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Chaichian S, Firoozabadi ZD, Rokhgireh S, Tahermanesh K, Kashi AM, Govahi A, Minaeian S, Mehdizadeh M, Ajdary M. CGRP neuropeptide levels in patients with endometriosis-related pain treated with dienogest: a comparative study. BMC Womens Health 2024; 24:257. [PMID: 38658933 PMCID: PMC11040845 DOI: 10.1186/s12905-024-03095-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Endometriosis (EM) involves the peripheral nervous system and causes chronic pain. Sensory nerves innervating endometriotic lesions contribute to chronic pain and influence the growth phenotype by releasing neurotrophic factors and interacting with nearby immune cells. Calcitonin gene-related peptide (CGRP), a pain-signaling neurotransmitter, has a significant role. This study examines the effect of Dienogest (DNG), a hormone therapy used for managing EM -related pain, on serum CGRP levels in EM patients. MATERIALS AND METHODS The Visual Analog Scale (VAS) assessed pain in diagnosed EM. INDIVIDUALS Serum samples were obtained to measure CGRP concentration. Participants received a 2 mg/day oral dose of DNG for six months as prescribed treatment. Additional serum samples were collected after this period to measure CGRP levels. RESULTS In the EM group, 6.7%, 33.3%, and 20% had ovarian EM, ovarian plus uterosacral, and ovarian plus bladder, respectively. The EM group showed higher CGRP serum levels than the control group (80.53 ± 16.13 vs. 58.55 ± 6.93, P < 0.0001). Still, after drug administration, CGRP serum levels significantly decreased compared to pre-treatment levels (69.66 ± 11.53 vs. 80.53 ± 16.13, P < 0.05). The EM group showed higher pain compared to the control group (7.93 ± 1.58 vs. 0.13 ± 0.35, P < 0.0001), but after drug administration, pain significantly decreased compared to pre-treatment levels (1.00 ± 2.00 vs. 7.93 ± 1.58, P < 0.05). CONCLUSION DNG administration reduces pain and serum CGRP levels in EM patients, offering the potential for innovative treatments and tailored options. Understanding neurotransmitter roles and drug effects can aid in discovering more effective modulators for these pathways.
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Affiliation(s)
- Shahla Chaichian
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
- Iranian Scientific Society of Minimally Invasive Gynecology, Tehran, Iran
| | | | - Samaneh Rokhgireh
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Kobra Tahermanesh
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Mehdizadeh Kashi
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
- Iranian Scientific Society of Minimally Invasive Gynecology, Tehran, Iran
| | - Azam Govahi
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sara Minaeian
- Antimicrobial Resistance Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Mehdizadeh
- Reproductive Sciences and Technology Research Center, Department of Anatomy, Iran University of Medical Sciences, Tehran, Iran
| | - Marziyeh Ajdary
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran.
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Ajdary M, Kashi AM, Derakhshan R, Chaichian S, Tahermanesh K, Mehdizadeh M, Minaeian S, Govahi A. NLRP3 concentration, oxidants, and antioxidants in plasma of endometriosis patients undergoing treatment with dienogest. J Gynecol Obstet Hum Reprod 2024; 53:102744. [PMID: 38346495 DOI: 10.1016/j.jogoh.2024.102744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/26/2024] [Accepted: 02/10/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE NOD-like receptor pyrin domain-containing 3 (NLRP3) is a cytosolic multi-protein complex that induces inflammation and is negatively regulated by progesterone. Previous researches have reported abnormal induction of reactive oxygen species (ROS) and progesterone resistance in endometriosis (EM). Since progesterone regulates ROS level and, consequently, inflammation, our objective is to investigate whether dienogest (DNG) regulates NLRP3 and whether the regulation of NLRP3 inflammasome by DNG in the blood plasma of patients with EM can affect oxidant and antioxidant markers. METHODS Plasma samples were obtained from control and EM patients experiencing pain symptoms to measure the level of NLRP3, oxidants, and antioxidants. Subsequently, these patients were given oral DNG 2 mg/day for six months for drug treatment. After six months, plasma samples were collected from the patients for re-examination. RESULTS The findings indicate that DNG reduced NLRP3 concentration and oxidant production while increasing antioxidant production in blood plasma. By reducing NLRP3, DNG was able to alleviate inflammation and pain caused by inflammation in EM patients. CONCLUSION In conclusion, the use of DNG in EM patients resulted in a decrease in NLRP3 concentration in the patient's plasma. Furthermore, this effect was enhanced by balancing oxidant/antioxidant levels, which may contribute to reducing inflammation associated with EM.
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Affiliation(s)
- Marziyeh Ajdary
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Roya Derakhshan
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shahla Chaichian
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Kobra Tahermanesh
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Mehdizadeh
- Reproductive Sciences and Technology Research Center, Department of Anatomy, Iran University of Medical Sciences, Tehran, Iran
| | - Sara Minaeian
- Antimicrobial Resistance Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Azam Govahi
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran.
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Tahermanesh K, Maleki M, Rezaei Moghaddam F, Nejati P, Shahriyari R, Fazel Anvari-Yazdi A, Rahnama Moghadam A, Salehiniya H, Falahatinodeh P, Allahqoli L, Alkatout I. Effects of Corrective Exercises on Work-Related Musculoskeletal Disorders and Quality of Life in Surgical Residents: A Pilot, Quasi-Experimental Study. J Surg Educ 2023; 80:1121-1128. [PMID: 37355402 DOI: 10.1016/j.jsurg.2023.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 04/24/2023] [Accepted: 05/29/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE Work-related musculoskeletal disorders (WMSDs) are one of the most important reasons for absenteeism, high costs of health care and human injuries; the latter are very common in medical staff. The present study was designed to evaluate the effects of corrective exercises on quality of life and work-related musculoskeletal disorders in surgical residents. METHODS In a quasi-experimental study with a one-group pretest-posttest design, we assessed the eligibility of 135 surgical assistants. All recruited participants performed corrective exercises and were followed for 12 months. The primary outcome of the study was any change in the surgical residents' work-related musculoskeletal disorders, which was assessed using the Nordic Musculoskeletal Questionnaire (NMQ) and the Numerical Pain Rating Scale (NPRS) prior to, and 3, 6, and 12 months after intervention. The secondary outcome was any change in the surgical residents' quality of life (QOL) score, which was assessed at baseline, 6 and 12 months after the intervention using the World Health Organization Quality of Life - BREF (WHOQOL-BREF) questionnaire. RESULTS One hundred eligible surgical residents were enrolled, of whom 67 (67%) completed the study. At baseline the majority of the participants were female and >30 years of age. Fifty-five percent of them used analgesic drugs. The use of analgesic drugs per week fell by 14.7% from baseline to 12 months; the change was statistically significant (p = 0.042). The effect of corrective exercises on the intensity of pain in the shoulder (p = 0.002), hand/wrist (p = 0.001), upper back (p = 0.03), lower back (p = 0.02) and knee (p = 0.01) was significant. Corrective exercises also led to a significant rise in the quality-of-life score (p < 0.019). CONCLUSIONS This study demonstrated the effectiveness of corrective exercises in reducing work-related musculoskeletal disorders and improving quality of life among surgical residents.
