سال:1393 | دوره: | شماره: |تعداد مقالات:12

Objective: Borderline ovarian tumors (BOT) constitute 15% of all epithelial ovarian cancers. The aim of this study is to analyze and discuss the management dilemmas associated with BOT. The purpose of this article was to collect and review the data on management dilemmas of BOT from numerous articles published since 1995. Additionally, the data of four patients with BOT, who were treated in our Institute, are presented and analyzed.Materials and Methods: For literature review we performed a literature search of relevant articles that were based on management dilemmas. Additionally, the data of 4 patients with BOT, who were treated in our Institute, are reported and reviewed by medical data information and patient interview, to establishing a database for a better understanding of the management dilemmas of BOT.Results: All the four cases were of reproductive age group. In three cases conservative fertility sparing surgery was done and in one patient radical surgery was done. All the four cases did not require adjuvant therapy. BOTs did not affect the outcome of pregnancy. Follow up of all the four cases is uneventful with no evidence of recurrence.Conclusion: Surgical management to excise all visible tumor tissue remains the keystone of therapy. Fertility being an important issue; conservative laparoscopic surgery is also a viable treatment option. Progression free survival is not influenced by the type of surgical approach (laparoscopic v/s laparotomy). Overall survival does not depend on the type of surgery (fertility sparing v/s non-sparing surgery). Even in advanced disease there is no proven benefit of adjuvant chemotherapy or radiotherapy.

Objective: The aim of this study was to determine the rate of chromosomal abnormalities in the products of first trimester miscarriages in patients who were under FSH ovarian stimulation and to compare the results with the products of miscarriages of naturally conceived pregnancies.Materials and Methods: This retrospective cohort study was conducted over a nine-year period. Included were 909 patients who conceived naturally and 76 infertility patients who were under FSH stimulation with first trimester miscarriages karyotyped. The rate of aneuploidy was compared between the two groups. The main outcome measure was the incidence of aneuploidy.Results: In 76 FSH-induced pregnancies, 12 (15.7%) had an abnormal karyotype. The rate of aneuploidy rate in miscarriages in the natural conception group was 22.3%. There was no statistically significant difference in age (32.7±4.2 vs.33.5±5.0), cycle day 3 FSH (7.9±2.3 mIU/ml vs.7.1±2.6 mIU/ml) or exogenous FSH doses (2419.7±643.7 IU vs.2616.5±947.5 IU) between the infertile patients with or without abnormal karyotypes.Conclusion: Exposure to exogenous FSH was not associated with increased aneuploidy rates in our infertile population.

Objective: Epidemiological research often seeks to identify a causal relationship between the risk factors and the disease. Earlier researches suggest that mother age, her weight at last menstrual period, race, the number of physician visit during the first trimester of pregnancy, may affect on her neonate birth weight. Mechanisms of mother lifestyle characteristics on her neonate weight are intricately complicated. These mechanisms, however, can be easily interpreted through an appropriate mathematical relationship. The present study aims to identify the factors of mother’s lifestyle characteristics which have statistical significant effects on her neonate birth weight based on statistical (or probabilistic) modeling.Materials and Methods: The present study is based on the secondary data collected at Baystate Medical Center, Springfield, Massachusetts during 1986. It was a routine data set. There was not any specific setting. Study subjects were 189 mothers, 59 of which had low birth weight babies and 130 of which had normal birth weight babies. Joint generalized linear log-normal statistical modeling of mean and variance is used.Results: The present analysis identifies that mother age (p=0.063), her weight at last menstrual period (p=0.019), race (p=0.017, p=022), smoking status (p=0.014), history of premature labor (p=0.008), history of hypertension (p=0.031, 0.039) and presence of uterine irritability (p=0.002) are statistically significant on her neonate birth weight. It has been detected that the variance of neonatal birth weight is non-constant, which invites the present study.Conclusion: Impacts of mother’s lifestyle characteristics on her neonate weight are explained based on mathematical relationships. This analysis supports many earlier research findings. However, the present analysis also has identified many additional casual factors that have explained the mean and variance of neonatal birth weight, which was not reported by the earlier investigators. In addition, some conflicts about the earlier research findings are attempted to be removed.

