Management and outcome of patients with combined vaginal septum, bifid uterus, and ipsilateral renal agenesis (Herlyn-Werner-Wunderlich syndrome).

OBJECTIVE: Herlyn-Werner-Wunderlich syndrome (HWWS) is a rare müllerian anomaly consisting of uterine didelphy, hemivaginal septum, and ipsilateral renal agenesis. The purpose of this study was to evaluate the natural history and outcome of patients with HWWS. METHODS: With ethics review board approval, all patients with uterine/vaginal anomalies were reviewed between 1982 and 2004. Patients with cloacal and/or anorectal anomalies were excluded. Presenting symptoms, preoperative investigations, operative management, and long-term follow-up were assessed. RESULTS: Of 80 patients identified with uterine/vaginal anomalies, 12 had HWWS. Median age at presentation was 13 years. Most patients (11/12) in this series presented with either abdominal pain and/or pelvic masses. Two patients had intra-abdominal abscesses. Seven patients were menstruating at presentation with 4 of these patients having dysmenorrhea. Symptom duration ranged from 0.5 to 12 months. Diagnosis was confirmed by ultrasound (n = 11), computed tomographic scan (n = 3), and/or magnetic resonance imaging (n = 2). Operative management included vaginal septectomy and drainage of the hematocolpos/hematometrocolpos. One patient required salpingectomy for pyosalpinx. Follow-up ultrasounds revealed no recurrent collections. Median follow-up was 3 years (2 months to 16 years). Eleven patients were asymptomatic after treatment. One patient complained of irregular menses. CONCLUSION: This is one of the largest reviews of HWWS in pediatric patients to date. Good long-term outcome occurs after vaginal septectomy. This diagnosis should be suspected in females with a pelvic mass and ipsilateral renal agenesis.

Cortisol levels and conduct disorder in adolescent mothers.

OBJECTIVE: To examine the association between cortisol levels and conduct disorder (CD) in adolescent mothers. Past research has shown that low levels of cortisol were associated with CD, particularly with its aggressive symptoms. The authors tested the hypothesis that adolescent mothers with CD would show lower levels of salivary cortisol compared to mothers without CD at 4 and 9 months postpartum. METHOD: Midmorning salivary cortisol levels were measured in 228 adolescent mothers (age at delivery 16.9 +/- 1 years [mean +/- SD]) during a laboratory visit at 4 and 9 months postpartum. CD was diagnosed during pregnancy according to the CD subsection on the criteria for antisocial personality disorder (DSM-III-R). RESULTS: Results did not confirm the hypothesis. Lower cortisol levels were not significantly associated with a CD diagnosis, the number of CD symptoms, or aggressive symptoms. CONCLUSIONS: Despite valid measures and strong statistical power, this study failed to find an association between cortisol levels and CD in a sample of adolescent mothers. The results may have been influenced by the fact that participants were 4 and 9 months postpartum and by comparisons of mothers with CD to mothers living in stressful circumstances.