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

Primary retroperitoneal mucinous tumor; report of two cases and review of literature

Primary retroperitoneal mucinous tumors are rare neoplasms and almost exclusively seen in women. In this case report we present two cases of this entity with their clinicopathologic features. The first patient was a 32 years old unmarried woman presented with abdominal pain. Ultrasound imaging demonstrated a solid and thick walled ovarian mass m. 105* 70*80 mm. At laparotomy a large retroperitoneal mass with extention to pelvis, dome of urinary bladder and upper abdomen was found and omentum was involved by the tumor. Histopathological examination revealed a mucinous adenocarcinoma with mural nodule contained high-grade anaplastic carcinoma in retroperitoneal space. The second case was a 36 years old woman with retroperitoneal mucinous cystadenoma. The first case died of disease at first month of her diagnosis. Primary retroperitoneal mucinous tumors that containing anaplastic carcinoma or sarcomas are highly aggressive tumors with poor prognosis showing metastasis by high-grade component

Fertility sparing treatment in young patients with early endometrial adenocarcinoma

Objective: The aim of this study was to evaluate fertility-sparing therapy in young patients with endometrial carcinoma

Methodology: This prospective study was carried out on 8 patients with clinical and radio-graphic stage IA, well differentiated endometrioid adenocarcinoma of the endometrium in Alzahra hospital, Tabriz, Iran. Treatment comprised high-dose megestrol acetate. Dilatation and curettage was repeated every three months

Results: The mean age of the patients was 30 [SD,3.21] years [range 24-35]. Of the 8 patients, 7 [87.5%] achieved complete response. The mean time to response was 6.5 months [range 3-9]. Of the complete responders, 3 of 7[42.8%] had recurrence; one patient underwent immediate hysterectomy, and 2 were successfully treated with second-line therapy and both subsequently conceived. Conception occurred in 3 of 7 patients [42.8%], in two more than once, However successful pregnancy occurred only in two patients. One patient developed Concomitant ovarian adenocarcinoma

Conclusions: High dose progestin therapy can be an effective fertility-sparing treatment in young patients with well differentiated stage IA endometrial endometrioid cancer confined to endometrium. However, close follow up is required because of risks of conservative treatment

randomized clinical trial to compare immediate versus delayed removal of foley catheter following abdominal hysterectomy and laparotomy

Indwelling urinary catheters are frequently used after surgery to prevent urinary retention. There is controversy about the ideal time to remove the catheter after surgery. This study compares the early and late Foley catheter removal following hysterectomy and laparotomy. In a clinical trial, 200 women candidate for hysterectomy or laparotomy were randomized to early removal of Foley catheter immediately or 24 hours after surgery. Early and late outcomes such as pain, fever, symptomatic urinary tract infection [UTI], the rate of recatheterization and patients' satisfaction were compared in two groups. There were no significant differences between two groups in symptomatic UTI, recatheterization rate and reinsertion of Foley catheter. The mean time of hospital stay were lower in the early removal group [P< 0.05]. The patients were more satisfied when the catheter was removed early. Immediate removal of Foley catheter seems to be more beneficial and satisfying for the patients than delayed removal

Perinatal outcome in relation to mode of delivery in Meconium-Stained Neonates

Meconium-stained amniotic fluid [MSAF] occurs in 7-22% of term pregnancies. It is less common before 38 weeks and more common after 40 weeks of pregnancy and associates with increased perinatal mortality and morbidity. The aim of this study was to determine if the perinatal outcome is affected by mode of delivery in meconium-stained amniotic fluid. Five hundred meconium stained neonates born at Alzahra Hospital were studied from 2008 to 2010. All pregnancies were at 36-42 weeks, single fetus, cephalic presentation and normal fetal heart rate pattern. Umbilical cord arterial blood gasses were analyzed immediately after delivery. Perinatal outcome was compared in normal vaginal delivery [NVD] and cesarean section [CS] groups. From 500 meconium-stained neonates 73 were born through [NVD] and 427 by CS. Two groups were not significantly different for the maternal age, gestational age and meconium concentration. Although the mean PH was in normal range [PH>7.2] and mean 1st min and 5th min Apgar scores were higher than 8 in two groups, mask ventilation, intubation and suctioning, respiratory distress and admition in NICU were significantly higher in NVD group. Serious complications like MAS and asphyxia were not statistically different between groups. According to the results of this study it is advisable that cesarean section be limited in MSAF to abnormal fetal heart rate pattern and PH<7.2

Omental torsion in pregnant woman: a case report and review of literature

Omental torsion is a rare cause of acute abdomen which is frequently diagnosed intraoperatively. We report a case of 23-year-old pregnant woman who presented to our hospital with right lower quadrant pain. She underwent laparotomy for probable diagnosis of appendicitis or ovarian torsion. A gangeranous mass of greater omentum was found. Partial omentectomy was performed and recovery was uneventful. Omental torsion as a rare cause of acute abdomen should be considered in differential diagnosis in pregnant women

effect of supplemental iron elimination on pregnancy outcome

To assess the effect of eliminating supplemental iron on pregnancy outcome. A clinical trial was conducted at Alzahra hospital from 2007 to 2009. Nine hundred sixty healthy women at first trimester of pregnancy with Hb>12 gr/dl and BP<140/90 mmHg were randomized into receiving daily one multivitamin+30 mg elemental iron or multivation + placebo tablet from 13 weeks of pregnancy. Iron parameters were analyzed at the 1st trimester and before delivery by using ELISA. Monthly Hb and Hct checkup was performed for placebo group and whom with Hb < 10.5 gr/dl at the end of 2nd trimester or Hb < 11 at 3rd trimester, excluded from the study. Finally 410 women in iron group and 372 in placebo group accomplished the study. The mean weight gain of mothers in iron group was significantly greater than placebo group. [11.57kg vs. 11.09kg, p=0.018]. Iron parameters at delivery time decreased, in two groups and were meaningful in placebo group. Neonatal complications were not significantly different between groups. The rate of preterm labor, IUGR, PROM, placental abruption, gestational diabetes and preeclampsia were not significantly different between groups except for pregnancy induced hypertension [6.7% in iron group vs. 3.4 in placebo group, p=0.04]. Considering iron is a possible source of producing free radicals which has ability of oxidative damage, it is recommended that in iron-replete non anemic women at beginning of pregnancy especially who are at high risk for hypertension, iron should not be prescribed until Hb falls below normal level