[Oncogynecological aspects of adnexal masses].

UNLABELLED: Adnexal masses are frequently found in both symptomatic and asymptomatic women. The frequency of them is 7,8% in reproductive aged women and 2,5-18% in postmenopausal patients. AIM: to investigate clinical significance of the Risk of Malignancy Index (RMI) and to compare it with histological findings in patients with adnexal masses. PATIENTS AND METHODS: 345 patients with adnexal masses were evaluated. Depending on the menopausal status, serum CA-125 level and ultrasonographic findings RMI scores were calculated for each of patients. RESULTS: according to RMI all the patients were divided in to two groups: first group - 283 (62%) of patients with RMI less then 200 and the second group -52 (38%) women with RMI more then 200. The patients of the second group were referred to the oncologist. Among the patients with RMI <200, 137(48,4%) endometriomas, 73(25,8%) serous cystadenoma, 45(15,9%) dermoid cysts, 22(7,8%) paraovarian cysts, 2 (0,7%) adenocarcinoma were detected after histological examination. In patients with RMI >200, 25% of benign ovarian tumors, 34,6% of borderline and 40, 4% of malignant tumors were verified. CONCLUSIONS: RMI when used in the presence of a pelvic mass is a useful triage tool to determine those women who should be referred to a gynaecological oncologist. During laparoscopy, in cases of intraoperative malignancy suspicion staging should be performed: videorecord of the surgery, biopsy of the adnexal mass and contralateral ovary, biopsy of the omentum and peritoneum, and aspiration of the peritoneal fluid for cytological examination.

[Role of the genetic factors, detoxication systems and oxidative stress in the pathogenesis of endometriosis and infertility (review)].

The aim of this paper is to provide a systematic review of the role of the genetic factors, detoxication systems and oxidative stress in the pathogenesis of endometriosis and infertility. Endometriosis and infertility are still both the most uncommon diseases in gynecology. Many aspects of female reproductive function are strongly influenced by genetic factors, and numerous studies have attempted to identify susceptibility genes for disorders affecting female fertility such as polycystic ovary syndrome, endometriosis, fibroids, cancer (ovarian, vulvar, cervical), premature ovarian failure, recurrent pregnancy loss and pre-eclampsia. The most solid evidence linking specific polymorphisms to endometriosis is showed by the studies investigating a phase II detoxification enzyme. No data were found concerning influences of the genetic factors on the female infertility. Contrary, a lot of studies devoted to the genetic factors of male infertility are presented. It's known that endometriosis associated with increased systemic oxidative stress. The implication of increased systemic oxidative stress in disease progression or the association with other oxidative stress-related pathologic conditions needs to be addressed in further studies. The majority of studies suggest a reduced antioxidant capacity in infertile wome with endometriosis. In the present review we discussed the role of the genetic factors in the pathogenesis of endometriosis and infertility. NAT2 polimorphism, xenobiotic methabolism and exogenous factors are somehow related with these diseases. An altered balance between pro-oxidant antioxidant activities may have an impact on folliculogenesis and adequate embryo development.

[Clinico-dermatoglyphic correlations in patients with hyperandrogenia]. / Kliniko-dermatoglificheskie paralleli u patsientok s giperandrogeniei.

A clinical dermatoglyphic study of 100 infertile hyperandrogenic patients demonstrated signs of androgenization in all of those. Their dermatoglyphic parameters differed from normal. Hyperandrogenic patients with treatment-resistant infertility showed a higher degree of androgenization and more significant deviations of dermatoglyphic parameters, as compared to the patients whose treatment resulted in pregnancy. Dermatoglyphic characteristics should be taken into account in predicting the practicability of treatment in patients with infertility due to hyperandrogenism.

[Results of laparoscopy in patients with polycystic ovary syndrome after surgical treatment]. / Rezul'taty laparoskopii u patsientok s sindromom polikistoznykh iaichnikov, perenesshikh khirurgicheskie metody lecheniia.

