Ovary In Girls Research Articles

Puberty progression in girls with Turner syndrome after ovarian tissue cryopreservation.

To study the impact of unilateral ovariectomy for ovarian tissue cryopreservation (OTC) on the function of the remaining ovary in girls with Turner syndrome. A prospective cohort study as follow up of OTC in a research setting (The TurnerFertility trial, NCT03381300). University hospital in Nijmegen, the Netherlands. A total of 28 girls with Turner syndrome with follicles in their cryopreserved ovarian cortex tissue, aged 5-19 years. Of the 28 girls, 21 girls had a 45,X/46,XX mosaic karyotype, five had structural aberrations of the X-chromosome, one girl had a 45,X monosomy, and one girl had a 45,X/47,XXX karyotype. Girls were monitored annually after OTC for pubertal development and levels of anti-Müllerian hormone (AMH), Follicle Stimulating Hormone, Luteinizing Hormone, Estradiol, and Inhibin B. Thelarche, menarche and onset of premature ovarian insufficiency. The girls were monitored for a median duration of 3.4 years (maximum 6.6 years). The pubertal development of five prepubertal girls is still unknown, all were under the age of 10 and had low gonadotropins and estradiol levels at the end of the follow-up. Seven of the eight girls around pubertal age (10-12 years) experienced spontaneous thelarche, while one received medication to induce puberty. Eleven of the fourteen girls between the age of 14-17 years experienced spontaneous menarche, three other girls with thelarche still had ongoing puberty at the end of follow-up with normal gonadotropins and AMH levels above the detection limit. Around six to twelve months after OTC, a decline in AMH concentration was observed in 57% of girls (16/28 girls), followed by an increase in AMH concentration in the following years. Six of the total 28 girls started hormone replacement therapy due to symptoms of premature ovarian insufficiency, and all had AMH levels below 0.50 μg/L before OTC. Pubertal development progressed after unilateral ovariectomy for OTC in most girls with Turner syndrome. Hormone replacement therapy was required within a few years for girls with unfavorable parameters before OTC, such as AMH below 0.50 μg/L. Decisions regarding OTC should be personalized, considering the girl's preferences and specific characteristics.

On the question of the characteristics of the menstrual cycle in adolescent girls with obesity

Background. Due to the increasing prevalence of abnormal uterine bleeding (AUB) among obese adolescent girls, a factorial analysis of the probable causes of this pathology is highly relevant.
 Aim. To analyze and characterize clinical, hormonal, metabolic features and parameters relevant to the assessment of ovarian reserve in adolescent girls with obesity and AUB.
 Materials and methods. The study included 2 groups of obese adolescent girls who have passed at least 12 months from the start of menarche, who do not have endocrine and severe somatic diseases; main group: adolescent girls with obesity (SDS BMI more than 2) and abnormal uterine bleeding of the type of opso-oligomenorrhea and secondary amenorrhea; comparison group: adolescent girls with obesity (SDS BMI more than 2) and absence of menstrual cycle disorders.
 Results. Among adolescent girls without AUB, severe forms of obesity (34 art.) were more common than in the group with AUB. According to the metabolic status, plasma triglyceride and cholesterol levels were significantly higher in the AUB group compared with adolescent girls without menstrual disorders (p=0.035 and 0.043, respectively).When assessing carbohydrate metabolism, no significant differences between the groups were obtained (p=1.000). According to the results of the study of the hormonal status, no significant differences between the groups were obtained. The hirsute number had no significant differences in the groups. The correlation analysis revealed a positive correlation between the severity of obesity with the HOMA index (p=0.034), a positive correlation of the prolactin level with the hirsute number (p=0.021) and estradiol (p=0.04). The median level of anti-muller hormone in the group with AUB was significantly higher compared to the group without AUB (6.13 ng/ml vs 2.09 ng/ml, p0.05). When analyzing the follicular apparatus of the ovaries, it was found that the median volume of both the right and left ovaries in girls of group 1 with obesity and the AUB was larger than in the comparison group. The median number of follicles in the section in group 1 also indicated a greater number of them compared to the comparison group.
 Conclusion. In the studied groups, girls with a more severe degree of obesity were more often associated with the absence of AUB, but metabolic disorders were more common in the group of girls with AUB. When assessing the ovarian reserve, a direct correlation was obtained between the level of anti-muller hormone and the number of antral follicles in the ovary.

