value of transvaginal ultrasonography in the endometrial evaluation of breast cancer patients using tamoxifen

To estimate the value of transvaginal ultrasonography [TVU] in evaluating the endometrium in breast cancer patients on tamoxifen, and to investigate the relationship between TVU and histologic endometrial findings in these patients. 107 breast cancer patients taking tamoxifen were included in this study. TVU was performed twice for each patient: prior to starting tamoxifen therapy and 1 year after taking tamoxifen. An endometrial thickness of >5 mm was considered abnormal. Endometrial biopsy was performed at the same time the 2nd TVU was done. The patients were divided into 2 groups: symptomatic [group A] and asymptomatic [group B], based on whether or not there was abnormal vaginal bleeding. 31 patients [29%] were symptomatic, while the remaining 76 [71%] were asymptomatic. The endometrial thickness increased after 1 year of taking tamoxifen from 4.84 +/- 0.4 mm to 6.34 +/- 2.1 mm in group A and from 4.73 +/- 0.3 mm to 5.67 +/- 1.95 mm in group B [p > 0.05]. Endometrial biopsy revealed 77 [71.96%] atrophic endometria and 21 [19.62%] polyps. A comparison between the 2 groups showed a significant difference in patients with endometrial atrophy and atypical hyperplasia. Patients who had an endometrial thickness of >5 mm had a significantly higher prevalence of atypical hyperplasia [p = 0.003] and polyps [p = 0.041]. The sensitivity, specificity, positive predictive and negative predictive values of TVU were 63.3, 28.57, 25.67 and 66.66%, respectively. Our study showed a discrepancy between TVU and endometrial biopsy findings, due to the specific histology of the endometrium in breast cancer patients using tamoxifen. Due to this discrepancy, TVU alone is not an effective screening test for endometrial pathology and its application alone might lead to an undesirably high frequency of invasive diagnostic procedures

Comparison of the effects of letrozole and clomiphene citrate on ovulation and pregnancy rate in patients with polycystic ovary syndrome

For more than four decades clomiphene citrate has been the first line of the treatment for ovulatory disorders. The aim of this study was to compare the effects of letrozole and clomiphene citrate on ovulation and pregnancy rate in patients with polycystic ovary syndrome. In this prospective double-blind study, 100 patients with polycystic ovary syndrome were randomized into two equal groups. The first group received letrozole, 5mg daily [per oral] and the second group received clomiphene, 100mg daily during the 3rd-7th days of the menstrual cycles. Intramuscular human chorionic gonadotropin [hCG] [10,000 IU] was administered to trigger ovulation when at least one mature follicle [>/= 18mm] was developed. Ovulation occurred in 30 patients [60%] of the letrozole group and in 16 patients [32%] of the clomiphene group, which showed a statistically significant difference [P=0.009]. The mean number of follicles with diameter >/= 14 mm on the day of administration of hCG was 1.06 +/- 0.95 in the letrozole group and 1.14 +/- 1.17 in the clomiphene group, which showed non-significant difference [P=0.962]. No difference was found in the endometrial thickness between the two groups. A non-significant increase in pregnancy rate was observed in the letrozole group [26% v 14% P=0.21]. Ovulation rate was higher in letrozole group and administration of letrozole was associated with a non-significant increase in pregnancy rate

Second trimester cardiac output and its predictive value for preeclampsia

To predict women at risk of preeclampsia in the second trimester by the assessment of maternal cardiac output [CO]. Between October 2001 to November 2003, we carried out a cross-sectional, prospective, hospital-base study in Shiraz University of Medical Sciences, Shiraz, Iran. Cardiac output was measured in 102 normotensive women at gestational age 19-25 weeks by Doppler echocardiography. Patients with CO >7.4 L/min were considered high risk group [Group 1] and those with CO. Twenty percent [6/30] of patient in Group 1, and 1.4% of patients in group II developed preeclampsia [p<0.003]. A cut off point of 7.34% L/min was chosen for prediction of preeclampsia that showed 85.7% sensitivity, 74.2% specificity with a negative predictive value of 98% and positive predictive value of 20%. Cardiac out put is significantly elevated in preclinical state of preeclampsia. Echocardiography is a non-invasive method to evaluate the maternal homodynamic during the second trimester and can help to identify high-risk patient before the development of preeclampsia, thereby it may improve the outcome of pregnancy