Circulating HPV DNA in patients with cervical precancerous lesions and cervical cancer.

OBJECTIVE: In our review article we focused on the circulating HPV DNA and its potential role in the pathogenesis of cervical cancer and in the evaluation of patients´ prognosis with cervical cancer Design: The article is a systematic review study analyzing available scientific articles focused on the circulating HPV DNA. SETTING: Clinic of Obstetrics and Gynecology, Jesenius faculty of Medicine in Martin, Comenius University in Bratislava, Slovakia. METHODS: In our study we searched the medical database PubMed with the key words: circulating HPV DNA, cervical cancer, cervical precanceroses. The core of our work is focused on the scientific articles published in English language since year 1995. RESULTS: We identified 13 studies in PubMed database analyzing the circulating HPV DNA in the process of cervical carcinogenesis. It is clear from the results that circulating HPV DNA is a significant prognostic marker of cervical malignant diseases including the early stages. CONCLUSION: The results focused on circulating HPV DNA show the significance of molecular biology in assessing the prognosis of cervical cancer. This idea has to be supported by further relevant studies. The uniformity of studies and use of the most sophisticated methods could help to answer the question about the real role of circulating HPV DNA in the process of cervical carcinogenesis and disease progression.

[Coeliac disease as a possible cause of some gynecological and obstetric abnormalities]. / Celiakia ako mozná prícina niektorých gynekologicko-pôrodníckych ochorení.

OBJECTIVE: To bring a review of available literature sources on the prevalence of coeliac disease and its possible impact on gynecological and obstetric disorders. DESIGN: Review article. SETTING: Gynecology and Obstetrics Clinic, Jessenius Faculty of Medicine, Comenius University in Bratislava, Martin, Slovakia. METHODS: Analysis of literary sources. CONCLUSION: Coeliac disease is an autoimmune enteropathy caused by abnormal immune system response to gluten. Over the last decade when the prevalence of the disease increases rapidly confirming the relationship between coeliac disease and a range of reproductive disorders. Problems in this area are mostly confirmed in untreated women. Among the atypical symptoms of coeliac disease also include infertility such as delayed onset of menstruation, early menopause, secondary amenorrhea, infertility and pregnancy complications, such as recurrent abortions, intrauterine fetal growth restriction, small fetus for gestational age, low birth weight and premature birth.

Perivascular epithelioid cell tumors of the uterine cervix.

The World Health Organization (WHO) defines PEComas as mesenchymal tumors composed of histologically and immunohistochemically distinctive perivascular cells. Uterus is the most common site of a subgroup of PEComas not otherwise specified(NOS). PEComas of the uterine cervix are extremely rare, and only thirteen cases have been described in the English literature to date. In this review, we summarize the available data concerning diagnostics, immunohistochemical analysis, genetics and treatment of cervical PEComas. Radical hysterectomy with bilateral salpingooophorectomy is the best surgical approach available. Adjuvant therapy in its present form is not efficient. Therefore, further studies are needed to evaluate the newest treatment strategies.

[Fetal magnetocardiography: a promising way to diagnose fetal arrhytmia and to study fetal heart rate variability?]. / Fetálna magnetokardiografia: Slubný spôsob diagnostiky fetálnych arytmií a stúdia fetálnej srdcovej variability?

OBJECTIVE: An overwiev of the new diagnostic method of fetal wellbeing - fetal magnetocardiography (fMCG). DESIGN: A review article. SETTING: Department of Gynecology and Obstetrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovak Republic. METHODS: An analysis of the literature using database search engines PubMed, and SCOPE in field of fMCG. RESULTS: Fetal magnetocardiography is a non-invasive technique able to monitor the spontaneous electrophysiological activity of the fetal heart. Compared to cardiotocography and fetal electrocardiography, this is a more effective method with a higher resolution. The signal obtained from the fetal heart is sufficiently precise and the quality allows an assessment of PQRST complex alterations, and to detect fetal arrhythmia. Thanks to early diagnosis of fetal arrhythmia, there is the possibility for appropriate therapeutic intervention and the reduction of unexplained fetal death in late gestation. fMCG with high temporal resolution also increases the level of clinical trials which record fetal heart rate (FHR) variability. According to the latest theories, FHR variability is a possible indicator of fetal status and enables the study of the fetal autonomic nervous system indirectly. fMCG is an experimental method that requires expensive equipment. It is yet to be shown in the future, if this method will get any application in clinical practice.

