Iranian Journal of Obstetrics, Gynecology and Infertility
Year:2001 | Volume:3 | Issue:5-6|Papers Count:18

Objective: The aim of this trial was to investigate the toxicity and efficacy of a 3-day topotecan administration schedule in combination with cyclophosphamide in the management of recurrent ovarian cancer. Methods: Patients with recurrent measurable ovarian cancer who had up to 2 prior chemotherapy regimens for the management of their disease participating in this phase II trial were to receive topotecan at a dose of 1.25 mg/m2/day x 3 days in combination with cyclophosphamide at 600 mg/m2 on day 1 every 21 days. Dose escalation and reductions were permitted.Results: A total of 36 patients (median age = 65; range 37-84) were treated with this combination regimen. 17 were platinum sensitive and 19 were platinum resistant. A total of 169 cycles of chemotherapy was administered (Median = 4; range = 1-10). Major toxicity included grade 4 neutropenia (68.6%), peutropenic fever (7.1%), grade 3 thrombocytopenia (18.3%), and requirement for blood transfusion (19.5%). Dose escalation was possible in 3 (8.3%), and dose reduction was required in 14 (38.9%) patients. Overall response rate was 25% and 44.5% demonstrated stable disease. Median progression free interval and overall survival was 5:4 and 23.5 months respectively, independent of platinum sensitivity. Conclusion: The 3-day topotecan schedule in combination with cyclophosphamide appears to have good activity in recurrent ovarian cancer regardless of platinum sensitivity. Neutropenia was the only severe toxicity and was less prevalent than other reported trials of topotecan. This tolerable regimen offers patients more convenience and appears to have moderate activity.

The purpose of this study was to determine the efficacy and safety of using 5% meperidine for spinal anesthesia in patients undergoing non-emergency cesarean section and also to compare it with heavy lidocaine. Fifty full term pregnant women. with ASA physical status I or II, presenting for non-emergency cesarean section under spinal anesthesia were randomly divided into two groups with 25 in each. All patients received IV 15 ml/kg Ringer's solution 15 minutes prior to block, and IV 10 mg metoclopramide just before entering the O.R. For spinal anesthesia, patients were given either 5% meperidine 1.25 mg/kg or 5% heavy lidocaine 60-75 mg intrathecally. The sensory blockade in all except two patients in the lidocaine group and one patient in the meperidine group, who required sedation and analgesia during surgery, was adequate for cesarean section. None of the mothers suffered from any major side effects. The incidence of hypotension was lower in the meperidine group than in lidocaine group (p < 0.05). All the newborns in both groups cried immediately after birth and had an Apgar score greater than 7. The mean duration of postoperative analgesia was 371 ± 24 minutes in the meperidine group and 146 ± 7 minutes in the lidocaine group (p < 0.001). It is concluded that intrathecal 5% meperidine in a dose of 1.25mg/kg is superior to 5% heavy lidocaine because the incidence of hypotension is lower and the duration of postoperative analgesia is so much longer. The commercial 5% solution of meperidine can be used without adding any additive for this purpose.

Introduction: Several methods are used for the treatment of stress urinary incontinence (SUI); and their early results are relatively similar, but late outcomes are different. We represent our results by the modified Burch Procedures (Tanagho) in the treatment of SUI for a 12 year follow up perios.Methods: From 1988 to 2000, 52 females with SUI 65% of whom had a history of anterior colporhaphy were operated with modified Burch urethropexy. Then early and late results were evaluated in 31 of these cases.Results: Results indicated that urinary retention in 3 cases (10%), difficulty in voiding in the first week after operation in 4 cases (12%), complete response was 93.5% in, one year's follow-up, 89.4% in 3 year's follow-up and 75% in 5 and 15 year's follow-up were observed.Conclusion: Modified Burch for the treatment of SUI is a very easy and safe technique and has clear advantages in patients with a history of anterior colporhaphy or patients with moderate cystocele.

Objectives: To evaluate the correlation between indirect anthropometric techniques for estimating body fat mass (BFM) and to examine the relation of age at menarche to IQ and BFM as determined by these parameters.Design: Cross sectional study (in Autumn 2000) correlating measurements of weight, Body Mass Index (BMI), Triceps Skin Fold (TSF) thickness, Subscapular Skin Fold (SSSF) thickness and Intelligence Quotient (IQ) and their relations to age at menarche.Participants: A total of 578 adolescent girls from ten guidance schools in five educational districts of Mashhad These districts are of various socio-economic and cultural status. Methods: Questionnaires, Interview, Measurement of body indexes, Raven test (Raven matrices for determining IQ) Multiple Regression, Pearson Correlations, Analysis of varieties. Results: Anthropometric Parameters for estimating BFM correlated well to each other. Age at menarche did not correlate with BFM measured by anthropometric parameters when studied at the onset of menarche, but it did well correlate with these indexes if studied any time postmenarche, regardless of the interval between the onset of menarche and the present age (p < 0.001) The correlation was negative. IQ correlated negatively to the age at menarche. Correlation was significant at the 0.001 level (P < 0.001).Conclusion: 1- Anthropometric Parameters are well correlated with each other for estimating body fat content.2- BFM does not trigger puberty onset in healthy girls; and it is not an absolute determinative factor for initiation of menarche, but it can be considered a co-factor for the onset of it.3- Mental development and physical growth are parallel processes, so that a slower mental development would be expected when the physical growth is delayed.

