Surgical Correction of Vaginal Agenesis via Modified Laparoscopic Vecchietti Procedure.

OBJECTIVE: To describe surgical correction of vaginal agenesis via a modified laparoscopic Vecchietti procedure with the goal of disseminating knowledge and improving surgical technique CASE: An 18-year-old female presented with primary amenorrhea, age-appropriate secondary sex characteristics, a shallow vagina, and 46,XX karyotype. Imaging showed rudimentary uterine horns and normal ovaries, kidneys, and spine. Diagnosis of Mayer-Rokitansky-Küster-Hauser syndrome type I was made. After an unsuccessful attempt at vaginal dilation and extensive counseling, the patient chose to have a laparoscopic Vecchietti procedure. Vecchietti vaginoplasty eliminates the need for grafts and creates a neovagina with accelerated vaginal dilation by stretching the introital mucosa with a spring mechanism. RESULTS: A modified laparoscopic Vecchietti procedure was performed. Postoperatively, daily suture adjustments were made. When the device was removed after 7 days, the examination revealed a 9-cm vaginal canal, which was maintained with self-dilation.

A comparison of abdominal and vaginal hysterectomy for the large uterus.

OBJECTIVE: To compare the perioperative outcomes of women with an enlarged uterus (>or=250 g) who had abdominal and vaginal hysterectomies. METHOD: Retrospective study of the perioperative outcomes of 288 consecutive women with an enlarged uterus, of whom 200 underwent an abdominal hysterectomy and 88 a vaginal hysterectomy, all for benign gynecological conditions. RESULTS: Among the perioperative complications, only the risk of ileus was significantly higher in the group that underwent abdominal hysterectomy. Although the need for blood transfusions was similar between the groups, mean perioperative hemoglobin change was significantly lower for women who had the abdominal approach. Vaginal hysterectomy shortened the length of hospitalization significantly but did not affect the operative time. All of these differences remained significant after adjusting for uterine weight (P<0.05). Baseline characteristics were similar between the groups, except for uterine weight. CONCLUSIONS: For women with a uterus weighing 250 g or more, vaginal hysterectomy shortens the hospital stay without significantly increasing perioperative morbidity when compared with the abdominal route.

Urinary tract infections in women with bacterial vaginosis.

OBJECTIVE: To evaluate the risk of urinary tract infections in women with bacterial vaginosis. METHODS: One hundred twenty-nine women who presented for routine gynecologic examinations were evaluated for bacterial vaginosis and urinary tract infections between June 1998 and March 1999. RESULTS: Sixty-seven women had bacterial vaginosis and 62 women did not. Fifteen women with bacterial vaginosis (22.4%) had urinary tract infections, compared with six (9.7%) of those without it. Bacterial vaginosis was associated with an increased risk of urinary tract infections (odds ratio 2.79; 95% confidence interval 1.05, 8.33). CONCLUSION: Women with bacterial vaginosis are at increased risk for urinary tract infections.

Creation of neovagina by laparoscopic Vecchietti operation.

The Vecchietti operation is a surgical technique that creates a neovagina by dilation in 7-9 days. The authors report a case of a 17-year-old woman with müllerian agenesis, Mayer-Rokitansky-Kuster-Hauser syndrome, in whom the Vecchietti operation was performed. A neovagina with a depth of 11 cm was created in 7 days. There were no complications, and the functional result was excellent.

Efficacy of fibrin glue for in vitro sealing of human chorioamniotic membranes.

OBJECTIVE: To assess the changes in tensile strength properties of artificially punctured chorioamniotic membranes after sealing the defect with fibrin glue, a tissue sealant. STUDY DESIGN: Chorioamniotic membranes were obtained from 30 term, uncomplicated pregnancies immediately after delivery. Adjacent, same-sized strips were cut from each membrane sample. After baseline tensile strength properties were obtained, identical size holes were made on each strip, and fibrin glue was applied onto half the specimens. Following adequate stabilization of fibrin, tensile strength properties--rupture tension, strain to rupture and work to rupture--were measured. RESULTS: Membrane puncture decreased the tensile strength characteristics, indicating weakening of the chorioamniotic membranes: Rupture tension (g/cm) dropped from 153.1 +/- 12.3 to 76.8 +/- 15.7; strain to rupture (%) from 193.9 +/- 29.9 to 152.6 +/- 36.8; and work to rupture (g x cm) from 560.8 +/- 51.8 to 239.0 +/- 65.5 (P < .05). Significant increases were noted in rupture tension (116.0 +/- 19.6), strain to rupture (173.5 +/- 30.8) and work to rupture (394.3 +/- 91.3) after application of fibrin glue; however, all three measurements remained less than prepuncture values (P < .05). CONCLUSION: Fibrin glue effectively improved the structural integrity of artificially punctured chorioamniotic membranes.

