Comparison of preemptive effect of intravenous ketorolac versus meperidine on postoperative shivering and pain in patients undergoing cesarean section under spinal anesthesia: A prospective, randomized, double-blind study.

BACKGROUND: Pain and shivering are two unpleasant problems in postoperative period. Various techniques are used to alleviate the postoperative shivering and pain. We compared the preemptive prescription of a single dose of intravenous meperidine and ketorolac on postoperative pain and shivering in patients undergoing cesarean section with spinal anesthesia. METHODS: One hundred and fifty patients who were scheduled for elective cesarean section under spinal anesthesia were randomly allocated to one of three study groups to receive intravenous ketorolac (group K), meperidine (group M) or normal saline (group P). Time to first analgesic request, analgesic requirement in the first 24 hours after surgery, body tympanic temperature, hemodynamic variables and incidence of shivering were assessed as outcome variables. RESULTS: There was no significant difference between meperidine and ketorolac groups in terms of prevalence of shivering, although both groups were different from the placebo group (p<0.04). The mean time to first analgesic request was longer in group k (3.8±1.4) and groups M (3.3±1.2) than in group P (2.1±0.8) hours (p<0.001). CONCLUSIONS: The preemptive prescription of a single dose of intravenous meperidine and ketorolac can provide a satisfying analgesia immediately after surgery and decrease shivering prevalence without any serious side effects.

High rate of advanced colorectal polyps in a 10-year-long retrospective study in Qazvin, Iran.

BACKGROUND: Polyps are common lesions in the gastrointestinal (GI) tract. Colon cancer is mostly a result of progression from polyps. The present study aimed to evaluate demographic, clinical, and histological characteristics of colorectal polyps in Iran, particularly neoplastic and advanced types. MATERIALS AND METHODS: Over a period of 10 years, specimens of all colorectal polyps obtained from colonoscopy were studied. The variables subjected to statistical analysis were age, sex, and the chief clinical complaint of the patients who underwent colonoscopy, their motivation, and the site, size, and histological types of detected polyps. The level of significance was set at p value<0.05. RESULTS: Data were obtained from a total of 352 patients. No difference was seen between male and female patients regarding histological types. Only in nine patients was screening the reason for colonoscopy. Almost two-thirds (66.2%) of the polyps were neoplastic. Familial polyposis syndrome and inflammatory bowel disease were seen in 4.3% and 3.0% of the patients with neoplastic polyps, respectively. Sites of polyps were the sigmoid, rectum, and descending colon in 40.1%, 34.5%, and 17% of the cases, respectively. The advanced type made up 58.8% of neoplastic polyps. Only 3.6% of the patients undergoing colonoscopy in the study period had biopsied polyps. DISCUSSION: No difference was observed between male and female patients in terms of overall incidence of polyps, histological and anatomical profiles, and mean age distribution. Anatomical and histological profiles agreed with the studies performed in areas with a low risk of colon cancer. The findings show that colonoscopy was not performed when it was necessary. A meaningful increase in the number polyp biopsy cases and a corresponding decrease in polyp size in the last few years of the study can be associated with the presence of more GI specialist clinicians in hospital centers, and this holds out much hope for the further improvement of the situation in the future.

Epidemiological and clinicopathological characteristics of lung cancer in a teaching hospital in Iran.

BACKGROUND: Lung cancer is one of the most commonly diagnosed cancers and the most frequent cause of cancer-related death worldwide. In Iran, it ranks second and third as the cancer-causing death in men and women, respectively. We carried out this study to find out the demographic, clinical, and histological characteristics and risk factors of lung cancer in a referral tertiary center in Iran. MATERIALS AND METHODS: A retrospective study was conducted on cases of primary lung cancer based on the results of registered cancer reports of cytological and pathological specimens between March 2001 and March 2012. Demographic variables, clinical manifestations, histology and location of tumors were determined based on the data found in the medical records of each patient. Definite or probable etiologic factors were identified. Data analysis was performed with SPSS version 16 and a p-value ≤ 0.05 was considered as significant. RESULTS: A total of 203 patients, with a mean age of 65.7 years (SD=11.2), with primary lung cancer were identified, 81.3% being men. Of the total, 110 cases (54.2%) were living in urban areas. In 53.2% of cases, the site of tumor was on the right side and in 72.9% of cases the lesion was centrally located. The histological types of lung cancer were squamous cell carcinoma (SCC) in 107 cases (52.7%), adenocarcinoma (AC) in 30 cases (14.8%), and small cell carcinoma (SC) in 27 cases (13.3%). Significant correlations between the gender and residence, smoking, and the histological type and location (central or peripheral) of tumor were found. The percentage of smokers was 75.2% in men and 15.8% in women. CONCLUSIONS: Smoking was the most important risk factor and squamous cell carcinoma the most common histological type of lung cancer in our study. Male sex and being a smoker was associated with histological types of SCC while being nonsmoker had relationship with adenocarcinoma.

Clinicopathological features of colon adenocarcinoma in Qazvin, Iran: a 16 year study.

BACKGROUND: Colorectal cancer (CRC) was the fourth most commonly diagnosed cancer in Iran between 2000 and 2009, with adenocarcinoma (AC) as the most common histological type. Demographic, topographic and histological variables are important in the epidemiology and biology of cancer. The aim of this study was to investigate clinicopathological features of colon adenocarcinomas in Qazvin, Iran. MATERIALS AND METHODS: With a retrospective design, patient records of two pathology wards from March 1997 to March 2013 were studied with regard to anatomical location and histological classification. A broader anatomical grouping was also used including distal vs proximal regions and right sided vs left sided tumors. Data were analyzed using T-test and chi-square test. RESULTS: 118 (50.9%) male and 114 (49.1%) female patients were included in the study. Mean age was 57.3±14.7 years, with 29.2% under 50 years. There was no significant gender difference for age at diagnosis. The rectum (56%) and sigmoid colon (25%) were the most frequent anatomical locations. Proximal cases accounted for 18.6% in males and 8.8% in females (p=0.02). AC was more prevalent than other usual types in younger patients. The proportion of proximal cancer was 1.7% in first eight years of the study period vs 12.1% in the second one (p=0.005). A similar trend was also seen in right sided colon cancers (p=0.018). CONCLUSIONS: Young people are also at risk for the cancer with poor prognosis. Screening programs and weight loss in obese individuals can reduce incidence and complications of CRC.