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Journal Article 2009; 30(2): 262-267 PubMed PMID: 19675521 Citation  Keywords:  Adolescent, Adrenal Hyperplasia, Congenital:pathology, Child, Child, Preschool, Disorders of Sex Development:pathology, Female, Genitalia:abnormalities, Genitalia, Female:abnormalities, Humans, Infant, Male, Reconstructive Surgical Procedures, Treatment O.   

INTRODUCTION: Ambiguous genitalia always present diagnostic and therapeutic problem. Long-term results of feminizing operations are unsatisfactory in some cases and reports from follow-up after feminizing genitoplasty are rare in the literature. Systematic studies are needed to evaluate ultimate function of all girls undergoing feminizing surgery. In our opinion, the lack of worldwide-accepted scale for the assessment of long-term effects of feminizing genitoplasty, enabling the possibility of comparing outcomes between institutions and countries, may contribute to this deficit of reliable data.

AIM: The aim of the study was the evaluation of the outcomes of surgical management of masculinization using a novel scale developed by the authors.

MATERIAL AND METHODS: We examined 43 patients aged 3-24 years (mean age 15,4 years) operated due to ambiguous genitalia. Most of the patients were females with congenital adrenal hyperplasia (CAH) diagnosed in 38 of subjects (88.4%).The patients were operated at the age from 10 months - 15 years (mean age 4,5 years). Five patients had to be reoperated. The effects of surgical management in ambiguous genitalia were assessed using our own scale. We evaluated five anatomical and cosmetic parameters (general appearance, size of pudendal labia, symmetry of pudendal labia symmetry, size and position of clitoris, size of introitus and position of urethra opening), each of them was scored 0-2 points.

RESULTS: In 36 of examined patients the result of the surgery was considered good, in 4 patients - satisfactory and in 3 - poor. The most common complication of feminizing genitoplasty in our patients was stenosed vagina (in 10 patients, 23.8%). Location of urinary coil in anterior wall of vagina was found in 6 patients (13.9%) and in 1 patient it was invisible (2.3%). Post-operational clitoral enlargement was found in 3 cases (6.9%).

CONCLUSION: Taking into consideration controversial data about the results of feminizing genitoplasty, a standarized, well-defined and commonly accepted scale enabling comparison between methods and institutions is necessary. In our opinion scoring scale makes the evaluation more precise and the results are more comparable....

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Journal Article 2008; 29(1): 11-15 PubMed PMID: 18283270 Citation  Keywords:  Adolescent, Age Factors, Child, Child, Preschool, Endoscopy:methods, Female, Genital Diseases, Female:diagnosis, Genitalia, Female:abnormalities, Humans, Hysteroscopy, Laparoscopy,.   

: Early proper diagnostics and treatment of developmental age pathologies in most cases facilitate correct sex organ development, as well as reproductive functions formation. To make the foregoing possible, it is necessary to apply minimally invasive and safest methods like vaginoscopy, hysteroscopy and laparoscopy. The main application field of vaginoscopy and hysteroscopy in pediatric and adolescent gynecology is the diagnosis and treatment of vulvar and vaginal pathologies and developmental anomalies of sex organ. The laparoscopy is becoming a more and more popular method in the treatment of adnexal tumors in children, due to its little invasiveness, quick recovery and less severe pain complaints after the surgery. The application of these endoscopic procedures should always be preceded by the complex noninvasive diagnostics, such as ultrasonography and magnetic resonance imaging. The endoscopic procedures facilitate wide-ranging diagnostics and simultaneously therapeutic management, ensuring minimal invasion and high safety of the surgery. They should be considered diagnostics and treatment of choice in the pathology of vulva, vagina, developmental anomalies of sex organ and adnexal tumors in patients of the developmental age....

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Comparative Study 2007; 28(5): 704-707 PubMed PMID: 17984927 Citation  Keywords:  Adult, Female, Genitalia, Female:pathology, Humans, Infertility, Female:diagnosis, Laparoscopy:methods, Microsurgery:instrumentation, Pelvis:pathology,.   

OBJECTIVES: To compare the efficacy of microlaparoscopy and laparoscopy in the assessment of pelvic region in infertile women.

MATERIALS AND METHODS: 47 patients (aged 24-35) had microlaparoscopy and subsequent laparoscopy performed in order to diagnose the cause of infertility. Pelvic region assessment was performed in both procedures and the results were afterwards compared in regard to duration of the operations and findings reported by independent surgeons. The data was statistically analyzed using Statistica for Windows 5.1.

