فهرست مطالب mansoureh vahdat

Recurrence of endometrial polyp following the hysteroscopic polypectomy is a significant concern for both the patients and physicians. This study aimed to evaluate the efficacy of combining hysteroscopic polypectomy with endometrial resection in reducing the rate of recurrence in women over 40 years old.

In a single-blinded clinical trial, 94 women with endometrial polyps who were unwilling to future pregnancy were identified and randomly allocated to the intervention (hysteroscopic‎ polypectomy + endometrial resection) ‎and control group (hysteroscopic‎ polypectomy alone) group (n=47/each). Randomization was done using a simple randomization technique‎. The primary outcome measure was the polyp recurrence. The secondary outcome measure was the number of adverse events.

In total, polyp recurrence occurred in two (4.3%) patients of the intervention group and nine patients (19.1%) of the control group (P=0.019). All the recurrences occurred in the premenopausal patients (P=0.012). No adverse event was observed in any patients of both groups.

Adding endometrial resection to hysteroscopic polypectomy, especially in postmenopausal women, is a safe method that significantly reduces the risk of recurrence of the endometrial polyp.

Uterine septum is one of the most common congenital abnormalities in women that leads to numerous gynecological problems and adverse obstetrics outcomes. This study aimed to evaluate the effects of Hysteroscopic Resection on pregnancy outcomes in women undergone the surgery.

In this quasi-experimental study, 90 women were included from April 2016 to June 2018 from patients attending to Rasoul Akram hospital of Tehran. The inclusion criteria included: the age lower than 35 years old, primary infertility, idiopathic recurrent spontaneous abortion, BMI between 19 and 30, and having informed consen. Septum was resected by scissor upward and lateral. After 10 months of follow-up in average, we assessed rate of live births, abortions, birth weight and presentation.

82 individuals were assessed for occurrence of conception (response rate=91%). The mean age of patients was 30.01 ± 6.76 years and the mean BMI was 26.25 ± 4.88. Out of 82 patients, 36 patients were pregnant, of whom 16 (44.4%) had abortions. 5 (14.9%) of the pregnancies ended with preterm birth, and 6 (17%) ended with stillbirth.

The present study showed that the infertile patients with uterine septum and with no other causes of infertility were more likely to be pregnant compared to other patients with idiopathic infertility. Our study showed that post-operation fertility following Hysteroscopic Resection was lower than that in previous reports. According to the findings of this study, scissors may be safe, effective and cost-effective method for removing uterine septa.

Endometriosis is routinely treated with laparoscopy, which despite significant advantages over laparotomy cannot diminish postoperative pain. Insufficient postoperative pain control decreases patient satisfaction. This study was designed to evaluate the efficacy of intraperitoneal dexmedetomidine (DEX) combined with bupivacaine on postoperative pain in endometriosis laparoscopic surgery. Fifty-three patients with endometriosis, scheduled for laparoscopy in Rasoul-e-Akram Hospital, Tehran, from January 2016 to May 2017 who were randomly divided into three groups, including group 1 (G1, n = 21) received 50 mL intraperitoneal saline, group 2 (G2, n = 16) received 50 mL intraperitoneal instillation of bupivacaine 0.25%, and group 3 (G3, n = 16) received 50 mL bupivacaine 0.25% plus dexmedetomidine 1 µg/kg. Each patient with a history of allergy to local anesthetics or dexmedetomidine, cardiac disease, renal or hepatic failure, severe pulmonary disease; in addition, pregnant and comorbid obese patients were excluded from the study. Patients’ postoperative pain was assessed in the recovery room after 2, 6, 12, 24, and 48 hours using visual analogue scale (VAS). Total analgesic consumption was also recorded. The postoperative VAS scores were significantly lower in group 3 than other groups in the recovery room, and 2, 6, 12, 24 and 48 hours after the surgery (P < 0.001). However, there was no significant difference between 1 and 2 groups. Furthermore, total VAS in the first 24 hours in group 3 was significantly lower than the two other groups (P < 0.001). We conclude 1 μg/kg intraperitoneal DEX administration combined with bupivacaine may prolong postoperative analgesia and decrease rescue analgesia requirement compared with bupivacaine alone.

