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Pelvic exenteration is an essential part of complex treatment of advanced tumours of the small pelvis. The strategy of surgery is well known and consensual. However, the optimal extent of lymphadenectomy is still under discussion. The aim of this paper is to summarize the strategy of surgery and the extent of lymphadenectomy.Review of the literature and retrospective analysis of 63 patients of our cohort, operated on at the Department of Surgery of the First Faculty of Medicine, Charles University and Thomayer Hospital between 1999-2015.The paper describes indications for pelvic exenteration, the strategy of surgery and the necessary extent of lymphadenectomy.

The overview of vascular anatomy and abnormalities of retroperitoneal pelvic and paraaortic area in relation to the radical oncogynecological surgery.Retrospective study.Gynecologic Oncology Center, Department of Obstetrics and Gynecology, Faculty of Medicine, Masaryk University and University Hospital Brno.The overview of visualized vascular anatomy of retroperitoneal pelvic, infrarenal suprapelvic and subhepatic area in relation to the radical oncogynecological surgery. Presentation of physiological vascular anatomy. Summary of the most common abnormalities and potential complications in terms of vascular injury. Basic management of these complications from the viewpoint of oncogynecologist.The perfect knowledge of vascular anatomy and its possible abnormalities has represented an absolute necessity for uncomplicated course and sufficient extent of radical surgery.

Octreotide is a synthetic analogue of natural somatostatin. Octreotide effect on lymphorrhea reduction in gynecological malignancies has only been assessed in case studies.Original work.Gynecologic Oncology Center, Department of Obstetrics and Gynecology, Faculty of Medicine, Masaryk University and University Hospital Brno.In 2014 there was a prospective, randomized, one-institution study. Patients underwent surgery including pelvic or pelvic and paraaortic lymphadenectomy for cervical, uterine and ovarian cancer. The informed consent was signed. Octreotide was evaluated in relation to diagnosis, surgery (laparoscopy versus laparotomy), pelvic and/or paraaortic lymphadenectomy, number of removed lymph nodes and their positivity, neoadjuvant chemotherapy, adjuvant chemotherapy, adjuvant radiotherapy, albumin, BMI, number of days with drains postoperatively, number of days in hospital, blood loss during surgery, time of surgery, total number of drains placed into abdominal cavity. In follow up period, within 1 year after surgery, we searched for lymphocele, lymph-edema of lower extremities and lymphatic ascites in relation to lymphorrhea.44 patients (9 cervical, 19 endometrial and 16 ovarian cancer) were enrolled in two statistically comparable randomized groups. "Octreotide group", which paradoxically showed lymphorrhea of 4082 ml on average, (without 1992 ml, p = 0.001), needed drainage for more days (p = 0.001). The diagnosis had no influence on lymphorrhea in both groups (p = 0.966). The neoadjuvant chemotherapy was administered (p = 0.026), the more lymph nodes were removed (p = 0.018), the more days the drainage was in place (p0.001), the bigger the lymphorrhea; no relationship between lymphorrhea and age (p = 0.631), albumin level (p = 0.584), BMI ( p= 0.966) or number of positive nodes (p = 0.259), length of surgery (p = 0.206), blood loss (p = 0.494). Nor lymphedema (p = 0.404), nor lymphocele (p = 0.086), correlated with postoperative lymphorrhea. Lymphatic ascites was associated with lymphorrhea (p = 0.048).Octreotide did not reduce lymphorrhea and the incidence of lymphocele, lymphedema of lower extremities and lymphatic ascites within one year of follow-up period after surgery. According to our results, we do not recommend to administer the octreotide in oncogynecological patients after pelvic and/or paraaortic lymphadenectomy.

To review contemporary knowledge of the hCG molecule, its isoforms and the importance of glycosylation. Biologic variants and glycoforms of hCG have different biological activities and functions related to the control of menstrual cycle, conception, gestation as well as gynaecologic and non-gynaecologic malignancies.A review.Department of Obstetrics and Gynaecology, University Hospital Olomouc.To present own experience and an overview of recent literature in molecular biology, clinical biochemistry and clinical practice.Recent knowledge of the role of hCG glycosylation in physiologic and pathologic events in female organism will provide a better understanding of regulation of processes like ovulation (co-operation of pituitary hCG with LH), implantation and hemochorial placentation (invasivity of hyperglycosylated hCG). Some biologic variants and isoforms of hCG are important for the prediction of certain pathologies of pregnancy, prenatal screening of inborn errors (free beta hCG) as well as in the treatment of infertility.

