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ارتباط بين سطح LH روز سوم سيكل و پاسخ تخمدان در سيكلهاي لقاح خارج رحمي (IVF) Relation between third day LH level and ovarian response in IVF cycles 2 1 سالهاي اخير اوج پيشرفت در درمان ناباروري بوده است بطوريكه ابداع روشهاي جديد سهم بسزايي در اين پيشرفت داشته‏اند. در اين روشها، فاكتورهاي بسياري جهت ارزيابي و تشخيص در نظر گرفته مي‏شود. هدف از اين مطالعه بررسي ارتباط سطح LH روز سوم سيكل در سيكلهاي لقاح خارج رحمي با ميزان پاسخ تخمدان مي‏باشد. مطالعه از نوع توصيفي (Case series) بوده و بنابراين 78 بيمار كانديد IVF با شرايط ورود به مطالعه، انتخاب و بر اساس سطح LH روز سوم بدو دسته تقسيم شدند. گروه اول شامل 14 نفر با mIU/ml3LH< و گروه دوم 64 نفر، باmIU/ml3LH> بودند. بيماران براساس برنامه درماني رژيم طولاني ثابت با آگونيست گنادوتروپينها به همراه گنادوتروپين انساني وارد سيكل درماني شدند. در پايان دو گروه از نظر تعداد فوليكول، تعداد تخمك بدست آمده، طول مدت تحريك تخمداني، تعداد آمپولهاي گنادوتروپين مصرفي، تعداد جنين بدست آمده، ميزان حذف سيكل و نهايتاً ميزان بارداري با يكديگر مقايسه شدند. براساس نتايج بدست آمده و با توجه به 05/0 < P value ، هيچگونه ارتباطي بين سطح LH روز سوم و سن بيمار، نوع ناباروري، علت ناباروري و طول مدت ناباروري ملاحظه نگرديد. از طرف ديگر دو گروه از نظر پاسخ تخمدان، ميزان فوليكول و تخمك بدست آمده، طول مدت تحريك، تعداد آمپول مصرف شده، تعداد جنين بوجود آمده، ميزان لغو شدن سيكلها و ميزان بارداري كلينيكي، تفاوت آماري معني‏داري نشان ندادند. اين بدان معني است كه سطح LH روز سوم در سيكلهاي لقاح خارج رحمي با ميزان موفقيت ارتباطي ندارد. 2 Infertility treatment has reached to prominent improvements in recent years and new methods of ART have important role in these improvements. Several factors are considered for patient’s evaluation in these methods. For this purpose, we decided to evaluate the relation between third day LH with ovarian response in IVF cycles. This is a prospective study and 78 IVF candidates were chosen base on study requirements and were divided into two groups according to third day LH level. First group was consisted of 14 women with LH<3 mIU/ml, and second group was consisted of 64 women with LH>3. Patients had gone under treatment cycle base on long treatment plan with agonist gonadotropins and human gonadotropins. Then two groups were compared for number of follicle, number of retrieved oocyte, duration of ovarian stimulation, number of used gonadotropin ampules, number of resulted embryos, cancellation rate of cycles and finally pregnancy rate. Base on results and considering P value<0.05, significant differences were not observed between the two groups in third day LH, patient age, kind of infertility, cause of infertility and duration of infertility. In other hand, two groups did not show any significance difference in ovarian response, number of follicle and retrieved oocyte, stimulation duration, number of used ampules, cancellation rate of cycles and pregnancy rate. This reveals third day LH level is not associated with success rate in IVF cycles. 14 19 Batool B Hossein Rashidi بتول حسین رشیدی Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Iran brh17@hotmail.com Leila L Aghaghazvini لیلا آقا قزوینی Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Iran Roghayeh R Moghimi رقیه مقیمی Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University Iran Luteinizing Hormone (LH)Ovarian responseOvarian stimulationIVFInfertility 80.pdf Berek J.S., Adashi E.y. Infertility. Novak’s gyneglogy, Williams and Wilkins, Baltimore. Philadelphia, London Paris. 1996.##Kenneth J.R., Ross S. Evaluation of the infertile couple, infertility treatment. Kistner’s gynecology principles and practice. Mosby, St Louis, Baltimore, Boston, Philadelphia. 1995; PP 278- 324.##Speroff l., Glass R.H., Kase N.G., et al. Clinical gynecologic endocrinology and infertility regulation of menstrual cycles. Female and male infertility. Assist Reprod. Williams and Wilkins, Baltimore. Margland. 1998; PP 809- 947.##Navot D., Rosen W. Z., Margalith E.J. Ovarian hyperstimulation syndrome in novel reproductive technologies: prevention and treatment. Fertil Steril. 1987; 58: 249- 56.##Muasher S. J. Controversies in assisted reproduction treatment of low responders. J Assist Reprod Genet. 1993; 10: 111- 2.##Winslow K.L., Toner J.P., Brzyski R.G. The gonadotropine agoinst stimulation test sensitive predictor of performance in the IVF cycle. Fertil Steril. 1991; 56 (1): 711.##Muasher S. J., Oehninger S., Simonettis S., et al. The value of basal and/or stimulate serum gonadotrophin levels in prediction of stimulation response and IVF outcome. Fertil Steril. 1988; 50: 298- 307.##Noci I., Biagiotti R., Maggi M., et al. Low day 3 LH values are predictive of reduced response to ovarian stimulation. Hum Reprod. 1998; 13 (3): 531-4.##Loumaye E., Billion J. M. Prediction of individual response to controlled ovarian hyperstimulation by means of a clomiphene citrate challenge test. Fertil Steril. 1990; 53: 295- 301.##Stanger J. Reduced IVF of human oocyte from patient with raised LH level during the follicular phase. Br J Obs Gyn. 1985; 92: 385- 93.##Scott R.T., Hofmans G.G. Prognostic assessment of ovarian reserve. Fertil Steril.1995; 63: 1- 11.##

موفقيت بارداري بدنبال مصرف متفورمين در بيماران با سندرم تخمدان پلي‏كيستيك(PCOS) تحت درمان با ART Pregnancy rate following Metformin consumption in patients with PCOS under ART treatment 2 1 ناباروري با شيوع حدود 15% يكي از مشكلات عمده جامعه بوده كه گاهي در طولاني مدت تداوم زندگي خانوادگي را تهديد مي‏كند. يكي از شايعترين علل ناباروري در زنان، علل تخمداني به خصوص سندرم تخمدان پلي‏كيستيك مي‏باشد. از آنجائيكه در اين بيماران متفورمين از طريق كاهش سطح انسولين ممكن است سبب بهبود تعداد و كيفيت تخمكها و افزايش ميزان باروري گردد، اين مطالعه با هدف بررسي تأثير متفورمين در بهبود پاسخ بيماران سندرم تخمدان پلي‏كيستيك در سيكل ART صورت گرفت. اين مطالعه به صورت كلينيكي-تصادفي برروي 100 بيمار مراجعه كننده نابارور مبتلا به سندرم تخمدان پلي‏كيستيك، به بيمارستان شريعتي شهر تهران در طي سال 79-1378 انجام شد. افراد بر اساس معيارهاي ورود به مطالعه، به دو گروه (A، 44 نفر و B، 46 نفر) به صورت تصادفي تقسيم شدند و 10 بيمار به دليل عدم استفاده صحيح از داروها از مطالعه حذف گرديدند. در گروه A علاوه بر پروتكل بلندمدت براي تحريك تخمك‏كذاري، متفورمين با دوز mg 500 سه بار در روز تجويز شد و يافته‏ها با استفاده ازشاخصهاي آماري و آزمون آماري t-test و مجذور كاي مورد تجزيه و تحليل قرار گرفتند و 05/0P< معني‏دار تلقي شد. نتايج نشان داد سطح استراديول در گروه A بطور متوسط ml/pg 1056±2159 و در گروه B pg/ml1050± 2842 بود و اختلاف معني‏دار وجود داشت(002/0P=). ميزان HMG مصرفي در گروه A 6/7±23 آمپول و در گروه B 12/8±34/31 آمپول بود و بين دو گروه اختلاف معني‏داري وجود داشت(001/0P=). تعداد تخمك‏ها اختلاف معني‏دار نداشتند، ولي از نظر تعداد تخمك‏هاي نارس (ژرمينال وزيكول) اختلاف معني‏دار بوده است (047/0P=). از نظر طول مدت درمان، تعداد تخمك و تعداد بارداري اختلاف معني‏دار بين دو گروه ديده نشد. بنابراين با توجه به يافته‏هاي فوق متفورمين قادر خواهد بود از طريق كاهش ميزان مقاومت به انسولين و هيپرآندروژنيسم در افراد مبتلا به سندرم تخمدان پلي‏كيستيك سبب كاهش واضح در سطح استراديول سرم و ميزان HMG مصرفي در اين بيماران شده و در بهبود كيفيت تخمكها تاثير مي‏گذارد. 