Results of post-operative abdomino-pelvic radiotherapy in intermediate- and high-risk epithelial ovarian carcinoma.

To review the outcome of successive surgery, chemotherapy and abdomino-pelvic radiotherapy in ovarian cancer; 212 patients who had been treated with surgery, chemotherapy, and APRT, during 10 years were studied. The patients ranged in age from 23 to 76 years (median 53). International Federation of Gynecology and Obstetrics staging showed 32 patients in stage Ic, 57 in stage II and 123 in stage III. Serous carcinoma was the most frequent type. Most of the patients had grade 1 histology. The majority had undergone optimal cytoreductive surgery. They were put on platinum-based chemotherapy and got APRT. Chemotherapy was started before, after or three courses before and three after radiation. Radiotherapy was delivered using Cobalt-60 anterior posterior fields to encompass the peritoneal cavity. They received at least 2000 cGy to abdomen and 5000 cGy to the pelvis. Minimum follow-up was 60 months. The result showed that most of the patients experienced RTOG grade 1 or 2 acute toxicities that responded to medication. Late complications were reasonable (3.8%), mostly were managed conservatively. Unplanned radiation interruptions were necessary in 42 patients (20%). Stage, grade and histology affected survival. Failure sites were abdomen in 35 cases, pelvis in 34, both pelvis and abdomen in 19 and distant metastasis in 34 cases. Overall, five-ear survival was 84.4%, 65%, 21% in stages Ic, II, III, respectively. We came to the conclusion that: Abdomino-pelvic radiotherapy is a safe adjuvant treatment in ovarian cancer and is well tolerated by most patients. Abdomino-pelvic radiotherapy does not significantly increase treatment complications in ovarian cancer. Radiation should be concerned in patients with high probability of recurrence of epithelial ovarian tumours.

The comparison of bleeding patterns with high-dose and low-dose hormone replacement therapy in postmenopausal women.

Our objective was to compare vaginal bleeding patterns with lower doses of conjugated equine estrogen (CEE) and medroxyprogesterone acetate (MPA), in a randomized, double-blind, placebo-controlled trial. A total of 112 healthy, postmenopausal women were divided into three groups. Group A received CEE 0.625 mg/day plus MPA 2.5 mg/day; group B received CEE 0.3 mg/day, plus MPA 1.25 mg/day; and another group received placebo. All medications were continued for 13 months and bleeding data were analyzed in each group. The percentage of patients who experienced no bleeding in cycle one was 45.2% in group B. These values were significantly greater than the figure for group A (18.2%) and lower than in the placebo group (66.7%). A linear trend between time since menopause and cumulative amenorrhea was observed in cases in group B and the placebo group in all cycles (p < 0.05). This finding was significant in only cycle 13 in group A. In conclusion, a higher rate of amenorrhea was observed with a lower-dose regimen of CEE/MPA, which may be the appropriate regimen.

Location of the appendix in the gravid patient: a re-evaluation of the established concept.

OBJECTIVES: To determine the anatomical location of the appendix, as it may change during pregnancy. METHODS: In this prospective study conducted from October 1995 to March 1999, 291 women of reproductive age were evaluated for appendix location. They were divided into three groups: group A, 165 women between 37 and 40 weeks of pregnancy who underwent elective cesarean delivery; group B, 26 women between 19 and 39 weeks of gestation with acute appendicitis who underwent appendectomy; and group C (the control group), 100 non-pregnant women with acute appendicitis who underwent appendectomy. Appendix location was considered normal within 2 cm of the McBurney point; otherwise, it was considered to be a position change. RESULTS: In group A, 2 (15%) of 165 women and in group B, 6 (23%) of 26 women had a change in the position of the appendix. In the control group, 17% had change in position. There were no significant differences between group A and B compared with group C. In group B, no relation between height of fundus and point of tenderness was seen. CONCLUSION: Our study did not show that pregnancy changes the location of the appendix.

Effects of metformin therapy on hyperandrogenism in women with polycystic ovarian syndrome.