O-275 Is there a case for ovarian tissue cryopreservation in young girls and Turner syndrome patients?

Abstract The development of new cancer drugs and drug combinations has led to a dramatic increase in the survival rates of prepubertal and postpubertal girls undergoing myeloablative treatment for malignant or non-malignant diseases. This includes girls who will receive high doses of alkylating agents, total body irradiation, or high radiation doses to the craniospinal, abdominal or pelvic area. Chemotherapy is also used as a conditioning regimen before hematopoietic stem cell transplantation for treatment of, for example, beta thalassaemia or homozygous sickle-cell anaemia. The corollary of improved treatment outcomes of childhood diseases is that many survivors are now at risk of multi-faceted, chronic morbidity, impaired quality-of-life and psychosocial problems. Depending on the nature and duration of their treatment some, but not all, young patients facing fertility threatening diagnosis and treatments will have an increased risk of adverse pregnancy outcomes and premature ovarian insufficiency (POI) as their future fertile potential will be defined by the number of follicles remaining in their ovaries following completion of their chemotherapy/radiotherapy. While a fully functioning hypothalamic-pituitary-ovarian axis and uterus are vital to the reproductive potential of adult females, Ovarian tissue cryopreservation (OTC) is now being used to safeguard the future fertility of prepubertal and adolescent girls and young women undergoing treatments that have a high risk of causing POI. OTC is increasingly advocated for young girls receiving an early diagnosis of the most common sex chromosome abnormality- Turner Syndrome (TS) who have a high risk of POI. In theory the ovaries of girls, including TS patients with an adequate ovarian reserve, are well suited to OTC as their ovaries contain high numbers primordial follicles which can be used to preserve future fertility. Ovarian tissue can be removed laparoscopically and early staged follicles cryopreserved in situ within slices of cortex. The operative approaches used for tissue removal from paediatric and adolescent patients are variable and invasive and are dependent on patient age, health and ovarian reserve at the time of tissue recovery. Extensive research has shown that ovarian cryopreservation techniques are robust and that experienced practitioners can achieve high levels of survival of both the ovarian stroma and follicle compartments post thaw. Cryobanked ovarian cortex collected from prepubertal and postpubertal girls has been shown to function normally and support fertility, pregnancy to term and the birth of healthy babies following orthotopic autografting in adulthood. Regardless of patient age at tissue preservation, autografting of frozen-thawed ovarian cortex at either the site of the retained ovary or into the peritoneal cavity results in an immediate and significant follicle loss due to ischaemia and accelerated apoptosis. Those primordial follicles that survive graft revascularization have been shown to have the capacity to grow to preovulatory stages, to reinstate hormonal function and to undergo ovulation and restore natural fertility. Alternatively, follicle growth can be induced in autografted tissue by controlled ovarian stimulation before oocyte harvest for insemination in vitro using assisted reproductive technologies. Graft functional longevity remains variable between patients and may extend from months to years. Alternative methods for fertility restoration such as the complete in vitro growth and maturation of oocytes and the construction of artificial ovaries remain unproven in humans. While OTC can be recommended for young girls at high risk of developing ovarian insufficiency for genetic reasons or following high dose chemotherapy and/or irradiation, to date very few young patients with stored ovarian tissue have used their tissue for fertility restoration. OTC therefore remains experimental and further research is needed to establish the risks, benefits, efficacy, safety and ethical and clinical frameworks for offering fertility preservation to girls during childhood and adolescence and to girls with TS.

