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TYPE OF STUDY: Summary review. SETTING: Department of Gynaecology and Obstetrics, 1st Faculty of Medicine, Charles University and Hospital Na Bulovce, Prague; Department of Physiology, Faculty of Science, Charles University, Prague; Department of Children and Adolescent Medicine, 1st Faculty of Medicine, Charles University in Prague and General Teaching Hospital, Prague. INTRODUCTION: Intrauterine growth restriction (IUGR) is one of the most common problems in obstetrics. Its incidence is ranging between 3-10%, according to the type of study population and chosen criteria. The cutoff value mainly used for defining the IUGR is weight below the 10th percentile for gestational age. The minority of authors defines the cutoff value under the 5th or 3rd percentile. Any pathological interference with normal vascular development of placenta may have a critical impact on foetal growth and development. Ischaemia is the most common cause of IUGR in normally well-supplied placenta. IUGR is then a consequence of insufficient extension, branching, and dilatation of capillary loops during the formation of terminal villi. METHODS: This paper is a review focused on up-to-date-known data concerning changes in placental angiogenesis and their impact on IUGR development. CONCLUSION: The aim of this review is to summarize the knowledge concerning the mechanisms of development of the vascular supply to the placenta under physiological conditions and in conditions that result in IUGR.

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OBJECTIVE: To summarize new data which can help in decision on tailoring treatment of cervical precancerosis. DESIGN: Review article. SETTING: Department of Gynaecology and Obstetrics, First Faculty of Medicine, Charles University and Hospital Na Bulovce in Prague; Oncogynaecological Center, First Faculty of Medicine, Charles University and General University Hospital in Prague. RESULTS: Precancerous lesions of the cervix are represented by squamous cervical intraepithelial neoplasias (CIN) and glandular adenocarcinomas in situ (AIS). The usual treatment of cervical precancerosis is conisation. However, some complications, particularly subsequent adverse pregnancy outcomes, follow all surgical treat-ments of cervix. The treatment could be postponed in women who wish to conceive and who suffer from CIN with a low risk of transformation to invasive cancer. The presence of modifying factors can help to stratify CIN lesions according to their malignant potential. The determination of detected HPV genotypes may help in this decision, because the fate of CIN 2/3 depends on the genotype of associated HPV infection. Cervical lesions associated with HPV 16, 18 or 45 are at a much higher risk of rapid progression to invasive cancers than lesions associated with other HR HPV genotypes. Surgical treatment of CIN 2/3 in women with a desire for future child-bearing can be postponed in cases non-associated with HPV 16, 18 and 45, on a case by case basis. Attempts are made to improve evaluation of the lesions by using biological and molecular markers, especially p16INK4a staining. Younger age, ongoing pregnancy, favourable colposcopic findings, negative p16INK4a staining and immunocompetency are independent factors supporting the choice of conservative management. Adenocarcinoma in situ management substantially differs from the management of CIN. CONCLUSION: It is important both to assess all modifying factors correctly and to minimize any harm from unnecessary surgical treatment or overtreatment of cervical precancer lesions. KEYWORDS: cervical intraepithelial neoplasia, adenocarcinoma in situ, conisation, tailoring treatment, human papillomavirus genotype, p16.

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The most common malignancies of the female genital tract are endometrial carcinomas, whose are generally proceeded by hyperplasia. The maintenance of tissue homeostasis is to great extent governed by apoptosis, whose defects can lead to the preneoplastic and/or cancerous changes. Endometrial apoptosis involves among others three groups of proteins of the Bcl-2 family. First group contains anti-apoptotic proteins (e. g. Bcl-2, Bcl-xL). The other two groups belong to the pro-apoptotic proteins with three (e. g. Bax, Bak) or one (e. g. Bad, Bid) so-called BH domains. Bad and Bid trigger the oligomerization of Bak and Bax protein, which permeabilize the outer mitochondrial wall. Unlike Bid, Bad cannot directly trigger apoptosis. Instead, Bad lowers the threshold at which apoptosis is induced, by binding anti-apoptotic Bcl-2 proteins. However, their mutual counterbalance or synergism in the human endometrium has not been reported yet.In this study, the levels of Bid and Bad were measured using SDS-PAGE and Western blotting with specific antibodies, with the aim to analyse expression of Bid and Bad proteins in normal (NE), hyperplastic (HE) and cancerous (CE) endometrium. We demonstrated that Bid expression in CE reached only 47% and 50% of this observed in NE and HE. Conversely, Bad expression in HE reached only 40% and 36% of this observed in NE and CE, respectively. We detected no significant changes of Bid expression between HE and NE, and levels of Bad protein were not different between CE and NE.Trend of Bid and Bad protein expression is clearly opposite in HE and CE. We hypothesise that disrupted apoptotic program in CE seems to be reduced further by lowering levels of direct apoptotic trigger protein Bid. We suggest that the adenocarcinoma tissue of human endometrium thus tries to strengthen its apoptotic effort by lowering the apoptotic threshold via higher Bad levels.

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BACKGROUND: Review of revised staging system for vulva, explaining the changes of staging and their impact on the prognosis of disease is presented. AIM: The main objectives of a reliable staging system include an assessment of prognosis, planning treatment, and the evaluation of their outcomes. A good staging system must meet three basic characteristics: validity, reliability and practicality. Since medical research and practice in the field of oncology have shown explosive growth, the staging of vulvar cancer and some other cancers did not give a good spread of prognostic groupings. Changes based on new findings were proposed in 2008 by the FIGO Committee on Gynecologic Oncology, approved, and published a year later the changes in the staging system for carcinoma of the vulva. Stage 0 was deleted, since it represents preinvasive lesion. Stage IA remained unchanged and stage I and II were combined. The number and morphology of the involved nodes were taken into account, and the bilaterality of positive nodes has been discounted. CONCLUSION: The purpose of a good staging system is to offer a classification of the extent of gynecological cancer, in order to provide a method of conveying ones clinical experience to others for the comparison of different treatment methods. As a result of the explosion of medical research in the field of oncology, the staging of some of the gynecological cancers became outdated and did not give a good spread of prognostic groupings. According to the revised staging for carcimona of the vulva, patients are divided to groups with similar prognosis. Therefore, exchange of relevant information between oncological centers is facilitated, thus disseminating knowledge and stimulating research in other parts of the world.

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