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

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.

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.

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.

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.

Heavy Worm Burden of Moniliformis moniliformis in Urban Rats with Histopathological Description

BACKGROUND

Due to scarcity of human reports, we took advantage of the heaviest infection of M. moniliformis in rats, to describe histopathological and microanatomical valuable useful keys while confronting human occurrences.

METHODS

Samples were obtained from captured rats in Tehran, capital of Iran, during two decades. Tissue sections were performed through hematoxylin and eosin staining to describe histopathological changes in rat's intestines.

RESULTS

Totally, nine rats were found infected with M. moniliformis amongst 272 obtained rats. Heavy infection has been distinguished in 2 individuals with parasite burden of 141and 73 adult worms. Cross sections of worms within the lumen show mucosal thickness, infiltration of eosinophilic leukocyte and increase in goblet cells.

CONCLUSION

Beyond the uncommonness of human infection with M. moniliformis unitended infections should not be ignored. Abundance of rats and roaches as definite and intermediate hosts must be considered particularly in countries with poor hygiene.

Establishment of Hymenolepis diminuta Life Cycle to Provide Parasite Mass Production

BACKGROUND

The main object of this experimental work was to practise laboratory production both adult and the larval stage of Hymenolepis diminuta with conventional modification to make further studies easier. MATERIALS #ENTITYSTARTX00026;

METHOD

Adults H. diminuta were collected from urban rats in Tehran, Iran. The beetles became infected using blended gravid segments with flour as bait. Cysticercoids have been saved after precise dissection of invertebrate hosts. The exposure of infected beetles to laboratory rats was performed to establish the life cycle.

RESULT

Out of 57 collected rats, three rats were infected with H. diminuta. Almost all exposed beetles found infected with the larval stage of parasite. About one-month later H. diminuta eggs were seen in stool examination of laboratory rats.

CONCLUSION

Rare human occurrence of H. diminuta along with light level of clinical manifestation of this parasite, underestimate the concerns toward its public health importance. Nowadays, various field of studies, such as biochemistry with special focuses on the capability of H. diminuta tegument absorption have performed apart from parasitological views alone. In the present study, establishment of this parasite life cycle has practically provided the access of adult and cysticercoid stages of the tapeworm in further researches.