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Affiliation(s)
- Kobra Tahermanesh
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Maleki
- School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.
| | | | - Parisa Nejati
- Department of Sports and Exercise Medicine, School of Medicine, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Roya Shahriyari
- Department of Obstetrics and Gynecology, Bank-e-Melli Iran Hospital, Tehran, Iran
| | - Abbas Fazel Anvari-Yazdi
- Division of Biomedical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, Canada
| | | | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | | | - Leila Allahqoli
- Midwifery department, Ministry of Health and Medical Education, Tehran, Iran.
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Tahermanesh K, Hakimpour S, Govahi A, Rokhgireh S, Mehdizadeh M, Minaeian S, Barati M, Chaichian S, Kashi AM, Nassiri S, Eslahi N, Ajdary M, Ahmadi M. Evaluation of expression of biomarkers of PLAGL1 (ZAC1), microRNA, and their non-coding RNAs in patients with endometriosis. J Gynecol Obstet Hum Reprod 2023; 52:102568. [PMID: 36868502 DOI: 10.1016/j.jogoh.2023.102568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/19/2023] [Accepted: 02/28/2023] [Indexed: 03/05/2023]
Abstract
Since the PLAGL1 (ZAC1) gene is expressed in the human endometrium. It may be involved in the etiology of endometrial disorders by its abnormal regulation and expression. This study aimed to investigate the Zac1 gene and related microRNA and LncRNA and its alterations in patients with endometriosis. Blood plasma, ectopic (EC) and eutopic (EU) endometrial samples were gathered from 30 patients with endometriosis and 30 healthy fertile women, and the Q-PCR technique was used to determine the expression level of Zac1 mRNA and microRNAs (miR-1271-5p, hsa-miR-490-3pin) and LncRNAs (TONSL-AS1 TONSL, KCNQ1OT1 KCNQ1). According to the results, the Zac1 gene and KCNQ1OT1 KCNQ1, TONSL-AS1 TONSL LncRNA expression were significantly decreased in the endometriosis group versus the control group (P < 0.05). MiR-1271-5p and hsa-miR-490-3pin microRNA expression were significantly raised in the endometriosis group as opposed to the control group (P < 0.05). In summary, this research for the first time revealed that identifying Zac1 expression provides us with new indicators for evaluating endometriosis.
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Affiliation(s)
- Kobra Tahermanesh
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Sahar Hakimpour
- Department of Physiology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | - Azam Govahi
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Samaneh Rokhgireh
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mehdi Mehdizadeh
- Reproductive Sciences and Technology Research Center, Department of Anatomy, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sara Minaeian
- Antimicrobial Resistance Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmood Barati
- Department of Biotechnology, Faculty of Allied Medicine, Iran University of Medical Science (IUMS), Tehran, Iran
| | - Shahla Chaichian
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | | | - Setare Nassiri
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Neda Eslahi
- Air Pollution Research Center, Iran University of Medical Science, Tehran, Iran
| | - Marziyeh Ajdary
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran.
| | - Maryam Ahmadi
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
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Nassiri S, Karimian Z, Tahermanesh K, Farasatinasab M. Surviving surgery; succumbing to pharmacotherapy: A case report underscoring the importance of PRN order clarification for patient safety. J Healthc Risk Manag 2023; 42:40-44. [PMID: 36843570 DOI: 10.1002/jhrm.21534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 02/28/2023]
Abstract
"Pro re nata" (PRN) or "as needed" medicine administration and usage is a relatively neglected area in medication management (pharmacotherapy/pharmaceutical care) which contributes to error-prone use of medications and is unsafe for patients. In this case, we report the incident of diclofenac toxicity in a 51-year-old woman due to a prescription of 100 mg diclofenac suppositories PRN, or as needed, for postoperative pain control without explanation of the maximum daily dose (150 mg daily), which led to arbitrary consumption of 3 g of diclofenac over 5 days (600 mg daily) by the patient, and subsequent development of metabolic acidosis, acute kidney injury, and sudden cardiac arrest. The implementation of practical guidelines and training programs for health care workers to appropriately prescribe, dispense, and administer PRN medicines are necessary, and should at least include providing clarification for their indication, dose and frequency, as well as any cautionary instructions to ensure safe and effective use of such medicines.
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Affiliation(s)
- Setare Nassiri
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Karimian
- Heidelberg Institute of Global Health, Faculty of Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Kobra Tahermanesh
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Farasatinasab
- Department of Clinical Pharmacy, School of Pharmacy-International Campus, Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
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Mehdizadehkashi A, Chaichian S, Rokhgireh S, Tahermanesh K, Mirgaloybayat S, Saadat Mostafavi R, Khodaverdi S, Ajdary M, Ahmadi Pishkuhi M. Does laparoscopic treatment of deep endometriosis improve sexual dysfunction. Caspian J Intern Med 2023; 14:349-355. [PMID: 37223304 PMCID: PMC10201115 DOI: 10.22088/cjim.14.2.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/15/2022] [Accepted: 06/06/2022] [Indexed: 05/25/2023]
Abstract
Background Endometriosis is one of the common gynecological problems during the reproductive years, affecting the quality of life, fertility, and sexual function of women. It is known that sexual dysfunction and quality of life are interrelated. Therefore, this study aimed to evaluate the effect of resection of endometriosis lesions via laparoscopic surgery on the improvement of sexual dysfunction in women with endometriosis. Methods This clinical trial was performed on 30 patients with endometriosis. The Female Sexual Function Index, Endometriosis Health Profile-30, and Visual Analog Scale were completed for the patients before laparoscopic surgery and three, six, and 12 months after surgery. The results were examined and compared before and after the intervention using the ANOVA test. Results The present results showed that the mean pain score of the patients (dysmenorrhea, dyspareunia, and pelvic pain) was significant after laparoscopic surgery (P<0.005). The female sexual function improved after laparoscopic surgery compared to the preoperative phase, and changes in the domains of psychological stimulation, humidity, and sexual orgasm were significant (P<0.005). Moreover, the female quality of life scores increased in all dimensions compared to the preoperative phase, although these improvements were not statistically significant. Conclusion The present results revealed that laparoscopic surgery is an effective treatment, leading to a considerable improvement in female sexual function.