Overview of classification, anatomical conditions, methods and complications of pelvic and paraaortic lymph-node dissection.Review article.Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Medical Faculty, Charles University, Prague.Lymphadenectomy is classified according to its extent into sentinel lymph-node biopsy, debulking, sampling and systematic procedure and according to approach into extraperitoneal or transperitoneal procedure. The most complex variant is systematic pelvic and paraaortic lymph-node dissection, which requires removal of fatty-lymphatic tissue from anatomically strictly defined areas. Procedure can be performed from laparotomy, laparoscopically or robotically.The main objective criterium of systematic procedure is the number of harvested nodes. The most common complications comprise bleeding and lymphocele formation.Pelvic and paraaortic lymphadenectomy represent basic component of surgical management in majority of gynecological cancers. The knowledge of extent, different techniques and ability to solve complications represents essential skill in gynecological oncology.

Information sheet about metastatic tumors of the female genital tract.Literature review with case reports.Department of Gynaecology and Obstetrics, Faculty of Medicine, Masaryk's University and Fakulty Hospital, Brno.Literature review about metastatic tumors of the female genital tract with illustrative case reports.Secondary gynecological malignant tumors are much less common than primary tumors of the female genital tract with the exception cancer of the fallopian tube and the vagina. Primary malignant tumors of the fallopian tube and the vagina are rare, the primary location of the tumor usually is in other areas of the female genital tract and the tumor grows directly into the above-mentioned organs secondarily. There is talking about metastatic malignant tumors of the female genital tract in the strict sense in the case of extragenital primary origin the cancer. Metastases can be caused by direct penetration of the tumor from anatomically adjacent organs, particularly from the bladder and the rectum, or are going through the lymph or the blood vessels. The most common primary location of the tumor are the breast, the stomach and the bowel in this case. Secondary laesions of the female genital tract can be sometimes the first clinical manifestation of the primary extragenital malignant tumor, simultaneously represent clearly negative prognostic factor for the disease. Differential diagnostic algorithm for solving the secondary laesions of the female genital tract requires a multidisciplinary approach and cooperation with the pathologist and the clinical oncologist. Surgical treatment, the indication and extent based on adequately performed staging, is essential for the diagnosis of the primary tumor and is necessary as the palliative treatment for the elimination event, clinical symptoms and for the improving quality of the life.

The methods of bloodless medicine are used in many surgical fields. This article aims to draw attention to the possible use of these procedures in gynecological surgery to reduce the number of transfusions.

To present our experience with ultrasound-guided minimally invasive bioptic techniques in gynecologic oncology.Original paper.Gynecological Oncology Center, Department of Obstetrics and Gynecology, Charles University, First Faculty of Medicine and General Faculty Hospital, Prague.Minimally invasive ultrasound-guided biopsy may be done in patients with primary inoperable disease, suspicious recurrence of gynecological or non-gynecological malignancy or in case of diagnostic uncertainty of pelvic tumor origin.Ultrasound-guided minimally invasive bio-psy represents an accessible and relatively simple method useful in many indications, not only in gynecologic oncology.