2 Infertility with an incidence of about 15% has mainly been one of the community burdens that have even been threatening to the continuity of the family life. One of the most prevalent causes of women infertility is ovarian causes particularly PCOS. Since Metformin may improve quality and increase the number of ova, and likewise increase fertilization rate via reducing the level of insulin, this study was conducted with aim of investigating responses of patients with PCOS in the cycle of ART. This was a randomized clinical trial on 100 infertile patients with PCOS who referred to Shariati Hospital in Tehran during 1999-2000. The subjects were randomly categorized in to 2 groups (A=44 and B=46 women). Ten patients were eliminated from study due to ignoring the treatment plan. Group A received Metformin at a dose of 500 mg t.i.d in addition to induction of ovulation with long protocol. The results were analyzed using t-test and X2 and P<0.05 was considered as significant. Results showed that average level of estradiol in group A was 2159±1056pg/ml and 2842±1050pg/ml in group B, with a significant difference (P=0.002). We administered 23±7.6 ampules of HMG for the subject’s in group A and 31.34±8.12 ampules for those in group B (P=0.001). The difference in number of oocytes was not significant, where as we found a significant difference in the number of germinal vesicle (P=0.047). There were no significant differences in course of treatment, numbers of oocytes and the number of pregnancy between 2 groups. Considering the findings of this study by using Metformin, we improve the quality of ova in patients with PCOS. This happens due to the effect of Metformin through reducing insulin resistance and hyperandrogenism in patients with PCOS leading to a prominent drop in estradiol levels in serum that in turn lowers the need for administration of HMG and result in improving oocyte quality 19 24 Mahtab M Zeinalzadeh مهتاب زینال زاده Department of Obstet . and Gynecol , Yahyanejad Hospital, Babol Medical Sciences University Department of Obstet . and Gynecol , Yahyanejad Hospital, Babol Medical Sciences University Iran zeinalmahtab@yahoo.com Ashraf A Alyasin اشرف آل یاسین Department of Obstet . and Gynecol ,Shariati Hospital, Tehran Medical Sciences University Department of Obstet . and Gynecol ,Shariati Hospital, Tehran Medical Sciences University Iran Marzieh M Agha Hossinei مرضیه آقاحسینی Department of Obstet . and Gynecol ,Shariati Hospital, Tehran Medical Sciences University Department of Obstet . and Gynecol ,Shariati Hospital, Tehran Medical Sciences University Iran MetforminInfertilityAssisted Reproductive TechniquesPolycystic ovary syndrome 81.pdf Speroff L., Glass R.H., Kase N.G. Clinical gynecologic endocrinology and infertility. 6thEdition,Baltimore, Lippincott Willims & Wilkins. 1999; pp 1097- 133.##Balen A.H., Conway G.S., Kaltsas G., et al. PCOS: the spectrum of the disorder in 1741 patients. Hum Repord. 1995; 10: 2107.##Conway G.S. PCOS: clinical aspects. Baillieres Clin Endocrinol Metab. 1996; 10:263.##Conway G.S., Jacobs H.S. Clinical implications of hyperinsulinemia in women. Clin Endocrinol. 1993; 39: 623.##Soule S.G. Neuroendocrinology of PCOS. Baillieres Clin Endocrinol Metab. 1996; 10: 205.##Balen A.H., Tan S.L., Jacobs H.S. Hypersecration of Luteinising hormone: a significant cause of infertility and miscarriage. Br J Obs Gyn. 1993; 10: 82.##Kiddy D.S., Hamilton F.D., Seppala M, et al. Diet-induced changes in sex hormone binding globulin and free testosterone in women with normal or PCO correlation with serum insulin and ILGF-1. Clin Endocrinol. 1994; 31: 771.##Rossing M.A., Daling J.R., Weiss N.S. Ovarian tumors in a cohort of infertile women. N Engl J Med. 1994; 331: 771.##Seibel M.M. A comprehensive text of infertility. 2th Edition, Boston, Appelton & Lange. 1999; pp 121- 32.##Velazquez E.M., Mendoza S.G., Wang P., et al. Metformine therapy is associated with a decrease in plasma plasminogen activator inhibitor-1, Lipoproteine (a), and immunoreactive insuline levels in patients with the PCOS. Metabolism. 1997; 46: 54.##Jacobs H.S. PCOS: etiology and management. Curr Opin Obs Gyn. 1995; 7: 203.##Vandermolen D.T. Metformine increases the ovulatory rate and pregnancy rate from clomiphene citrate in patients with polycystic ovary syndrome who resistant to clomiphene citrate alone. Fertil Steril. 2001; 75(2): 310- 5.##Sturrock N.D., Lannon B., Fay T.N. Metformine does not enhance ovulation induction in clomiphene resistant polycystic ovary syndrome in clinical practice. Br J Clin Pharmacol. 2002; 53(5): 469- 73.##Stadtmauer L.A. Metformine treatment of patients with polycystic ovary syndrome undergoing in vitro fertilization improves outcomes and is associated with modulation of the insuline-like growth factors. Fertil Steril. 2001; 75(3): 505-9.##Leo V., Carca A.L. Effect of Metformine gonadotropine induced ovulation with polycystic ovary syndrome. Fertil Steril.1999; 72(2): 282-5.##Uhelan J.G., Vdahos N.F. The ovarian hyperstimulation syndrome. Fertil Steril. 2000; 72(2): 282- 5.##Fulghesa A.M., Villa P. The impact of insulin secration on the ovarian response to exogenouse gonadotropins in PCOS. Clin Endocrinol Metab. 1997; 82(21): 644- 8.##

نقش اندازه گيري ßHCG سرم بر پيش بيني سندرم فوليكول تهي Role of serum ßHCG measurement in prediction of Empty Follicle Syndrome 2 1 يكي از موارد مهم در درمان بيماراني كه نياز به انجام لقاح آزمايشگاهي و انتقال آن به رحم دارند، گرفتن تخمكهاي با كيفيت و تعداد مناسب مي‏باشد. متأسفانه در بعضي از موارد عليرغم ظاهر خوب تخمدان در بررسيهاي سونوگرافيك و اندازه‏گيريهاي هورموني، هيچ تخمكي پس از تزريق HCG بدست نمي‏آيد كه اين مسئله تحت عنوان سندرم فوليكول تهي (empty follicle syndrome) ناميده مي‏شود. هدف از اين مطالعه بررسي رابطه بين سطح βHCG سرم و بروز سندرم فوليكول تهي در بيماران تحت درمان ناباروري با تحريك تخمك‏گذاري مي‏باشد. اين مطالعه بصورت آينده‏نگر و موردي شاهدي بر روي 1009 بيمار انجام گرفت كه 135 نفر به دلايل مختلف از مطالعه خارج شده و از 874 نفر باقيمانده 3/23% افراد تحت درمان با روش IVF معمولي و 7/76% آنان كانديد استفاده از ميكرواينجكشن (تزريق داخل سيتوپلاسمي اسپرم) بودند. كليه بيماران تحت درمان با HMG و GnRHa با پروتكل طولاني مدت بودند. در كليه آنان در طي دورة درمان تعداد فوليكول رشد يافته مورد ارزيابي قرار گرفت و ميزان سطح βHCG سرم در زمان تزريق HCG و زمان گرفتن اووسيتها اندازه‏گيري و با تعداد اووسيت بدست آمده مقايسه شد. در بررسي نتايج اين مطالعه در 34 نفر از بيماران (9/3%) هيچ تخمكي بدست نيامد (گروه I)، در 92 نفر (5/10%) تعداد تخمك بدست آمده كمتر از 50% فوليكولهاي رشد يافته بود (گروه II) و نهايتاً در 748 نفر (5/85%) تعداد تخمكهاي بدست آمده بالاي 50% فوليكولهاي رشد يافته بود (گروه III). 