Activity of coagulation factor XI in patients with spontaneous miscarriage: the presence of risk alleles.

The aim of this study was to compare the activity of coagulation factor XI (FXI) between patients with spontaneous miscarriage versus control group with no history of miscarriage and thrombosis, and then we evaluated the occurrence of risk alleles in the relation to miscarriage. FXI activity was determined using a coagulometer (Sysmex, CA 1500, Japan). Single nucleotide polymorphisms (SNPs) of F11 and CYP4V2 genes were evaluated. We examined 55 patients versus 31 control subjects. We found significantly higher activity of FXI (p = 0.04) in patients versus control subjects. The occurrence of two SNPs (rs2289252 and rs2036914) of the F11 gene and SNP (rs13146272) of CYP4V2 gene was not significantly different between both groups. Increased activity of FXI may be a potential risk factor for miscarriage. High activity of FXI diagnosed in women with history of miscarriage is not probably caused by the presence of studied SNPs.

[Genetic aspects of pelvic floor defects and stress urinary incontinence in women]. / Genetické aspekty defektov panvového dna a stresovej mocovej inkontinencie u zien.

OBJECTIVE: An overwiev of the genetic aspects of pelvic floor defects and stress urinary incontinence in women. DESIGN: A review article. SETTING: Department of Gynecology and Obstetrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovak Republic. METHODS: An analysis of the literature using database search engines PubMed, BLAST and Ensembl in field of POP and SUI. RESULTS: Pelvic organ prolapse (POP) and stress urinary incontinence (SUI) affect a large number of women and often requires surgical correction. Moreover, these diseases are not only individual health but also social and economic burden on patients and society. It is possible to prevent or at least timely intervene these pathologies by screening of risk patients. The incidence of these disorders leads to find possible genetic factors. In ethiopathogenetic studies of pelvic floor defects and stress urinary incontinence it is looking for genes associated with these diseases and optimization of molecular biology methods is necessary to determine the possible gene mutations or polymorphism site. Selection of relevant genetic factors tend to clarify the pathomechanism of SUI and POP that can greatly affect their current diagnostics and therapeutics. KEYWORDS: prolapse, stress urinary incontinence, polymorphism, gene expression.

[Breech presentation - an analysis of results in one perinatal center]. / Poloha plodu koncom panvovým - analýza výsledkov jedného perinatologického centra.

OBJECTIVE: A retrospective analysis of medical records during years 2007-2011 considers maternal and fetal outcome in patients with breech presentation terminated by vaginal delivery versus caesarean section (CS). DESIGN: Retrospective analysis. SETTING: Department of Gynecology and Obstetrics, Jessenius Faculty of Medicine, Comenius University, Martin, Slovak Republic. METHODS: Authors devided patients with breech presentation of fetus (n = 299) to groups of single pregnancies terminated in term (n = 197), before term (n = 67) and to group of multiple pregnancies (n = 35). All groups were devided according to the way of termination of pregnancy by vaginal delivery, by acute CS and by planned CS. Main followed parameters: parity, gestational week, Apgar score, birth weight, birth length, fetal gender, indications for CS, mortality and neonatal morbidity, umbilical artery pH, convulsions, admit to neonatal intensive care unit, intubation of neonate, intracranial bleeding, cervical spine and peripheral nerve injuries. RESULTS: Total cohort of breech deliveries was 299. In the group of single pregnancies in term was 19.8% terminated by vaginal delivery (n = 39), 32.5% deliveries by acute CS (n = 64). The most common indication was fetal hypoxia (43.8%). By planned CS was terminated 47.7% deliveries (n = 94). The most common indication for CS was footling presentation (54.3%). Severe neonatal morbidity was rare and without significant difference according to the type of termination of pregnancy. Neonatal outcome was comparable in the group of preterm deliveries(n = 67) terminated by vaginal delivery or by CS. All neonatal deaths were associated with extreme prematurity and not with type of termination of gravidity. CONCLUSION: Clinical outcomes between vaginal breech deliveries and breech deliveries terminated by CS in term in singleton pregnancies were not significant different. Mortality of neonates delivered by preterm delivery was associated with severe prematurity.

