Review of Asherman syndrome and its hysteroscopic treatment outcomes: experience in a low-resource setting.

BACKGROUND: Asherman syndrome is one of the endometrial factors that influence a woman's reproductive capacity. However, in our context, it needs to be well-documented. This study aimed to evaluate the clinical characteristics and hysteroscopic treatment outcomes of Asherman syndrome. METHOD: A retrospective follow-up study from January 1, 2019, to December 31, 2022, was conducted on cases of Asherman syndrome after hysteroscopic adhesiolysis at St.Paul's Hospital in Addis Ababa, Ethiopia. Clinical data were collected via telephone survey and checklist. Epidata-4.2 and SPSS-26 were employed for data entry and analysis, respectively. RESULT: A total of 177 study participants were included in the final analysis. The mean patient age was 31 years (range: 21-39) at the initial presentation, and 32.3 years (range: 22-40) during the phone interview. The majority of the patients (97.7%) had infertility, followed by menstrual abnormalities (73.5%). Among them, nearly half (47.5%) had severe, 38.4% had moderate, and 14.1% had mild Asherman syndrome. The review identified no factor for 51.4% of the participants. Endometrial tuberculosis affected 42 patients (23.7%). It was also the most frequent factor in both moderate and severe cases of Asherman syndrome. Only 14.7% of patients reported menstrual correction. Overall, 11% of women conceived. Nine patients miscarried, three delivered viable babies, and six were still pregnant. The overall rate of adhesion reformation was 36.2%. Four individuals had complications (3 uterine perforations and one fluid overload) making a complication rate of 2.3%. CONCLUSION: Our study revealed that severe forms of Asherman syndrome, which are marked by amenorrhea and infertility, were more common, leading to incredibly low rates of conception and the resumption of regular menstruation, as well as high recurrence rates. A high index of suspicion for Asherman syndrome, quick and sensitive diagnostic testing, and the development of a special algorithm to identify endometrial tuberculosis are therefore essential. Future multi-centered studies should focus on adhesion preventive techniques.

Perfusion magnetic resonance imaging in Asherman syndrome.

BACKGROUND: Microvascular scarring compromises the functionality of the endometrium, and vascular flow at the junctional zone (JZ) may be the key to understanding poor reproductive outcomes in women with Asherman syndrome (AS). AIMS: To investigate whether vascular perfusion of the uterus, measured by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is impaired in women with intrauterine adhesions (IUA) and AS. MATERIALS AND METHODS: A prospective observational cohort pilot study of 23 women with IUA treated with hysteroscopic synecholysis and a control group of two patients with cervix cancer were subject to DCE-MRI with gadolinium to assess uterine vascularity. Twelve regions of interest (ROIs) were allocated on the DCE-MRI image incorporating the JZ, with control ROI placed at the psoas muscle. Individual ROIs were compared to the mean total perfusion (TP) in the same uterus. Pre- and post-operative perfusion analyses were performed on five women. Receiver operator curves (ROC) were used to analyse MRI as a predictor of IUA. RESULTS: There was no significant difference in perfusion; a trend toward reduced perfusion was observed in women with IUA compared to the controls. The ROC was predictive of higher-grade and inoperable IUA. CONCLUSIONS: Reduced perfusion on DCE-MRI as assessed by ROC predicted higher-stage AS. The results of this study support further investigation of DCE-MRI as a prognostic tool for AS prior to surgical intervention to assist in providing prognostic guidance for women suffering from AS.

A retrospective cohort study to examine factors affecting live birth after hysteroscopic treatment of intrauterine adhesions.

