[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.

Acquired clitoral enlargement. Diagnosis and treatment.

Clitoral hypertrophy is usually seen in congenital malformations, specifically in intersexual stages of hormonal expression. Acquired clitoral hypertrophy is a relatively rare condition, and data in the literature concerning this problem are sparse. Articles usually consist only of case reports. Among the contributing factors in the etiology of acquired clitoral hypertrophy, the following three are the most frequent: (1) endocrinopathies including virilizing tumors of the ovaries or adrenals, (2) neurofibromatosis (of both clitoral subcutis and corpora cavernosa), and (3) pseudohypertrophy of the clitoris. The first step in correcting acquired clitoral enlargement must be to determine and stop the cause of the hypertrophy, followed by a period of simple observation. If clitoral enlargement does not disappear over time, surgical correction is necessary.

Autoimmune antiovarian antibodies and their impact on the success of an IVF/ET program.

In previous papers, we referred to studies of the influence of antiovarian autoantibodies on menstrual cycle disorders in adolescent girls. We examined autoantibodies against ooplasma, zona pellucida, membrana granulosa, theca folliculi interna, and lutein cells. In infertile women in the IVF/ET program, we studied the positivity of antiovarian antibodies and cytokines, namely, TNF-alpha and IL-1 beta, in follicular fluid correlated with the following subgroups, characterized by the outcome of in vitro fertilization, as follows: G, pregnant; F, fertilized; N, nonfertilized; and O, no oocyte gained. The presence of autoantibodies corresponds to the success or failure of the IVF/ET program. Our results support the hypothesis that antiovarian autoantibodies play an important role in both the endocrine and the reproductive function of the human ovary and that it can influence them negatively.

Circulating immune complexes in acute leukemia.

Circulating immune complexes (CIC) were measured at the time of diagnosis in 81 patients with acute leukemia or blast crisis of chronic myeloid leukemia using precipitation by 3.75% polyethyleneglycol. Elevated CIC levels did not adversely influence complete remission duration and survival, patients with normal CIC levels exhibited mostly shorter remission and survival than those with elevated or borderline levels. No significant correlation was observed between CIC levels and Hb, WBC, CBC, platelet count, age, serum bilirubin, total protein, fibrinogen, AST and ALT levels, presence of hepatosplenomegaly and/or lymphadenopathy, HbSAg positivity, complete remission duration and survival. The lack of correlation may be caused by altered immune response in leukemic patients, but the obtained results may also be affected by the nonspecific nature of the method used for the detection. Simultaneous detection of CIC levels by multiple tests and evaluation not only of the number but also of the composition and size of CIC may decrease the incidence of false results. Nevertheless, only the establishment of antigen-specific assays may resolve the controversies in the detection of CIC and thus contribute to a more precise assessment of the role of CIC in prognosis of cancer, as well as to the verification of reliability of using CIC as a tumor marker.

Circulating ovarian autoantibodies and FSH and LH levels in adolescent girls with primary menstrual cycle disorders.

Seventy three adolescent patients with primary menstrual disturbances were studied by immunofluorescent methods for prevalence of ovarian autoantibodies (O-Ab), the enzyme immunoassay (EIA) method for examination of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) hormonal levels was used. Clinically healthy girls (40) served as controls. Patients were divided into a group of 13 girls with primary amenorrhea (PA) and a group of 60 girls with oligo and/or secondary amenorrhea (OSA). In the PA group 38.5% positivity linked to ooplasm (OO), zona pellucida (ZP), and membrana granulosa cells (MG), as well as 46.2% to theca folliculi interna (TI) and 53.8% to lutein cells (LC), was detected. Statistically significant differences (p < .05) of LH levels between OO immunopositive and negative girls (19.0 and 9.4 mU/ml) were found, while FSH values were not different. In the OSA group a 16.7% positivity linked to OO, 23.3% to ZP and MG, 38.3% to TI, and 58.3% to LC were detected. Significant linkage between MG immunopositive and negative girls and FSH:LH ratio values were estimated. FSH values were significantly different (p < .05) for PA and OSA groups (23.7 and 6.7 IU/l) which corresponded particularly with higher findings of Ab in germ line-cells (OO-, ZP-, and MG-Ab). A striking correlation between evidence of O-Ab and menstrual cycle irregularities was found. It could support a possible coincidence of autoimmune mechanism in these dysfunctions. Localization of O-Ab-binding was verified at the electron microscopic level.

Premenarchal and postmenarchal girls with insulin-dependent diabetes mellitus: ovarian and other organ-specific autoantibodies, menstrual cycle.

