Resectoscopic treatment of complete longitudinal vaginal septum.

Every gynecologist can easily recognize vaginal abnormalities and the subsequent disturbances of sexual function, such as dyspareunia and apareunia, arising from them. In the case of congenital vaginal septum, it is extremely important to completely assess the abnormality before planning for surgical treatment. Because normal vaginal development is subsequent to the canalization and fusion of the two Müllerian ducts once vacuolization has occurred, but not their union, a duplication of different degree will be the consequence. If the defect is complete, a didelphys uterus with a double vagina will result. The aim of our report is to describe the endoscopic technique used to treat three cases of complete longitudinal vaginal septum and to highlight the main differences between our technique and the standard surgical procedure.

Precancerous lesions of the uterine cervix.

The presence of mucous and non-pathologic elements liable to hamper analysis of the smear is one of the main problems in ploidy assessment of precancerous cervical lesions. For our study, we employed a sampling system guided by microcolpohysteroscopy, which we used to identify the pathologic zone and select the morphologically altered elements only. Fifty-five cervical lesions and 6 negative controls were analyzed. All controls and 24 lesions were diploid, 15 polyploid and 16 aneuploid. All but one aneuploid lesions had a histological diagnosis of GIN. We failed to observe any significant difference in the aneuploid percentage of high and low grade lesions while diploid cases decreased in proportion to the severity of the lesion. The samples obtained had the advantage of being representative, technically valid and at the same time extremely suitable for an automated image analysis of ploidy. Thus this new sampling method could be extensively used.

Operative Laparoscopy for the Treatment of Ovarian Dermoids

From January 1, 1991, to October 31, 1993, 67 patients with a histologic diagnosis of benign cystic teratoma were treated by operative laparoscopy in nine centers in Rome. The mean age of patients was 29.7. years, ranging from 16 to 45 years. The mean diameter of the cysts was 41.6 mm, ranging from 20 to 120 mm. The procedures were completed by laparoscopy in 62 cases (92.5%) whereas 5 cases were converted to laparotomy. Conservative treatment was performed in all cases except seven cases (10.44%), where ovariectomy was performed. No recurrences occurred in all patients, with a follow-up of at least 3 months. We conclude that operative laparoscopy can be considered a valid alternative to classic laparotomy for dermoid cysts.

Flow cytometric DNA analysis of the human cervix affected by human papillomavirus and/or intraepithelial neoplasia.

The relative DNA contents of 164 cellular samples from 59 patients affected by the viral cytopathic effects (VCE) of human papillomavirus (HPV) infection and/or by cervical intraepithelial neoplasia (CIN) and 12 cellular samples from 12 normal donors were analyzed by flow cytometry (FCM) with the aim of correlating the cytometric measurements with the morphologic and etiologic parameters. The unselected group of 59 patients was found to be characterized by statistically significant differences in average ages in the VCE and CIN (31.4 years) and CIN only (44.8 years) subgroups. Of the pathologic samples, 32 (54%) exhibited at least one cell subpopulation with an abnormal DNA content; in all but 2 of those cases, a diploid cell subpopulation was also present. The results indicate a relationship between the FCM ploidy and the morphologic classification, as shown by the increase in the occurrence of subpopulations with abnormal DNA contents from VCE only (38%) to VCE + CIN 1 (57%), to VCE + CIN 2/3 (70%). These results suggest that cytometric parameters, in association with the determination of the HPV types and in parallel to the colpocytohistopathologic criteria, can contribute to a more accurate characterization of cervical lesions in diagnostic and prognostic terms.

Cervical isthmic adhesions and the endometrium: hysteroscopic study (suggestion for an endometrial inhibiting factor).

Our experience is based on 212 cases of uterine synechiae, 127 of which were located exclusively in the cervical isthmic area, while the entire cavity was free from adhesions. Notwithstanding this, many patients failed to achieve pregnancy until the scar was removed; likewise menstrual flow was improved after hysteroscopic removal of cervical adhesions. Is it possible to hypothesize an isthmic-endometrial reflex suppressing the endometrial response to the hormonal stimuli? In 76 of 127 observations (= 59.8%) the endometrium of otherwise normal cavity failed to be synchronous with the phase, showing the characteristic hysteroscopic patterns of hypo-atrophic or proliferative mucosa. The menstrual changes and pregnancies after adhesiolysis are reported, suggesting the possible explanation for such a phenomenon, pointing out the preliminary significance of our work, and the importance of further microscopic and ultrastructural studies.