[Rapid detection of the most common chromosomal aneuploidies in the second-trimester amniotic fluid using QF-PCR]. / Rýchla detekcia najbeznejsích chromozómových aneuploídií z plodovej vody v druhom trimestri tehotnosti vyuzitím QF-PCR.

OBJECTIVE: To introduce QF-PCR method for detection of the most common chromosomal (trisomy 21, 18 and 13) and gonosomal aneuploidies at our department in the second-trimester amniotic fluid. To test the hypothesis of chromosomal aneuploidies detection using STR markers of Aneufast® kit via analysing free fetal DNA (ffDNA) isolated from plasma of pregnant women with confirmed trisomy 21 in fetus. DESIGN: A prospective clinical study. SETTING: Department of Obstetrics and Gynecology, Jessenius Faculty of Medicine and University Hospital in Martin, Slovak Republic. METHODS: The samples of amniotic fluid were obtained from 67 women (twin pregnancy in 3 cases) in the 2nd trimester (15th to 22nd gestational week (g.w.)). Samples were examined using multiplex QF-PCR via Aneufast kit. In the case of positivity for trisomy 21, they were re-examined using Devyser Resolution 21 kit. All samples were parallelly evaluated by cytogenetic karyotyping. We also analyzed ffDNA from the plasma of 3 high-risk women using Aneufast kit. The plasma samples were obtained in the 2nd trimester(17th to 21st g.w.). Qiaamp DSP Virus kit was used for ffDNA isolation. Trisomy 21 of 3 fetuses was confirmed by karyotyping after 2nd trimester amniocentesis. RESULTS: In the cohort of 70 samples, 7 pathological results (six trisomies 21 and one trisomy 18) were obtained. There was 100% concordance with cytogenetic karyotype in all samples examined by QF-PCR. The amplification of tracked chromosome 21 fragments was not evaluable in the case of ffDNA analysis. CONCLUSION: QF-PCR was approved as reliable, rapid, quite simple and financially bearable method of prenatal diagnostics. Despite the fact of good availability and work implementation of Aneufast® kit, results of ffDNA analysis are insufficient. We did not obtain interpretable results after ffDNA analysis from maternal plasma in trisomy 21 fetuses.

[Biochemical aspects of fetal hypoxia]. / Biochemické aspekty fetálnej hypoxie.