Objective: There is evidence for genetics components in PCOS based on familial clustering of cases. We examined the contribution of genetics impact and some lipid/serum profiles to PCOS in a cohort study of Iranian twins.Materials and Methods: As a prominent predisposing risk factor for PCOS, serum lipid profiles (Triglyceride, Total cholesterol, HDL, LDL, Apo lipoprotein A-I, Apo lipoprotein B and lipoprotein A), were analyzed in 154 subjects of PCOS. The diagnosis of PCOS has been based on the Rotterdam consensus criteria in this study. We also studied 16 identical twin pairs discordant for PCOS to evaluate the effects of environmental risk factors (including lipid indices profiles) for PCOS. Furthermore, we compared these 16 twin pairs with PCOS, in which just 15 (93.75%) of them was concordant for abnormal lipid profiles. Also the impact of lipid profile in patients with PCOS was confirmed by comparing total 22 identical and non-identical twin pairs, in which 21 out of them (95.45%) showed abnormal lipid profiles.Result: PCOS and increased cholesterol level were higher in identical versus non-identical twins with concordance rates of 1.5 and 1.65 (based on the Rotterdam consensus criteria), respectively. Analysis of identical pairs showed weak association between impact of lipid profile and PCOS while in non-identical pairs, the PCOS was associated with an increased environmental risk (lipid profile).Conclusion: Different lipid indices were affected by environmental and genetic risk factors in PCOS, but the contribution of environmental and genetic factors to the various PCOS-related changes in ovarian structures remains to be established.

Objective: Worldwide overpopulation has brought about lots of problems for people especially for developing countries. However, there is a success at reduction of population rate from 2.1% on 1960 to 1.7 on now, 95 million is increased every year.Materials and Methods: This cross sectional-descriptive study was designed retrospectively on 396 and 484 DMPA user women aged 15-49 years referring to health care centers in Ardabil & Tabriz respectively by classification sampling who were injected their first DMPA between 2009-2012. Due to being a cross sectional study 800 women were selected (400 for Ardabil and 400 for Tabriz). Questionnaire was arranged at two parts: demographic and main reasons for continuation and discontinuation and its side-effects. Then data were collected via completing questionnaires by researchers and interviewing subjects after signing the consent form. Data were analyzed by SPSS 12 software using analysis variance (ANOVA) and correlation.Results: The mean of continuation rate of DMPA is 2.60 and 6.52 months at Ardebil and Tabriz respectively. By using t-test the mean of continuation rate differs between two cities and its rate is higher at Tabriz.Conclusion: According to the results of this study focusing on low level of continuation rate of DMPA at both cities and its most common side-effect (Amenorrhea) care givers could help in term of sufficient counseling and educating women desiring DMPA injection. This factor could result in more satisfaction use and improve continuation rate of DMPA.

Objective: Surfactant replacement therapy and respiratory support are the corn stones for respiratory distress syndrome treatment. Natural surfactants, which are animal derived, have been considered superior to synthetic ones, but the superior type of natural surfactant is still unknown. This study was conducted to compare the efficacy of two types of natural surfactants, Poractan alfa (Curosurf) and Alveofact, in the treatment of respiratory distress syndrome (RDS).Materials and Methods: In a randomized clinical trial 130 inborn preterm newborn infants with gestation age less than 32 weeks were randomly allocated to two groups; 66 neonates received Curosurf and 64 infants treated with Alveofact.Results: Demographic characteristics of infants were similar in two groups’ patients. The mean number of surfactant replacement therapy was significantly more in Alveofact group (1.79±0.92 vs.1.22±0.48, p<0.001). The remaining on ventilator support through 7 days was noted in 9 infants that all of them was treated with Alveofact, p=0.001. The mean duration of oxygen supplementation and hospital stay were 10.97±2.21 and 24.50±23.85 days in Alveofact group vs.7.31±1.65 and 25.25±20.61days in Curosurf group, p=0.03 and p=0.16 respectively. The rate of complications was similar among patients in two groups.Conclusion: Our data demonstrate short term benefit with respect to respiratory support in Curosurf treated patients without significant difference in other consequences till discharge. Future studies with larger number of patients are recommended for determining superior natural surfactant.