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Affiliation(s)
| | - Shahla Chaichian
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Samaneh Rokhgireh
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Kobra Tahermanesh
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shahla Mirgaloybayat
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Sepideh Khodaverdi
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Marziyeh Ajdary
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahin Ahmadi Pishkuhi
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Tehran, Iran
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Tahermanesh K, Hakimpour S, Govahi A, Keyhanfar F, Kashi AM, Chaichian S, Shahriyaripour R, Ajdary M. Treatment of Ovarian Hyperstimulation Syndrome in a Mouse Model by Cannabidiol, an Angiogenesis Pathway Inhibitor. Biomed Res Int 2022; 2022:1111777. [PMID: 36588534 PMCID: PMC9797301 DOI: 10.1155/2022/1111777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/04/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
Studies suggest that ovarian hyperstimulation syndrome (OHSS) can be treated by reducing the level of vascular endothelial growth factor (VEGF). However, due to the side effects of commercially available VEGF-reducing drugs, they can be ruled out as a suitable treatment for OHSS; therefore, researchers are looking for new medications to treat OHSS. This study is aimed at investigating the effects of cannabidiol (CBD) in an OHSS model and to evaluate its efficacy in modulating the angiogenesis pathway and VEGF gene expression. For this purpose, 32 female mice were randomly divided into four groups (eight mice per group): control group, group 2 with OHSS induction, group 3 receiving 32 nmol of dimethyl sulfoxide after OHSS induction, and group 4 receiving 30 mg/kg of CBD after OHSS induction. The animals' body weight, ovarian weight, vascular permeability (VP), and ovarian follicle count were measured, and the levels of VEGF gene and protein expression in the peritoneal fluid were assessed. Based on the results, CBD decreased the body and ovarian weights, VP, and corpus luteum number compared to the OHSS group (p < 0.05). The peritoneal VEGF gene and protein expression levels reduced in the CBD group compared to the OHSS group (p < 0.05). Also, CBD caused OHSS alleviation by suppressing VEGF expression and VP. Overall, CBD downregulated VEGF gene expression and improved VP in OHSS.
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Affiliation(s)
- Kobra Tahermanesh
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sahar Hakimpour
- Department of Physiology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | - Azam Govahi
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Fariborz Keyhanfar
- Department of Pharmacology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Shahla Chaichian
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Roya Shahriyaripour
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Marziyeh Ajdary
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
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Khan KN, Ogawa K, Iwasa K, Kuroboshi H, Okimura H, Koshiba A, Manabe E, Izumi M, Akira S, Kashi M, Allahqoli L, Tahermanesh K, Matloobi M, Ramasauskaite D, Silkunas M, Cerniauskaite M, Tintara H, Klangsin S, Horiguchi G, Teramukai S, Sawa T, Fushiki S, Itoh K, Nakashima M, Fujishita A, Guo SW, Kitawaki J, Mori T. A targeted educational programme improves the awareness and fundamental knowledge on menstrual pain and endometriosis in young women: The Endometriosis Awareness Promotion Project (EAPP). Reprod Biomed Online 2022; 45:1216-1229. [DOI: 10.1016/j.rbmo.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/19/2022] [Accepted: 07/12/2022] [Indexed: 10/17/2022]
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Tahermanesh K, Gorginzadeh M, Hanjani S, Shahriyari R, Anvari-Yazdi AF, Kelarestaghi H, Alkatout I, Allahqoli L. Ovarian suspension loop: an assembled device for ovarian lifting and immobilization during laparoscopic cystectomy. J Turk Ger Gynecol Assoc 2022; 23:126-129. [PMID: 35642443 PMCID: PMC9161004 DOI: 10.4274/jtgga.galenos.2022.2021-10-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Matloobi M, Amini L, Shahali S, Haghani H, Tahermanesh K, Hassanlouei B, Allahqoli L, Alkatout I. Effect of sex education on sexual function and sexual quality of life in women with endometriosis: A quasi-experimental study. Int J Gynaecol Obstet 2022; 159:702-710. [PMID: 35514234 DOI: 10.1002/ijgo.14254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/22/2022] [Accepted: 05/03/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the effect of a sex education program on sexual function and sexual quality of life in women with endometriosis. METHODS In a quasi-experimental study, women with endometriosis who had undergone laparoscopic surgery were assigned to an intervention group (n = 36) or a control group (n = 36). The intervention group received a sex education program consisting of two sessions a week (90 min each) for two consecutive weeks; the control group received none. Both groups were followed for 12 weeks. Sexual function and sexual quality of life were assessed on the Female Sexual Function Index (FSFI) and the Sexual Quality of life-Female (SQOL-F) questionnaire before the intervention, as well as 8 and 12 weeks after the intervention. Outcomes were analyzed using Student t test, the χ2 test, Fisher exact test, and repeated measures analysis of variance. RESULTS The mean age of the study participants was 36.9 ± 5.7 years. The two groups did not differ significantly in terms of demographics and pre-intervention clinical characteristics. At the end of the study, sex education reduced female sexual dysfunction by 58.1% in the intervention group. The mean FSFI score increased significantly in the intervention group from pre-intervention to 8 and 12 weeks post-intervention compared with the scores in the control group (P < 0.001). CONCLUSIONS Sex education appears to be a promising intervention for reducing sexual dysfunction and improving sexual function and sexual quality of life in women with endometriosis. Future studies should encompass longer periods of follow up to obtain further data on the efficacy of sex education in this setting.
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Affiliation(s)
- Maryam Matloobi
- Department of Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Amini
- Nursing Care Research Center (NCRC), Department of Midwifery, Reproductive Health, and pregnancy, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Shadab Shahali
- Department of Midwifery and Reproductive Health, Tarbiat Modares University, Tehran, Iran
| | - Hamid Haghani
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Kobra Tahermanesh
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Babak Hassanlouei
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | | | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Kiel, Germany
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Mehdizadeh A, Chaichian S, Mirgaloybayat S, Rokhgireh S, Tahermanesh K, Kadivar M, Farzaneh F. Right-side inguinal canal endometriosis at ultrasound: A case report. Int J Reprod Biomed 2022; 20:59-64. [PMID: 35308322 PMCID: PMC8902790 DOI: 10.18502/ijrm.v20i1.10409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/22/2021] [Accepted: 11/01/2021] [Indexed: 11/24/2022] Open
Abstract
Background The first case of inguinal endometriosis was described by Cullen. Endometriosis in the round ligament could be in the pelvic or inguinal area and is a rare disease occurring in 0.6% of women. Women with inguinal endometriosis have a painful inguinal mass during menstrual cycles and they mostly have a history of surgery. The right side is more commonly involved in inguinal endometriosis than the left side (90-94%). A history of gynecologic or abdominal surgery is common in women with inguinal endometriosis. Case presentation In our case, a 39-yr-old virgin woman presented with localized pain in the right inguinal that had been present for 4 yr. She did not have any history of previous surgery, and abdominal ultrasonography showed a hypoechoic mass with minimal vascularity. Inguinal endometriosis was correctly diagnosed by two expert radiologists preoperatively, and she underwent laparoscopic surgery. Conclusion Considering inguinal endometriosis in the differential diagnosis of women with inguinal masses is important, even if there is no history of gynecologic or abdominal surgery.