OBJECTIVE: To evaluate independent factors that affect the chance of live birth (LB) after hysteroscopic adhesiolysis in patients with intrauterine adhesions. DESIGN: Retrospective cohort study. SETTING: Hysteroscopic center of Fuxing Hospital in Beijing, China. PATIENT(S): Patients diagnosed with Asherman syndrome between June 2020, and February 2022. INTERVENTION(S): Hysteroscopic adhesiolysis is followed by a second look hysteroscopy to assess the outcome and follow-up for a year. MAIN OUTCOME MEASURE(S): Live birth rate (LBR) without the use of assisted reproductive technologies at 12-month follow-up. RESULT(S): Of the 544 women included in the cohort, the pregnancy rate at the end of 1 year of follow-up was 47.6% (95% confidence interval [CI] 45.5%-49.7%), and the LBR was 41.0% (95% CI 38.9%-43.1%). Stepwise multiple logistic regression analysis identified three independent predictors of LB in decreasing order of significance: increase in menstrual flow after surgery (odds ratio [OR] 3.69, 95% CI 1.77-8.21), postoperative endometrial thickness in the midluteal phase (OR 1.53, 95% CI 1.31-1.80), and the severity of recurred adhesion at second-look hysteroscopy (OR 0.62, 95% CI 0.50-0.76). Among subjects with good independent prognostic factors, namely, increased menstrual flow after surgery, postoperative endometrial thickness in the midluteal phase >6 mm, and no or minimal recurrence of adhesions at second-look hysteroscopy, the LBR was 69.0% (95% CI 65.4%-72.6%). On the other hand, in women (n = 26) without any of the three good prognostic factors, none had a successful LB (0). CONCLUSION(S): Overall, the LBR after treatment for Asherman syndrome was 41.0%. The prognosis is dependent on three outcome measures after surgery, namely, improvement in menstrual flow, postoperative endometrial thickness, and the minimal degree of recurrent adhesions at second-look hysteroscopy.

A Patient with Partial 17α-Hydroxylase Deficiency Initially Diagnosed with Asherman Syndrome and Pheochromocytoma.

This study present a case of a 49-year-old woman who suffered from resistant hypertension, hypokalemia, hypomenorrhea, and infertility. She was hospitalized 6 years earlier for hypomenorrhea and abdominal pain at the Xiamen Maternity and Child Health Hospital, where she was diagnosed with Asherman syndrome. During hospitalization, a computed tomography examination revealed an adrenal mass. She was referred to Xiamen University Affiliated Zhongshan Hospital for pheochromocytoma and underwent surgical resection of the left adrenal gland. The adrenal cortex adenoma was confirmed by pathological biopsy. Six years later, the patient also presented with hypertension and hypokalemia to our emergency department. A diagnosis of 17α-hydroxylase deficiency was established through the analysis of clinical and laboratory characteristics. The genetic analysis of CYP17A1 revealed compound heterozygous mutations, 1 of which was a mutation of c.1226 C>G, and the other c.297+2T>C.

Multi-Lineage Human Endometrial Organoids on Acellular Amniotic Membrane for Endometrium Regeneration.

Asherman's syndrome is an endometrial regeneration disorder resulting from injury to the endometrial basal layer, causing the formation of scar tissue in the uterus and cervix. This usually leads to uterine infertility, menstrual disorders, and placental abnormalities. While stem cell therapy has shown extensive progress in repairing the damaged endometrium and preventing intrauterine adhesion, issues of low engraftment rates, rapid senescence, and the risk of tumorigenesis remain to be resolved for efficient and effective application of this technology in endometrial repair. This study addressed these challenges by developing a co-culture system to generate multi-lineage endometrial organoids (MLEOs) comprising endometrial epithelium organoids (EEOs) and endometrial mesenchymal stem cells (eMSCs). The efficacy of these MLEOs was investigated by seeding them on a biocompatible scaffold, the human acellular amniotic membrane (HAAM), to create a biological graft patch, which was subsequently transplanted into an injury model of the endometrium in rats. The results indicated that the MLEOs on the HAAM patch facilitated endometrial angiogenesis, regeneration, and improved pregnancy outcomes. The MLEOs on the HAAM patch could serve as a promising strategy for treating endometrial injury and preventing Asherman's syndrome.

Association of intrauterine synechiae with pituitary gonadotrophin pulse patterns: A pilot study.

