Relationships between serum luteinizing hormone level, endometrial thickness and body mass index in polycystic ovary syndrome patients with and without endometrial hyperplasia

Background: The endometrial hyperplasia measured by ultrasound in poly cystic ovary syndrome [PCOS] women is strongly related to pathologic endometrial thickness, but there is no consensus on the relation between serum luteinizing hormone [LH] and either of these factors: pathologic endometrial hyperplasia and body mass index [BMI]

Materials and Methods: In this observational cross-sectional study, three hundred fifty infertile PCOS women were involved in this research. An endometrial biopsy was taken by using a pipelle instrument, regardless of menstrual cycle's day and all samples were reported by the same pathologist. Basal serum LH level was compared between two subgroups [hyperplasia and non-hyperplasia]. The intended population was divided into three groups according to BMI and basal serum LH, later on the comparison was made in three groups. Chi-square test was applied to compare nominal variables between groups. Mann-Whitney U, and one way ANOVA tests were used to compare means on the basis of the result of normality test

Results: The frequency of endometrial hyperplasia was 2.6%. Endometrial thickness in the patients with endometrial hyperplasia was significantly higher than that of a normal endometrium [10.78 +/- 3.70 vs. 7.90 +/- 2.86 respectively, P=0.020]. There was no relation between endometrial hyperplasia and serum LH [P=0.600]. The ANOVA test showed serum LH levels were not the same among three BMI groups [P=0.007]. Post hoc test was also performed. It showed that the LH level in normal BMI group was significantly higher than those of other groups [P=0.005 and P=0.004], but there was no statistical difference between overweight and obese groups [P=0.8]. We found no relationship between BMI and endometrial thickness in PCOS patients [P=0.6]

Conclusion: Sonographic endometrial stripe thickness is predictive for endometrial hyperplasia in PCOS women. We could not find out any relationship between serum LH level and BMI with endometrial thickness in PCOS patients. However, our study confirmed a diverse relationship between serum LH level and BMI in PCOS patients

MRNA expression of VEGF and its receptors in fallopian tubes of women with ectopic pregnancies

Establishment of viable pregnancy requires embryo implantation and placentation. Ectopic pregnancy [EP] is a pregnancy complication which occurs when an embryo implants outside of the uterine cavity, most often in a fallopian tube. On the other hand, an important aspect of successful implantation is angiogenesis. Vascular endothelial growth factor [VEGF] is a potent angiogenic factor responsible for vascular development that acts through its receptors, VEGF receptor 1 [VEGFR1] and VEGFR2. This study aims to investigate mRNA expression of VEGF and its receptors in fallopian tubes of women who have EP compared with fallopian tubes of pseudo-pregnant women. We hypothesize that expression of VEGF and its receptors in human fallopian tubes may change during EP. This was a case-control study. The case group consisted of women who underwent salpingectomy because of EP. The control group consisted of women with normal fallopian tubes that underwent hysterectomy. Prior to tubal sampling, each control subject received an injection of human chorionic gonadotropin [hCG] to produce a state of pseudo-pregnancy. Fallopian tubes from both groups were procured. We investigated VEGF, VEGFR1 and VEGFR2 mRNA expressions in different sections of these tubes [infundibulum, ampulla and isthmus] by reverse transcription polymerase chain reaction [RT-PCR] and quantitative PCR [Q-PCR]. RT-PCR showed expressions of these genes in all sections of the fallopian tubes in both groups. Q-PCR analysis revealed that expressions of VEGF, VEGFR1 and VEGFR2 were lower in all sections of the fallopian tubes from the case group compared to the controls. Only VEGFR2 had higher expression in the ampulla of the case group. Decreased expressions of VEGF, VEGFR1 and VEGFR2 in the EP group may have a role in the pathogenesis of embryo implantation in fallopian tubes

Comparison of two dimensional and live three dimensional ultrasounds for the diagnosis of septated uterus

Background: Traditionally, septate uterus was diagnosed with invasive method like hysterosalpingography and hysteroscopy. Nowadays transvaginal ultrasonography was reported to be a sensitive tool for detection of septate uterus too

Objective: The objective of the present study was to evaluate the application of two dimensional ultrasound [2-DUS] and real time three dimensional ultrasound [3-DUS] in differentiating various type of septated uterus. Hysteroscopy confirmation was assigned as the gold standard

Materials and Methods: This retrospective study was performed among 215 infertile women with suspected septate uterus from October 2008 to July 2012. An inclusion criterion was septated uterus based on HSG or experiencing abortion, preterm labor, or recurrent IVF failure. Fusion anomalies were excluded from the study [unicornuate, bicornuate and didelphys anomalies]. The results of 3D and 2D sonographies were compared, while they were confirmed by hysteroscopy result in detection of septated uterus. Kappa index for agreement between 2DUS and hysteroscopy, as well as 3-DUS and hysteroscopy in detection of septate uterus was carried out. By receiver operating characteristic [ROC] curve, cut off points for predicting the kind of anomalies were proposed

