comparison of pain intensity and anxiety during bone marrow biopsy under general anesthesia or local anesthesia in children with acute leukemia

Background: In recent years, the need to decrease pain and anxiety in patients with acute leukemia during invasive diagnostic and therapeutic measures has been emphasized. This study was performed with the aim of evaluating pain and discomfort caused by bone marrow aspiration under general anesthesia compared with local anesthesia

Materials and Methods: This cohort study was performed on 239 patients with acute leukemia under 18 years of age admitted to Dr. Sheikh Hospital in Mashhad during two years

Children undergoing bone marrow aspiration with either general anesthesia with propofol or local anesthesia with lidocaine were compared in terms of pain intensity [Visual Analogue Scale], resistance to procedure, and the fear and anxiety during aspiration. Results were evaluated with SPSS software version 16 using t test and chi-squared test

Results: Among the 135 patients who were under general anesthesia, 20.1% showed a slight resistance to apply the anesthesia mask. The least amounts of pain, fear, and anxiety were reported. Among the 104 patients under local anesthesia, 80.2% had physical resistance, 44.4% had severe and very severe pain, and 86.1% showed intense fear and anxiety. In the general anesthesia group, physical resistance [p=0.01], pain [p=0.01], and fear and anxiety [p<0.005] were significantly lower than in the local anesthesia group

Conclusion: In bone marrow aspiration, general anesthesia is more acceptable to children and their parents than local anesthesia. This method can greatly reduce pain, resistance, and fear caused by the aggressive actions during bone marrow aspiration in children

comparison between venables standardized respiratory questionnaire and pre-shift spirometry in screening of occupational asthma in a steel industry

Occupational asthma [OA] is the most common occupational lung disease in developed countries. One of the causative agents is metal fume that may be encountered in steel industries. Screening for the OA is mainly performed by questionnaire but in our country spirometry is used more commonly. To compare the diagnostic value of the Venables standardized respiratory questionnaire and pre-shift spirometry as screening tools for OA. In a cross-sectional study, we investigated 450 workers of a steel industry by the Venables standardized questionnaire. We also performed a pre-shift spirometry as the screening spirometry and a post-shift spirometry. A person with 10% drop in post-shift FEV[1] compared with the pre-shift value was considered as asthmatic [our gold-standard]. The results of the questionnaire and the pre-shift spirometry were then examined against the gold-standard test results. For each test, sensitivity, specificity, positive and negative predictive values were calculated. The overall prevalence of OA among our studied workers was 3.9% [95% CI: 1.9%-5.9%]. The highest rate was seen in those working in catering [25%] and welding [10%] units. Pre-shift spirometry and the questionnaire had low sensitivity [42.9% and 28.6%, respectively] and positive predictive values [16.7% and 3.6%, respectively]; moderate specificity [92.4% and 71.6%, respectively] and high negative predictive values [97.9% and 96.5%, respectively]. Taking into account the ease of use of the questionnaire, it seems that it is more feasible to use questionnaire as the primary screening tool for the diagnosis of OA

[Investigation of the association between worry, problem solving styles, and suicidal thoughts [without depression] in non clinical population]

Suicide is one of the leading causes of death among adults in the world. Traditionally, studies on suicide have emphasized the relationships of mood disorders, psychotic disorders, and some personality disorders with suicide. But the relationship between suicide and other forms of psychopathology, such as anxiety disorders, has received less empirical attention and, there are a few studies concerning the effects of anxiety without depression on suicidal behaviors. The goal of this study was to evaluate the relationship between worry, suicidal thoughts and problem solving styles in non clinical population. This research is a correlation study. Sixty six female students who were not depressed completed the Paykel's instrument for measuring suicidal thoughts and attempts, Cassidy and Long problem solving style and Penn State Worry Questionnaires [PSWQ]. Data were analyzed by means of descriptive and inferential statistics. People with suicidal thoughts, people with suicidal plans and normal people showed significant differences in the extent of worry and problem solving styles [P<0.01]. There was a significant correlation between worry and three subscales of problem solving styles. Covariance analysis revealed the extent of worry has affected some of problem solving styles. The results of this study not only supported the relationship between worry, problem solving styles and suicidal thoughts and plans but also demonstrated that worry is an effective factor in developing tendency towards using some problem solving styles