36 ساعت بعد از تجويز HCG سطح متوسط βHCG سرم در گروه I (107± 6/154)، گروه II (4/90± 7/141) و گروه III (6/56± 156) بوده است. هيچ گونه اختلاف معني‏داري بين نتايج سطح سرمي ßHCG و سندرم فوليكول تهي وجود نداشت (194/0P=). 2 One of important matter in treatment of patients who need in vitro fertilization and embryo transfer to uterus is retrieval of good quality and enough number of oocytes. Unfortunately, in some cases though ovary had good appearance in ultrasound and hormonal aspect, no oocyte was retrieved after HCG injection, which this condition is known as empty follicle syndrome. The aim of this study is to determine the relationship between serum ßHCG and empty follicle syndrome (EFS) in infertile women undergoing ovulation induction. This research was a prospective and case control study over 1009 patients, which 135 patients were omitted due to different reasons and amongst 874 remaining patients, 23.3% had undergone IVF and 76.7% of them had undergone intracytoplasmic sperm injection. All patients with HMG and GnRHa treatment had undergone long protocol. Then the numbers of mature oocytes were assessed during treatment and level of serum ßHCG was measured on time of HCG injection and oocytes retrieval and it was compared with retrieved oocytes. In evaluation of results of this study, no oocytes were found in 34 (3.9%) patients (group I) and less than 50% matured follicles were found in 92 (10.5%) patients (group II) and finally more than 50% matured follicles were found in 748 (85.5%) patient (group III). Mean level of serum ßHCG was (154.6±107) in group I, (141.7±90.4) in group II and (156±56.6) in group III, 36 hours after HCG injection. The results showed no significant difference between βHCG and EFS (P=0.194). 25 31 Mahnaz M Ashrafi مهناز اشرفی Department of Obstet . and Gynecol Faculty of Medicine, Iran Medical Sciences University Department of Obstet . and Gynecol Faculty of Medicine, Iran Medical Sciences University Iran ashrafi@royaninstitute.org Tahereh T Madani طاهره معدنی Infertility Research group of Royan Institute Infertility Research group of Royan Institute Iran Jila J Ahmady ژیلا احمدی Infertility Research group of Royan Institute Infertility Research group of Royan Institute Iran Empty follicle syndromeBHCGIVFOvulation induction 82.pdf Coulan C.B., Bustillo M., Schulman J.D. Empty follicle syndrome. Fertil Steril. 1986; 48: 1153- 5.##Ben-Shlomo I., Schiff E., Levran D., et al. Failure of oocyte retrieval during in vitro fertilization: a sporadic event rather than a syndrome. Fertil Steril. 1991; 55: 324- 7.##Korosi T., Bazane K.Z., Bartha C., et al. Empty follicle syndrome as cause of unsuccessful in vitro fertilization. Orv Hetil. 1998; 139(42): 2515- 7.##Ashkenazi J., Feldberg D., Shelef M. et al. Empty follicle syndrome: an entity in the etiology of infertility of unknown origin or a phenomenon associated with purified follicle stimulating hormone therapy. Fertil Steril. 1987; 48: 152- 4.##Galache Vega P., Garcia Martinez M., Santos Halis Cak R., et al. The empty follicle syndrome: a biological reality (Spanish). Gynecologic Y Obstetricia de Mexico. 1989; 157: 260- 2.##Tsuiki A., Rose B.I., Hung T.T. Steroid profiles of follicular fluids from a patient with the empty follicle syndrome. Fertil Steril. 1988; 49: 104- 7.##Ndukwe G., Thornton S. Curing empty follicle syndrome. Hum Reprod. 1997; 12(1): 21- 3.##Zegers-Hochschid F., Fenandez E. The empty follicle syndrome a pharmaceutical industry syndrome. Hum Reprod. 1995; 140(9): 2262- 5.##Quintans C.J., Donaldosn M.J., Blanco L.A., et al. Empty follicle syndrome due to human errors: its occurrence in an in vitro fertilization program. Hum Reprod. 1998; 13(10): 2703- 5.##Traina V., Boyer P. Failed oocyte retrieval in in vitro fertilization with documented positive serum beta-human chronic gonadotropin (HCG) concentration on day HCG 1. Hum Reprod. 1993; 8(11): 1854- 5.##Awonuga A., Govindhai J., Zierke S., et al. Continuing the debate on empty follicle syndrome: can it be associated with normal bioavailability of beta-human chronic gonadotropin on the day of oocyte recovery? Hum Reprod. 1998; 13(5): 1281- 4.##

عوارض زودرس يائسگي در زنان شهر تهران Early complications of menopause among women in Tehran 2 1 با افزايش اميد زندگي در كشورهاي توسعه يافته‏اي چون ايران، پديدة يائسگي نيز بيشتر ديده مي‏شود. بروز عوارض زودرس يائسگي مي‏تواند كيفيت زندگي اين زنان را به شدت تحت تأثير قرار دهد. مطالعه توصيفي و مقطعي به بررسي عوارض زودرس 441 مورد زنان يائسه در سطح شهر تهران با استفاده از روش نمونه‏گيري خوشه‏اي پرداخته است. ميانگين سن يائسگي نمونه‏ها 45/4±51/48 سال بدست آمد. در اين مطالعه متغيرهاي سن، سن اولين قاعدگي، وضعيت ازدواج، شيردهي، سابقه مصرف قرصهاي ضدبارداري، سابقه مصرف قرصهاي جايگزيني هورموني، ‌ورزش، مصرف كلسيم خوراكي، دارويي و سيگاركشيدن مورد بررسي قرار گرفت. با استفاده از پرسشنامه استاندارد جونز (Jones) كليه عوارض زودرس يائسگي مورد بررسي قرار گرفت. ميانگين جمع امتيازات مربوط به عوارض زودرس 8/6±1/12 بدست آمد. 3/60% افراد داراي عوارض زودرس شديد بودند. براساس نتايج حاصل از اين مطالعه متغير ورزش با كاهش عوارض يائسگي به طور معني‏داري ارتباط داشت (001/0=P). اما بين عوارض زودرس يائسگي و متغيرهاي شيردهي، سيده بودن، سابقه مصرف قرصهاي ضدبارداري خوراكي، سابقه مصرف قرصهاي درماني جايگزين هورموني، مصرف كلسيم دارويي و مصرف كلسيم غذايي ارتباط معني‏داري يافت نشد. در اين راستا به منظور تقليل عوارض زودرس يائسگي تغيير الگوي زندگي زنان موجود در اين سن و از جمله توجه به ورزش و فوايد آن حائز اهميت است. 2 Life expectancy has increased dramatically in developing countries such as Iran. Menopause as a relatively recent phenomenon brought about new challenges. Early complications of menopause can greatly influence the quality of life. Current study aimed at investigating early complications of 441 menopausal women who lived in Tehran using cluster sampling method. The mean age of menopause was 48.51±4.45. Following variable were included in the study: age, age of menorah, education status, marital status, breast feeding, history of oral contraceptive usage and hormone replacement therapy, exercise, calcium intake (diet/drug) and smoking. Using Jones standard questionnaire, the early complication of menopause were asked by interview. The mean value for total score of these complications were 12.1±6.8, 60.3% of which had severe complication. Exercise was found to reduce the rate of complications significantly (P=0.001). To reduce the early complication of menopause, a fundamental change in menopausal women’s life-style is suggested among which exercise is a must. 31 41 Shayesteh Sh Jahanfar شایسته جهانفر Department of Obstet . and Gynecol Iran Medical Sciences University Department of Obstet . and Gynecol Iran Medical Sciences University Iran jahan@iums.ac.ir Fahimeh F Ramezani Tehrani فهیمه رمضانی تهرانی National Center of Reproductive Health Research, Deputy of Research, Ministry of Health and Medical Education National Center of Reproductive Health Research, Deputy of Research, Ministry of Health and Medical Education Iran Seyyed Mehdi SM Hashemi سیدمهدی سادات هاشمی Department of Biostatistics, School of Medical Sciences, Tarbiat Modares University Department of Biostatistics, School of Medical Sciences, Tarbiat Modares University Iran WomenEarly complicationsMenopauseAge of menopauseExercise 83.pdf Research on the menopause. Geneva, Switzerland: World Health Organization. 