arezoo esmailzadeh

Wolffian adnexal tumors (FATWOs) originate from the mesonephric duct remnants. FATWOs are extremely rare, and 100 incidental FATWOs have been reported in English literature. Most FATWOs have a low potential for malignancy, but aggressive behavior, including recurrence and metastasis, has been described in a few cases; There is no standard protocol for optimal treatment of FATWOs. The case described here is a 35-year-old female who presented with a right-side ovarian mass via abdominal ultrasound. She had a history of left salpingo-oophorectomy due to an abdominal mass, which both histopathologic and immunohistochemical study’s findings were consistent with  Wolffian tumor. Later, she underwent total abdominal hysterectomy with tumor debulking because of the probable malignant behavior of the tumor. FATWO has a heterogeneous histologic pattern,which may make its diagnosis challenging. No specific immunohistochemical markers have yet been recognized for FATWO and pathogenesis or molecular alterations are not definitive.  Therefore, there is no comprehensive recommendation for optimal clinical management of FATWO or its recurrence.

More than 75% of epithelial ovarian cancer (EOC) cases are diagnosed in advanced stages, which is associated with tumor recurrence and chemotherapy resistance. So far, to the best of our knowledge, a similar study has not been conducted in Iran to investigate the clinical characteristics and survival rate of these patients treated with neoadjuvant chemotherapy (NACT).

This study aimed to evaluate the clinical characteristics and survival of patients treated with NACT followed by cytoreductive surgery and the factors affecting survival.

This retrospective cohort study was conducted on 147 advanced ovarian cancer cases who were treated with NACT referring to the Gynecology Oncology Department of Imam Khomeini Hospital in Tehran, Iran, between 2011 and 2021 and met the inclusion criteria for this study. The survival curve and Cox regression method were used to analyze the data.

The results revealed that 8.9% of advancedEOC (147/1,650) were treated with NACT and the average number of NACT courses was 4.12 periods. The survival rates of 1, 3, 5, and 8 years were 85.31%, 44.05%, 18.35%, and 13.77%, respectively. The mean and median of survival time were 47.7 and 36 months,respectively. Nearly 80% of the patients had stages 3C and 4A before receiving NACT. Based on the results of the adjusted Cox regression model, tumor marker level showed a significant relationship with survivalrate (P=0.008), and also peritoneum involvement had a clinically significant impact on survival with a hazard ratio of 2.88.

The results suggested that8.9% of ovarian cancer cases were treated with NACT. It was also revealed that the average number of NACT courses was 4.12 periods and the 8-year survival rate was 13.77%. CA125 tumor marker level showed a significant relationship with survival rate, and peritoneum involvement had a clinically significant impact on survival.

Venous resection and reconstruction are common during pancreaticoduodenectomy due to pancreatic adenocarcinoma. Multiple treatment options have been offered for venous injury repair. In this regard, the present study used the peritoneum as a conduit for the superior mesenteric vein (SMV) reconstruction during colon cancer surgery. The case was a 55-year-old woman with colon adenocarcinoma. The SMV damage was 6 cm in length. The defect was replaced with peritoneal conduit derived from parietal peritoneum of the abdominal wall. Coalition and flow of the SMV were confirmed by contrast-enhanced computed tomography examinations. The patient had a good condition over the six-month follow-up period. Peritoneal conduit might be a promising choice for SMV defects in emergent conditions due to its availability and lower overall costs.

Coronavirus disease 2019 (COVID-19), newly emerging in the world as a pandemic disease, can have rare extrapulmonary manifestations. Few studies have reported coagulation disorders, induced by coronavirus; however, hemorrhage is an extremely rare and life-threatening phenomenon in COVID-19.

Herein, we present a 31-year-old woman referring with vaginal bleeding, melena, skin ecchymosis, mucosal bleeding, melena, hematuria, and hypovolemic shock. At our center, she was diagnosed as a case of severe internal hemorrhage due to ovulation site hemorrhage and underwent emergency surgery, complicated by prolonged international normalized ratio, which could be due to the presence of COVID-19 in the patient, detected by spiral computed tomography.

This case showed the importance of examining COVID-19in any patients referring to the hospital during the pandemic as well as paying greater attention to the effect of COVID-19 on coagulation disorders in these patients.

