Gonadotropin-releasing Hormone Agonist Plus Aromatase Inhibitor in the Treatment of Uterine Leiomyoma in Near Menopause Patient: A Case Series Study

OBJECTIVES: There are many drugs for of symptomatic fibroids. Gonadotropin-releasing hormone (GnRH) agonists are the well known drugs. Also, aromatase inhibitors are effective. All published studies surveyed the effect of one of these two drugs. In this study as the first study decided to evaluate the effectiveness of the combination of GnRH agonists + aromatise inhibitor on the uterine fibroids. METHODS: A cross-sectional prospective case series study was performed on 10 known cases of uterine fibroids late perimenopause, at least 3 myomas >5 cm, abnormal uterine bleeding and anemia due to fibroids, candidate for hysterectomy, no tendency to surgery. A single dose of Diphereline 11.25 mg, SR plus 2.5 mg of Letrozole daily for 4 weeks with add-back therapy + calcium carbonate were used. The second dose of Diphereline 11.25 mg, SR was used 3 months after the first injection. The patients were followed until 3 years. RESULTS: The mean age of the study group was 49.90 ± 1.66. The mean fibroid size reduced from 15.05 ± 57.20 cm to 13.56 ± 39.39 cm (P = 0.012) and fibroid volume reduced from 72.78 ± 110.6 to 50.96 ± 64.2 (P = 0.116). There was no signification changes in the serum level of hormones at the end of six months. Eight cases were menopause at the end of the study and hypoestrogenism symptoms did not happened in none of the cases until the end of 24 months. Except in one case, there was no need to do surgery on others. CONCLUSIONS: Combination of Diphereline + Letrozole probably could prevent surgery in cases that have multiple fibroids, perimenopause, anemic and candidate for surgery.

General versus spinal anesthesia in laparoscopic ovarian cystectomy

One of the most common and choice surgical procedures for most elective surgeries are laparoscopy performed preferably under general anesthesia. In this study cases that underwent laparoscopic ovarian cystectomy with general anesthesia were compared with those who were underwent spinal anesthesia. In this prospective analytic study, 60 patients undergone elective laparoscopic ovarian cystectomy received spinal anesthesia or general anesthesia in divided 30 cases. Duration of surgery was shorter in spinal anesthesia; mean hospital fee was lesser in general anesthesia. Postoperative antiemetic use was higher in spinal anesthesia. Hospital stay time and analgesic use were the same. Conversion to general happened in only one case. Eleven cases experienced shoulder pain during surgery. Spinal anesthesia was adequate and safe technique in our cases

Ovarian immature teratoma during pregnancy: a case report

Germ cell tumors are derived from the primordial germ cells of the ovary and immature teratoma is the second most common germ cell malignancy. About 50% of pure immature teratomas of the ovary occur in women between the ages of 10 and 20 years, and they rarely occur in pregnancy. A 21-year-old woman, gravid 1, para 0, at 18 weeks of gestation, was incidentally diagnosed with a right ovarian mass 180 mm by 200 mm, 160 mm in diameter, during a prenatal ultrasound scanning. She underwent surgery by unilateral salpingo-oophorectomy and surgical staging. The result of pathology showed a stage 1a grade 1 immature teratoma of ovary. Her pregnancy continued until term. At 38 weeks she delivered with breech presentation a normal 2900 g male newborn by cesarean section. Although immature teratomas of ovary during pregnancy are rare, clinicians should consider their eventuality in younger pregnant women in asymptomatic cases

Globozoospermia syndrome: two case reports

Globozoospermia is a rare but severe cause of male infertility. The presence of 100% round-headed spermatozoa and lack of acrosome are the diagnostic criteria of total globozoospermia. The pathogenesis of globozoospermia most probably originates in spermiogenesis, specifically in acrosome formation and sperm head elongation. Mutations of a numbers of genes are linked to the globozoospermic phenotype. Intracytoplasmic sperm injection [ICSI] combined with assisted oocyte activation improves the fertilization rate of these cases. Two cases of globozoospermia with infertility are presented in this study

unruptured isthmic ectopic pregnancy: a case report

About 1% of pregnancies are ectopic, usually implants in the fallopian tube. Most ectopic pregnancy [EP] continues to grow and lead to rupture the tube. The most common site of EP is the ampulla and 12% occurs in isthmic portion. Early Rupture is the usual outcome of isthmic pregnancy and usually there is early tubal rupture in the first few weeks. In this report a 29 years old infertile woman had a large size unruptured isthmic EP in left fallopian tube following ovulation induction that was managed with laparoscopy. Therefore, an isthmic EP may attain a large size prior to rupture

Deliveries of four healthy neonates after multiple myomectomy

Two main risk factors of uterine rupture during pregnancy or labor are prior uterine myomectomy and cesarean section. The risk of uterine scar rupture increases with increase of the size and numbers of incision. Severe complications may occur following uterine scar rupture. We report a case with prior large and multiple myomectomies, repeat cesarean sections, deliveries of 4 normal large, alive fetuses without any complication or uterine scars rupture

Are abnormal yolk sac characteristics important factors in abortion rates?

