Association of IL-8 -251T>A and IL-18 -607C>A polymorphisms with susceptibility to breast cancer - a meta-analysis.

BACKGROUND: Previous studies have evaluated the association of IL-8 -251T>A and IL-18 -607C>A polymorphisms with a risk of breast cancer in different populations, but the results remain inconsistent and inconclusive. Thus, we performed this meta-analysis to explore the associations. METHODS: A comprehensive literature search in PubMed, EMBASE, Web of Science, Scopus, SciELO, SID, and CNKI for all eligible studies published up to October 1, 2020. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were used to evaluate the intensity of associations. RESULTS: A total of 12 case-control studies including seven studies with 2,370 cases and 2,314 controls on IL-8 -251T>A, and five studies with 900 cases and 882 con-trols on IL-18 -607C>A polymorphism were selected. Pooled data showed that IL-8 -251T>A (AT vs. TT: OR= 1.187; 95% CI 1.038-1.356; P = 0.012) and IL-18 -607C>A polymorphisms (A vs. T: OR = 1.205; 95% CI 1.055-1.377; P = 0.006; AA vs. TT: OR = 1.379; 95% CI 1.056-1.802; P = 018; and AA vs. AT+TT: OR = 1.329; 95% CI 1.053-1.678; P = 0.017) were associated with increased risk of breast cancer in overall. Moreover, when the studies were stratified by ethnicity, the IL-8 -251T>A was significantly associated with breast cancer risk in Africans. Publication bias tests provide no evidence of presence of publication bias in a meta-analysis. CONCLUSION: This meta-analysis results revealed that the IL-8 -251T>A and IL-18 -607C>A polymorphisms are associated with susceptibility to breast cancer. However, further multicenter studies with larger sample sizes in different ethnicities are required to make a better assessment of these associations.

Is cryotherapy effective in all women with low-grade cervical intraepithelial neoplasia?

OBJECTIVE: This study was designed to investigate the incidence the premalignant and malignant cervical lesions at the 12-month follow-up investigation between cryotherapy and non-cryotherapy groups. PATIENTS AND METHODS: A prospective cohort study was performed in women with CIN 1 and PCB, who were referred to the gynecology clinic at Imam Hospital affiliated to Mazandaran University of Medical Sciences (MAZUMS), Sari, Iran, from February 2015 to November 2019. Of 232 patients, 131 consented to cryotherapy and underwent the treatment, while 101 were unwilling to undergo the treatment. After 12 months, we performed a Pap smear, a colposcopy, and a histopathological investigation of the cervix in both groups. Primary and secondary outcomes were compared between groups. The primary outcome was the comparison of incidence premalignant and malignant cervical lesions in cryotherapy and non-cryotherapy groups. The secondary outcome was a comparison of the accuracy of the Pap smear test versus colposcopy for the detection of premalignant and malignant cervical lesions in women with or without a history of cryotherapy. PATIENTS: Totally, abnormal cytological, positive colposcopic, and positive histopathological findings were reported in 41.56%, 20.26%, and 13.79 %, respectively. By histology biopsy, premalignant and malignant cervical lesions were reported in 28.24% (37/131) and 36.63% (32/101) of women in the cryotherapy and the non-cryotherapy group, respectively. This statistic did not differ significantly between groups (p = 0.78). Pap smears were abnormal in 39.7% and 44.5% of women in the cryotherapy and the non-cryotherapy group, respectively. A positive colposcopy was obtained in 27 (20.6%) and 19 (18.8%) women in the cryotherapy and the non-cryotherapy group, respectively. The diagnostic accuracy of the Pap smear test and colposcopy in detecting cervical neoplasia did not differ in women who had undergone cryotherapy and those who had not (p>0.05). CONCLUSIONS: This prospective study showed that cryotherapy is no appropriate treatment for patients with CIN1 and PCB.

Effects of Dietary Approach to Stop Hypertension diet on androgens, antioxidant status and body composition in overweight and obese women with polycystic ovary syndrome: a randomised controlled trial.