To determine the prognostic factors in early stages of cervical cancer, a retrospective study was performed on 49 cases of cervical cancer (Stages I, II) who underwent radical hysterectomy and lymphadenectomy in Imam Khomeini Hospital between 1371-75. The mean age of cases was 51.3 ± 10.7, and the median of follow up period was 30 months with range 1-64 months. During follow up time 4 cases (8.2%) expired and recurrence rate was 6.1% (3 cases).The depth of cervical invasion was > 2/3 in all 7 cases, and the tumor size was> 4 cm in 6 cases Association between tumor size and disease outcome was statistically significant (P = 0.03). The 40 month disease free interval survival rate was 65% in patients with tumor size> 4 cm and was 95% in tumor size < 4 cm. Although the difference between survival rate according to tumor size was considerable, it was not statistically significant (P = 0.06).There was not any significant association between depth of cervical invasion, lymphnodes metastasis, lymphovascular space and parametrium involvement and hystiologic type of tumor with disease outcome.

Objective: The purpose of this study is to show the fertility rate, pregnancy outcomes and also the complications of pregnancies in female renal transplantation recipients, in Imam Reza Medical Center in the past twelve years.Study design: This is a historical prospective study. From the 550 patients who have received renal transplants in our department, 198 were women and 94 in fertility age. From those, 12 women had 18 pregnancies. All of them were followed carefully by nephrologists, urologists and obstetricians; and in their medical files, in addition to the demographic criteria, the stage of renal disease, renal insufficiency, the period between renal transplant and pregnancy etc. have been recorded. Statistical evaluations were done by this data.Results: In this study the fertility rate was 12.76%. The pregnancy outcomes showed 22.22% abortion, 11% premature preterm labour and 66.67% live births; but 38.4% of neonates had low birth weight. Finally, because of renal insufficiency, we had 11% maternity mortality rate. Conclusion: After kidney transplant the fertility rate is increased, and most pregnancies are successful; but unfortunately, some serious complications may occur. So, these patients, for pregnancy with addquate prenatal care.

Objective: In spite of the increasing rate of cesarean section and its public acceptance, many are not aware of its complications. To provide information on pregnant women's knowledge and attitude about vaginal versus abdominal delivery we carried out the present study.Methods: 204 pregnant women attending the two major maternity centers in Kerman consecutively were studied. a special questionnaire, including statements for evaluation of knowledge and attitude, was prepared; and its validity was confirmed. Data gathered through these questionnaires were analyzed.Results: The level of women's knowledge was low as a whole (63.5% weak). 96.5% and 33% of women had positive attitudes towards vaginal delivery and cesarean section, respectively. On the other hand, 40.5% had negative attitudes to cesarean section. There was a significant relationship between their level of knowledge and attitude.Housewives, and those with more parity and more previous cesarean sections, had positive attitudes to vaginal delivery. The level of knowledge was higher in the women with previous history of abortion. 59.8% and 35.78% of women were interested in having vaginal and abdominal delivery respectively.Conclusion: Considering the low level of knowledge in the women it can be concluded that young people in the society need more training and education about this subject during their first various periods of reproductive lives and education.

Low risk gestational trophoblastic disease (LRGTD) has a good prognosis with single-agent chemotherapy. The goal is to offer a safe, effective, inexpensive, inexpensive and convenient therapy for patients with LRGTD. Puls Actinomycin-D, Puls Methotrexate, 5-day Actinomycin and Methotrexate leucovorin were compared on 54 cases of LRGTD in Mirza Kocak Khan Hospital, through a longiudinal study.During 2.5 years study patients received puIs Actinomycin-D (n-19), puls MTX (n = 13), 5-day Actinomycin (n = 8), MTX leucovorin (n =15).66.7% (n = 34) achieved remission with first line chemotherapy; remission rate was 100%, and no recurrence was seen after one year of follow up.Primary response rate was 68.8% (n = 11) for puis Actinomycin, 61.5% (n = 8) for puls MTX, 57.5% (n = 4) for 5-dayActinomycinand 73.3% (n = 11) for MTX and leucovorin. These differences were not significant. The mean time to responses was different among the four groups, with a range of 66-78 days. But the differences were not statistically significant. The mean course of chemotherapy were twice in puls MTX (8.4 ± 1.8) compared with other groups (4.3 ± 1.5) which is significant (p = 0.0001).

