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Assessing the role of enema in improving outcomes and complications of benign gynecological laparoscopy: a randomized clinical trial
Zahra Asgari, Azam Barkhordarinasab, Reihaneh Hosseini , Alireza Hadizadeh, Venus Chegini, Sara Farzadi,
Volume 79, Issue 11 (2-2022)
Abstract
Background: mechanical bowel preparation (MBP) is a common practice before laparoscopic gynecologic surgeries but the role and efficacy of preparation have been questioned. this study assesses visualization and bowel handling in a group of patients who receive MBP and the control group and thereafter; compares the results.
Methods: We designed and conducted this randomized, single-blinded and controlled trial on patients who underwent advanced gynecologic laparoscopic surgeries. This clinical trial was carried out between July 2020 and January 2021. The patients were enrolled from l the laparoscopic office. 120 women aged 18-65 years undergoing level 2 and 3 benign gynecologic laparoscopic surgeries were randomized to bowel preparation with a normal saline enema (n=60) or non-bowel preparation (n=60) groups. Our patients underwent level 2 and 3 of benign laparoscopic gynecologic surgeries with or without MBP. The visualization and bowel handling were assessed by the primary surgical team and a questionnaire was later obtained. The outcomes included intraoperative surgical view and bowel handling, preoperative and post-operative patient signs and symptoms. The patients were also assessed in respect to discomfort prior and after the surgery, this assessment was obtained using a questionnaire. The gathered data was analyzed using IBM’s SPSS v26 software.
Results: there was no difference in intraoperative visualization and bowel handling between the two groups. We also found no clinical improvements in respect to discomfort and symptoms. MBP even increased the distention rate amongst patients (P-value=0/04). We tried to evaluate whether MBP had any effects on haemorrhage and blood loss during the surgery and to assess this we compared hemoglobin levels before and after the surgery. We compared the subtracted values between the two groups and found no significant difference (T-test=1.135, P=0/259) (see table 4). However, hospitalization duration was about 5 hours longer in the group who received MBP.
Conclusion: MBP with normal saline enema does not improve intraoperative visualization and bowel handling. And it also does not reduce patient complication rates and post-operative symptoms either. MBP also increases hospitalization duration and puts extra pressure on the healthcare system. Therefore, a normal saline enema is not recommended before benign gynecologic laparoscopic surgeries.
 

Bartholin gland cancer in a young woman: a case report
Ali Taghizadeh, Leila Pourali , Amirhosein Jafarian , Farokh Seilanian Toosi , Ghazal Ghasemi, Marjaneh Farazestanian, Mitra Enzebati,
Volume 79, Issue 11 (2-2022)
Abstract
                                                                        
 
 
 
 
 
 
 
Background: With 6,020 new cases and 1,150 deaths annually in the United States, vulvar cancer is uncommon, resulting in age-adjusted incidence rates of 2.8 and 1.7 per 100,000 in white and black women, respectively. Vulvar cancer represents about 4% to 6% of malignancies of the female genital tract and 0.6% of all cancers in women. Vulvar cancer predominantly affects postmenopausal women, and it is the most common anogenital cancer in women with more than 70 years of age. HPV infection is associated with a significant number of vulvar cancers. Bartholin Gland carcinoma is a rare form of vulvar malignancy that accounts for less than 5% of all vulvar cancers and 0.001% of all genital cancers. The aim of this study was to report a rare case of Bartholin's cancer in a young patient.
Case Report: The patient was a 37-year-old woman p2l2 (history of two pregnancy and two delivery) who had complains of severe pain in perineal area and was referred to the gynecology emergency clinic, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran, in June 2020. In past medical history she had no previous history of medical illnesses or surgical interventions. She had swelling and pain in perineal area since one year ago. Bartholin Gland abscess was diagnosed and she received some oral antibiotics, but did not improve. On the last examination under anesthesia, a firm mass of about 3 cm was palpated in the third distal part of posterior vagina which was at the site of Bartholin Gland and was necrotic. The pathologic report of the mass biopsy confirmed the diagnosis of squamous cell carcinoma. The patient was underwent chemo radiation therapy. At a follow up visit about 5 month later she was cured completely and there was not any symptom of recurrence or metastasis.
Conclusion: In dealing with any patient with diagnosis of Bartholin Gland abscess, in the case of resistance to medical treatment, further evaluation and biopsy of the mass should be considered to rule out Bartholin's gland cancer.
 

 

Evaluation role of beta-2 adrenoceptor agonist and antagonist in the expression of gap junction genes (connexin 37/43) in cumulus cells of women with poor ovarian response
Farideh Zafari Zangeneh , Samad Muhammadnejad, Mohammad Mehdi Naghizadeh, Maryam Bagheri, Elnaz Hekmat,
Volume 79, Issue 11 (2-2022)
Abstract
Background: Connexon is a membrane structural protein in the gap junctions. These cellular connections are responsible for transporting ions and messenger molecules to the oocyte. This study aimed to investigate the role of beta-2-adrenoceptors in the process of follicle growth based on the expression of the two connexins 37/43 in the gap junctions that have a primary role in the mitotic resumption and oocyte maturation.
Methods: This case-control study was conducted from April 2019 to November 2020 at the Reproductive Health Research Center of Tehran Imam Khomeini Hospital was performed on women with the poor ovarian response (POR) and control (women donate eggs) groups. Both groups had entry criteria with a body mass index under 28 m2/kg and 20-45 years old. Exit criteria were including no drug use except ovarian stimulants and no illness. The diagnosis was made agreeing to the Bologna model criterion. Ovulation stimulation cycle was performed, and then after the puncture, cumulus cells were isolated by enzyme and were freezing in -80 centigrade until the time of inserting into the cell culture medium. Isoproterenol (agonist) and propranolol (antagonist) at a concentration of 100 nM were added to the culture medium as the beta-2 adrenoceptors selective drugs. After culture, RNA extraction was performed and the concentration was read by Nanodrop, and then cDNA was synthesized. Gene expression was determined by real-time PCR.
Results: The findings of connexin expression in the three study groups: without the drug (P<0.001), propranolol (P<0.001), and isoproterenol (P<0.001) were significant compared to the control group. Isoproterenol decreased expression but propranolol increased it (P<0.001).
Conclusion: These findings confirm the important role of connexins 37 and 43 in cumulus cleft junctions that propranolol was able to increase its expression. Therefore, we suggest firstly these two connexins can be an effective target for oocyte growth and maturation. Secondly, propranolol could be a new treatment for women with POR and be effective in assisted reproductive technology (ART).
 

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