Doppler Assessment of the Uterine Arteries for the Definition of Pubertal Onset in Girls

Abstract Pelvic ultrasonography (US) is a quick, non-invasive and low-cost method, and doppler analysis facilitates assessment of flow impedance measurement in the uterine vascular tree. The pulsatility index (PI) reflects blood flow impedance in the vessel distal to the sampling point and has been suggested as a parameter to define pubertal development. In order to evaluate the PI and US measurements of uterus and ovaries in girls with different pubertal stages, we performed a cross-sectional study in girls with normal pubertal development. US and Doppler assessed PI of the uterine arteries (defined as the difference between the peak systolic flow and end-diastolic flow divided by the mean maximum flow velocity), endometrial thickness, uterine and ovarian volumes were evaluated. All the US exams were performed with the same equipment by the same radiologist. Clinical data such as the age of menarche, pubarche and thelarche were recorded. Statistical analyses were performed in SPSS, with ANOVA test, Spearman correlation and ROC curve with Youden. One hundred and sixty-nine girls aged 5-16 years (mean 11.3 ± 1.8) who performed two hundred and two pelvic US were included (Tanner 1=20%, Tanner 2=22%, Tanner 3=23%, Tanner 4=17%, Tanner 5=17%). Mean age of thelarche, pubarche and menarche were 11.1 ± 1.8, 10.2 ± 1.2 and 12.2 ± 1.1 years respectively. Prepubertal girls (Tanner 1) had mean PI significantly higher than girls in initial puberty (Tanner 2 and 3 grouped) and in late puberty (Tanner 4 and 5 grouped), respectively 6.5 ± 2.27 vs. 4.15 ± 1.55 vs. 2.82 ± 1.06, p<0.001 for all the comparisons. ROC curve analysis demonstrated that the PI is able to identify the onset of puberty with an area under the curve of 0.80 ± 0.04, P<0.001, and a cutoff point of IP=5.05 presented a sensitivity of 0.77 and a specificity of 0.80 to identify the onset of puberty. When we combined the cutoffs of IP <5.05 plus uterine volume >3.75 cm³, we found a sensitivity of 0.72 and specificity of 0.90 to detect puberty. We identified a strong negative correlation between PI and uterine volume (rs=-0.72, p<0.001) and a moderate negative correlation with endometrial thickness (rs=-0.68, p<0.001) and right (rs=-0.60, p<0.001) and left (rs=-0.59, p<0.001) ovarian volumes. In conclusion, we found a significant reduction of the PI during pubertal development, reflecting a progressive increase in blood flow to the uterus, which can be a valuable non-invasive and highly specific tool to confirm the onset of puberty.

MALIGNANT NEOPLASMS OF OVARIES IN CHILDREN AND ADOLESCENTS

Tumors of the ovaries in girls represent an actual problem in modern gynecology. First of all, this is due to diagnostic difficulties, due to the absence of characteristic complaints, asymptomatic course and the complexity of the gynecological examination, which leads to the establishment of an erroneous diagnosis, the lack of correct and timely treatment and, as a consequence, the occurrence of complications that often negatively affect the reproductive function of the patient in further. The differential diagnosis of ovarian tumors in girls is still one of the most important problems of modern practical gynecology. The presence of a combined pathology in many patients, which is in 30-40% according to the WHO, puts the problem of the possibility of the simultaneous correction by surgeon and gynecologist. In connection with the difficulty of diagnosing, the diagnosis of such patients must necessarily include an examination by a pediatric surgeon and gynecologist with ultrasound examination of the retroperitoneal space, abdominal cavity organs, and small pelvis. Errors in the differential diagnosis of genital and extragenital diseases occur quite often and are mainly due to the similarity of clinical symptoms. This article presents a clinical case of the diagnosis and management of a 14-year-old patient with an adjacent diagnosis, as well as diagnostic search criteria for the differential diagnosis of gynecological and surgical pathologies.

FEATURES OF THE DIFFERENTIAL DIAGNOSIS OF OVARIAN TUMORS IN GIRLS

Tumors of the ovaries in girls represent an actual problem in modern gynecology. First of all, this is due to diagnostic difficulties, caused by the absence of characteristic complaints, asymptomatic course and the complexity of the gynecological examination, which leads to making of an erroneous diagnosis, the lack of correct and timely treatment and, as a result, complications that often negatively affect the reproductive function of the female patient in further. The differential diagnosis of ovarian tumors in girls is still one of the most important problems of modern practical gynecology. In many patients, the presence of a combined pathology, which is 30-40% according to WHO data, puts the problem of the possibility of simultaneous correction of such pathology by both surgeons and gynecologists. In connection with the difficulty of diagnosing, the diagnosis of such patients must necessarily include an examination of a pediatric surgeon and a children’s gynecologist with ultrasound examination of the retroperitoneal space, abdominal cavity organs, and small pelvis. Errors in the differential diagnosis of genital and extragenital diseases occur quite often and are mainly due to the similarity of clinical symptoms. This article presents a clinical case of the diagnosis and management of a 14-year-old female patient with an adjacent diagnosis, as well as criteria for the diagnostic search for the differential diagnosis of gynecological and surgical pathologies.

