Comparison of fentanyl and combination of pethedine and midazolam for pain control during extracorporeal shock wave lithotripsy

زمینه و هدف: با توجه به لزوم کنترل درد حین سنگ شکن، این مطالعه با هدف مقایسه کارآیی و عوارض داروی مخدر فنتانیل با ترکیب پتیدین و میدازولام جهت کنترل درد حین عمل سنگ شکن ضربه ای برون اندامی انجام شد. روش بررسی: در این کار آزمایی بالینی یک سو کور 89 بیمار با سن بالاتر از 18 سال واجد شرایط انجام عمل سنگ شکن ضربه ای برون اندامی به صورت تصادفی به دو گروه مداخله (45 نفر) و کنترل (44 نفر) تقسیم شدند. در بیماران گروه مداخله 1 میکروگرم بر کیلوگرم فنتانیل و در گروه کنترل 7/. میلی گرم بر کیلوگرم پتیدین و 02/. میلی گرم بر کیلوگرم میدازولام به صورت وریدی تزریق شد. سپس در هر دو گروه، سنگ شکن به روش استاندارد انجام و شدت درد حین عمل هر 20 دقیقه و دو ساعت بعد از عمل با مقیاس سنجش درد (VAS) اندازه گیری شد. کارآیی عمل بر اساس پیگیری های بعدی بیماران ارزیابی شد. داده ها به کمک آزمون آماری کای دو تجزیه و تحلیل شدند. یافته ها: گر چه فراوانی عدم درد و درد خفیف در گروه مداخله (به ترتیب 6/26 و 4/24) و فراوانی درد شدید در گروه کنترل بالاتر (5/32) بود ولی این اختلاف معنی دار نبود. همچنین نتایج بررسی میزان کارآیی عمل در بیماران دو گروه مداخله و کنترل تفاوت معنی داری را نشان نداد. نتیجه گیری: فنتانیل تزریقی با دوز کم مانند ترکیب پتیدین و میدازولام در کنترل درد حین عمل سنگ شکنی برون اندامی دارویی با عوارض کم و کارآیی مناسب است و می تواند به صورت سرپایی مورد استفاده قرار گیر

MP-02.14: Prevalence of disease in brothers of patients with varicocele: a comparison with healthy controls

Introduction: We performed a study to examine brothers of patients with varicocele to determine the familial risk for varicocele. Methods: Ninety-five patients with varicocele who presented with infertility, testicular pain, or cosmetic problems were enrolled in the study. Their healthy brothers were asked to refer and examined. A total of 131 men without varicocele aged 10 years or older were assessed along with their 56 brothers with varicocele. A group of 150 men referred for employment examinations were selected as control group and assessed for varicocele. Results: The mean ages of the patients, their brothers and the controls were 21.8 � 8.1 years, 20 � 8.9 years, and 19.2 � 5.6 years, respectively. Varicocele was seen in all, 60(45%), and 15(10%) of them, respectively. Varicocele grades 1, 2, and 3 were seen in 8(14.3%), 9(16.1%), and 49(87.5%) of the patients, in 20(15.3%), 24(18.3%), and 30(22.9%) of their brothers, and in 2(1.3%), 2(1.3%), 3 (2%) of the controls, respectively. Bilateral involvement was present in 10(17.9%), 14(10.6%), and 5(3.3%) of the patients in the three groups, respectively. The overall frequency of varicocele and the frequency of grades 2 and 3 varicocele were signifi- cantly higher in brothers of the patients than in the controls (P � .01; P � .05). Conclusions: The high frequency of varicocele among the brothers of our patients may be an indicative of a hereditary behavior of the disease, warranting more investigation in this regard

Prevention of Bradycardia by Atropine Sulfate During Urological Laparoscopic Surgery A Randomized Controlled Trial

anesthesia for laparoscopy. The aim of this study was to evaluate the efficacy of atropine sulfate for prevention of bradyarrhythmia during laparoscopic surgery. Materials and Methods: Sixty-four candidates for urological laparoscopic surgery were randomly assigned into 2 groups to receive either atropine sulfate or hypertonic saline solution (as placebo), intravenously 3 minutes before induction of anesthesia for the laparoscopic procedure. Then, all of the patients underwent anesthesia intravenous sodium thiopental and atracurium, followed by isoflurane or halothane inhalation. Heart rate and blood pressure were recorded preoperatively in the recovery room, preoperatively in the operation room, after induction of anesthesia, after induction of pneumoperitoneum, and postoperatively. Results: A significant decreasing trend was seen in the heart rates during the operation in patients without atropine sulfate. Nine of 32 patients (28.1%) in this group developed bradycardia, while none of the patients with atropine sulfate prophylaxis had bradycardia perioperatively (P <.001). The mean decreases in systolic blood pressure between induction of anesthesia and pneumoperitoneum were 15.7 +/- 10.2 mm Hg in group 1 and 23.5 +/- 9.8 min Hg in group 2 (P <.001). The mean decreases in diastolic blood pressure between these two measurements were 8.7 +/- 5.2 min Hg in group 1 compared to 12.1 +/- 6.2 mm Hg in group 2 (P =.001). Conclusion: This study suggests that routine prophylaxis with an anticholinergic agent might be helpful in prevention of sinus bradycardia during urological laparoscopic surgery

Varicocele in brothers of patients with varicocele.

