Comparison of Propofol-Fentanyl with Midazolam-Ketamine Combination in Pediatric Patients Undergoing Kidney Biopsy.

INTRODUCTION: Kidney biopsy is a procedure of choice for the diagnosis of many kidney diseases. In children it is performed with the use of sedatives. The aim of this study was to compare the combination of propofol/fentanyl with midazolam/ketamine for sedation in pediatric patients undergoing kidney biopsy. METHODS: In this double-blinded clinical trial, seventeen children, candidate of kidney biopsy were included and randomized into two groups. One group received Midazolam/Ketamine with doses of 30 to 50 µg/kg and 0.25 to 1 mg/kg, and the other group were sedated with propofol/fentanyl combination in doses of 0.5 to 1 mg/kg and 0.5 to 1 mg/kg, respectively. Administration time, medication doses, total procedure time, need for analgesic use after the procedure, and patient relaxation, with no agitation during and after the biopsy were recorded. RESULTS: Nine patients received midazolam/ketamine and eight received propofol/fentanyl. None of them experienced vomiting or itching after sedation. There were no meaningful differences in qualitative variables of the need for pain relief between two groups. Regarding the distribution of pain at the time of sedation, and 1, 3, 6, and 24 hours after sedation, there was no significant statistical difference between the two groups. There was also no significant statistical difference between the two groups, regarding patients' relaxation during, and 1, 3, 6, and 24 hours after biopsy. CONCLUSION: There was no statistically significant difference between the degree of sedation and the analgesic effect of the two regimens in the two groups.  DOI: 10.52547/ijkd.6982.

Evaluating success of curettage in the surgical treatment of endometrial polyps.

OBJECTIVES: To determine treatment efficacy of curettage on endometrial polyp. METHODS: The quasi-experimental pre-and-post study was conducted in 2011-12 at the gynaecology department of Imam Reza Hospital, Mashhad, Iran, and comprised patients who underwent hysteroscopy for endometrial polyp. Location, size, number and base condition of the polyps were recorded before the patient underwent curettage. Hysteroscopy was then performed and the condition of the remaining polyps was compared with initial findings. Also, the remaining polyps were resected. SPSS 13 was used for statistical analysis. RESULTS: There were 51 patients in the study with a mean age of 33.14 ± 8.19 years (range: 23-59 years)Besides, there were 82 polyps; 38(46.3%) having a narrow base, and 44(53.7%) having a wide base. The mean polyp size was 2.39 ± 2.63cm.After performing curettage, 23 (28.0%) polyps were removed completely, 39(47.6%) had size reduction, and 20(24.4%) had no change in size. Curettage could not significantly remove polyps (p < 0.001). Polyps smaller than 2cm were more likely to have been removed compared to the bigger ones (p = 0.003).Polyps with wide base were more significantly removed than those with narrow base (p < 0.001).Further, those with wide base and also smaller than 2 cm were removed more significantly than others (p < 0.001).The location of polyps had no effect on removal probability by curettage (p = 0.114). CONCLUSION: Curettage was not found to be a reliable method for endometrial polyp removal. If hysteroscopy is not accessible, the size of the polyp should be determined by vaginal sonograghy to estimate the probability of its removal by curettage.

Epidemiology and trend of cancer in Yazd, a central province of Iran, 2005-2009.

BACKGROUND: Cancer incidence rate is increasing in the world particularly in developing countries. The awareness regarding cancer incidence and distribution helps policy makers and researchers to design comprehensive plan for controlling cancer. The aim of this study was to determine the incidence rate and trend of cancer in Yazd Province, central Iran. METHODS: Data from Yazd cancer registry were derived from 2005 to 2009. Direct standardization through world standard population produced by the world health organization was used and Age- Standardized Incidence rate (ASR) was calculated. Data were analyzed using ASR, by EXCEL and SPSS software. RESULTS: The new cases of cancer were 4631 patients from 2005 to 2009. Mean age of these patients was 57.98 ±27.49 years and 53.5% were male. Female patients were approximately 5 years younger than males. The most frequent cancer was breast in women followed by skin, colorectal, hematologic system and stomach. The 5 most frequent cancers in men were skin, bladder, colorectal, stomach and prostate. The ASR in 2005 to 2009 was respectively 85.2, 86.1, 92.6, 102.2 and 104.7 per 100,000 populations. CONCLUSIONS: ASR of cancer is increasing rapidly in Yazd Province. It is necessary to have a comprehensive health policy for prevention and control of this problem.

Effect of lidocaine volume and concentration on preventing incidence and severity of propofol injection pain.