FEATURES OF THE DIFFERENTIAL DIAGNOSIS OF OVARIAN TUMORS IN GIRLS (OBSERVATION FROM THE PRACTICE)

Tumors of the ovaries in girls represent an actual problem in modern gynecology. First of all, this is due to diagnostic difficulties, caused by the absence of characteristic complaints, asymptomatic course and the complexity of the gynecological examination, which leads to making of an erroneous diagnosis, the lack of correct and timely treatment and, as a result, complications that often negatively affect the reproductive function of the female patient in further. The differential diagnosis of ovarian tumors in girls is still one of the most important problems of modern practical gynecology. In many patients, the presence of a combined pathology, which is 30-40% according to WHO data, puts the problem of the possibility of simultaneous correction of such pathology by both surgeons and gynecologists. In connection with the difficulty of diagnosing, the diagnosis of such patients must necessarily include an examination of a pediatric surgeon and a children’s gynecologist with ultrasound examination of the retroperitoneal space, abdominal cavity organs, and small pelvis. Errors in the differential diagnosis of genital and extragenital diseases occur quite often and are mainly due to the similarity of clinical symptoms. This article presents a clinical case of the diagnosis and management of a 14-year-old female patient with an adjacent diagnosis, as well as criteria for the diagnostic search for the differential diagnosis of gynecological and surgical pathologies.

Лапароскопічна корекція рецидивних пахвинних гриж у дітей

Повторна операція з приводу рецидиву пахвинної грижі у дітей, яка виконується традиційним доступом у пахвинній ділянці, завжди ускладнюється наявністю грубих рубців та порушенням звичайних анатомічних відношень між органами та тканинами пахвинної ділянки. Висока травматичність повторного втручання також ускладнюється наявністю зрощень між кремастерним м’язом та елементами сім’яного канатика у хлопчиків та значними спайками в ділянці круглої зв’язки матки у дівчат, що призводить до грубого порушення усіх ланок дренажних систем яєчка у хлопчиків та розвитку порушень васкуляризації яєчника у дівчат. Наведені чинники спонукають дитячих хірургів до пошуку нових, менш травматичних та високоефективних методів операційного лікування рецидивних пахвинних гриж у дітей. Цим завданням повною мірою відповідає вдосконалений нами спосіб лапароскопічної корекції рецидивної пахвинної грижі з проведенням інтраопераційного УЗД-контролю пахвинної ділянки з боку втручання. За період з 2013 до 2015 р. у хірургічному відділенні КЗ “ДСКМЦМД ім. проф. М. Ф. Руднєва” ДОР м. Дніпра було виконано 18 лапароскопічних втручань при рецидивних пахвинних грижах у дітей, яким перше втручання виконували традиційним доступом у пахвинній ділянці. Всі діти були у віці до 3 років. При аналізі випадків рецидиву пахвинних гриж дійшли висновку, що рецидиви з’являлися у дітей раннього віку і, частіше, після операційних втручань з приводу защемлених пахвинних гриж, які оперували традиційними способами. Таким чином, запропонований нами спосіб лапароскопічної корекції рецидивних пахвинних гриж дозволяє ліквідувати грижовий мішок без додаткового травмування структур пахвинного каналу, які перебувають у стані рубцевого процесу, що виник після попереднього хірургічного втручання в пахвинній ділянці. Крім того, гарний косметичний ефект операції перешкоджає формуванню повторних спайок та грубих післяопераційних рубців. У ході проведеної нами роботи доведено, що серед заходів, які спрямовані на відновлення порушень дренажних систем яєчка при порушенні облітерації піхвового відростка очеревини у хлопчиків та для збереження васкуляризації яєчника у дівчат, головне місце займають: своєчасне повторне хірургічне лікування дітей, використання патогенетично обґрунтованих способів хірургічної корекції патології на рівні глибокого пахвинного кільця з використанням сучасної лапароскопічної техніки.