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Affiliation(s)
- Abolfazl Mehdizadeh
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shahla Chaichian
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Tehran, Iran
| | - Shahla Mirgaloybayat
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Samaneh Rokhgireh
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Kobra Tahermanesh
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Kadivar
- Department of Pathology, Hazrat-e-Rasool Akram General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Farahnaz Farzaneh
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
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Chaichian S, Saadat Mostafavi SR, Mehdizadehkashi A, Najmi Z, Tahermanesh K, Ahmadi Pishkuhi M, Jesmi F, Moazzami B. Hyaluronic acid gel application versus ovarian suspension for prevention of ovarian adhesions during laparoscopic surgery on endometrioma: a double-blind randomized clinical trial. BMC Womens Health 2022; 22:33. [PMID: 35148732 PMCID: PMC8832808 DOI: 10.1186/s12905-022-01607-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 01/27/2022] [Indexed: 11/28/2022] Open
Abstract
Background This study aimed to compare the effect of ovarian suspension and hyaluronic acid gel to prevent re-adhesions after laparoscopic endometrioma surgery.
Methods This randomized clinical trial was conducted at Rasoul-e-Akram and Pars Hospitals, Tehran, Iran, 2016-18. Fifty patients with bilateral endometrioma and pelvic adhesions, the candidates of laparoscopic surgery, were included. In each patient, at the end of ovarian cystectomy and adhesiolysis, one of the ovaries was randomly sutured to the abdominal wall, and the HYAcorp Endogel covered the other; the adhesion rate was compared between the groups by ultrasonography, three-month after surgery.
Results Mean age of patients was 32.6 years. Presurgical variables were similar between right and left ovaries and the study groups (P > 0.05). Postsurgical ultrasonography showed that ovarian soft markers, including < 1/3 ovarian adhesions (minimal adhesions) in 80.5% of ovaries of the Endogel group and 35.5% of the ovarian suspension group (P < 0.001) with higher ovarian mobility in the Endogel group (65% vs. 22%) (P = 0.001). In addition, site-specific tenderness and ovarian fading margin were lower in the Endogel group (P < 0.001).
Trial registration Clinical trial registry number: IRCT2015081723666N1, 12.19.2015, Date of registration: 01/02/2016; https://en.irct.ir/trial/20174?revision=20174. Date and number of IRB: 2015, I.R.IUMS.REC.1394.24703. Conclusion Hyaluronic acid gel can be more effective than ovarian suspension in preventing ovarian adhesions after laparoscopic treatment of endometriosis.
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Affiliation(s)
- Shahla Chaichian
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Zahra Najmi
- Zanjan University of Medical Sciences, Zanjan, Iran
| | - Kobra Tahermanesh
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahin Ahmadi Pishkuhi
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Jesmi
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Bahram Moazzami
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
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Tahermanesh K, Hanjani S, Saadat Mostafavi SR, Shahriyari R, Fazel Anvari-Yazdi A, Karimi-Zarchi M, Samimi M, Karimi A, Allahqoli L, Alkatout I. Hourglass cesarean scar: A neglected external niche in association with the internal niche. Int J Gynaecol Obstet 2021; 157:478-480. [PMID: 34839526 DOI: 10.1002/ijgo.14052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 11/05/2021] [Accepted: 11/26/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Kobra Tahermanesh
- Department of Obstetrics and Gynecology, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Soheil Hanjani
- Department of Obstetrics and Gynecology, Good Samaritan Medical Center, Brockton, Massachusetts, USA
| | | | - Roya Shahriyari
- Department of Obstetrics and Gynecology, Bank-e-Melli Iran Hospital, Tehran, Iran
| | - Abbas Fazel Anvari-Yazdi
- Division of Biomedical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Mojgan Karimi-Zarchi
- Department of Gynecology Oncology, Iran University of Medical Sciences, Tehran, Iran
| | - Mansooreh Samimi
- Department of Gynecology and Obstetrics, Kashan University of Medical Sciences, Kashan, Iran
| | - Anita Karimi
- Department of Internal Medicine, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences
| | - Leila Allahqoli
- School of Public Health, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Kiel, Germany
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14
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Mehdizadehkashi A, Rokhgireh S, Tahermanesh K, Eslahi N, Minaeian S, Samimi M. The effect of vitamin D supplementation on clinical symptoms and metabolic profiles in patients with endometriosis. Gynecol Endocrinol 2021; 37:640-645. [PMID: 33508990 DOI: 10.1080/09513590.2021.1878138] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To our knowledge, data on the effects of vitamin D supplementation on clinical symptoms and metabolic profiles in patients with endometriosis are limited. This study was conducted to determine the effects of vitamin D supplementation on clinical symptoms and metabolic profiles in patients with endometriosis. METHODS The current randomized, double-blind, placebo-controlled trial was conducted among 60 patients (aged 18-40 years old) with endometriosis. Participants were randomly allocated into two groups (30 participants each group) to receive either 50,000 IU vitamin D or placebo each 2 weeks for 12 weeks. RESULTS Vitamin D supplementation significantly decreased pelvic pain (β - 1.12; 95% CI, -2.1, -0.09; p=.03) and total-/HDL-cholesterol ratio (β - 0.29; 95% CI, -0.57, -0.008; p=.04) compared with the placebo. Moreover, vitamin D intake led to a significant reduction in high-sensitivity C-reactive protein (hs-CRP) (β - 0.64 mg/L; 95% CI, -0.97, -0.30; p<.001) and a significant increase in total antioxidant capacity (TAC) (β 47.54 mmol/L; 95% CI, 19.98, 75.11; p=.001) compared with the placebo. CONCLUSIONS Overall, our study demonstrated that vitamin D intake in patients with endometriosis resulted in a significant improvement of pelvic pain, total-/HDL-cholesterol ratio, hs-CRP and TAC levels, but did not affect other clinical symptoms and metabolic profiles.