Postoperative hemorrhage is one of the most frequently cited complications of total abdominal hysterectomy (TAH). This study aimed to investigate the effect of a single preoperative dose of sublingual misoprostol on reducing blood loss during total abdominal hysterectomies.

This study was a single-blind randomized controlled trial (RCT). The statistical population included all women who were candidates of hysterectomy in 2017 and 2018. A total of 132 patients were randomly selected and classified into two groups of misoprostol (N=66) and placebo (N=66). Examining intraoperative blood loss was considered a primary outcome. Moreover, levels of hemoglobin before and 24 hours after the surgery, the need for a blood transfusion, febrile morbidity, and the duration of hospitalization were regarded as secondary outcomes. The means of bleeding in the two groups were compared using a t-test.

There were no significant differences between the two groups in the baseline characteristics (P<0.05). After the surgery, the mean of hemoglobin values was lower in the placebo group compared to the misoprostol one, and this difference was statistically significant (P<0.001). There was a significant difference in intraoperative blood loss between the two groups, and it was significantly higher in the placebo group (P<0.001).

Taking a single preoperative dose of sublingual misoprostol is effective in reducing intraoperative blood loss after total abdominal hysterectomies. Additionally, this intervention led to a decline in hemoglobin.

We praise the article by Mokhtari-Zaer et al. (2015) published in the Avicenna Journal of Phytomedicine on the effects of saffron on smooth muscle activity (Mokhtari-Zaer et al., 2015). It was a well-designed and interesting study on the therapeutic properties of Crocus sativus which is a precious plant cultivated in our country. We do believe that along with all other medicinal effects, saffron or its active constituents, primarily crocin and crocetin, could also have some clinical implications in the gynecology field. Historically and particularly in traditional Persian medicine, saffron has been regarded as an abortifacient agent (Hosseinzadeh and Nassiri-Asl, 2013; Schmidt et al., 2007). Farmer women exposed to saffron had increased rates of miscarriage (Ajam et al., 2014). This could be due to the fact that saffron stimulates uterine contractions. However, in Table 1 of the article by Mokhtari-Zaer et al. (2015), a relaxant effect of saffron on uterine contraction was mentioned (Mokhtari-Zaer et al., 2015). Concerning various components of saffron including crocin, picrocrocin, crocetin, and safranal, each could have different actions on muscular tissue. As an antispasmodic, saffron is used for stomach pain by helping digestion and improving appetite. It also reduces tension and alleviates symptoms of premenstrual syndrome and renal colic (Agha-Hosseini et al., 2008; Moshiri et al., 2006; Kashani et al., 2018). In one study, the impact of saffron on cervical ripening in term pregnant women was evaluated for the first time in the form of a clinical trial (Sadi et al., 2016). They concluded that saffron could induce cervical priming which is a perquisite for vaginal delivery by improving the bishop score. Cervical ripening caused by prostaglandins such as misoprostol or prostaglandin E1 is associated with simultaneous increase in uterine muscle contractility which is apparently in contrast with the effects of saffron as a relaxing agent (Vahdat et al., 2015). In a study by Sadraei et al, the effects of Crocus sativus extracts on uterus contractions were assessed in vitro. Following removal of the uteri of rats, spontaneous rhythmic contractions were induced using potassium chloride (KCL). According to their results, Crocus sativus increased these contractions and showed spasmodic action on muscle fibers (Sadraei et al., 2003). Likewise, in other studies, saffron had stimulatory effects on uterus as a result of myogenic and neurogenic actions resulting in prolonged bleeding, premature birth and abortion (Tafazoli et al., 2004; Modaghegh et al., 2008). This stimulatory effect of saffron on uterine musculature, however, is sometimes desirable in obstetrics to enhance the process of labor and also in gynecology for facilitating the surgical procedures on the uterus (Sadi et al., 2016; Vahdat et al., 2015). Thus, the exact mechanism of action of saffron derivatives on uterus and cervix has not been fully elucidated yet. In all the studies mentioned, the effects of the plant extract were assessed without purifying or differentiating its different elements which could have different or even opposing actions. With the availability of saffron tablets in Iran which mainly consists of crocin, with the brand name of Krocina, we believe that it would be much easier to assess the impact of this particular component of saffron on uterine or cervical tissue to clarify the exact mechanisms underlying abortion or induction of labor.
In the end, we congratulate Mokhtari-Zaer et al on their article and we appreciate the Avicenna Journal of Phytomedicine editorial board for their judicious concern on this topic. We hope to read well-controlled randomized clinical trials regarding the beneficiary effects of saffron in future

