Comparison of ketamine and fentanyl for postoperative pain relief in children following adenotonsillectomy

Adenotonsillectomy has a high incidence of postoperative pain. Therefore, the purpose of this study was to evaluate the effectiveness and safety of either ketamine or fentanyl for postoperative pain relief in children following adenotonsillectomy. Sixty children aged 3-12 years, scheduled for adenotonsillectomy, were enrolled in this randomized, double-blind study. Patients were divided into two groups of 30 cases and received intravenous ketamine (0.5 mg kg(-1)) or fentanyl (1 microg kg(-1)). Modified Hannallah pain scale or Observational Pain Scores (OPS), nausea, vomiting, bleeding, rescue analgesia, sedation and post-anesthesia recovery scores were recorded both at first and 15th minute postoperatively. Moreover, patients receiving ketamine (group 1) or fentanyl (group 2) had comparable OPS and sedation score both on arrival and at 15th minute in the recovery room (p > 0.05). Although rescue analgesics were similarly required in both groups (p > 0.05), the time to reach rescue analgesia was shorter in group 1 (p = 0.001). Only one patient in fentanyl group had nausea and vomiting in the first 15 min that needed antiemetic in the recovery room. In conclusion, intravenous fentanyl (1 microg kg(-1)) compared with intravenous ketamine (0.5 mg kg(-1)) might provide extended time to first analgesic in children undergoing adenotonsillectomy. Interestingly, fentanyl and ketamine did not differ in post-operative vomiting.     

Comparison the effects of metoclopramide and dropridol associated with dexamethasone on post operative nausea and vomiting

The aim of study was, comparison of effects of Metoclopramide and Dropridol associated with Dexamethasone on prevalence of nausea and vomiting after operation was considered. In this study 160 patients ASA physical status I were divided into two groups. In both groups, premedication and induction of anesthesia were given equally according to weight. To the first group, Metoclopramide associated with Dexamethasone and to the second group, Dropridol associated with Dexamethasone was ordered. At the end of the operation, after removing tracheal tube, prevalence of nausea and vomiting in both groups was considered after 2 h and results were analyzed with t-test and Chi-square. Ratio of nausea and vomiting after operation in the first group was 24% and in the second 8%. So results show that prevalence of nausea and vomiting in the second group was considerably lower than the first group (p < 0.004). According to the results of this study our conclusion, Dropridol with dexamethasone given at the before of general anesthesia was more effective in decreasing the prevalence of nausea and vomiting in patients compared with metoclopramide with dexamethasone.     

Effect of adding ketamine to pethidine on postoperative pain in patients undergoing major abdominal operations: a double blind randomized controlled trial

To determine the effect of adding ketamine to pethidine in reducing post-operative pain in patients undergoing major abdominal operations, in a double blind randomized controlled trial, 100 patients aged 15-60 years who were candidate for elective major abdominal surgery allocated into two groups of pethidine + ketamine group (5 mg pethidine and 0.25 mg kg(-1) ketamine) or pethidine and placebo group (10 mg pethidine and NS) according to the regimen prescribed in postanesthesia care unit. Severity of pain (using visual analogue scale), prescribed dose of pethidine and side effects were recorded until 24 h after operation. Regarding post-operative pain, pethidine + ketamine group showed significant lower scores in all the times except 0 min, 2, 6 and 16 h. Nausea was significantly less frequent amongst pethidine + placebo group at times of 0, 15, 30 and 45 min (p < 0.05). Comparison of two groups did not show significant differences in prescribed pethedine dose in 0, 9, 12, 16, 20 and 24 h (p > 0.05). Yet, the mean dose of administered pethidine as rescue analgesic was significant lower in pethidine + ketamine group compared to pethidine + placebo group (112 +/- 31.5 mg vs. 133.5 +/- 24.5 mg, p < 0.001). In conclusion, our results showed that co-administration of ketamine and pethidine in postanesthesia care unit will improve postoperative pain and reduce narcotic consumption. It may, however, increase rate of postoperative nausea in the first hour after operation.     