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Affiliation(s)
| | - Samaneh Rokhgireh
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Kobra Tahermanesh
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Neda Eslahi
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sara Minaeian
- Antimicrobial Resistance Research Center, Institute of Immunology and Infectious Disease, Iran University of Medical Sciences, Tehran, Iran
| | - Mansooreh Samimi
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
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15
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Tahermanesh K, Mirgalobayat S, Aziz-Ahari A, Maleki M, Hashemi N, Samimi M, Fazel Anvari-Yazdi A, Shahriyaripour R, Pecks U, Allahqoli L, Alkatout I. Babu and Magon uterine closure technique during cesarean section: A randomized double-blind trial. J Obstet Gynaecol Res 2021; 47:3186-3195. [PMID: 34131999 DOI: 10.1111/jog.14889] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 05/22/2021] [Accepted: 05/29/2021] [Indexed: 11/29/2022]
Abstract
AIM We compared the effectiveness of the Babu and Magon uterine closure technique and unlocked double-layer uterine closure on the integrity and thickness of the uterine scar. METHODS A randomized double-blind trial was performed at Hazrat-e Rasoul -e-Akram Hospital, Tehran, Iran, from March 2018 to December 2019, in 72 pregnant women who were candidates for cesarean section for the first time. Women were randomly assigned to the Babu and Magon uterine closure technique (intervention group, n = 34) or double-layer closure of the uterine incision (control group, n = 38). The primary outcome of the study was the frequency of myometrial defects at the site of the scar (niche), and a large niche. Secondary outcomes, including the time taken for uterine closure and postpartum hemorrhage (early and late), were compared between groups. RESULTS Adjacent myometrium thickness (AMT) between the two groups was not statistically significant. A niche was reported in 23.5% (8/34) and 50% (19/38) of women in the intervention and controls, respectively (p = 0.02). A large niche was reported in 2.9% (1/34) and 23.7% (9/38) of women in the intervention and controls, respectively (p < 0.01). The duration of uterine closure was not statistically significant between the two groups. Hemoglobin levels did not differ significantly between groups during the first 24 h post-surgery. CONCLUSION The results of the study showed that the technique of uterine closure is one of the main potential determinants of myometrial healing. The Babu and Magon uterine closure technique seems to lead to tissue alignment during suturing and consequently cause better myometrial healing, although this issue calls for well-founded longer studies of appropriate design.
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Affiliation(s)
- Kobra Tahermanesh
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Shahla Mirgalobayat
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Alireza Aziz-Ahari
- Department of Radiology, Rasoul Akram Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Maryam Maleki
- School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Neda Hashemi
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mansooreh Samimi
- Department of Gynecology and Obstetrics, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Abbas Fazel Anvari-Yazdi
- Division of Biomedical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, Canada
| | - Roya Shahriyaripour
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Ulrich Pecks
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Leila Allahqoli
- School of Public Health, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Tahermanesh K, Hanjani S, Shahriyari R, Anvari-Yazdi AF, Allahqoli L, Alkatout I. The blooming phenomenon: a rare but a dilemma in hysteroscopic resection of myomas. J Turk Ger Gynecol Assoc 2021; 23:63-67. [PMID: 34082489 PMCID: PMC8907434 DOI: 10.4274/jtgga.galenos.2021.2021.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Modern surgical technologies allow gynecologists to treat most submucosal myomas hysteroscopically by some form of resection. What appears on imaging or direct visualization to be a submucosal myoma can be a single tumor, or may represent multiple smaller myomas appearing as one, compacted together in a typical pseudo capsule. During myoma resection, the effect of the media used to induce distension can vary, depending on the morphology of the myomas. After starting resection, the pressure of the distending media can push truly solitary myomas to somewhat flatten against the uterine wall. However, in the second type of myoma, the fluid can displace the myomas into the uterine cavity, an appearance similar to the blooming of a flower. The tip of the hysteroscope may enter the dissected spaces between the myomas, which impairs the panoramic view. This phenomenon may cause inadequate treatment of the myomas encountered during hysteroscopic myomectomy. In this study, the “Blooming phenomenon” is introduced, and the problems created by this phenomenon and solutions for its management are considered.
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Affiliation(s)
- Kobra Tahermanesh
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Soheil Hanjani
- Department of Obstetrics and Gynecology, Good Samaritan Medical Center, Brockton, Massachusetts, USA
| | - Roya Shahriyari
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Abbas Fazel Anvari-Yazdi
- Department of Biomedical Engineering, Materials and Biomaterials Research Center (MBMRC), Tehran, Iran
| | | | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany
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17
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Mehdizadehkashi A, Chaichian S, Haghighi L, Eshraghi N, Bordbar A, Hashemi N, Derakhshan R, Mirgalobayat S, Rokhgireh S, Tahermanesh K. The Impact of COVID-19 Pandemic on Stress and Anxiety of Non-infected Pregnant Mothers. J Reprod Infertil 2021; 22:125-132. [PMID: 34041009 PMCID: PMC8143014 DOI: 10.18502/jri.v22i2.5801] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: The newly emerging COVID-19 has caused severe anxiety around the world and it is infecting more people each day since there is no preventive measure or definite therapy for the diseases. The present study aimed to evaluate its effect on anxiety and stress of pregnant mothers during perinatal care. Methods: Three–hundred pregnant mothers without COVID–19 infection who were referred to the hospitals affiliated to Iran University of Medical Sciences for delivery during April 2020, based on negative clinical symptoms and the results of polymerase chain reaction (rt-PCR) for COVID–19, were recruited by census method and asked to complete the Persian version of the perceived stress scale (PSS); participants views about their anxiety level and the role of COVID–19 as the source of their stress and worries were recorded. Women who refused to continue the study were excluded. The frequency of variables and mean scores were calculated using SPSS v. 21. Results: Mean age of mothers was 30.20±16.19 years; 31.3% were primigravida and mean gestational age was 38.00±4.14 weeks. Moreover, 16.3% asked for earlier pregnancy termination and 39% requested Cesarean section (C/S). Assessing the mothers’ anxiety revealed a high/very high level of anxiety in 51.3%. The majority felt worried and frustrated because of COVID–19 (86.4%). Social media had a great impact on the level of stress among these mothers (60.3%). Conclusion: COVID-19 pandemic is an important source for the increased anxiety and stress among healthy pregnant mothers.
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Affiliation(s)
| | - Shahla Chaichian
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ladan Haghighi
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Nooshin Eshraghi
- Department of Perinatology, Shahid Akbarabadi Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Arash Bordbar
- Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Neda Hashemi
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Roya Derakhshan
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Shahla Mirgalobayat
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Samaneh Rokhgireh
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Kobra Tahermanesh
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
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18
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Rokhgireh S, Gorginzadeh M, Mehdizadehkashi A, Tahermanesh K, Alizadeh S. Broad ligament pregnancy in the presence of an intrauterine contraceptive device: A case report. Int J Surg Case Rep 2021; 79:421-423. [PMID: 33529821 PMCID: PMC7851414 DOI: 10.1016/j.ijscr.2021.01.080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 01/15/2021] [Accepted: 01/15/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Abdominal pregnancy though scarce is associated with considerable morbidity and mortality. Few cases till now have been diagnosed or managed by laparoscopy. CASE PRESENTATION In this study, a case of an abdominal pregnancy in a woman with intrauterine contraceptive device (IUD) in situ and a history of cesarean section is described. CLINICAL DISCUSSION Our case was a brief description of a broad ligament pregnancy as a subcategory of abdominal pregnancy .It was located medial to the pelvic sidewall, lateral to the uterus, inferior to the fallopian tube and superior to the pelvic floor. CONCLUSION The pregnancy was in the location of the left broad ligament which was diagnosed on laparoscopic evaluation.