This study was undertaken to determine if there were different abortion rates between normal and abnormal yolk sacs. In this cohort study, the yolk sac characteristics of 193 consecutive pregnant women, of 5-6.5 weeks gestation, with normal body mass index [BMI] were prospectively evaluated. All patients underwent two-dimensional transvaginal ultrasonography, which was performed by the same sonographer. We considered the following yolk sac characteristics as normal for classification: diameter: 2-5 mm; round shape; absence of degenerative changes; equal number with embryos; echogenic rim and hypoechoic center. Yolk sacs that had diameters smaller than 2 mm or larger than 5 mm; a shape that was not round [i.e., oval or distorted]; the presence of degenerative changes; hyper- or hypo-echogenic rim; hyperechoic center and unequal number with embryos were considered abnormal. Based on the above classification, patients were divided into two groups, study [abnormal yolk sac] and control [normal yolk sac]. The study group contained 22 cases and the control group consisted of 164 cases. The primary outcome measure was the abortion rate between both groups. Chi-square and students't test were used for data analysis. A total of 193 cases were evaluated. We excluded 2 cases. Among the remaining 191 cases, 22 [11.51%] had abnormal yolk sacs of which spontaneous abortion occurred in 14 [63.63%] cases. In the control group, out of 169 [89.49%] cases, spontaneous abortion was noted in 6 [3.55%]. There was a statistically significant difference in abortion rates between the two groups [p=0.000]. According to the results of this study, it is obvious that abnormal yolk sac characteristics are associated with spontaneous abortion

Is previous tubal ligation a risk factor for hysterectomy because of abnormal uterine bleeding?

Post tubal ligation syndrome [PTLS] is a term used to describe a variety of post tubal ligation side effects or symptoms. These include increased menstrual bleeding and hysterectomy. Whether or not post tubal syndrome is a real entity, it has been a subject of controversy in the medical literature for decades. Numerous studies have reported conflicting conclusions about these symptoms. In this study the incidence of hysterectomy for bleeding disorders among sterilized women was compared with the incidence of hysterectomy for bleeding disorders among non-sterilized female population of the same age. This study was carried out on 160 women, 38-52 years, who underwent hysterectomy in Amir University Hospital, Semnan, Iran, from September 2008 to September 2011. After gathering of data from medical records, in this study, the incidence of hysterectomy for bleeding disorders among sterilized women was compared with the incidence of hysterectomy for bleeding disorders among nonsterilized female population for the same age. The mean age of the study group was 44/4 +/- 5/7 and the mean age of the control group was 45/2 +/- 5/3, [p=0.424]. The mean parity of the study group was 3/8 +/- 1/8 and the mean parity of the control group was 3/5 +/- 1/4, [p=0.220]. So, in regard to age and parity, two groups were matched. Hysterectomies were performed for 160 cases and abnormal uterine bleeding was the cause of hysterectomy in 67 cases. Among 67 cases, 19 cases [37.3%] had previous tubal sterilization + hysterectomy [study group] and 48 cases [44%] were not undergoing tubal sterilization but had hysterectomy for abnormal bleeding causes [control group]. Statistical analyses showed that there were not significant differences between two groups, [RR=0.85; 95% CI: 0.56-1.28; p=0.418]. The result of this study showed that previous tubal sterilization is not a risk factor for undergoing hysterectomy because of abnormal uterine bleeding

prevalence and route of delivery of prolonged pregnancies

To evaluate the prevalence, rate and indications for cesarean deliveries in prolonged and post-term pregnancies Prospective descriptive cross-sectional study Department of Obstetrics and Gynecology, University Hospital Amir, Semnan, Iran. One hundred and sixty-four cases of prolonged pregnancy were encountered during the study period from September 2009 to September 2010. Data regarding total deliveries, number of prolonged pregnancies and cesarean delivery were gathered and the prevalence of prolonged pregnancy, the cesarean delivery rate and the indications for cesarean deliveries evaluated. Prevalence of prolonged pregnancies and cesarean delivery rates Delivery and cesarean section Total deliveries during this period were 1157. Forty-one and 13 deliveries were beyond 41 weeks [prolonged pregnancy] and 42 weeks [post term pregnancy] respectively. The prevalence of prolonged pregnancy and post term pregnancy was 3.5 and 1.12% respectively. The cesarean delivery rate for prolonged and post-term pregnancy were 31.7 and 38.46% respectively. The most common indications for cesarean deliveries were failure to progress and meconium staining of amniotic fluid. The prevalence of prolonged and post-term pregnancy was low and the incidence of cesarean section was high in these cases. The most common indications for cesarean section were dystocia [failure to progress] and meconium staining of amniotic fluid

Can vaginal pH predict menopause?

