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

Biliary pseudolithiasis during ceftriaxone therapy in children

Ceftriaxone is almost widely used in the treatment of pediatric infection and this is accompanied by some complications. The aim of this study was to determine the incidence of abnormal ultrasonography findings of gallbladder [pseudolithiasis or sludge] during ceftriaxon therapy and its relation to fasting, sex and G6PD deficiency. This quasi-experimental survey was done in Amirkola Children's Hospital, Babol, Iran. First ultrasonography was done before initiation of ceftriaxone therapy and it was repeated 24-48 hours after therapy and in the 5th, 7th, 10th and 14th day after the treatment. If abnormal finding was seen, ultrasonography was done weekly in the first two weeks until the side effect disappeared. Data was collected and analyzed by SPSS software. Of all 108 patients, who were between 3 months to 10 years old, 20 cases had abnormal findings in gallbladder [2 sludges and 18 pseudolithiases]. Length of fasting before ceftriaxone therapy had a positive relation with possibility of stone formation [p<0.005], but age, sex, duration of therapy and G6PD deficiency were not related [p>0.05]. In four cases pseudolithiasis was formed after only 1-2 doses of ceftriaxone. Shortest and longest periods of resolution of complications were 1 and 17 days respectively after formation. Incidence of pseudolithiasis or sludge formation during ceftriaxone therapy was 18.5% and fasting had a great effect on these complications

Evaluation of carpal tunnel syndrome by laser doppler flowmentry

Autonomic disturbance can leads to blood flow changes that can be studied by various methods. To assess the blood flow changes in patients with severe carpal tunnel syndrome by laser Doppler flowmetry. Ten patients with severe unilateral carpal tunnel syndrome confirmed by electrodiagnostic examination enrolled in this study. Patients comprised one man and nine women with mean age of 37 years, an average duration of symptoms for 29 weeks. Unaffected hand and little finger of affected hand were used as control. Skin blood flow was measured in neutral, flexed and extended positions of hands. There was significant reduction of skin blood flow of median nerve territory as compared to control [unaffected hand] [p<0.05]. There was also significant [p<0.05] reduction of blood flow of median nerve territory as compare to ulnar nerve territory of affected hand except in extended position. Circulatory disturbances are seen in hand skin of CTS patients. This change depends on the type and severity of CTS. This study showed a reduction of skin blood flow in severe form of CTS