Human ejaculate. Effects on the biomechanical properties of the human chorioamniotic membranes.

OBJECTIVE: To determine the effects of human ejaculate on the biomechanical properties of the human chorioamniotic membranes. STUDY DESIGN: Equivalent strips of chorioamniotic membranes were obtained from 30 term, uncomplicated pregnancies immediately after delivery and incubated for 0, 1 and 24 hours with either ejaculate or pseudoamniotic fluid. Three biomechanical properties--rupture tension, strain to rupture and work to rupture--were compared. RESULTS: One hour of incubation with pseudoamniotic fluid alone did not significantly change the membrane biomechanical parameters, but these parameters were reduced after one hour of exposure to ejaculate (P < .05). Twenty-four hours of incubation decreased all three properties in both the ejaculate and control groups without any significant difference between the two groups. CONCLUSION: In vitro exposure to human ejaculate for one hour significantly weakens the human chorioamniotic membranes.

Massive hemoperitoneum from endometriosis of the fallopian tube. A case report.

BACKGROUND: Endometriosis is a common gynecologic disease that usually presents with pelvic pain and infertility in the reproductive years. It can be complicated by bleeding, such as hematuria or hemoptysis; however, acute massive hemoperitoneum caused by tubal endometriosis without any concomitant disorder has not been reported previously. CASE: An unusual case of massive hemoperitoneum led to preshock as a result of bleeding from a tubal endometriosis implant in a previously healthy 29-year-old woman without previous history suggesting endometriosis. CONCLUSION: Although the most common gynecologic cause of hemoperitoneum in a reproductive-age woman is ruptured ectopic pregnancy, endometriosis should also be considered, especially after exclusion of pregnancy.

Trospectomycin in acute pelvic inflammatory disease: a preliminary report.

OBJECTIVE: The purpose of this study was to compare the clinical efficacy and safety of intravenous trospectomycin to that of cefoxitin plus doxycycline in the treatment of women hospitalized with acute pelvic inflammatory disease (PID). METHODS: Thirty-nine patients admitted with a clinical diagnosis of an acute PID were enrolled in this prospective, single-blind study. Patients were treated with either intravenous trospectomycin, 500 mg every 8 h, or intravenous cefoxitin, 2 g every 6 h, plus oral or intravenous doxycycline, 100 mg every 12 h, in a 2:1 ratio. The patients were followed for clinical response and side effects. Both groups of patients were discharged on oral doxycycline for 10 days. Appropriate cultures were obtained before starting inpatient treatment, on completion of inpatient treatment, and at 2 follow-up visits. RESULTS: The overall success rate for trospectomycin was 95.6% and for cefoxitin/doxycycline was 91.6%. This difference was not statistically significant (P = 0.63). Trospectomycin was found to be effective against Chlamydia trachomatis. CONCLUSIONS: Single-agent therapy with trospectomycin may be as effective as cefoxitin plus doxycycline in the treatment of women hospitalized with acute PID.

Significance of genital mycoplasmas in pelvic inflammatory disease: innocent bystander!

OBJECTIVE: Our objective was to determine the role of Mycoplasma hominis and Ureaplasma urealyticum in pelvic inflammatory disease (PID). METHODS: The clinical and microbiologic variables in 114 patients with a clinical diagnosis of PID were compared prospectively according to the isolation of M. hominis and U. urealyticum from their endometrial cavities. RESULTS: The groups were epidemiologically well matched. Clinical parameters such as temperature, leukocyte count, erythrocyte count, and C-reactive protein on admission and length of hospital stay were similar in the patients, regardless of their mycoplasma status. A significant percentage of the patients either continued or started to harbor genital mycoplasmas after the resolution of PID without any significant clinical sequelae. CONCLUSIONS: The presence of genital mycoplasmas does not change the clinical presentation and course of PID. Both M. hominis and U. urealyticum can persist or colonize the endometrium after complete recovery from PID. Therefore, the genital mycoplasmas do not seem to have a dominant pathogenic role in PID.

Traumatic atlanto-occipital dislocation with survival: a case report and review of the literature.

The number of patients who have survived traumatic atlanto-occipital dislocation, the usual outcome of which is death from brain stem transection, has increased in the past two decades due to improvements in on-scene resuscitation and transportation. This case of survival after traumatic atlanto-occipital dislocation is of interest because the patient had a complete neurologic recovery and a magnetic resonance imaging (MRI) study was obtained to confirm the diagnosis and rule out associated injuries.