1999 (World Health Organization-Technical Report series 680).##Know K.T. Epidemiology of the menopause. Br Med Bull. 1999; 48: 249-61.##Snowdon D.A., Kane R.L., Beeson W.L., et al. Is early natural menopause a biological marker of health and aging? Am J Pub Heal. 1998; 79: 109-14.##Jones M.M., Marshall D.H., Nordin B.E. A standard questionnaire to evaluate the early complications of menopause. Curr Med Res Opin. 1999; 4(13): 12- 20.##McKinlay S.M., Brambilla Posone J.G. The normal menopause transition. Moturitas. 1999; 14:103-15.##Treloar A.E. Menarche, menopause and intervening fecund ability. Hum Biol. 1994; 46:89-101.##MacMahon B., Worcester J. Age at menopause, United States. 1960- 2. Rockville; US Department of health, education and welfare, public health services, national center for health statistics, 1996: 1-19 (Vital and Health Statistics, Series 1, Vol 11, no 19).##Scagy R.F.R. Menopause and reproductive span in rural niugini. In proceedings of the annual symposium of the papua new guinea medical society. Port Moresby, Papua new guinea. 1993; 126-44.##Willerr W., Stampfer M.J., Bain C. Cigarette smoking, relative weight and menopause. AM J Epidemiol. 1999; 117:651-8.##Michnovicz J.J., Hershopf R.J., Naganuma H. Increased 2-hydroxylation of estradiol as a possible mechanism for the anti-estrogenic effect of cigarette smoking. N Engl J Med. 1996; 315: 1305-9.##Longcope C., Johnston C.C. Androgen and estrogen dynamics in pre- and postmenopausal women: a comparison between smokers and non smokers. J Clin Endocrinol Metab. 1998; 67: 379-83.##Whelan E.A., Sandler D.P., M.C. Connaughey D.R. Menstrual and reproductive characteristics and age at natural menopause. Am J Epidemiol. 1999; 131: 623-32.##Stanford J.L., Hartge P., Brinton L. Factors influencing the age at natural menopause. J Chronic Dis. 1998; 40:995-1002.##Van Keep P.A., Brand P.C., Lehert P. Factors affecting the age at menopause. J Biosoc Sci. 1999; 6(suppl):37-55.##Balfour J.A., Heel R.C. Transdermal oestradiol. A review of its pharmacodynamic and pharmacokinetic properties and therapeutic efficacy in the treatment of menopausal complaints. Drugs. 1999; 40: 561- 82.##Kronenbery F. Downey J.A. Thermoregulatory physiology of menopause hot flashes: a review. Can J Physiol Pharmacol. 1997; 65:1312-24.##Kronenberg F. Hot flashes: epidemiology and physiology. Ann N Y Acad Sci. 1995; 592-86, discussion. 123- 33.##McKinlay S.M., Jeffery M. The menopausal syndrome. Br J Prev Soc Med. 1999; 28: 108-15.##Lock M. Contested meaning of the menopause. Lancer 1998: 337:1270-2.##Beyene Y. Cultural significance and physiological manifestations of menopause: a bicultural analysis.Cult Med Psychiatry. 1996; 10: 47- 71.##Thornton J.G. Menopausal hot flushes: personal experience in Africa (letter). Trop Doct 1984; 14- 135.##Sherman B.M., Wallace R.B., Bean J.A. The relationship of menopausal hot flushes to medical and reproductive experience. J Gernotol. 1999; 36: 366-9.##Lange-Collett J. Promoting health among perimenopausal women through diet and exercise. J Am Acad Nurs Pract. 2002; 14(14): 172-7.##Scopacasa F., Nead A.G. Horowitz M. Effects of dose and timing of calcium supplementation on##Jahanfar S., Ramezani Tehrani F., Sadat Hashemi M. Late complications of menopause among Iranian women. Med J Islam Repub Ir (In press).##Sitruck-Ware R. Estrogen therapy during menopause. Practical treatment recommendations. Drugs. 1999; 39(2): 203-17.##

اثرات عقيم سازي عصاره گياه چريش روي موش صحرائي نر Sterility effects of Neem (Azadirachta indica) extract on male rat 2 1 امروزه به دليل مشكلات متعدد ناشي از آفت‏كشهاي سنتزي تلاش بر اين است تا آفت كشهاي بيولوژيك و طبيعي جايگزين آنها گردد. از جمله اين موارد استفاده از فرآورده‏هاي گياهي است. گونه گياهي Azadirachta indicaـ چريش- از جمله گياهان با ارزشي است كه مطالعات متعدد روي عصاره مغز دانه آن اثرات ضد باروري و سقط جنيني موقت و قابل بازگشت آن را در حيوانات آزمايشگاهي به اثبات رسانده است. لذا بر آن شديم تا ضمن مطالعه اين ويژگي، ميزان دوز مؤثر جهت عقيم‏سازي دائم جوندگان براي كنترل جمعيت آنها را بدست آوريم. در اين بررسي 24 موش صحرايي نر نژاد (Wistar) 5-4 ماهه ( با وزن 200-150 گرم) بصورت تصادفي انتخاب شده و به 4 گروه شامل 6 موش تقسيم شدند. به گروه اول آب و به سه گروه ديگر به ترتيب mg/kg5، mg/kg15 وmg/kg25 عصاره گياه چريش(عصاره تجاري Neemazal با مقدار آزاديراكتين 1% ) به مدت 6 روز متوالي به روش گاواژ خورانده شد. در روز هاي چهارم و نهم آزمايش، از تمام گروه‏ها خونگيري و بررسيهاي هماتولوژيكي و سرمي (هورمون تستوسترون) انجام شد. در روز دهم آزمايش دو حيوان از هر گروه آزمايشي تشريح شدند تا بررسيهاي بافت شناسي بر روي بيضه آنها انجام شود. سپس حيوانات باقيمانده گروه براي تست باروري در كنار موشهاي صحرائي ماده بالغ قرار گرفتند. بعد از مشاهدة تكثير در حيوانات ماده، اين گروهها از مراحل آزمايش خارج شدند. مقادير MCH، هموگلوبين گروه سوم در مرحله اول (05/0P<) و مرحله دوم (به ترتيب 001/0P< و 01/0P<) و مقدار گلبولهاي سفيد گروه سوم در مرحله دوم (05/0P<) نسبت به گروه كنترل افزايش معني‏داري نشان داد. اما در مورد مقادير ساير فاكتورهاي بررسي شده، بين نمونه‏هاي كنترل و آزمايش اختلاف معني‏داري مشاهده نشد. بين مقدار هورمون تستوسترون گروههاي كنترل وآزمايش اختلاف معني‏داري ديده نشد. موشهاي ماده مجاور شده با گروهي كه mg/kg15 عصاره گياه چريش دريافت كرده بودند پس از گذشت 60 روز زايمان نمودند (دوره بارداري اين حيوانات 23-20 روز است). در گروهي كه mg/kg25 عصاره دريافت كردند نيمي از حيوانات تحت آزمايش به علت تجويز دوز بالاي عصاره تلف شده و در نيم ديگر آنها پس از گذشت 3 ماه توليدمثل ديده شد. نتايج بررسيهاي بافت‏شناسي هم بيانگر ايجاد تغييراتي در سير اسپرماتوژنز، شامل از بين رفتن اسپرماتوزوئيدها، توليد اسپرم‏هاي غيرطبيعي و پرخوني بافت بينابيني در برخي توبولهاي اسپرم‏ساز بود. لذا با گذشت زمان (90-60 روز) و ترميم سلولهاي آسيب ديده مجدداً توليدمثل ديده مي‏شود. با توجه به نتايج حاصل به نظر مي‏رسد كه بتوان