[Paediatric and adolescence gynaecology in Czech Republic]. / Gynekologie detí a dospívajících v Ceské republice.

Pediatric gynecology is a subdivision of gynecology and obstetrics and completes its care of women. The founder of the subject, Rudolf Peter, considered its essential role in the prevention of woman infertility. Important difference represents the lack of estrogens and the absence of sexual life. The most frequent diseases of this age are vaginal discherge (vulvovaginitis), bleeding during non-estrogenized period, onset and disturbancies of menstrual cycle, labial adhesions, congenitalal malformations, disorders of pubertal development and tumors. Pediatric gynecology is an independent specialization in the respect to Insurance companies, it is an independent professional specialization (attestation) and it has its own international exam IFEPAG. Pediatric gynecologists are organized in the Czech Society of Pediatric and Adolescent Gynecology CLS JEP and internationally in FIGIJ federation. Both organizations organizes Czech and international scientific congresses.

[Autoimmune ovarian failure in adolescent girls]. / Autoimunitní poskození ovarii u dospívajících dívek.

BACKGROUND: The aim of the study was to map the incidence of antiovarian antibodies (AOA) in adolescent girls with ovarian cycle irregularities in comparison with girls with the regular cycle. The relation between the AOA positivity and structural changes in the bioptic samples of ovaria was examined. MATERIAL AND RESULTS: The studied cohort included 39 girls with primary amenorrhea (N = 18) and oligo/secondary amenorrhea (N = 21). All patients were tested for the presence of antiovarian antibodies (AOA) in the serum and levels of FSH and LH. The examination was done at the beginning of the study and after six months of therapy, in most of the cases by the hormone substitution treatment. In indicated cases the laparoscopic ovarian biopsy was done. A patients with serious failure of ovarian cycle the positivity of antibodies against various components of ovaria was found. Significantly higher levels of FSH was also found, LH levels were not higher. In our patients the depletion and alteration of the follicular apparatus in the cortex of ovaria belonged to the common findings. The control examination after the six month of hormonal substitution brought about lower levels of AOA, in some patients AOA fully disappeared. CONCLUSIONS: Incidence mapping of antiovarian antibodies in patients with ovarian cycle irregularities correlate with findings of elevated atresia. Ovarian cycle irregularities can later or earlier turn into the extinction of the follicular apparatus and fibrotization of the ovarian cortex.

[Hydatic cysts--echinococcosis]. / Echinokoková nákaza--echinococcosis.

The case diagnosis and treatment of hydatic cyst in the right and left lobe of the liver in a 28 year old pregnant woman is described in the article.

Treatment of autoimunne ovarian damage in adolescent girls.

INTRODUCTION: To investigate levels of antiovarian autoantibodies in girls and young women with disturbances of menstrual cycle before and during treatment with hormonal therapy. To explain morphological changes in ovarian structure in these patients. MATERIAL AND METHODS: Studied group included 39 patients. 18 patients were treated for primary amenorrhoea, 21 for menstrual cycle disorders. Patients included in the study were repeatedly examined at the beginning of the study and after six months during which they were treated by estrogen and gestagen. In all patients we have tested FSH, LH and FSH/LH ratio, presence of antiovarian antibodies. Results were compared with those obtained in control women. 21 antiovarian antibodies positive patients were indicated for laparoscopic biopsy. Bioptic sample was examined using light and electron microscopy. RESULTS: Our treatment with hormonal therapy lead to the reduction of ovarian antigens. In 85% of the cases marked decrease of antiovarian autoantibodies levels was observed, while in 28% of the cases the levels were undetectable. From morphological changes of the bioptic sample enhanced atresia of follicules at different developmental stages was frequently observed. It evoked marked reduction of follicular apparatus up to its complete disappearing. CONCLUSION: The results of our study and mapping of the antiovarian antibodies positivity support our hypothesis that the antiovarian antibodies positivity corresponds with the clinical symptoms. Appropriate treatment with hormonal replacement therapy minimizes ovarian destruction, preserves ovarian hormonal functions and saves healthy ovarian tissue necessary for future fertility.

[Malignant tumors of the female genitalia in childhood--yesterday, today and tomorrow]. / Zhoubné nádory rodidel v detském veku vcera, dnes a zítra.