BACKGROUND There is a considerable number of studies on the efficacy HPV (human papillomavirus) vaccination against different cancers but relevant information is scattered in diverse journals. This paper is a review summarizing current knowledge of the potential of HPV vaccination against all HPV related cancers. AIM HPV infection is probably the most frequent sexually transmitted disease. At least 13 HPV genotypes are classified as carcinogenic or probably carcinogenic in respect to cervical cancer. Almost 100% of cervical cancers are linked to HPV infection. HPV 16 and HPV 18 are the most frequently involved genotypes and account together for approximately 70% of cervical cancer in the world. Persistent high risk HPV infection is responsible for a significant proportion of vulvar, vaginal, anal and penile carcinomas. The virus has also been implicated in oncogenesis of head and neck cancers, including oropharyngeal cancers. HPV infection can play an important role in cancerogenesis of lung, esophagus, breast, and colon and rectum. On the contrary, published results indicate that HPV infection is not associated with prostate oncogenesis. Strong predominance of HPV 16 has been reported for all HPV associated cancer sites. Generally, it is estimated that approximately 5.2% of all cancers are associated with oncogenic HPV infection. Currently, there are two vaccines on the market; quadrivalent Silgard® (Gardasil®) and bivalent CervarixTM. Large trials for both vaccines have shown efficacy against HPV related infection and disease. Efficacy has been very high in HPV naive subjects to vaccine related types. While HPV vaccination is currently approved for the prevention of cervical cancer, it also has the potential in the prevention of all HPV associated malignancies. The Czech republic belongs to countries that cover HPV vaccination of girls at the age of 13- 14 years by general health insurance. Overall impact of this vaccination remains to be evaluated. The new issues of the role of HPV in oncogenesis, as well as the potential effect of HPV vaccination against HPV related nongenital cancers are discussed. CONCLUSION Approximately 5.2% of all human cancers are associated with oncogenic human papillomavirus infection. HPV vaccination against the most risky HPV oncotypes may cause a significant reduction of these cancers mainly in the HPV naive population.

Pelvic exenteration is the essential part of complex treatment of advanced urologic, gynaecologic and colorectal tumours of the small pelvis. The aim of this work is to summarize the individual types of pelvic exenteration, their indications, contraindications and long-term results.Overview of the current literature and retrospective analysis of our cohort of 37 patients operated on at the Department of Surgery of the First Faculty of Medicine, Charles University, and Thomayer Hospital during the period 1999-2012.This work summarizes the classification, indications and types of pelvic exenteration.

To analyze our experience with transperitoneal laparoscopic dissection of lymphatic nodes in women with gynecologic malignancies.Retrospective clinical study.Center of gynecologic endoscopy and minimally invasive surgery; Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Medical Faculty in Prague.Analysis of data from our laparoscopic procedures in the years 2006-2011. The following procedures have been included: systematic pelvic lymphadenectomy (PLN), paraaortic lymphadenectomy (PALN), pelvic sentinel node excision, focused dissection of bulky lymphatic nodes from pelvis or paraaortic area.We performed 177 primarily laparoscopic procedures pointed at dissection of pelvic and/or paraaortic lymph-nodes. The mean operating time and the mean number of lymph-nodes was 82 minutes and 26.5 nodes in patients with PLN, and 75 minutes and 12.5 nodes in patients with PALN. The overall rate of laparo-conversions was 4.5%; the incidence of major complications was 6.8% and of serious bleeding 5.6%. Laparoscopic lymphadenectomy could not be performed or completed in 2.3% of cases. Complications were more frequently associated with PALN than with PLN.Laparoscopic approach to PLN and PALN is feasible in vast majority of patients. It provides adequate earnings of the lymphatic nodes, tolerable operative time, and relatively low complication rate. The highly experienced operation team for especially high infrarenal PALN is necessary.

Review of new staging systems for gynaecological cancers and their impact on prognosis and planning treatment.Review article.Department of Gynaecology and Obstetrics, First Faculty of Medicine and University Hospital Na Bulovce, Charles University, Prague; Department of Radiotherapeutic Oncology, First Faculty of Medicine and University Hospital Na Bulovce, Charles University, Prague; Department of Pathology, University Hospital Na Bulovce, Prague.Every staging system should have 3 basic characteristics: it must be valid, reliable, and practical. Over the years, these staging classifications--with the exception of cervical cancer and gestational trophoblastic neoplasia--have shifted from a clinical to a surgical-pathological basis. Changes based on new findings were proposed in 2008 by the FIGO Committee on Gynecologic Oncology, approved in September 2008 by the FIGO Executive Board, and published in 2009. The greatest changes were made in the new staging system for carcinoma of the vulva and others in the new staging systems for carcinoma of the cervix and carcinoma of the endometrium. A new stanging system was also created for uterina sarcomas, based on the criteria used in other soft tissue sarcomas. A clinical staging system for carcinoma of cervix continues because surgical staging cannot be employed worldwide (especially in third world countries). Stage 0 has been deleted from the staging of all tumours, since it is pre-invasive lesion and it is not an invasive tumour. In the revised staging system for carcinoma of the endometrium, four fundamental changes have occurred, which will be discussed. Carcinosarcoma is still staged identically to carcinoma of the endometrium. A completely new staging system was created for adenosarcomas, along with an almost identical staging system for leiomyosarcoma and endometrial stromal sarcoma. The staging system for carcinoma of ovary and Fallopian tube remains without changes.Since medical research and practice in the field of oncology have shown explosive growth, the staging of some of the gynaecological cancers did not give a good spread of prognostic groupings. Therefore, revised FIGO and TNM staging system has been structured to represent major prognostic factors in predicting patients' outcomes and lending order to the complex dynamic behavior of gynaecological cancers. The purpose of good staging system is to offer a classification of the extent of gynaecological cancer in order to provide a method of conveying one's clinical experience to others for the comparison of treatment methods.

