Role of local anesthetics on pain relief in endometrial biopsy: randomized clinical trial

Endometrial biopsy is necessary for diagnosing the reason of abnormal uterine bleeding in perimenopausal women. Currently outpatient endometrial biopsy is used for evaluation of abnormal uterine bleeding which is associated with moderate to severe pain. Using lidocaine is one of the procedures which is used for pain relief while biopsy. This study is aimed at comparing the effect of different local anesthesia procedures on pain relief during endometrial biopsy. In this randomized clinical trial, 160 multiparous 40-55 years old women with AUB [Abnormal Uterine Bleeding], candidates for endometrial biopsy, were randomly assigned into four equal groups, to receive: 1-intrauterine lidocaine; 2-cervical spray lidocaine;3- intrauterine lidocaine plus cervical spray lidocaine; or 4-intrauterine distilled water. Pain relief was measured at 3 different times: during endometrial biopsy, just after and 15 minutes after biopsy. Pain intensity was reduced significantly at different times in intrauterine lidocaine and intrauterine lidocaine with cervical spray lidocaine receivers in compare with the groups which received cervical spray lidocaine and distilled water. The mean of difference pain relief during biopsy and 15 minutes after that was reduced significantly in the group which received intrauterine lidocaine and intrauterine lidocaine with cervical spray lidocaine in comparison with the other two groups. Intrauterine lidocaine was effective during endometrial biopsy, and using it with cervical spray lidocaine had no more beneficial effect

Effect of letrozole on endometrial histology in patients with disordered proliferative endometrium and simple hyperplasia

This is a preliminary study investigating the efficacy of aromatase inhibitor letrozol on endometrial histology in patients with disordered proliferative endometrium or simple hyperplasia. In a randomized clinical trial, 92 patients with abnormal uterine bleeding who had disordered proliferative endometrium or simple hyperplasia in endometrial biopsy, were randomized into case and control groups. patients received 2.5 mg of letrozole daily in case group [n=46] and 40 mg of megestrol acetate daily in control group [n=46] for 3 months. Endometrial biopsy was performed 3 to 4 weeks after completion of therapy to assess response. After intervention in letrozole group, response to treatment was seen in 93% cases [including endometrial atrophy in 58.7% cases and weakly proliferative endometrium in 34.78% cases] and in megestrol group response to treatment was seen in 85% cases [including endometrial atrophy in 41.3% cases and weakly proliferative endometrium in 43.47% cases]. The difference between two groups was not statistically significant [P=0.31]. The results of this study show that pre and post menopausal women with disordered proliferative endometrium or simple hyperplasia can be successfully treated with letrozole alone. However, due to the lack of significant difference between the two groups, further studies with larger sample size is recommended for better clearance of the topic

Paraovarian hydatid cyst mimicking acute abdomen

Echinococcosis is a parasitic disease that is produced by Echinococcus granulosus and still represents an important medical problem in many countries. Echinococcosis in extrahepatic sites is usually asymptomatic unless the cyst causes symptoms due to pressure, as in our case, or ruptures to the peritoneal cavity. Echinococcal cysts at unusual locations many times pose diagnostic dilemmas, and the diagnosis sometimes is made intraoperatively. Primary ovarian and paraovarian cyst hydatid disease is a very rare entity. In our case, a 25-year-old female gravida 1, para 1, was admitted to the emergency department of the Alzahra Hospital of Tabriz due to diffuse abdominal pain, nausea, abdominal distension and urinary frequency of ten-day duration and exacerbation of pain from a few hours before admission. Clinical examination revealed tachycardia of 105 per minute, normal body temperature and normal blood pressure. Abdominopelvic sonography revealed a mass with regular thick contour located in the left ovary suggestive of huge cystadenoma or carcinoma of the ovary. Emergent laparotomy was performed for suspected adnexal torsion. Intra operative findings were a large paraovarian mass with thick wall without any torsion. Mass was removed completely and sent for frozen section study. Pathological examination showed the diagnosis of hydatid cyst. The postoperative period was uneventful and the patient was discharged 3 days later, with the advice to receive Albendazole. The patient referred to a general surgeon for management of the hepatic cysts

Urinary incontinence during pregnancy and postpartum incidence, severity and risk factors in Alzahra and Taleqani hospitals in Tabriz, Iran, 2011-2012

This is a cohort study that investigated the incidence, severity and risk factors of Urinary Incontinence during pregnancy and postpartum in nulliparous women. In this cohort study, 441 nulliparous women were studied. The women were followed up from the beginning of pregnancy until the postpartum period. The prevalence of urinary incontinence was determined among them. Risk factors that could play a significant role were analyzed using questionnaires. In this study, 441 nulliparous women with an average age of 28.1 +/- 3.7 years were studied. The prevalence of urinary incontinence in the third trimester of pregnancy was 39.4% and it was 31% in the postpartum period. Vaginal delivery, maternal weight, and fetal weight [> 4 kg] were the most important risk factors for increasing the incidence rate of urinary incontinence. In this study, age had no role in incontinence. The severity of incontinence in 26.6% of the participants over 5 was based on visual analogue scale [VAS] scoring. Urinary incontinence is one of the common disorders during pregnancy and postpartum period that can affect quality of women life significantly. Type of delivery and maternal and fetal weights are the most important risk factors for increasing this disorder. Unlike previous studies, age did not play any role in incontinency in this study

Comparison of the efficacy of 0.05% tretinoin with 7% alpha-hydroxy acid cream in the treatment of ephelides: a controlled clinical trial

Anti-inflammatory and hypo-pigmenting effects of topical tretinoin and alpha-hydroxy acids have been documented. This study was designed to compare the efficacy of 0.05% tretinion cream with 7% alpha-hydroxy acid in the treatment of ephelides. In this clinical trial 80 patients with ephelides were selected and allocated into two groups. One group was treated with 0.05% tretinoin cream every other night. The other group was treated with 7% alpha-hydroxy acid cream in the same manner. Both groups were treated with antisolar creams and followed every month for 5 months. After 5 months excellent therapeutic response was achieved in 3 [7.5%] of patients who were treated with 0.05% tretinoin cream compared to 8 [20%] in alpha-hydroxy acid cream. Good therapeutic response was observed in 20 [50%] of tretinoin group versus 16 [40%] in alpha-hydroxy acid group. Patient's satisfaction from treatment was consistent with evaluation by dermatologists [P=0.384 and P=Q.l32]. Both 0.05% tretinoin cream and 7% alpha-hydroxy acid cream are equally efficient in the treatment of ephelides