Objective: Artificial insemination (AI) has been used to treat infertile couples for approximately 200 years. Time interval between administration of Human Chorionic Gonadotropin (HCG) and intrauterine insemination (IUI) is one of controversial subjects in AI. Fertility rate is in the highest level on the day before ovulation. The aim of study is to compare pregnancy rate in standard IUI versus simultaneous HCG administration with IUI.Materials and Methods: In a randomized, controlled clinical trial, 141 women 20-35 years selected for IUI among patients referring to infertility clinic of Al-Zahra hospital in Tabriz, Iran in 2013.they were entered into study in two groups of simultaneous (n=71) and standard (n=70). After ovulation stimulation by clomiphene and human menopausal gonadotropin (HMG) and creating up to 3 dominant follicles in each patient, a single dose of HCG was administered; thereafter, IUI was done in the simultaneous group instantly and 34-40 hours following HCG injection in the standard group.Results: In the standard and simultaneous groups, mean pregnancy rate per patient was 25.7% and 21.1% respectively (p=0.52) and pregnancy rate per IUI cycle was 16.4% and 15.3% respectively (p=0.82) that was not significantly different. Furthermore, between two groups in terms of age, the number of mature follicles, and endometrial thickness, there was no significant difference.Conclusion: Although difference in pregnancy rate between two groups was not statistically significant, simultaneous HCG with IUI is a comfort method for patients due to less cost and fewer patient’s referrals to clinic.

Objective: The impossibility of determining the exact time of childbirth and measuring the length of latent phase may be the reason of different encounters with this stage of labor. This study investigates the impact of early admission of women in latent phase referred to Tabriz Taleghani Hospital.Materials and Methods: A descriptive study was conducted in 2011 on 250 women during latent phase admitted to Tabriz Taleghani Hospital in which they were randomly selected for the survey. A five part questionnaire was used for data collection aimed to investigate (respectively) demographic characteristics, Partograph form, evaluating checklists of second, third and forth stages of labor, the results of a pre-discharge examination and also the first ten days after childbirth Results: According to the findings 187 of the labors were stimulated by oxytocin induction (74.8%) while 18.8% of the oxytocin treated women were hypotonic, 139 (55.6%) underwent amniotomy, 6.8% of the fetus had FHR abnormalities including Bradicardia and tachycardia. No neonatal deaths were reported and just 2 of the newborns were admitted to the neonatal ward. Of the total 28 (11.2%) had prolonged latent phase and 54 (21.6%) of the patients had prolonged active phase of labor. The mean drop in hemoglobin and hematocrit rates during admission for delivery was, respectively, 1.35±1.41 and 3.8±4.1.Conclusion: Admission in the latent phase of labor is associated with increased length of labor and stay in postnatal ward, increased maternal and infant complications and interventions. Therefore it is recommended that all the women should be given adequate training during pregnancy. They also should be advised that in the absence of medical problems it is best to be admitted when active labor begins to prevent many complications.

The ductus venosus regulates the distribution of oxygen and placental nutrients by restricting the centralization of blood flow in fetal circulation. The ductus venosus is a small vein transmitting oxygen-rich blood from the umbilical vein to the fetal heart.. Increasing numbers of case reports are being published about ductus venosus agenesis with cardiac structural abnormalities, other malformations, chromosomal abnormalities, and stillbirth. Heart failure, hydrops and unexplained polyhydramnios could also be associated with ductus venosus agenesis. In the follow-up of fetuses with ductus venosus agenesis, care must be taken to examine for hydrops and heart failure. The agenesis of ductus venosus is often only found in fetuses by coincidentally. Herein we discuss the prenatal diagnosis of isolated agenesis of the ductus venosus presenting with a dilated inferior vena cava and without any disturbance of fetal hemodynamics and any other malformation. In conclusion a dilated inferior vena cava can be a sign of ductus venosus agenesia.

