Tehran University Medical Journal

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The autopsies, which have been performed within the last 50 years, have revealed that real prevalence of prostatic carcinoma is more frequent than clinical one. The real prevalence of prostatic carcinoma, is prevalence combination of carcinomas which have been revealed clinically (They have been confirmed by autopsy or by operation) and the prostatic latent carcinomas are those, which are found in autopsy or randomly in the biopsies taken for hyperplasia. But they have no clinical syndromes. In order to review prevalence of prostatic latent carcinoma in Iran, all prostatic lesions (Including hyperplasia or carcinoma) were studied in Imam Khomeini medical complex during 10 years (1981-91), in university Jihad center and medical center of Iran within 2 years and in Yazd faculty of medicine within 3 years (1981-84). The total cases were 1110 among which 1085 cases were selected upon reviewing for statistical analysis. At first all lamellas were studied, then the ratio of adenocarcinoma to total prostatic lesions were analyzed and types of carcinoma and their percentage in total cases were identified. Finally the prostatic latent carcinoma and its percentage in total malignancy cases were presented

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This study was focused on analysis of expenditure on all the medical services given at Neuro-Surgery Department of Imam-Khomeini Hospital in the year of 1994 (1373). In this study, all the information on descriptive method and the techniques of cost analysis and cost per unit of service provided accountancy, were analysed. 573 patients were considered in this study. 522 of them underwent 13 different types of neuro-surgery operations. 92.6% of them total departmental costs were related to current expenditures and 7.4% of that was related to the capial expenditures. The personnel costs with 49% was the highest portion of the total costs. Percentage wise, the costs were as follows: Medicine, materials and equipment 22%, food 17.6%, depreciation 7.4%, fuel, water, electricity and telephone 3.5%. The mean duration of stay was 16.3 days for every in-patient. The percentage of occupied bed was 58% if the percentage of desired bed occupancy was supposed 80%, therefore, 22% of the bed, plus 3512 bed-day were gone wasted. The real cost of med-care policy need to be more rational for the operation and hospitalization. It should be mentioned that the wasted time was 886 hours and wasted cost was 71, 708, 410 Rials in operation room.

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One method of drug smuggling is body packing or body stuffing, placement of narcotics (opium, heroin, hashish, …) inside intestinal tract for transfer from city to city or country to country. Estimating of the methods for transferring, content of packets, packaging, cause of death and results of diagnostic and therapeutic methods can effectively decrease the number of body packer and law execution. This study is case series by randomized sampling. Several parameters such as sex, age, marital status, addiction, job, level of education, type of opioids and their weight and number of packets, result of abdominal X-ray, surgery needs, were collected from April 1999 to December 2000. Through this period of time, 32 male smuggler who had swallowed drug packets were detained. The average age was 41 years (max=62, min=20). The minimum weight of the opium carried by this smugglers was below 20 gram and maximum weight was 1000 grams (median=360 grams). The minimum number of packets were one packet and maximum number of packets were 54 (median=10 packets). In 84 percent of body smugglers the content of packets was opium, 13 percent was heroin and 3 percent was hashish. From the cases, 81 percent of smugglers were addicts themselves. Death occurred in 7 cases from which 3 were after surgery.

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Background: The role prophylactic antibiotics in otologic surgery continues to be debated and perhaps misused. Prior studies have provided conflicting evidence with benefits obtained from the use of prophylactic antibiotics in surgery for chronic otitis media.

Materials and Methods: The current study was designed to evaluate the role of prophylactic antibiotics in the wound infection and outcome of surgery for chronic ear disease. It was the authors' impression that there was no difference between topical and systemic antibiotics in such surgery. Patients who met the inclusion criteria (n=193) were randomly assigned to a topical treatment group or a control group receiving only intravenous antibiotics for 1 dose intra operatively and 3 dose there after. Patients were followed post-operatively and observed for clinical evidence of infection, graft failur and hearing status.

Results: There was no statistically significant difference between the two groups with regard to the incidence of postoperative infection or graft survival.