BACKGROUND: Polycystic ovary syndrome (PCOS) is the most common endocrine disease in reproductive age women. The present study aimed to determine the effects of Dietary Approaches to Stop Hypertension (DASH) diet on reproductive hormones, plasma total antioxidant status and anthropometric indices in overweight and obese PCOS women. METHODS: In this randomised controlled clinical trial, 60 women with PCOS were randomly assigned to one of two diets with energy restriction: the DASH diet and a control diet. The DASH and control diets consisted of 50-55% carbohydrate, 15-20% protein and 25-30% total fat. The DASH diet was designed to be rich in vegetables, fruits, whole grains and low-fat dairy products, as well as low in saturated fats, cholesterol, refined grains and sweets. In the present study, the anthropometric indices, body composition, total testosterone, androstenedione, sex hormone binding globulin (SHBG), free androgen index and 2,2'-diphenyl-1-picryylhydrazyl (DPPH) scavenging activity were measured before and after 3 months. RESULTS: The consumption of DASH diet compared to the control diet was associated with a significant reduction in weight [-5.78 (1.91) kg versus -4.34 (2.87) kg, P = 0.032], body mass index (BMI) [-2.29 (0.15) kg m-2 versus -1.69 (0.20) kg m-2 , P = 0.02], fat mass [-3.23(1.66) kg versus -2.13 (1.26) kg, P = 0.008] and serum androstenedione [-1.75 (1.39) ng mL-1 versus -1.02 (0.72) ng mL-1 , P-value = 0.019]. Increased concentrations of SHBG [28.80 (21.71) versus 11.66(18.82) nmol L-1 , P = 0.003) and DPPH scavenging activity [30.23% (19.09) versus 12.97% (25.12) were also found in the DASH group. CONCLUSIONS: The DASH diet could improve weight loss, BMI and fat mass. Furthermore, it could result in a significant reduction in serum androstenedione and a significant increase in antioxidant status and SHBG.

Evaluate the Effectiveness of Conservative Treatment for Menorrhagia in Women who were Admitted to the Shahid Sadoughi Hospital of Yazd-Iran in 2014-2015.

BACKGROUND AND AIM: Abnormal uterine bleeding is one of the most common debilitating menstrual problems. The first therapeutic strategy for abnormal uterine bleeding is drug treatment. This study was, therefore, designed to determine the efficacy of megestrol, medroxyprogesterone, GnRh agonist, Levonorgestrol IUD and endometrial ablation on bleeding and also to evaluate the side effects of each methods in patients with menorrhagia who were admitted to the Shahid Sadoughi clinic of Yazd University of Medical Sciences. METHODS AND MATERIALS: Based on an analytical study with consideration of patients' medical history, 89 patients with age range of 25-50 years old were included. Each patient, under gynecologist supervision, received one of treatments for three month. The evaluation of patients bleeding in response to treatment were performed using a check list filled by patients and the results were compared before and after treatment. Medroxyprogesterone acetate, megestrol, GnRh agonist (Triptorelin embonate), Levonorgestrol IUD and endometrial ablation was used for patients as their characteristics. Each treatment was conducted for a period of 3 months. Megestrol 40 mg per day on an ongoing basis, medroxyprogesterone from 15th day of menstruation for 10 nights and Diphereline 3.75 mm (manufactured by Aria Health) were administered every 28 days. Mean of bleeding before and after treatment and complications of conservative therapy were evaluated. Statistical analysis of the data were performed using paired t test and Wilcoxon tests on spss-19 software. RESULT: Mean of age was 41.2 (25-50). Megestrol treatment with a frequency of 27% (24 patients) and endometrial ablation with a frequency of 20.2% (18 patients) were the most used therapy in this study. All of these ways of conservative treatment can decrease bleeding significantly. The complications of these methods of treatment were not significantly different. (p=0.37).Satisfaction of women after 2-3 months of treatment were increasing because spotting is common in the first months of therapy. CONCLUSION: The results of this study indicate that all five methods are good enough to treat menorrhagia. All these methods can replace hysterectomy, especially in this age range in which preserve fertility is of particular importance, and patients can also be protected from hysterectomy, a heavy surgery, and surgery and post surgery complications.