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Affiliation(s)
- Samaneh Rokhgireh
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mansoureh Gorginzadeh
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | | | - Kobra Tahermanesh
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Shima Alizadeh
- Department of Obstetrics & Gynecology, Emam Complex, Vali-e-Asr Hospital, Tehran University of Medical Science(TUMS), Tehran, Iran.
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19
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Mehdizadehkashi A, Tahermanesh K, Rokhgireh S, Astaraei V, Najmi Z, Rakhshande M, Allahqoli L, Ahmadi Pishkuhi M, Alkatout I, Chaichian S. Uterine Isthmus Tourniquet during Abdominal Myomectomy: Support or Hazard? A Randomized Double-Blind Trial. Gynecol Obstet Invest 2020; 85:396-404. [PMID: 32937634 DOI: 10.1159/000510512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/22/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES A tourniquet has been suggested as a useful means of reducing massive hemorrhage during myomectomy. However, it is not clear whether the restricted perfusion affects the ovaries. In the present study, we examined the effect of a tourniquet on ovarian reserve and blood loss during myomectomy. MATERIALS AND METHODS In a randomized double-blind clinical trial, fertile nonobese patients scheduled for abdominal myomectomy at Rasool-e-Akram Hospital from February 2018 to June 2019 were randomized to a tourniquet (n = 46) or a non-tourniquet group (n = 35). Serum levels of anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH) were measured before and 3 months after surgery, blood loss was recorded during surgery, and serum levels of hemoglobin (Hb) were recorded before surgery, 6 h and 3 days after surgery. SPSS version 21 was used for statistical analysis. RESULTS Demographic, obstetric, and myoma characteristics were similar in the 2 groups (p > 0.05). The mean baseline values of AMH and FSH did not differ between groups (p > 0.05). After surgery, only FSH was higher in the control group (p = 0.043). Despite the time taken to fasten and open the tourniquet, the mean operating time was shorter in the tourniquet group (p < 0.001). Blood loss was higher in the control group (p = 0.005). The drop in Hb levels at 6 h after surgery was higher in the non-tourniquet group (p = 0.002). Blood loss was significantly associated with the duration of surgery (r = 0.523, p < 0.001). CONCLUSION The use of a tourniquet during abdominal myomectomy significantly reduced the mean volume of blood loss compared to the non-tourniquet group, while it did not prolong the duration of surgery, nor reduced the ovarian reserve. A tourniquet is a safe and efficient measure during abdominal myomectomy.
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Affiliation(s)
| | - Kobra Tahermanesh
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Samaneh Rokhgireh
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Vahideh Astaraei
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Najmi
- Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mehrnoosh Rakhshande
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Allahqoli
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahin Ahmadi Pishkuhi
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ibrahim Alkatout
- Campus Kiel, Kiel School of Gynaecological Endoscopy, University Hospitals Schleswig-Holstein, Kiel, Germany
| | - Shahla Chaichian
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran,
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20
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Gorginzadeh M, Tahermanesh K, Hanjani S, Khorshidizadeh A, Allahqoli L, Sadeghipour A, Anvari-Yazdi AF. Uterine intracavitary angioleiomyoma. J OBSTET GYNAECOL 2020; 40:1186-1188. [PMID: 32068451 DOI: 10.1080/01443615.2019.1705775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Mansoureh Gorginzadeh
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Kobra Tahermanesh
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Soheil Hanjani
- Department of Obstetrics and Gynecology, Good Samaritan Medical Center, Brockton, MA, USA
| | - Azadeh Khorshidizadeh
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Leila Allahqoli
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Alireza Sadeghipour
- Pathology Laboratory, Rasoul Akram Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Abbas Fazel Anvari-Yazdi
- Department of Biomedical Engineering, Materials and Biomaterials Research Center (MBMRC), Tehran, Iran
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21
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Rokhgireh S, Mehdizadehkashi A, Tahermanesh K, Gorginzadeh M. Association of endometrioma with ovarian teratoma and mucinous cystadenoma in a patient diagnosed with endometriosis: A case report. World J Obstet Gynecol 2019. [DOI: 10.5317/wjog.v8.i2.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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22
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Rokhgireh S, Mehdizadehkashi A, Tahermanesh K, Gorginzadeh M. Association of endometrioma with ovarian teratoma and mucinous cystadenoma in a patient diagnosed with endometriosis: A case report. World J Obstet Gynecol 2019; 8:8-12. [DOI: 10.5317/wjog.v8.i2.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/15/2019] [Accepted: 12/15/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Co-occurrence of different tumor types in a same patient’s ovaries diagnosed with endometriosis is a rare phenomenon.
CASE SUMMARY In this article we present an uncommon association of three distinct ovarian pathologies in a same woman presenting with adnexal mass. A 31-year-old nulliparous woman with a large persistent adnexal mass underwent laparoscopic surgery. Imaging demonstrated a multi-cystic mass with internal echoes. Tumor markers were within normal range. Based on histopathologic assessment, benign mucinous cystadenoma and mature cystic teratoma of the right ovary together with endometrioma of left ovary were revealed.
CONCLUSION In cases of large adnexal mass, the of existence of more than one tumor type and the involvement of the contralateral ovary is possible. Also, the possibility of concurrent underlying malignancy or diminished ovarian reserve should be kept in mind.