BACKGROUND: Intrauterine synechiae (IS) is an acquired uterine condition that occurs when scar tissues (adhesions) form within the uterus and/or cervix, causing menstrual disturbance. However, approximately 50% of patients with IS are refractory to treatment. Therefore, other endocrine disturbances, such as gonadotropin disturbance, may affect treatment success. STUDY AIM: To analyze gonadotropin levels in women with and without IS. METHODS: Ten women with refractory IS experiencing amenorrhea since at least 6 months and nine with normal menstrual cycles (control group) were included in this study. Blood sample were collected every 10 minutes during a 4-h period. The serial ultrasound was performed in both groups for evaluating the cycle phase. Blood was collected when the follicles size was between 5-10 mm. Serum LH, FSH, progesterone and estradiol concentrations were measured. To detect LH and FSH pulses, the technique proposed by Santen and Bardin was adopted; therefore, one pulse was defined as a 20% increase in the concentrations as to the preceding point, followed by an important decrease. RESULTS: No differences were observed between the study groups at baseline. Estradiol levels were lower in the IS group than in the control group, but the difference was not statistically significant. During the first hour of monitoring, cumulative FSH pulsatile frequency of IS group was lower than one of control. CONCLUSION: Our data suggest that the estradiol levels of IS participants are lower than those of women with normal menstrual cycle. The role of this finding in the physiology of uterine synechiae requires further investigation.

Severity of intrauterine adhesions and pregnancy success rates after treatment: Comparison of adhesions obtained from open myomectomy versus uterine curettage

Intrauterine adhesions (IUA) are rare. A retrospective comparative study was conducted between January 1, 2015, and December 31, 2018. Group A comprised 117 women who developed IUAs after open myomectomy, while Group B comprised 113 women who developed IUAs following uterine trauma caused by uterine instrumentation after a termination of pregnancy (TOP) or spontaneous miscarriage. The IUA grade and pregnancy rates and outcomes were compared using the March classification system. All patients underwent hysteroscopic adhesiolysis. The adhesions tended to be more severe (45/117, 38.5%) in Group A than in Group B (29/113, 25.7%); however, this difference was not statistically significant (Chi-Suare 5.047; p = .080). The period of observation was 24 months from the last hysteroscopy. The pregnancy rate in Group A (26, 22.2%) was significantly lower than in Group B (46, 40.7%) (OR: 2.403, 95% CI: 1.352­4.271; p = .003). Open myomectomy was the preceding aetiological factor in a greater proportion of women with IUA in our study. In cases where pregnancy is desired after open myomectomy, especially where the endometrial cavity is breached, postoperative hysteroscopy to exclude IUAs is recommended.

Restauración endometrial y embarazo tras utilización de Plasma Rico en Plaquetas (PRP) en pacientes con Síndrome de Asherman: Presentación de tres casos / Endometrial restauration and Pregnancy after Plasma rich in Platelets (PRP)administration in patients with Asherman Syndrome: Report of three cases

OBJECTIVO: Estudiar la recuperación del crecimiento endometrial en pacientes afectados por el Síndrome de Asherman. DISEÑO: Administración de Plama Rico en Plaquetas (PRP). LUGAR: Clínica IRMO S.L. Santa Cruz de Tenerife. PACIENTES: Presentación de 3 casos. RESULTADOS: El endometrio se midió antes de la aplicación del PRP y a las 48 horas. Durante los seis meses que duró el tratamiento se observó un incremento del grosor endometrial. CONCLUSIONES: El PRP es un procedimiento seguro y económico con muy bajo riesgo de transmisión de enfermedades infecciosas o reacciones inmunológicas, siempre que se haga con una muestra de sangre autóloga. En los tres casos estudiados queda demostrado claramente la mejora del engrosamiento endometrial por acción del PRP. Finalmente, podemos concluir que el PRP es un método efectivo para evitar la aparición de adhesiones y para recuperar un buen engrosamiento endometrial en pacientes con Síndrome de Asherman

