Septate uterus with double cervix and longitudinal vaginal septum. A case report.

BACKGROUND: Congenital uterine anomalies in the general population are estimated to have an incidence of 0.001-10%. The septate uterus, the most common form of structural uterine anomaly, has the highest reproductive failure rate. A rare developmental variant is a septate uterus with cervical duplication and a complete longitudinal vaginal septum. The existence of this anomaly challenges classical müllerian developmental theory. Traditional transabdominal metroplasty has been replaced by operative hysteroscopy in the surgical correction of a septate uterus, with laparoscopy aiding in the diagnosis and contributing to the safety and efficiency of the procedure. CASE: A 28-year-old, nulliparous woman with a septate uterus with cervical duplication and complete longitudinal vaginal septum was diagnosed by combined laparoscopy and hysteroscopy. Excision of the complete longitudinal vaginal septum followed by hysteroscopic partial resection of a thick uterine septum with laparoscopic assistance was performed. However, because of the septum's broad base and the rigidity of the operative resectoscope, we opted to proceed with transabdominal metroplasty. CONCLUSION: Only six cases of septate uterus with cervical duplication and complete longitudinal vaginal septum have been reported. Although its counterpart, the septate uterus, has effects on preterm labor, fetal presentation, infertility and spontaneous abortion, its reproductive outcome has not been assessed. Review of the literature suggests that surgical correction in the setting of poor reproductive outcome has been beneficial. Laparoscopically assisted hysteroscopic resection of the uterine septum is a safe, effective surgical technique of uterine reunification and is preferable to transabdominal methods. However, in certain cases, conventional transabdominal metroplasty may still be required.

Color Doppler aided prenatal diagnosis of a type 1 cystic sacrococcygeal teratoma simulating a meningomyelocele.

Type 1 cystic sacrococcygeal teratomas, usually associated with good outcome following neonatal resection, must be differentiated at the time of prenatal diagnosis from sonographically similar meningomyeloceles, which carry a grave prognosis. We present an unusual case in which color Doppler imaging assisted correct midtrimester prenatal diagnosis of a large type 1 cystic sacrococcygeal teratoma closely simulating a meningomyelocele.

Comparison of Maxon suture with Vicryl, chromic catgut, and PDS sutures in fascial closure in rats.

Two hundred ten rats were randomized into one of five study groups to compare standard absorbable sutures with a new synthetic absorbable suture. We evaluated Maxon (polyglyconate), Vicryl (polyglactin), chromic catgut (catgut), and PDS (polydioxanone) with respect to tissue inflammatory reaction, knot security, suture tensile strength, and suture absorption. The results indicate that Maxon and PDS elicited a lower degree of chronic inflammation when compared with Vicryl and chromic catgut. The tensile strengths of Maxon and Vicryl significantly exceeded those of PDS and chromic catgut during the critical period of wound healing. Maxon and PDS retained a larger percentage of tensile strength during the long postoperative period, whereas Vicryl and chromic catgut were mostly absorbed. Maxon is an excellent addition to the armamentarium of the gynecologic surgeon.

Human papillomavirus: detection of viral DNA sequences and evidence for molecular heterogeneity in metaplasias and dysplasias of the uterine cervix.

Colposcopic-directed biopsies of the uterine cervix from 22 patients were analyzed for the presence of human papillomavirus (HPV) DNA and structural antigens. 11 of the biopsies were classified microscopically as mild dysplasia, 3 as moderate dysplasia, 1 as severe dysplasia, and 7 as squamous metaplasia. Nonstringent hybridization with a bovine papillomavirus type 1 DNA probe and immunocytochemical analysis with an antiserum against papillomavirus genus-specific structural antigens were performed on all specimens. Of the 11 mild dysplasias, both HPV DNA and structural antigens were detected in 5, only HPV antigens in 3, only HPV DNA in 1, and neither DNA nor structural antigens in 2. Both HPV DNA and structural antigens were present in the 3 cases of moderate dysplasia. Only HPV DNA sequences were detected in the single case of severe dysplasia. HPV DNA was detected in 2 cases of squamous metaplasia. The 5 remaining cervical biopsies showing squamous metaplasia, tissue from 3 placentas, and 6 cervical carcinomas were negative for HPV DNA and structural antigens. Restriction enzyme cleavage patterns of HPV DNA in the dysplasias suggested that there are multiple virus types or subtypes associated with cervical dysplasia. Stringent hybridization with a HPV type 11 (HPV-11) probe revealed that only 1 of 10 dysplasias contained sequences with homology to the probe. Of the remaining 9 dysplasias, 5 contained HPV sequences detected under nonstringent hybridization. 2 of 4 squamous metaplasias contained viral sequences which hybridized to the HPV-11 probe as well as 1 of 6 cervical carcinomas.

Papillomavirus infection of the cervix I. Correlation of histology with viral structural antigens and DNA sequences.

Eight cervical biopsies showing mild dysplasia and one showing squamous metaplasia were studied for the presence of papillomavirus (PV) antigens using an immunoperoxidase method having immunospecificity against the genus-specific (common) structural antigen(s) and for PV-specific DNA sequences by molecular hybridization under nonstrigent conditions. Of the eight cases showing mild dysplasia, both PV antigens and PV DNA sequences were detected in five, PV antigens only in one, and PV DNA sequences only in one; viral antigens and DNA sequences were not detected in the remaining lesion. A characteristic cellular atypia (PV-induced atypia) was present in the superficial and intermediate layers of the epithelium in the six cases positive for viral antigens, and a proliferation of basal and parabasal cells (PV-induced hyperplasia) occurred in five of these. PV structural antigens were localized within nuclei of some of the cells displaying atypia but not in the proliferating cells. The PV-specific DNA sequences in all six cases had the properties of unintegrated PV-DNA. In view of the demonstration of both PV antigens and DNA sequences in this distinctive lesion (PV-induced atypia and/or hyperplasia), traditionally regarded as a form of dysplasia, it is proposed that this lesion be referred to as "papillomavirus infection of the cervix."