A prospective study of 53 IDM evaluated for neonatal mortality rate and NICU admission. 6238 pregnancyies with 6390 babies delivered in Imam Reza Hospital since 1.1.77 for 23 months. 53 of 6390 (0.84%) newborns were IDM. Overt diabetes in pregnancy occurred in 3.3 of 1000 pregnant women. The prevalence of gestational diabetes is 0.5%. The relative risk for NICU admission and mortality is 4 and 1.8 respectively. Hyaline membrane disease (HMD) is the most common cause of death in neonates. Congenital malformation, asphyxia and infection were the other causes of death.Improvement in antepartum care, fetal monitoring, vigorous control of maternal metabolism, and maternal education will result in improvement in perinatal mortality and morbidity.

Objective: The objective of this research was to compare the efficacy of mefnamic acid and tranexamic acid on a mount of menstrual blood loss of patients with hypermenorrhea that were coming to the Gynecologic Clinic of Booali Hospital. Material and Method: Fifty patients with hypermenorrhea were selected. Randomly 25 patients were managed with Tranexamic acid and another 25 patients were managed with mefnamic acid during their first 5 days of menstruation. Range of ages of patients were between 25 to 45 years old and their parity were less than 5, and their contraception did not include OCP or IUD.Gynecologic study such as' endometrial biopsy and fractional D & C were performed, if needed, to rule out organic causes. Patients who sufferedfrom other diseases such as peptic ulcer, inflammatory bowel disease, thromboembolic disease and coagulation disorders were not included. Efficacy of management was determined with number of pads that were used before and after management with both drugs during first 5 days of menstruation, and results were evaluatead with the statistical t - test method. Conclusion: This study showed that both mefnamic acid and tranexamic acid are effective in decreasing menstrual blood loss and the effect of tranexamic acid in decreasing menstrual blood loss is a little more than mefnamic acid.

Objective: To determine the most useful clinical signs and symptoms and further evaluate the factors contributing to delay in diagnosis and to assess overall outcomes in appendicitis in pregnancy, we performed a retrospective contemporary evaluation of pregnant women with the diagnosis of acute appendicitis.Study design: In this retrospective study from 1370-1375 the case record of all pregnant women with the diagnosis of acute appendicitis were analyzed with chi-square test. Results: Eighty-four patients had the admitting diagnosis of pregnancy and acute appendicitis. Gestational stage at the diagnosis was the first trimester in 32%, second stage 44% and third trimester in 16%. 54 patients had pathologically proven acute appendicitis. Nineteen patients were taken to the operating room within 24 hours of presentation.Conclusion: Our study found that physical examination on presentation was the most reliable diagnostic tool for appendicitis, and there is a higher incidence of perforation with delayed diagnosis.

Objective: Based on serological evidences Toxplasmosis infection is a widespread disease. With regard to this fact and because of the occurrence of congenital toxoplasma infections due to asymptomatic infections in pregnant women, determination of the rate of toxoplasma antibodies during pregnancy seems to be necessary.Method and Material: In this cross-sectional and descriptive study the prevalence of toxoplasma antibodies (lgG) in Zahedan Women was determined by the IPA method. Blood samples (n = 200) were collected randomly from women referred to child and mother's clinic during & months in Jan. 1997 to Sep 1998.Result: The results showed that the general prevalence of the positive cases based on titer IgG ≥ 120 was 27%. moreover 73% of pregnant women in Zahedan were seronegative, and they were prone to acute toxoplasmosis during their pregnancy' therefore, considering this fact and trying to omit its risk factors especially during pregnancy is very important.

Placental site trophoblastic tumor, that is called trophoblastic pseudotumor, is a persistent proliferation of trophoblasts in the placental implantation sit. In research of literature 100 cases of this disease was reported.Clinical signs of this tumor differ from other trophoblastic diseases. Thus, the diagnosis of this tumor has been very late. This case is a trophblastic placental site tumor in a 30-year old with secondary ammenorrhea and previous molar pregnancy in late years. Clinical study and laboratory evaluation was detected in placental trophoblastic tumor. With chemotherapy treatment and hysterectomy, it was cured.

Acquired brachial plexus injury historically has been linked with excessive lateral traction applied to the fetal head, usually in association with shoulder dystocia. Recent reports in the obstetric literature, however, have suggested that in utero forces may underlie a significant portion of these injuries. Brachial plexus palsies may therefore precede the delivery itself and may occur independent of the actions of the accoucheur. Thus we propose that the long-held notions of a traction-mediated pathophysiologic mechanism for all brachial plexus injuries warrant critical reappraisal.