Conclusion: The use of prophylactic antibiotics in surgery for chronic otitis media can be recommended as an alternative method.

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Background: The important of angiogenesis for the progressive growth and viability of solid tumors is well established. Only few data are available for hematologic neoplasms.

Materials and Methods: To investigate the role of angiogenesis in the acute myloid leukemia (AML) bone marrow biopsies from 30 adults with newly diagnosed, untreated AML(day 0) were evaluated. Further studies were done after completion on remission induction of treatment (day 35 of 7×3 regimen n=13, complete remission in AML (m3) treat with arsenic trioxide n=17). Micro-vessels were scored in at least 3 areas of highest micro-vessel density in representative section of each bone marrow specimen using immunohistochemistry for Von Willbrand factor.

Results: Median micro-vascular density (MVD) were in AMLM3 patients before treatment, %6.81±3.58 and after treatetment %3.48±3.06 (p<0.0001). In other AML patients MVD were befor treatment %3.38 and after treatment %3.6.

Conclusion: In conclusion, there is evidence of increased micro-vessel density in the bone marrow of patients with AML, which supports the hypothesis of an important role of angiogenesis in AML. MVD was reduced with chemotherapy and arsenic. Furthermore , these finding suggest that antiangiogenesis therapy might constitute a novel strategy for the treatment of AML.

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Background: Bone marrow transplantation (BMT) is the treatment of choice for many patients with malignant and nonmalignant diseases. Long-term complications such as osteoporosis should be considered, because it is directly associated with the morbidity and mortality. The purpose of this study is to assess the bone mineral density after allogenic or autologous bone marrow transplantation in patients with leukemia or lymphoma.
Methods: We prospectively investigated 63 patients undergoing BMT for acute and chronic leukemia and lymphoma. At the end of the study, a total of 28 patients were assessed. Bone mineral density (BMD) was measured prior BMT, and 6 and 12 months after BMT. Osteocalcin, bone alkaline phosphatase and C-terminal telopeptides of type 1 collagen (ICTP) were assessed. Serum concentration of calcium, phosphorous, vitamin D, PTH and sex hormones (FSH, LH, testosterone and estradiol) were also measured.
Results: There was a significant decrease in the bone mineral density of the femoral neck six months after BMT (p<0.001), 1.01±0.13g/cm² prior to BMT and 0.96±0.13 g/cm² at six months, but no considerable changes were seen in lumbar vertebrae. Bone loss between the 6th and 12th months was not observed. The levels of ICTP and phosphorus increased significantly by the 12th month (p=0.04). The level of calcium was higher at the 6th month (p=0.002) but the level of vitamin D and PTH decreased by the end of the study (p=0.04 and p=0.01, respectively) and the average of osteocalcin did not increase significantly. In women, the level of estradiol decreased by the 6th month (p=0.01), but the testosterone changes were not significant.
Conclusion: The risk of bone loss in both allogeneic and autologous BMT is higher in the femoral neck than the lumbar vertebrae, occurring mainly in the first six months after BMT. Preventive and clinical procedures should be considered.

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Background: Major clinical manifestations of antiphospholipid syndrome (APS) in the central nervous system are generally arterial thrombotic events and a number of non-thrombotic neurologic syndromes. Antiphospholipid antibodies (APAs) are one of the important risk factors for cerebrovascular accidents (CVA). The aim of present study was to assess the relationship between APA titers and CVA in this clinically important age group.
Methods: This case-control study was carried out on patients under 50 years old who had CVA (stroke or transient ischemic attack) in Shahid Sadoughi Hospital in Yazd (central Iran) from Dec 2003 until March 2005. In this study, 61 patients with CVA were compared with 68 age- and gender-matched control subjects. Lupus anticoagulant assay results and APA titers were assessed in both groups.
Results: The mean value of IgM APA titers in patients with cerebrovascular accidents was 6.492 MPL (IgM antiphospholipid units) and 1.846 MPL in the control group. The difference between the two groups was significant (p-value: 0.000). In 12 (20%) of the patients with cerebrovascular accidents, IgM titers were higher than 10 MPL, one of whom had an IgM titer higher than 40 MPL. The mean value of IgG titers in the case group was 5.50 GPL (IgG antiphospholipid units) and 3.51 GPL in the control group. The difference between the two groups was significant (p-value: 0.012). Thirteen (21%) patients with cerebrovascular accidents had IgG titers higher than 10 GPL. The difference between the LA assay results was not significant between the two groups (p-value: 0.311).
Conclusion: The present study showed a positive relationship between APL (IgM and IgG) titers and CVA in patients under 50 years old.

