Laparoscopic repair of bilateral inguinal hernias in a patient with müllerian agenesis.

OBJECTIVE: To report a case of laparoscopic repair of bilateral inguinal hernias in a patient with müllerian agenesis. DESIGN: Case report. SETTING: Hospital. PATIENT(S): An 18-year-old woman with müllerian agenesis who presented with symptomatic inguinal hernias containing ovaries. INTERVENTION(S): Laparoscopic repair of bilateral inguinal hernias. MAIN OUTCOME MEASURE(S): Hernia repair was accomplished laparoscopically. RESULT(S): Outpatient laparoscopic repair of bilateral inguinal hernias with reduction of ovaries was performed using an extraperitoneal approach without complication. CONCLUSION(S): Laparoscopic approach of inguinal hernias can be an option for surgical repair in patients with müllerian agenesis even when the hernias contain ovaries.

Production of testosterone and estrogen in vitro by gonadal tissue from a 46,XY true hermaphrodite with gonadal failure and gonadoblastoma.

A phenotypic female patients with 46,XY true hermaphroditism and clitoromegaly was found at laparotomy to have normal müllerian structures with a right streak gonad and a left dysgenetic ovotestis that contained a gonadoblastoma. Karyotypes of peripheral lymphocytes and cells from labial skin and both gonads were all 46,XY, so an unrecognized mosaic or chimera was unlikely. Tissue from both gonads was studied in vitro and estrogen and testosterone production measured. The streak produced 186.6 pg/mg/24 hr of estrogen and 78 pg/mg/24 hr of testosterone, whereas the dysgenetic ovotestis produced 85.8 pg/mg/24 hr of estrogen and 184.6 pg/mg/24 hr of testosterone (more than double the testosterone produced by the streak). Comparisons between these data and those previously published suggest that dysgenetic streak gonadal tissue is more active steroidogenically than postmenopausal ovarian stroma.

Late recurrences of gestational trophoblastic neoplasia.

Presented are two cases of recurrence of gestational trophoblastic neoplasia more than 1 year after apparently successful therapy. Both patients initially had had nonmetastatic disease, were clinically free of disease, and had had repetitively negative serum radioimmunoassay titers for the beta subunit of human chorionic gonadotropin for 2 to 3 years. The development of these late recurrences re-emphasizes the need for prolonged follow-up monitoring of patients after apparently successful therapy for gestational trophoblastic neoplasia.

Prolactin-producing pituitary tumors: medical therapy.

Although the traditional alternatives for treatment of pituitary tumors have been radiotherapy or surgery or both, further investigation and better understanding of the pathophysiology of this disturbance might make it possible to select a few small pituitary tumors to treat with bromoergocryptine with only a slight risk if pregnancy occurs. Although it appears that the risks of pregnancy are minimal in small tumors, it is still necessary to follow the patients through pregnancy to avoid any catastrophic events. The use of medical therapy in selective patients at minimal risk may thus avoid the risk of surgical procedures and the loss of other trophic hormone function from radiotherapy.

Spontaneous regression of prolactin-producing pituitary adenomas.

Two women evaluated for amenorrhea, galactorrhea, and hyperprolactinemia had radiographic changes of the sella turcica (localized erosion on trispiral tomography) suggestive of a pituitary tumor. Both patients experienced spontaneous regression of apparent prolactin-secreting adenomas with a marked decrease in the quantity of galactorrhea and a reduction of serum prolactin concentrations to the normal range. One patient noted a marked improvement of headaches and spontaneous menses resumed in the other patient.

The obstetrical management of conjoined twins.

A pair of conjoined twins (thoracopagus) was delivered abdominally after antepartum diagnosis. Obstetrical planning is more likely to be successful with antepartum diagnosis, which can be done only if the possibility of conjoining is considered with each twin gestation. Once a twin gestation is suspected, ultrasonography should be performed for confirmation. Conjoined twins should be suspected in a gravid mother with multiple gestations and an abnormal fetal attitude. When the images cannot be separated on ultrasonography, amniographic examination, using a double contrast medium of oil-water, should demonstrate dye in the gastrointestinal tract and a union between the twins, as well as establish the presence of a monoamniotic sac. Because of increased fetal morbidity and mortality of vaginal delivery in monoamniotic twins, even if not conjoined, elective cesarean section at term will ensure the best chance for fetal survival.