BACKGROUND: Propofol is one of common anesthetic drugs used in anesthesia. The most common side effects of propofol are local pain. Pretreatment with lidocaine can reduce propofol injection pain. OBJECTIVES: The aim of the present study was to assess and compare the efficiency of lidocaine 0.4% and 2% in reducing the incidence and severity of propofol injection pain. PATIENTS AND METHODS: This was a double blind prospective clinical trial on children 4-8 years old with class ASA I and II candidates who were referred to Dr. Shaikh Hospital in Mashhad for elective surgery. Sample size calculated 50 patients in each groups based on pilot study. 100 children's were randomly divided equally in two groups, who were injected with lidocaine solutions 2% and 0.4% respectively. patient's pain evaluation based on VSD (verbal descriptor scale) and NRS (Numeric Rating Scale) using patient's verbal reaction and behavior namely fretting, hand drag and tearing. The collated data was analyzed. RESULTS: There was nosignificant difference as to the first three variables (age, gender and weight P > 0.2). The significant difference regarding pain experience in both groups was noteworthy (P > 0.2). CONCLUSIONS: Most of the studies compared lidocaine with other drugs or its efficiency at different doses. Our study is different in that we applied a constant dose of lidocaine in various volumes and concentration. This result shows that lidocaine with the same does but lower concentration and higher volume is more effective in preventing propofol injection pain. Using diluted lidocaine with the dosage of 1 mg/kg and a concentration of 0.4% is an effective way to relieve pain caused by propofol injection in children.

The association of anesthetic method with developing back pain after lower extremity operations.

BACKGROUND: Selection of anesthetic approach for lower extremity operations is often a controversial issue for anesthesiologists. OBJECTIVES: The aim of this study was to compare the incidence and severity of back pain between general and spinal anesthesia, and to find effective factors in developing postoperative back pain. PATIENTS AND METHODS: In a randomized clinical trail, 148 patients with elective lower extremity surgeries were randomly allocated into two groups of 74. The first group received general anesthesia and the second group underwent spinal anesthesia. The incidence of back pain was observed and documented. The severity of back pain was assessed at the first, fourth and eighth postoperative weeks by visual analogue scale. RESULTS: The mean of patients' age was 35.50 ± 13.34 years. The incidence and mean of back pain severity among all participants were respectively 35.80% and 15.95% at the first week, 7.40% and 2.43% at the fourth week, and 1.4% and 0.27% at the eighth postoperative week. The incidence and mean of back pain severity in spinal group were respectively 39.2% and 18.11% at the first, 12.2% and 3.92% at the fourth, and 2.7% and 0.54% eighth postoperative weeks. In general anesthesia group, these figures were respectively 32.4% and 13.78% at the first week and 2.7% and 0.95% at the fourth postoperative week. No back pain was reported at the eighth postoperative week. The incidence and severity of back pain in the first week showed significant difference between the two groups, while the mean severity of back pain showed significant difference at the fourth week after operation. CONCLUSIONS: Spinal anesthesia could be probably considered as the sole effective factor in the development of back pain after operation.

Role of liver function enzymes in diagnosis of choledocholithiasis in biliary colic patients.

Liver functional tests due to inflammatory process which induced by cholecystitis might changed and some clinicians suggested that these changes might help us to stone prediction in common bile ducts and decrease hazards of performing ERCP and other invasive procedures. Present study was performed for assessment of role of liver functional test in diagnosis of common bile duct stone in patients with cholecystitis and help in their management. Present prospective study was performed between April 2010 and March 2011 on 350 patients who come to our hospital with cholecystitis or biliary colic diagnosis. Patients with cholesistitis diagnosis were underwent operation for removing gall bladder stone and retrograde cholangiopancreatography (ERCP) was performed for patients with suspicious to biliary colic and common bile duct (CBD) stones. Ultrasonography, aspartate aminotransferases (AST), alanine aminotransferases (ALT), alkaline phosphatase (ALP) and direct and total serum bilirubin were measured for all of participated patients. Mean of AST. ALT, ALP and total and direct bilirubin were had no significant differences between two study groups. In logistic regression analysis, after entering into the model only CBD diameter (OR: 20; P=0.00) and elevated serum level of ALT (OR: 2; P=0.04) were remained into the model and were known as independent predictor of cholelithiasis. Elevated level of liver enzymes had not main role in CBD diagnosis and ERCP had no to perform for suspicious CBD stone only with elevated liver enzyme and even with normal ultrasonography findings. Endosonography as non invasive procedure recommend for patients before ERCP.