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Background: As an important diagnostic and therapeutic procedure for patients with intrauterine diseases, hysteroscopy permits a good view of the uterine cavity, thereby increasing diagnostic accuracy. Complications often encountered during hysteroscopy primarily concern problems with cervical dilatation and include uterine perforation, cervical tears, and the creation of false tracts. In this study, we investigate the utility of vaginal misoprostol for cervical dilatation in women undergoing hysteroscopy.

Methods: This triple-blind, randomized, placebo-controlled study was carried out at Mirza Khoochak Khan Hospital, Tehran, Iran. We excluded women who were pregnant, had genital tract infection, or history of cervical trauma. We randomly assigned 80 women with abnormal uterine bleeding or intrauterine lesions to receive either 200 μg vaginal misoprostol or placebo. Ten to twelve hours prior to hysteroscopy, the placebo or misoprostol was administered to the posterior vaginal fornix. Data regarding cervical response and outcome of operative hysteroscopy, as well as complications, were analyzed.

Results: The mean cervical width, as estimated by Hegar dilator, was significantly greater in the treated group (7.8±1.6mm) than that in the control group (5.6±2.2mm, p<0.001). In the misoprostol group, 28 (70%) patients required cervical dilatation, compared with 38(95%) in the placebo group (p=0.001). A significantly shorter median time of cervical dilatation to Hegar number 9 was found in the treated subjects than in the controls (60 vs. 180 seconds, p<0.001). The mean operative time was significantly shorter in the treated group (8.8±8.7 minutes) compared with that of the control group (13.1±10.1 minutes, p=0.043).

Conclusions: Vaginal misoprostol before operative hysteroscopy lessens the need for cervical dilatation, facilitating hysteroscopic surgery.

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Background: Transitional Cell Carcinoma (TCC) of bladder is the second most common urogenital malignancy and because of its high rate of recurrence (two third of tumors recur) vigilant surveillance is necessary. There have been a lot of efforts to find a proper biomarker for detecting urothelial cancers because available methods are expensive and invasive (like cystoscopy) or have a low degree of sensitivity (like urine cytology). Urothelial malignancies, like other cancers tend to express a large amount of telomerase. The aim of this study was to evaluate the possible application of voided urine human telomerase reverse transcriptase (hTERT) mRNA assay in detecting low-grade bladder carcinoma in comparison with urine cytology.

Methods: Voided urine samples were collected from 49 patients who were supposed to go under operation. Samples were examined by both Quantitative Real-time RT-PCR (for measuring hTERT mRNA level) and cytology the results were then compared to the final pathologic studies.

Results: Regardless of clinical stage and or pathological grade of tumor, sensitivity of telomerase test and urine cytology was 74% and 16% respectively. There was a strong correlation between results of urine cytology and stage and/or grade of tumor however, sensitivity of telomerase test was acceptable regardless of stage and or grade of tumor. There was a statistically significant difference between sensitivity of urine cytology and telomerase test (p<0.001).

Conclusion: Detection of hTERT-mRNA can potentially be used as a non-invasive method for diagnosis and follow up of bladder carcinoma instead of urine cytology.