Laparoscopic studies have been done in 42 patients after laparotomic ovarian wedge resection (group 1), 12 women after laparoscopic ovarian thermocauterization (group 2) and 24 patients after laparoscopic ovarian wedge resection (group 3). Prominent adhesions were found out in the pelvis in group 1 women and milder ones in group 2 patients. The incidence of adhesions was significantly lower in group 3. It suggests that wedge resection using laparoscopy represents a method of choice for surgical ovarian correction.

[Characteristics of hirsutism in fertile Russian and Armenian women and in infertile patients]. / Charakter ochlupení u fertilních zen ruské a arménské národnosti a u neplodných pacientek.

The authors investigated the characteristic features of pubescence in healthy fertile women of Russian (n = 300) and Armenian nationality (n = 150) and in infertile patients (n = 300). They assessed the criteria or normal female pubescence, liminal pubescence and hirsutism in the two populations. In healthy Armenian women the criteria of normal female pubescence and hirsutism are more marked (p less than 0.001) than in Russian women. In Armenian women significantly more frequently (p less than 0.05) an increased sensitivity of the skin to testosterone was observed, as compared with Russian women. In infertile patients hirsutism was found in 20%.

[Value of roentgenography of the bones of the skull vault and the sella turcica for the prognosis of the effectiveness of the treatment of infertility in patients with hyperandrogenia]. / Znachenie rentgenografii kostei svoda cherepa i turetskogo sedla v prognozirovanii éffektivnosti terapii besplodiia u patsientok s giperandrogeniei.

Thorough clinical and roentgenological examinations of the skull were conducted in 83 infertile patients with hyperandrogenism. The parameters of their health status evidenced various degrees of androgenism. The roentgenological picture of their skull and Turkish saddle was significantly different from the normal one. A small and round-shaped pattern of the Turkish saddle was significantly more often documented in the hyperandrogenic females whose infertility treatment was a failure. These prognostic criteria should be considered when the practicability of the treatment for this pattern of infertility is discussed.

[Multiple correlation analysis of hormone parameters in sterile female patients with hyperandrogenism (correction of endometriosis)]. / Mnohocetná korelacní analýza hormonálních parametru u sterilních pacientek s hyperandrogenismem (correction of endometriózou).

The authors examined 100 infertile women of reproductive age with various degrees of hyperandrogenism. As a result of multiple correlation analysis it was found that the state of hirsutism and the ratio of body weight to height are the most sensitive indicators of the testosterone action in reproductive age (r = + 0.56, p less than 0.1, r = + 0.60, p less than 0.05). There was no correlation between LH, FSH, PRLI, E2 T and K values. The assembled results suggest the variable character of factors which influence clinical manifestations of the disease and explain the heterogeneity of symptoms.

[Clinical manifestations of hyperandrogenism in infertile women]. / Klinické projevy hyperandrogenismu u neplodných zen.

The authors investigated clinical manifestations of hyperandrogenism in infertile women with hirsutism. Assessment of accurate quantitative indicators (hirsutic number, clitoral index, body mass growth coefficient and morphogram) made it possible to characterize the manifestations of hyperandrogenism in infertile women (n = 112). Correlation analysis revealed that the state of hirsutism and the body mass growth relations are the most sensitive indicators of the action of androgens (testosterone) in fertile age.

[Diagnostic and surgical laparoscopy in polycystic ovary syndrome]. / Diagnosticheskaia i operativnaia laparoskopiia pri sindrome polikistoznykh iaichnikov.

A total of 202 patients with polycystic ovaries were involved in examination. The study has distinguished the laparoscopic signs of polycystic ovaries: smooth glossy tightly stretched surface of the ovaries with a characteristic vascular pattern or loops; the presence of subcapsular cysts. Ovarian section shows small cysts with transparent or yellowish contents. The histologic signs are thickening of the protein coating, increased count of primary, secondary and cystic atretic follicles (by 2-5 times) and a lowered level of tertiary follicles. Clinical and hormonal signs include disordered rhythm of the menstrual cycle, stable anovulation, a high (over 2) LH/FSH index, an elevated T level. Laparoscopic resection of the ovaries to make their size normal is a method of choice among this technique, standard or wide ovarian biopsy.