To present our experience with ultrasound-guided minimally invasive interventions in gynecologic oncology.Original paper.Oncogynecological Center, Department of Obstetrics and Gynecology, Charles University in Prague - First Faculty of Medicine and General Faculty Hospital, Prague.We provide minimally invasive punction interventions under ultrasound guidance using either abdominal or vaginal probe in three indication groups - diagnostics (tru-cut biopsy), therapy (punction drainage of lymphocyst) and palliation (insertion of permanent peritoneal catheter).Ultrasound-guided minimally invasive interventions represent a group of accessible and relatively simple methods useful in many indications, not only in gynecologic oncology. Adoption of these methods allows to broadening the spectrum of interventions offered and decreasing patient's stress.

To present up-to-date knowledge concerning risk-reducing surgery in carriers of susceptibility mutations among hereditary breast/ovarian cancer syndrome and Lynch syndrome.Review.Oncogynecological Center, Department of Obstetrics and Gynecology, Charles University in Prague - First Faculty of Medicine and General Faculty Hospital, Prague.After having reviewed the now-a-days literature and summarized our experience we present here an overview of risk-reducing strategies in gynecology and a proposal of guidelines to risk-reducing salpingo-oophorectomy and hysterectomy.Risk-reducing salpingo-oophorectomy or hysterectomy is the most effective strategy for gynecological cancer prevention in susceptibility gene mutation carriers so far. This type of surgery, however, requires specific indication work-up and techniques different from those standardly used.

Information sheet about the most frequently complications of radical oncogynecological operations.Literature review with case reports.Department of Gynaecology and Obstetrics, Faculty of Medicine, Masaryk's University and Faculty Hospital, Brno.Literature review about complications of radical oncogynecological operations with illustrative case reports.Radical oncogynecological operations, due to their size, associated with a higher morbidity compared with traditional gynecological surgery. The literature states morbidity parameters between 25-45% depending on the center of erudition and range of out performance. Basic division of surgical complications is on perioperative complications and postoperative complications, which are further divided into early and late. The most frequently intraoperative complication is large blood loss requiring the application of blood substitutes. Less common complications are injury to the urinary bladder, ureter, rarely bowel or neural structures, especially nerve obturatorius. Among early postoperative complications are dominated urological complications, particularly urinary bladder hypotonia, another important group are the vascular complications, ie trombembolia and bleeding. Between late postoperative complications is possible to define several basic groups, ie urology, intestinal, lymphovascular and complications associated with laparotomy wound suture. Prevention of complications should be based on several basic assumptions. These include adequate erudition and composition of the operating team, perfect knowledge of anatomical conditions in the pelvic retroperitoneum, the paraaortic, the paracaval and inguinal area, implementation radicality adequate performance in relation to the extent of the disease and developing new surgical techniques (eg nerve sparing surgery). Absolute necessity is also the possibility of interdisciplinary cooperation with other surgical disciplines, which is important both in terms of preventing complications, and for their event subsequent solutions.

A description of intensity modulated radiation therapy (IMRT) technique and its implementation in the treatment of gynecologic malignancies.A review article.Department of Oncology and Radiotherapy, University Hospital in Hradec Králové.General explanation of IMRT priciples, its benefits and limitations, and a review of published data about its utilization in the treatment of endometrial, cervical, and vulvar carcinoma.IMRT represents an accessible and highly conformal external beam radiothrapy technique, which enables a significant sparing of healthy tissue with consequent reduction of radiation morbidity in comparison with other conventional and conformal techniques. A feasibilty of dose excalation with preservation of low toxicity is another advandage of IMRT. It can be utilized in the treatment of most frequent gynecologic tumors, especially in endometrial, cervical, and vulvar carcinoma.