STUDY OBJECTIVE: To estimate various organ-specific autoantibodies and detect other endocrine autoimmune disorders and menstrual cycle characteristics in girls with Type 1 insulin dependent diabetes mellitus (IDDM). DESIGN: Prospective cohort study from 1993 to 1998, duration 4.5 years. SETTING: Diabetes & Endocrine Clinic of the University Hospital, Motol, Prague. PATIENTS: 53 IDDM girls (group A--43 postmenarchal, group B--10 premenarchal), 15.5 +/- 2.5 (8-19) years old, 6.2 +/- 4.3 years after IDDM onset. MAIN OUTCOME MEASURES: Ovarian autoantibodies directed to ooplasm, zona pellucida, membrana granulosa, theca folliculi interna, and lutein cells, insulin autoantibodies, thyroid peroxidase and thyroglobulin autoantibodies. Menstrual cycle character, endocrine glands disturbance. Diabetes control, body mass index, duration of IDDM. RESULTS: Ovarian autoantibodies in at least one of the followed structures were found in 67.9% of the IDDM girls. In the control group of 21 healthy girls of corresponding age, the positive findings in lutein cells were found in only 4.8% of the girls (P < 0.01 versus IDDM girls). The lutein cells commonly associated with theca folliculi interna cells were the most frequent immunopositive structures in diabetic girls (P < 0.05 versus another positive ovarian autoimmune structure). Autoantibodies directed to ovarian steroid producing cells were frequent in IDDM patients with both irregular and normal menstrual cycles. Irregular menstrual cycles were diagnosed in 27.9% of IDDM girls, polymenorrhea in half of them, and oligomenorrhea in the remainder. Diabetes control in our patients (glycosylated hemoglobin HbA1c in postmenarchal girls 10.1 +/- 2.0%) did not differ between those with regular and those with irregular menstrual cycles. Over a follow-up period one-third of the girls with oligomenorrhea and a long-term noncompliance (HbA1c 13.5%) developed secondary amenorrhea. Insulin autoantibodies were found in 67.8%, thyroid peroxidase autoantibodies in 12.5%, and thyroglobulin autoantibodies in 10.4% of the IDDM girls. Autoimmune thyroiditis was diagnosed in 5 IDDM patients (9.4%); hypothyroidism developed in 3 of them. Menstrual cycle was irregular in 4 of the 5 girls with autoimmune thyroiditis (polymenorrhea in 1, oligomenorrhea in another 3 girls). CONCLUSIONS: An increased incidence of various circulating autoantibodies may be markedly demonstrated in IDDM girls. Their reproductive function might have an important relationship to an evidence of ovarian autoantibodies. Menstrual cycle disturbances could be linked to the poor diabetes control, to the presence of ovarian and other autoantibodies, and also to other autoimmune disease.

[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.

[Psychosexual development and sex life of women with congenital adrenogenital syndrome]. / Psychosexuální vývoj a pohlavní zivot zen s kongenitálním adrenogenitálním syndromem.

OBJECTIVE: The aim of the study was to examine the psychosexual development and sexual life of 13 adult women with congenital adrenogenital syndrome. DESIGN: A clinical study. SETTING: Psychiatric clinic, Gynecological clinic and Sexological institute, Medical Faculty of the Charles University in Prague. METHODS: The examination was carried out using a structured interview and three tests: MF (Masculinity and feminity), SFW (Sexual function of women) and SAI (Inventory of sexual arousibility). RESULTS AND CONCLUSION: It was ascertained that only about one third of the patients were coitally active and that the first intercourse was delayed. The results of the questionnaire SFW were in 66% subnormal and an adequate sexual arousability was found only in 40% of examined persons (the test SAI).

[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.

[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.

[Clinical study of a triphasic contraceptive preparation (Norgestimate 180/215/250 micrograms + ethinylestradiol 35 micrograms) in a population of Czech women]. / Klinická studie s trífázovým antikoncepcním prípravkem (norgestimát 180/215/250 micrograms + etinylestradiol 35 micrograms) v populaci ceských zen.

