Assessing the percent of necrosis after neoadjuvant chemotherapy with 24hr infusional cisplatin/3 days doxorubicin intermittent with ifosfamide-doxorubicin for osteosarcoma

Introduction: osteosarcoma is the most common primary bone tumor in children and young adults and appropriate chemotherapy can increase limb sparing and overall survival. Yet, the toxicity of chemotherapy regimens including MTX can be life threatening. Therefore; we tried another chemotherapy regimen for these patients. Method and materials: we investigated 15 patients aged 15 to 40 years old and used continuous infusion of cisplatin, doxorubicin intermittently with ifosfamide, doxorubicin as neoadjuvant chemotherapy. Percent of necrosis and toxicities was recorded for each patient. Results: Out of 15 patients investigated, 13 were males and 2 females. Tumor necrosis≥ 90% (defined as good necrosis) was observed in 60% of patients. 26.7% of the patients showed leucopenia grade three or four, 26.7% had anemia grade three or four, and 20% showed thrombocytopenia grade three or four. Conclusion: The above chemotherapy regimen can cause as good necrosis as the chemotherapy regimens including high dose of MTX with reduced toxicity and less nursing cares and laboratory tests. Of course small sample size limits extension of our result to all patients but trying this regimen is recommended in more patients to see more reliable results

Effect of magnesium sulphate added to lidocaine on inferior alveolar nerve block success in patients with symptoms of irreversible pulpitis: a prospective, randomized clinical trial

AIM: To investigate the effect of magnesium sulphate used as an adjuvant to lidocaine with epinephrine local anaesthetic on the success of inferior alveolar nerve blocks (IANB) in patients with irreversible pulpitis undergoing root canal treatment. METHODOLOGY: In a double-blind clinical trial, following power calculation, 124 patients with symptoms of irreversible pulpitis in mandibular molar teeth were selected and initial pain data was collected using a Heft-Parker (Heft & Parker 1984) visual analogue scale. The first group (control) received IANB with 1.8 mL of a local anaesthetic solution containing 1.8% lidocaine with 1:88,000 epinephrine whist the second group (test) received IANB with 1.8 mL of an anaesthetic solution containing 1% magnesium sulphate, and 1.8% lidocaine with 1:88,000 epinephrine. Pain data was collected after access cavity and penetration of files in the canals using a Heft-Parker visual analog scale. Two patients were not included in the study as they did not consent and a further 54 patients were excluded as they did not report lip numbness within 15 minutes after IANB administration, thus the data presented in this study is related to 68 patients. The data were analyzed using chi-square and t- test (α=0.05). RESULTS: The success of pulpal anaesthesia with IANB was 82% for the magnesium sulphate group and 53% for the control group. There was a significant difference in the effectiveness of the IANB between the 2 groups (P < 0.001). There was no significant difference between the magnesium sulphate and control groups regarding gender (P =0.598) or age (P = 0.208) or initial pain scores (P = 0.431). CONCLUSIONS: The addition of 1% magnesium sulphate to 1.8% lidocaine with 1:88,000 epinephrine resulted in a positive impact for the success of IANB in patients with a diagnosis of irreversible pulpitis related to mandibular molar teeth undergoing root canal treatment. Thus magnesium sulphate may be used as adjuvant for achieving profound pulpal anaesthesia in challenging cases. However, more studies with larger sample size and different concentration doses must be carried out to establish an appropriate conclusion before its routine clinical use

Assessment of the analgesic effects of extrapleural infusion of ropivacaine in neonates with esophageal atresia (EA) repair