Tetra-amelia is known as an anomaly characterized by the absence of all four limbs. It is a rare congenital anomaly, with an incidence of 1.5-4 per 100, 000 births. It occurs as a result of developmental interruption between 24th and 36th days after fertilization. Its etiology is not well known. It may be observed isolated or associated with other anomalies. In this paper, we present an interesting case of an intra-uterine diagnosed tetra-amelia male fetus with the recurrence in the previous two more male fetuses in the same family. Tetra-amelia syndrome observed in all three male fetuses of a couple with blood relationship is presented. The first two male newborn died just after birth due to prematurity in 28th and 32nd weeks. The third male fetus was in 23nd weeks of the intrauterine life. There was no exposure to teratogenic agents in this pregnancy. It detected that the third male baby had subcutaneous edema, intra-abdominal ascites and lateral ventricle enlargement in cranium. Since tetra-amelia due to genetic inheritance based on X chromosome was suspected, the family was offered the options of termination of pregnancy, karyotype analysis and genetic consultation.

Most maternal cardiac disease in Western societies is now congenital in origin. This relates to the significant improvements in congenital cardiac surgery during the last years. Some patients will present for the first time in pregnancy with symptoms and learn that they have congenital heart disease. So all patients should have a detailed evaluation and appropriate counseling before pregnancy. Ebstein anomaly is a rare and complex congenital heart disorder occurring in 1 per 200 000 live births and, first described by a German physician Wilhelm Ebstein in 1866 in a report titled, "Concerning a very rare case of insufficiency of the tricuspid valve caused by a congenital malformation. This anomaly accounts for 0.5%-0.7% of cases of congenital heart disease. The average life duration of patients with Ebstein’s anomaly is 25-30 years. The malformation consists of apical displacement of the tricuspid valve with resultant regurgitation and enlargement of the right heart chambers, resulting in arrhythmias and heart failure. The common cardiac anomalies associated with the condition are atrial septal defect (ASD) in 90% of patients, anatomic or functional tricuspid atresia in 30%, Wolff-Parkinson-White (WPW) syndrome in 15% and less commonly ventricular septal defect (VSD), pulmonic stenosis or atresia and mitral valve prolapse. Survival into adulthood is common and patients present with cyanosis, dyspnea and palpitations.

Objective: The objective of present work was mainly to phytochemical, antioxidant properties and examine the effect of Lavandula angustifolia Mill. Essential oil on Preoperative Anxiety in Patients undergoing Diagnostic Curettage (Gorgan, Iran).Materials and Methods: Essential oil of plant in blooming was obtained by hydro distillation method (clavenger) and analysed by (GC/MS). Antioxidant activity determined by 1, 1-diphenyl-1-picrylhydrazyl (DPPH) assay, anti anxiety effects were studied using Spielbergers state anxiety inventory questionery method and analyzed by using SPSS 18 statistical Software and t-test (0.05%).Results: Carvacrol (26.2%), limonene (19.6%), 1, 8-cineole (11.8%), terpinen-4-ol (7.6%), spathulenol (4.9%), α-pinene (4.2%), p-cymene (4.2%), caryophyllene oxide (2.7%), and terpinolene (2.6%) were the prominent components of essential oil and showed good antioxidant property via radical scavenging activity (DPPH) assay with IC50 values of 4.3±0.12% to compare with BHT standard (2.18±0.3%). Clinical results showed that among 100 patients with average anxiety scores for the case group and the control was recorded 53.37±9.8 and 49.19±12.96, respectively and the difference was not significant (P<0.08), but after intervention, this difference was found to be statistically significant (P<0.0001) with regard to the results 40.28±6.66 and 47.87±12.96 for cases and controls, respectively.Conclusion: There is a positive relationship between essential oil components, its antioxidant activity in reducing anxiety in patients undergoing curettage (D&C), especially in the night before the surgery.