از عصاره اين گياه بعنوان عامل ضدباروري استفاده كرد، تحقيقات بيشتر و لحاظ مسائلي همچون به صرفه‏بودن اقتصادي، فرمولاسيون مناسب آنرا تهيه و در طعمه حيوانات مورد استفاده قرار داد و بدين طريق، روشي جديد در كنترل نسل و ازدياد تعداد جوندگان مضر كشاورزي ارائه نمود. 2 Nowadays uses of synthetic pesticides has caused a lot of environmental problems. For this reason there is an effort to replace them with biopesticides. One of these ways is the use of plant bioproducts. Various studies on Azadirachta indica (Neem) have proven that the seed extract of this plant has reversible infertility and spontaneous abortion properties. In this study we are trying to determine the effective dose of its seed extract for sterility of rodent pests. In this survey, 24 male wistar rats with 4-5 months old (weighing about 150-200 grams) were selected randomly. They were divided into 4 subgroups each containing 6 rats. The Neem extract (Neem Azal 1%) was fed to 3 groups by gavage for six days. The first group was fed with water and others were fed with Neem extract (5mg/kg, 15mg/kg and 25mg/kg respectively). Hematological parameters were determined on 4th and 9th day of the experiment. On the 10th day two animals from each group were dissected for histological study of testes. Remaining animals were tested for fertility with fertile female rats. There were no significant differences between control and treated groups. After observing reproduction in female rats, these groups were excluded from study. There were no significant differences between control and treated groups in their hematological parameters except for MCH and hemoglobin on 4th (P<0.001, P<0.01 respectively) and 9th day (p<0.05) and WBC on 9th day (p<0.05) in third group, which showed an increase. There were no significant differences between serum testosterone levels. In group which received 15 mg/kg extract, reproduction occurred after 60 days (reproduction cycle in rats is 20-23 days). In group which received 25mg/kg extract, half of the animals died due to high doses of Neem extract and in the remaining half, reproduction occurred after 3 months. Histological results of testes indicated abnormality in spermatogenesis and sperms production in some of the semniferous tubules. Therefore after 60-90 days and repair of injured cells, reproduction is observed again. Base on the results of this study it seems that we can use Neem seed extract as an anti-fertility agent, considering its cost benefit ratio and suitable formulation, we can use it as rodent baits to control harmful agricultural rodents. In this way we have a new method of controlling deleterious rodents. 4 14 Masoumeh M Mahmoudi Meymand معصومه محمودی میمند Department of Pharmacology, Faculty of Medicine, Tehran Medical Sciences University Department of Pharmacology, Faculty of Medicine, Tehran Medical Sciences University Iran ghazikha@sina.tums.ac.ir Mohsen M Morowati محسن مروتی Department of Pesticide Research, Plant Pests and Diseases Research Institute Department of Pesticide Research, Plant Pests and Diseases Research Institute Iran Mahmoud M Ghazi Khansari محمود قاضی خوانساری Department of Pharmacology, Faculty of Medicine, Tehran Medical Sciences University Department of Pharmacology, Faculty of Medicine, Tehran Medical Sciences University Iran Batool B Nasrollazadeh بتول نصرالله زاده Department of Embryology, Faculty of Medicine, Tehran Medical Sciences University Department of Embryology, Faculty of Medicine, Tehran Medical Sciences University Iran Bagher B Minaie باقر مینایی Department of Anatomy, Faculty of Medicine, Tehran Medical Sciences University Department of Anatomy, Faculty of Medicine, Tehran Medical Sciences University Iran Neem (Azadirachta indica)Anti-fertilitySpermatogenesisSpermatozoaPesticideRat 79.pdf Singleton G.R., Hinds L.A., Herwig L., et al.Ecologically-based management of rodent pests. Australian Centre for International Agricultural Reaserch, Canberra. 1999.##Randhawa N.S., Parmar B.S. Neem. Research and Development, Society of Pesticide Science, India. New Dehli Agricultural Research Institue. 1993; pp 283.##Gogati S.S., Marathe A.D. Anti –viral effect of neem leaf (Azadirachta indica) extracts on chinkungunya and measles viruses. J Res Edu Indian Med. 1989; 8: 1-5.##Singh N., Sastry M.S. Anti-microbial activity of neem oil. Indian J Pharmacol. 1981; 13:102.##Kher A., Chaurasia S.C. Anti-fungal activity of essential oils of three medicinals plants. Indian Drug. 1997; 15:41- 2.##Fujiwara T., Takeda T., Ogihara Y., et al. Studies on the structure of polysaccharides from bark of Melia Azadirachta. Chem Pharm Bull. 1982; 30: 4025- 30.##Lal R., Sankarnaryanan A., Mathur V.S., et al. Antifertility effect of neem oil in female albino rats by intra vaginal and oral routes. Indian J Med Res. 1986; 83: 89- 92.##Mukherjee S., Garge S., Talwar G.P. Early post implantation contraceptive effects of a purified fraction of neem (Azadirachta indica) seeds, given orally in rats: possible mechanisms involved. Ethnopharmacol. 1999; 67: 287- 96.##Parshad O., Singh P., Gardner M., et al. Effect of aqueous neem (Azadirachta indica) extract on testosterone and other blood constituents in male rats. Med J. 1994; 43: 71- 4.##Talwar G.P., Shah S., Mukherjee S., et al. Induced termination f pregnancy by purified extracts of Azadirachta indica (neem): mechanisms involved. Am J Reprod Immunol. 1997; 37: 485- 91.##Raizada R.B., Srivastava M.K., Kaushal R.A., et al. Azadirachtin, a neem biopesticide: subchronic toxicity assessment in rats. Food Chem Toxicol. 2001; 39: 477- 83.##Krause W., Adami M. Extracts of neem (Azadirachta indica) seed kernels do not inhibit spermatogenesis in the rat. In: Proc 2nd Intl Neem Conf Rauischholzhausen Fed Rep Germany. 1983; 483- 789.##Garge S., Doncel G., Chabra S., et al. Synergistic spermicidal activity of neem seed extract, reetha saponins and quinine hydrochloride. Contraception. 1994; 50: 185- 90. 14-Sander F.V., Cramer S. D. A practical method of testing the spermicidal action of chemical contraceptives. Hum Fertil. 1941; 6: 134.##Sander F.V., Cramer S. D. A practical method of testing the spermicidal action of chemical contraceptives. Hum Fertil. 1941; 6: 134.##Sinha K.C., Riar S.S., Tiwary R.S., et al. Neem oil as a vaginal contraceptive. Indian J Med Res. 1984; 79:131- 6.##Shaikh P.D. Studies on the antifertility effect of Azadirachta indica leaves on the testis of albino rats. M Phil Dissertation. Karnataka University, Dharwad, India. 1990.##Awasthy K.S. Genotoxity of a crude leaf extract of neem in male germ cells of mice. Cytobios. 2001; 106: 151- 64.##