Laparoscopy in elective and emergency management of ovarian pathology in children and adolescents.

IntroductionOvaries are one of the most common locations of tumor masses in children. Some of them require surgery due to the risk of malignancy or necrosis. This organ seems to be ideal for the laparoscopic approach.AimTo evaluate the usefulness of laparoscopy in surgery of lesions located in the ovaries in patients under 18 years of age and assess the risk of changes in the ovaries in girls with acute abdominal symptoms.Material and methodsRetrospective evaluation of hospital records of the period 1996–2012 from a single hospital was performed. 105 laparoscopic procedures of ovarian pathology in patients aged 0–18 (mean: 13.5) years were reviewed. The overall sample was divided into groups depending on the indication and mode of surgery. Group I: elective or emergency surgery, imaging findings of ovarian cysts bigger than 5 cm or causing pain. Group II: elective surgery, the ovarian tumor visible in imaging (solid mass or mixed). Group III: treatment for acute abdomen, without visible ovarian pathology in the preoperative imaging studies. Group IV: elective treatment of other indications, incidental finding.ResultsThere were no deaths or major complications. There were no conversions. Average length of hospital stay after surgery was 2.5 days. The risk of appendicitis in patients referred for surgery due to ovarian cysts visualized in ultrasound, in the factual absence of ovarian pathology (false positive ultrasound), in the presented material was 5.2%. The risk of lesions in the ovaries in patients operated on due to acute abdominal pain, with no findings in the pre-operative ultrasound (false negative ultrasound), in the presented material was 7.4%. The risk of coexistence of changes in the ovaries with appendicitis found during the procedure due to acute abdominal pain in the study group was 6%.ConclusionsThe laparoscopic treatment for ovarian masses is safe and efficient. The risk of wrong preoperative diagnosis (ovary mass vs. appendicitis) is in any direction between 5 and 8%, which is a number large enough to be taken into consideration when surgical training and legislation is concerned.

Ultrasonic Morphology of Uterus and Ovaries in Girls with Pituitary Hyperplasia Secondary to Primary Hypothyroidism

We aimed to study uterine and ovarian morphology, hormonal levels, and pituitary height in prepubertal girls with pituitary hyperplasia secondary to primary hypothyroidism (PH) before and after thyroid hormone replacement therapy. We investigated 24 prepubertal girls with severe PH who were divided into 2 groups: secondary pituitary hyperplasia (group A, n=18), without pituitary hyperplasia (group B, n=6). Serum levels of free triiodothyronine (FT3), free thyroxine (FT4), thyrotropin (TSH), follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), testosterone (T) and prolactin (PRL), pituitary height, uterine volume (UV), ovarian volume (OV), follicular diameter (FD), and follicular number (FN) in group A were measured before and 3-month after levothyroxine therapy. Age-matched healthy prepubertal girls (control group, n=30) were also enrolled in the study. The levels of FT3 and FT4 were significantly lower and the values of TSH, FSH, E2, PRL, pituitary height, UV, OV, and FD were significantly higher in group A than in the control group (all p<0.05). In group B, FT4 levels were significantly lower and TSH levels were significantly higher than in the control group (both p<0.05); the values of FSH, E2, PRL, UV, OV, and FD tended to be higher than those in the control group; there were no statistically significant differences (all p>0.05). After 3-month of therapy, hormonal levels regressed and imaging abnormalities decreased. Our results indicate that PH patients with pituitary hyperplasia have enlarged uterus, ovaries and follicles, as well as high values of FSH, E2, PRL, and pituitary height, which are improved after levothyroxine therapy.

