Background: Endometriosis is routinely treated with laparoscopy, which despite significant advantages over laparotomy cannot diminish postoperative pain. Insufficient postoperative pain control decreases patient satisfaction. Objectives: This study was designed to evaluate the efficacy of intraperitoneal dexmedetomidine (DEX) combined with bupivacaine on postoperative pain in endometriosis laparoscopic surgery. Methods: 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. Results: 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). Conclusions: We conclude 1 µg/kg intraperitoneal DEX administration combined with bupivacaine may prolong postoperative analgesia and decrease rescue analgesia requirement compared with bupivacaine alone.
Background: The cavum septum pellucidum is an important marker for identifying and evaluating the fetal neural axis. Evaluation of the characteristics of the Cavum septum pellucidum is recognized as an important (fetal) factor for fetal ultrasound in the second and third trimesters of pregnancy. Objectives: This study aimed to evaluate the size range of cavum septum pellucidum in the second and third trimesters of pregnancy in women referred to Ali Ibn-e Abitaleb Hospital Clinic of Zahedan. Methods: This was a descriptive-analytical study performed at Ali Ebne Abitaleb Hospital of Zahedan in 2018. Ultrasound examinations were performed on all pregnant women in the second trimester (18 to 20 weeks) and third (36 to 38 weeks). Information such as maternal age, size of septum pellucidum, and gestational age were included in the checklist. Ultimately, the data were entered into SPSS software for statistical analysis. Results: In this study, a total of 500 fetuses were evaluated. The mean age of the mothers under study was 26.36 years old. The mean cavum septum pellucidum size in the second trimester was 3.71 ± 0.81 and 6.11 ± 1.09 mm in the third trimester. The mean size of cavum septum pellucidum in the second trimester of pregnancy was significantly lower than in the third trimester (P < 0.001). Conclusions: The mean size of cavum septum pellucidum in the present study was 4.91 mm, similar to the size of other studies.
Background: Abdominal pain is one of the most common complaints during pregnancy and is always debated due to its numerous differential diagnoses. Acute appendicitis is the most common complication requiring surgery during pregnancy. Objectives: The present study aimed to investigate symptoms, signs, and paraclinical findings in cases of pregnancy appendectomy within 2015 - 2019. Methods: This retrospective study examined the frequency of appendectomy in pregnant women referring to Ali ibn Abi Talib Hospital of Zahedan in Iran. This study assessed 58 pregnant women who referred to Ali Ebne-e Abitaleb hospital and underwent appendectomy from April 2015 to March 2019. Finally, the data were evaluated in terms of age, gravidity, gestational age, body temperature, clinical symptoms, complications of appendectomy, type of surgery, and white blood cells (neutrophil). For data analysis, the information was entered into SPSS software (version 22). Results: In the present study, the most common symptoms and signs of patients were tenderness and right lower quadrant (RLQ) pain (87.93%), nausea (75.9%), leukocytosis (72.4%), migration of pain (65.5%), vomiting (58.6%), and anorexia (53.4%). Additionally, the most common appendicitis trimester for appendicitis in pregnancy was the second thermistor (62.1%). Conclusions: Tenderness in the RLQ area was the most important feature of appendicitis; however, nausea and leukocytosis were also common. Ultrasound was not a powerful imaging method due to the identification of less than half of the patients; nevertheless, the Alvarado score for acute appendicitis was helpful in numerous cases.
Background: The evolution of fertility treatment methods such as laparoscopic surgery and assisted reproductive technology (ART) leads to an increased chance for conception in women with endometriosis. However, it is still not clear which treatment is more likely to result in endometriosis recurrence. Objectives: The current study aimed at assessing the recurrence rate of endometriosis and its main determinants following fertility treatment with surgery or ART. Methods: The current historical cohort study was conducted on 51 consecutive women with endometriosis undergoing fertilization procedures, including laparoscopic surgery (n = 42) and ART (n = 9) in Tehran from 2006 to 2016. All patients with complete hospital records were enrolled in the study. The patients in the two groups were followed up for five years for endometriosis recurrence. Results: Within the follow-up time, the rate of endometriosis recurrence in patients of the surgery and ART groups was 28.6% and 44.4%, respectively, indicating no significant difference between the groups (P = 0.436). In this regard, the 1-, 2-, and 3-year recurrence-free survival rate in the ART group was 87.5%, 50.0%, and 50.0%, and in the surgery group was 96.9%, 90.6%, and 70.5%, respectively. Using the Cox proportional hazard modeling adjusted for baseline variables, the method of fertilization (ART or surgery) could not affect the rate of long-term recurrence of endometriosis (odds ratio = 1.428, 95% confidence interval: 0.177 - 9.900, P = 0.784). Conclusions: The method of fertilization treatment-e g, surgery, and ART- may not affect the rate of endometriosis recurrence in women with subfertility caused by endometriosis.
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