OBJECTIVE: To study the recovery of endometrial growth in patients affected by Asherman Syndrome. DESIGN: Administration of Plama Rico in Platelets (PRP). PLACE: Clínica IRMO S.L. Santa Cruz of Tenerife. PATIENTS: Presentation of 3 cases. RESULTS: The endometrium was measured before the application of PRP and at 48 hours. During the six months of the treatment, an increase in endometrial thickness was observed. CONCLUSIONS: PRP is a safe and economical procedure with very low risk of transmission of infectious diseases or immunological reactions, provided it is done with an autologous blood sample. In the three cases studied, the improvement of endometrial thickening by PRP action is clearly demonstrated. Finally, we can conclude that PRP is an effective method to prevent the appearance of adhesions and to recover a good endometrial thickening in patients with Asherman Syndrome

Thick “Swiss Cheese” Appearance of Uterine Endometrium in Postmenopausal Women with Different Gynecologic Conditions

OBJECTIVES: To uncover gynecologic conditions with similar transvaginal sonographic findings of thick uterine endometrium with honeycomb appearance in pre-and postmenopausal women.METHODS: We retrospectively reviewed cases of patients with endometrial tissue biopsy from January 2010 to December 2016. We also collected office flexible hysteroscopic findings and surgical pathologic results. We analyzed data from 393 patients with confirmed endometrial pathology. Among these patients, 69 had transvaginal ultrasonographic images with thick uterine endometrium and honeycomb or “Swiss cheese” appearance.RESULTS: We found gynecologic conditions such as submucosal leiomyoma with degeneration, endometrial polyp, pseudocystic endometrial change associated with tamoxifen use, progesterone associated endometrial change, pyometra, retained placenta, and uterine synechiae manifested with similar thick endometrium with “Swiss cheese” appearance in transvaginal sonographic images. The most common diagnosis in postmenopausal women was atrophic endometritis, followed by endometrial cancer and endometrial polyps. The most common diagnosis in premenopausal women was abnormal uterine bleeding without pathologic conditions.CONCLUSIONS: Sonographic findings of thick uterine endometrium with “Swiss cheese” appearance need to be considered together with a thorough review of the patient's history and chief complaint before making a tentative diagnosis due to the various conditions sharing the feature.

Tratamiento con plasma autólogo rico en plaquetas en una paciente estéril con un endometrio refractario / Treatment with rich platelets autologous plasma in a sterile patient with suspected refractory endometrium

Paciente de 36 años con esterilidad primaria de 2 años. Tras estudio completo se decide donación de ovocitos. En los controles se observa un grosor endometrial adelgazado. Con el diagnóstico de endometrio refractario, se realiza un tratamiento con estrógenos a altas dosis, vitamina E y pentoxifilina durante 3 meses. Como el grosor endometrial no aumenta, asociamos AAS. Finalmente se administra intraútero plasma autólogo rico en plaquetas. A las 96 horas se observa un endometrio de 7,3 mm, transfiriéndose dos embriones vitrificados, resultando en un aborto bioquímico. Discusión: El tratamiento médico del endometrio refractario constituye un reto. Existen numerosas opciones terapéuticas, hormonales y no hormonales. Sin embargo, la mayoría de estas opciones están escasamente evaluadas por lo que se requieren de estudios mejor diseñados y con mayor tamaño muestral (AU)

36 years old patient with primary sterility of 2 years. An oocyte donation was decided after the study. An endometrial thickness slimmed was observed in different visits. With the diagnosis of refractory endometrium, a treatment was performed with high-dose estrogen, vitamin E and pentoxifylline for 3 months. As the endometrial thickness did not increase, we associated AAS. Finally intrauterine platelet-rich autologous plasma was administered. At 96 hours 7.3 mm of endometrium was observed, two vitrified embryos transferred, resulting in a biochemical abortion. Discussion: The medical treatment of refractory endometrium is a challenge. There are many therapies, hormonal and nonhormonal options. However, most of these options are poorly evaluated so they require better designed studies and larger sample size (AU)

