Causes of delay in proper treatment of patients with undescended testis

Undescended testis [UDT] is the most common endocrine disorder in male children. Delayed diagnosis and treatment of UDT lead to complications such as infertility, malignancy and testis rotation. The aim of this study was to evaluate the causes of delay in proper treatment of patients with undescended testis in our population. An observational, descriptive, cross sectional study of 143 male patients, who applied to Shahid Sadoughi University Hospitals for orchiopexy operation was performed. The maximum recommended age for orchiopexy was 18 months. The mean age at referral was 5.34 years. Only 44 [30.8%] cases were operated on before the age of 18 months. The most common reasons of delay in treatment were absence of early diagnose [42.5%], parent's unawareness of surgery necessity and its complications associated [33.7%] and parent's disregard [23.5%]. Only 19.6% of patients were diagnosed at born in the hospital. 49% of parents had the correct information for proper operation age and 40.6% of them had enough information about necessity of surgery and side effects of disease. Parent's literacy, place of living and type of cryptorchidism had no significant relation with delay diagnosis [p> 0.05]. These results revealed that late diagnosis by physician and lack of insight of parents are the main reasons in delayed diagnosis and treatment of UDT. Therefore, education of parents and careful physical examination of the babies at birth and regular follow-up until 18 months can prevent the delay in diagnosis

Preoperative oral dextromethorphan does not reduce pain or morphine consumption after open cholesyctectomy

Dextromethorphan [DM], the D-isomer of the codeine analogue levorphanol, is a weak, noncompetitive N-Methyl-D-Aspartate [NMDA] receptor antagonist. It has been suggested that NMDA receptor antagonists induce preemptive analgesia when administrated before tissue injury occurs, thus decreasing the subsequent sensation of pain. The study was conducted in the Dr Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. In this seventy two patients scheduled for elective cholesyctectomy between February 2005 and December 2006 were randomized into three equal groups to receive as premedication either oral dextromethorphan 45 mg [Group D45 = 24], dextromethorphan 90 mg [Group D 90 = 24] or placebo [Group C, n = 24], 120 min before surgery. A visual analogue scale [VAS] for pain of each patient measured at arrival in the ward and 6 and 24 hours after surgery, was recorded. The demographic characteristics of patients, ASA physical status class, duration of surgery, and the basal VAS pain score were similar in the two groups. There was no significant difference in the mean of the VAS pain scores measured over time or morphine consumption between three groups. Dextromethorphan, 45 and 90 mg orally administrated 2 h before surgery had no effect on postoperative morphine requirement and pain intensity