Age of menarche as a risk factor for gynecological cancer in Iranian women and review of the literature.

BACKGROUND: This study analyzed the age of menarche in different regions of Iran with a review of previous studies and examined the changes of menarche age over the past years. MATERIALS AND METHODS: A descriptive and cross-sectional study which was conducted in 11 different provinces of Iran with a sample size of 26,831. The year of birth and age of menarche in the population obtained through health records which were available in the health centers collected and also questioning the subjects under investigation. RESULTS: The highest average age of 14.6 years obtained from Kermanshah province and the lowest was from Kerman with 12.98 years. The lowest average was observed with age group under 30 (13.22) and the highest age of menarche (13.53) belonged to the 30 to 40 year age group. The average age of menarche in this study was 13.24 years. DISCUSSION: A declining trend of about two to four months for each ten years has been observed in girls born in 1920s to 1940s and then an upward trend of about nine months for ten years in subjects born in 1950s and 1960s. The stressful condition of war and poor economic and social conditions of Iranian people can justify this upward leap. However in women under 30 years of age, the menarche age showed a rapid declining trend to 13.22 years. CONCLUSION: Obtaining accurate information and knowing all the factors affecting this issue can be very useful in planning the public health in women and health educational programs.

Evaluation of the effect of GnRH agonist on menstrual reverse in breast cancer cases treated with cyclophosphamide.

UNLABELLED: Twenty-five percent of breast cancer cases are detected during premenopausal period and the number of young women suffering from breast cancer is increasing in the world, especially in Iran. Preservation of fertility and ovarian function leads to improved quality of life of these patients. The aim of this study was to evaluate the effect of gonadotropin releasing hormone (GnRH) agonist on menstrual reverse in breast cancer cases treated with cyclophosphamide regimen. MATERIALS AND METHODS: This randomized clinical trial (RCT) was conducted on 42 adenocarcinoma cases. Mean age of patients was 37 +/- 5 years (range 25 to 45). Primary stages to Stage II (T2N1M0) whose histology reports were negative ER/PR were enrolled in this study. All the enrolled patients were candidates for cyclophosphamide (600 mg/m2), adriamycin (60 mg/m2), and taxoter (75 mg/m2) chemotherapy regimens. RESULTS: Spontaneous menstrual reverse occurred in 90.5% of patients receiving diphereline at three to six months after treatment which occurred in 33.3% of control cases. In control group, 14.3% (three cases) had oligomenorrhea and hypomenorrhea during chemotherapy and 19%(four cases) had spontaneous menstrual reverse at three to six months. It should be noted that there was a significant difference between controls and cases (p < 0.001). This difference was insignificant in cases younger than 35 years (p < 0.594). In 100% of patients older than 35 years who received diphereline, spontaneous menstrual reverse occurred during six months after chemotherapy, but this occurred in only 20% of controls (p < 0.001). Mean serum level of follicle stimulating hormone (FSH) and luteinizing hormone (LH) during and at three months after therapy was significantly lower in cases in comparison with controls, but serum level of estradiol was significantly more in cases three months after chemotherapy (p < 0.001). CONCLUSION: GnRH agonists significantly improve ovarian function andfertility. They also lead to spontaneous menstrual reverse in negative ER/PR breast cancer cases.

Evaluation of serum CA 125 level and its relation to surgical, histopathologic and ultrasonographic findings in patients with pelvic mass.