Preemptive analgesia with local lidocaine infiltration for single-level open disc operation

To evaluate the impact of preemptive local analgesia at the incision site for postoperative pain in patients undergoing disc operation. In this prospective, randomized, double-blinded, placebo-controlled study 166 patients were assigned to either lidocaine (n = 83) or placebo (n = 83) groups. The incision site was infiltrated with either 20 mL of 2% lidocaine and 0.9% saline in lidocaine group or 0.9% saline before the incision. Morphine (5 mg) was used for postoperative pain treatment. Postoperative pain was measured with Visual Analog Scale (VAS) in 6, 12, 24 and 48 h. Data were analyzed with SPSS software, using Chi-square and t-tests. The groups were matched for age, sex, type of operation, mean length of hospital stay and mean length of operation. Statistical analysis revealed no significant difference in visual analog scores of pain severity at 6, 12, 24 and 48 h after surgery between lidocaine and placebo groups (6 h: 38.22 +/- 26.87 vs. 34.52 +/- 24.43, p = 0.35; 12 h: 33.26 +/- 28.83 vs. 28.01 +/- 24.71, p = 0.20; 24 h: 26.71 +/- 23.31 vs. 22.85 +/- 22.48, p = 0.27; 48 h 16.35 +/- 10.16 vs. 15.23 +/- 8.90 p = 0.45). The amount of narcotics used post operatively had no meaningful difference in the groups (lidocaine 10.07 +/- 8.24 mg vs. placebo 10.54 +/- 9.31 mg p = 0.73). Preemptive analgesia with lidocaine 2% used subcutaneously before skin incision has no effect in reducing postoperative pain, narcotics demand and duration of hospital stay.     

Effects of combination of intrathecal lidocaine and two doses of intrathecal midazolam on post-operative pain in patients undergoing herniorrhaphy: a randomized controlled trial

Assessment of the effect of combination of intrathecal midazolam and lidocaine on postoperative pain was the aim of this study. This randomized controlled trial was performed during 2007 in a teaching hospital of Arak University of Medical Sciences. Forty five male patients who were candidates for elective inguinal herniorrhaphy entered the study and randomly divided into three groups of control (lidocaine 5% plus normal saline), M 0.5 (lidocaine 5% and midazolam 0.5 mg) and M 1.0 (lidocaine 5% and midazolam 1 mg) according intrathecal solution injected for spinal anesthesia. Mean arterial blood pressure, heart rate, post-operative pain, narcotic requirements and complications (nausea, vomiting, pruritic, headache, hypotension and bradycardia) were recorded. The severity of post-operative pain was lowest in M 1.0 group in all postoperative measurements except at 2 h after operation. With regard of complications, only there was significant difference in vomiting between three groups which had the highest frequency in M 0.5 group. No severe hypotension was seen; though, bradycardia occurred in one patient in M 0.5 group which needed treatment. Present findings suggest that administration of intrathecal midazolam (especially 1 mg) together with lidocaine is effective in reducing post-operative pain in patients undergoing open inguinal herniorrhaphy and is not associated with adverse effect.     

Comparing the effects of ginger and metoclopramide on the treatment of pregnancy nausea

This study assesses the effects of ginger on nausea and vomiting caused by pregnancy and compares it with metoclopramide medicine. This study was a randomized double-blind controlled trial. Metoclopramide, Ginger and placebo were putted in similar capsules. The medicines were administered three times a day. Then the Rhodes questionnaire was completed and its score were calculated. Data were analyzed by Chi square test, ANOVA and Repeated measurement. The intensity of changes in nausea, vomiting and Rhodes during study were statistically different in two groups of ginger and metoclopramide compared with placebo (p < 0.05), but it was not statistically significant between two groups of ginger and metoclopramide. According to our study, ginger is less effective than metoclopramide in reducing nausea and vomiting but it could be a good alternative for metoclopramide.     

Effects of oral clonidine premedication on haemodynamic response to laryngoscopy and tracheal intubation: a clinical trial