OBJECTIVE: To assess the efficacy, acceptability and safety of triphasic oral contraceptive pill containing norgestimate 180/215/250 micrograms and ethinylestradiol 35 micrograms. DESIGN AND SETTING: Prospective, open-label, non-comparative, multicenter study in 409 centers in the Czech Republic. METHODS: Body weight, blood pressure, bleeding pattern, headaches, nausea, breast tenderness, acne, pregnancies and side effects were monitored before the start of the treatment, after three and six cycles of oral contraceptive use. Liver function tests were carried out before and after the treatment. RESULTS: Evaluating 26,432 cycles in 4,720 women the theoretical Pearl index was 0.15. There were no significant changes in body weight (61.45 kg before vs 61.58 kg after the treatment). There were clinically significant changes neither in the blood pressure nor in the liver function tests. Evaluating the bleeding pattern there were similar incidences of irregular bleeding/spotting before the treatment and up to the third treatment cycle (16.15%, resp. 17.86%); then the incidence dropped down (8.41% after the third cycle). Amenorhea was very rare (0.41% resp. 0.35% up to, resp. after the third cycle). Decreasing incidences compared to pretreatment state were observed for headache, breast tenderness and acne. The effect on acne was remarkable (28.3% of women complaining of acne before the treatment vs 6.51% after the six treatment cycles). There were no serious adverse events observed during this study. CONCLUSION: Triphasic oral contraceptive pill containing norgestimate and ethinylestradiol proved in a large multicenter study high both efficacy and acceptability.

[Effect of estrogens on final body height in girls with a constitutionally tall stature--risk or benefit?]. / Ovlivnení definitivní telesné výsky estrogeny u dívek s konstitucne vysokým vzrustem--rizika nebo prínos?

OBJECTIVE: Investigation of the effect of a long-term oestrogen treatment on the growth and development of children, elaboration of a theoretical model for remaining growth of girls on a long-term oestrogen therapy predicting reduction of the final height in girls with constitutionally tall stature, analysis of early and late side-effects of therapy. TYPE OF STUDY: Open clinical study. NAME AND PLACE OF DEPARTMENT: Endocrine out-patient clinic of the Second Paediatric Department and gynaecological out-patient clinic for children and adolescents of the Gynaecological-Obstetric Department, Second Medical School--Charles University and University Hospital Prague--Motol. METHOD: Elaboration of theoretical model for remaining growth of girls on a long-term oestrogen therapy was based on an analysis of the remaining growth of upper and lower body segment of healthy Czech girls. RESULTS: The extent of assumed reduction of the final height in girls with constitutionally tall stature treated with oestrogen declines with advancing age at the onset of treatment. The optimal age for the onset of treatment is between 10 and 11 years. CONCLUSION: Treatment can be recommended only in girls with growth prediction above 185 cm and serious psychological difficulties resulting from excessive height, always after careful analysis of the biological development and growth prediction. In every case it is necessary to evaluate the possible benefit of treatment in relation to potential risks. The greatest problem is according to the authors late onset and overrating of the therapeutic possibilities.

[Synthetic vaccines for immunization against infection with hepatitis B virus]. / Syntetické vakciny k imunizaci proti infekci virem hepatitidy B.

The paper informs on the present state of preparation of a vaccine against infection with the hepatitis B virus, using techniques of genetic engineering. Synthesis of immunogenic peptides derived from the structure of HBaAg amino acids stimulated the administration of several oligopeptides derived from the structure of HBsAg. Experiments with the decapeptide derived from the S-portion of HBsAg revealed that also a small peptide, when administered with adjuvants, is immunogenic, Synthesis of HBsAg protein in a culture of Saccharomyces cerevisiae was already tested clinically and proved to be an effective vaccine. It will be probably also possible to prepare the vaccine by formation of the anti-idiotype, induced by HBsAg anti Ig. The authors' own observation revealed that the administration of anti HBsAg immunoglobulin (Hepaga) causes in rabbits the formation of a component which reacts in serum by the RIA technique as HBsAg.

[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.

[Detection of antibodies and assessment of an international unit of anti-HBs specific immunoglobulin, HEPAGA]. / Detekce protilátek a stanovení mezinárodní jednotky specifického imunoglobulinu anti-HBs, HEPAGA.

The authors submit information on the presence and titre of antibodies against antigens of the hepatitis B virus [HB] and the Czechoslovak specific anti-HBs immunoglobulin, HEPAGA, and on the presence of the delta-antibody. The presence of the antibody against the surface antigen of the HB virus [HBsAb, anti-HBs] was examined in 32 batches, the antibody against the nucleus of the HB virus [HBcAb] and e-antigen [HBeAb] in a total of 27 batches. HBsAb was positive in the majority of cases still when diluted 1/2,500,000; HBcAb when diluted in the range from 1/25,000 to 1/2,500,000; the positivity of HBcAb ended with the exception of one batch at the dilution of 1/250. The delta antibody was detected only in batches from 1982 and 1983, in a maximum dilution of 1/8. All examinations were made by the radioimmunoassay [RIA] technique. The authors give also an account of the assessment of the international HEPAGA [IU/ml]. The last batch has 170 IU/ml.

[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.