-secreting and/or growth hormone secreting pituitary tumours have been treated with bromocriptine in doses of about 10 mg/day for several months. Nine of these patients were previously submitted to external or interstitial radiotherapy and one case to pituitary microsurgery. Serum prolactin concentration in patients with prolactinomas was still very high within one year after pituitary irradiation or operation, i.e. 5,125.6 +/- 974 mU/l (mean +/- SEM). It has been reduced to normal level only during bromocriptine therapy, i.e. to 329.1 +/- 88mU/l (p less than 0.001), and increased thereafter, but remained to a significantly lower concentration than before bromocriptine treatment, i.e. 2,709.0 +/- 553 mU/l (p less than 0.05). Serial pneumonecephalotomography has demonstrated the reduction of tumour size afrer bromcriptine therapy to two prolactinomas with suprasellar extension. In patients with acromegaly the effects of bromocriptine were less evident. The antitumoral effects of bromocriptine on prolactin-secreting adenomas is independent and additional to the effects of pituitary radiotherapy or microsurgery, and has therapeuticical implications.

[Treatment of female stress incontinence. Direct vaginal urethrocystopexy using D. Alessandrescu's method]. / Beitrag zur Behandlung der Stressinkontinenz bei der Frau. Direkte Urethrozystopexie auf vaginalem Weg nach D. Alessandrescu.

In cases of urinary stress incontinence the urethrocystopexy in the vaginal route by the technique of Dan Alessandrescu is described. After 2-10 years 98% out of 489 patients were cured.

[Etiopathogenic and diagnostic aspects of postabortion peritonitis]. / Aspecte etiopatogenice si diagnostice in peritonita post-abortum.

PIP: The causes, diagnosis, and treatment of postabortion peritonitis are discussed with reference to 85 cases, analyzing the causal agents and their sensitivity to various antibiotic treatments, and classifying them by frequency and clinical symptoms. The following germs were found in the patients: Staphylococcus hemolyticus, Esch. coli, Pseudomonas, Proteus, Procyaneus, and Enterococcus, which showed different responses to the various antibiotics used. The importance of a correct diagnosis of the cause of the disease for the proper application of intensive therapy and modern methods of treatment of infections is emphasized. The clinical evolution of a generalized peritonitis, secondary to a septic abortion, is described in detail.^ieng

[Therapeutic results in obstetrical peritonitis; clinical-statistical study conducted during a 10-year period]. / Rezultatele terapiei peritonitelor obstetricale; studiu clinico-statistic pe 10 ani.

PIP: A comparative study of the therapeutic methods used in 96 cases of obstetrical peritonitis is reported. The importance of early diagnosis and intervention is emphasized, and the concept of minimum surgical measures, such as laparotomy and drainage, applied in the course of complex reequilibration measures, treatment of infections and gastroduodenal aspiration, is discussed. Uterine exeresis is used only in cases in which the vitality and functions of the organ are jeopardized. Laparotomy and drainage were performed in 52 cases, and hysterectomy in 13 cases. The principles of drainage and its application to individual cases are described and discussed.^ieng