Uterus and ovaries in girls and young women with Turner syndrome evaluated by ultrasound and magnetic resonance imaging

To determine uterine and ovarian size in Turner syndrome (TS) and to compare uterine and ovarian size evaluated by transabdominal ultrasound (US) and magnetic resonance imaging (MRI) in girls with TS and two groups of controls. A cross-sectional study. Forty-one girls with TS (17·0 ± 3·3 years, range 11·2-24·9 years), 50 healthy age-matched controls (16·9 ± 3·2 years, range 12·5-25·0 years) and 107 Tanner-stage-matched controls (15·0 ± 3·2 years, range 10·1-24·2). Uterine and ovarian volume by US and MRI. Ovaries were detected in 37% in TS by US and in 55% in TS by MRI (P = 0·1). Total ovarian volume was lower in TS compared to both groups of controls (TS vs C-US: median 1·1 ml (range 0·1-29·3) vs 11·52 ml (1·9-77·9), P = 0·001, TS vs C-MRI: 1·0 ml (0·1-34·2) vs 13·2 ml (2·4-30·1), P < 0·0005). Mean difference in total ovarian volume measured by MRI and US in patients with TS was 2·3 ± 3·8 ml (P = 0·01). Mean uterine volume by MRI was lower in TS compared to controls (29·5 ± 25·1 vs 54·3 ± 23·3 ml, P < 0·0005). Uterine volume by US was lower in TS at Tanner stage B5 compared to controls (TS vs C: 33·6 ± 18·2 vs 50·2 ± 18·0 ml, P = 0·007). A larger ovarian volume was detected by MRI in TS compared to US. This finding is important with the advancements of performing ovarian biopsies for cryopreservation and later reimplantation. Mean uterine volumes by MRI and US in fully matured TS were lower compared to controls despite appropriate hormonal replacement therapy in TS.

US assessment of estrogen-responsive organ growth among healthy term infants: piloting methods for assessing estrogenic activity.

A mother's circulating estrogen increases over the third trimester, producing physiological effects on her newborn that wane postnatally. Estrogenization might be prolonged in newborns exposed to exogenous estrogens, such as isoflavones in soy formula. We evaluated ultrasonography for monitoring growth of multiple estrogen-responsive organs in healthy infants and developed organ-growth trajectories. We studied 38 boys (61 visits) from birth to age 6 months and 41 girls (96 visits) from birth to age 1 year using a partly cross-sectional, partly longitudinal design. We measured uterus and ovaries in girls, testes and prostate in boys, and kidneys, breasts, thymus, and thyroid in all children. We imaged all organs from the body surface in one session of < 1 h. Uterine volume decreased from birth (P < 0.0001), whereas ovarian volume increased sharply until age 2 months and then decreased (P < 0.001). Testicular volume increased with age (P < 0.0001), but prostatic volume showed minimal age trend. Breast bud diameter showed no age trend in girls but declined from birth in boys (P = 0.03). US examination of multiple estrogen-responsive organs in infants in a single session is feasible and yields volume estimates useful for assessing potential endocrine disruptor effects on organ growth.

Location of the ovaries in girls from newborn to 18 years of age: Reconsidering ovarian shielding

Location of the ovaries in girls from newborn to 18 years of age: Reconsidering ovarian shielding

Location of the ovaries in girls from newborn to 18 years of age: reconsidering ovarian shielding

Guidelines for ovarian shielding are to place a lead shield in the midline of the abdomen at the level of the umbilicus. However, the ovaries are routinely seen at other locations on all types of imaging examinations. To determine the position of the ovaries in girls, newborn to 18 years of age, in order to assess efficacy of ovarian shield placement. We identified 336 girls who underwent lumbar spine and pelvic MRI. Images were reviewed noting the position of the ovaries relative to anatomic landmarks: symphysis pubis, iliac crest and anterior superior iliac spine (ASIS). In 174 girls a total of 307 ovaries were visualized. The girls were divided into three age groups and analyzed together. Right and left ovaries were analyzed together. The mean, 95% confidence interval (CI), standard deviations and range were calculated. The ovaries lay at or below the iliac crest (the level of the umbilicus), most often just medial to the ASIS and above the pubic symphysis in girls of all ages. Current methods of shielding only the midline of the pelvis for the purpose of reducing radiation dose to the ovaries during radiographic imaging are ineffective given that the ovaries are almost always positioned laterally in the pelvis. Therefore current shielding techniques should be changed; lead ovarian shields should be placed in a lateral position or even abandoned if relevant anatomy will be obscured.