Genital tumors in children and adolescents represent 1.5 to 2.0% of al malignancies in these age groups. Organ incidence differs from that in adult women. In children and in young adolescents non-epithelial gynaecological tumors predominate, while carcinomas are rare and their incidence rises with the age of girls. Malignant tumors of the external genital are very rare (sarcomas of the soft tissues). Malignancies of vagina are represented by the embryogenic rabdomyosarcoma, yolk sack tumor and tumor of pale cells or vaginal adenocarcinoma. All these tumors are highly malignant. Cytostatics are used as the basic therapy and only later the less radical surgery is recommended. Radiotherapy is used in chemoresistant tumors. Vaginal bleeding of the premenarcheal girl is an early symptom and requires immediate examination, including vaginoscopy. Tumors of uterus in childhood do not occur and they are rare in postmenarcheal girls. Ovarian tumors represent about 1.5% of all tumors in childhood and adolescence and about 95% of all gynaecologic tumors. They differ in types from those of adults: Epithelial tumors (carcinomas) do not occur in childhood, germinal and gonadal stromal tumors are typical in this age. Mature differentiated teratomas are usually benign and the less differentiated they are, the worse biological effect they have (not mature or mixed teratomas). It seems that nowadays the proportion of immature and mixed teratomas has been rising. Dysgerminom occurs more frequently in Y-chromosome karyotypes. It has malignant progression with early propagation along lymph vessels into the lymph nodes. Beside ovarectomy, also lymphadenectomy at the affected side is performed and the treatment proceeds with chemotherapy. For the prognostic reasons, immunological examinations, DNA ploidity identification and other tests are recommended. Gonadal stromal tumors are always unilateral, malignant, and frequently hormonally active, but they usually have a good prognosis. In order to preserve fertility of the young girl with ovarian tumors, uterus should be spared as well as the macroscopically healthy contra-lateral ovarium. To protect gonad from the adverse effects of oncological treatment, pharmacologically induced regression to premenarcheal stadium has been tested. Present development of paediatric and adolescent gynaecology is aimed to preserve for patients with tumors all prospects of future pregnancy, either in the natural way or using methods of assisted reproduction with a donated oocyte. Complex treatment of gonadal malignancies in childhood in future will be aimed not only at the lifesaving but also at the preservation of the highest possible quality of life, including the motherhood.

[Growth and development in untreated girls with slowly progressing idiopathic central or borderline-onset puberty]. / Rust a vývoj nelécených dívek s pomalou progresí idiopatické centrální predcasné nebo hranicne nastupující puberty.

OBJECTIVE: To analyse growth and development of girls with slowly progressive idiopathic precocious or early puberty. DESIGN: Long-term open clinical study. SETTING: Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University, Prague. METHODS: In 20 untreated girls with slowly progressive puberty starting at 6-9 years neurogenic aetiology was excluded. During follow-up period 4.7 +/- 2.2 (2-8.5) years (mean +/- SD; range), sexual development (Tanner criteria), age at menarche, menstrual cycle and auxological parameters were evaluated. RESULTS: 13 girls reached menarche at 11.1 +/- 0.9 years (3.7 +/- 1.1 years after the onset of puberty), earlier than in their mothers (12.9 +/- 1.1 years) and Czech standards (P < 0.05). Menstrual cycle 28 (24-29) days was regular in all 6 girls with gynaecological age > 2 years. In one girl microprolactinoma was diagnosed, therapy with bromocryptine started at the age 14.7 years (3.5 years after menarche). At the onset of follow-up, bone age (TW20) advancement was 1.8 +/- 1.4 years above the chronologic age. Initial prediction of final height (graphic method) was 162.3 +/- 5.5 cm vs final prediction 163.7 +/- 5.1 cm. Final height 162.2 +/- 5.7 cm achieved 7 girls vs target height 163.6 +/- 5.2 cm (NS). CONCLUSION: In untreated girls, menarche occurred later after the first signs of puberty than in normal population, menstrual cycle was regular. Height potential was preserved, final height corresponded with their target height. Not all girls with early and slowly progressive puberty should be treated. Therapy is necessary in organic aetiology, rapid progressive precocious puberty and impaired growth prognosis.

[Turner syndrome: overview of problems, present status, proposals for care and a protocol for monitoring in childhood, adolescence and adulthood]. / Turneruv syndrom: prehled problematiky, soucasný stav, návrh koncepce péce a protokol sledování v detství, adolescenci a v dospelosti.

BACKGROUND: Girls and adolescents with Turner syndrome (TS) usually receive intensive medical care in a multidisciplinary team, coordinated by paediatric endocrinologist. Majority of them are discharged from specialist clinics following the induction of puberty and attainment of final height. Patients with Turner syndrome have a reduced life expectancy, they are known to have multi-system impairments in addition to the short stature and to the absence of sexual development. Aim of this study is to propos a continuous follow-up by multidisciplinary team of physicians starting in childhood and following the discharge from the paediatric care. METHODS AND RESULTS: This paper highlights the medical and psychosocial problems associated with Turner syndrome in childhood, adolescence and in adulthood. Analysis of these problems served as a background to management strategy. CONCLUSIONS: Women with Turner syndrome are at risk of number of medical problems. Quality of their life and the life expectancy can be improved with increasing awareness to comorbities associated with Turner syndrome. Assisted reproduction technologies has recently offered a chance for pregnancy and delivery of a healthy child also to women with Turner syndrome. Therefore, long-term follow-up by multidisciplinary team of physicians knowledgeable about these medical problems is necessary. Introduction of a centralised system of systematic multidisciplinary approach to patients with Turner syndrome from childhood and adolescence to adulthood seems to be very important.

