Non-surgical vaginal dilation is a safe and effective method for the creation of neovagina in the patient with vaginal agenesis. Compared to surgical methods, non-surgical vaginal dilation has the advantage of low morbidity, the creation of a more physiologic vaginal milieu, and no surgical scarring. To overcome some technical limitations of original Frank's method, in 1981 Ingram proposed a modification of the technique that used dilators of gradually increasing size mounted on a bicycle seat stool. Although several studies have shown satisfactory outcomes using Ingram's method, there are some practical difficulties in making and handling the bicycle seat stool. This article reports a case of a 24-year-old woman with Mayer-Rokitansky-Kster-Hauser syndrome whose vaginal agenesis is successfully treated with a simplified version of Ingram's method. This method uses dilators of gradually increasing size mounted on an ordinary chair instead of a bicycle seat stool. When necessary, the patient may use a fulcrum under the dilator.
Vagina/*abnormalities/pathology ; Humans ; Gynecology/instrumentation/methods ; Female ; Adult ; Abnormalities/therapy

Non-surgical vaginal dilation is a safe and effective method for the creation of neovagina in the patient with vaginal agenesis. Compared to surgical methods, non-surgical vaginal dilation has the advantage of low morbidity, the creation of a more physiologic vaginal milieu, and no surgical scarring. To overcome some technical limitations of original Frank's method, in 1981 Ingram proposed a modification of the technique that used dilators of gradually increasing size mounted on a bicycle seat stool. Although several studies have shown satisfactory outcomes using Ingram's method, there are some practical difficulties in making and handling the bicycle seat stool. This article reports a case of a 24-year-old woman with Mayer-Rokitansky-Kster-Hauser syndrome whose vaginal agenesis is successfully treated with a simplified version of Ingram's method. This method uses dilators of gradually increasing size mounted on an ordinary chair instead of a bicycle seat stool. When necessary, the patient may use a fulcrum under the dilator.
Vagina/*abnormalities/pathology ; Humans ; Gynecology/instrumentation/methods ; Female ; Adult ; Abnormalities/therapy

We present a case of vaginal ectopic ureter with ipsilateral partial duplication of the upper ureter (Y-type ureter), ipsilateral hypoplastic pelvic kidney and bicornuate uterus in a 20-year-old woman who presented with mild urinary incontinence since infancy. Ultrasonography, computed tomography and intravenous pyelography examination showed a left kidney with no evidence of a right kidney. Cystourethroscopy showed absence of the right hemitrigone. Magnetic resonance (MR) urography demonstrated the presence of a bicornuate uterus, an ectopic dysplastic right kidney in the pelvic cavity, and a right ureter that terminates in the vaginae fornix. The patient underwent right nephroureterectomy and urinary continence was restored completely. Although congenital malformations of the urinary tract are frequently associated with genital tract abnormalities, to best our knowledge, this is the first report of the coexistence of all of these anomalies in an individual. Our report also highlights the importance of MR urography in the diagnosis of such rare and complex anomalies.
Female ; Humans ; Kidney ; abnormalities ; pathology ; Kidney Diseases ; diagnosis ; pathology ; Magnetic Resonance Imaging ; Ureter ; abnormalities ; pathology ; Urinary Incontinence ; etiology ; Uterus ; abnormalities ; pathology ; Vagina ; abnormalities ; pathology ; Young Adult

PURPOSE: To evaluate the relibility of transrectal ultrasonography (TRUS) to define adult female genital organ and to diagnose and stage the cervical carcinomas. METHODS AND MATERIALS: After analysis of normal ultrasonographic anatomy of female pelvis in ten healthy women, I performed TRUS in thirty patients of uterine cervical carcinomas by rotating the 5 MHz electronic linear array transducer(SL2, Siemens, Erlangen, Germany) along the reference sagittal plane in the middle of uterine cervix & vagina. The results of TRUS were analyzed and compared to FIGO, surgical pathology, CT and MRT, ect. RESULTS: TRUS allowed good visualization of the uterus, uterine cervix, parametrium, vagina, anterior rectal wall, walls of the urinary bladder, and uterine cervical carcinomas. The accuracy of staging with TRUS was 83%, compared with the accuracy of 67% for clinical staging according to the criteria of the International Federation of Gynecotogy and Obstetrics(FIGO). For extent of parametrial involvement, the sensitivity of TRUS was 93%, with the specificity of 86% and the diagnostic accuracy of 89%. The same reliability parameters for clinical evaluation were 71%, 79%, and 75% respectively. CONCLUSION: Above findings suggest that low-cost TRUS could be usefully applied to pretreatment evaluation of patients with uterine cervical carcinoma.
Adult ; Cervix Uteri ; Diagnosis* ; Female ; Genitalia ; Humans ; Pathology, Surgical ; Pelvis ; Sensitivity and Specificity ; Ultrasonography* ; Urinary Bladder ; Uterus ; Vagina

