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

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

Vascular endothelial growth factor and insulin-like growth factor-1 in preterm infants with retinopathy of prematurity

<p><b>INTRODUCTION</b>Retinopathy of prematurity (ROP) can lead to severe visual impairment. This study was conducted to determine the levels of biochemical mediators (i. e. vascular endothelial growth f actor [ VEGF] and insulin- like growth factor-1 [IGF-1]) in the blood of premature infants with proliferative ROP.</p><p><b>METHODS</b>Blood samples from 71 preterm infants born at or before 32 weeks of gestation were obtained 6-8 weeks after birth. These infants were classified into two groups according to their eye examination results. The control group consisted of 41 infants who had no evidence of ROP, and the study group consisted of 30 infants with proliferative ROP at stage III or higher. Blood VEGF and IGF-1 levels were measured using enzyme-linked immunosorbent assay.</p><p><b>RESULTS</b>The mean gestational ages of the infants at birth were 28.4 ± 1.6 and 28.8 ± 1.6 weeks in the study and control groups, respectively (p = 0.259). The mean postmenstrual age of the infants at the time of blood sampling was 34.9 ± 1.2 weeks in the study group and 34.6 ± 1.3 weeks in the control group (p = 0.339). The mean blood IGF-1 (18.48 ± 11.79 µg/L and 16.75 ± 13.74 µg/L in the study and control groups, respectively; p = 0.580) and VEGF (267.35 ± 103.43 pg/mL and 237.52 ± 130.92 pg/mL in the study and control groups, respectively; p = 0.305) levels of the infants were not significantly different between the two groups.</p><p><b>CONCLUSION</b>At 6-8 weeks after birth, blood IGF-1 and VEGF levels were not found to be significantly different between premature infants with proliferative ROP and those without.</p>

Hysteroscopy as a minimally invasive surgery, a good substitute for invasive gynecological procedures

Hysteroscopy is a safe and high efficient procedure so it is changing to a widespread procedure in dealing with many gynecologic and obstetrical conditions. This study aimed to evaluate the diagnostic and therapeutical efficiency of hysteroscopy in managing the common conditions including abnormal uterine bleeding, abortion and infertility. This was a descriptive cross-sectional study to compare hysteroscopy as a minimally invasive approach with conventional laparatomy and hysterectomy or repair of mulerian anomalies and watch the uterine cavity for intrauterine pathology in cases of infertility. Overall 277 women underwent hysteroscopy were evaluated in three groups: with AUB 226 cases, with infertility 34 cases and with recurrent abortions with septate uterus17 cases. The overall success rate was recorded and analyzed after six months in order of indication of hysteroscopy Hysteroscopy as sole diagnostic procedure in 16.5, 8.8 and 14.3%of AUB, infertility and abortion cases, respectively. In AUB cases, curettage, myomectomy, polypectomy and hysterectomy were the main diagnostic-therapeutical approaches along with hysteroscopy. In infertiles, myomectomy, polypectomy were the main diagnostic-therapeutical approaches In abortion group, laparoscopy guided, septum resection adhessiolysis, curettage and myomectomy were the main aproach. There was not any major complication. The diagnostic-therapeutically measures accompanying with the hysteroscopy were successful in 73.5% of the bleeding group and 33.3% of the infertility group in follow-up period. Based on our results, hysteroscopy is a safe, accurate and highly-efficient procedure in managing women with abnormal uterine bleeding, recurrent abortion due to septate uterus