Objectives: Endometrial biopsy is necessary for diagnosing the reason of abnormal uterine bleeding in perimenopausal women. Currently outpatient endometrial biopsy is used for evaluation of abnormal uterine bleeding which is associated with moderate to severe pain. Using lidocaine is one of the procedures which is used for pain relief while biopsy. This study is aimed at comparing the effect of different local anesthesia procedures on pain relief during endometrial biopsy. Materials and Methods: In this randomized clinical trial, 160 multiparous 40-55 years old women with AUB (Abnormal Uterine Bleeding), candidates for endometrial biopsy, were randomly assigned into four equal groups, to receive: 1-intrauterine lidocaine; 2-cervical spray lidocaine; 3-intrauterine lidocaine plus cervical spray lidocaine; or 4-intrauterine distilled water. Pain relief was measured at 3 different times: during endometrial biopsy, just after and 15 minutes after biopsy. Results: Pain intensity was reduced significantly at different times in intrauterine lidocaine and intrauterine lidocaine with cervical spray lidocaine receivers in compare with the groups which received cervical spray lidocaine and distilled water. The mean of difference pain relief during biopsy and 15 minutes after that was reduced significantly in the group which received intrauterine lidocaine and intrauterine lidocaine with cervical spray lidocaine in comparison with the other two groups. Conclusion: Intrauterine lidocaine was effective during endometrial biopsy, and using it with cervical spray lidocaine had no more beneficial effect.
Objectives: This is a cohort study that investigated the incidence, severity and risk factors of Urinary Incontinence during pregnancy and postpartum in nulliparous women. Materials and Methods: In this cohort study, 441 nulliparous women were studied. The women were followed up from the beginning of pregnancy until the postpartum period. The prevalence of urinary incontinence was determined among them. Risk factors that could play a significant role were analyzed using questionnaires. Results: In this study, 441 nulliparous women with an average age of 28.1 ± 3.7 years were studied. The prevalence of urinary incontinence in the third trimester of pregnancy was 39.4% and it was 31% in the postpartum period. Vaginal delivery, maternal weight, and fetal weight (> 4 kg) were the most important risk factors for increasing the incidence rate of urinary incontinence. In this study, age had no role in incontinence. The severity of incontinence in 26.6% of the participants over 5 was based on visual analogue scale (VAS) scoring. Conclusion: Urinary incontinence is one of the common disorders during pregnancy and postpartum period that can affect quality of women life significantly. Type of delivery and maternal and fetal weights are the most important risk factors for increasing this disorder. Unlike previous studies, age did not play any role in incontinency in this study.
IntroductionPelvic prolapse is the downward and forward movement of a pelvic member towards its natural place and pelvic prolapse is displacement of the bladder, cervix, urethra, or rectum due to defects in pelvic support system. This condition is one of the most common abnormalities among older women. Urogenital prolapse is a common finding in 30% of women attending gynecologic of outpatient clinic (1-2) and affects up to 50% of women over 50 years (1,3). Up to 50% of women who had vaginal delivery suffer from degrees of prolapse, which is symptomatic only at the 20% of patients (4,5). In a study conducted in 1990 in America, it was reported that vaginal prolapse is the most common indication for hysterectomy in women over 50 (6). Urethral descent usually is seen with posterior and anterior wall of vagina/enterocele. Common symptoms include urinary frequency, urgency, incontinence, urinary increasing time of urination, feeling of incomplete emptying of the bladder and weak urinary flow. Posterior vaginal wall prolapse symptoms include disposal problems associated with prolonged excretion of urine, feeling of incomplete emptying of the bladder, constipation and fecal discharge with finger (1). Feeling of something coming down and sexual and urinary symptoms generally described as symptoms of prolapse especially in young women due to inadequacy of urethra (7). Most women with advanced anterior vaginal prolapse do not suffer from incontinency (1,8). Women who have severe pelvic prolapse may also have severe stress urinary incontinence (SUI). Reduction