OBJECTIVE: The aim of this study was to determine the relationship between the levels of tumour marker CA 125 antigen and pelvic tumour size, histopathological type, stage, bilateral status, ascites, type of surgery, and postoperative complications. MATERIALS AND METHODS: A retrospective cross-sectional descriptive study was conducted on 203 patients with a pelvic mass who were visited in the Shahid Sadoughi hospital in Yazd, Iran from 2007 to 2010. Data were analyzed by software SPSS v.14. RESULTS: Statistical analysis, based on Fisher's exact test, showed that patients with pelvic mass who presented with either of bilateral involvement/ascites (p = 0.000), higher stage (p = 0.001), inability for complete resection (p = 0.000), or postoperative complications (p = 0.001) had significantly higher serum concentrations of CA 125 antigen. There was no relationship between serum level of CA 125 and such variables as tumor size (p = 0.883) and abdominal ultrasound findings (p = 0.297). CONCLUSION: Using CA 125 as a diagnostic and prognostic tool in patients with newly-discovered pelvic mass can be helpful in some aspects, but cannot estimate size of the tumor and its solid/cystic status. It also cannot predict post-surgical complications of malignant pelvic masses.

A comparison of the effect of levonorgestrel IUD with oral medroxyprogesterone acetate on abnormal uterine bleeding with simple endometrial hyperplasia and fertility preservation.

OBJECTIVE: Endometrial hyperplasia is clinically important, because it can lead to abnormal uterine bleeding (AUB) which itself can precede endometrial cancer. Endometrial carcinoma is the most common malignancy of the female genital tract, occurring in about 75%-85% younger, perimenopausal women as endometrial hyperplasia. The treatment is hysterectomy or hormone therapy with progesterone. The aim of this study was, therefore, to compare the effect of levonorgestrel intrauterine device (LNG-IUD) with medroxyprogesterone acetate (MPA) on simple endometrial hyperplasia for fertility preservation. MATERIALS AND METHODS: Forty women in reproductive age (22-47 years) with AUB with endometrial biopsies confirming simple hyperplasia, were enrolled in this study and then randomly divided into two groups. All patients presented with designed special checklist which was filled with satisfaction. Complete history and physical examination especially blood pressure (BP), body mass index (BMI), breast examination, bimanual vaginal examination, and transvaginal sonography (to measure the thickness of endometrial and exclude the other pathologic lesions) were performed. In the first group, treatment was performed with MPA (20 mg/daily) for ten days and in other group with LNG-IUD was prescribed. After three months, transvaginal sonography and biopsy of endometrium were done. The status of AUB and side-effects of two methods,along with the rate of satisfactory were evaluated. RESULT: The findings showed the significant differences in the treatment of simple hyperplasia between two groups (LNG-IUD group vs. MPA group) (p < 0.047). Recovery of AUB in the group LNG was enhanced (p < 0.047). Endometrial thickness was reduced in both groups (p < 0.001), but further reduction in LNG group was seen. Also, LNG was tolerated more than MPA. Side-effects of MPA were more and reached significance (p < 0.003). The rate of satisfaction with LNG was higher than MPA and reached significance (p < 0.048). CONCLUSION: The results of this study show that LNG-IUD is more effective than MPA in treatment of simple endometrial hyperplasia and can be helpful in young women who want to preserve their fertilities.

Cancer in pregnancy: a 10-year experience in shahid sadoughi hospital, yazd, iran.

INTRODUCTION: Although occurrence of cancer during pregnancy is rare, it leads to high morbidity and mortality in both mother and fetus. Recent trends in prolongation of child-bearing age have made cancer-associated pregnancies more frequent than past. As yet there are few documents concerning cancer and its related treatment outcomes during pregnancy. This study aimed at describing clinical characteristics of pregnant women with cancer in the Shahid Sadoughi hospital in Yazd, Iran. MATERIALS AND METHODS: Case series were reviewed retrospectively, which included 19 pregnant women diagnosed with cancer in Shahid Sadoughi hospital from 2002 to 2012. Data collected comprised demographics, pregnancy characteristics and outcomes, type of cancer, clinical stage, treatment and oncological. RESULTS: From 17 pregnant women with cancer, 4 women had gynecologic cancers and 13 had non-gynecologic cancers. The Following tumors were observed: breast [6], acute myeloblastic leukemia [3], uterine cervix carcinoma [3], ovary [1], chronic myelogenous leukemia [1], lymphoma [1], papillary carcinoma of thyroid [1], and pseudopapillary carcinoma of pancreas [1]. The mean age of patients was 30.6 years, and the mean gestational age at diagnosis was 21.1 weeks. Surgical treatment was performed in 3 patients, 6 patients were treated by chemotherapy, and in 3 by both. DISCUSSION: Although cancer during pregnancy is uncommon, it is considered an important problem due to unsuitable maternal and fetal outcomes and lack of standard management guidelines. Our cases represent examples of feasible or justifiable managements for them.