INTRODUCTION: The aim of this study was to evaluate varicocele patients' brothers to determine whether they are at a higher risk of varicocele than the general population of men. MATERIALS AND METHODS: A total of 56 patients with varicocele and their 131 brothers (> 16 years old) were evaluated. The brothers had no complaints of infertility, pain, or cosmetic problems. They were all examined for varicocele. One hundred and fifty men who referred for employment medical examinations were considered as the control group. RESULTS: Of the subjects, 39 (69.6) had grade III varicocele. Sixty (45.8) of the brothers had varicocele. The grade of varicocele was III in 16 (26.7) brothers. In the control group, varicocele was present in 15 (10) which was grade III in 5 (33.3). The frequency of varicocele was 4.5-fold greater in the brothers of the patients than the controls (P<.001). Also, the frequency of grade III varicocele was significantly more than grades I and II in the patients in comparison with their brothers and controls with varicocele (P<.001). There was no significant difference in the grades between the controls and the patients' brothers (P=.31). The frequency of bilateral varicocele was not statistically different between the three groups (P=.14). CONCLUSION: Our findings showed that a significant increase is seen in the prevalence of varicocele in the patients' brothers compared to men in the general population, warranting evaluation of the first-degree relatives of men who present with varicocele

Prevention of Bradycardia by Atropine Sulfate During Urological Laparoscopic Surgery: A Randomized Controlled Trial

&lt;p&gt;&lt;strong&gt;Introduction:&lt;/strong&gt; Cardiac arrhythmias are a well-recognized complication of anesthesia for laparoscopy. The aim of this study was to evaluate the efficacy of atropine sulfate for prevention of bradyarrhythmia during laparoscopic surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and Methods:&lt;/strong&gt; Sixty-four candidates for urological laparoscopic surgery were randomly assigned into 2 groups to receive either atropine sulfate or hypertonic saline solution (as placebo), intravenously 3 minutes before induction of anesthesia for the laparoscopic procedure. Then, all of the patients underwent anesthesia intravenous sodium thiopental and atracurium, followed by isoflurane or halothane inhalation. Heart rate and blood pressure were recorded preoperatively in the recovery room, preoperatively in the operation room, after induction of anesthesia, after induction of pneumoperitoneum, and postoperatively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A significant decreasing trend was seen in the heart rates during the operation in patients without atropine sulfate. Nine of 32 patients (28.1%) in this group developed bradycardia, while none of the patients with atropine sulfate prophylaxis had bradycardia perioperatively (P &lt; .001). The mean decreases in systolic blood pressure between induction of anesthesia and pneumoperitoneum were 15.7 ± 10.2 mm Hg in group 1 and 23.5 ± 9.8 mm Hg in group 2 (P &lt; .001). The mean decreases in diastolic blood pressure between these two measurements were 8.7 ± 5.2 mm Hg in group 1 compared to 12.1 ± 6.2 mm Hg in group 2 (P = .001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; This study suggests that routine prophylaxis with an anticholinergic agent might be helpful in prevention of sinus bradycardia during urological laparoscopic surgery.&lt;/p&gt

Effects of hydrophilic extract of Nasturtium officinale on prevention of ethylene glycol induced renal stone in male Wistar rats

Background: Nasturtium officinale is a traditional herb that is used for diuresis. Objectives: The aim of this study is to determine the effects of hydrophilic extract of Nasturtium officinale on ethylene glycol-induced renal stone in male Wistar rats. Materials and Methods: In this study 32 male Wistar rats were randomly divided in six groups and studied during 30 days. Two groups of negative and healthy control received 1% ethylene glycol in water respectively. Low and high dose preventive groups, in addition to 1% ethylene glycol, daily gavaged with 750 mg/kg and 1.5 g/kg of extract respectively. All rats were hold in metabolic cages individually in days 0, 15 and 30 and 24-hour urine samples were collected and checked for urinary parameters of stone formation. In 30th day, rats were anesthetized with ether, and after taking serum sample from them, were sacrificed and their kidneys were sent for pathological evaluation and for presence and volume of calcium oxalate crystals. Results: Percentage of calcium oxalate crystals in negative control groups (75%), preventive groups with low dose (28.6%) and high dose (57.1%) in comparison to healthy control group (12.5%) increased (P < 0.05). In 30th day urinary oxalate concentration in preventive and negative control groups were more than healthy control group (P < 0.05). Conclusions: This research showed that the Nasturtium officinale extract has no significant effects in urinary and chemical parameters efficient in calcium oxalate stone crystals in rat but its extract in low dose has some preventive effect on renal stone formation