Cerclaje, tratamiento quirúrgico conservador en embarazo ectópico cervical, tres casos. Instituto Salvadoreño del Seguro Social, Hospital Materno Infantil 1 de Mayo / Cerclage, conservative surgical treatment in cervical ectopic pregnancy, three cases. Instituto Salvadoreño del Seguro Social, Hospital Materno Infantil 1 de Mayo

Menos del 1% de los embarazos ectópicos se implantan en el canal cervical por abajo del orificio cervical interno, la etiología de esta implantación es desconocida aunque se asocia a curetaje previo, síndrome de Asherman, leiomiomas, presencia de DIU entre otras. Timor-Tritsch define el diagnóstico ecográfico como el saco coriónico implantado debajo de OCI, canal cervical dilatado, embrión con latido cardiaco o presencia de infiltración cervical confirmada por Doppler. No existe un consenso en relación al tratamiento de esta condición, se ha tratado con Metrotexate sistémico o intracervical, embolización arterial selectiva, aspiración guiada por ecografía, aunque la histerectomía fue el tratamiento en los casos de sangrado incontrolable...

Medicina natural y tradicional en el tratamiento de 3 mujeres con síndrome de Asherman / Natural and traditional medicine in the treatment of 3 women with Asherman syndrome

Se presentan 3 casos clínicos de féminas con síndrome de Asherman, procedentes del Policlínico Docente Ramón López Peña, tratadas con medicina natural y tradicional. Se aplicaron técnicas bioenergéticas (acupuntura y microsistema de oreja, hidroterapia, dietas hipotóxicas, reflexoterapia podal) y de respiración. Todas las pacientes mejoraron su cuadro clínico, pues se le restableció el flujo menstrual y la gestación, lo cual demostró la eficacia del tratamiento empleado(AU)

Three case reports of females with Asherman syndrome, belonging to Ramón López Peña Teaching Polyclinic, treated with natural and traditional medicine are presented. Bioenergetic techniques (acupuncture and ear microsystem, hydrotherapy, hipotoxic diets, foot reflex therapy) and breathing techniques were applied. All the patients improved their clinical pattern, because the menstrual flow and pregnancy were reestablished, which demonstrated the effectiveness of the treatment(A)

Medicina natural y tradicional en el tratamiento de 3 mujeres con síndrome de Asherman / Natural and traditional medicine in the treatment of 3 women with Asherman syndrome

Se presentan 3 casos clínicos de féminas con síndrome de Asherman, procedentes del Policlínico Docente "Ramón López Peña", tratadas con medicina natural y tradicional. Se aplicaron técnicas bioenergéticas (acupuntura y microsistema de oreja, hidroterapia, dietas hipotóxicas, reflexoterapia podal) y de respiración. Todas las pacientes mejoraron su cuadro clínico, pues se le restableció el flujo menstrual y la gestación, lo cual demostró la eficacia del tratamiento empleado.

Three case reports of females with Asherman syndrome, belonging to "Ramón López Peña" Teaching Polyclinic, treated with natural and traditional medicine are presented. Bioenergetic techniques (acupuncture and ear microsystem, hydrotherapy, hipotoxic diets, foot reflex therapy) and breathing techniques were applied. All the patients improved their clinical pattern, because the menstrual flow and pregnancy were reestablished, which demonstrated the effectiveness of the treatment.

Achados histeroscópicos na cavidade endometrial após ablação endometrial / Hysteroscopic appearance of the endometrial cavity after endometrial ablation

