Martin Farber

Congenital absence of the uterine cervix

Surgical correction of congenital atresia of the uterine cervix by creation of a fistulous communication between the functioning endometrial cavity and the vagina with the use of the atretic cervix as a conduit has been performed in two patients. This technique, which permits egress of menstrual blood and the retention of the capacity to reproduce, should replace hysterectomy as the treatment of choice for this extremely unusual and formerly hopeless Müllerian duct anomaly.

surgery For Congenital Absence Of The Vagina

The Counsellor modification of McIndoes procedure was used to create a vagina in 12 of 15 patients who presented with Rokitansky-Kuster-Hauser syndrome. Eighty percent of these patients, followed postoperatively from 4 months to 8 years, report satisfactory coital function. Our experience suggests that a malleable stent fashioned to conform to the surgically created neovagina is superior to a preformed, nonmoldable stent to which the endopelvic fascial dissection must conform.

Reconstructive Surgery for Congenital Atresia of the Uterine Cervix

Reconstructive surgery for congenital atresia of the uterine cervix, utilizing the atretic cervix as a conduit for the permanent fistulous communication between the endometrial cavity and vagina, has resulted in the establishment of cyclic menses in four patients followed for up to 27 months postoperatively. A detailed review of maternal obstetric histories failed to reveal a common factor causally related to this extremely unusual and formerly hopeless congenital anomaly of the Müllerian ducts.

Bicornuate uterus and partial atresia of the fallopian tube.

Partial atresia of the fallopian tube was discovered in two patients with double uteri of the bicornuate variety. The abnormal tube in each case was ipsilateral to a noncommunicating, nonfunctioning, rudimentary uterine horn. A normal fimbriated end led to a short, patent ampullary portion that ended blindly in the mesosalpinx. Realization of the potential for the coexistence of congenital malformation of the fallopian tubes with various uterine malformations suggests that extreme caution be exercised during adnexal surgery in patients with anomalous development of the müllerian ducts.

Diagnostic Evaluation of Hirsutism in Women by Selective Bilateral Adrenal and Ovarian Venous Catheterization*†*Supported in part by General Clinical Research Centers Branch Grant RR-0054.†Presented at the Thirty-Fourth Annual Meeting of The American Fertility Society, March 29 to April 1, 1978, New Orleans, La.

To determine the most significant secretory source of their androgens, 13 hirsute nonvirilized women underwent selective bilateral adrenal and ovarian venous catheterization to obtain effluent blood for the assay of testosterone and delta4-androstenedione. In three patients the testosterone and delta4-androstenedione gradients were significantly greater in the adrenal venous effluents. Testosterone and delta4-androstenedione gradients were significantly greater in the ovarian venous effluents in four patients. In six patients there were no significant differences in the testosterone gradients between the adrenal and ovarian venous effluents. The delta4-androstenedione gradients were greater in the adrenal venous effluents in three of these patients, greater in the ovarian venous effluents in one, and not significantly different in two of these patients. The fact that the measurement of urinary 17-ketosteroid excretion, the suppressibility of peripheral plasma androgens with dexamethasone, and the stimulation of peripheral plasma androgens with human chorionic gonadotropin correlated poorly with the selective catheterization data suggests that the former modalities are imprecise in the diagnostic evaluation of hirsutism in women.