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Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 B ackground: Preterm birth which is defined as delivery before 37 completed weeks was implicated in approximately two thirds of neonatal death. Also preterm labors are the most common cause of mortality and morbidity of infants in recent years and it costs high prices for health system. We evaluate the relationship between prepregnancy maternal body mass Index (BMI) and spontaneous and indicated preterm birth.
Methods: This study included 250 healthy pregnant women, without any risk factors of preterm birth, were classified into categories that were based on their body mass index. Association between BMI, weight gain and rout of delivery were examined. Rates of indicated and spontaneous preterm birth were compared.
Results: Obese women delivered at a more advanced gestational age. (38/34±1/66 weeks vs 37/61±2/44, p=0/006). Obese patients had significantly lower incidence of spontaneous preterm birth at < 37 weeks of gestation (16/8% vs 31/2% p=0/008). Obese women had larger infants (3354/95±596/75 vs 311.24±558/357 p=0/001), and had more frequent cesarean delivery (69/6% vs 52/8%, p=0/006). Weight gain during pregnancy is poorly correlated with prepregnancy BMI (14/41±7/93 kg vs 13/78±4/94kg, p=0/4) and preterm birth.
Conclusion: In this survey, there was adverse correlation between body mass index (BMI) before pregnancy and preterm labor less than 37 completed weeks and we suggest more study for evaluation between spontaneous and induced preterm labor mechanism and in obese and non obese women. However according to this survey obesity before pregnancy is associated with a lower rate of spontaneous preterm birth.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 !mso]> ject classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id=ieooui> Background: Polyethylene glycol (PEG) solution can induce complications when used as preoperative bowel preparation. The aim of this study was to compare two methods for mechanical bowel preparation in elective operations of colon.
Methods: In a randomized clinical trial, 129 patients elected for anastomosis of colon and referred to the surgical clinic of Imam Khomeini Hospital of Tehran between March 2008 and March 2009 were included. They were randomly allocated into two groups of PEG1 (1liter of PEG or 70gr plus 15 mg bizacodil, n=63) and PEG4 (4 liter of PEG), according to the way of bowel preparation and on the day before surgery, they received oral and IV prophylactic antibiotics and cleared solutions. In the morning of the surgery, they received their medication during 240 minutes. Then, they underwent anastomosic surgery of colon. The principle variables recorded were nausea, vomiting, flatulence, Na and K in the night before surgery, patients' and surgeons' satisfaction from bowel preparation and postoperative infection and leakage.
Results: The majority of the patients were male (62%). Nausea (28.57% vs. 98.48%, p=0.001), flatulence (36.51% vs. 95.45%, p=0.001), and vomiting (4.76% vs. 75.76%, p=0.001) were significantly lower in PEG1 and the patients' satisfaction were significantly higher (59.02% vs. 1.52%, p=0.001) Peroperative Na was significantly higher in PEG4 group (141.21±3.63 vs. 139.94±2.97mg/l, p=0.001) and serum K was significantly lower (3.55±0.25 vs. 3.76±0.21, p=0.001). Surgeons' satisfaction were significantly higher in PEG4 group (good to very good 72.73% vs. 43.54%, p=0.001). Postoperative infection of surgical site, anastomosis leakage and ICU admission were comparable between study groups.
Conclusions: Bowel preparation with 1 liter of PEG plus 3 bizacodile pills instead of 1 liter of PEG in patients undergoing elective anastomosis of colon is not only associated with lesser nausea, vomiting, flatulence, but also increases the patients' satisfaction and tolerance, lessens electrolyte disturbances and do not influence postoperative infection of surgical site and anastomosis leakage.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Gastric adenocarsinoma is the first leading fatal malignancy in Iran. Despite advances in novel therapeutics approaches for gastric cancer (GC) patient, tumor dissemination via blood stream to distant organ is still the major cause of death. Therefore, there is urgent need to establish sensitive methods for early detection of disseminated tumor cells in peripheral blood (PB) and bone marrow (BM) specimens of gastric cancer patients.
Methods: In the present study, we use Carcinoma Embryonic Antigen (CEA) as a tumor marker and Glyceraldehyde 3-Phosphate Dehydrogenase (GAPDH) as an internal control to detection and quantification of disseminated tumor cells in PB and BM specimens of affected individuals. Total RNA was extracted from AGS (gastric cancer) cell line and CEA and GAPDH fragments were generated by reverse transcription. The amplified fragments were cloned into pTZ57R/T vector separately. Double cloning of these genes has done into one pTZ57R/T vector. Serial dilution of this recombinant plasmid is used to construct standard curve, each containing a known amount of input copy number. Total RNA was extracted from BP and BM specimens of 35 GC patients. cDNA of the specimens were synthesized by reverse transcription and subjected to Quantitative Real-Time PCR (QRT-PCR).
Results: We developed a highly sensitive and specific quantitative PCR for CEA and GAPDH using Real-Time PCR based on TaqMan technology. CEA mRNA was detected in 23% of PB and 20% of BM specimens. There was no CEA mRNA detecting in control group.
Conclusions: The QRT-PCR for CEA can be a useful technique for detection of micrometastases in the PB and BM specimens of gastric cancer patients.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Although the short-term results of kidney transplantation have improved greatly during the past decades, the long-term results have not improved according. Graft loss due to chronic allograft dysfunction (CAD) is a major concern in renal transplant recipients (RTRs). There is little data about disease progression in this patient population. In this paper, we investigated history of kidney function as the pattern, waiting time and rate of pass from intermediate stages in RTR with CAD.

