Comparison of efficacy of meperidine and fentanyl in terms of pain management and quality of life in patients with cervical cancer receiving intracavitary brachytherapy: a double-blind, randomized controlled trial.

OBJECTIVE: The aim of this study was to compare the effectiveness of two sedative regimens, a benzodiazepine with either meperidine or fentanyl, in relieving pain in patients with cervical cancer undergoing intracavitary brachytherapy in terms of pain score and quality of life. METHODS: Forty unselected outpatients undergoing brachytherapy (160 fractions) were enrolled with informed consent and randomized to receive a benzodiazepine with either meperidine or fentanyl. The perceived pain score according to a standard 10-item numeric rating scale was collected every 15 min during the procedure, and the perceived quality of life was determined at the end of each procedure using the EuroQol five-dimension questionnaire. The patients and medical staff members directly involved with the procedure were blinded to the medication used. RESULTS: The patients' pain levels were mild in both analgesic groups. Meperidine appeared to be slightly more effective than fentanyl, although the differences in the average pain score and quality of life were not statistically significant. CONCLUSION: Both meperidine and fentanyl in combination with benzodiazepine were effective in relieving pain and discomfort in patients undergoing brachytherapy. TRIAL REGISTRATION: NCT02684942, ClinicalTrials.gov.

High prevalence of advanced colorectal neoplasia in the Thai population: a prospective screening colonoscopy of 1,404 cases.

BACKGROUND: Increasing morbidity and mortality from colorectal cancer is evident in recent years in the developing Asian nations. Particularly in Thailand and most neighbouring low-income countries, screening colonoscopy is not yet recommended nor implemented at the national policy level. METHODS: Screening colonoscopy was offered to 1,500 healthy volunteers aged 50-65 years old who were registered into the program between July 2009 and June 2010. Biopsy and surgery was performed depending on the identified lesions. Fecal immunochemical tests (FIT) were additionally performed for comparison with colonoscopy. RESULTS: There were 1,404 participants who underwent colonoscopy. The mean age of the cohort was 56.9 ± 4.2 years and 69.4 % were females. About 30 % (411 cases) of all colonoscopies had abnormal colonoscopic findings, and of these, 256 cases had adenomatous polyps. High risk adenomas (villous or tubulovillous or high grade dysplasia or size > 1 cm or > 3 adenomatous polyps) were found in 98 cases (7 %), low risk adenoma in 158 cases (11.3 %), and hyperplastic polyps in 119 cases (8.5 %). Eighteen cases (1.3 %) had colorectal cancer and 90 % of them (16 cases) were non-metastatic including five stage 0 cases, seven stage I cases, and four stage IIA cases. Only two cases had metastasis: one to regional lymph nodes (stage IIIB) and another to other organs (stage IVA). The most common cancer site was the distal intestine including rectum (7 cases, 38.9 %) and sigmoid colon (7 cases, 38.9 %). Ten colorectal cancer cases had positive FIT whereas 8 colorectal cancer cases were FIT-negative. The sensitivity and specificity of FIT was 55.6 % and 96.2 %, respectively, while the positive predictive value was 16.4 % and negative predictive value was 99.4 %. The overall survival of colorectal cancer cases at 5-year was 83.3 %. CONCLUSION: High prevalence of colorectal cancer and high-risk adenoma was found in the Thai population aged 50-65 years old by screening colonoscopy. FIT was not sensitive enough to detect colorectal cancer in this asymptomatic cohort. Integration of screening colonoscopy into the national cancer screening program should be implemented to detect early cases of advanced colorectal neoplasia and improve survival of colorectal cancer patients in Thailand.

Estimation of the proper length of nasotracheal intubation by Chula formula.

OBJECTIVES: To assess whether Chula formula can predict the proper length of nasotracheal intubation. MATERIAL AND METHOD: This was a prospective study of 100 patients (50 males and 50 females) who underwent general anesthesia with nasotracheal intubation (number 8.0 for male and 7.0 for female) between December 2005 and March 2007. The Chula formula was used to calculate the length of endotracheal tube (ETT) at the right external naris = 9 + (body height/10) cm. After intubation, a fiberoptic bronchoscope was inserted into the ETT to measure the distance from the tip of ETT to the carina and the distance from the upper border of the cuff of ETT to the vocal cords. RESULTS: The mean length of nasotracheal tube at the right external naris calculated by Chula formula was 25.4 cm in males and 24.4 cm in females. The mean distance from the tip of ETT to the carina was 3.9 cm in males and 3.1 cm in females. The mean distance from the upper border of the cuff of ETT to the vocal cords was 2.6 cm in males and 3.0 cm in females. Ninety-three patients with upper border of the cuff of ETT had it placed at least 2 cm below the vocal cords, and in seven patients, the distance from the tip of ETT to the carina was found to be 1 to 1.9 cm. In every patient, it was found that the tip of ETT was placed at least 2 cm cephalad to the carina. CONCLUSION: In the present study, the Chula formula could be used to predict the proper length of nasotracheal intubation in 93 of 100 patients.