Effects of a surgical treatment of congenital cervicovaginal agenesia.

OBJECTIVE: Congenital agenesis of the uterine cervix and vagina is one of the rarest congenital defects. The objective of this manuscript is to present our experience and effects of a surgical treatment in five girls with inborn agenesis of the uterine cervix and vagina, who were operated in our clinic. METHOD: The vagina is reconstructed in four stages: (1) formation of vaginal recess; (2) phantomization of vagina; (3) joining of the reconstructed vagina with the uterus; (4) revision and correction of the junction. GnRH analogs were administered to avoid menstrual blood flow into the peritoneal cavity during phantomization. RESULTS: Patency of the uterovaginal junction was maintained with a #6 intubation tube. Normal menstruation was restored in all patients. Atresion of the canal at the uterovaginal junction was disclosed after 3-8 months in three of the patients. Patency was restored with surgical hysteroscope and the canal was mechanically distended. Clinical and ultrasonographic followup in the patients will continue.

Is neuropeptide Y responsible for constitutional delay of puberty in girls? A preliminary report.

Constitutional delay of puberty (CDP). in otherwise healthy girls is defined as failure to develop secondary sexual features past the age of 13 years (two standard deviations above the mean age at which secondary sexual features appear in the population of girls). The inhibitory action of neuropeptide Y (NPY) on the gonadotropic and somatotropic systems in experimental animals and stimulation by NPY of the hypothalamic-pituitary-adrenal axis have been reported, prompting us to study the levels of NPY, insulin-like growth factor-I (IGF-I) and cortisol in eight girls with CDP and normal weight (body mass index (BMI) 21.7+/-4.5 kg/mn2). The results were compared with those from a group of 40 girls (BMI = 20.0+/-3.1 kg/m2) who demonstrated a normal course of puberty (NP). All girls were studied at menarche (mean age at menarche, study vs. control: 16.4+/-0. 7 vs. 12.6+/-0.9 years). To measure NPY and IGF-1 we used a radioimmunoassay method, whereas cortisol was measured with an enzyme immunoassay. Blood was collected between 08.00 and 09.00 following an overnight fast. NPY was higher in girls with CDP (181.6+/-106.4 pg/ml) than in girls with NP (55.5+/-26.3 pg/ ml; p < 0.001). In the former group, cortisol was higher (397.3+/-241.6 nmol/l) than in NP girls (142.7+/-98.0 nmol/l; p < 0.01). Levels of IGF-I in CDP girls were lower than in NP girls (558.0+/-122.6 vs. 756.5+/- 226.8 ng/ml; p < 0.01). The results corroborate the involvement of NPY in sexual maturation and its role in delayed puberty.

Leptin, neuropeptide Y, beta-endorphin, gonadotropin, and estradiol levels in girls before menarche.

More than two decades of clinical studies have provided us with the opportunity to develop and implement criteria that distinguish three phases during pre-menarche, paralleling rising levels of estrogens, namely 'pre-estrogenization', 'onset of estrogenization' and 'full estrogenization'. The aim of this study was to examine the relationships between somatic features and levels of leptin, neuropeptide Y (NPY), beta-endorphin, gonadotropin and estradiol in pubertal girls before menarche. Weight, height, body mass index (BMI), tertiary sex features, estrogen-related changes in hymen, fat and lean body mass were studied on a quarterly basis in 45 girls. At the same time, ovarian and uterine dimensions were established sonographically and serum was obtained for the determination of leptin, NPY, beta-endorphin, gonadotropin, and estradiol levels. Onset of estrogenization in girls was marked by weight loss, followed by an increase in total, fat and lean body mass, and pubertal acceleration of growth. At the time of full estrogenization, lower NPY and beta-endorphin levels were observed, accompanied by an increase in gonadotropin secretion. Changes in leptin levels are consistent with a role of this hormone in metabolic signaling.

[Adolescent endometriosis]. / Endometrioza u dziewczat.

DESIGN: The aim of our study was estimation of frequency of occurrence endometriosis at girls operated from different indications, research of predisposing factors and estimation of selected biophysical parameters. MATERIAL AND METHODS: Material determined 14 of patients in 13 to 21 years old of life operated on account of endometriosis of sexual organs in our Clinic in years 1996-1999. We study the frequency of occurrence of illness, analysis of perceptible clinical reasons, clinical stage of disease using ASF classification. It was analysed according to gynaecological age of girls, periodical complaints, cystical changes in ultrasound investigation. In serum of blood the level of CA125 was analysed with ready sets of firm Abbott. Congenital malformations were classed according to Buttram classification. CONCLUSIONS: On base obtained of results one ascertained, that protracted pain in pelvis not responding to analgesic and antiphlogistic treatment is indication to complex diagnostics with regard of laparoscopy making possible diagnosis of endometriosis. One ascertained also, that sensibilizing of doctors on predisposing factors to formations of endometriosis (congenital malformations, intrauterine device) can contribute to preventive activities.