Methods: In a single-center retrospective study, 214 RTRs with CAD investigated at the Urmia University Hospital urmia, Iran from 1997 to 2005. Kidney function at each visit assessed with GFR. We apply NKF and K/DOQI classification of chronic kidney disease (CKD) staging system to determine pattern of disease progression per stage in this group of patients.
Results: The pure death-censored graft loss was 26% with mean waiting time 81.7 months. 100% of RTRs passed from stage I to II in mean waiting time 26.3 months. The probability of prognostic factors transition from stage II to III was 88.9% with mean waiting time 25.5 months, transition from III to IV was 55.7% with mean waiting time of 24.9 months and transition for stage 4 to IV was 53.5% with mean waiting time of 18.2 months. In overall rate of transition from stage i to j in patients with stage III at the beginning of the study (time of start CAD's process) was faster than others.
Conclusions: This study revealed, that kidney function in first years after transplantation is one of the most important II to III of survival probability per stage and death-censored graft loss. Therefore care of RTRs in first year could potentially increase long-term kidney survival.

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Background: Laryngotracheal stenosis is one of the most challenging problems for otolaryngologists. Several methods were developed to treat this problem. However, in many cases, this symptom could be recurred and the patients would suffer from operations for treatment. In this survey, the effect of topical mitomycin-C after laser therapy and dilatation for preventing laryngotracheal stenosis is considered. Methods: Twenty three cases suffered from laryngotracheal stenosis were studied in a clinical trial between years 2006-2007 in Amir-alam educational Hospital in Tehran, Iran. The patients were divided into two groups. In 12 patients (case group), we used topical mitomycin-C (1mg/ml for 4 min) after dilatation and laser therapy, and in 11 of them (control group), this solution was not used. All patients were controlled by endoscopy one and three months later, and then followed up. The results of this study were compared statistically. Results: In the control group after treatment (dilatation and laser), the average changed- vertical and horizontal lengths of stenosis were 0.47±0.77mm and 0.50±0.60mm respectively. However in the control group these changed averages were 2.28±1.15mm and 2.23±1.03mm, respectively after treatment (p<0.0001). The average changed cross section between the two groups were different significantly (p<0.0001), too. Conclusions: In the laryngotracheal stenosis, the use of topical mitomycin-C could reduce the recurrence of the stenosis after dilatation and after the laser procedures. In addition, the need for repeated therapy will be reduced.

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Background: Coarctation of aorta is narrowing of proximal descending aorta. Interventional procedures such as balloon angioplasty & stent implantation has been progressively in use as alternatives for surgery in increasing number of children with diagnosis of coarctation of aorta. The aim of this study was to evaluate the use of endovascular stent in children with coarctation of aorta.

Methods: We evaluated effectiveness and safety of stenting in all patients younger than 18 years old with coarctation and re-coarctation of aorta which treated by stenting between years 2004-9 at rajaei - heart centre in Tehran, Iran.

