Inguinal endometriosis: a case series and review of the literature.

BACKGROUND: Inguinal endometriosis is one of the most common forms of endometriosis. The present study introduces 8 cases of inguinal endometriosis and discusses probable theories of inguinal endometriosis by reviewing the literature. CASE PRESENTATION: 8 Iranian cases of inguinal endometriosis with a mean age of 36 years were presented. Catamenial groin pain and swelling were the most common complications. Also, patients usually had accompanying symptoms such as pelvic pain and dysmenorrhea. One-half of patients had a history of previous abdominal surgery. Ultrasound was diagnostic in 4 patients (50%), and magnetic resonance imaging was used in two patients (25%). Among 6 patients who underwent hormonal therapy, 4 experienced an endometriosis size increase. Inguinal endometriosis was right-sided in 87.5% of patients, and among 4 patients who underwent surgery, 75% had proximal site involvement of the round ligament. CONCLUSION: According to the rarity of inguinal endometriosis, it is more likely to be a misdiagnosis with other inguinal disorders such as inguinal hernia. Inguinal endometriosis should be considered in patients who undergo inguinal herniorrhaphy, with suspected findings such as thickening of the hernia sac wall, bloody fluid inside the sac, or thickening of the extraperitoneal round ligament during the surgery.

The Use of Peritoneal Suction Drainage to Reduce Shoulder Pain Caused by Gynecological Laparoscopy.

PURPOSE: To compare the outcomes of patients undergoing uncomplicated laparoscopic gynecologic procedures with and without drainage, and investigate the effects of drainage on postoperative shoulder pain, hospital stay and analgesic medications. PATIENTS AND METHODS: In this randomized clinical trial, 92 patients undergoing uncomplicated laparoscopic gynecologic procedures at Pars Hospital, Tehran, Iran, between April 2012 and July 2014 entered the study. Patients were randomly divided into two groups: one group received a drain at the end of operation, whereas the second group didn't receive a drain. For patients closed with drainage, Hemovac plastic passive drains were inserted without negative pressure. Severity of the patients' postoperative shoulder pain was evaluated at rest using the 10-point visual analogue scale (VAS) at 12 h, 24 h, and 48 h after surgery. RESULTS: There was no difference between the two groups regarding age, weight, height, BMI, the cause of surgery and the blood loss during the surgery. At 12 h and 24 h after surgery, the shoulder pain was statistically lower in the group with drainage (P < 0.001 for both). There was no statistically significant difference between mean VAS scores of the case and control group at 48 hours post-surgery (P = 0.806). A significantly higher postoperative demand for analgesics was observed in the control group (P < 0.001). There was no statistically significant difference between two groups regarding the length of hospital stay. CONCLUSION: Our findings suggest that drainage may be useful to prevent postoperative shoulder pain among patients undergoing gynecological laparoscopic surgeries and decrease the need for pain medication. Further studies are recommended to assess the feasibility and cost effectiveness of using this method for reducing the postoperative shoulder pain.

Chemoprotective effects of hesperidin against genotoxicity induced by cyclophosphamide in mice bone marrow cells.

The preventive effect of hesperidin as a flavonoid was investigated in mouse bone marrow cells against genotoxicity induced by cyclophosphamide. Mice were orally (gavages) pretreated with solutions of hesperidin at four different doses (50, 100, 200, and 400 mg/kg b.w.) for five consecutive days. Mice were injected intraperitoneally on the fifth day with cyclophosphamide (50 mg/kg b.w.) and killed after 24 h for the evaluation of micronucleated polychromatic erythrocytes (MnPCEs) and the ratio of PCE/(PCE+NCE) (polychromatic erythrocyte/ polychromatic erythrocyte + normochromatic erythrocyte). Three last doses of hesperidin significantly reduced frequency of MnPCEs induced by cyclophosphamide (p<0.0001). Hesperdin at dose 200 mg/kg b.w. reduced MnPCEs 2.37 time and also completely normalized PCE/ (PCE+NCE) ratio. Histological examination of bone marrow showed that hesperidin affected on proliferation and hyper cellularity of immature myeloid elements in bone marrow that reduced by cyclophosphamide. It is obvious that hesperidin, may with antioxidative activity, reduced the oxidative stress and genotoxicity induced by cyclophosphamide in mouse bone marrow cells.