Herlyn-Werner-Wunderlich (HWW) syndrome is a rare congenital urogenital defect. It is detected by unilateral low vaginal obstruction, uterus didelphys, and ipsilateral kidney agenesis. It usually becomes apparent with pain, dysmenorrhea, and presence of a vaginal or pelvic mass. Purulent vaginal discharge may also happen rarely because of infective complications of the obstructed hemivagina. In this report, we describe a post-pubertal case with acute abdominal pain.

 The patient was a 13-yr-old girl who was referred to us with acute abdominal pain one year after the onset of her menarche. In the pelvic examination, we detected hematocolpos. Abdominopelvic-computed tomography scan confirmed the presence of mullerian duct anomalies with uterus didelphys. This case of HWW syndrome along with pyocolpus was managed by vaginal septum resection, drainage of pus, and salpingectomy.

The symptoms of HWW syndrome should be monitored in early puberty to prevent more complications.

Gestational weight gain (GWG) is an important issue for all pregnant women due to its effect on pregnancy outcomes. Regarding this, the aim of the present study was to assess the relationship of GWG with cesarean section, birth weight, and gestational age at birth in the women with a pre-pregnancy body mass index (BMI) of ≥ 25 kg/m2.
This cross-sectional study was conducted on 2,147 obese or overweight pregnant females who had singleton births as a secondary analysis. The data were collected by filling out a checklist in 103 hospitals, which were equipped with department of obstetrics and gynecology, in Tehran province, Iran, in 2015. Data analysis was performed using binomial logistic regression model in Stata software version 14.
According to the results, the prevalence of cesarean section was 74.35%. Furthermore, the mean GWG was 11.7 kg. The odds of cesarean delivery in the women with low and high GWG were 0.62 times smaller and 1.20 times larger than that for normal GWG, respectively (95% CI: 0.42-0.92, P=0.019 and 95% CI:0.90-1.59, P=0.197, respectively). After adjusting for confounding variables, GWG had no significant association with birth weight and gestational age at birth in the overweight and obese women.
The findings of this study revealed a significant relationship between GWG and cesarean section. Furthermore, the odds of cesarean section in the women with low GWG was less than that in the women with normal GWG. Regarding this, GWG should be considered as one of the determinants of cesarean delivery. Therefore, it is suggested to conduct further prospective cohort studies to clarify the impact of GWG on pregnancy complications.

Placenta accrete refers to an abnormality of placental implantation in which the anchoring placental villi attached to myometrium rather than decidua resulting in a morbidity adherent placenta. Placenta increta (chorionic villi penetrate into the myometrium) and placenta percreta (chorionic villi penetrate through the myometrium to the uterine serosa or adjacent organs) are related, but more severe, abnormalities of placental implantation. The pathogenesis is primarily attributed to defective decasualization of the implantation site. Placenta accreta has been recognized mostly in the third trimester however may also present in second trimester. It has very heavy, life-threatening hemorrhage to both the mother and fetus. The authors’ report a patient with two previous cesarean deliveries, who had been referred for pregnancy termination from Iranian legal medicine organization with 15 weeks of gestational age and placenta acctera. In this patient, uterus preservation and hysterectomy abortion was performed. The case totally lost 1500 cc blood and she was discharged from hospital two days later, with feeling of well- being. We have examined this patient after 1.5 months, she wasn’t vaginal bleeding and the uterus was in the pelvic and serum BHCG (with titer) was negative.

Polycystic ovary syndrome (PCOS) is a frequent condition in reproductive age women with a prevalence rate of 5-10%. This study intends to determine the relationship between PCOS and the outcome of assisted reproductive treatment (ART) in Tehran, Iran.
In this historical cohort study, we included 996 infertile women who referred to Royan Institute (Tehran, Iran) between January 2012 and December 2013. PCOS, as the main variable, and other potential confounder variables were gathered. Modified Poisson Regression was used for data analysis. Stata software, version 13 was used for all statistical analyses.
Unadjusted analysis showed a significantly lower risk for failure in PCOS cases compared to cases without PCOS [risk ratio (RR): 0.79, 95% confidence intervals (CI): 0.66-0.95, P=0.014]. After adjusting for the confounder variables, there was no difference between risk of non-pregnancy in women with and without PCOS (RR: 0.87, 95% CI: 0.72-1.05, P=0.15). Significant predictors of the ART outcome included the treatment protocol type, numbers of embryos transferred (grades A and AB), numbers of injected ampules, and age.
The results obtained from this model showed no difference between patients with and without PCOS ac- cording to the risk for non-pregnancy. Therefore, other factors might affect conception in PCOS patients.