We report a case of mixed tumor arising in the lower vaginal wall. The patient was a 20-yr-old nullipararous woman. The tumor was relatively well-defined with expansile margin, and showed solid sheets or fascicles of stromal-type spindle cells and ovoid epithelial cells with sparsely scattered nests of mature squamous epithelium and glands lined by mucinous epithelium. Cellular atypia was not conspicuous, however, mitosis was counted upto 6 per 10 high power fields. We examined this tumor immunohistochemically and ultrastructurally and reviewed the articles to identify the histogenesis. Positive reaction for vimenin and cytokeratin of stromaltype spindle cells and presence of desmosome-like structures and tonofilaments on electron microscopic examination suggested the epithelial origin of the stromaltype spindle cells.
Adult ; Female ; Humans ; Immunohistochemistry ; Keratins/biosynthesis ; Microscopy, Electron ; Mitosis ; Mixed Tumor, Malignant/*diagnosis/pathology/ultrastructure ; Vagina/*pathology ; Vaginal Neoplasms/*diagnosis/pathology/ultrastructure ; Vimentin/biosynthesis

OBJECTIVE: To analyze magnetic resonance imaging (MRI) findings of Mullerian remnants in young females clinically suspected of Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome in a primary amenorrhea workup. MATERIALS AND METHODS: Fifteen young females underwent multiplanar T2- and transverse T1-weighted MRI at either a 1.5T or 3.0T MR imager. Two gynecologic radiologists reached consensus decisions for the evaluation of Mullerian remnants, vagina, ovaries, and associated findings. RESULTS: All cases had bilateral uterine buds in the pelvic cavity, with unilateral cavitation in two cases. The buds had an average long-axis diameter of 2.64 +/- 0.65 cm. In all cases, bilateral buds were connected with fibrous band-like structures. In 13 cases, the band-like structures converged at the midline or a paramedian triangular soft tissue lying above the bladder dome. The lower one-third of the vagina was identified in 14 cases. Fourteen cases showed bilateral normal ovaries near the uterine buds. One unilateral pelvic kidney, one unilateral renal agenesis, one mild scoliosis, and three lumbar sacralization cases were found as associated findings. CONCLUSION: Typical Mullerian remnants in MRKH syndrome consist of bilateral uterine buds connected by the fibrous band-like structures, which converge at the midline triangular soft tissue lying above the bladder dome.
Abnormalities, Multiple/*pathology ; Adolescent ; Adult ; Female ; Humans ; Kidney/abnormalities/pathology ; Magnetic Resonance Imaging/*methods ; Middle Aged ; Mullerian Ducts/abnormalities/pathology ; Retrospective Studies ; Somites/abnormalities/pathology ; Spine/abnormalities/pathology ; Uterus/abnormalities/pathology ; Vagina/abnormalities/pathology

PURPOSE: lntra-arterial cisplatin infusion chemotherapy delivers higher concentration of this therapeutic agent to the limited area of cervical carcinoma. We evaluated the role of endorectal ultrasonography (ERUS) in the analysis of the tumor response to this chemotherapy. MATERIALS AND METHODS: ERUS was done in 20 patients of cervical carcinomas limited to the pelvis by rotating the 5 UHz linear arraytransducer along the reference sagittal plane in the middle of uterine cervix and vagina. We examined and compared the change of tumor size and morphology on ER US, before, during and after intra-arterial cisplatin (50 mg/m2) chemotherapy through internal lilac artery near uterine arterial branching. Colposcopy and radical hysterectomy with pelvic lymphadenectomy were performed in all patients, and ERUS findingswere compared with those findings. RESULTS: ERUS correlated well with surgery in the estimation of preoperative tumor size and morphology. Tumor reduction rate on ERUS (100-the largest area of the preoperative tumor/the largest area of the initial tumor) was as follows: more than 75% decrease of the original size in 3 patients, 75% -50% in 6 patients, 50%-25% in 8 patients, and less than 25% in 3 patients. Hyperechoic reflecting areas were noted in 4 patients, which corresponded to gaseous necrosis on postoperative pathology. CONCLUSION: ERUS is helpful to evaluate the morphologic change of cervical carcinoma limited tothe pelvis in intra-arterial cisplatin chemotherapy.
Arteries ; Cervix Uteri ; Cisplatin* ; Colposcopy ; Drug Therapy* ; Female ; Follow-Up Studies* ; Humans ; Hysterectomy ; Lymph Node Excision ; Necrosis ; Pathology ; Pelvis ; Ultrasonography* ; Vagina