The objective of this study was to evaluate the efficacy of pre-anesthetic orally administration of clonidine on pulse rate and blood stress response to laryngoscopy and tracheal intubation. In a double-blinded, randomized study, 274 ASA I and II subjects with age of 18 to 45 years scheduled for elective surgery under general anesthesia were enrolled. They were randomly allocated to receive oral clonidine (0.2 mg) or placebo as premedication 90-120 min before surgery. All the patients received Succinylcholine (1.5 mg kg(-1)) after induction of anesthesia with Fentanyl (50 microg) and Thiopentone (5 mg kg(-1)). The anesthesia was maintained with halothane (1.5 Mac) in 50% mixture of N2O/O2. Heart rate and systolic blood pressure were recorded before, immediately after and then every 5 min after intubation until 20 min. The Clonidine group showed a significant superiority over placebo in the prevention of increase in systolic blood pressure as well as heart rate over the intubation. A significant difference was observed in both heart rate and systolic blood pressures were significantly higher in Control group at three subsequent measurements following intubation. The results of this study suggest that orally administered clonidine in preanesthetic period, provides more haemodynamic stability and attenuates the stress response to laryngoscopy and intubation.     

Metformin as an adjunct to insulin for glycemic control in patients with type 2 diabetes after CABG surgery: a randomized double blind clinical trial

Perioperative hyperglycemia is common in patients with type 2 diabetes undergoing Coronary Artery Bypass Graft (CABG) surgery and there is a direct relation between postoperative hyperglycemia and mortality rate in these patients. The aim of the present study is to determine the efficacy of metformin on glycemic control in diabetic patients after CABG surgery. In a randomized double blind clinical trial, 100 patients with type 2 diabetes admitted in open heart ICU after CABG surgery in Mazandaran Heart Center were enrolled. They were randomly assigned to two intervention and control groups. Three hours after extubation, therapeutic antiglycemic regimens were applied in these two groups and continued for three days. Intervention group received regular insulin infusion along with two metformin 500 mg tablets per twelve hours while control group received regular insulin infusion with two placebo tablets per twelve hours. Blood glucose level and other parameters were measured and recorded in determined intervals. To analyze the data, independent T-test, paired T-test, Mann-Whitney and repeated measure ANOVA tests were employed. Mean blood glucose level was not significantly different in the two groups at the beginning of the ICU admission; however, mean glucose level in insulin-metformin group, twelve hours after the initiation of the study, was significantly lower than insulin group (p < 0.05). In addition, mean doses of potassium and insulin demand as well as mean number of episodes of hyperglycemia, hypoglycemia and glucose levels out of the accepted range were significantly lower in insulin-metformin group (p < 0.05). Alterations in mean levels of lactate, BE, pH and creatinine were not statistically significant in these two groups. It seems that adding metformin to insulin leads to a better glycemic control in type two diabetic patients undergoing CABG surgery without causing metabolic acidosis. Therefore, it might be a potential option in blood glucose control protocol in this group of patients.     

Randomized double blind comparison between sciatic-femoral nerve block and propofol-remifentanil, propofol-alfentanil general anesthetics in out-patient knee arthroscopy

The aim of this study is the evaluation preparation and discharge times as well as the side-effects, patient satisfaction and costs after out-patient knee arthroscopy performed with a combined sciatic-femoral nerve block or a propofol-remifentanil, propofol-alfentanil general anesthetics. Sixty patients, (remifentanil group 1, n = 20), (alfentanil group 2, n = 20) and a combined sciatic-femoral nerve block (PNB group 3, n = 20). In group 1, anesthesia was induced with remifentanil (1 mic kg(-1) followed by 0.5 mic kg(-1) min(-1) i.v), in group 2 alfentanil (20 mic kg(-1) followed by 2 mic kg(-1) min(-1) i.v, in both groups (group 1, 2) propofol was given 2 mg kg(-1) i.v followed by 9 mg kg(-1) h(-1) i.v. Patients then received atracurium 0.6 mg kg(-1) i.v. to facilitate endotracheal intubation. In the PNB group (group 3), patients received a sciatic-femoral nerve block with ropivacaine 25 mL 0.75 mg using a multiple injection technique aided by a nerve stimulator and a short, bevelled, Teflon-coated stimulating needle. There was no significant difference in the duration of stay in the post anesthesia care unit and day surgery unit between groups, there was significant increase in the time to first urination in PNB group than the other two groups. Also there was no significant difference in the stay in delay surgery. The cost of disposal materials, preoperative and post operative times were higher in PNB group. The cost of drugs was higher in remifentanil and alfentanil groups than PNB group; the total cost was insignificant in the three groups. In conclusion, this prospective randomized study suggests that in patients undergoing out-patient arthroscopy, a combined sciatic-femoral nerve block (using a small volume of ropivacaine 0.75%) compared with a propofol-remifentanil or propofol-alfentanil general anesthetics techniques may provide similar intraoperative analgesic efficacy, a shorter length of stay in the PACU and an increased likelihood of bypassing the first phase of postoperative recovery.     

