Journal of Obstetrics, Gynecology and Cancer Research
Volume:3 Issue: 2, Spring 2018

Aims:

 The rate of induced abortion is growing worldwide. In this study, we aimed at comparing using misoprostol with or without Letrozole in abortion.

Materials and Methods:

 In this placebo-controlled trial, 46 women with a gestational age of fewer than 20 weeks, who were candidates of legal abortion, were selected by simple randomization sampling method and randomly assigned into two groups. Drug group received 10mg daily Letrozole (4 tablets of 2.5mg) for 3 days prior to taking Misoprostol and the placebo group received daily placebo (4 tablets with the exact appearance of Letrozole) with the same instructions. After 3 days, Misoprostol was given to all the participants based on their gestational ages. The data were analyzed by SPSS 16 software, using independent sample t-test and Chi-square test.

Findings :

21 women (45.7%) had a successful complete abortion, and curettage was needed for 25 women (54.3%). Successful abortion rate was significantly higher in the group receiving Letrozole (78.3%) than the group receiving placebo (13.0%; p=0.0001). Mean induction-abortion interval was 22.61±7.721 hours in the drug group and 24.09±8.251 hours in the placebo group, which was not significantly different (p>0.05). There was no significant difference between the two groups in terms of vaginal bleeding and adverse effects.

Conclusion:

 Using 10mg daily Letrozole for 3 days followed by oral Misoprostol results in a significantly higher rate of complete abortion compared with placebo in women with a gestational age of less than 20 weeks.

Aims :

Breast cancer is one of the most prevalent recurrent cancers among women. Several factors affecting multiple recurrences of this disease have been studied and recognized in various studies. One of the various types of models used to analyze recurrent events considering the lack of homogeneity among patients is a frailty model. The aim of the present study was to investigate joint frailty modeling for multiple recurrent events and its application in patients with breast cancer.

Materials and Methods:

 In this survival and retrospective analysis, 342 patients with breast cancer whose records were registered for follow-up in a Cancer Research Center at Shohadaye Tajrish Hospital, Tehran, Iran, from 2006 to 2015, were selected. The sampling method was purposive. These patients were monitored for at least 6 months after diagnosis and their latest statuses. For data analysis, the joint frailty survival model was used. Running the model and conducting the data analysis were performed by codes in Frailtypack using R 3.4.1 statistical software. 

Findings:

Three-year and five-year survival rates for the patients were 0.79 and 0.68, respectively. The risk of multiple recurrences (Local and metastases) increased for the patients with tumor grades greater than I. It was found that when neglecting the relationship between multiple recurrences in the patients with breast cancer, a significant correlation was missed.

Conclusion :

With regard to the significant variance of the frailty component of the metastases event, the patients with the same predictive variables are prone to different levels of metastases risk.

Aims :

Ovarian cancer is the 4th cause of women’s mortality occurring due to cancer. Malignant germ cell tumors (GCTs) account for 5% of malignant ovarian tumors and 70% of ovarian tumors in women between the ages of 10-30 years old. The aim of the present study was to detect the frequency of malignant ovarian germ cell tumor and distribution of demographic features in the most crowded gynecology oncology clinic.

Materials and Methods :

This cohort descriptive-analytical study was conducted on cases with malignant ovarian tumor managed in Vali-Asr hospital, Tehran, Iran, from 2001 to 2018 (n=1540). The malignant germ cell tumors cases were extracted (n=128) and evaluated in point of epidemiologic and demographic data via the software SPSS 24.

Findings :

128 patients (8.3%) had GCTs. The average age was 23.88±7.85 years. 79.7% lived in the city, 76.6% had medium economic status and 53.6% had normal body mass index. Premature puberty was revealed in one person. Karyotype XY was detected in 5 persons. About 70.3% of the patients had no parity. In parous women, the highest percentage was related to a childbirth (55.0%). A history of infertility was detected at 6.1%. In 10 patients, the tumor was detected during pregnancy.

Conclusion:

 The highest frequency is related to the early young women with no considerable association with socioeconomic and weight status. It is possible that parity would be a protective factor for this tumor. In the case of adnexal mass during pregnancy, Malignant Germ cell tumors should be rolled out.

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.

Aims :

Owing to the effects of anesthesia on pain after hysterectomy as well as different advantages and disadvantages of spinal anesthesia (SA) and general anesthesia (GA), giving priority to one of these techniques over the other still seems controversial. The aim of the present study was to compare SA with GA in terms of pain intensity, the frequency of nausea and vomiting and morphine requirements after abdominal hysterectomy. 