Informations about paraneoplastic syndromes occurring in gynecological malignancies.Literature review with case reports.Department of Gynaecology and Obstetrics, Faculty of Medicine, Masaryk's University and Faculty Hospital, Brno.Literature review about paraneoplastic syndromes in gynecological malignancies with illustrative case reports.As paraneoplastic syndromes known symptoms that accompany cancer, but not linked directly with the progression of primary bearings or creation distant metastases. These symptoms require attention especially because in some cases may be manifestations of primary tumor, which has not yet been diagnosed. The paraneoplastic syndromes that have occurred in the malignancy, which are of interest to oncogynecologists include fever tumor origin, anorexia and weight loss, paraneoplastic syndromes endocrine, neurological, musculosceletal, haematological and skin. As part of the diagnosis is necessary interdisciplinary cooperation involving the participation of not only oncogynecologist, but also dermatologist, neurologist, rheumatologist, hematologist and other specialists according to the current state and the dominant issue patiens.

Benefit evaluation of robot-assisted surgery in gynecological oncology. The parameters observed were feasibility, safety, overal surgery length and economic aspects.Prospective study analysing our experience in 10 patients operated due to gynaecological malignancy, adnexal tumors or planned for the procedure used as a part of extensive oncological surgery.Department of Gynecology and Minimally Invasive Surgery Na Homolce Hospital, Prague.The surgeries were performed with Da Vinci robotic system (Intuitive Surgical, inc., USA) including surgeon's console with stereoscopic viewer with hand and foot controls. The second component of the system was In Site vision system with 3D 12 mm endoscope. The third part comprised of 3 telerobotic arms with Endowrist instruments. From 2/2006 to 9/2006 10 patients were operated upon. 2 patients with early invasive cervical cancer, 2 patients with cervical cancer in situ (CIS), 3 patients with complex ovarian tumors, 2 patients with symptomatic atypical endometrial glandular hyperplasia and 1 patient underwent necessary gynecological surgery as a part of oncological treatment of breast cancer. The range of surgery included Total robotic hysterectomy, Robot-assisted vaginal hysterectomy with adnexectomy and frozen section, Robot-assisted radical vaginal trachelectomy with pelvic lymphadenectomy and unilateral adnexectomy with frozen section. The average age of patients was 52 years (range 32-58 years). 30% of patients had a previous laparotomy in their history.All procedures were finished with robot-assisted system. In 2 patients a temporary conversion to laparoscopy was made. In 3 patients a technical fault of the robotic system was noticed. This was corrected during the surgery. The overal surgery time was significantly longer (29 hours for robot-assisted versus 12 hours for laparoscopy). This represented operation time increase of 59% in comparison to identical laparoscopic procedures in our department in 2006. This was caused by lengthy assembly and disassembly time of the robotic system. No patients experienced any peroperative or postoperative comlications. The costs in our setting were approximately 10 times higher in comparison to laparoscopy.Our preliminary experience shows that Robot-assisted surgery is comparable to the standard laparoscopic procedure in terms of feasibility and outcome, but costs are considerably higher owing to longer operating time and the use of more expensive instruments. A major limitation is the lack of a large operation field. The enormous costs and the lack of appropriate instruments can be a major problem in the further expansion of robotic surgery. The use of robotic system in gynecologic oncologic surgery and in abdominal surgery in general offers, at this stage, no relevant benefit and thus is not justified. Clinical data demonstrating improved outcomes are so far lacking for robotic surgical application within the abdomen.