It is known that the subcutaneous injection of silicone can lead to severe pulmonary complications, followed in some patients by respiratory failure. Currently, silicone is being increasingly applied in the field of plastic surgery and, unfortunately, the illicit injection of silicone fluid by uncertified practitioners is not uncommon in Korea. We offer a critical pathologic review of 5 cases of pulmonary silicone embolism following illegal injection to the vaginal wall, four of which were fatal and came to legal autopsy. Our findings again confirm that subcutaneously injected silicone can gain access to the pulmonary vascular tree and cause pulmonary embolism. The histologic changes observed in the lung are variable and include four patterns i.e., the mere presence of silicone emboli, congestion and hemorrhage, acute pneumonitis, and diffuse alveolar damage despite the severe critical course in all cases. We were unable to find any histologic pattern that correlates well with the clinical course. Apart from producing emboli in the pulmonary vessels, subcutaneous injection of silicone can obviously cause serious pulmonary disease due to its ability to induce acute to induce acute pneumonitis and even possibly acute respiratory distress syndrome.
Adult ; Case Report ; Fatal Outcome ; Female ; Human ; Injections ; Middle Age ; Pulmonary Embolism/*chemically induced/*pathology ; Silicones/administration & dosage/*adverse effects ; Vagina

PURPOSE: This study was done to determine whether muscle strength training programs have an impact on improving symptoms of urinary incontinence (UI) and physical function among elderly women with UI who reside in long-term care facilities. METHODS: A randomized controlled trial was conducted. Participants had to be over 65 years, score over 15 score on the mini-mental state examination, and be able to walk alone or with an assistant. Seventy residents were randomly allocated to either the training group (n=35) or control group (n=35). The program consisted of 50 minutes, twice a week for 8 weeks, and included Kegel's exercise, Thera-band training and indoor walking. Main outcomes were UI symptoms, peak vaginal pressure and physical functions measured with timed up and go test (TUG), one leg standing test (OLST), activities of daily living (ADL) and grip strength. Changes in outcome measurements were calculated from baseline to 4 weeks and to 8 weeks using repeated measures ANOVA. RESULTS: There were significant differences in peak vaginal pressure (p<.001), TUG (p<.001), OLST (p=.012) and grip strength (p<.001) in the interaction between groups and time. CONCLUSION: Future studies are suggested to confirm the effect of muscle strength training in long-term care facilities where elderly women with UI reside.
Aged ; Aged, 80 and over ; Female ; Hand Strength ; Humans ; Long-Term Care ; Muscle Strength/*physiology ; Resistance Training ; Urinary Incontinence/pathology/*therapy ; Vagina/physiology ; Walking

We would like to report a case of leiomyoma of the ovaries in a dog. Leiomyoma is commonly seen in the vagina in dogs. However, it is a very rare neoplasm in the ovaries. As there have only been a few reported cases, this report provides valuable information on veterinary medicine and pathology. Masses found in the ovaries need to be differentiated from other ovarian tumors. Therefore, we describe the gross, histopathological, and immunohistochemical features of a case of ovarian leiomyoma in a 10-year-old female Yorkshire Terrier dog. The mass on the right of the uterus was found accidentally by pelvic ultrasonography. Laparatomy revealed a large multi-nodulated ovarian mass. Grossly, cut surfaces of the mass showed multiple firm whitish nodules in the cortex and bloody loose connective tissue in the medulla. Histopathologically, the cortex of the mass was composed of spindle cells forming interlacing fascicles. The cells had elongated, blunt-ended nuclei and eosinophilic cytoplasm as detected by hematoxylin and eosin staining. Immunohistochemical stained sections were immunoreactive for alpha-smooth muscle actin and desmin but negative for vimentin and S-100. Therefore, differential diagnosis confirmed leiomyoma based on morphology and positive staining for alpha-smooth muscle actin and desmin.
Actins ; Animals ; Child ; Connective Tissue ; Cytoplasm ; Desmin ; Diagnosis, Differential ; Dogs* ; Eosine Yellowish-(YS) ; Eosinophils ; Female ; Hematoxylin ; Humans ; Leiomyoma* ; Ovary* ; Pathology ; Ultrasonography ; Uterus ; Vagina ; Veterinary Medicine ; Vimentin