Results and Complications of Spinal Anesthesia in Percutaneous Nephrolithotomy

Introduction: Percutaneous nephrolithotomy (PCNL) is the treatment of choice for large kidney calculi, staghorn calculi, and calculi that are multiple or resistant to shock wave lithotripsy. In many centers, PCNL is performed under general anesthesia. However, complications under spinal anesthesia can be less frequent. We evaluated the impact of spinal anesthesia on intra-operative and postoperative outcome in patients undergoing PCNL. Materials and Methods: The intra-operative and postoperative anesthetic and surgical outcomes were evaluated in 160 consecutive patients who underwent PCNL under spinal anesthesia in the prone position. Results: The mean age of the patients was 40.0 ±14.3 years, and the mean operative time was 95.0 ± 37.8 minutes. The mean calculus size was 34.2 ± 9.8 mm. Ten patients had staghorn calculi (mean size, 4.2 ± 1.1 cm; mean operative time, 140 ± 40 minutes). Return of sensory and motor activity took 140.0 ± 19.7 minutes and 121.0 ± 23.8 minutes, respectively. During the first part of anesthesia, 18 patients developed hypotension, which was controlled by ephedrine, 10 mg, intravenously. Ten patients (6.3%) needed blood transfusion and 6 complained of mild to moderate headache, dizziness, and mild low back pain for 2 to 4 days after the operation, which improved with analgesics and bed rest. Seventy percent of the patients had complete clearance of calculus or no significant residual calculi larger than 5 mm on follow-up ultrasonography. Conclusion: Spinal anesthesia is safe and effective for performing PCNL and is a good alternative for general anesthesia in adult patients

Comparison efficacy of oral Peganum harmala seed versus tamsulosin on pain relief and expulsion of renal and ureteral stones; a randomized clinical tria

Introduction: Kidney stones are glycoproteins sediments that are formed inside kidney tubules and collecting ducts and are made of acid crystals and minerals. Objectives: This study aimed to compare the effects of Peganum harmala seed and tamsulosin on pain relief and expulsion of renal and ureteral stones in patients candidate for medical therapy. Patients and Methods: in this randomized clinical trial 80 patients older than 18 years with kidney and ureteral stones sized 4 to 10 mm were randomly allocated to one of two groups by simple sampling method. In group one, after performing ultrasonography and confirming the presence of 4 to 10 mm stone one capsule of tamsulosin 0.4 mg was prescribed per night for two weeks. In group two, harmala seed preparing in form of capsule with dose of 50 mg/kg/d, was prescribed after meal as the same of first group. Two weeks later patients were re-visited and urinary tract ultrasonography was conducted and the change in size of stones and presence of residual stones evaluated and recorded. The severity of pain in the patients was checked using VAS (visual analogue scale). Then the data was collected and analyzed at the end of the study. Results: Mean size of stones after treatment were 4.07±3.66 and 5.15 ± 3.63 mm respectively (P= 0.21). Mean numbers of stones before and after treatment were 0.59±1.38 and 1.18±0.94 (P=0.052). Pain score decreased significantly in both groups which was more significant in P. harmala group (P=0.002). Efficacy of treatment (sum of complete and partial response) in the two groups was 77.5 % and 77.8 % respectively and no significant differences between the two groups were seen (P=0.06). There was no significant side effect in the two groups. Conclusion: This study showed that both P. harmala seed and tamsulosin decrease urinary stone size and numbers without significant difference, but pain score decreased significantly by P. harmala

Analysis of Serum Prostate-Specific Antigen Levels in Men Aged 40 Years and Older in Yasuj, Iran

Introduction: Serum prostate-specific antigen (PSA) is still the simplest marker for early diagnosis and follow-up of prostate cancer. Because racial differences in PSA levels have been found, we performed this study to determine the reference level of serum PSA for men in Yasuj, in southwest Iran.Materials and Methods: Men aged 40 years and older who had been referred to any of the Yasuj hospitals for a blood cell count for any reason were randomly selected. Those with a history of prostate cancer, prostatitis, urinary tract infection, bladder outlet obstruction, or transurethral procedures were excluded. Blood samples were taken, and PSA levels were measured. Results: Prostate-specific antigen levels in the 95th percentile were 1.35 ng/mL, 1.85 ng/mL, 3.2 ng/mL, and 4.4 ng/mL for men aged 40 to 49, 50 to 59, 60 to 69, and older than 69 years, respectively. Mean serum PSA levels were 0.7 ng/mL, 0.9 ng/mL, 1.6 ng/mL, and 2.2 ng/mL, respectively. Conclusion: A comparison of our results with those from studies in the United States and Japan shows that the reference PSA level in our society is significantly lower than that for white and black Western men, and slightly lower than that for Japanese men. Although we examined men with no history of prostate cancer, cancer was not ruled out by diagnostic test; hence, our results may be overestimated. Further investigations in Iran are warranted. </p