Case Reports

(1971). Distinguishing between the chromosomes involved in Down's syndrome (trisomy 21) and chronic myeloid leukemia (Ph') by fluorescence. Nature, 230, 167-168. usual finding in true hermaphroditism with the exception of a limited few who demonstrate a 46,XY chromosomal complement or a variant due to mosaicism. The diagnosis of true hermaphroditism requires the demonstration of both ovarian and testicular tissue in the same individual. These patients usually have varying degrees of ambisexual development. The testicular tissue is generally located in the scrotum or outside the abdomen, while the ovarian tissue is usually found in an intra-abdominal position. Hinman (1935) classified true hermaphroditism into four categories. (1) Bilateral with testis and ovary or ovotestis on each side and usually demonstrating a uterus and tubes. (2) Unilateral with ovotestis on one side and an ovary or testis on the other side (these appear to be the most frequent). (3) Lateral with testis on one side and an ovary on the other side. (4) Indeterminates with no conformity as to location or type of gonadal tissue. Case Report Clinical History and Details of Surgical Repair. The patient was a well developed, well nourished, alert, cooperative 3-year-old Tunisian child with no visible ana-tomic abnormalities other than ambiguous genitalia. He was the 3rd sib of a normal healthy young mother aged 26 at the birth of the propositus. There was no history of hormonal therapy or other medication taken prenatally. The pregnancy was normal and delivery in a local Tunisian hospital was without incident with a sage-femme (midwife) in attendance. There was no history of con-sanguinity nor was there a history of any similar defect in the family. The child progressed normally, walked and talked at approximately one year. This child was being reared as a male despite the fact that the ambiguous genitalia were noted at birth. Physical examination of the external genitalia revealed a small phallus which lacked a penile aperture. A slit-like mucosal lined aperture resembling a urogenital sinus was located on the ventral side at the base of the phallus. Urine was voided through this slit-like aperture and caused the child no discomfort. The scrotum was not fused and gave the appearance of labia. Palpable masses in both inguinal areas could be expressed downward into the labia like structures. A chordee was present. Laboratory examinations were not remarkable; creatinine, urea, total protein, and electrolytes were all within normal range. Urinary excretion of …