[Evaluation of general anesthesia in pediatric dental procedures]

The use of general anesthesia for extensive dental procedures in children is sometimes necessary to provide safe, efficient, and effective care. Hospital dentistry and using general anesthesia is limited in our country. The aim of this study was evaluating the extensive pediatric dental procedures which have been done under general anesthesia during a two-year period. This descriptive cross-sectional study was done on 72 pediatric patients who had been transferred into the operating room for dental procedures. General anesthesia was induced with sevoflurane in presence of parents. Then anesthesia was maintained with propofol or remifentanyl and nitrous oxide. Vital signs and any predefined intra and postoperative side effects were recorded. Statistical analysis was performed in SPSS software using mean values and standard deviation. The mean age of the patients was 7.2 +/- 4.10 years and mean anesthesia time was 2.1 +/- 1.48 hours. Thirty one patients [43.1%] had no coexisting disease. 26.4% had cerebral palsy and 15.2% had mental retardation. 15.3% of patients had unknown syndromes. Dental procedures included 215 palpotomies, 57 palpectomies, 293 amalgam fillings, 123 glass-ionomer restorations, 15 scalings, 138 extractions and 101 crown cases. Tachycardia was reported in 9 patients, bradycardia in 7, and hypertension in 6 and hypotension in 1 case during anesthesia. Hemorrhage and swelling were the most common complications during interventions that were seen in 7% and 2.1% respectively. 592 teeth were treated finally. Vomitting, pain and agitation were more common complications after recovery that was reported in 28, 17 and 7 cases respectively. Illusion and restlessness occurred in one patient due to central anticholinorgic syndrome which resolves spontaneously 96 hours after the surgery. Although it is impossible to have a control group under local anesthesia due to long operation time, in our study, extensive dental procedures under general anesthesia were an acceptable method with few preventable complications in special cases such as poor cooperation even in presence of coexisting diseases. Certainly, quality of care will be increased with providing hospital dentistry programs. More studies with more cases are needed

Comparison of recovery time and complications in general anesthesia with remifentanyl and propofol and topical anesthesia with conscious sedation in non -complicated cataract phaco surgery

Eye surgery especially cataract surgery is done at an ambulatory basis under local or general anesthesia. Remifentanyl is an ultra-short-acting opioid and propofol is a short-acting anesthetic. They may be used for maintenance of anesthesia. The aim of this study was evaluating and comparing the hemodynamic changes, recovery time, and complications between these drugs and topical anesthesia in non-complicated cataract phaco surgery. This clinical trial study was carried out in a 6 months period in 2006 at Khatam Hospital, Mashhad. Patients with non-complicated cataract surgery were divided into 3 groups of 25: control, remifentanil and propofol groups. Topical anesthesia was used in the first group. In the second and third groups induction was done by propofol, Atracorium and LMA. Maintenance of anesthesia in second group was done with propofol 5 mg/kg/h and in third group with remifentanil 0.25 micro g/kg/min. All the procedures were done by a surgeon. Patients were monitored on NIBP, HR, Spo2 continuously and recovery complications were checked. The patients with cardiopulmonary disorders, hypertension and p-blocker usage were excluded from this study. Data was analyzed by SPSS 13 software, ANOVA, Chi-square, fisher exact test and regression. P

[Fiberoptic laryngoscopic assisted diagnosis and operation of congenital and recurrent tracheoesophageal fistula]

Fiberoptic laryngoscopy [FOL] is usually used in the management of difficult airway intubations. Since its introduction, it has been used for few other indications. In this paper we present a new indication of fiberoptic bronchoscopy [FB] to detect the exact location of tracheoesphageal fistula [TEF] intraoperatively in fourteen cases of pediatric group patients to prevent an unnecessary traumatic manipulation during operation. In all of these cases [12 esophageal atresia and TEF and 1 recurrent TEF and 1 pure TEF] we were able to detect the exact location of TEF with using a LF type Fiberoptic laryngoscope which was been passed through the endotracheal tube. The TEF could then be found and repaired perfectly with minimal dissection and trauma to the trachea and esophagus through thoracotomy [Except 1 case that did not need thoracotomy] Postoperative course was uneventful and all of the patients were discharged in good condition. We believe that intraoperative fiberoptic bronchoscopy in these types of operations not only leads to shortening the operation time, but it can also prevent unnecessary trauma to vital thoracic organs

