Tehran University Medical Journal

Background: The use of serial quantitative beta-human chorionic gonadotropin (β-HCG) with transvaginal ultrasound to enhance early diagnosis of ectopic pregnancy (EP) improves options for conservative treatment with methotrexate (MTX). The aim of this study was to evaluate the outcome of unruptured EP treated with a single dose of intramuscular MTX injection.

Methods: This clinical trial included 41 EP patients with specific inclusion criteria for medical treatment. For each patient, MTX (50 mg/ml) was administered intramuscularly and a repeat dose was given if the weekly decrease in the level of β-HCG was less than 15%. The therapy was considered successful if the level of β-HCG fell below 10 mIU/cc without surgical intervention.

Results: Overall, 78% of the patients were successfully treated, among whom 18.7% received second doses of MTX. Of the patients who were successfully treated, 60% presented with vaginal bleeding without pelvic pain however, of those patients in whom the treatment failed, 88% presented with pelvic pain together with vaginal bleeding. Furthermore, the presence of free peritoneal fluid on vaginal ultrasound was a significant predictor of treatment failure (p<0.005). There was no relation between the women's age, gravidity or parity, the size of the conceptus, gestational age, pretreatment serum β-HCG titer, endometrial thickness on vaginal ultrasound and the efficacy of treatment.

Conclusions: With a reasonably high success rate, we found systemic single-dose MTX treatment to be a safe, conservative therapy for EP. However, when free peritoneal fluid is noted upon transvaginal ultrasound or when the patient presents with pain, the threshold for surgical intervention may be lower.

Background: Leukemia inhibitory factor (LIF) is a group of secreted glycoproteins with molecular weights ranging from 38-67 kD, resulting from differential protein glycosylation. LIF is constitutively expressed at high levels in the human fallopian tube epithelium and has an important role in the motility and vitality of sperm. In the present study, the effect of human recombinant LIF on human sperm motility and survival in vitro was investigated.

Methods: Normal spermatozoa of 30 fertile men were collected and after preparation were incubated in Ham's F10+FCS 10% medium, containing various concentrations (0, 3, 5, 10, and 50 ng/ml) of LIF at 37 ºC under 5% CO2 for 6, 24 and 48 hours. Sperm motion characteristics were measured using a Makler chamber. Sperm survival was determined using the hypoosmotic swelling test. Collected data were analyzed by one-way ANOVA and LSD test using SPSS version 11. The difference in values were considered significant when p<0.05.

Results: Sperm motility was significantly higher after 24 h exposure to 5-10 ng/ml LIF (p<0.05). The survival rate of sperm was significantly prolonged when exposed to 50 ng/ml LIF (p<0.05). Nonprogressive motility and survival rate of sperm were significantly higher after 48 h exposure to 50 ng/ml and 10-50 ng/ml LIF, respectively. (p<0.05). There was no significant difference in progressive sperm motility during the 48 h exposure of sperm to the various concentrations of LIF.

Conclusion: According to our results, the effect of LIF on sperm motility and survival were dependent on the dose of LIF supplementation and the length of incubation.

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Empyema is one of the most common and important thoracic diseases which can lead to some sort of debilitating consequences if does not managed properly. Surgery usually is indicated in the third stage of the disease which contains more and devastating complications that do not respond to the other treatment options. This investigation evaluates the role of thoracoscopy (minimal invasive surgical intervention) in the management of second stage of empyema.
Methods: In a prospective investigation, 54 patients with stage II of empyema were selected and divided in two groups. In control group, patients were treated with chest tube thoracic drainage plus antibiotics administration, on the other side, Thoracoscopic diagnosis and drainage was added to the modalities of the control group. Thoracoscopy is aimed to explore the total thoracic cavity for releasing the fibrous bands and adhesions and draining of the loculated abscess. At the end of procedure plural cavity wash out and chest tube insertion were done.
Results: The rate of complication was 35% and 8% (p<0.05) in control group and investigated group, respectively. The average admission days were significantly greater in control group (the investigated group got better faster) (p<0.05). The need for thoracotomy was 7 time greater in control group (p<0.05).
Conclusion: Application of Thoracoscopy for stage 2 of empyema is a safe modality which can be advised for all of the patients. This minimally invasive technique can decrease complications rate, need for thoracotomy and hospital admission time.

Background: In the Mediterranean region , Kaposi's sarcoma (KS) has a high prevalence especially in patients with AIDS. Iran is located close to the Mediterranean region and the HIV prevalence is increasing in our country . In some stages, Kaposi's sarcoma is morphologically similar to other vascular tumors. Owing to the presence of human herpesvirus 8 (HHV-8) in all cases of Kaposi's sarcoma , detection of virus DNA by PCR method can help in the identification of non-diagnostic cases. Moreover, the prevalence of HHV-8 genotypes is different in various regions of the world and in different races. There are limited studies performed on the HHV-8 genotypes in Iranian population.

Methods: Patients with Kaposi's sarcoma from 2001 to 2011 who refer to Tehran Razi Hospital were enrolled in this study. HHV-8 DNA was extracted from paraffin blocks and amplification of the virus genome was performed by PCR method . Finally, the target DNA fragment was used for sequencing and genotype determination.

Results: PCR was performed on 53 cases. In 8 cases with suspicious morphology, PCR was negative and they were excluded from study. Of remaining 45 cases, 35 had positive PCR results, 7 had negative results and 3 had low PCR product. Samples from 28 cases that had positive PCR results, which were acceptable for genotyping, were chosen for sequencing. Twenty cases had genotype C, 7 cases had genotype A and one case was negative. The results are consistent with other studies in our geographical area. No correlation was found between the different microscopic stages and HHV-8 Genotypes.

Conclusion: Since the HHV-8 is obtained in almost 100% of KS lesions and PCR s ensitivity in detection of the virus is close to 100 %, KS diagnosis can be confirmed in suspicious cases by detection of HHV-8 DNA on paraffin blocks. Moreover the prevalence of HHV-8 genotype was determined in Iran.

Background: Dyspareunia is a pain that is occurs in the genital area before, during or after intercourse and is an important factor for sexual dysfunction. The aim of this study was to evaluate the effect of pelvic floor physical therapy on sexual function and muscle strength and endurance of pelvic floor (as a non-invasive therapy) in women with dyspareunia.

Methods: In this clinical trial study, 32 women in the age range of 20-50-year-old and sexually active with complaints of dyspareunia, before the investigation were examined in terms of genital health and strength and endurance of the pelvic floor muscles. After the confidence of mental health, patients underwent pelvic floor rehabilitation for 10 sessions during 3 months. After assessment, myofascial release techniques and progressive pelvic floor muscles exercise was performed for patients based on their primary strength. Finally, patients were compared in terms of the severity of dyspareunia, sexual performance status (by using female sexual function index questionnaire), improvement of symptoms, pelvic floor muscle strength and endurance before (first session of physiotherapy) and after (after 3 months) investigation.

Results: In the remaining 32 patients with dyspareunia with a mean age of 38±1.24 years, desire index score 0.95 unit, arousal index score 1.01 unit, lubrication index score 0.67 unit, orgasm index score 0.71 unit, satisfaction index score 1.03 unit, pain index score was increased 1.05 unit, strength index score 2.44 unit, endurance index score 7.06 unit were increased in comparison to before the investigation that showed a significant different with P< 0.0001.

Conclusion: According to obtained results, pelvic floor physical therapy had a significant effect in women with dyspareunia. So that the severity of dyspareunia, pelvic floor muscle strength and endurance had clinically significant improvement after pelvic floor physiotherapy.