Caesarean section (CS) rates have risen substantially worldwide over the past decades particularly in Latin America, the Caribbean and Iran. In this way, the aim of the study was to determine the rate of CS among multiparous, and indentifying the related factors.
This cross-sectional study was performed on 2189 multiparous who gave singleton birth in Tehran province, Iran from 6-21 July 2015. Data were collected by a researcher-made questionnaire through interview with mothers and review of their medical records. Logistic regression analysis was used to evaluate factor associated with CS.
The CS rate was 71.8% in this study. In univariate analysis, higher maternal age, parents’ educational level, economic status, body mass index (BMI), parity, infant weight, baby’s head circumference, history of abortion, and use of assisted reproductive technology were associated with CS. Moreover, multivariate analysis has shown a significant relationship between CS and mother’s age, mother’s education, economic status, BMI, parity, infant weight and baby’s head circumference.
The CS rate among multiparous in Tehran is substantially high. Therefore, there are essential requirements for providing immediate strategies (such as education and psychological interventions to increase women’s knowledge about the risks of CS as well as to change women’s attitude toward CS and improving the quality of natural delivery) to reduce CS rate. Furthermore, factors such as mother’s age, economic status, BMI, parity, infant weight and baby’s head circumference were related to CS.

Although leiomyomas are the most common gynecologic disorders, non-puerperal uterine inversion due to leiomyoma is considered as a rare clinical problem. This condition can occur as a complication of a large sub-mucous leiomyoma that leads to dilate cervix and protrude into vagina. The patient may have several symptoms such as heavy vaginal bleeding, pelvic pain and intermittent acute urinary retention.

Case:

 We presented a 32-year-old nulliparous woman with 17 years of unexplained infertility and diagnosis of a large vaginal prolapsed non-pedunculated leiomyoma.

Haultain’s procedure was used to reposition uterine inversion and remove leiomyoma through a posterior incision, using laparotomy.

Threatened miscarriage is a common complication in pregnancy that leads to adverse pregnancy outcomes such as preterm labor. This study aimed to compare the vaginal progesterone (Cyclogest) versus 17-alpha-hydroxyprogesterone caproate (Proluton) on preventing preterm labor in pregnant women with threatened abortion at less than 34 weeks’ gestational age.
This balanced randomized, double-blind, single-center controlled clinical trial included 190 women with threatened abortion. They were then randomly allocated into Cyclogest (n=95) and 17-alpha-hydroxyprogesterone caproate (Proluton, n=95) groups. Interested outcome was preterm labor less than 34 weeks. The Pearson chi-square and Student’s t test were used to compare two groups. The data were analyzed by Stata software version 13.
The risks of preterm labor less than 34 weeks in Proluton and Cyclogest groups were 8.6 and 6.52%, respectively. There was no significant difference for risk of preterm labor less than 34 weeks [relative ratio (RR): 1.31, 95% confidence interval (CI): 0.47- 3.66, P=0.59] between two groups.
Risk of preterm labor in the vaginal progesterone group and 17-alpha hydroxyprogesterone caproate group in pregnant women with threatened abortion is the same (Registration Number: IRCT2014123120504N1).

Various factors such as maternal weight gain during pregnancy are important in the occurrence of preterm birth. Among these, the role of maternal weight gain during pregnancy is less studied. The present study was performed with aim to determine the relationship between maternal pre-pregnancy weight, body mass index and gestational age at birth.
In this cross-sectional study which was conducted in Tehran in July 2015, a total of 5170 deliveries were examined of which 77 cases were twin pregnancy and excluded from the study and finally, 5093 were analyzed. The data related to pregnancy and delivery in 103 hospitals was collected by 103 trained midwives by using a designed questionnaire. Data analysis was performed by Stata software (version 13), and descriptive statistics methods and linear simple regression. P Multiple linear regression analysis revealed that weight gain during pregnancy was significantly associated with gestational age at birth (P=0.001), so that for every one unit increase in weight gain during pregnancy, gestational age at birth increases 0.052 weeks (95% CI: 0.036-0.068 weeks) (P=0.001) and the chance of preterm labor decreases, but maternal weight (P=0.818), height (P=0.894) and body mass index (P=0.991) were not significantly associated with gestational age.
Weight gain during pregnancy is of the important factor in gestational age at birth, so that appropriate weight gain during pregnancy leads to reduced preterm birth in pregnant women.