Trabectedin for metastatic soft tissue sarcoma: a retrospective single center analysis

Soft tissue sarcoma (STS) comprises a large variety of rare malignant tumors. Development of distant metastasis is frequent, even in patients undergoing initial curative surgery. Trabectedin, a tetrahydroisoquinoline alkaloid isolated from the Caribbean marine tunicate Ecteinascidia turbinata, was approved in 2007 for patients with advanced STS after failure of anthracyclines and ifosfamide, or for patients unsuited to receive these agents. In this study, we retrospectively analyzed 25 patients who had been treated with trabectedin at our institution between 2007 and 2010. The majority (72%) had been heavily pre-treated with ≥2 previous lines of chemotherapy. Response assessed by conventional RECIST criteria was low, with only one patient achieving a partial remission (PR) and 10 stable disease (SD) after three cycles of treatment. However, median progression-free survival (PFS) and overall survival (OS) were significantly prolonged in this population compared to non-responders, with 7.7 months versus 2.1 months (p < 0.0001; HR 15.37, 95% CI 4.3 to 54.5) and 12.13 months versus 5.54 months (p = 0.0137; HR 3.7, 95% CI 1.3 to 10.5), respectively. PFS for all patients was 58% at three months and 37% at six months. Side effects, including neutropenia, elevation of liver transaminases/liver function tests, and nausea/vomiting, were usually mild and manageable. However, dose reductions due to side effects were necessary in five patients. We conclude that trabectedin is an effective and generally well tolerated treatment for STS even in a heavily pre-treated patient population.     

The study of antinociceptive effect of hydroalcoholic extract of Teucrium oliverianum (a plant used in southern Iranian traditional medicine) in rat by formalin test

Objective: Antinociceptive and anti-inflammatory activities of hydroalcoholic extract of Teucrium Oliverianum were investigated by formalin test model. This study was conducted in on the male Wistar rats, weighting 150-180 g. The animals were divided into seven groups (n = 7) and received 200, 400, 600 and 800 mg kg(-1) of hydroalcoholic extract of teucrium oliverianum intraperitoneally, respectively. Negative control group received normal saline (5 mL kg(-1)) and the positive control groups received 2.5 mg kg(-1) morphine and 300 mg kg(-1) aspirin, intraperitoneally respectively. The results showed that all doses of extract have significant analgesic effect (p < 0.05) in all studies times in comparison with negative control. The best result achieved with 600 mg kg(-1) of extract. The result revealed that the analgesic effect of the extract (600 mg kg(-1)) \was less than aspirin (300 mg kg(-1)) on the second phase of pain and less than morphine (2.5 mg kg(-1)) in both phases of the pain, more than aspirin in first phase of pain. One group of animals was treated with naloxone (1 mg kg(-1), i.p.) and suitable dose of extract (600 mg kg(-1), i.p.). Also, Naloxone inhibited analgesic effect of alcoholic extract of Teucrium Oliverianum. It can be concluded that the alcoholic extract of Teucrium oliverianum may exert its effect through opioid receptors, stimulating GABAergic system or promotes the release of endogenous opipeptides or decreasing free radicals.     

The hypolipidemic effect of Citrullus colocynthis on patients with hyperlipidemia

Citrullus colocynthis is one of the medical herbs that traditionally have been used as an antidiabetic medication in tropical and subtropical countries. The aim of this study was to investigate the hypolipidemic effect of Citrullus colocynthis beyond the hypoglycemic impact on human. One hundred dislipidemic patients were randomly divided into two groups namely treated (n = 50) group and placebo (n = 50) group. The subjects were treated daily by powdered seeds of Citrullus colocynthis (300 mg) and placebo for 6 weeks. The serums, TG, Chol, LDL-C, HDL-C, SGOT and SGPT were measured with enzymatic methods at the beginning and the end of the project. The significance of differences within these groups was calculated by Paired T-test and by analysis of covariance between them. There were significant differences within and between treated and placebo groups during our treatment in TG and in Cholesterol after intervention (p < 0.05). A daily intake of 300 mg day(-1) of powdered seeds of Citrullus colocynthis can lower the triglyceride and cholesterol concentration significantly in nondiabetic hyperlipidemic patients.     

