True hermaphrodite, 46,XX/46,XY karyotype with surgical reconstruction of ambiguous genitalia: a case report and literature review.

A 17-year-old phenotypic female with ambiguous genitalia is presented. The patient complained of progressive dysmenorrhea, passing urine and menstrual blood through the same opening since menarche. Pelvic examination revealed and enlarged clitoris with prominent phallus, an enlarged right labio-scrotal fold with palpable gonad and a 3 mm diameter opening of both the urethral meatus and vaginal orifice at the vestibule. Chromosome analysis showed 46,XX/46XY karyotype. Laparotomy via right inguinal incision confirmed true hermaphroditism because of finding a right unilateral ovotestis. Factors leading to delay in presentation are discussed and the need for early diagnosis and management is emphasized. The clinical, cytogenetic features, gonadal histology and management are described and discussed.

A cost-effectiveness analysis of routine pretreatment investigation for staging in cervical cancer patients.

Two methods of analysing the cost-effectiveness of routine pretreatment investigation of 524 cervical cancer patients were studied. It seems to be cost-effective to perform the complete pretreatment investigation only in patients at clinical stage III, while in initial stage I and II patients, only chest X-ray and IVP should be performed. This will be more significant if most of the patients are in an early stage and the hospital costs are higher, as well as the very high professional fees for private consultations especially in the developed countries. Following this suggestion, the direct and indirect cost to the patients and their relatives will be reduced without compromising the treatment of cervical cancer.