Attitude and knowledge of Iranian female nurses about human papilomavirus infection and cervical cancer: a cross sectional survey.

BACKGROUND AND AIM: Human Papilomavirus (HPV) is one of the most widespread sexually transmitted diseases is highly related to cervical cancer in women. Cervical cancer's crude incidence rate in Iran is 6-8 per 100,000. The HPV vaccine provides a chance to considerably decrease the transmission of most types of HPV. The aim of this study was to evaluate awareness and knowledge of HPV infection and vaccines and to assess the attitude and approach toward these vaccines among female nurses at Shahid Sadoughi University of Medical Sciences, Yazd, Iran. MATERIALS AND METHODS: This cross-sectional, descriptive study was performed among 380 female nurses. Data were collected using a questionnaire was consisted in demographic variables and questions on knowledge of participants about HPV infection, HPV vaccine and cervical cancer and also questions on attitude of ourses towards HPV vaccination. The validity and internal consistency of questionnaire was confirmed during experts consents and pilot testing (alpha = 0.79). Data analysis was performed using SPSS15 using chi2-test or Fisher's exact test. RESULTS: Three hundred and eighty questionnaires were distributed and 357 female nurses completed and returned their questionnaires: Only one hundred and thirty-one of the nurses (36.7%) knew about HPV infection and how it can cause abnormal pap Smear results. about 147 (41.2%) of the nurses stated they would want to be vaccinated. About 146 (40.9%) of respondents supported vaccination of preadolescent girls. CONCLUSION: The results of this study confirm the lack of knowledge about HPV vaccine and its relation to cervical cancer and also the ways of this cancer prevention. Our study shows an urgent need to design similar studies in other regions of Iran and draw a broad estimation on knowledge of different target groups to make a national program to increase the knowledge of women on this matter and help to decrease the rate of cervical cancer in Iranian population.

Response to neoadjuvant chemotherapy with paclitaxel and cisplatin in locally advanced cervical cancer.

PURPOSE: The purpose of this study was to evaluate the efficacy and toxicity of paclitaxel and cisplatin as neoadjuvant chemotherapy for patients with Stage IB2 to IIB cervical cancer and determine factors accountable for response. MATERIALS AND METHODS: From November 2009 to January 2011, a total of 19 patients with Stage IB2 to IIB cervical cancer were treated with three ten-day courses of paclitaxel 60 mg/m2 and cisplatin 80 mg/m2 followed by type III radical hysterectomy and adjuvant therapy if indicated, or chemoradiation in non-resectable patients. RESULTS: Clinical response occurred in 79% (15/19) of patients, including 10.5% (2/19) with complete response, and 68.5% (13/19) with partial response. Four (21%) patients were nonresponders including 16% (3/19) with stable and 5.2% (1/19) with progressive disease. Resectability rate was 68.5% (13/19). Pathological optimal response rate was 46% (6/13) including, 15% (2/13) with complete and 31% (4/13) with residual disease < three mm stromal invasion response (PR1). Suboptimal response (PR2) (residual disease with > three mm stromal invasion) was 54% (7/13). It appears that both clinical and pathological response were correlated with tumor stage and size. Clinical response was seen in 87.5% of tumors sized = < eight cm vs 33.3% of tumors sized > eight cm (p = 0.166) and optimal pathological response was seen in 66.7% of tumors sized < four cm vs 28.6% of tumors sized four to eight cm, (p = 0.286), although because of small number of patients, the difference was not statistically significant. Adjuvant therapy was necessary for 38.5% (5/13) patients. Toxicities were not life-threatening and all manageable. CONCLUSIONS: The present results suggest that neoadjuvant chemotherapy (NAC) with paclitaxel and cispaltin is a highly active and well-tolerated regimen. Best candidates are patients with stages IB2/IIA bulky and IIB non-bulky than IIB bulky groups.

