Creation of a neovagina following Williams vaginoplasty and the Creatsas modification in 111 patients with Mayer-Rokitansky-Kuster-Hauser syndrome

Objective: Evaluation of the Creatsas modification of Williams vaginoplasty for the creation of neovagina in patients with Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH syndrome). Design: Record of perioperative and postoperative results and complications, Follow-up evaluations of patients yearly after the operation. Setting: Division of Pediatric-Adolescent Gynecology and Gynecologic Corrective Surgery, University of Athens (tertiary referral center). Patient(s) One hundred eleven patients with MRKH syndrome. Intervention(s): Surgical creation of neovagina using the Williams vaginoplasty technique (group A: 10 patients) or the Creatsas modification of the previous method (group B: 101 patients). Main Outcome Measure(s): Length and width of the neovagina, and the quality of sexual life postoperatively. Result(s): A functioning vagina of 10 to 12 cm depth and 5 cm width was created in eight of the patients in group A (80%) and in 98 of those in group B (97.02%). A vagina of 7 to 9 cm depth and 2 to 3 cm width was created in the rest of the patients in both groups. In group A, two wound openings were reported (20%); in two of the patients hemorrhage occurred during the first intercourse, compared to none in group B. A satisfactory sexual life was reported from 94.47o of the patients and an adequate one from 4.16% of them. Conclusion(s): The Creatsas modification of Williams vaginoplasty is a simple and effective technique for the creation of a functioning neovagina in young women with vaginal aplasia. (C) 2001 by American Society for Reproductive Medicine

Development of leiomyomas on the uterine remnants of two women with Mayer-Rokitansky-Kuster-Hauser syndrome

Objective: To describe two cases of leiomyoma development in patients with Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH syndrome). Design: Case report. Setting: Second Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Athens, Greece. Patient(s): A 42-year-old woman with MRKH syndrome presented with lower abdominal pain, and a 38-year-old woman with MRKH syndrome presented with an asymptomatic left adnexal mass. Interventions(s): Clinical examination, transabdominal ultrasonography, IV urography, laparoscopy. Main Outcome Measure(s): Ultrasound. Result(s): In both cases, laparoscopy revealed a leiomyoma originating from the left uterine remnant. The leiomyomas and the adjacent uterine remnants were laparoscopically excised. Conclusion(s): In rare cases, leiomyomas can originate from the fibromuscular tissue of uterine remnants in patients with MRKH syndrome

Measurable serum markers of oxidative stress response in women with endometriosis

Objective: To evaluate the hypothesis of increased systemic oxidative stress in patients with endometriosis. Setting: Tertiary care university hospital. Design: Cross-sectional study. Patient(s): Sixty-six women of reproductive age undergoing laparoscopy. Intervention(s): All women were investigated for endometriotic foci during laparoscopy. Forty-five women had laparoscopically and histologically confirmed endometriosis, and 21 women did not have endometriosis. Main Outcome Measure(s): Four markers of oxidative stress were assessed in the serum of each patient: heat shock protein 70 (HSP70), HSP70b′, thioredoxin (TRX), and ischemia-modified albumin (IMA). Result(s): Mean serum HSP 70b′ level was higher in patients with endometriosis compared with controls (0.178 ng/mL, SD 0.103, and 0.135 ng/mL, SD 0.014, respectively). The disease stage did not affect HSP70b′ levels. Heat shock protein 70, IMA, and TRX levels did not differ between patients with endometriosis and controls. Women with a history of arterial hypertension had higher mean IMA levels compared with women with normal blood pressure independently of the presence of endometriosis (106.7 [SD 25.4] U/mL and 85.0 [SD 11.5] U/mL, respectively). Conclusion(s): Endometriosis is associated with increased systemic oxidative stress. The implication of increased systemic oxidative stress in disease progression or the association with other oxidative stress-related pathologic conditions needs to be addressed in further studies. © 2009 American Society for Reproductive Medicine

Synchronous primary ovarian and endometrial carcinomas

The purpose of this study was to describe the diagnosis, treatment, and follow-up of patients with concomitant primary ovarian and endometrial carcinomas. From a database of 339 endometrial and ovarian carcinomas, 9 patients with synchronous primary ovarian and endometrial malignancies were studied. Four patients (44%) had endometroid carcinoma in the ovaries and the endometrium, and 5 (56%) had differing histology. The mean age of the 9 patients was 55.4 +/- 5.1 years. Abnormal uterine bleeding was the main symptom in 4 patients (44.4%), whereas three (33.3%) presented with pelvic pain and 2 (22.3%) with ascites. All 9 women underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. In 4 cases, omentectomy and lymphadenectomy was also carried out. Peritoneal washing showed positive results for malignant cells in 4 cases. In 8 patients, chemotherapy was administered after the operation. All patients have remained alive without evidence of recurrence 5-8 years after the operation (100% 5-year survival rate). It is concluded that the frequency of synchronous primary ovarian and endometrial carcinomas is 2.6%, and the prognosis following appropriate treatment is favorable

Ovarian masses during adolescence: clinical, ultrasonographic and pathologic findings, serum tumor markers and endocrinological profile

This retrospective study was undertaken to assess the epidemiological and clinical features, laboratory findings, preoperative work-tip, surgical treatment and pathologic findings in adolescents with ovarian cysts. All adolescents who were referred to our institution and had been operated on because of a diagnosed ovarian mass, from January 1997 to June 2003, were included in this study. Forty-four cases of women with an ovarian mass were retrospectively analyzed. These patients, aged between 12 and 21 years, had 47 ovarian masses (three patients had bilateral lesions), of which 49% were non-neoplastic and 51% were neoplastic. Of the neoplastic lesions, 62.5% were germ cell tumors, 20.8% were epithelial and 16.7% were sex cord-stromal tumors. Of the neoplastic tumors, 95.8% were benign while 4.2% were malignant. Procedures included 30 operative laparoscopies (68.2%) and 14 exploratory laparotomies (31.8%). Simple excision of the ovarian cyst was performed in 39 cases (88.6%). According to our study, most of the adolescents with an ovarian cyst underwent an operation because of a neoplastic lesion. The majority of ovarian tumors occurring in adolescents are non-epithelial in origin, and germ cell tumors are the most common histological type. Ultrasound examination is one of the most important diagnostic tools. Preoperative diagnostic approach of these patients should always include careful history taking, physical examination, imaging and evaluation of serum assays. Gynecologists who care for young girls must be familiar with the differential diagnosis of ovarian masses whose surgical treatment should be conservative when appropriate, so that hormonal status and future fertility are not compromised in this group of patients