Review of literature concerning pelvic exenterative procedures.Review article.Department of Obstetrics and Gynecology, Charles University, Prague.Review and critical assessment of published data.Pelvic exenterations are standard procedures in oncogynecology which have no alternative in certain indications. The most frequent indications are recurrences or progressions of cervical, vulva or vaginal cancers. Exenterative procedures might be used in primary treatment in some cases of locally advanced tumors. Mortality of current procedures reaches 5% to 10%, early and late postoperative morbidity is frequent (40-60%). Recently explorative laparoscopy is used in preoperative staging to decrease the number of aborted procedures due to distant metastasis or pelvic tumor inoperability. The procedure with high morbidity, causing impairment of quality of life, is justified due to good follow-up results--5-years overall survival is about 50-60%. It should be emphasized that with no treatment in these patients median of survival reaches about 6 months.

Review of advanced radicality in pelvic exenterations.Review article.Department of Obstetrics and Gynecology, General Faculty Hospital and Ist Medical Faculty of the Charles University, Prague.Review and critical assessment of published data.More extensive radicality in pelvic exenterations make possible to use surgical treatment in some cases of lateral recurrences or central recurrences with the attachment to the pelvic side wall. One possible technique is a combination of en bloc exenteration with pelvic bone resection, most frequently sacrum. Experiences in gynecological tumours are so far limited. Laterally extended resection was described in lateral infrailiac pelvic wall recurrences. The only one presented paper related to laterally extended procedures showed a reasonable overall survival of patients; however follow-up is limited.

Discussion of experiences with pelvic exenterations.Case-report.Department of Obstetrics and Gynecology, Department of Urology, Department of Surgery, Department of Pathology, Department of Clinical Oncology, General Teaching Hospital and Ist Medical Faculty of the Charles University, Prague, Czech Republic.Presentation of 4 cases of pelvic exenterations. Discussion with published data.Altogether four cases of pelvic exenterations are presented, one case of supralevator total exenteration for recurrent cervical cancer, one case of infralevator total exenteration for recurrent vaginal cancer, one case of supralevator anterior exenteration in the treatment of locally advanced cancer of urinary bladder, and one case of supralevator posterior exenteration for recurrent vaginal cancer.

Analysis of contemporary knowledge of proteomics and its aplication in diagnostics of ovarian cancer and other malignant tumours.Review article.Department of Gynecology and Obstetrics, 1st Faculty of Medicine, Charles University, Prague.An overview of published data.Proteomics deals with the analysis of proteins present in the organism in normal and pathologic conditions. Protein expression is characteristic of particular types of cells and tissues. The main improvement of protein analysis in clinical practice is early diagnostics of oncological diseases and specification of prognosis.

Presented are two cases of unusual adnexal tumor described under the term "female adnexal tumor of probable wolffian origin (FATWO)" in the bibliography. One lesion was 18 cm large tumor located in the ovary in 85-year-old woman, the second one was a 5 cm large pedunculated mass arising from broad ligament in 40-year-old female. Three main structural patterns often coexisted and comprised solid or diffuse, sieve-like and tubular arrangement of spindle or epithelial cells. Cellular atypia and mitotic figures were practically absent. Clinical follow up confirmed benign behavior in both cases. Discussed is differential diagnosis and review of the literature.

The authors present a survey of available pharmacological possibilities of treatment of nausea and vomiting aimed at their application in oncological therapy of gynecological neoplastic diseases.A review article. NAME AND ADDRESS OF THE INSTITUTION: Gynecological-Obstetrical Clinic, First Medical Faculty, Charles University and General Faculty Hospital, Praha. SUBJECT AND METHOD OF THE STUDY: A survey of published data from the Czech and foreign professional literature.5-HT3 receptor antagonists take up the most important position in the antiemetic treatment of oncological patients. They efficiently prevent and treat vomiting induced by anticancer drugs with high and very high emetogenic effect. They have been used as monotherapy or in combination with corticoids. In the treatment of nausea and vomiting or vomiting induced by anticancer drugs with medium or light emetogenic effect, antiemetic preparations from the corticoid series and dopamine receptor antagonists may be recommended. In the treatment of anticipation vomiting, benzodiazepines are indicated for their anxiolytic and psychosedative influence.

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.