Comparing letrozole with medroxyprogesterone acetate (MPA) as hormonal therapy for simple endometrial hyperplasia without atypia in adult and middle-aged women.

BACKGROUND: The aim of this survey was to compare the effect of letrozole with medroxyprogesterone acetate (MPA) in treatment of simple endometrial hyperplasia to preserve fertility in young women. MATERIALS AND METHODS: Forty-five patients referred to Shahid Sadoughi gynecology clinics from 2009 until 2011 who suffered from abnormal vaginal bleeding or endometrial thickness, that underwent curettage with diagnosis of simple endometrial hyperplasia without atypia were enrolled. The patients were divided randomly into two groups. First group including 22 women receive ten mg MPA, for ten days during a month for three months. All cases were followed by interview, endometrial curetage, and vaginal sonography. Serum level of estradiol was checked before and after treatment. At the end of the study, biopsy was retaken in 41 patients. All the patients were under observation by two gynecologists. RESULTS: Age range of patients was 20 to 42 years. Mean body mass index (BMI) in the MPA and letrozole groups was 29.13 +/- 4.8 and 25.42 +/- 4.2, respectively. Fifty and 34.8 percent of cases had history of obesity or polycystic ovarian syndrome (PCOS) in MPA and letrozole groups, respectively. Forty-one selected cases (20 of the MPA and 21 of the letrozole groups) continued the treatment for three months. The endometrial thicknesses decreased in both groups. Serum estradiol level also decreased in both groups. The most common complication in the MPA and letrozole groups was headache (27.3%) and flashing and dizziness, respectively. The side-effects were reported less in the letrozole group and the most common ones in this group were dizziness and flashing. DISCUSSION: In women suffering from simple endometrial hyperplasia without atypia, letrozole can lead to decrease of serum estradiol level and endometrial thickness like MPA. In both groups, there was no simple hyperplasia report in curettage report following treatment. It should be noted that there was an incomplete response to treat case with pathology of disordered proliferative type. CONCLUSION: Letrozole is a good therapeutic option in simple endometrial hyperplasia without atypia: cases candidate for medical treatment. To confirm the effect and safety of letrozole, more studies with larger samples are recommended.

New results regarding trends in Iranian women's health and a comparison with WHO data.

Half of the world's population consists of women, who play important roles in cultural formation and education, maintain and promote households and their health, and consequently affect the community. In a general sense, women's health may be an important cornerstone for the formation of a healthy community. In developing countries, 67% of women work in the agriculture sector and produce 55% of the food products throughout the world. In East Asian countries, which have the highest level of cloth and furniture export, 74% of workers are women. Due to these considerations, we assessed women's health indicators in Iran. We reviewed health information from national health reports, including two national health surveys conducted in 1991 and 2009 with a sample size of 1/1,000 of the Iranian population, the 2000 Iran Demographic and Health Survey, and all published indices that were calculated in 2006 or later. The most important finding was that the maternal mortality rate decreased from 54 per 100,000 live births in 1991 to 37.4 per 100,000 live births in 1997. It decreased further to 24.7 per 100,000 live births in 2006. The Millennium Development Goal is 18-22 per 100,000 live births in 2015.

Rate of use of contraceptive methods and risk factors in Tehran, the capital of Iran, in 2010 compared to other cities and regions.