Polycystic ovarian syndrome (PCOS) is one of the most common endocrine diseases in women. This syndrome is characterized by hyperandrogenism, chronic anovulation, infertility and obesity. The association between PCOS-related hyperandrogenemia and insulin resistance is well documented in the literature. Insulin resistance and the resulting raised plasma levels of insulin are reported to be responsible for the high androgen concentration observed in patients with PCOS. In this prospective study, blood samples for levels of testosterone (T), dehydroepiandrosterone sulfate (DHEAS), luteinizing hormone (LH), follicle-stimulating hormone (FSH), LH/FSH, prolactin and fasting blood sugar (FBS) before starting metformin administration were obtained randomly from 40 women who were apparently obese, had PCOS and had been referred to a university hospital. Metformin was then given at a dose of 500 mg three times a day for 8 weeks, after which time the pretreatment study was repeated. Clinical symptoms of PCOS, including acne and hirsutism score and body mass index (BMI), were assessed before and after the treatment cycle. Metformin therapy resulted in a significant decrease in total testosterone levels and FBS. There was also a significant decline in BMI, length of the menstrual cycle, acne and hirsutism score. There were no significant changes in the levels of DHEAS, prolactin, FSH or LH, or in LH/FSH. The effect of metformin on subjects with elevated DHEAS levels was different to that on individuals with normal DHEAS levels. In the latter group there were only significant improvements in the length of the menstrual cycle, BMI and testosterone and DHEAS levels. It is concluded that metformin therapy in subjects with PCOS results in a decrease in fasting blood sugar and testosterone levels, and leads to a significant improvement in the clinical manifestation of hyperandrogenism. These responses also related to the level of adrenal function.

Calcium to creatinine ratio in a spot sample of urine for early prediction of pre-eclampsia.

OBJECTIVES: Based on the fact that urinary calcium excretion decreases in pre-eclampsia, this study was designed to determine the predictive value of calcium to creatinine ratio in a spot urine sample. METHODS: The calcium to creatinine ratio was measured in a spot urine sample of 102 normotensive women at 20-24 weeks' gestation who attended the prenatal care clinic of the Shiraz University of Medical Sciences. The women were followed-up until delivery and grouped according to pre-eclampsia occurrence. The prevalence of pre-eclampsia was measured and compared with the calcium to creatinine ratio. RESULTS: Ninety-four women remained normotensive during pregnancy and eight developed pre-eclampsia. Mean age, gestational age at the beginning of the study, and gestational age at delivery did not differ significantly between the two groups. Mean urinary calcium concentration (15.9+/-8.5 mg/dl in normotensive vs. 10.2+/-7.5 mg/dl in pre-eclamptic women), and mean birth weight (3192+/-336.3 g vs. 2712+/-468.9 g) were significantly lower in pre-eclamptic patients (P=0.03 and 0.005, respectively). Mean calcium to creatinine ratio was also significantly lower in the pre-eclamptic group (P<0.03). CONCLUSIONS: Single urine calcium to creatinine ratio may be an effective method for screening women at greatest risk for pre-eclampsia.

Does contraceptive method change the Pap smear finding?

The aim of the present study was to investigate the effect of various types of contraceptives on morphological finding of Pap smear results. Pap smear results of 7,753 fertile women who presented to 15 different family planning services in Fars Province (south of Iran) were analyzed according to their methods of contraception. The population consisted of 2241 women who used intrauterine device (IUD) as a contraceptive method (Group 1), 2521 women who were oral contraceptive (OCP) users (Group 2), and the control group, which consisted of women who used other methods of contraceptive. Comparison between the Pap smear results showed a higher number of benign cellular changes among Group 1 (22.4%) than Group 2 (19.3%), and the differences were statistically significant (p = 0.009). In addition, 80.6% women who used oral contraceptive pill (OCP) as contraceptive showed cellular changes within normal limits, while it were 77.6% for intrauterine device (IUD) users. Compared with Group 2, Group 1 had a significantly higher percentage of metaplastic cells in their Pap smear results (G1 7.4%, G2 5.8%, p < 0.05). No epithelial abnormalities were reported in Pap smears. Trichomonas vaginalis was higher in G1 than the other groups (p < 0.005), but the difference was not statistically significant for candidiasis. It may be concluded that in this population, IUD and OCP had no effect on morphological pattern of the Pap smears, but there was a significant increased rate of trichomonas infection in IUD users.