Instruments and Methods:

 This double-blind clinical trial was conducted on 40 abdominal hysterectomy candidates with American Society of Anesthesiologists I and II presenting to Kowsar Hospital, Semnan, Iran, in 2015. All the patients were briefed on the pain assessment scale the day before the surgery, randomly divided into two groups of GA and SA and underwent abdominal hysterectomy using the same technique. Postoperative pain was then recorded upon admission to post-anesthesia care unit and 6 and 12h later. Furthermore, frequency of nausea and vomiting as well as intravenous morphine requirements was recorded within the first 12h after the surgery. Data were analyzed using independent t-test and Chi-square by SPSS 16 software.

Findings :

Postoperative pain was found to be significantly lower upon entering PACU and 6 and 12h later in the SA group compared to that in the GA group, as was the case for the frequency of nausea and vomiting as well as the dose of intramuscular morphine (p<0.05).

 Conclusion:

Generally, postoperative pain in SA is lower than in GA, although different postoperative complications such as nausea and vomiting are observed.

Introduction:

 Timely diagnosis of gestational trophoblastic neoplasia (GTN) is essential for successful management of the condition and preservation of fertility. The aim of the present study was to describe a case of misdiagnosis GTN with brain and lungs metastasis.

Patient information :

the present case study was conducted in Imam Khomeini hospital, Tehran, Iran, in 2017. A 35-year-old woman presented with acute headaches and left hemiplegia one month after the conclusion of her term pregnancy. The patient was previously diagnosed as a case of subarachnoid hemorrhage and inferior sagittal sinus thrombosis and was unsuccessfully treated with anticoagulant drugs leading to worsening signs and symptoms. Her initial β-hCG at admission to the hospital was 22,000,000IU/L, which lead to diagnosis of GTN with extensive metastatic lesions in the lungs and brain. Due to extensive intracranial hemorrhage, the patient was first treated with whole brain radiation therapy for 10 sessions daily (Total Dose=3000cGy). EMA-EP treatment was initially withheld due to concern for bleeding during concurrent radiation therapy. Following the brain radiation therapy, the chemotherapy was started for the patient. Upon completion of 3 cycles of EMAEP, the patient’s hCG was lowered to 5IU/L. The treatment was continued for 5 more cycles and resulted in hCG reading of under 2IU/L at her last visit.

Conclusion :

This case highlights the variable presentation of GTN which might easily cause misdiagnosis and delayed treatment and shows excellent response to treatment despite late treatment and massive tumor burden with some modifications to plan of treatment

Introduction:

 Many different Doppler-derived techniques have been proposed for overall assessment of cardiovascular well-being. In this report, 3 cases of high output cardiac failure were presented with the aim of evaluating the effect of fetal weight on fetal combined cardiac output (CCO).

Patients Information:

 The first and second cases were referred to Yas Hospital for the management of fetal anemia at 31and 29 weeks of gestation, respectively, and the third case had a large solid and vascular sacrococcygeal teratoma at 17 weeks. The fetal weight in the first case was less than 10 percentile, in the second case was in normal limit, and in the third one was above 90 percentile. Left ventricle, right ventricle, CCO, and weight-indexed CCO were assessed for both fetuses and all were above normal limit, indicating high output cardiac failure. Right to left cardiac output ratio also increased obviously.

Conclusion:

 The fetal growth restriction overestimates the weight-indexed CCO and the weight above 90 percentile underestimates it. In these conditions, CCO seems more precise in demonstrating the true burden on fetal heart in comparison with weight-indexed CCO.

Aims:

 Cervical cancer is one of the most common cancer in the female since 1990. Neoadjuvant chemotherapy (NACT) uses before surgery, especially in countries with limited radiotherapy facilities. The aim of the present review was to study the effect of NACT before radical surgery in comparison with other treatments and various clinical outcomes.

Information and Methods:

 This study is a systematic review and includes previous publishes about cervical cancer and effect of NACT before radical surgery. Over 40 previous studies were reviewed, none of them was case report, at least 5 studies were randomized clinical trials and 6 of them were meta-analysis or systematic review.

Findings :

NACT before surgery demonstrates advantages to reduce the rate of lymph node metastasis and parametrial infiltration, so improves progression-free survival in patients with pelvic lymph node invasion (Approximately 35% of stage IB2–IIB bulky). NACT also decreases tumor volume and minimizes the need for adjuvant radiotherapy, thus NACT under consideration of quality of life and cost-effectiveness should be recommended. NACT is really effective in decreasing incidence of pathological risk factors.

Conclusion:

 NACT response associated with the stage of diagnosis, tumor size and pathology of the specimen (Squamous tumor has a better response than a non-squamous tumor). NACT seems to be feasible in the management of stage IB bulky cervical cancer, NACT followed by surgery represent an alternative to primary chemoradiotherapy in young and sexually active patients.