Results: The women were evaluated by 2-DUS [n=89] and [II] 3-DUS [n=126]. All women underwent hysteroscopy, following 2-DUS and 3-DUS at the same or subsequent cycle. The results of kappa [K] index were 0.575 and 0.291 for 3-DUS and hysteroscopy, as well as 2-DUS and hysteroscopy, respectively. Also, the cutoff points were 27% for arcuate and subseptate, and 35% for differentiating septate and subseptate

Conclusion: Real time 3-DUS has better ability for visualization both uterine cavity and the fundal uterine, so it has higher agreement in detection of septate uterus than 2-DUS

Prophylactic administration of haloperidol plus midazolam reduces postoperative nausea and vomiting better than using each drug alone in patients undergoing middle ear surgery

The efficacy of using midazolam or haloperidol for prevention of postoperative nausea and vomiting [PONV] has been investigated before. The main object of the present study was to evaluate the anti-emetic effects of combining administration of intravenous haloperidol with intravenous midazolam on PONV in patients underwent middle ear surgery in comparison with using each drug alone. Study design was randomized, double-blind, placebo-controlled. 80 patients, aged 18-60 years, scheduled for middle ear surgery in Kashani Hospital Medical Center under general anesthesia were enrolled in this randomized, double-blind, placebo-controlled study. Patients were divided into 4 groups of 20 each and received haloperidol 2 mg i.v. [Group H]; midazolam 2 mg i.v. [Group M]; haloperidol 2 mg plus midazolam 2 mg i.v. [Group HM]; saline i.v. [Group C]. The incidences of PONV and complete response were evaluated at 0-2 hours after arrival to the PACU and 2-24 hours after arrival to the ward in 4 groups. Patients in group HM had significantly lower incidence of PONV compared with groups H, M, and C throughout 0-24 h [P<00.5]. The HM group had the lowest incidence of PONV [0-2, 2-24, and 0-24 h] and the highest incidence of complete response. Postoperative anti-emetic requirement was significantly less in group HM compared with group M or H [P<0.05]. Combine administration of haloperidol 2 mg plus midazolam 2 mg significantly reduced PONV better than using each drug alone in patients underwent middle ear surgery under general anesthesia

[Effect of music therapy on physiological pain responses of blood sampling in premature infants]

Premature infants undergo painful and stressful procedures during care and treatment. Nurses can help to reduce shortand long-term effects of pain caused by diagnostic and therapeutic procedures using various methods including music therapy. The aim of this study was to assess the effect of music therapy on physiological pain responses of premature infants during and after blood sampling. This was an experimental study with crossover design conducted on 20 premature infants hospitalized in the intensive care unit of a hospital affiliated to the Tehran University of Medical Sciences for a five months period in 2010-11. Infants were randomly allocated in two groups of experiment and/or control. Each infant was considered as its own control. We assessed the physiological pain responses caused by blood sampling such as heart rate and oxygen saturation level. Infants in the experiment group listened to the Transitions music five minutes before until 10 minutes after the blood sampling. The responses were recorded and reviewed ten minutes before until ten minutes after the blood sampling in both groups and physiological changes were detected. Data were analyzed using ANOVA and Chi-square tests in the SAS and SPSS. Results showed significant difference in heart rate between the experiment and control groups during needle exit [P=0.022]. There was also significant difference in heart rate between experiment and control group in the first 5 minutes of blood sampling [P=0.005]. Results showed that music therapy could reduce some physiological responses of pain during and after blood sampling. Music therapy can be used as a beneficial intervention following painful procedures such as blood sampling in the NICU

Minimum effective dose of tramadol in the treatment of postanesthetic shivering

To determine the minimum effective dose of intravenous administration of tramadol on controlling postanesthetic shivering [PAS] and frequency of effects. Seventy five patients who had shivering grade III or IV after general anesthesia with isoflurane in the recovery room were included in the study. The patients were divided randomly among five groups to receive the same dose of tramadol: 0.2 mg/kg, 0.4 mg/kg, 0.6 mg/kg, 0.8 mg/kg and 1 mg/kg. The shivering grades, tympanic temperature immediately prior to administering the treatment, time spent to control shivering, shivering relapse, time interval between the two shivering periods and side effects were registered. Data were analyzed with SPSS software, version 14. Chi-square test, t-student test and analysis of variance were used where they were appropriate. P value<0.05 was considered significant. There were no statistically significant differences among treatment groups with respect to demographic data, duration of anesthesia, room temperature of postanesthesia care unit, shivering grade before treatment and central temperature at the time of treatment. There was no significant difference among the number of patients who stopped shivering with 0.2 mg/kg compared with 1 mg/kg of tramadol. There was no significant difference among the five doses for shivering relapse. Frequency distributions of side effects were not different among the five groups. All patients completely stopped shivering with tramadol 0.4 mg/kg or more in 5 minutes after treatment. With 0.2 mg/kg only 80% of patients stopped shivering. Although the difference between 0.2 mg/kg and 1 mg/kg was not statistically significant, because of the limited number of cases we were not able to reject type two errors. According to this study, we suggest 0.4 mg/kg of tramadol for shivering control