ميزان تداوم استفاده از وسايل پيشگيري از بارداري و علل قطع آن در شهر زاهدان Continuation rate of contraceptive methods and causes of their discontinuation in Zahedan 2 1 علي‏رغم موفقيتهاي چشمگيري كه در زمينه كنترل مواليد در دهه‏هاي اخير در ايران انجام گرفته است، با عنايت به محدوديت منابع مالي كشور، لازم است در راستاي مهار هر چه بيشتر رشد جمعيت, مطالعات بيشتري در زمينه چگونگي استفاده از امكانات موجود صورت پذيرد. هدف از اين مطالعه بررسي تداوم استفاده از وسايل پيشگيري از بارداري و عوامل تعيين‏كننده در قطع آن در زنان مراجعه كننده به مراكز بهداشتي، درماني شهر زاهدان مي‏باشد. مطالعة حاضر در نواحي مختلف شهر زاهدان در اواخر سال 1379انجام شد. 1743 نفر زناني كه در اين مطالعه شركت كردند مطالعه شدند. از ابتداي سال 1377 يكي از چهار روش پيشگيري از بارداري: قرص ضدبارداري, آي‏يودي, آمپول و نورپلانت را استفاده مي‏كردند. ميانگين سن زنان مورد بررسي 6±27 سال, ميانگين سن همسرانشان 8±33 و ميانگين تعداد فرزند 2±8/2 بود.6/89% زنان خانه‏دار و 7/28% زنان بيسواد بودند. متداولترين روش مورد استفاده قرصهاي ضدبارداري با فراواني 2/71% و پس از آن آمپول با 9/12%، آي‏يودي با 7/12% و نورپلانت با1/3% بودند. با استفاده از روش كاپلان‏ماير بيشترين تداوم استفاده طي سال اول به ترتيب مربوط به قرص LD (92%) و پس از آن نورپلانت (86%)، آي‏يودي (82%) و آمپول (53%) بود. بيشترين تداوم استفاده در پايان سال سوم به ترتيب مربوط به نورپلانت (78%)، LD (70%), آي‏يودي (60%) و آمپول (44%) بود. بيشترين علت قطع قرصهاي ضدبارداري و آمپول تغيير روش و بيشترين علت قطع آي‏يودي و نورپلانت عوارض جانبي بود. تداوم استفاده از وسايل فوق با هيچكدام از متغيرهاي سطح سواد زنان و همسران آنها, شغل زنان و همسران آنها, تعداد فرزند و سن آخرين فرزند، ارتباط آماري معني‏داري نشان نداد. آزمون كاكس نشان داد كه تداوم استفاده از وسايل با نوع وسيله و مركز بهداشتي، درماني در ارتباط مي‏باشد. بررسي بيشتر دلايل آن و مشاوره مناسب با زنان در زمان انتخاب وسايل پيشگيري و شش ماه اوليه استفاده از آن توصيه مي‏شود. 2 Although significant success is obtained on birth control in recent decades, but considering limitation of financial sources to control population growth, it seems necessary to conduct more studies on quality usage of contraceptives. Aim of this study is to evaluate contraceptive continuation rate and main factors for their discontinuation in Zahedan in year of 2000. 1743 women were chosen who were using one of birth control methods: OCP, IUD, injections and Norplant from beginning of 1998. The mean age of the women was 27±6 years and mean age of their husband was 33±8 years. Average number of their children were 2.8±2, 89.6% of them were housewife and 28.7% were illiterate. Oral contraceptive was the most popular method of contraception with frequency of 71.2%, and other methods included injection 12.9% , IUD 12.7% and Norplant 3.1% respectively. Kaplan Mayer technique showed that the highest continuation rates for LD (92%), Norplant (86%), IUD (82%), injection (53%) respectively at first year. At the end of three years continuation rate was Norplant users (78%), LD users (70%), IUD (60%) and injection (44%) respectively. Common reason for discontinuation of OCP and injection was change of method and common cause of discontinuation for IUD and Norplant was side effects. Contraceptive continuation was not significantly the level of women’s education and their husband’s, women’s job and their husband’s, number of children and age of last child. Contraceptive continuation in Cox model showed a significant relation with type of contraceptives and health centers. Therefore more studies are proposed for the reasons and proper consultation with women on time of contraceptive methods and up to first six months. 41 50 Fatemeh F Rakhshani فاطمه رخشانی Public Health Department, Faculty of Health, Zahedan Medical Sciences University Public Health Department, Faculty of Health, Zahedan Medical Sciences University Iran rakhshanif@yahoo.com Mehdi M Mohammadi مهدی محمدی Department of Epidemiology &amp; Statistics , Faculty of Health, Zahedan Medical Sciences University Department of Epidemiology & Statistics , Faculty of Health, Zahedan Medical Sciences University Iran Mojgan M Mokhtari مژگان مختاری Department of Obstet . and Gynecol Department, Faculty of Medicine, Zahedan Medical Sciences University Department of Obstet . and Gynecol Department, Faculty of Medicine, Zahedan Medical Sciences University Iran Roya R Refahi رویا رفاهی Zahedan Medical Sciences University Zahedan Medical Sciences University Iran Contraceptive continuationContraceptivesCauses of discontinuationBirth controlMothers health 84.pdf Blanc A.k., Curtis S., Croft T. Does contraceptive discontinuation matter? Quality of care and fertility consequences. Measure Evaluation Technical Report Series. 1999.##Mahdy N.H. Probability of contraceptive continuation and its determinants. Eastern Mediterranean Health. 1999; 5(3): 526- 38.##Fleming D. Continuation rates of long acting methods of contraception. Family planning and well woman service. 1998; 57(1): 19- 21.##Rosenberg M.J., Waugh M.S. Oral Contraceptive discontinuation: a prospective evaluation of frequency and reasons. Am J Obs Gyn. 1998; 179(3): 577- 82.##Matteson P.S., Hawkins J.W. What family methods women use and why they change them. Health Care Women Int. 1993; 14(6): 539- 48.##Beksinka M.E., Rees H.V., Smit J. Temporary discontinuation: a compliance issue in injectable users.Contraception. 2001; 64(5): 309- 13.##Townsend P.K. Contraceptive continuation rates in Popua New Guinea. PNG Med J. 1983; 26 (2): 114- 21.##Koenig M.A., Hossain M.B., Whittaker M. The influence of quality of care upon contraceptive use in rural Bangladesh. Stud Fam Plan. 1997; 28 (4): 278- 89.##

مقايسه فراواني زايمان طبيعي و سزارين و علل آن در شهرستان شاهرود ( 1379) Comparison of frequency of vaginal delivery with cesarean section and its causes in Shahroud (2000) 2 1 امروزه سزارين به عنوان يك عمل جراحي عادي انجام مي‌شود و علاوه بر اين كه بسياري از امكانات, تجهيزات و تختهاي بيمارستاني و افراد مجرب در ارتباط با اين عمل درگير مي‌‌شوند, ميزان مرگ و مير و عوارض زايماني در مادراني كه تحت عمل سزارين قرار مي‌گيرند به طور چشم‌گيري بيش از مادراني است كه زايمان طبيعي دارند. هدف از اين مطالعه بررسي و مقايسه فراواني زايمان طبيعي، سزارين و علل آن در شهرستان شاهرود مي‏باشد, تا از نتايج آن در جهت برنامه‌ريزي صحيح در رابطه با ترويج زايمان طبيعي استفاده گردد. اين پژوهش يك مطالعه مقطعي مي‌باشد. ابزار گردآوري داده‌ها دو پرسشنامه است كه بر اساس اهداف پژوهش تنظيم و پس از تعيين روايي و پايايي آن اطلاعات مورد نياز طي مدت پنج ماه جمع‏آوري گرديد. نتايج بررسي نشان داد كه تعداد كل زايمان در طي اين مدت در شهرستان شاهرود 1221 نفر بود كه 3/1% زايمان‏ها با وسيله (واكيوم)، 1/42% توسط سزارين و 6/56% زايمان طبيعي بوده است. در اين مطالعه شايع ترين علل سزارين به ترتيب، سزارين قبلي (1/26%), تمايل به بستن لوله‏ها (5/9%) و عدم تطابق سر با لگن (4/8%) بود. شيوع سزارين در شهرستان شاهرود نسبت به آمار قابل قبول بين المللي (22-20%) بيشتر است. با در نظر گرفتن اين مسئله كه شايع ترين علت آن، سزارين قبلي بوده و بسياري از محققين افزايش وضع حمل واژينال پس از عمل سزارين را بي خطر مي‏دانند، مي‌توان اين اميد را داشت كه با آموزش همگاني در جهت ترويج انجام زايمان طبيعي اين شيوع بالاي انجام عمل سزارين در اين شهرستان و به طور كلي در سطح كشور، كاهش يابد. 2 Cesarean is performed as a routine surgery nowadays and not only many facilities, hospital beds and equipments and professional personnel are involved but also mortality rate and pregnancy complications are more common in women who have undergone cesarean than those who have vaginal deliveries. The aim of this study was to evaluate and compare the frequency of vaginal delivery, cesarean and its causes in Shahroud, so that finding would be used for proper planning to promote vaginal delivery. This is a cross-sectional study. Data gathering instruments are two questionnaires, which were prepared base on objectives of research. When their validity was determined, necessary information was gathered in 5 months. Results showed that total number of delivery in Shahroud were 1221 cases which 1.3% of deliveries were with vaccum 42.1% cesarean and 56.6% vaginal deliveries at this period. The most common causes of cesarean were previous history of cesarean (26.1%) willing to perform tubectomy (9.5%) and cephalopelvic disproportion (8.4%). Cesarean frequency in Shahroud is higher than accepted international statistics (20-22%). Considering that the most common cause of cesarean is history of previous cesarean and since many researches believe that vaginal delivery is safe after cesarean, we hope this outbreak of cesarean rate decreases in this town and consequently all over the country by public training to promote vaginal delivery. 50 59 Nahid N Bolbol Haghighi ناهید بلبل حقیقی Obstetrics ultrasound, Shahrood University of Medical Sciences. Obstetrics ultrasound, Shahrood University of Medical Sciences. Iran ebrahimi43@yahoo.com Hossein H Ebrahimi حسین ابراهیمی Nursing Department, Shahroud Medical Sciences Faculty Nursing Department, Shahroud Medical Sciences Faculty Iran Mohammad Esmaeil ME Ajami محمد اسماعیل عجمی Midwifery Department, Fatemiyeh Hospital, Shahroud Midwifery Department, Fatemiyeh Hospital, Shahroud Iran Cesarean sectionVaginal deliveryVaccumMothers health 85.pdf Schuitemaker N., Von Roosmaien J., Dekker G., et al. Maternal mortality after cesarean section in the Netherlands. Acta Obs Gyn Scand. 1997; 76(4): 332- 4.##جزایری حمید. بارداری و زایمان ویلیامز. جلد دوم، تهران: مرکز نشر اشارت، 1376.##Wirakusmah F.F. Maternal and prenatal mortality morbidity associated with cesarean section in Indonesia.J Obs Gyn. 1995; 21(5): 475-81.##Cunnigham F., Mocdonald P., Leveno K., et al. Cesarean section and cesarean hysterectomy. Williams obstetrics. 19th texa. Prentice Hail International, INC. 1993; 591- 4.##گزارش وزارت بهداشت و درمان و آموزش پزشکی، معاونت امور درمان و دارو، بررسی میزان سزارین و ترویج زایمان طبیعی در کشور، 1993.##جزایری حمید. بارداری و زایمان ویلیامز، جلد سوم، تهران، مرکز نشر اشارت، 1376.##James D.K., Steer P.J. High risk pregnancy. 2nd Edition. Harcourt Brace and Company. 1999.##گزارش سالانه واحد آمار دانشکده علوم پزشکی شاهرود به وزارت بهداشت، درمان و آموزش پزشکی، گزیده‏ای از فعالیت‏های 1378دانشکده علوم پزشکی و خدمات بهداشتی درمانی شاهرود طی سال 1378.##Elliot M. Pediatrician attendance at cesarean delivery: necessary or not? Obs Gyn. 1999; 93 (3): 338– 40.##Mattox J. Core textbook of obstetrics Edition. 1998.##وزارت بهداشت، درمان و آموزش پزشکی، معاونت امور درمان و دارو، بررسی میزان سزارین و ترویج زایمان طبیعی در کشور، 1375.##Giuseppe L., Pantaleo G. Maternal complications associated with cesarean section. Perinatal Med. 2001; 29 (4): 29.##Rageth J.C., Juzi C. Delivery after previous cesarean, a risk evaluation. Obs Gyn. 1999; 93(3): 332- 7.##Richman V.V., Lack of local reflection of national changes in cesarean delivery rates: the Canadian experience. 1999; 80(2): 393- 5.##Cunningham M., Gant L., Gils trap H. Williams obstetrics. 20th Edition, Appleton and Lange. 1997.##Rageth J.C., Juzi C. Delivery after previous Cesarean: risk evaluation. Obs & Gyn. 1999; 93(3): 335.##Jukelevics N. Vaginal birth after cesarean section: an online textbook for pregnant women and new parents on pregnancy and childbirth. 1999.##Abu Heija A.T., Ziadeh S.M. Correlation of decrease in cesarean section rates and decrease in perinatal mortality. Ann Saudi Med. 1995; 15(1): 29- 31.##WHO the partograph part I. WHO Division of family Health, Geneva, 1994.##

گزارش يك مورد ازدواج به وصال نرسيده به مدت 14 سال و درمان موفقيت آميز آن A fourteen year unconsummated marriage and its successful treatment (a case report) 2 1 ازدواج به وصال نرسيده (UCM) به ازدواجي اطلاق مي‏شود كه زن و شوهر هيچگاه نزديكی (Coitus) نداشته باشند. عوامل مختلفي از جمله علل رواني، اجتماعي و جسمي به عنوان عامل بروز آن معرفي شده است. زوج معرفي شده در اين مقاله، با سابقه 14 سال ناباروري به علت UCM و تمايل به داشتن فرزند تحت درمان قرار گرفتند. در طول دوره ازدواج و در پيگيري UCM زن تحت چندين نوبت عمل جراحي جهت ديلاتاسيون، ميومكتومي و الكتروكوتري تخمدان‏ها قرار گرفت و يك دوره روان درماني نيز براي وي انجام شد. همچنين به علت تمايل داشتن فرزند براي بيمار، 10 بار تلقيح داخل رحمي اسپرم (IUI) به عمل آمد كه تمامي موارد ناموفق بود. زوجين پس از بررسي روانپزشكي، با استفاده از روشهاي زوج درماني (couple therapy) و سكس‏تراپي تحت درمان قرار گرفتند و سپس براي كاهش اضطراب در زن روان‏درماني انفرادي انجام شد. پس از حدود 5 ماه براي اولين بار نزديكي طبيعي و منجر به بارداري و زايمان ترم گرديد. پيش از اين در درمان UCM تركيب سكس تراپي و سايكوتراپي انفرادي زن، بكار نرفته است. روشهاي درماني ديگر نظير سكس‏درماني زوج، درمان رفتاري-هيپنوتيك، روان درماني به روش سايكوسوماتيك به صورت منفرد يا همگام با درمانهاي اورولوژي و ژنيكولوژي مورد استفاده قرار گرفت. با توجه به عدم آگاهي كافي درباره روابط جنسي و نيز وابستگي به خانواده پدري به عنوان عوامل مهم و شايع ايجادكننده اين اختلال به نظر مي‏رسد آموزش روابط جنسي در مراكز آموزشي و بهداشتي كشور، ضروري است. 2 Unconsummated marriage (UCM) is defined as a marriage with no intercourse action. Different etiologies have been introduced as the causative agents including psychiatric, social and physical factors. The reported couple had under gone treatment due to 14 years history of UCM and wanting a child. During marriage and UCM follow up the wife had undertaken multiple surgeries for cervical dilatation, myomectomy, electrocautery and a course of psychotherapy. According to their please to have a child, 10 times IUI had been performed which were unsuccessful. Approximately after psychiatric assessment, couples were treated by sex therapy methods and then individual psychotherapy was performed for wife to reduce anxiety. After 5 months, pregnancy occurred via normal intercourse, which resulted in a term delivery. Combination of couple sex therapy and individual psychotherapy haven’t been used before to treat UCM. Other methods such as dual sex therapy, hypno-behavioral therapy and psychosomatic therapy have been used separately or in combination with urology and gynecologic treatments. Since inadequate knowledge about sexual relationship and dependency to paternal family are of the most important and frequent reasons of this disorder, it seems sexual relation education in educational and health centers in our country is necessary. 