OBJETIVO: Verificar o aspecto da cavidade uterina após a ablação endometrial histeroscópica, a prevalência de sinéquias após o procedimento e, com isso, avaliar a importância da histeroscopia realizada no pós-operatório dessas pacientes. MÉTODOS: Foram avaliados, retrospectivamente, os laudos dos exames de 153 pacientes que haviam sido submetidas à histeroscopia ambulatorial após ablação do endométrio devido a sangramento uterino anormal de causa benigna, no período entre janeiro de 2006 e julho de 2011. As pacientes foram divididas em dois grupos: HIST≤60 (n=90), com pacientes submetidas ao exame no período de 40 a 60 dias após o procedimento, e grupo HIST>60 (n=63), das que foram examinadas entre 61 dias e 12 meses. RESULTADOS: No grupo HIST≤60, 30% das pacientes apresentavam algum grau de sinéquia; aderências grau I foram descritas em 4,4%; grau II em 6,7%; grau IIa em 4,4%; grau III em 7,8%; e 2,2% apresentavam grau IV. No HIST>60, sinéquias foram descritas em 53,9% dos casos, 3,2% tinham sinéquias grau I; 11,1%, grau II; 7,9%, grau IIa; 15,9%, grau III; e 4,8%, grau IV. Hematometra foi descrito em 2,2% dos casos do HIST≤60 e em 6,3% no HIST>60. CONCLUSÕES: A cavidade uterina de pacientes submetidas à histeroscopia ambulatorial até 60 dias após a ablação endometrial mostrou menor número de sinéquias quando comparada com as cavidades uterinas de pacientes que foram submetidas ao exame após 60 dias. Acompanhamento em longo prazo é necessário para avaliar plenamente o impacto da histeroscopia ambulatorial após a ablação endometrial. .

PURPOSE: To examine the aspect of the uterine cavity after hysteroscopic endometrial ablation, to determine the prevalence of synechiae after the procedure, and to analyze the importance of hysteroscopy during the postoperative period. METHODS: The results of the hysteroscopic exams of 153 patients who underwent outpatient hysteroscopy after endometrial ablation due to abnormal uterine bleeding of benign etiology during the period from January 2006 to July 2011 were retrospectively reviewed. The patients were divided into two groups: HIST≤60 (n=90) consisting of patients undergoing the exam 40-60 days after the ablation procedure, and the group HIST>60 (n=63) consisting of patients undergoing the exam between 61 days and 12 months after the procedure. RESULTS: In the HIST≤60 group, 30% of the patients presented some degree of synechiae: synechiae grade I in 4.4% of patients, grade II in 6.7% , grade IIa in 4.4%, grade III in 7.8%, and grade IV in 2.2%. In the HIST>60 group, 53.9% of all cases had synechiae, 3.2% were grade I, 11.1% grade II, 7.9% grade IIa, 15.9% grade III, and 4.8% grade IV. Hematometra was detected in 2.2 % of all cases in group HIST≤60 and in 6.3% of all cases in group HIST>60. CONCLUSIONS: The uterine cavity of the patients submitted to diagnostic hysteroscopy up to 60 days after endometrial ablation showed significantly fewer synechiae compared to the uterine cavity of patients who underwent the exam after 60 days. Long-term follow-up is necessary to fully evaluate the importance of outpatient hysteroscopy after endometrial ablation regarding menstrual patterns, risk of cancer and prevalence of treatment failure. .

Síndrome Asherman / Síndrome Asherman

El síndrome de Asherman también llamado sinequias uterinas o adherencias uterinas es una condición que se caracteriza por la presencia de adherencias y/o fibrosis en la cavidad uterina debido a cicatrices. Se han utilizado otros términos para referirse esta entidad como adherencias intrauterinas traumáticas, atresia cervical/uterina, esclerosis endometrial, y otros...