BACKGROUND: Unwanted pregnancies and deaths from abortion cost the lives of 500 women daily. This study was designed to determine the rate of use of contraceptive methods and the risks. MATERIAL AND METHODS: This cross-sectional study was conducted in 2010 in Tehran, Iran. Total sample size was 304 participants who all filled out a questionnaire which had two parts. Data were analyzed by SPSS. FINDINGS: The results showed that age (p = 0.003), employment status (p = 0.001), number of children (p = 0.001), and marriage (p = 0.01), had a significant relation with type of contraceptive method while, education did not correlate with contraceptive methods. DISCUSSION: New and often younger couples with no experience about different contraceptive methods may tend to use natural methods because of their lack of knowledge of other techniques. Use of modern contraceptives early in marriage or even before marriage could be a good strategy.

Conservative management of young women with endometrial carcinoma or complex atypical hyperplasia: report of three cases and literature review.

BACKGROUND: Although endometrial cancer is primarily a postmenopausal disease, 25% of patients are in premenopausal age with 3-5% being 40 years old or younger. The younger groups of women with endometrial carcinoma are frequently nulligravid with a history of infertility and strong desire to preserve fertility, which may pose a therapeutic dilemma for both patients and physicians. CASE REPORTS: We report on three young women with atypical complex hyperplasia or early-stage endometrial cancer that were treated with conservative hormonal therapy. DISCUSSION/CONCLUSION: Hormonal therapy has been proposed for young women with endometrial cancer (grade 1) who wish to preserve their fertility. However, detailed evaluation including physical examination, history taking, performing D&C, examining the specimen by a skilled pathologist, using imaging techniques, especially contrast enhanced MRI and for some patients explorative laparoscopy with sampling of peritoneal and lymph nodes, and evaluation of adnexa is necessary. Also for patients in Stage I/grade 1, advisory sessions on the benefits and side-effects of high-dose progesterone with evaluation of the endometrium every three months until total regression is recommended.

Conservative surgery in cervical cancer: report of two radical abdominal trachelectomies and literature review.

AIM: Radical trachelectomy or removal of the cervix and uterine ligaments with uterus and ovary preservation is done in primary stages of cervical cancer in women who wish to preserve their fertility. CASES: The first case had cervical cancer in situ with lymphovascular involvement, while the second case had papillary serous adenocarcinoma, Stage Ib1 (lesion < 4 cm and limited to the cervix) diagnosed during pregnancy, who underwent surgery two months following labor. Radical trachelectomy and total pelvic lymphadenectomy to preserve the uterus were done without any intra- or postoperative complications. Both patients had regular postoperative menstruation, but in the second case, the disease relapsed in the vaginal cuff and the patient was a candidate for radical hysterectomy and radiotherapy. CONCLUSION: Radical trachelectomy as a new technique to preserve fertility in early stages of cervical cancer seems to be less effective in adenocarcinoma than squamous cell carcinoma due to a worse prognosis.

Centralization of ovarian cancer surgery: do patients benefit?

BACKGROUND: The aim of the study was to compare the effect of surgery in patients with ovarian cancer by gynecologist-oncologists and general gynecologists on overall survival. MATERIAL AND METHODS: In a retrospective study all patients diagnosed with primary ovarian cancer at Vali-e-Asr Hospital (Tehran, Iran) between April 1999 and January 2005 were eligible for enrollment. A total 157 consecutive patients with ovarian cancer were available for analysis. There were no significant differences between the two groups with respect the stage, age and histological type of tumor. Of 157 patients, 60 were treated by gynecologist-oncologists and 95 by general gynecologists, and two patients were treated by general surgeons. RESULTS: The number of patients who had optimal cytoreductive surgery performed was higher in the gynecologist-oncologist group than the number in the general gynecologist group (p < 0.001). The majority of patients in the general gynecologist group needed a second operation while only a few in the gynecologist-oncologist group needed one (p < 0.001).The interval between initial surgery and beginning of chemotherapy was significantly longer in the gynecologist-oncologist group as compared to the general oncologist group (p = 0.001). Overall survival and disease-free survival were considerably better in the gynecologist-oncologist group but the difference was not significant. CONCLUSION: Patients with ovarian cancer should be referred to Gynecology-Oncology Departments for optimal treatment.

Uterine involvement in advanced epithelial ovarian cancer.