Helicobacter pylori seropositivity in patients with hyperemesis gravidarum.

OBJECTIVES: To test the hypothesis that infection with Helicobacter pylori is associated with hyperemesis gravidarum. METHODS: From November 1999 to February 2001, we enrolled 54 pregnant women with hyperemesis gravidarum and 53 asymptomatic pregnant women in a prospective study. Specific serum immunoglobulin G for Helicobacter pylori was assayed in the sera of the study group and compared with the asymptomatic group. Chi-square and Student's t-test were used accordingly for statistical analysis of the data. RESULTS: Serologically positive Helicobacter pylori infection was detected in 44 out of 54 patients with hyperemesis gravidarum (81.5%) whereas 29 out of 53 asymptomatic gravidas (54.7%) had positive antibody titers for Helicobacter pylori. The ratio of Helicobacter pylori seropositivity in pregnant women with hyperemesis gravidarum was significantly higher than asymptomatic pregnant women (P<0.01). The mean (+/-S.D.) of the IgG titer was 69.7 (+/-77.5) in the hyperemesis gravidarum group and 34.5 (+/-47.8) in the control group (P<0.01). CONCLUSIONS: There is a significant association between Helicobacter pylori infection and hyperemesis gravidarum in our hyperemetic pregnant patients.

Assessment of a breast cancer screening programme in Shiraz, Islamic Republic of Iran.

A breast cancer screening programme was evaluated for approximately 10,000 women aged 35 years and older. There were 67 cases of breast cancer. Highest rates of attendance were seen among younger women (35-44 years) and middle socioeconomic groups. Lowest rates were among those aged over 65 years and low socioeconomic groups. The rate of detection by self-examination was similar to that by health personnel examination. At all stages of screening, positive findings were most common among the high socioeconomic class. Attendance decreased steadily from first to last stages of serial screening. Although mammography is the most sensitive method of detection, because of its high cost we suggest establishing breast self-examination education programmes and encouraging women to self-examine.

Assessment of a breast cancer screening programme in Shiraz, Islamic Republic of Iran

A breast cancer screening programme was evaluated for approximately 10,000 women aged 35 years and older. There were 67 cases of breast cancer. Highest rates of attendance were seen among younger women [35-44 years] and middle socioeconomic groups. Lowest rates were among those aged over 65 years and low socioeconomic groups. The rate of detection by self-examination was similar to that by health personnel examination. At all stages of screening, positive findings were most common among the high socioeconomic class. Attendance decreased steadily from first to last stages of serial screening. Although mammography is the most sensitive method of detection, because of its high cost we suggest establishing breast self-examination education programmes and encouraging women to self-examine

Reproductive behaviour in women in Shiraz, Islamic Republic of Iran.

Data on the reproductive behaviour of women in Shiraz are presented. A total of 9934 randomly selected women aged > or = 35 years of all socioeconomic levels were interviewed. The mean age at menarche +/- standard deviation was 13.96 +/- 1.23 years, mean age at first marriage was 17.10 +/- 4.24 years and mean age at first pregnancy was 19.50 +/- 3.90 years. The mean number of children was 4.56 +/- 1.70 children, although for illiterate women it was 6.76 +/- 1.76 children and for high-school- or university-educated women it was 3.36 +/- 1.70 children. The mean age at menopause was 47.80 +/- 3.78 years.

Reproductive behaviour in women in Shiraz, Islamic Republic of Iran

Data on the reproductive behaviour of women in Shiraz are presented. A total of 9934 randomly selected women aged >/= 35 years of all socioeconomic levels were interviewed. The mean age at menarche +/- standard deviation was 13.96 +/- 1.23 years, mean age at first marriage was 17.10 +/- 4.24 years and mean age at first pregnancy was 19.50 +/- 3.90 years. The mean number of children was 4.56 +/- 1.70 children, although for illiterate women it was 6.76 +/- 1.76 children and for high-school or university-educated women it was 3.36 +/- 1.70 children. The mean age at menopause was 47.80 +/- 3.78 years