Gynecologic malignancies (including breast cancer) represent a substantial proportion of neoplastic disorders in women. The problems associated with the treatment of gynecologic cancer is not limited to gynecology and oncology, but involve other specialties, including, in the case of breast cancer, surgery and radiology. The incidence of gynecologic cancer increases with age, similarly to other tumors or some internal disorders, including diabetes mellitus. In many patients, especially elderly, a coincidence of cancer and diabetes mellitus is observed. The presence of diabetes mellitus, similarly to that of other comorbid conditions, may have a profound impact on the prognosis and the choice of treatment for the individual patient. Moreover, some studies indicate that diabetes mellitus increases the risk of breast and endometrial carcinoma. As in other areas of medicine, a close collaboration between specialists treating the tumor (surgeon or gynecologist, medical and radiation oncologist) with physicians specialized in treating comorbid conditions (internal medicine, cardiology or diabetes medicine) is inevitable. The current state of the treatment of gynecologic cancer is reviewed, with a special focus on breast cancer. The progress in breast cancer treatment illustrates how the understanding of molecular mechanisms underlying tumor growth and evidence-based medicine can lead to a major improvement of the prognosis of cancer.

The author presents a review of gynaecological complications of obesity. He mentions the problem of gestation in obesity, surgical complications and hormonal abnormalities in obese women. A classical complication of obesity is sterility. Obesity is also a risk factor for a number of gynaecological tumours. The author emphasizes the importance of weight reduction in the treatment of sterility and for the prevention of gynaecological tumours. An increase of body weight must be prevented in gynaecological hormonal treatment and contraception.

The incidence and mortality of malignant tumours of the uterine cervix, uterine body and ovary are analysed.Retrospective study.Department of Obstetrics and Gynecology, Medical Faculty and Faculty Hospital, Charles University, Plzen.Analysis of relevant dates from the National Oncological Registry 1986-1995.The incidence of the cervical carcinoma oscilated around 22 (22.7-21.6), the mortality slightly decreased (9.6-8.4). The incidence of the corpus carcinoma rose again (25.9-28.9), its mortality declined (7.4-6.9). The incidence of malignant ovarian tumours significantly increased (16.3-23.4), the mortality became slightly higher (14.8-16.2). The incidence of the ovarian carcinoma got ahead the incidence of the cervical carcinoma (23.4:21.6) and it occupied the second place after the corpus carcinoma.It is necessary to screen systematically gynecological malignant tumours and concentrate its treatment to specialized centers. Correct reports of these tumours and their precise staging is needed, too.

A review on participation of chlamydiae in the origin of the HIV-infection, carcinoma and atherosclerosis. The antibodies against the newly discovered pgp3 protein of C. trachomatis were found in 83-87% of the seropositive HIV patients. The participation of C. trachomatis in the etiology of cervical and ovarian carcinoma has been discussed in a number of articles. Simultaneous examinations along different lines allow the hypothesis, that C. trachomatis acts as a cofactor in the development of ovarian and cervical carcinoma. Chronic infection by C. pneumoniae appears to be one of the risk factors of pulmonary carcinoma. Many papers dealing with the relation of chlamydiae and atherosclerosis have been published. The relation between the chronic C. pneumoniae-infection and atherosclerosis has been assessed serologically and by direct demonstration of chlamydiae in atheromatous plaques.

Treatment of women suffering from malignant disease of reproductive organs has its specific ethical, deontological and psychological aspects. The disease is affecting the organs of "feminine identity" and has a very strong emotional impact on each woman. The awareness of the nature of the disease and its treatment brings a long-term stress for each patient. There is a very delicate moment in the relation between the patient and the physician: to inform about the nature of the disease, treatment and its consequences. Such information should be released only in proper time and in proper way, considering the individual character of the patient, her age, intelligence and her present somatic and psychic status. Response of each woman and her adaptability to the disease and its treatment is very individual--depending on the woman's personality, her age, education and, of course, her social background. The physician, as well as, the other personnel must be aware of this fact. They have to choose the most proper psychotherapy and provide the patient with the adequate social support.

The authors investigated a group of 195 patients from the Centre of Oncological Prevention for human papillomavirus (HPV) in the lower genital tract. The diagnostic set ViraPap/ViraType was used for detection. It is based on double hybridisation of viral DNA and on the use of polyclonal and monoclonal antibodies with chemoluminiscent reaction. The test was totally positive in 23.1% of women. 5.1% tests were positive in the low-risk group of viruses (LR-HPV) and 19.5% in the high risk group (HR-HPV). Precancerous lesions (CIN I-III) or invasive cancer were found in 86.7% of positive tests. In patients with CIN III 37.1% were HPV positive and all patients with invasive cancer were positive. The results support an association between CIN and HPV infections. The possible role of HPV in cancerogenesis is discussed as well as the clinical importance of their detection.