Results: we studied 53 patients younger than 18 years old with a follow up of six months. Totally 54 stents were implanted. Mean (±SD) age of the patients was 11.6±4.2yrs. Seventeen cases (32%) were younger than 10 years old, and 36 cases (68%) were 10 years and older. Mean (±SD) weight was 39.24±18kg. 16 cases weighting less than 25kg. Peak systolic pressure gradient (SPG) decreased from 46.26±17.07 to 1.03±0.19mmHg after procedure (p<0.001). There was no significant difference (p<0.001) in the gradient before and after stenting in the patients with native coarctation (Vs re-coarctation cases), less than 25 kg and under 10 years old groups. Complications developed in 44% of cases while dominantly were minor except in two cases re-dilatation of stent was not needed during six month of follow-up of the patients.

Conclusions: Stenting of coarctation of aorta can decrease complications and can be used safely in children weighing bellow 25kg and in children below 10yrs old.

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Background: With respect to the importance of hepatitis B vaccination of high-risk groups such as prisoners, this study was performed to assess the comparability of a short-course double-dose vaccination schedule with the standard 3-dose schedule.
Methods : Within a randomized clinical trial, a short-course vaccination (at months 0 and 1) with 20 microgram (double-dose) doses of the vaccine was compared to the standard method of hepatitis B vaccination (at months 0, 1 and 6, with 10-microgram doses) in 100 prisoners in Zahedan city in Iran in 2009. We made sure the sera from all the individuals were negative for markers of previous hepatitis B infection. Subsequently serum from all the participants was tested for anti-HBs antibody 1, 2 and 7 months after the first dose of vaccination.
Results : Seroconversion rates (HBsAb>10 mIU/ml) 1, 2 and 7 months after the first dose of vaccination were similar in the routine (11%, 79% and 94%, respectively) relative to the double-dose group (26%, 95% and 93 %, respectively). The mean values of anti-HBs antibody titers were similar in the 1st and 2nd months for the two groups but it was significantly higher (P=0.002) in the routine dose (514 mIU/ml) versus the double-dose group (130 mIU/mL), in the 7th month.
Conclusion: Demonstrating comparable results with the standard 3-dose schedule, it seems that short-term double-dose vaccination for hepatitis B is a safe and acceptable method for use in high-risk groups such as prisoners.

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Background: Bone Marrow Transplantations (BMT) are limited by low CD34+ cell counts in umbilical cord blood (UCB) and these cells need to be expanded for success in such procedures. To achieve this goal, ex vivo expansion of hematopoietic stem cells (HSCs) by enhancing their self-renewal activity on demineralized bone matrix (DBM) scaffold coated with mesenchymal progenitor cells (MPCs) and unrestricted somatic stem cells (USSCs) was recommended. TGF-b pathway is a key inhibitory factor for HSCs self-renewal. In this study ex vivo expansion and downregulation of TGF-b pathway were simultaneously performed.

Methods: USSC cells were isolated from UCB and then coated on DBM scaffold as a feeder layer. UCB CD34+ cells were isolated from UCB by magnetic activated cell sorting (MACS) method and were transfected by siRNA against TGFbR2 in two-dimensional (2D) and three-dimensional (3D) cultures by co-cultivation with USSC. TGFbR2 expression levels were evaluated by quantitative real-time PCR. Cell count and flow cytometry were performed and clonogenic activity was evaluated.

Results: Ex vivo expansion of CD34+ cells was significantly enhanced (41±0.7 folds) by TGFbR2 downregulation, especially in 2D than 3D cultures. Finally, 2D culture showed less TGFbR2 expression levels and higher increase in the percentage of CD34 markers by flow cytometry assay.

Conclusion: The 3D siRNA delivery system would be of lower efficiency in contrast to 2D settings where the cells have less freedom and are in more contact with the feeder layer.