BACKGROUND: With an increasing trend for sparing fertility in gynecologic malignancies, we tried to assess uterine involvement in all stages of epithelial ovarian cancer (EOC) in an evidence-based study. METHOD AND MATERIAL: From September 1999 to September 2005, 177 patients with epithelial ovarian cancer underwent staging laparatomy in the Gynecologic Oncology Department, Vali Asr University Hospital, Tehran, Iran. Staging data from patient files and pathologic reports were analyzed. RESULT: Of the 177 cases with EOC, 26% of patients were in Stage I, 13.6% Stage II, 53.1% Stage III and 7.3% Stage IV. Uterine Involvement was 17.9% with serosal involvement in 25 cases (78.1%) and myometrial involvement in seven cases (21.9%). Of these cases 84.4% were in Stages III or more and all had omental involvement (Stage IIIa 7.4%, Stage IIIb 14.8%, Stage IIIc 63% and Stage IV 14.8%). Only 15.6% cases of normal appearing omentum had uterine tumoral involvement. CONCLUSION: Only eight cases had myometrial involvement out of 177 cases of EOC (all in Stage III). All the eight patients had omental or gross pelvic tumoral involvement. In this study we found that in the absence of gross pelvic or omental involvement in EOC, there is really none or minimal chance of myometrial involvement. Future multicenter studies with more cases will show whether standard hysterectomy by multiple serosal biopsies could be replaced.

Fertility sparing in young women with ovarian tumors.

BACKGROUND: Surveys have shown that fertility sparing in patients with ovarian tumors has proven to be effective. Thus this approach in ovarian tumor cases has been carried out. The purpose of this study was to evaluate the clinical outcome and pregnancies in women who suffered from ovarian tumor and underwent conservative treatment. MATERIALS AND METHODS: All cases who received conservative treatment and those who had recurrence of the disease during the follow-up period were evaluated at Vali-Asr Hospital from 2000-2004. RESULTS: 60 of 410 patients with ovarian tumor (age range: 13-34) were treated conservatively. Three patients (5%) were infertile. Histology of tumors showed: 26 (43.3%) germ cell tumors, 15 (25%) borderline tumors, ten (16.7%) epithelial tumors and nine (15%) sex cord tumors. The cases were followed for 12-48 months. Seven term pregnancies occurred in six patients. Three in the borderline group, two in the germ cell group, one in the epithelial group and one in the sex-cord group. Nine recurrences were reported among our cases. Two of the patients (serous carcinoma and immature teratoma, both Stage IIIc) died during follow-up due to refusal to undergo radical surgery. CONCLUSION: Fertility preserving surgery in young women with epithelial ovarian tumors, borderline and sex-cord tumors Stage I, grade 1 and 2 is recommended.

Assessment of two emergency contraceptive regimens in Iran: levonorgestrel versus the Yuzpe.

OBJECTIVE: The purpose of this study was to compare the efficacy and tolerability of two emergency contraception (EC) methods, levonorgestrel versus the Yuzpe. METHODS: In a prospective, randomized, comparative study, we included 122 healthy volunteers who in the observed cycle had had only one act of unprotected intercourse within 72 h of treatment. They were randomly allocated in levonorgestrol group (n=62) and Yuzpe (n=60). The levonorgestrel regimen consisted of two pills: 0.75 mg levonorgestrel, taken twice in the 12-h interval within 72 h after unprotected intercourse. The Yuzpe method included two HD contraceptive pills taken as another regimen. Data were collected by questionnaire at first and 3 weeks later. The differences were compared with X2 & Fisher exact tests. RESULTS: There were no significant differences between two groups in any of the observed parameters. The levonorgestrel regimen was found superior to Yuzpe because it's more effectiveness (respectively 100% vs 91%, p=0.026) and fewer side effects. CONCLUSION: The study showed more effectiveness and safety of the levonorgestrel regimen as emergency contraception. Thus we recommend levonorgestrel as an alternative EC method instead of the Yuzpe regimen in Iran or other developing countries in order to decrease unwanted pregnancy.