Review Article Levonorgestrel Intrauterine System Mirena: An Update

Mirena is a levonorgestrel-releasing intrauterine system. Apart from being a reliable contraception, Mirena is now widely indicated for its non contraceptive benefits which include treatment of menorrhagia, dysmenorrhoea, premenstrual symptoms, fibroids, adenomyosis, endometriosis etc. It is now used even for hormone replacement therapy. This review article tries to explore different aspects of Mirena for treatment of menorrhagia compared to other available methods based on recent trials

Pregnancy Outcome after Multifoetal Sac Reduction to Twin in Higher Order Multiple Pregnancies.

Objective: The aim of the study was to evaluate maternal and foetal outcome after fetoreduction in higher order multiple pregnancy. Materials and methods: This descriptive study was conducted at the Infertility Care and Research Centre (ICRC), Dhaka between 2006 and 2009. In eleven (11) cases, multifoetal pregnancy reduction (MFPR) were performed and maternal and foetal conditions were analyzed. All patients got pregnant after fertility treatment. The procedure was done between 8-10 weeks of gestation except in one case which was done at 17 weeks. Transvaginal approach under spinal anaesthesia was adopted for intracardiac injection of potassium chloride till cessation of cardiac pulsation. Antibiotic, aspirin, antispasmodic and progesterone were used for all patients. Main outcome measures were uterine contraction, leaking membrane, bleeding, infection, abortion, gestational age and birth weight. Results: Out of these eleven patients eight patients delivered twins at 37 weeks and one patient delivered a set of twin at 34 weeks and their antenatal period was uneventful. Two patients had abortions, one of which was not related with the procedure. No perinatal death was reported among 18 babies. Each of the babies born had an average weight of 2.42 kg. There was no serious maternal complication except rise of temp in one patient. Conclusion: Fetoreduction can improve the chances of survival and can reduce perinatal morbidity of remaining fetuses and can reduce maternal distress without any adverse affect to mother and foetuses. Key words: Sac reduction, multiple pregnanc

Multiparametric MRI/ultrasound fusion-guided biopsy decreases detection of indolent cancer in African-American men

© 2017 Macmillan Publishers Limited, part of Springer Nature. All rights reserved. Background:Analysis of systematic 12-core biopsies (SBx) has shown that African-American (AA) men tend to harbor higher risk prostate cancer (PCa) at presentation relative to other races. Multiparametric magnetic resonance imaging (mpMRI) and MRI-ultrasound fusion-guided biopsy (FBx) have been shown to diagnose more intermediate- and high-risk PCa in the general population; however, the efficacy in AA remains largely uncharacterized. We aim to evaluate the utility of FBx in an AA patient cohort.Methods:Men suspected of PCa underwent an mpMRI and FBx with concurrent SBx from 2007 to 2015 in this institutional review board-approved prospective cohort study. Patient demographics, imaging and fusion biopsy variables were collected. ‡ 2, Mann-Whitney U-test and McNemar\u27s tests were performed to compare proportions, means and paired variables, respectively. Clinically significant PCa (CSPCa) was defined as Gleason score 3/43+4.Results:Fusion biopsy demonstrated exact agreement with SBx risk categories in 64% of AA men. There was no statistically significant difference in the detection of CSPCa between FBx vs SBx (68 vs 62 cases, P=0.36). However, FBx detected 41% fewer cases of clinically insignificant PCa (CIPCa) compared with SBx (FBx 30 vs SBx 51 cases, P=0.0004). The combined FBx/SBx biopsy approach detected significantly more cases of CSPCa (FBx/SBx 80 vs SBx 62 cases, P=0.004) while detecting comparable number of cases of CIPCa (FBx/SBx 45 vs SBx 51 cases, P=0.37) compared with SBx alone. FBx/SBx also detected more CSPCa in patients with a history of prior negative SBx (FBx/SBx 28 vs 19 cases, P=0.003).Conclusions:FBx when used in combination with SBx detected more cases of CSPCa while not significantly increasing the diagnosis of CIPCa in AA men. Future multicenter studies will be needed to validate ultimately the clinical implications of FBx in AA patients