[Growth hormone, insulin, IGF-1 and estradiol levels during maturation of internal sex organs before and at menarche]. / Zmiany stezen GH, insuliny, IGF 1 i E2 oraz ich wplyw na wzrost wewnetrznych narzadów plciowych u dziewczat przed i w terminie menarche.

INTRODUCTION: The growth hormone (GH) is the main activator of growth, exerting its biological effects through IGF-1 and IGF-2 growth factors. Secretion of GH is partly controlled by steroid sex hormones. MATERIAL AND METHODS: Body mass, height, BMI, and body composition were recorded every three months in 45 healthy girls 8 years of age. Tertiary sex features according to Tanner were determined. Transabdominal ultrasound of the uterus and ovaries was done. GH, insulin, and IGF-1 levels in serum were measured radioimmunologically with commercial test kits. E2 levels were determined with an immunoenzymatic method. RESULTS: GH levels increased until stage M3 of breast maturation and gradually decreased during stage M4 (12 girls with menarche). IGF-1 and insulin levels continued to increase until stage M4. Uterine and ovarian dimensions correlated with levels of hormones studied. CONCLUSION: High levels of GH and IGF-1 during the early and central stages of puberty seem to affect the maturation of internal sex organs.

[Surgical treatment in child gynecology. Germ cell tumors of the ovary in girls]. / Leczenie operacyjne w ginekologii dziewczecej i dzieciecej. Nowotwory germinalne jajnika u dziewczat.

The authors presented 50 girls with germ cell tumours of the ovary. 9/50 (4.5%) were malignant germ-cell tumours. There were 5 patients with pure dysgerminomas, 1 with endotermal simus tumor, 3 with immature teratomas, 3 with gonadoblastoma, 38 with mature teratoma. Kariotype 46XY was present in patients. Authors prefer fertility sparing operative treatment. Primary postoperative therapy in malignant tumors was chemotherapy or radiotherapy. Authors recommend sift out ultrasonographic investigation. Girls should be individually considered for appropriate ovarian surgical procedures. The operative treatment should be as conservative as possible. Absence of follicle apparatus in the gonads require determination of levels of gonadotropin and kariotype.

[Ovarian cancer in girls]. / Rak jajnika u dziewczat.

DESIGN: The aim of our study was a clinical analysys of diagnosis, operative treatment and monitoring of epithelial ovarian cancer in girls. MATERIALS AND METHODS: Authors described 11 epithelial malignant tumors of ovaries in girls aged 12-16. Clinical aspects, pathology stage, grade treatment, monitoring and survival were evaluated. Three of the patients had ovarian cancer. A 19-year old patient with stage Ia of epithelial ovarian cancer was managed conservatively. Four years later she give birth. For 10 years no malignant of has been observed. Seven patients with ovarian borderline epithelial tumors were treated. The tumors in 5 patients were of serous and in 2 of mucinous type. CONCLUSIONS: We suggested that patients of stage I who wish to preserve childbearing function may be treated with unilateral salpingo-ovariectomy and chemotherapy.

[Operative treatment of developmental abnormalities of sexual organs in girls]. / Wady wrodzone narzadów plciowych u dziewczat.

DESIGN: The aim of our study was a clinical analysis of operative treatment of developmental abnormalities of sexual organs. MATERIALS AND METHODS: The authors describe developmental abnormalities of sexual organs in girls aged 12-19 79(1.4%) girls were treated from among 5432 surgically treated patients in the course 6 years. Among these abnormalities were the following: agenesia of vagina, agenesia of cervical canal, absence of cervix of uterus, obstructed normal or rudimental vagina, occlusion of hymen. There were complex abnormalities too. Congenital abnormalities were subject to the reconstructive operative treatment. CONCLUSIONS: We recommend that developmental defects should be treated in specialist centres well equipped and experience of in operative procedures and postoperative monitoring.

[Breast malignancy in girls]. / Rak sutka u dziewczat.

The authors described 19 year old patient with breast cancer and two teen-age patients with juvenile papillomatosis of the breast. Authors have postulated that among different problems of pediatric gynecology it is necessary to notice pathology of breast.

[Age at menarche and the investigation of selected biophysical parameters in the course of menarche]. / Wiek menarche i analiza wybranych parametrów biofizycznych w terminie menarche.

