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Background & Objective: The Paris System for Reporting Urinary Cytology (TPS) is a new method for evaluating urinary cytology designed to reduce unreproducible reports. The aim of this study was to reclassify and compare urinary cytology reports with TPS criteria to determine the frequency of unreproducible reports compared to the previous system. Methods: In this study, the laboratory electronic registration system analyzed patients' urine samples taken by voided or washing and brushing methods. The cytological evaluation was performed considering the previous system and TPS by a pathologist. The results of the two systems were compared, and the sensitivity and specificity of TPS were calculated. Results: Urine samples were taken from 876 patients. The mean age of patients was 63.36 ± 12.62. Comparing the routine classification system and TPS, it was observed that the number of atypical reports in the TPS system decreased by 12%, and all of these cases were downgraded to the negative group in the new classification. The sensitivity and specificity of TPS were 29.4% and 95.1%, respectively, if suspected malignancy and positive reports for malignancy were considered. Finally, if positive reports for malignancy were selected, sensitivity and specificity changed to 11.8% and 100%, respectively. Conclusion: Although the TPS system has low sensitivity for the diagnosis of urothelial malignancies, due to its high specificity, it is possible to consider and use this classification for screening patients.
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Background: Most patients suffer from moderate to severe pain after elective laparotomy. They often require opioids to alleviate their pain. Opiates invariably induce certain side effects and, occasionally, dependence. Intraoperative infusion of lidocaine and low-dose ketamine reduces postoperative pain and analgesic requirements. This study aims to evaluate the effects of simultaneous infusion of lidocaine and ketamine during open abdominal surgery on the postoperative pain severity and analgesic consumption. Methods: In this randomized, double-blinded, single-center study that was performed in Iran, 80 patients scheduled for elective open abdominal surgery under general anesthesia were enrolled in two LK and P groups. Group LK (n=40) received lidocaine-ketamine infusion, and group P (n=40) received placebo (normal saline). Both infusions were started thirty minutes after initiation of surgery and were terminated once the surgery was completed. For postoperative pain management, patient-controlled analgesia (PCA), including fentanyl and paracetamol, was administered for both groups. All patients were evaluated for pain visual analogue scale (VAS) and total adjunctive analgesic (diclofenac suppository) consumption within the first 24 hours after the surgery. The data were analyzed using SPSS. P values <0.05 were considered significant. Results: Intraoperative infusion of Lidocaine and Ketamine resulted in desirable postoperative pain control. Patients of LK group demonstrated a significant reduction in the pain score at 1, 6, 12, 18, and 24 hours after termination of surgery (p<0.001). It also resulted in a decreased requirement for postoperative analgesics, as cumulative analgesic consumption was decreased meaningfully in the patients of LK group (p<0.001). Conclusion: Intravenous infusion of lidocaine and ketamine during elective open abdominal surgery reduces pain intensity and analgesic requirements in the first 24 hours postoperatively, without major additional side effects.