Broad spectrum of hysteroscopic surgery / 대한산부인과학회지

OBJECTIVE: To evaluate the spectrum of hysteroscopic surgery to be extended. METHODS: Total 1101 women who had undergone hysteroscopic operations with Urione(R) solution and Normal saline as distension media between Feberary 2001 and December 2008 were selected. Clinical characteristics, laboratory data and postoperative result were retrospectively analyzed. RESULTS: Hysteroscopic myomectomy was 884 cases. hysteroscopic polypectomy was 447 cases. Hysteroscopic adhesiolysis was 89 cases. Hysteroscopic adenomyomectomy or adenomyolysis was 66 cases. Hysteroscopic IUD removal was 31 cases. Hysteroscopic ablation for DUB and endometrial hyperplasia was 32 cases. Hysteroscopic septolysis was 18 cases. Hysteroscopic conceptus removal was 6 cases. Mean size of myoma was 3.4 cm. Mean operation time was 47 minutes. Mean deficit of distension media was 193 cc. Average duration of hospitalization was 4.9 days. Average change of Hb. was 1.5 g/dL. Complications of hysteroscopic operation were 16 cases. That is uterine perforation (n=9), hyponatremia (n=2), pulmonary edema (n=2), delayed bleeding (n=2) and bladder perforation (n=1). CONCLUSION: The indication of hysteroscopic op. can be very extended. Pure intramural myoma, subserosal myoma, endometrial polyps, adenomyosis, uterine synechiae, uterine septum, endometrial hyperplasia, DUB and ectopic conceptus can be resected by hysteroscopic operation. Intraoperative ultrasonographic guidance is very important. It makes the complication and morbidity rate to be lower.

Analysis of 81 cases of congenital anomalies of the vagina / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the types, clinical features and therapeutic approaches of congenital anomalies of the vagina.</p><p><b>METHODS</b>The clinical data of 81 patients with congenital anomalies of the vagina were analyzed retrospectively.</p><p><b>RESULTS</b>There were 5 types in these 81 patients, and 16 (19.7%) patients showed absence of the vagina, 15(18.5%) had vaginal obstruction, 10 (12.3%) had transverse vaginal septum,14(17.2%) had longitudinal vaginal septae,18(22.2%) had septum obliquus, and 8 (9.8%) had imperforate hymen. Forty-eight (59.2%) patients presented with primary amenorrhea, and 22(27.1%) complained of irregular pelvic pain. Fifteen of the patients with absent vagina underwent amnion artificial vaginoplasty, and the others were treated with incising and removing the septum, all having good clinical outcomes.</p><p><b>CONCLUSION</b>Amnion artificial vaginoplasty is a good option for treatment of absent vagina.</p>

The surgical treatment of severely injured vagina / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the surgical methods of treating severely injured vagina.</p><p><b>METHODS</b>A retrospective study was carried out on the clinical materials and results of 7 patients suffered from severe vaginal injury.</p><p><b>RESULTS</b>Different surgical approaches such as trans-suprapubic, transperineal or both approaches were applied according to the position of the atresia, meanwhile, different surgical methods such as skin graft, free flap transplantation, vaginal mucous flap advancement, direct anastomosis of the two ends, "Z" plasty was used to repair the vagina according to the different defect of the vagina, except for 1 case complicated with vaginorectus fistula, all the other cases were achieved satisfactory results.</p><p><b>CONCLUSIONS</b>The accurate judgment of the severity of the vaginal injury and the understanding of the changed anatomy around the injured vagina was the key points to the success of the surgical treatment of traumatic vaginal atresia.</p>

Hidrometrocolpos y polidactilia en una niña de dos años: síndrome de McKusick-Kaufman / Hydrometrocolpos and polydactytly in two-years-old girl: McKusick-Kaufman syndrome

Se conoce por hidrometrocolpos la distensión del útero y la vagina causada por la obstrucción al drenaje de las secreciones genitales. Aunque la mayoría de los casos son esporádicos, el hidrometrocolpos puede formar parte de un síndrome de herencia autosómica recesiva, el síndrome de McKusick-Kaufman, que se caracteriza por polidactilia postaxial, alteraciones cardiacas congénitas e hidrometrocolpos, como manifestaciones principales. En niñas con polidactilia, la presencia de una masa quística en pelvis debe alertar siempre de la posibilidad de un hidrometrocolpos. El diagnóstico ecográfico puede ser difícil, por lo que el estudio se completará con una vaginocistoscopia cuando se sospeche su existencia. Presentamos el caso de una niña de dos años y medio con hidrometrocolpos y polidactilia postaxial. Se describen los hallazgos clinicopatológicos en el contexto del espectro del síndrome de McKusick-Kaufman (AU)