[Transanal endorectal surgery with a modified hand-made device]

Gasless transanal endoscopic microsurgery of rectum promises to offer a safe and effective option for the selective treatment of patients with rectal lesions. This study describes personal experience of using a modified hand-made device for transanal endoscopic surgery to facilitate surgical access to selected intrarectal lesions with an acceptable cost, safety and effectiveness. This descriptive cross-sectional study carried out from 2003 to 2005 at Ghaem Hospital of Mashhad University of Medical Sciences. This study was approved by the local committee of Medical Ethics. Nine patients including 4 men and 5 women with rectal polyp or tumors with low likelihood of malignancy enrolled in this study. Transanal endoscopic surgery was performed and pathological studies were done on tissue specimens. Data analyzed by SPSS. The location of the mass in the rectum ranged from 5-20 cm from anal verge, and tumors ranged in size from 2 to 7 cm. Mean age of patients was 65 years. Curative local excision performed in 7 of 9 patients [77.8%]. The complications included wound separation [n=1], massive postoperative bleeding [n=1] and temporary incontinence [n=2]. There was no mortality, either recurrence within a follow-up period of 20 months. Mean of operative time recorded 55 minutes. Two patients underwent radical operation later, because of rectal polyposis and involved tomour margin. Transanal endoscopic surgery is a safe and effective option for the selective treatment of rectal lesions. The used device lowered the expenses and simplified the system, using a hand-made special rigid cylinder

Comparison of clinical improvement between metformin and Diane in women with polycystic ovary syndrome

Metfomin, a biguanide antihyperglycemic drug, has been shown in improvement ovarian function and glucose metabolism in women with polycystic ovary syndrome [PCOS], but results concerning its effects on insulin sensitivity are controversial. Oral contraceptive pills are commonly used in the treatment of PCOS; but like metformin, their influence on insulin sensitivity is not well known. The aim of this study was to compare the clinical improvement between Metformin and Diane in women with polycystic ovary syndrome. This research was a prospective randomized clinical trial study. We randomized 60 [20-49 years old] women with PCOS either to metformin [500 mg] X3 daily for 6 months or to ethinyl estradiol [35 microg] cyproterone acetate [2 mg] oral contraceptive pills [Diane] for 6 months. This study prolonged for 2 years. Results showed that metformin significantly decreased the waist to hip ratio, body mass index [BMI], serum glucose and insulin concentrations and improved menstrual cyclicily hirsutism score and Insulin sensitivity. Diane decreased hirsutism score and improvement in .the menstrual pattern but slight effect in carbohydrate metabolism and increase serum glucose. Metfomin, probably by way of its effects on adipose tissue, leads to reduction of hyperinsulinemia and concomitant improvement; in the menstrual pattern and clinical manifestation hyperandrogenism and therefore, it offers a useful alternative treatment for anovulatory women with PCOS. Dian slight increased in fasting glucose, BMI and Waist To hip ratio but it is an effective treatment for women with hyperandrogenism and hirsutism