IS-006 Laparoscopic strategy for inguinal hernias containing ovary in girls : When to operate irreducible ovary?(the 44th Annual Meeting of Japanese Society of Pediatric Surgeons)

IS-006 Laparoscopic strategy for inguinal hernias containing ovary in girls : When to operate irreducible ovary?(the 44th Annual Meeting of Japanese Society of Pediatric Surgeons)

Policystic ovary syndrome—three-dimensional transrectal ultrasound in adolescent patients. Diagnosing and monitoring of treatment

Objective: Policystic ovary syndrome (PCOS) consists of endocronological and metabolic symptoms. Up till now, the ultrasound evaluation of ovaries in girls with diagnosed PCOS was performed transabdominally, which sometimes appeared inappropriate. US diagnosis is based mostly on evaluation of size of ovaries and the number of follicles. The aim of this study is to try to make an assessment of the usefulness of transrectal US in evaluation of structure of ovaries, the degree of vascularisation in power and colour Doppler mode, as well as quantitive flows before and after the treatment (Diane-35).

Timing of puberty and fetal growth.

Children born small for gestational age (SGA: birth weight or birth length more than 2 standard deviations below the mean score) are at a higher risk of perinatal morbidity and mortality and of a number of chronic diseases in later life such as hypertension, decreased insulin sensitivity, diabetes mellitus type 2 and an increased risk of cardiovascular disease. The programming of the endocrine axes occurs during critical phases of fetal development and might thus be affected by intrauterine growth retardation. Studies in Northern Spanish adolescent girls have indicated associations between reduced fetal growth and the occurrence of precocious adrenarche, pubarche, hyperandrogenism, polycystic ovary syndrome (PCOS) and hyperinsulinism. These findings have attracted much attention because it might have serious consequences in later life. However, hyperandrogenism and precocious pubarche were not confirmed in a large Dutch study in short children born SGA. Two studies reported a lower number of follicles in the ovaries in girls born SGA, which might have an impact on fertility. Clearly, further studies are required before definite conclusions can be drawn. There are still only limited data concerning the timing of puberty in children born SGA. Most studies indicate that these children start their puberty at a normal age but relatively early within the normal range. Age at menarche seems comparable with controls. Data on duration of puberty, influence of puberty on attainment of adult height, peak height velocity during puberty and fertility are not yet known.

Normal ovaries in neonates and infants: a sonographic study of 77 patients 1 day to 24 months old.

Normal values for ovarian measurements in adults have been revised over the past decade. A recent report stated that ovarian cysts were common in healthy girls 2-13 years old, refuting the findings of a 1984 study. No large sonographic study of normal ovaries in girls 1 day to 24 months old has been performed. We evaluated ovaries in girls in this age group to determine the normal volume and prevalence of ovarian cysts. The ovaries of 77 consecutive patients 1 day to 24 months old were evaluated during routine pelvic sonography. Patients were divided into three age groups: 1 day to 3 months old (when gonadotropin levels are highest because of loss of placental hormonal influence), 4-12 months old (an intermediate group), and 13-24 months old (when gonadotropin levels are low). Ninety-eight ovaries were imaged in three dimensions. The mean volume was 1.06 cm3 (range, 0.7-3.6 cm3) among girls up to 3 months old; 1.05 cm3 (range, 0.2-2.7 cm3) among girls 4-12 months old; and 0.67 cm3 (range, 0.1-1.7 cm3) among girls 13-24 months old. We found no significant difference in mean volumes among the three groups. The prevalence of ovarian cysts was similar in all three groups; ovarian cysts were seen in 84% of all imaged ovaries. Macrocysts (cysts larger than 9 mm) were seen in 18% of all cystic ovaries. Ovaries of girls 1 day to 24 months old can have volumes greater than 1 cm3. Ovarian cysts are common. Macrocysts can be seen despite claims that they are rare in girls less than 11 years old.

Tumor-like formations and tumors of the ovaries in girls and girls

The analysis of the clinical course of tumor-like formations and ovarian tumors in 40 girls and adolescents aged 6 to 17 years is presented. More frequent development of proliferating tumors was noted. The immediate and long-term results of surgical and combined treatment of these patients have been studied. Practical recommendations for early diagnosis of ovarian tumors and methods of treatment are given.

Graaf's vesicle formation in female fetuses and girls

Graaf's vesicles are formed both in the ovaries of female fetuses beginning in the 7th month of uterine life and in the ovaries of girls who have not reached puberty.