DESIGN: The aim of our study was a currently clinical analysis of menarche. MATERIALS AND METHODS: The mean age of menarche was investigated in 4497 girls between 1975-1997 69 girls were examined throughly in the course of menarche. Age at menarche, body weight, height, body mass index (BMI), some of the hormones and ultrasonography of sexual organs were investigated. RESULTS: We demonstrated that mean age of menarche was 13.1 year, height 159.2 cm, weight 48 kg, body mass index (BMI) 18.9. Mean size a mucous membrane was 5.7 mm. Ratio of uterus to cervix indicated dominance of the uterus. Mean levels of hormones were: E2--89.4 pg/ml, FSH--6.2 UI/ml, LH--5.7 UI/ml. Relation LH to FSH was nearly 1.

[Significance of ultrasonographic examinations in the diagnosis of premature and normal puberty in girls]. / Znaczenie badan ultrasonograficznych w diagnostyce przedwczesnego i prawidlowego pokwitania u dziewczat.

Dynamic and individual course of the processes being associated with puberty and also the necessity of establishing instantaneous diagnosis of disturbances occurring at that period made it indispensable to apply simple and non-invasive diagnostic methods. The aim of the study was to estimate the usefulness of ultrasonographic measurements of the first- and second-rate genital features in the course of normal puberty, as well as differentiating, on the basis of the said measurements, various forms of premature puberty. Ultrasonographic examination of the internal genital organs allows for their precise assessment, without any simultaneous invasiveness ascribed to the method. The study material comprised 248 girls. The normal puberty was evaluated in 138 girls. The studied girls were divided into groups by resorting to gynaecological criteria, it means, from the age proceeding since the menarche, considered as being modern and highly objective criteria of development. The study also included 64 girls with different forms of premature puberty, as well as a group of 46 healthy girls lodging in the same age compartment. All the studied persons were evaluated with regard to measurements of the ovary length, width, thickness and volume. The ratio of volume of the left ovary to the right one was calculated, with the size and the number of ovarian follicles being evaluated by employing the four-grade scale in own modification (F1 < 2 mm diameter, F2 < 3 mm, F3 < 5 mm, F4 > 5 mm). At evaluating the uterus, the accomplished measurements included the length of uterine cervix, the length, width, thickness and the volume of the body of the uterus. Next, the ratio of the cervical length to the body of uterus was calculated. The presence or absence of endometrium in the uterine cavity as well as within the cervical canal was estimated too. In menstruating girls the investigations were performed between 7-9 day of the cycle. The ultrasonographic examinations were carried out with a trans abdominal probe, the frequency being 3.5 or 5 MHz, with apparatus of Brüel & Kjaer or Acusson Companies. The established results were elaborated statistically. In the course of normal puberty the ovarian development is dynamic and involves both glands (Tab. 1-4). At the same period the body of the uterus increases while the cervical length remains unchanged (Tab. 6-9). The termination of the morphological development concerning the first- and second-rate genital features occurs at the time of gynaecological age +2. The girls with premature puberty of the central origin as compared with the control group display higher degree of development of the first- and second-rate genital features (Tab. 10-14). These differences are not observed in girls with premature development of mammary glands (Tab. 11-15) and also with premature growth of public hair (Tab. 12-16). The results of the studies have made it possible to provide the following conclusions: the ultrasonographic examinations of the first- and second-rate genital features constitute a valuable aid for determining the stages of normal puberty, thus facilitating the detection and differentiation of the disturbances. The ultrasonographic examination claims to be a basic diagnostic method for various forms of premature puberty.

[HPV virus infections and other promotion factors of the carcinogenic process in girls]. / Zakazenie wirusem HPV oraz inne czynniki promocyjne w procesie karcinogenezy u dziewczat.

HPV virus infections and other promotion factors in the development of carcinogenic process at 101 girls from different social groups were evaluated. Chronic infection of the cervix was found at the group of 56 smoking girls, aged 15-18, having sexual contacts with many partners. 10 of them were infected by HPV virus. These data indicate that particular health care and widely understood cervical carcinoma prophylaxis in such groups are necessary.

[Follow up results of treatment for premature puberty (central origin)]. / Odlegle wyniki leczenia przedwczesnego pokwitania pochodzenia osrodkowego.

Distant treatment results of premature central origin puberty with chlormadinone (Polfa) were described. Premature central origin puberty was diagnosed at 19% (38/202) of patients examined with premature puberty as a initial diagnosis. Annual medium height intake 5.5 cm +/- 1.2 cm and puberty inhibition testify to proper drug doses. Hormonal treatment should be employed till patients height is 150 cm, what is usually obtained at the age 9 at half. It makes possible to obtain final height of 162 cm +/- 4.2 cm. The average menarche age of treated girls was 10- and 11 months, and the first menstruation approximately 15 months after hormonal treatment.