RESULTS: There were no major differences in the assessment of the pelvic region and found abnormalities in the analyzed postoperative protocols. All the diagnosed abnormalities were described similarly by both surgeons; the differences referred only to subjectively evaluated sizes of findings. The assessment of the pelvic region during microlaparoscopy was fully satisfactory in all cases, none required earlier than scheduled conversion to laparoscopy. The duration of endoscopic procedures was calculated from the moment of trocars insertion into the peritoneal cavity. The average duration time of microlaparoscopic evaluation was 6'20"+/-45", while in laparoscopy - 3'40"+/-32" (p<0.0001).

CONCLUSIONS: Microlaparoscopy and laparoscopy are of similar efficacy in the assessment of small pelvis organs and in detecting pathological changes. Both procedures differ significantly only in regard to the duration....

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Comparative Study 2005; 26(6): 766-770 PubMed PMID: 16380676 Citation  Keywords:  Adult, Comorbidity, DNA, Viral:analysis, Diabetes Mellitus, Type 1:epidemiology, Female, Fetal Blood:virology, Genitalia, Female:virology, Humans, Infant, Newborn, Infectious Disease Transmission, Vertical:statistics & numerical data, Mouth:virology, Papi.   

OBJECTIVE: The aim of the study was to evaluate the prevalence of human papillomavirus, both types of a low oncogenic risk (HPV 6, 11) and a type carrying a high oncogenic risk (HPV 16) in the genital tract of the pregnant patients, their venous blood, the cord blood and the oral cavities of the neonates. Normal pregnant women and pregnant women with insulin dependent diabetes mellitus (IDDM) diagnosed before pregnancy were included in the study.

DESIGN: The study group consisted of 15 pregnant women aged 22 to 32 years with IDDM diagnosed before pregnancy. The control group consisted of 30 patients aged 18 to 38 years, with normal pregnancy. The DNA of HPV types 6, 11 and 16 was studied in the discharge from the cervical canal, the maternal venous blood, the cord blood and the buccal smear obtained from the neonates. To detect of viral DNA the PCR was used.

SETTING: A university teaching hospital delivering approximately 2000 women annually.

RESULTS: Human papillomavirus (HPV) was found in 12 (26.7%) of the 45 pregnant women. Of the 15 patients with pregestational IDDM the DNA of HPV was detected in four (26.7%) of the patients. The DNA of HPV types 6 and 11 was found in three (20%) patients. The DNA of HPV type 16 was detected in one pregnant patient in the study group (6.67%). Of the 30 control patients, HPV DNA was detected in eight (26%). In two (6.6%), infection with oncogenic and non-oncogenic types of HPV was diagnosed. The DNA of HPV types 6 and 11 was found in six (20%) subjects. Of the 30 control patients, the DNA of HPV type 16 was detected in four (13.3%). The transmission of HPV from HPV-positive mother to fetus was found in 50% of cases.

CONCLUSIONS: (i) There was a similar level of occurrence of HPV infections in pregnant women with IDDM when compare with normal pregnancy. (ii) High percentage of HPV transmission from mother to neonate was determined. (iii) The cesarean section probably does not protect the neonate from HPV infection. (iv) There is a suggestion that fetus may be affected by HPV infection during intrauterine life....

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Journal Article 2001; 22(4): 243-247 PubMed PMID: 11524630 Citation  Keywords:  Adult, Anti-Anxiety Agents:therapeutic use, Anxiety Disorders:drug therapy, Genitalia, Male:drug effects, Gonadotropins:blood, Humans, Hypothalamo-Hypophyseal System:drug effects, Isoindoles, Male, Middle Aged, Piperazines:therapeutic use, Prolactin:blood.   

BACKGROUND: Serotonin (5-HT) agonists are reported to affect prolactin (PRL) and gonadotropin secretion. A small study was conducted on male patients with generalized anxiety disorders to investigate the clinical and neuroendocrinological effects of the 5-HT(1A) receptor agonist tandospirone (TDS) on the hypothalamo-pituitary-gonadal (HPG) axis.

METHODS: The subjects for the present study included 11 male outpatients. Informed consent was obtained from all subjects involved in this study. The endocrine studies were done before and during TDS administration. Psychiatric ratings were done using the Japanese version of the Spielberger's State-Trait Anxiety Inventory.

RESULTS: We found that both state- and trait-anxiety scores were significantly reduced by TDS treatment; there was no significant difference in PRL, gonadotropins or testosterone (T) between the patients and normal controls; TDS administration showed significant stimulatory effects on PRL and T; and PRL change between baseline and TDS steady state (DeltaPRL) did not show a significant correlation with improvement in state or trait-anxiety scores.

CONCLUSIONS: Our results indicate that PRL response may not provide a clinical predictor; (2) PRL level may not reflect the level of anxiety, and 5-HT(1A) may have stimulatory effects on PRL. However, further, double-blind evaluation with a larger sample would be needed for clarification of effects of 5-HT(1A) on the HPG axis....

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