[Comparative study of the diagnostic value of hysterosalpingography and laparoscopy]. / Sravnitel'noe izuchenie diagnosticheskoi cennosti gisterosal'pingografii i laparoskopii.

A total of 100 women had either hysterosalpingography with watersoluble Verografin or lipidsoluble Jodlipol for the assessment of tubal patency. Of these, all had laparoscopy. Laparoscopy have been shown to be the best test of tubal abnormalities. Hysterosalpingraphy with lipidsoluble contrast medium is poorly informative while the method of investigating the tubal pathology and cannot be used in clinical practice.

[Androgenization in patients with polycystic ovary syndrome]. / Androgenizatsiia u bol'nyh s sindromom polikistoznyh iaichnikov.

150 infertile patients with the polycystic ovary syndrome (PCOS), aged 19 to 36 years, have been investigated. PCOS was diagnosed on the basis of clinical symptoms, and the diagnosis was verified by laparoscopy, followed by histologic investigation of ovarian biopsy specimens. Hirsutism was found in 43% of the patients, while hair growth was marginal in 30% and normal in 27%. Testosterone (T) levels were increased significantly (p less than 0.05) in the PCOS patients with hirsutism or marginal hair growth, as compared to reference values.

[Endoscopic surgery in the treatment of polycystic ovary syndrome]. / Endoskopicheskaia hirurgiia v lechenii sindroma polikistoznyh iaichnikov.

202 patients with the polycystic ovary syndrome (PCOS) were investigated and divided into three groups depending on the variant of endoscopic surgical correction of polycystic ovaries. The highest conception rate (70.6%) was noted in group III; the ovaries of patients in this group were reduced to normal size as a result of dissection. We conclude that endoscopic resection of polycystic ovaries with reduction of ovarian size to normal limits may be considered a preferred variant of surgical treatment for PCOS.

[Clinical and laboratory findings in patients with infertility and various forms of hyperandrogenism]. / Kliniko-laboratornye pokazateli u patsientok s besplodiem pri razlichnykh formakh giperandrogenii.

The study groups included 120 infertile females with hyperandrogenism: group I-47 patients with androgenic adrenal hyperfunction; group II-51 patients with androgenic adrenal and ovarian hyperfunction; group III-22 patients with androgenic ovarian hyperfunction. The patients with an adrenal pattern of hyperandrogenism demonstrated lower degrees of androgenization (lower hirsutism and clitorism) as well as a less pronounced impairment of the menstrual cycle versus the examinees from the other groups mentioned.

[The effect of a decrease in body weight in patients with the polycystic ovary syndrome]. / Vliianie snizheniia massy tela u bol'nykh s sindromom polikistoznykh iaichnikov.

Eighty patients with the polycystic ovaries syndrome and excessive body mass were examined. In 60 patients body mass reduction resulted from diets and in 20 it occurred over the course of acupuncture. Such treatment resulted in pregnancy in 27 (33.7%) patients. Therefore, diets or acupuncture for body mass reduction are recommended for patients with polycystic ovaries and obesity as the first stage of treatment.

[The polycystic ovary syndrome and increased body mass]. / Sindrom polikistoznyh iaichnikov i izbytochnaia massa tela.

Eighty patients with the polycystic ovarys syndrome (PCOS) and excessive body weight were investigated. Weight loss was achieved by means of a diet in 60 patients, and acupuncture in 20 patients. This kind of treatment resulted in pregnancy in 27 (33.7%) patients. Therefore therapeutic diet or acupuncture may be recommended as the first stage of treatment for weight reduction in PCOS patients.

[Effectiveness of infertility therapy in patients with hyperandrogenism]. / Effektivnost' terapii besplodiia u pacientok s giperandrogeniei.

170 patients of reproductive age with hyperandrogenemia and infertility were examined. 101 (59.4%) patients became pregnant after the complete therapy of infertility. The examination of patients after non-effective therapy stated that they had had more height stage of androgenemia and remarkable deviation in results of genetic observation in comparison with the same indications of the pregnant women.