OBJECTIVE: To evaluate validity of biochemical diagnostic methods of fetal hypoxia. DESIGN: A case-control study. SETTING: Department of Gynecology and Obstetrics, Jessenius Faculty of Medicine, Comenius University, Martin, Slovak Republic. METHODS: We included 67 patients, and they were retrospectively divided into group of controls (n=36), and studied group (n=31) according to pH in umbilical artery (UA) <7.15. Acid-base parameters were assessed with Rapidlab 248, Bayer Healthcare LLC, East Walpole, USA. We determined criterion for metabolic acidosis (MAC) as pH UA <7.15, resp. base deficit (BD) UA >12 mmol/l. Postpartal lactate concentration in umbilical vein (UV) and UA was determined with lactatemeter Accutrend Lactate, Roche Diagnostics, Switzerland. Quantitative assessment of fetal human protein S100B was provided with ELISA (Sangtec 100 ELISA, DiaSorin Inc., Stillwater, Minnesota, USA). Fetal erythropoietin concentration in UV was examined with immunoenzymatic assessment Access EPO (Beckman Coulter, Inc., Fullerton, CA, USA). STATISTICS: histograms, Kolmogorov-Smirnov test, Mann-Whitney test, Spearman's rho; statistical significance: p<0.05, Receiver Operating Characteristic curves, Area Under the Curve. RESULTS: The best correlation was between fetal acid-base parameters and lactate in UA (p<0.0005). Significant correlation was between EPO in UV, and protein S100B in UV (p<0.05). EPO in UV significantly correlated with lactate in UA (p<0.05). Correlation between EPO in UV and protein S100B was not significant. According to ROC curves in prediction of fetal hypoxia, we found an excellent accuracy (AUC>0.9) for lactate in UA, good accuracy (AUC>0.7) had EPO in UV. Results for protein S100B were not significant. The highest sensitivity had EPO in UV, while the highest specificity has had lactate in UA. CONCLUSION: An indisputable evidence of labor management quality is the fetal metabolic status. On the basis of our results, the suitable clinical markers are lactate and EPO, in addition to acid-base parameters.

[Biophysical methods in diagnosis of intrapartal fetal hypoxia]. / Biofyzikálne metódy diagnostiky intrapartálnej fetálnej hypoxie.

OBJECTIVE: To evaluate validity of biophysical diagnostic methods of fetal hypoxia. DESIGN: A case-control study. SETTING: Department of Gynecology and Obstetrics, Jessenius Faculty of Medicine, Comenius University, Martin, Slovak Republic. METHODS: We divided the patients according to pH in umbilical artery (UA) < 7.15 into two groups: controls (n = 36), and studied (n = 31), retrospectively. We performed continuous simultaneous fetal monitoring with cardiotocography (CTG), fetal pulse oxymetry (IFPO), and ST segment analysis of fetal electrocardiogram (STAN). STATISTICS: histograms, Kolmogorov-Smirnovov test, Mann-Whitney test, Spearman's rho; statistical significance: p < 0.05, Receiver Operating Characteristic curves, Area Under the Curve. RESULTS: The most frequent was intermediary CTG pattern (n = 32; 47.76%). Non-reassuring IFPO was in 22 cases (32.86%), and ST events were present in 4 cases (5.97%). CTG validity in prediction of pH in UA < 7.15: sensitivity 80.0%, specificity 50.0%, positive predictive value (PPV) 22.1%, and negative predictive value (NPV) 93.4%, respectively; IFPO sensitivity was 76.3%, specificity 71.4%, PPV 32.2%, and NPV was 94.4%. Validity of STAN was not significant, because of low frequency of ST events in our study. Satisfactory accuracy (AUC > 0.8) had combined continuous monitoring with CTG, IFPO and STAN. Good accuracy (AUC > 0.7) had CTG by itself, and combined monitoring with IFPO and STAN, respectively. IFPO by itself had only sufficient accuracy (AUC > 0.6). CONCLUSION: The most valid method of fetal wellbeing objectification is combined simultaneous monitoring with CTG, IFPO and STAN. Our results support the effort in the development of integrated sensor for CTG, IFPO, and STAN.

[Selected markers in early prediction of preeclampsia]. / Vybrané markery v skorej predikcii preeklampsie.

OBJECTIVE: Review of actual trends in early prediction of preeclampsia. SUBJECT: Literature review. SETTING: Department of Gynecology and Obstetrics, Jessenius Faculty of Medicine, Comenius University, Martin, Slovak Republic. SUBJECT AND METHOD: Literature review of markers used in early prediction of preeclampsia. Review of their reliability and possible advantage of combination. CONCLUSION: Preeclampsia is a major cause of maternal and perinatal morbidity and mortality worldwide. Onset of clinic symptomes of preeclampsia can appear after 20 weeks of gestation. To find a single marker, or their combination, in early prediction of preeclampsia is one of the goals of modern perinatology. We look at some of the potential markers, which can fulfil these criteria.