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Affiliation(s)
- Samaneh Rokhgireh
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran 1449614535, Iran
| | | | - Kobra Tahermanesh
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran 1449614535, Iran
| | - Mansoureh Gorginzadeh
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran 1449614535, Iran
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Haghighi L, Hashemi N, Tahermanesh K, Najmi Z, Baba Heydariyan P, Khaledi M. Mesenteric ischemia in pregnant woman: a case report. J OBSTET GYNAECOL 2019; 39:1012-1014. [PMID: 31161835 DOI: 10.1080/01443615.2019.1572077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Ladan Haghighi
- Department of Obstetrics and Gynecology, Iran University of Medical Sciences , Tehran , Iran
| | - Neda Hashemi
- Department of Perinatology, Fellowship of Perinatology, Iran University of Medical Science Endometriosis Research Center , Tehran , Iran
| | - Kobra Tahermanesh
- Fellowship of Minimally Invasive Gynecology Endometriosis Research Center Iran University of Medical Sciences , Tehran , Iran
| | - Zahra Najmi
- Fellowship of Minimally Invasive Gynecology Zanjan University of Medical Sciences , Zanjan , Iran
| | - Pegah Baba Heydariyan
- Department of Pathology, Rasool Akram Hospital Iran University of Medical Sciences , Tehran , Iran
| | - Mojdeh Khaledi
- Endometriosis Research Center Iran University of Medical Sciences , Tehran , Iran
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Kaveh M, Tahermanesh K, Hanjani S, Abed SM. B-Lynch plus technique for uterine conservative surgery in an asymmetric atonic uterus. Int J Gynaecol Obstet 2018; 142:370-371. [PMID: 29877589 DOI: 10.1002/ijgo.12562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 04/06/2018] [Accepted: 06/06/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Mania Kaveh
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Kobra Tahermanesh
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Soheil Hanjani
- Department of Obstetrics and Gynecology, Good Samaritan Medical Center, Brockton, MA, USA
| | - Seyedeh Mehr Abed
- School of Medicine, Yasuj University of Medical Sciences (YUMS), Yasuj, Iran
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25
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Kaveh M, Tahermanesh K, Mehdizadeh Kashi A, Tajbakhsh B, Mansouri GH, Sadegi K. Endometriosis of Diaphragm: A Case Report. Int J Fertil Steril 2018; 12:263-266. [PMID: 29935074 PMCID: PMC6018178 DOI: 10.22074/ijfs.2018.5379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/05/2017] [Indexed: 11/26/2022]
Abstract
Endometriosis affects about 10% of women of reproductive age. Its main feature is the presence of stroma
and endometrial glands in sites other than the uterus, mainly in pelvis. Pelvic peritoneum, ovaries, uterine
ligaments, bladder, intestines, andcul-de-sac are among the affected areas. Sometimes endometriosis can be
found outside of the pelvis and even above abdominal cavity, like indiaphragm.Herein, we present a case of
an asymptomatic diaphragmatic endometriosis that was discovered incidentally during laparoscopy of pelvic
endometriosis, as well as our appropriately proposed treatment protocol.
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Affiliation(s)
- Mania Kaveh
- Endometriosis Research Center, Iran University of Medical Science, Tehran, Iran.,Department of Obstetrics and Gynecology, Zabol University of Medical Science, Zabol, Iran
| | - Kobra Tahermanesh
- Endometriosis Research Center, Iran University of Medical Science, Tehran, Iran
| | - Abolfazl Mehdizadeh Kashi
- Endometriosis Research Center, Iran University of Medical Science, Tehran, Iran. Electronic Address:
| | - Banafsheh Tajbakhsh
- Endometriosis Research Center, Iran University of Medical Science, Tehran, Iran
| | - G Hazal Mansouri
- Endometriosis Research Center, Iran University of Medical Science, Tehran, Iran.,Department of Obstetrics and Gynecology, Kerman University of Medical Science, Kerman, Iran
| | - Kambiz Sadegi
- Pain Research Center, Iran University of Medical Science, Tehran, Iran.,Department of Anesthesiology, Zabol University of Medical Science, Zabol, Iran
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Tahermanesh K, Fazel Anvari-Yazdi A. Author's Reply. J Minim Invasive Gynecol 2017; 25:344-345. [PMID: 29102508 DOI: 10.1016/j.jmig.2017.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 10/25/2017] [Indexed: 11/27/2022]
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Almassinokiani F, Mehdizadeh Kashi A, Musavi A, Khodaverdi S, Tahermanesh K, Ariana S. Rectal perforation in a 42-year-old woman due to Henoch-Schönlein purpura: a case report. Reumatismo 2017; 69:131-133. [PMID: 28933137 DOI: 10.4081/reumatismo.2017.948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 06/28/2017] [Accepted: 07/04/2017] [Indexed: 11/23/2022] Open
Abstract
Henoch-Schönlein purpura (HSP) is caused by deposition of IgA-containing immune complexes within the blood vessels. HSP mostly occurs in children and is less common in adults. In addition to palpable purpura, arthritis or arthralgia, renal disease and abdominal pain, gastrointestinal symptoms occur in 50% of children. These can be caused by gastrointestinal hemorrhage, bowel ischemia and necrosis, intussusception, and bowel perforation. In adults, intussusception is less frequent than in children. We report a 42-year-old woman referred to our hospital with acute abdominal pain. After laboratory and radiologic examinations, laparatomy was performed which revealed rectal perforation due to HSP. HSP is a multisystem disorder. Abdominal pain in patients with HSP may herald a serious gastrointestinal problem also in adult patients.
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Affiliation(s)
- F Almassinokiani
- Department of Minimally Invasive Gynecology Surgery, Minimally Invasive Surgery Research Center, Iran University of Medical Sciences (IUMS), Tehran.
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Mehdizadehkashi A, Tahermanesh K, Fazel Anvari-Yazdi A, Chaichian S, Azarpira N, Nobakht M, Abed SM, Hashemi N. Ultrastructural Investigation of Pelvic Peritoneum in Patients With Chronic Pelvic Pain and Subtle Endometriosis in Association With Chromoendoscopy. J Minim Invasive Gynecol 2016; 24:114-123. [PMID: 27693809 DOI: 10.1016/j.jmig.2016.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/16/2016] [Accepted: 09/22/2016] [Indexed: 01/07/2023]
Abstract
STUDY OBJECTIVE To evaluate the pelvic peritoneum under chromoendoscopy by scanning electron microscopy (SEM) as well as light microscopy with hematoxylin and eosin staining and immunohistochemistry (IHC) assays in patients with chronic pelvic pain (CPP) associated with subtle endometriosis. DESIGN Case series study (Canadian Task Force classification II). SETTING A referral academic community tertiary medical center. PATIENTS Three women aged 29 to 37 years were referred to the obstetrics and gynecology clinic of the tertiary university hospital with CPP. They were suspicious for endometriosis, were not responding to medical treatments, and had undergone previous pelvic laparoscopy to determine the stage of endometriosis and preparation of peritoneal samples under the guidance of staining with methylene blue in 0.25% dilution. INTERVENTIONS Comparison of stained and unstained pelvic peritoneal samples after the instillation of 0.25% methylene blue into the pelvic cavity. MEASUREMENTS AND MAIN RESULTS In 3 patients, laparoscopic examination showed minimal endometriosis. A total of 18 samples (9 stained and 9 unstained) from the 3 patients were prepared for SEM. Ten of the samples (55.6%) showed microstructural peritoneal destruction (7 of 9 stained [77.7%] and 3 of 9 [33.4%] unstained). Eighteen samples (9 stained and 9 unstained) from the 3 patients were also prepared for IHC. Six of these samples (33.3%) were S-100-positive, including 4 of 9 (44.4%) stained samples and 2 of 9 (22.2%) unstained samples. CONCLUSIONS In general, in the context of CPP and endometriosis, there is no established relationship between the severity of pain and stage of endometriosis. In the pathophysiology of CPP associated with endometriosis, ultrastructural changes can play a significant role. Under methylene blue staining, some destroyed areas were detected, but the stained areas do not necessarily correlate with increased microstructural peritoneal destruction.