Aims:

 Since there is no consensus on the best diagnostic method for perimenopausal women with abnormal uterine bleeding. The aim of this study was to investigate the association between endometrial thickness in transvaginal ultrasound and the results of Pipelle endometrial sampling in perimenopausal women with abnormal uterine bleeding.

Materials and Methods:

 In this cross-sectional descriptive study, all perimenopausal women with abnormal uterine bleeding who referred to Rasoul Akram and Akbarabadi Hospitals, Tehran, Iran in 2016 and 2017 were considered. The current study was carried out on a corpus of 68 perimenopausal women with abnormal uterine bleeding. All these patients underwent a transvaginal ultrasound conducted by an operator. Afterward, all of them had a Pipelle endometrial sampling performed by a gynecologist. The current study was carried out on a corpus of 68 perimenopausal women with abnormal uterine bleeding. A chi-square, Mann Whitney, and Kruskal Wallis tests were used. The obtained data were analyzed using SPSS 22.

Findings:

 A statistical mean endometrial thickness in patients with benign diagnoses was 7.55±2.72mm and it was 15.57±2.99mm in patients with malignant diagnoses which indicated no statistically significant difference (p<0.001). Evaluating a receiver operating characteristic curve (ROC) demonstrated that the cut-off point of endometrial thickness was 10.50 with a sensitivity of 85% and a specificity of 85%.

Conclusion:

 Determining the cut-off point of 10.50mm for endometrial thickness using transvaginal ultrasound in perimenopausal women is a suitable, non-invasive method, the results of which can predict the results of Pipelle endometrial sampling well.

Context: The current study aimed at providing an evidence - based and up-to-date review of the literature regarding the assessment and outcomes of pregnancy in patients with renal transplant.
Design: It was a review of the current literature.
According to the current study findings, the function or survival of renal allograft was not adversely affected by getting pregnant. Therefore, ideal care for these patients needs a multidisciplinary approach including maternal-fetal medicine, nephrology, and neonatology specialists.

Ovarian fibromas are the most common benign solid ovarian tumors, which are often difficult to diagnose preoperatively. Ovarian fibromas, especially in bilateral cases, may be cases of Gorlin-Goltz syndrome (GGS), a rare autosomal dominant disorder with predisposition to basal cell carcinomas (BCCs) and other various benign and malignant tumors. This case report describes a 25 year-old female with GGS, bilateral ovarian fibroma, endometriosis and septated uterus, which was referred to the Gynecology Clinic of Rasoul-e-Akram Hospital in October 2016. This patient had facial asymmetry due to recurrent odontogenic keratocysts. In young cases of ovarian fibromas as reported here, conservative surgical management can preserve ovarian function and fertility. These patients must be followed up by a multidisciplinary team and submitted to periodic tests.