[Quality and effectiveness of electronic fetal monitoring]. / Kvalita a efektivita elektronického monitorovania plodu.

OBJECTIVE: To evaluate effectiveness of electronic fetal monitoring methods during labor. DESIGN: A case series study. SETTING: Department of Gynecology and Obstetrics, Jessenius Faculty of Medicine, Comenius University, Martin, Slovak Republic. METHODS: We followed 112 fetuses with simultaneous continuous monitoring (cardiotocography (CTG), intrapartal fetal pulse oxymetry (IFPO), and analysis of ST segment in fetal electrocardiogram (STAN)) during labor. We determined the effective time for every diagnostic tool. STATISTICS: histograms, Kolmogorov-Smirnov test, Spearman's coefficient; significance (alfa): p<0.05. RESULTS: The effective time decreased significantly in a row: CTG > STAN > IFPO (94.8% +/- 15.1% vs. 90.4% +/- 18.3% vs. 87.4% +/- 21.2%). STAN was the most effective tool in the second stage of labor (91.3% +/- 9.4%). CONCLUSION: The most effective fetal monitoring tool is CTG. However STAN is the best diagnostic method in the second stage of labor, because of its bio-signal quality.

[Ovarial hyperstimulation syndrome in the differential diagnostics of acute abdomen]. / Ovariálny hyperstimulacný syndróm v diferenciálnej diagnostike náhlej brusnej príhody.

INTRODUCTION: The massive world-wide development of assisted reproduction (AR) technology and marked increase of females with infertility treatment lead to different medical complications. One of them is ovarian hyperstimulatory syndrome (OHSS), potential fatal complication in AR. It demonstrates with abdominal discomfort, nauzea, vomitus, ascites, and general alteration. It can imitate an acute abdomen syndrome, and it can lead to the primary surgical assessment. AIM: The description of OHSS as a cause of an acute abdomen syndrome. METHODS: Authors present a case of OHSS with the symptomatology of acute abdomen, which was handled by surgeon, primarily. CONCLUSION: Consistent patient history, including gynecological history, and careful physical and laboratory examinations with relevant imaging methods lead to the elimination of invasive procedures. OHSS is the most actual in differential diagnosis of acute abdomen in fertile females for that reasons.

[Streptococci group B in perinatology]. / Streptokoky skupiny B v perinatológii.

OBJECTIVE: Assessment of screening and prophylaxis of streptococci group B (GBS). DESIGN: Retrospective study. SETTING: Department of Gynecology and Obstetrics, Jessenius Faculty of Medicine, Comenius University, Martin, Slovak Republic. METHODS: Groups of patients: A-GBS negative (n=601), B-GBS positive (n=166), and C-unknown GBS status (n=238). RESULTS: We assessed 1005 deliveries; antenatal screening was done in 767 patients (166 GBS positive). Intrapartal antibiotic prophylaxis (IAP) was the most frequent in group B (75.3%), (A-10.0%, C-15.0%). The most common antibiotics: ampicillin, and cephalosporins of the 1st and 2nd generation. The interval from rupture of membranes (ROM) to the first IAP dose was significantly the shortest in group B. The longest interval from ROM to delivery was in group A (490 min.). CONCLUSION: This study shows the possibilities for improvement in GBS prophylaxis, in unknown GBS status, and preterm delivery, particularly.

[Hormonal treatment effectivity in hyperandrogenic syndrome]. / Efekt hormonálnej liecby hyperandrogénneho syndrómu.

OBJECTIVE: To evaluate effectiveness of hormonal treatment of hyperandrogenic syndrome (HAS). DESIGN: Prospective randomized study. SETTING: Department of Gynecology and Obstetrics, Jessenius Faculty of Medicine, Comenius University, Martin, Slovak Republic. METHODS: We assessed effect of one-year-long hormonal treatment on menstrual cycles (MC), clinical signs of HAS, and ultrasound finding (USG) in 90 patients with HAS. Patients were divided into three groups with 30 females: A--35 microg ethinylestradiol (EE) with 2.0 mg cyproterone acetate/day; B--30 microg EE with 2.0 mg dienogest/day; C--30 microg EE with 3.0 mg drospirenone/day. RESULTS: It was achieved a positive effect on MC regularity in every group during the first six months of treatment (p < 0.001). Signs of hirsutism, virilization, and USG finding were significantly better in group A. CONCLUSION: The most effective hormonal treatment in our study was the combination of 35 microg EE with 2.0 mg cyproterone acetate/day.