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Affiliation(s)
| | - Kobra Tahermanesh
- Endometriosis and Gynecologic Disorders Research Center, Department of Obstetrics and Gynecology, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | | | - Shahla Chaichian
- Minimally Invasive Techniques Research Center in Women, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Negar Azarpira
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maliheh Nobakht
- Department of Anatomy, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Mehr Abed
- School of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Neda Hashemi
- Endometriosis and Gynecologic Disorders Research Center, Department of Obstetrics and Gynecology, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Fazel Anvari-Yazdi A, Tahermanesh K, Hadavi SMM, Talaei-Khozani T, Razmkhah M, Abed SM, Mohtasebi MS. Cytotoxicity assessment of adipose-derived mesenchymal stem cells on synthesized biodegradable Mg-Zn-Ca alloys. Mater Sci Eng C Mater Biol Appl 2016; 69:584-97. [PMID: 27612751 DOI: 10.1016/j.msec.2016.07.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/13/2016] [Accepted: 07/06/2016] [Indexed: 11/16/2022]
Abstract
Magnesium (Mg)-based alloys have been extensively considered as biodegradable implant materials for orthopedic surgery. Mg and its alloys are metallic biomaterials that can degrade in the body and promote new bone formation. In this study, the corrosion behavior and cytotoxicity of Mg-Zn-Ca alloys are evaluated with adipose-derived mesenchymal stem cells (ASCs). Mg-2Zn and Mg-2Zn-xCa (x=1, 2 and 3wt.%) alloys were designated. Mg alloys were analyzed with scanning electron microscopy and potentiodynamic polarization. To understand the in-vitro biocompatibility and cytotoxicity of Mg-2Zn and Mg-2Zn-xCa alloys, ASCs were cultured for 24 and 72h in contact with 10%, 50% and 100% extraction of all alloys prepared in DMEM. Cell cytotoxicity and viability of ASCs were examined by MTT assay. Alloying elements including Zn and Ca improved the corrosion resistance of alloys were compared with pure Mg. The cytotoxicity results showed that all alloys had no significant adverse effects on cell viability in 24h. After 72h, cell viability and proliferation increased in the cells exposed to pure Mg and Mg-2Zn-1Ca extracts. The release of Mg, Zn and Ca ions in culture media had no toxic impacts on ASCs viability and proliferation. Mg-2Zn-1Ca alloy can be suggested as a good candidate to be used in biomedical applications.
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Affiliation(s)
- Abbas Fazel Anvari-Yazdi
- Department of Biomedical Engineering, Materials and Biomaterials Research Center (MBMRC), Tehran, IR, Iran
| | - Kobra Tahermanesh
- Endometriosis and Gynecologic Disorders Research Center, Department of Ob. & Gyn., Rasoul-e Akram Hospital, Iran University of Medical Sciences (IUMS), Tehran, IR, Iran.
| | | | - Tahereh Talaei-Khozani
- Tissue Engineering Lab, Anatomy Department, School of Medicine, Shiraz University of Medical Sciences (SUMS), Shiraz, IR, Iran
| | - Mahboobeh Razmkhah
- Shiraz Institute for Cancer Research, School of Medicine, Shiraz University of Medical Sciences (SUMS), Shiraz, IR, Iran
| | - Seyedeh Mehr Abed
- School of Medicine, Yasuj University of Medical Sciences (YUMS), Yasuj, IR, Iran
| | - Maryam Sadat Mohtasebi
- Shiraz Institute for Cancer Research, School of Medicine, Shiraz University of Medical Sciences (SUMS), Shiraz, IR, Iran
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Chaichian S, Mehdizadehkashi A, Tahermanesh K, Moazzami B, Jesmi F, Rafiee M, Goharimoghaddam K. Leiomyosarcoma of the Broad Ligament With Fever Presentation: A Case Report and Review of Literature. Iran Red Crescent Med J 2016; 18:e33892. [PMID: 27330834 PMCID: PMC4913035 DOI: 10.5812/ircmj.33892] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 12/09/2015] [Accepted: 02/09/2016] [Indexed: 11/16/2022]
Abstract
Introduction Leiomyosarcoma is a rare gynecologic malignancy that accounts for less than 1% of gynecological malignancies. Leiomyosarcoma of the broad ligament is an even rarer condition. According to Gardner’s criteria, the diagnosis is made when the mass is completely separated from the uterus and adnexa. So far, 23 cases of primary leiomyosarcoma of the broad ligament have been reported in the literature published in English. Case Presentation In September 2014, a 55-year-old, gravida 3, para 3 woman with a BMI of 30 and a chief complaint of fever and dizziness was admitted to the infectious-diseases ward of the Pars general hospital affiliated with Iran University of Medical Sciences in Tehran, Iran. Her symptoms had begun two weeks before. The results of a fever workup and examination for infectious, metabolic, and immunologic problems were all negative. Imaging modalities revealed an endometrial polyp, two calcified myoma in the body of the uterus, and a solid, heterogeneous 70-mm mass in the right para-cervical space, posterior to the broad ligament, and far from the ovary. After surgery, a histologic report revealed leiomyosarcoma. Conclusions Although a leiomyosarcoma of the broad ligament is rare, practitioners should consider it when dealing with masses in the region of the broad ligament. If there is any suspicion of malignancy, especially in the presence of fever, it is recommended to avoid morcellation during laparoscopy.
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Affiliation(s)
- Shahla Chaichian
- Minimally Invasive Techniques Research Center in women, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, IR Iran
- Pars Advanced and Minimally Invasive Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, IR Iran
| | - Abolfazl Mehdizadehkashi
- Pars Advanced and Minimally Invasive Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, IR Iran
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Abolfazl Mehdizadehkashi, Endometriosis Research Center, Iran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2122602478, E-mail:
| | - Kobra Tahermanesh
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Bahram Moazzami
- Pars Advanced and Minimally Invasive Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, IR Iran
| | - Fatemeh Jesmi
- Pars Advanced and Minimally Invasive Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, IR Iran
| | - Moezedinjavad Rafiee
- Pars Advanced and Minimally Invasive Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, IR Iran
| | - Katayoun Goharimoghaddam
- Pars Advanced and Minimally Invasive Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, IR Iran
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