Gossypiboma is defined as retained foreign object (sponge, needle, and instrument) in patient’s corpus after operation that is recognized as a medical error. It may induce catastrophic implications for the patient and medical care providers. We present a case with a 17-year-old gossypiboma after cesarean section.
A 49-year-old woman was admitted to the outpatient clinic of Rasool-e-Akram hospital of Tehran, Iran, in 2016 presenting with abnormal uterine bleeding (AUB), abdominal pain, and urinary symptoms for many years. She underwent hysteroscopy. Operative findings included intrauterine synechiae and a polypoid lesion. Besides, a thread-like foreign body was observed in the anterior surface of the uterine cavity, which was suspected as a cesarean section suture material that was extracted. After hysteroscopy, uterine bleeding stopped although abdominal pain and urinary symptoms maintained. Voiding cystourethrogram (VCUG) and MRI revealed a mass between uterus and bladder. Then, laparotomy was performed. After opening the abdominal wall under general anesthesia, we explored internal organs and encountered a necrotic mass revealing an old organized gauze between bladder and uterus, which infiltrated the uterus and trigon. It was extracted and then, hysterectomy and bladder repair were carried out.
Surgical sponges are the most common foreign materials retained in abdominal cavity.

Some previous studies have shown that in the surgical site infection, sterility of the surgeon’s hands is not so effective, while the other studies have shown the other way. Also some studies believe that most infections come either from pathogens of the patient’s skin or from the pathogens of the environment. This study is designed to compare the pathogens of the surgeon’s hands and surgical site for each patient with the same patient’s pathogens of the wound infection, and recognize the possible infection factor. However, there are some altering factors that make the final conclusion, difficult. Some of these factors are unknown. It is tried to match the conditions for all patients, to reduce the chance of biased results. However, some of them could not be prevented.
Methods and Materials: The current study is designed in the form of prospective cohort. In this study, 122 patients which have undergone cesarean operation in the two hospitals of Rasool Akram and Shahid Akbarabadi in the city of Tehran, are considered for the study. The method of sampling was that after washing the surgeon’s and surgeon assistant’s hands with sterile soap, a culture is taken from the grooves of their hand palms on the sheep blood agar, and after preparation of the operation site and before cutting, a culture is taken from the operation site. After 5 to 7 days, the patients are called by phone to the hospital, and their operation site is investigated. If any sign of infection including stiffness, erythma, and discharge is seen, once more a culture is taken from the operation site, and the type of pathogen of operation site and the surgeon’s and surgeon assistant’s hands and that of the wound site are compared and their relation are investigated. To reduce the chance of biased results, the type of operations are matched and all the known infectious factors, such as immune deficiency, diabetes, history of using immunosuppressor drugs, Corton, and rupture of membrane, are excluded from the study.
In this study, 122 patients have participated, which have undergone cesarean operation in Rasool Akram and Shahid Akbarabadi hospitals in Tehran. From these patients, 57% were from Akbarabadi hospital, 39% were above age of 30, 58% had urgent operation, 57% had repeated cesarean operation, 69% were obese, 9% were illiterate, 14% had hypertension or pre-eclampsy, 12% faced with tearing of operation gloves during operation, for %62 of them povidine iodine is used for washing the surgeon’s hands. The results were that in the 4.9% of cases, the surgeon’s hands culture results were positive, in 16.4% of the cases, the surgical site culture results were positive, and finally, in 6.6% of the cases, the wound infection culture results were positive. For investigation of the relation between the wound infection culture result and the other recorded parameters of the operation, the mean and standard deviation of the different parameters in the presence or absence of the wound infection are measured and compared with each other. Then, the significance of the relation is investigated with the calculation of the P Value, and with the calculation of the Odds Ratio for different parameters, their effects as a risk factor for wound infection positive culture is examined.
This study shows that the wound infection culture result has significant and direct relation with the surgeon’s hand culture result, but it rejects the significant relation between wound infection culture result and the surgical site culture result, that requires more samples and investigations for confirmation, and requires that all the samples are taken from a single hospital to reduce the chance of altering factors. This study also shows that for the wound infection culture result, these are some risk factors: age above 30, being an urgent operation, being a repeated operation, obesity, illiteracy, past medical history, hypertension or pre-eclampsy, type of washing solution (povidine iodine), and surgeon’s hands positive culture result. This study shows, as well, that for the surgeon’s hands positive culture result, being an urgent operation, and type of washing solution (povidine iodine) are some risk factors.