Arthroscopically-assisted vs. open surgery in repairing anterior cruciate ligament avulsion

The management of an Anterior Cruciate Ligament (ACL) avulsion is principally by surgery. There are two major techniques in this regard; fixation through open surgery (arthrotomy) or arthroscopically-assisted repair. These are not new in the literature; however, the debate regarding the better approach is still under debate. This study focused on comparing outcome and consequences of arthroscopically-assisted vs. open surgery in repairing ACL avulsion. In a randomized clinical trial, 44 patients with unilateral ACL avulsion were recruited in Tabriz Shohada teaching Centre during a 12 month period of time. These patients were randomized in two equal age and sex-matched groups underwent either arthroscopically-assisted or open ACL repair. The constructive technique was the same in both groups without using any graft. The minimum follow-up period was 6 months including 3 weeks, 3 months and 6 months postoperatively. Range of Motion (ROM), laxity, Anterior Drawer Test (ADT) result, duration of hospital stay, wound status, nonunion and return to previous work were compared between the two groups. Mean time of suture removal (p = 0.10), minimum and maximum ROM at months 3 (p = 0.43 and 0.22, respectively) and 6 (p = 0.73 and 0.77, respectively), ADT at months 3 and 6 (p = 0.16 for both), laxity at month 6 (p = 0.28) and wound status at week 3 (p = 0.35) were not significantly different between the two groups. There was no case of nonunion at month 6 in either group. The mean hospital stay was significantly shorter in the arthroscopy group (3.77 +/- 0.92 vs. 2.50 +/- 0.51 days; p < 0.001). The mean laxity score was significantly higher in the open surgery group at month 3 (4.82 +/- 0.59 vs. 4.45 +/- 0.60; p = 0.05). The rate of nonunion was significantly higher in the open surgery group at month 3 (40.9% vs. 9.1%; p = 0.02). Patients in the arthroscopically-assisted technique group returned sooner to previous work (17.41 +/- 1.53 vs. 14.82 +/- 0.96 weeks; p < 0.001). Based on our results, arthroscopically-assisted reconstruction of ACL avulsion is superior to open surgery.     

Comparison of topical triamcinolone and oral atorvastatin in treatment of paederus dermatitis Northern Iran

Dermatitis caused by stimulation of beetle paederus, is a common health problem in Northern and some southern parts of Iran. Since by now, traditional medicine and some corticosteroid agents have been used for treatment of dermatitis caused by beetle paederus. Because, there are few researches about classical treatment of the disease at academic level, this study planned to compare the effectiveness of triamcinolone ointment and atorvastatin tablet with placebo in treatment ofpaederus dermatitis in Northern Iran. A randomized double-blind clinical trial was carried out on 30 patients referred to the hospital and clinics at Sari and Neka countries in Northern Iran during 6 months. Patients were randomly divided into two therapeutic equal groups. The first group was triamcinolone ointment twice a day and a placebo atorvastatin tablet daily. The second group was oral atorvastatin one tablet (20 mg) daily and a placebo triamcinolone ointment twice a day. In Seventh day of visits, therapeutic response of the patients in triamcinolone and atorvastatin group were 93.33 and 80%, respectively. No significant differences were found in therapeutic outcome between the two groups (p > 0.05). The results showed both oftriamcinolone ointment and oral atorvastatin had similar effect on paederus dermatitis. Because the paederus dermatitis is a self-limited disease use of topical therapy for treatment of the disease is recommend.     

Comparing analgesic effects of a topical herbal mixed medicine with salicylate in patients with knee osteoarthritis