Insufficient control of post-thoracotomy pain can produce breathing dysfunction and long term staying in neonatal intensive care unit (NICU). It can increase the incidence of pulmonary complications such as atelectasis, pneumonia and respiratory failure. The aim of this study was to determine the analgesic effect of continuous extrapleural nerve block, using ropivacaine, in neonates younger than 7 days old with esophageal atersia (EA) and the incidence of atelectasis and duration of hospitalization in NICU. For this purpose, from February 2007 till January 2009 in Mofid children's hospital, 68 neonates under 7 days old whom were candidate for thoracotomy due to esophageal atresia were, randomly divided into two groups in a controlled clinical trial. The cases received extrapleural infusion of ropivacaine 0.5 (0.1 mL/kg/h for 48 h) and controls received acetaminophen 20 mg/kg three times a day via the rectal route. Hemodynamically unstable patients and those who suffered from hospital infections were excluded from the study. After the surgery, all patients had spontaneous breathing without endotracheal tube and stable hemodynamic in NICU. Pain level was determined for each neonate, based on the neonatal infant pain scale (NIPS) grading. The incidence of atelectasis in the first 48 h after operation and throughout the NICU staying were also determined. Results showed that there were no significant difference in the mean age, sex proportions and mean weight between the two groups. The mean pain score in the group received ropivacaine (1.9 ± 0.7) was significantly less than the control group (5.2 ± 0.6) (p < 0.001). Five percent of cases (n = 1) and 100 of the control group (n=20) had pain scores equal or greater than 3 (p < 0.001). The incidence of atelectasis among cases was less than the control group (35 vs. 65 respectively; p = 0.58). Duration of hospitalization in the case group (12 ± 5.6 days) had no significant difference from the control group (13.6 ± 4.8 days) (p = 0.3) In conclusion, the results showed that continuous extrapleural infusion of ropivacaine reduces the pain noticeably and atelectasis relatively, after thoracotomy in neonates younger than 7 days suffering from EA, compared to the acetaminophen group. © 2010 by School of Pharmacy

The difference between induction and maintenance dosages of propofol for general anesthesia in patients with and without sleep quality disorder

This study was conducted to compare propofol dose requirements between patients with and without sleep quality disorder (SQD) in order to achieve the same depth of anesthesia. Methods: In this comparative study, adult patients who were candidates for elective cataract surgery under general anesthesia in American Society of Anesthesiologists (ASA) class I or II were included. Using a validated questionnaire, patients were divided into two groups with Pittsburgh Sleep Quality Index (PSQI) higher and lower than five. Pre-induction with midazolam 0.02 mg/kg and fentanyl 2 µg/kg was administered 3 min before induction. Induction and 1-hour maintenance doses of propofol to achieve and maintain bispectral index score (BIS) 40–60 were measured and compared in the two groups. Results: Seventy patients, 47 of which (67.1%) were female, with the mean age of 63.83 ± 10.67 years were enrolled; 35 in SQD group and 35 in normal group. Baseline and demographic characteristics were not significantly different between the two groups. BIS score after pre-induction was significantly lower in SQD group compared with normal group (p = 0.002). Propofol dose at the time of induction and also 1 hour after induction was significantly lower in SQD group compared to normal group (p < 0.001). Total dose of propofol required was significantly lower in SQD group (209.26 ± 81.02) compared to normal group (342.91 ± 100.59) (p < 0.001). Based on the unstandardized Beta of multivariable linear regression model, mean total propofol requirement in SQD group was 113.43 mg less than normal group (p < 0.001). Conclusion: In the current study, induction and maintenance doses of propofol for general anesthesia were significantly lower in patients with SQD, in comparison with normal patients

Study of Serum level of Chrome in Bladder Cancer Patients

ABSTRACT Introduction & Objective: Chrome (Cr) is one of the carcinogen trace elements that its role in cancer induction is documented in many studies. In spite o this, there are limited studies about the relationship between chrome and bladder cancer. So we decided to study the serum concentration of Cr in patients with bladder cancer in comparison with healthy individuals. Materials & method: During this case control study, 51 patients with bladder cancer and 58 normal subjects, after matching in age, sex and smoking habits with case group, were selected. Blood samples were collected from each cases. Serum level of Cr was measured in all samples by using the Flameless Atomic Absorption Spectrophotometer. Finally data were analyzed, using student t test. Results: Mean age of participants was 62.74 ± 14.63 years in control group and 58.2 ± 9.8 years in case group. Mean of serum Cr concentration was 128.82 ± 16.99 µg/L in bladder cancer patients and 121.93 ± 16.67 µg/L in control group. The difference in Cr level of serum was significant between two groups (p < 0.05). Conclusion: Results of this study indicated the high level of Cr in the serum of bladder cancer patients. Performing of some strategies in reduction of environmental contaminations, finding the contaminated sources and modifying them, can be useful, for reduction of serum level of Cr, especially in high risk groups