[Single umbilical artery syndrome (review and a case report)]. / Syndróm jednej umbilikálnej artérie (review a kazuistika).

OBJECTIVE: Authors present a review of epidemiology, ethiopathogenesis and current diagnostic approaches of single umbilical artery syndrome (SUA). They describe one case of SUA complicated with intrauterine growth restriction (IUGR), and possible management of risk pregnancy like that. SUBJECT: Literature review and a case report. SETTING: Department of Gynecology and Obstetrics, Jessenius Medical Faculty, Commenius University, Martin, Slovak Republic. SUBJECT AND METHOD: The observation and management of one case with SUA and IUGR. CONCLUSION: SUA is the most frequent umbilical malformation. The finding of isolated SUA does not markedly increase perinatal morbidity and mortality, but its association with other pathologies leads to higher perinatal losses. An accurate management is still unclear (invasive antenatal diagnosis, especially), but SUA diagnosis should be a reason for more strict observation, timing of delivery, appropriate mode of delivery, and/or for more prompt intervention during pregnancy and labor. An early intervention and appropriate termination of pregnancy allowed delivery of live premature newborn with good posptartal adaptation and good prognosis was delivered after early intervention in our case.

HER-2 [Ile655Val] polymorphism in association with breast cancer risk: a population-based case-control study in Slovakia.

Breast cancer belongs to the most frequent types of cancer affecting women and it occurs at any age. Around 1600-1800 women are getting ill annually in the Slovak republic. One of the most important factors in connection with cancer genesis refers to changes in specific genes. HER-2 proto-oncogene belongs to low penetrating genes, which increase susceptibility to breast cancer genesis. Clinical studies demonstrated an association between polymorphism at codon 655 of this gene and increased risk for breast cancer development. The aim of this case-control based prospective study was to determine the distribution of HER-2 genotype and its association with risk factors of breast cancer in the population of women in Slovak republic. HER-2 genotypes were determined with PCR-RFLP method. The DNA was isolated from white blood cell nuclei. The frequency of Val allele in the cancer group was 29.79% and was higher than in the control group 15.84% (p<0.05). The presence of the heterozygote (Ile/Val) genotype was identified in 46.81% of patients in the case group and in 28.33% in healthy individuals, and the homozygote (Val/Val) genotype in 6.38% and 1.67, respectively (p<0.01). The risk of breast cancer development for carriers of one valine (Val) allele in genotype was two-times lower (OR=2.47) than for carriers of two Val alleles (OR=5.73) (p<0.05). Risk of cancer genesis for Val allele carriers was higher in multiparas (OR=2.90), among women with positive family history of breast cancer (OR=5.0), BMI>24 (kg/m2), and late menopause (OR=1.5). Contraceptives in anamnesis contrariwise showed tend to decrease the risk in Val allele carriers (OR=0.3). In conclusion, this study revealed relatively high frequency of the Val allele among the women population of the Slovak republic. Ile655Val polymorphism of HER-2 gene was associated with a statistically significantly increased risk of breast cancer all above in homozygotes for Val allele.

[TNF-alpha serum levels in women with endometriosis: prospective clinical study]. / Sérové hladiny TNF-alpha u zien s endometriózou: prospektivna klinická studia.