59 64 Nasrin N Mirzaie نسرین میرزایی Psychological Consultation Department, Sarem Medical Center Psychological Consultation Department, Sarem Medical Center Iran atsaremi@yahoo.com AbooTaleb AT Saremi ابوطالب صارمی Department of Obstet . and Gynecol Faculty of Medicine, Azad University &amp; Obs &amp; Gyn Department, Sarem Medical Center Department of Obstet . and Gynecol Faculty of Medicine, Azad University & Obs & Gyn Department, Sarem Medical Center Iran Unconsummated marriageSex therapyPsychotherapyInfertility 86.pdf Kaplan H.I., Sadock B.J. Synopsis of psychiatry. Behavioural Sciences, clinical Psychiatry. Lippincott,William’s Wilkins, 8th Edition. 1998; pp 708- 9.##Balint M. The other part of medicine. Lancet. 1961; 1: 40- 2.##براتی امیر حسین، محرابی فریدون. بررسی علل ازدواجهای به وصال نرسیده در ایران . دفترچه مقالات سمینار سراسری پایان نامه‏های پزشکی، سال 1377، ص 18-9.##Zargooshi J. Unconsummated marriage, clarification of etiology and treatment with intracorporeal injection. BJU. 2000; 86: 75- 9.##Watson J.P., Brockman B. A follow-up of couples attending a psychosexual problems clinic. Br J Clin Psychol. 1982; 21(2): 143- 4.##Masters W., Johnson V. Human sexual inadequacy. Boston, LittleBrown and Co. 1970.##Fuchs K. Hypnobehavioral approach for then -consummated marriage. I Am Soc Psychosom. Dent Med. 1972; 19 (3): 77- 82.##Kaplan H.S., Fyer A.J., Novick A. The treatment of sexual phobias: the combined use of antipanic medication and sex therapies. J Sex Mortalit Ther. 1982; 8(1): 3- 28.##Bramley H.M., Draper K., Kilvington J.M. Brief psychosomatic therapy for consummation of marriage. Br J Obs Gyn. 1981; 88: 819- 24.##Bramley H.M., Brown J., Draper K.C., et al. Non-consummation of marriage treated by members of the IPM: a prospective study. Br J Obs Gyn. 1983; 90: 908- 13.##Schover L.R., Montague D.K., Youngs D.D. Multidisciplinary treatment of an unconsummated marriage with organic factors in both spouses. Clev Clin J Med. 1993; 60(1): 72- 4.##

گزارش يك مورد سل پستان در بيمار با سابقه پرولاكتينوما Tuberculosis of breast in a woman with history of prolactinoma (a case report) 2 1 سل شامل طيف وسيعي از بيماريهاي باليني است و يكي از فراوانترين علل عفوني مرگ و مير در جهان مي‏باشد. از سال 1993 از سوي سازمان بهداشت جهاني اين بيماري به عنوان يك هدف مهم بهداشت جهان شناخته شده است. سازمان بهداشت جهاني با كشف داروي ضد سل ريشه‏كني سل را تا سال 2000 ميلادي پيش‏بيني مي‏كرد، ولي در سالهاي اخير اين بيماري رو به افزايش گذاشته است كه علت آن را پاندمي ايدز مي‏دانند. سل بيشتر اوقات مشكلات ريوي ايجاد مي‏كند ولي مي‏تواند ارگان خارج ريوي را نيز گرفتار كند. سل پستان يك بيماري بسيار نادر مي‏باشد كه گاهي اوقات با سرطان پستان اشتباه مي‏شود. اين مورد بيماري، گزارش يك بيمار 25 ساله است كه از سه سال قبل سابقه پرولاكتينوما داشته و از يك سال پيش دچار ترشحات چركي و توده در پستان شده و چندين بار تحت درمان جراحي درناژ آبسه و درمان طبي آنتي‏بيوتيك قرار گرفته بود. بالاخره با توجه به عدم پاسخ به درمان آنتي‏بيوتيك و عود آبسه، بيوپسي انجام شد كه در پاتولوژي گرانولوم همراه كازوئوز ديده شد. بيمار براي مدت 6 ماه با درمان سل بهبود يافت و تا يكسال علائمي از بازگشت بيماري مشاهده نشد. 2 Tuberculosis (TB) contains a broad range of clinical illnesses. It is the most frequent cause of death worldwide. TB was a global public health emergency from 1993 for world health organization. The world health organization estimated the eradication of tuberculosis until year of 2000, when detected the drug’s for tuberculosis treatment. But in later years AIDS pandemic increased the tuberculosis. Tuberculosis causes most of the time lung complication but also can infect other organs as well. Breast tuberculosis is a very rare infection that can be mistaken with breast cancer.This is a case report of female patient with 25 years age who has prolactinoma from three years ago and has milky and epudative discharge since one year ago. She had medical and surgical drainage. Since there was no response to treatment, biopsy was taken and pathologic evaluation demonstrated the granuloma with caseosis. Patient was treated with antituberculosis drug and there was no recurrent for one year follow up. 64 69 Gholamali Gh Ghorbani غلامعلی قربانی Health Research Center, Baghyatollah Medical Sciences University Health Research Center, Baghyatollah Medical Sciences University Iran amehrabitavana@yahoo.com Fatemeh F Tavakoli فاطمه توکلی Surgery Department, Faculty of Medicine, Baghyatollah Medical Sciences University Surgery Department, Faculty of Medicine, Baghyatollah Medical Sciences University Iran Breast massTuberculosisCaseosis granulomaprolactinoma 87.pdf Mandell G., Douglas R., Bennety. Principles and practice of infectious disease. 2000 5 (3): pp 2579-605.##Kakkar S., Kapila K., Singh M.K. Tuberculosis of the breast. Acta Cytol. 2002; 44(3): pp 292-6.##Novym. Current obstetric infection. Lange J. 1980; pp 781-2.##Bhatla R., Reghu C.V., Adhikari P. Diagnosis of tuberculosis. Indian Med Sic J. 1998; 25(11): 498- 506.##Wong F., Robled D., Barret O., et al. Breast tuberculosis. Gyn Obs J. 1997; 65:92- 5.##Shafer R., Kimd R., Weiss J., et al.Extrapulmonary tuberculosis. Med J. 1991; 70: 384- 9.##Manjn B. Imagin of breast. Radiol Ind J. 1999; 127- 32.##Romero C., Carreira C., Piot J., et al.Percutaneus treatment of breast tuberculosis abscess. Eur Radial J. 2000; 19(3): 531- 3.##Pop M., Zaharie T., Fabian A., et al. Tuberculosis infection. Pneumologia J. 1999; 48: pp 313-5.##Green R.M., Ormerod L.P. Mammory tuberculosis. Int Tuberc Lung J. 2000; 4(8): 788- 90.##Abbond P., Bancheri F., Bajolet O., et al. Breast tuberculosis. Gyn Obs J. 1997; 26(8): 822- 9.##Dyla T., Janko R. Breast tuberculosis. Pneumo Allergy J. 2000; 68: 57- 9.##Makanjuola D., Mushid K. Mammographic features of breast tuberculosis. Clin Radiol J. 1996; 51(5): 354- 8.##Ducroz B., Nael L.M., Gautler G., et al. Bilateral breast tuberculosis acase report. Gyn Obs J. 1992; 21(5): 484- 8.##Oh K.K., Kim H., Kook S. Imaging of tuberculosis in breast. Eur Rad J. 1998; 8(8): 147- 80.##Morsad F., Ghazli M., Boumgou K., et al.Breast tuberculosis a series of 14 cases. Gyn Obs. 2001; 30(4): 1331- 7.##