Knee osteoarthritis is the most common cause of disability among people and it is a common disease of joints that can lead to cartilage damage. In this study the analgesic effects of a herbal ointment containing cinnamon, ginger, mastic (Saghez) and sesame oil is compared with Salicylate ointment in patients suffering from knee osteoarthritis. It was a double-blind randomized controlled trail study. Patients with diagnosed arthritis were involved in the study and they were divided in two groups via block randomization method. For six weeks, twice a day, intervention group applied herbal ointment and control group used Salicylate ointment. The severity of pain, morning stiffness and limited motion were measured using Visual Analog Pain Scale. In order to analyze the trends of these three indexes, repeated measurement test was used. Ninety two participates with the mean age of 52.2 (+/- 12.4) years and with the mean disease period of 30.45 (+/- 30.3) months were involved in the study. There was no significant difference between two groups regarding the distribution of sex, weight, height, BMI and the duration of illness. No statistical difference was observed between two groups regarding pain relief, morning stiffness and limited motion; nevertheless in repeated measurements during second, forth and sixth weeks in both groups the decreasing trend of these three indexes had been statistically significant (p < 0.0001). It seems that using this herbal combination is clinically effective for patients suffering from knee osteoarthritis in order to decrease their pain, morning stiffness and limited motion; its effect is comparable with Salicylate ointment.     

Tetrodotoxin-bupivacaine-epinephrine combinations for prolonged local anesthesia

Currently available local anesthetics have analgesic durations in humans generally less than 12 hours. Prolonged-duration local anesthetics will be useful for postoperative analgesia. Previous studies showed that in rats, combinations of tetrodotoxin (TTX) with bupivacaine had supra-additive effects on sciatic block durations. In those studies, epinephrine combined with TTX prolonged blocks more than 10-fold, while reducing systemic toxicity. TTX, formulated as Tectin, is in phase III clinical trials as an injectable systemic analgesic for chronic cancer pain. Here, we examine dose-duration relationships and sciatic nerve histology following local nerve blocks with combinations of Tectin with bupivacaine 0.25% (2.5 mg/mL) solutions, with or without epinephrine 5 μg/mL (1:200,000) in rats. Percutaneous sciatic blockade was performed in Sprague-Dawley rats, and intensity and duration of sensory blockade was tested blindly with different Tectin-bupivacaine-epinephrine combinations. Between-group comparisons were analyzed using ANOVA and post-hoc Sidak tests. Nerves were examined blindly for signs of injury. Blocks containing bupivacaine 0.25% with Tectin 10 μM and epinephrine 5 μg/mL were prolonged by roughly 3-fold compared to blocks with bupivacaine 0.25% plain (P < 0.001) or bupivacaine 0.25% with epinephrine 5 μg/mL (P < 0.001). Nerve histology was benign for all groups. Combinations of Tectin in bupivacaine 0.25% with epinephrine 5 μg/mL appear promising for prolonged duration of local anesthesia.     

The effect of curcumin (active substance of turmeric) on the acetic acid-induced visceral nociception in rats

In the present study, the effect of chronic oral administration of curcumin in the presence or absence of morphine and noloxone was investigated on the visceral nociception induced by acetic acid in rats. Intraperitoneal injection of acetic acid (1 mL, 2%) produced contractions in the abdominal musculature (writhes). The latency time to the beginning of the first writhe was measured and the total number of writhes in the 1 h after acetic acid injection was counted. The latency time to the beginning of the first writhe was significantly (p < 0.05) increased and the number of writhes was significantly (p < 0.05) decreased by curcumin (20 and 40 mg kg(-1) body weight). The same results were obtained after subcutaneous injection of morphine (1 mg kg(-1) b.wt.). Naloxone at the dose of 1 mg kg(-1) body weight had no effect on pain intensity. Curcumin significantly (p < 0.05) enhanced the effect of morphine on the visceral pain responses, however did not reverse the effect of naloxone. Present data suggest that in the acetic acid-induced visceral nociception of rats, curcumin may produce an antinociceptive effect and the endogenous analgesic opioid system is involved in the curcumin-induced antinociception.     

Human papillomavirus infection in lung vs. oral squamous cell carcinomas: a polymerase chain reaction study