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Background: Laryngeal videostroboscopy is an important noninvasive diagnostic tool in patients with dysphonia. More than 50% of patients with dysphonia have a benign laryngeal lesion on vocal fold examination. The aim of this study was to evaluate patients with benign laryngeal lesions by videostroboscopy.
Methods: This cross-sectional study was done on 159 patients with dysphonia in Amiralam Hospital in Tehran, Iran during 2006-2007. All the patients underwent stroboscopic examination of the vocal folds, including their movement. We also evaluated the patients for mucosal status, mucosal wave and patterns of glottal closure.
Results: Eighty-two patients participating in the study were female and 77 were male. Reflux laryngitis and muscle tension dysphonia were the most observed disorders in the patient population. Patients with sulcus vocalis and intracordal cysts had the worst mucosal wave patterns.
Conclusion: Laryngeal videostroboscopy is a useful tool for the diagnosis and treatment planning in patients with benign laryngeal lesions.

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Background: Endometrioma of ovary is one of the common diseases during reproductive age and the effect of laparoscopic cystectomy of endometrioma on infertility is still matter of debate. We designed this case control study to evaluate the ovarian response to controlled ovarian hyperstimulation during IVF (In vitro fertilization) cycle following laparoscopic unilateral cystectomy of endometrioma.
Methods: In a case control study, we enrolled 30 women with history of unilateral laparoscopic cystectomy of ovarian endometrioma in stripping method who underwent IVF cycle in women Hospital, 2009-2012. The numbers of follicles in response to controlled ovarian hyperstimulation during IVF cycle in the ovary with history of  unilateral laparoscopic cystectomy of endometrioma were compared with those from the contralateral ovary.
Results: The mean age (±SD) of patients was 32.3 (±3.4). The mean (±SD) diameter of excised ovarian endometrioma was 42.4 (±10.4) mm. Interval since ovarian surgery to induction ovulation was 2.7 (±2.6) years. Mean number of follicles in the ovary with history of unilateral laparoscopic cystectomy of endometrioma was 2.5 (±1.2) with the range of 1 to 5 and in the control ovary 3.9 (±1.4) with the range of 1 to 6. There was significant difference in the number of follicles in the ovary with laparascopic cystectomy of endometrioma compared with opposite one (P<0.001).
Conclusion: Laparoscopic cystectomy for unilateral endometrioma is associated with a reduced ovarian response to controlled ovarian hyperstimulation during IVF cycle. We did not find any statistically significant difference in reduced ovarian response with regard to patients age, body mass index, size and location of the cyst, and time duration since ovarian cystectomy.

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Background: Recent studies have suggested that impaired fetal growth are indicators that may be present in the first trimester. The aim of this study was to investigate the relationship between crown-rump length (CRL) and pregnancy associated plasma protein-A (PAPP-A) measurements in first trimester for low birth weight (LBW).
Methods: This prospective cohort study were on 120 pregnant women in first pregnan-cy trimester, in Women's Hospital Mirza Kochak Khan in 2011-2012. Gestational age according to crown-rump length and gestational age according to last menstrual period (LMP), neonatal weight, small for gestational age, pregnancy associated plasma protein-A and low birth weight were recorded. Main outcome measures was weight and gestational age at birth. Statistical tests used included descriptive statistics, t-test, χ² and all tests were two-tailed and differences with P<0.05 were considered to be statistically significant.
Results: Our findings showed that a total of 120 cases were included CRL Z-score and log 10 (MOM PAPP-A) were positively correlated with fetal birth weight. The mean Crown-rump length Z-score was significantly can be reduced in LBW in first trimester pregnancy. (P<0.001) Mean PAPP-A in low birth weight was (0.4±0.11 MOM), but in normal weight infants was (1.04±0.7 MOM). (P=0.011) also mean PAPP-A in pregnant women with SGA infants is significantly less than other pregnant women (0.5±0.2 versus 1.1±0.7) (P<0.001).
Conclusion: Our data suggest that crown-rump length and maternal levels of PAPP-A measured during the first trimester are independent factors that influence fetal birth weight. But their predictive powers are not sufficiently good for them to be used alone for low birth weight screening.