The incidence of all malignant tumours of the female reproductive organs in our country is on average by 40% higher than the worldwide incidence and with the exception of carcinoma of the uterine cervix it is still slowly rising. Gynaecological oncology emphasizes: prevention with accurate classification of premalignant changes to ensure adequate treatment; radical surgery primarily in invasive forms as well as with regard to staging as a prerequisite for indication of adjuvant treatment; interdisciplinary team cooperation which indicates without time losses all therapeutic steps, incl. inoperable tumours, and ensures permanent follow-up.

The cell mediated immunity was examined by the leukocyte adherence inhibition (LAI) test in 21 patients with CIN III and 146 patients with invasive gynaecologic malignancies before treatment and at 3-month intervals. Our own LDV antigen and organ specific antigens were used. The test was highly specific (95.1%) in comparison with a control group of healthy blood donors. The sensitivity of the test was lower (64.7-86.8%). There was no correlation with the development of disease (remission or relapse). The test in a two-year investigation does not seem suitable for monitoring of disease. Depending the nature of LDV infection, only a longer investigation extending over more years would enable further conclusions.

The beneficial effects of combined estrogen-progestin-containing oral contraceptives (OCs) include prevention of pregnancy (less than 1 failure out of 100 regular users); the prevention of ectopic pregnancy; the reduction of preeclampsia (2.4 times lower risk compared with barrier methods); and reduction of pelvic inflammation to about one-half. The effects on menstruation include the reduction of sideropenic anemia (by lowering the incidence and duration of menstruation, OCs reduce the loss of iron to 50% or to as much as 33%); dysmenorrhea by 40% (symptoms receded in 90% of users); and premenstrual syndrome by 30%. OCs exert a favorable effect on menstrual epilepsy; reduce sports-related accidents in the premenstrual and menstrual periods; and reduce intermenstrual bleeding. The protection from cancer includes the lowering of endometrial cancer risk (every 2 years of use reduces the risk by 38%, 12 years of use by 70%, and the beneficial effects last 3-15 years); reduction of the risk of the ovarian cancer (already 3-6 months of use reduces the risk by 30%, and more than 5 years by 50% in women under 50 years of age with a longterm effect of 10 years or more, which drops sharply in women over 60 who are mostly at risk). Among other beneficial effects, they reduce benign mastopathy by 50-75%; reduce the risk of follicular ovarian cysts to 50% and the risk of corpus luteal ovarian cysts to 1/5; and they lessen bone loss which favorably affects osteoporosis. Low-dose OCs minimize the well-known risks of thrombotic and cerebrovascular accidents, myocardial infarction, hypertension, altered carbohydrate metabolism, gallbladder diseases, and liver cancer. A new OC with 30 mcg of ethinyl estradiol was tested with daily doses of 150 mcg of desogestrel. The high density lipoprotein (HDL) either increased or did not change with desogestrel: the HDL2 subfraction that protects from atherosclerosis did not change, and probably the HDL3 raised the HDL level.

One hundred and twenty-three female patients were subjected to ultrasound and CT examinations on account of suspected tumours in the area of the lesser pelvis, or to evaluate the postoperative situation. Twenty-five patients were subjected in addition to the mentioned examinations also to angiography of the pelvic arteries. From comparison of the results of the radiodiagnostic examination and the surgical (histological) diagnosis ensues that in patients with a malignant tumour of the ovaries and uterus and with a benign tumour of the uterus the CT examination gives-more satisfactory results than the ultrasound examination. In patients with a benign tumour of the ovaries ultrasonic and CT examinations were approximately equally satisfactory.

Radioimmunoscintigraphy is a diagnostic method which uses labelled monoclonal antibodies for the visualization of tumourous foci. It is a nuclear medical method which is developing rapidly. The author mentions basic investigations on the bio-distribution of antibodies in animal models as well as review of contemporary clinical studies with the diagnostic use of commercial monoclonal antibodies.