Müllerian anomalies are associated with infertility. Hysteroscopy as the gold standard for evaluating Müllerian anomalies is an invasive, expensive and risky procedure which requires enough experience. Transvaginal sonography (TVS) and hysterosalpingography (HSG) are less invasive procedures, but there is little known about the accuracy of these tests. The aim of this study was to evaluate the accuracy of the combination of TVS and HSG with hysteroscopy as the gold standard.
Medical records of infertile women who were undertaken all three diagnostic modalities were reviewed to analyze their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).
Ninety-nine infertile women were assessed with a mean±SD age of 29.1±6.47 years, mean±SD duration of themarriage of 8.9±10.28 years, and mean±SD duration of infertility of 5.6± 4.16 years. The sensitivity, specificity, PPV, and NPV of TVS were 98.55%, 30%, 76.4%, and 90%, respectively. HSG had a sensitivity of 95.6%, specificity of 60%, PPV of 84.62%, and NPV of 85.71%.When both modalities were combined, the sensitivity, specificity, PPV, and NPV were 94.2, 66.67, 86.67, and 83.33%, respectively. The diagnostic accuracy of single TVS, HSG or combined techniques was statistically similar that was equal to 77.7, 84.8 and 85.8 % respectively.
The accuracy of combination of two diagnostic modalities, 2D TVS and HSG is not higher than HSG alone for assessing uterine malformation in infertile women.

Some important complications such as cervical tears, creation of false tract and uterine perforation may happen during cervical entry of operative hysteroscope. These complications can be reduced by priming agents.. The current study aimed to determine the effect of vaginal evening primrose oil (EPO) on cervical ripening and dilatation before operative hysteroscopy.. Patients and Thirty-six non-menopausal patients without a history of normal vaginal delivery and fourteen menopausal patients who underwent operative hysteroscopy were selected for the study. By simple randomization method, twenty-eight females received two soft gels of EPO (each 500 mg) and twenty-two females received placebo; in both cases the soft gels were applied to the posterior vaginal fornix 6 - 8 hours before operative hysteroscopy.. The primary outcome measures were the total dilatation time starting with Hegar size «3 to end point of 10 mm» as well as the size of the first dilator used to apply force. The secondary outcomes were uterine cervico-vaginal complications and also adverse effects related to the use of vaginal EPO. The total cervical dilatation time was shorter among the subjects who received EPO than the ones who received placebo [Median: 33. 5 second (26. 25 - 41. 5) vs. 75 second (30 - 127. 5) P = 0. 003]. Also the first Hegar size that could be used to apply force for cervical dilatation was greater in size in the EPO group compared to those of the placebo group [Median: 8 mm (8 - 9) vs. 7 mm (5. 75 - 8. 25) P = 0. 002]. There were no uterine cervico-vaginal complications or adverse effects in the groups.. EPO is effective to ripen the cervix before hysteroscopy. It is easy to use, available, inexpensive, and has no serious adverse effects..

Müllerian anomalies are associated with infertility. Hysteroscopy as the gold standard of evaluating Müllerian anomalies is an invasive, expensive and risky procedure which requires enough experience. Transvaginal sonography (TVS) and hysterosalpingography (HSG) are less invasive procedures, but there is little known about accuracy of these tests. The aim of this study was to compare the accuracy of combination of TVS and HSG with hysteroscopy. Medical records of an infertile women who were undertaken all three diagnostic modalities were reviewed concerning their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Ninety nine infertile women with the mean age of 29.1± 6.47 years, mean duration of marriage of 8.93± 10.28 years, and mean duration of infertility of 5.59± 4.16 years were assessed. The sensitivity, specificity, PPV, and NPV of TVS were 30, 98.5, 90, and 23.6%, respectively. HSG had a sensitivity of 60%, specificity of 95.6%, PPV of 85.8%, and NPV of 15.4%. When both modalities were combined, the sensitivity, specificity, PPV, and NPV were 67, 94.2, 83.3, and 13.3%, respectively. Two dimensional TVS, HSG, and combination of both diagnostic modalities are not accurate enough for assessing uterine malformation in infertile women.