[Laparoscopic neovaginoplasty--a modification of the Vecchietti operation]. / Laparoskopická neoplastika pochvy--modifikace Vecchiettiho operace.

OBJECTIVE: To asses laparoscopic approach to neovaginoplasty. DESIGN: Retrospective clinical study. SETTING: Department of Gynecology and Obstetrics, 2nd Medical Faculty of Charles University. METHODS: Vecchietti's neovaginoplasty is considered to be the most advantageous technique of creating neovagina in vaginal agenesis, because of low perioperational morbidity and quicker recovery. Authors describe own modification of laparoscopic procedure based on designed equipment of themselves. RESULTS: Study evaluates 17 cases of laparoscopic procedures, which are compared with classical laparotomic approach we were experienced in past. Time of surgery was shorter (48 min vs. 66 min) and blood loss was lower (15 ml vs. 50-100 ml) in laparoscopic procedure. Number of complications was lower in this procedure too. There was no difference in length of hospital stay and size of neovagina. CONCLUSION: Laparoscopic modification is safe procedure and comparable with classic operation as regards surgical effect. Both types of procedures are determined for workplaces with experience in special reconstructive surgery and follow-up.

[Results from the Registry of Complications in Users of Hormonal Contraception in 1998]. / Výsledky Registru komplikací uzivatelek hormonální antikoncepce za rok 1998.

OBJECTIVE: To collect data on the use of hormonal contraception in the Czech Republic in 1998. SETTING: Department of Gynaecology and Obstetrics, Charles University School of Medicine and General University Hospital Prague. METHODS: A total of 2,134 questionnaires were sent to Czech gynaecologists in spring 1999. A total of 418 answers were processed. RESULTS: The estimated number of users presenting in gynaecologist's offices participating in our project was 237,099 women. The most often prescribed contraceptives were monophasic products (54.38%) containing 30-35 micrograms of ethinyl-estradiol (55.21%) with new progestins (53.8%) (norgestimate, gestoden, desogestrel). Regular follow-up of hormonal contraceptive users included the following examinations/tests: blood count in 8.5% offices, ultrasound examination in 8.0% offices, lipid spectrum in 49.8% offices, blood pressure in 74% offices, colposcopy in 97.6% offices, oncological cytology in 98.4% offices and liver tests in 77.1% gynecologist's offices. Only 10.85% of the gynaecologists did not perform lipid tests, almost 20% gynaecologists measured blood pressure only selectively in some users. 80 cases of cardiovascular disease were diagnosed, a figure consistent with an 0.0325% incidence of users. The most frequent complication was deep venous thrombosis (58 cases). The subgroup of women experiencing a cardiovascular event was not characterized by older age, higher body weight, more frequent smoking, or use of products with a higher oestrogen contents. CONCLUSION: There were major differences among gynaecologists in the follow-up of hormonal contraception users. The pattern of the products used varied markedly by regions. The number of diagnosed cardiovascular diseases was very low. Users with a previous a cardiovascular event were only exceptionally carriers of a risk factor.

[Prediction of the effect of a triphasic contraceptive agent with norgestimate on acne]. / Predikce vlivu trífázového antikoncepcního prípravku s norgestimátem na akné.

OBJECTIVE: Prediction of complexion changes in users of triphasic oral contraceptive containing norgestimate. DESIGN: Analysis of data from a prospective multicentre open study. SETTING: Department of Obstetrics and Gynaecology, Charles University, Prague. METHODS: Acne severity was evaluated in users of a triphasic norgestimate-containing contraceptive within a six month period. Based on subjective evaluation of acne, three subgroups of patients were selected: A) users where acne improved or disappeared; B) users in whom acne deteriorated, C) users who newly developed acne. Differences between group A and the other groups were established in the proportion or distribution of parameters related to the etiology of acne: age, weight, weight changes during the study, presence of hirsutism, presence of a regular menstrual cycle prior to the start of hormonal contraception use, and smoking. RESULTS: The effect of the pill use on acne was assessed in a total of 3,990 women. Out of 1,201 women with acne before the start of the study, improvement or disappearance of acne during the study was reported by 940 users (subgroup A) (78.27%). In 221 women (18.40%), the extent of acne remained unaltered whereas it increased (subgroup B) in only 30 women (2.50%). Acne newly developed during the study in 49 women (subgroup C), i.e., in 1.2% of the whole group. Users showing deterioration of acne (subgroup B) were found to have hirsutism less frequently. The subgroup even showed a decrease in mean weight during the study. Users with newly developed acne were--compared with subgroup A--significantly older, had a lower weight at the start of the study, and showed a higher frequency of regular menstrual cycles prior to starting hormonal contraception. The differences in the incidence of clinical parameters in the subgroups reached only borderline statistical significance and, hence, are not relevant. CONCLUSION: An extensive multicentric study confirmed the beneficial effect of a triphasic norgestimate-containing contraceptive on complexion. The presence of clinical parameters related to the etiology of acne does not allow to predict the individual response of the skin to hormonal therapy.