[Evaluation of apnea test in brain-dead patients]

Apnea testing is mandatory to confirm brain death. Serious side effects such as severe cardio-pulmonary complications, ICP elevation and pneumothoraces may occur during apnea testing. So, it should be performed as the last test after the other ones. However, its safety is a major issue .The aim of this study was to evaluate the results and complications of apnea test in brain dead patients in the course of three years. This cross sectional study was corried out from 2002 to 2005 at Mashhad University of Medical Sciences with a simple sampling method on 57 brain dead patients in whom apnea test was performed by the authors. After preoxygenation the test was done in 10 minutes during which the patients had been disconnected from the ventilator. ABG analysis proceeded in minutes 2, 5, 8 and 10. The test result assumed positive if PaCO2 was increased up to 60mmHg or more than 20mmHg from baseline value. All patients should had been preoxygenated. The test stopped whenever predefined complications occurred. All the data collected in a separated questionnaire. Statistical analysis was done using SPSS software and with ANNOVA test. From 57 brain dead patients in this study, 11 were female and 46 were male. The mean age of the patients was 25.28 years, ranging from 6 to 38 [SD= 14.3]. Serious complications occurred in 11 patients including severe hypoxia in 10 and cardiac arrest in one. These complications were more common in patients, before testing, with an unstable cardiopulmonary condition than the ones with a stable condition [53.84% versus 9.6%]. The mean period from death time to apnea testing was between minimally 36 hours and maximally 11 days. It was 11 days in a patient aged 15. In all cases, the results of the tests were positive and supported by clinical diagnosis of brain death. Apnea test is an invasive test. It may reduces the organ reservoirs and potentially induces tissue ischemia, due to severe cardio-pulmonary complications. Also, it is not able to reject brain death diagnosis, if it has already been confirmed by the other tests. It seems that an alternative test with a high index of safety should be considered or some modifications are needed. At least, it is suggested to be avoided in patients with an unstable cardiopulmonary condition

[Subpubic block in superficial operations of peins]

Circumcision is the most common surgical procedure. As same as other superficial operations, they cause not only severe postoperative pain but also are accounted a severe intraoperative stimulation. There are many anesthetic techniques for circumcision. It seems supplementary penile block to general anesthesia is the best approach. Our aim in this study is to evaluate the efficacy of sub pubic approach to dorsal penile nerve block in relieving postoperative pain. This descriptive study was done in Dr Sheikh Pediatric Hospital during summer of 2004. Sub pubic approach to dorsal penile nerve block was evaluated in 60 boys. Two injections were performed with plain Bupivacaine 0.5%, 0.1 ml/kg in each side [total 0.2 ml/kg] at puncture sites, which had been marked before, just 0.5 to 1 cm blow pubic symphisis and lateral to midline in the supine position. Postoperative pain was evaluated with two methods, FLACC and Wong and Baker, and parental report up to 24 hours after general anesthesia. Collected data was analyzed by using descriptive and analytical statistics. Two cases [3.3%] were excluded. Two patients [3.4%] experienced moderate pain postoperatively. Others [96.5%] were completely pain free up to 24 hours after procedure. No complications occurred. There was no relationship between needle length and patients' age. According to this and previous studies, although there is little experience, this technique is the most successful and safe approach for intra and postoperative long [up to 24h] pain relief that with some experience is also very easy

Review on Cynara scolymus L

Articholce [Cynara Scolymus L.] is one of non- native plants being cultivated in Iran. This plant is mostly used in foods, so that it is probably harmless. In this Article we are going to coucentrate on different stages of its cultivation and the clinical uses of it in relation with some clinical studies

Primary hyperoxaluria: report of four cases and review of the literature

In this paper we will present four cases of primary hyperoxaluria. All patients had a significant past medical history of polyuria [with or without microscopic hematuria] and polydypsia. All patients had a family history of their parents being cousins. Initial evaluation of all patients by ultrasound and plain abdominal films revealed nephrocalcinosis. Their clinical courses showed gradual loss of renal function over the follow-up years. We will also review primary hyperoxalurias and their management in this report