Uterine retroversion for vaginoperineal reconstruction following resection of distal rectal tumors.

PURPOSE: Vaginal and perineal reconstruction following wide resection of locally invasive rectal cancer can be challenging. Various techniques have been reported, all of which contribute the additional morbidity inherent in tissue procurement. We present a technique applicable to nonhysterectomized patients who undergo posterior vaginal wall reconstruction with retroversion of the in situ uterus. METHODS: Four nonhysterectomized patients with recurrent rectal carcinoma and abdominoperineal resection with en bloc resection of the posterior vagina leaving a large defect necessitating reconstruction of the vagina, perineum, or both, have undergone posterior vaginal wall and perineal reconstruction with uterine retroversion into the posterior pelvis and fixation to the perineum. RESULTS: Satisfactory vaginoperineal reconstruction was achieved in all our patients at 3 months. In addition, patients are able to resume sexual activity after tissue re-epithelialization. CONCLUSION: Uterine retroversion is a viable option for vaginal and perineal reconstruction.

Obstetrical factors governing the etiopathogenesis of lambdoid synostosis.

Lambdoid synostosis results in skull deformities of varying degrees characterized by occipital flattening over the involved suture and other compensatory changes in skull shape. Such changes include contralateral occipital bossing, contralateral frontal flattening, ipsilateral frontal bossing, and ipsilateral anteroinferior displacement of the pinna (ear shearing). These deformities tend to worsen during the first year of life. The etiology has been attributed to genetic factors and primary disorders of bone growth, in addition to secondary effects of other diseases and modulators of the in utero environment. To determine causal factors in the development of lambdoid synostosis, the authors reviewed medical records of the mothers of 13 children with lambdoid synostosis who were treated at the University Medical Center of the State University of New York at Stony Brook. Pre- and perinatal events, prior obstetrical, gynecological, medical, social, and family histories were considered. Births of normal infants immediately prior to and just after the affected babies were born were selected as controls. There is a significant association between increased duration of the first stage of labor and the development of lambdoid synostosis. Furthermore, our results indicate that this condition has a predilection toward male infants, and may be associated with preterm labor.