Journal of Obstetrics, Gynecology and Cancer Research
Volume:4 Issue: 4, Fall 2019

Epithelial ovarian cancer is one of the most common gynecological malignancies worldwide with an incidence of 225000 cases annually. For most patients, multimodality treatment including cytoreductive surgery and combination chemotherapy is an accepted standard of care. Despite the relatively favorable response to initial treatment, relapse free survival and overall survival are disappointing in patients with advanced ovarian cancer. Therefore, new treatment approaches have been proposed in recent years. The present review aims to describe the most relevant data published during the last four years on new approach to advanced ovarian cancer. Therefore, relevant studies were searched through Pubmed, Cochrane library and Scopus database published online until 2019. The most important changes studied in recent years have included the addition of new chemotherapy or targeted agent to first-line chemotherapy. Although combination of intravenous paclitaxel and carboplatin is currently accepted as the standard of care for treatment of advanced ovarian cancer, discussion around the intraperitoneal chemotherapy is still an important challenge. Additionally, much efforts have been dedicated to design an appropriate maintenance treatment as a goal of diminish the risk of recurrence. This review summarizes the results of most recent phase 3 trials surrounding optimal first-line chemotherapy, addition of a targeted agent including bevacizumab and maintenance treatment.

Cyclic mastalgia is clinically related to alterations in sex hormone levels during the menstrual cycle. A derangement in normal menstrual cycle leads to exacerbated mastalgia; which can also cause menstrual irregularities and abnormal uterine bleeding (AUB). A decrease in severity of mastalgia is observed in patients with simultaneous cyclic mastalgia and menstrual irregularities/AUB, following correction of menstrual irregularity. This study was designed and conducted to investigate the possibility of whether correction of menstrual irregularities can diminish cyclic mastalgia.

This case-control study was carried out on women suffering from simultaneous mastalgia and menstrual irregularity. One-hundred and fifty patients were randomly distributed between case and control groups, each including 75 patients. Patients in both groups took 100 mg vitamin E oral tablet daily for 3 months. Patients in case group also received low-dose oral contraceptive pills (OCP-LD) to correct menstrual irregularity. Patients recorded the severity of mastalgia in Cardiff breast pain chart using Visual Analogue Scale (VAS).

At the beginning of study, there was no significant difference in the number of days suffering from mild and severe mastalgia between two groups. However, at the end of the study, mild and severe mastalgia reduced significantly in the case group compared to the control group (P=0.003 and P=0.045, respectively).

In women with cyclic mastalgia, correction of menstrual irregularity leads to significant pain relief. Correcting menstrual irregularity is suggested as a first-line treatment in women with mastalgia.

Mycoplasma hominis, which belongs to the Mycoplasmataceae family, is an opportunistic pathogen of the genitourinary system. Mycoplasma genitalium, causing urethritis-endometritis-cervicitis, plays a role in prostatitis This study aimed to investigate the prevalence of M. genitalium and M. hominis among women with vaginal infection in Zabol, Iran.

In this cross-sectional study, 69 endocervical samples were taken from women aged 18 to 60 years who suffered from vaginal infections. DNAs extracted from the samples were applied as a template for 16SrDNA coding gene amplification using specific primers in two separate PCR reactions.

The highest infection rate was in the age group of 25 to 35 years, with a prevalence of 75%. The highest rate of negative PCR results (54%) was in the age group of 25 to 35 years, followed by the age groups of 36 to 45 years (28%), 18 to 24 years (4%), and older than 45 years (3%). The lowest rate was in the age group younger than 18 years (2%). Considering their levels of education, the highest rate of infection was seen in the subjects with bachelor’s degrees. The rate of Mycoplasma genitalium infection was equal in the subjects who had and did not have a miscarriage (50%). Only 5.7% of the subjects with negative PCR samples had a miscarriage and the rest (94.3%) did not experience a miscarriage.

Overall, the present study showed that the rate of Mycoplasma vaginal infections was very low Also there is no significance deference for infection rate between pregnant women with or without miscarriage history. However, those with Mycoplasma-negative PCR samples had a low miscarriage rate.

Cesarean hysterectomy is a major surgical risk happening in the setting of life threatening hemorrhagic events during or immediately after the cesarean section. In this study we assessed patients undergoing cesarean hysterectomy to determine their general and clinical characteristics.

In this descriptive cross-sectional study, 34 consecutive patients undergoing cesarean hysterectomy in training hospitals in Tehran, Iran, from 2016 to 2017 were enrolled. The age, BMI, gravid, parity, Apgar score, risk factors, chief complaints, drug history, and previous medical and surgical history were assessed and finally the preventability rate was determined.

The chief complaint was vaginal leak (VL), abnormal uterine bleeding (AUB), labor pain, and preeclampsia in 38.2%, 29.4%, 14.7%, and 2.9% of patients respectively, and the other patients had more than one complaint. Type of surgery was total, and supra-cervical in 58.8%, 41.2% of patients respectively. Bladder injury occurred in 41.2% of patients. Two cases were preventable, one was non-preventable, and all others were mixed.

 It may be concluded that the general characteristics among our patients undergoing cesarean hysterectomy is similar to those reported by similar studies. However further studies with larger sample size and multi-center sampling among Iranian patients are needed to develop more definite results.

Anticoagulant therapy has been used for the prevention and treatment of deep vein thrombosis and pulmonary embolism. Heparin-induced necrotizing skin lesion is a serious complication that can be potentially life-threatening.

Case Report: 

We report a 55-year-old female presenting with skin necrosis without thrombocytopenia after prescribing heparin prophylaxis. She had died as it was not possible to discontinue her heparin therapy.

Heparin-induced skin necrosis should be suspected in all patients who undergo UFH or LMWH. Observation of platelet count is recommended at the onset of skin lesions. Early diagnosis of this condition can be helpful for the management of this potentially mortal disease.

Mature cystic teratomas are rare neoplasms and consist of at least two to three embryonic layers. While these tumors are most commonly seen in the testes and ovaries, they have been reported elsewhere.

Case Report: 

A 22-year-old female patient referred to Mehr Hospital in Mashhad with symptoms of pelvic pain, tympanites, altered bowel habits, nausea, and vomiting. According to the performed examinations and evaluations, a mass of 37 × 20 mm was found in the retroperitoneum between the vagina and rectum. The patient underwent laparoscopic surgery and the cyst was completely resected. The patient was discharged a day after the surgery and no surgical complications were reported in conducted follow-ups. The pathologic finding also reported a dermoid cyst.

Resection surgery is the mainstay in the treatment of mature retroperitoneal teratomas. Although tumor characteristics can be diagnosed preoperatively by imaging modalities, a definitive diagnosis can only be made by histologic evaluations.