of prolapse during urodynamic assessments reveals non symptomatic cases of SUI in the 36 to 80% of women with advanced urogenital prolapse (1,9,10). Some recommend an anti-incontinency preventive procedure with prolapse restoration for prevention of post-operative urinary incontinence, but some do not recommend such a procedure (11)(12)(13)(14). For the First time in 1995 Ulmsten and Petros introduced a procedure to support the midsection of urethra without creating tension (15) providing a two-year cure rate of 84%. Since then this method which is named as tension free vaginal tape is used widely. Detayrace and colleagues reported 1 AbstractObjectives: To compare the Performing and not-performing of prophylactic surgery for urinary incontinence in women with pelvic organ prolapse. Materials and Methods: In a randomized controlled clinical trial that performed in department of Gynecology and Obstetrics of Tabriz University of Medical Sciences on women with advanced pelvic organ prolapse without history of urinary incontinence. The effects of performing and not-performing of prophylactic surgery for urinary incontinence in women with advance pelvic organ prolapse evaluated. Results: Mean age of patients was 53.83±5.52 years in the range of 41-66 years. Mean ICIQ-SF questionnaire scores at the first three questions in patients with pelvic organ prolapse with prophylactic surgery was 0.50±1.54 and in patients with pelvic organ prolapse without prophylactic surgery was 0...
Objectives: This is a preliminary study investigating the efficacy of aromatase inhibitor letrozol on endometrial histology in patients with disordered proliferative endometrium or simple hyperplasia. Materials and Methods: In a randomized clinical trial, 92 patients with abnormal uterine bleeding who had disordered proliferative endometrium or simple hyperplasia in endometrial biopsy, were randomized into case and control groups. patients received 2.5 mg of letrozole daily in case group (n=46) and 40 mg of megestrol acetate daily in control group (n=46) for 3 months. Endometrial biopsy was performed 3 to 4 weeks after completion of therapy to assess response. Results: After intervention in letrozole group, response to treatment was seen in 93% cases (including endometrial atrophy in 58.7% cases and weakly proliferative endometrium in 34.78% cases) and in megestrol group response to treatment was seen in 85% cases (including endometrial atrophy in 41.3% cases and weakly proliferative endometrium in 43.47% cases). The difference between two groups was not statistically significant (P=0.31). Conclusion: The results of this study show that pre and post menopausal women with disordered proliferative endometrium or simple hyperplasia can be successfully treated with letrozole alone. However, due to the lack of significant difference between the two groups, further studies with larger sample size is recommended for better clearance of the topic.
Echinococcosis is a parasitic disease that is produced by Echinococcus granulosus and still represents an important medical problem in many countries. Echinococcosis in extrahepatic sites is usually asymptomatic unless the cyst causes symptoms due to pressure, as in our case, or ruptures to the peritoneal cavity. Echinococcal cysts at unusual locations many times pose diagnostic dilemmas, and the diagnosis sometimes is made intraoperatively. Primary ovarian and paraovarian cyst hydatid disease is a very rare entity. In our case, a 25-year-old female gravida 1, para 1, was admitted to the emergency department of the Alzahra Hospital of Tabriz due to diffuse abdominal pain, nausea, abdominal distension and urinary frequency of ten-day duration and exacerbation of pain from a few hours before admission. Clinical examination revealed tachycardia of 105 per minute, normal body temperature and normal blood pressure. Abdominopelvic sonography revealed a mass with regular thick contour located in the left ovary suggestive of huge cystadenoma or carcinoma of the ovary. Emergent laparotomy was performed for suspected adnexal torsion. Intra operative findings were a large paraovarian mass with thick wall without any torsion. Mass was removed completely and sent for frozen section study. Pathological examination showed the diagnosis of hydatid cyst. The postoperative period was uneventful and the patient was discharged 3 days later, with the advice to receive Albendazole. The patient referred to a general surgeon for management of the hepatic cysts.
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