To review the role of vaginal pH in the diagnosis of menopause. This descriptive cross-sectional study was performed in the Department of Obstetrics and Gynecology, Amir University Hospital, Semnan, Iran from March 2008 to March 2009 on 200 women [100 non-menopausal and 100 post-menopausal] from 45-65 years old. The pH paper was placed directly in contact in the lower third side wall of the vagina, and the pH was measured. Simultaneous sampling and culture of the vaginal discharge and blood samples for follicle stimulating hormone [FSH] was performed in the same day. Cases of bacterial vaginosis, trichomonas or other vaginitis were treated, and again 2 weeks later, the vaginal pH was measured. The gold standard for the diagnosis of menopause was FSH >35IU, hypoestrogenemia symptoms, and amenorrhea for one year. Receiver operating characteristic curve was used to determine the best cut-off point. The sensitivity, specificity, positive and negative predictive values were evaluated. The mean +/- standard deviation age in the post-menopausal women was 58 +/- 3.8, and in non-menopausal women was 47.6 +/- 2. The vaginal pH in the diagnosis of menopause has a sensitivity of 92.7%, specificity - 83.5%, positivity - 84.9%, and negative -92% predictive values [cut-off point >6]. Our study suggests that the pH of the vagina can be a good alternative to test for the diagnosis of menopause

Dexamethasone in unexplained infertility

To determine if dexamethasone could be a suitable option in the treatment of patients with unexplained infertility. This study was carried out in the Obstetrics Department of Amir University Hospital, Semnan, Iran, from April 2001 to May 2008. One hundred and twenty-four cases of unexplained infertility that underwent ovulation induction and intrauterine insemination [IUI] [only one cycle] were evaluated, and divided into 2 groups. Sixteen cases were excluded, as they were unresponsive to the induction ovulation regimen. Group I [n=42] received clomiphene citrate [CC] + dexamethasone, and the control group [group II, n=66] received CC alone. These groups were the same in age, duration of infertility, and body mass index. The clinical pregnancy rates were evaluated in 2 groups by using statistical tests. The clinical pregnancy rate was 21.4% in group I, and 4.5% in group II. There was a significant statistical difference between the groups [relative risk=4.71, 95% confidence interval=1.35-16.42, p=0.0085]. The pregnancy rate in women with unexplained infertility that underwent ovulation induction with CC + dexamethasone + IUI was significantly higher than those who underwent ovulation induction with CC alone + IUI

Incidence of abnormal uterine bleeding in individuals who used hormonal contraceptive methods and referred to Semnan health centers [2006-2007]

In recent century, the rapid growth of population threats life. This shows the necessity of using contraception methods. In most women who use hormonal methods as acontraceptive method, uterine bleeding occurs and it result in that they stop using the methods and therefore leads to unwanted pregnancies. In this study, we investigated the incidence of abnormal uterine bleeding [AUB] in the different kinds of hormonal methods. This study was performed on 390 married women with normal menstruation and in age of 15-35 years who referred to Semnan health centers. They had used one of the hormonal methods at least more than one month. 130 women used DMPA, 130 women used minipill and 130 persons used LD tablets. All women who had AUB following using one of the hormonal methods were considered as AUB due to the hormonal method, except those had AUB for another reason that it was proved by sonography or other investigations. Patients' information was exactly recorded in questionnaires. The incidence of metrorrahgia in minipill and DMPA was more than its incidence for LD method and the incidence of oligomenorrhea in DMPA method was more than minipill and LD method. In addition, the incidence of amenorrhea in DMPA method was more than minipill. The period of using of these methods had reverse effect on the incidence of oligomenorrhea, polymenorrhea and menorrahgia but it had a direct effect on the incidence of amenorrhea. The incidence of menorrahgia in the 15-20 years old persons was more than other ages. The incidence of AUB in LD method is very low and seems it might be the most suitable hormonal contraceptive method, in case women aren't prohibited from using LD tablet. Regarding the high incidence of abnormal bleeding in minipill method, using another method instead of minipill method for contraception is recomened to women