The role of Human Papillomavirus (HPV) has been suspected in pathogenesis of various malignancies; however, the available data are not conclusive. This study aimed to determine and compare the frequency of HPV infection in oral and lung Squamous Cell Carcinoma (SCC) by a sensitive method. Sixty specimens of oral and lung SCC (30 cases each one) were reevaluated in Tabriz Imam Reza Centre in a 24 month period. Following genomic DNA extract, the Polymerase Chain Reaction (PCR) amplification was performed in presence of specific MY11 and MY09 primers for HPV infection. Three cervical specimens and a combination of PCR solution lacking DNA plus healthy persons' DNA samples were employed as positive and negative controls, respectively. The oral group was significantly older than the lung group (68.90 vs. 56.67 y, p < 0.001) with more males in the latter (83.3 vs. 60%; p = 0.04). Percentages of HPV infection in the oral and lung groups were comparable (20 vs. 10%, respectively; p = 0.47). Majority of patients with HPV infection were older than 60 years (88.9%) or male (88.9%). In the oral group, all these cases were well differentiated and the majority was of lower lip origin (83.3%). In the lung group, 66.7% of these specimens were moderately differentiated and the origin was bronchus in all cases. In conclusion, the rate of HPV infection in lung and oral SCC samples is rather lower than the previous reports in the literature. This rate is apparently higher in the oral than the lung SCC specimens.     

AO tubular external fixation vs. unreamed intramedullary nailing in open grade IIIA-IIIB tibial shaft fractures: a single-center randomized clinical trial

Although the intramedullary nailing is thought to be the method of choice for treatment of closed tibial shaft, there is ongoing debate on the optimal surgical approach in patients with open types of these fractures. In addition, choosing between the reamed and unreamed intramedullary nailing is still an issue for the orthopedic surgeons. In present study, we aimed to compare the outcome and consequences of OA tubular external fixation vs. unreamed intramedullary nailing in open grade IIIA-IIIB tibial shaft fractures. In a randomized clinical trial, 50 patients with open tibial shaft fractures (grades IIIA-IIIB) were recruited in Tabriz Shohada teaching centre in a 2-year period of time. They randomized in two equal groups underwent either AO tubular external fixation or unreamed intramedullary nailing. These 2 groups were matched for sex, age and fracture-grade. The follow-up time was one year. Union time, surgical outcome, postoperative complications and the ambulation time were compared between the two groups. Twenty five patients, 20 males and 5 females with a mean age of 30.80 +/- 5.24 years were allocated in unreamed intramedullary group and 25 other patients, 22 males and 3 females with a mean age of 28.92 +/- 8.88 years were studied in the external fixation group (p = 0.70 and 0.37, respectively). The two groups were matched for sex (p = 0.70) and age (p = 0.37). The time of union was 3, 4, 5 and 6 < or = weeks after operation in 28, 12, 32 and 28% of the cases in unreamed intramedullary group vs. 4, 12, 48 and 36% of the cases in external fixation group, respectively (p = 0.14). Post-operative infection, soft tissue injury, malunion and nonunion were documented in 16, 8, 0 and 4% of the cases in unreamed intramedullary group vs. 32, 12, 24 and 8% of the cases in external fixation group, respectively (p = 0.19, 0.50, 0.02 and 0.50, respectively). The mean ambulation time after operation was 2.92 +/- 2.43 weeks in the unreamed intramedullary nailing group vs. 2.68 +/- 2.14 weeks in the external fixation group (p = 0.71). Our results are in favor of unreamed intramedullary nailing against external fixation in treatment of open tibial shaft fractures.     

Effect of vitamin C supplementation on postprandial oxidative stress and lipid profile in type 2 diabetic patients

Diabetes mellitus is one of the most wide spread endocrine disorders and an important developing health problem in the world. Cardiovascular disease is a common complication of type 2 diabetes. Several risk factors for coronary heart disease cosegregate in type 2 diabetes, including hyperglycemia, hyperlipaemia, increases production of free radical and decrease in antioxidant defense system. In this study we evaluated the effect of vitamin C supplementation on fasting and postprandial oxidative stress and lipid profile in type 2 diabetic patients. 30 patients with type 2 diabetes from Nader Kazemi Clinic, Shiraz, Iran were randomly divided into 2 groups; vitamin C treatment group (1000 mg d(-1)) and placebo group from May to September 2010. Fasting and postprandial lipid profile and Malondialdehyde (MDA) level were measured at the beginning of the study and after six weeks of supplementation. Data analysis was carried out using Mann-Whitney U test with p < 0.05 being significant by SPSS software version 16.The result of the study showed a significantly decrease in fasting (p = 0.006) and postprandial MDA (p < 0.001) in vitamin C group compare to placebo group but not in lipid profile. This study suggests that vitamin C supplementation can decrease fasting and postprandial oxidative stress and may prevent diabetes complication.