OBJECTIVE: To determine serum levels of TNF-alpha (tumor necrosis factor alpha) as a prediction of endometriosis. DESIGN: Prospective clinical case control study. SETTING: Department of Obstetrics and Gynaecology and Department of Pathology, Jessenius Faculty Hospital, Kollarova 2, Martin, Slovakia. METHODS: The serum TNF-alpha was determined in women who underwent laparoscopy or laparotomy due to pelvic pain, infertility, dysmenorea or pelvic tumor. Endometriosis was confirmed histologically and classified by rAFS. RESULTS: On the basis of entering criteria 65 women were enrolled in this study. In 61 cases serum level of TNF-alpha was evaluated. The average serum level of TNF-alpha in the endometriotic group was 73.847 pg/ml (n=30) and without endometriosis was 21.089 pg/ml (n=31). We have found a significant statistical difference between the above mentioned groups in the medium levels of TNF-alpha (p<0.0001). We did not find statistical significance between TNF-alpha levels and in the group of women with endometriosis in relation to the stage of the disease (I.-II., III.-IV., adenomyosis). At a cut-off level of TNF-alpha 30 pg/ml there was a 63.33% sensitivity, 77.42% specificity, a positive prediction value 73.07%, and 68.57% of negative predictive value. CONCLUSION: TNF-alpha serum levels are good diagnostic markers of endometriosis in the spectrum of noninvasive methods.

[Laparoscopy in chronic pelvic pain--a prospective clinical study]. / Laparoskopia pri chronickej panvovej bolesti--prospektívna klinická stúdia.

OBJECTIVE: The aim of this study was to analyze the incidence, causes and management in women with chronic pelvic pain and to evaluate the role of laparoscopy. DESIGN: A prospective non-randomized clinical trial on 86 women with chronic pelvic pain. SETTING: Clinic of Gynecology and Obstetrics, JMF CU Martin, Slovak Republic. METHODS: A prospective clinical trial was performed on 86 patients with chronic pelvic pain, who have undergone laparoscopy from March 2003 to March 2004. Only patients with a pain history of at least 6 month were enrolled into this trial. Specific patient's history characteristics, laparoscopic and cytologic findings were reviewed and analyzed (pain interval, organic findings, preoperative ultrasound examination, previous surgical intervention, oral contraceptive usage, patient's medical history, menstrual cycle regularity, age, presence of dysmenorrhea). In all women, laparoscopy was performed under general anesthesia. RESULTS: During the study we have performed 309 diagnostic laparoscopic examinations, from which 86 (27.8%) were done due to chronic pelvic pain. The mean patient's age was 35.8 years (19-56). The mean parity was 1.6, ranging from 0-5. Pelvic organ pathology was present in 88.4% of the patients. The most frequent finding was endometriosis (31.4%). According to revised criteria of the American Fertility Society the presence of first, second, third and fourth stage of endometriosis was 55.6, 25.9, 11.1 and 7.4%, respectively. The most frequent occurrence of endometriotic lesions were on ligamenta sacrouterina (21.4%) and plica vesicouterina (19.0%). Pelvic adhesions, myomas, pelvic varicosities and chronic inflammatory process were present in 25.6, 15.1, 9.3 and 3.5% of the cases, respectively. No somatic origin of pain was identified at laparoscopy in 11.6% of patients. Preoperative ultrasonic examination with pelvic pathology findings were performed in 36 patients, and laparoscopy correlated with ultrasonographic findings in 31 (86.1%) cases. The average pain duration was 11.5 months (6-28) with the majority among women with history of previous surgical intervention (48.8%) and parturated women. Presence of pain was most common among women after 31 years of age. Predominantly, cytology examination of biological materials (peritoneal fluid, cyst fluid) revealed an increased histiocytic reaction in coincidence with chronic inflammation process in 31.6%. CONCLUSION: Invasive laparoscopy in chronic pelvic pain pertains to one of the most important examination procedures for its high specificity and sensitivity. Laparoscopy can reveal organic causes of pelvic pathology in 60% of cases with the possibility of following treatment. Our combined effort should stop the progression of such pathology leading to possible morphologic, functional and psychological alteration, especially among young women in fertile age. Today, endometriosis still remains the main cause of chronic pelvic pain in high percentage rate.