The purpose of the present study was to compare the serum levels of IL6 and CA125 in women with and without endometriosis. They were also compared in mild, moderate and severe cases. In this case-control study, CA125 and IL6 levels in 76 women with laparoscopic proven endometriosis were compared with 76 women without evidence of endometriosis. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were then calculated for each test. Both groups did not show significant difference in their age, BMI, ESR and gravidity. Mean serum levels of IL-6 and CA125 were significantly higher in the case group (30.4±6.43 vs 13.9±3.17 Pg/ml and 62.6±10.69 vs 16.6±1.79 IU/ml respectively). Considering a cutoff point of 30 Pg/ml for IL-6, sensitivity, specifically, PPV and NPV value of 21.1%, 66.6%, 86.8% and 23.37% were obtained, respectively. Considering a cutoff point of 35 IU/ml for CA125, sensitivity, specifically, PPV and NPV were 44.76%, 94.73%, 89.47% and 63.15%, respectively. Area under the ROC curve was 0.69 for CA125 and 0.54 for IL6, which showed a low value for these tests. Although CA125 and IL-6 were higher than normal controls in endometriosis, area under the ROC curve, did not show significant any diagnostic value for these tests.

Restless legs syndrome (RLS) is the most common movement disorder in pregnancy, which can be idiopathic or secondary. There are limited comparative data regarding these two forms of RLS. The aim of this study was to compare clinical features of idiopathic and secondary RLS in pregnant women. Over a period of 3 months, 443 women who admitted for delivery in two clinical centers were screened for RLS using four diagnostic criteria of the international RLS study group. A total of 79 subjects diagnosed with RLS were consecutively enrolled in the present study. All of them were interviewed for medical history and complaints during pregnancy and responded to self-administer international RLS rating scale. Ten subjects (12.9%) out of 79 pregnant women with RLS had idiopathic form, and their mean age was significantly higher than patients with secondary RLS (30.6 ± 7.3 years vs. 26.4 ± 4.6 years, P = 0.0260). Compared with women with secondary RLS, sleep duration in pregnancy was significantly decreased in idiopathic RLS group (P = 0.0460), whereas RLS severity score was similar in both groups. No significant difference was observed between the two groups in terms of other sleep complaints, the positive family history of RLS, parity, duration of pregnancy, or frequency of cesarean section (P > 0.0500). Idiopathic and secondary RLS have relatively similar courses and features during pregnancy. However, the idiopathic form may have more negative impact on sleep in pregnancy. Careful screening and effective treatment of idiopathic RLS before pregnancy is recommended to limit these disturbances.

With the advent of hystroscopic surgery, abnormalities confined to the uterine cavity such as endometrial polyps, submucous myomas, uterine septae and synechia, were supposed to be treated effectively. Diagnostic hysteroscopy is the gold standard for investigating the intrauterine diseases as it allows for biopsy and removal of lesions.. Forty premenopausal women without the history of normal vaginal delivery eligible for operative hysteroscopy were recruited. Patients were randomly assigned to receive 400 microgram vaginal misoprostol or no treatment, 10-12 hours before operative hysteroscopy. Main outcome measures were cervical width and duration of cervical dilatation.. Patients using vaginal misoprostol in treatment group had significantly greater cervical width compared with control group patients (mean: 7.85 vs. 5.80, P = 0.024).. The mean duration of cervical dilatation in misoprostol group was significantly lower than that of control group (30.50 s vs. 52.75 s, P = 0.030). The frequency of complications was similar in treatment and control groups..

With the advent of hystroscopic surgery, abnormalities confined to the uterine cavity such as endometrial polyps, submucous myomas, uterine septae and synechia, were supposed to be treated effectively. Diagnostic hysteroscopy is the gold standard for investigating the intrauterine diseases as it allows for biopsy and removal of lesions.. Forty premenopausal women without the history of normal vaginal delivery eligible for operative hysteroscopy were recruited. Patients were randomly assigned to receive 400 microgram vaginal misoprostol or no treatment, 10-12 hours before operative hysteroscopy. Main outcome measures were cervical width and duration of cervical dilatation.. Patients using vaginal misoprostol in treatment group had significantly greater cervical width compared with control group patients (mean: 7.85 vs. 5.80, P = 0.024).. The mean duration of cervical dilatation in misoprostol group was significantly lower than that of control group (30.50 s vs. 52.75 s, P = 0.030). The frequency of complications was similar in treatment and control groups..

Hysteroscopy is the gold standard method for diagnosis of intrauterine pathologies. Current study is a review of hysteroscopic findings performed over a period of 5 years in patients with abnormal uterine bleeding (AUB).. The aim of this study was a review of hysteroscopic findings performed over a period of 5 years in patients with abnormal uterine bleeding (AUB)..Patients and Materials: This descriptive analytic study was conducted prospectively on patients in reproductive, premenopausal or postmenopausal ages referring to our hospital with complaint of AUB. All patients underwent hysteroscopy (either diagnostic or therapeutic) by the same surgeons. Analysis was performed on the base of the hysteroscopic findings.. In our population study (379 patients) major menstrual pattern was menometrorrhagia. The most common diagnoses at operative hysteroscopy were endometrial polyps (17.8%), hyperplastic endometrium (15.2%), and uterine submucosal myoma (9.7%).The most common findings in patients with menometrorrhagia were myoma, and polyp where, the most common finding in patients with menorrhagia, and metrorrhagia was polyp. Our major complications were uterine perforation in 9, thermal injury in 3, and air emboli in one case.. In current study the most common pathology was found to be endometrial polyp. Myoma was the most common finding in patients with menometrorrhagic bleeding. Our major complications were uterine perforation, thermal injury, and air emboli..

From mid 1980s, hysteroscopy has replaced blind dilatation & curettage as a standard procedure for definite diagnosis as well as treatment of intrauterine pathologies such as abnormal uterine bleeding, and infertility. We aimed to evaluate the indications and complications of using hysteroscopy in the management of patients referred to a teaching hospital in Tehran during a 10-year period. Methods and Material:This is an observational analytic retrospective study that was done on the archived files of the patients referred to gynecologic department of Rasool Akram Hospital affiliated to Iran University of Medical Sciences during 1996-2006. A check list containing questions regarding the demographic variables, patient's complaints, findings of physical examinations and sonographic evaluations, previous treatments, and any complications was completed. The data were analyzed using SPSS software version 11.5and Chi-Square and ANOVA tests.Totally 910 files were reviewed. Of them, 26 were excluded because of incomplete records. The mean age of the remaining 884 patients was 34.8 years. Of the 656 multiparous women, 290 (44.2%) had at least one abortion. Also 427 women had abnormal uterine bleeding. After hysteroscopy only seven women (0.8%) had early complications and four women (0.5%) had late complications. In patients for whom myomectomy and septum resection were done, three and two cases of early complications were observed respectively. No complication was seen in patients with uterine ablation.Hysteroscopy is an effective method for management of intrauterine pathologies and is accompanied by low complications.

Laurence-Moon-Biedl syndrome is one of the rare disorders. Herein we report a case of Laurence-Moon-Biedl syndrome with urogenital sinus anomaly.Case Report: The patient was a 17 years old girl with colicky and periodic abdominal pain since 4 months ago who was referred to the gynecology ward of Rasoul Akram hospital affiliated to Iran University of Medical Sciences. In the physical examination we found an abdomino-pelvic mass at the umbilical region. In examination of the genitalia, the vestibule was not seen and no orifice was found between the urethra and the anus.During the laparotomy we found the mass was a huge vagina full of old blood and pyometra, which were drained. The uterus was enlarged but the fallopian tubes and the ovaries were normal. An incision was performed in the perineum, between the urethra and the anus. Then a petzer drain was inserted from the inside of the uterus to the incision.After operation, the patient was treated with conjugated estrogen 0.625 mg/day for 25 days and medroxy progesterone acetate 10 mg/day for 10 days. After discontinuing the both drugs she menstruated. After the first menstruation the petzer drain was dislodged.