Measurement of ipsilateral lung and heart dose in radiotherapy of left sided mastectomy patient's in common different clinical techniques: A phantom study

Background: the aim of this study was to compare the radiation dose to ipsilateral lung and heart for different radiotherapy [RT] techniques including; two tangential photon beams, electron therapy and combined photon-electron

Materials and Methods: treatment planning of the mentioned techniques on the CT images of a chest phantom was done using treatment planning system [TiGRT, Lina Tech, China]. According to the plans, the phantom was irradiated with 6 MV photon and 10 MeV electron beams of Siemens Primus linac. Radiation dose was also measured using LiF Thermo Luminescence Dosimeter [TLD] which was placed inside 3 mm depth holes of ipsilateral lung and heart on the phantom

Results: the mean [ +/- SD] radiation dose to the ipsilateral lung of the combined photon-electron was 66.12 +/- 5.16% of prescribed dose. Whereas for the heart, it was 64.05 +/- 2.62%. Mean [ +/- SD] dose of ipsilateral lung and heart for electron irradiation was 54.51 +/- 3.88 % and 34.21 +/- 3.41%, respectively. The mean [ +/- SD] radiation dose to ipsilateral lung and heart of the tangential was 50.73 +/- 3.01 % and 31.36 +/- 3.13%, respectively. The mean [ +/- SD] radiation dose to the chest wall-lung interface for electron therapy [72.44 +/- 2.01 %] was significantly different in comparison with tangential [65.23 +/- 4.20%; p = 0.045] and combined photon-electron [68.14 +/- 3.53 %; p = 0.032]

Conclusion: tangential beams is more suitable for treating mastectomy patients compared to the other techniques such as electron therapy and combined photon-electron, due to lower radiation dose to patient's ipsilateral lung and heart

[ relationship of spinal deformities with locomotion components of kepart test in elementary school students with dyspraxia]

Because of dyspraxia students have difficulty in some movements and deformity of the spine as a factor can lead to restriction of their movement, the purpose of the present study was to investigate the relationship between vertebral column deformities and components of the Kepart test in students with dyspraxia. The present descriptive analytical research is a cross-sectional study, involving the male elementary school students of Tehran in 2009. The participants were selected through multi-stage cluster sampling: Zone 4 was chosen by random from among the 22 municipal districts; 5 schools were selected by random from among many schools in the zone; finally, 1100 students were randomly selected. In the first step, we distributed the questionnaire about the conceptual - movement deficiency [validity 0.86]. Eighty students of 8 to 12 years with problems in at least 5 components [out of 14] participated in the Kepart test [validity 0.95]. From them, 34 students with the lowest scores were selected as the study subjects. Then, with the use of Spinal - Mouse machine, the vertebrate column deformities of students were studied from frontal and sagital aspects. For analyzing the data, Pearson's correlation coefficient was used in SPSS 13. The prevalence of deformities was flat back 40%, thoracic kyphosis 29.16% and thoracic scoliosis 20.83% in the subjects. A significant relationship [p=0.05, r=0.34] was found between lumbar lordosis and side walking in students with dyspraxia. Also, the prevalence of dyspraxia was 7.26%, and 2.18% suffered from severe dyspraxia. The results showed that the lower the amount of lumbar lordosis, the lower the students' ability to side walk

[Effect of gender and physical activity on serum vascular endothelial growth factor at rest and response to submaximal exercise]

Although the effects of exercise on angiogenic factors is a topic that has attracted the attention of many researchers worldwide, the possible impacts of gender and physical activity on the rate of angiogenic factors at rest and response of acute exercise have not been investigated so far and which is why we conducted this research. Sixteen women [8 active, 8 sedentary] and 16 men [8 active, 8 sedentary] participated in this study. Three days after determination of V02max, they exercised for 1 h at 70% V02 max. Serum was collected from the vein at rest and at 0 and 2 h, post exercise. Serum vascular endothelial growth factor [VEGF] was measured by ELISA kits. Serum levels of VEGF decreased immediately after exercise in groups, a change that was temporary and transient. At rest, no difference between serum VEGF of groups was seen. On the other hand, changes in VEGF levels in response to exercise between groups were not significant. Acute submaximal exercise decreases the main angiogenic factor involved in development of capillary network. Gender and physical activity do not affect serum levels of the vascular endothelial growth factor at rest or response of exercise

Assessment of zinc concentration in random samples of the adult population in Shiraz, Iran

Zinc is an essential micronutrient for human health. However, little is known about concentration of this mineral among Iranian population. This study was carried out to determine the current zinc status, evaluate the impact of certain factors like age, sex and Body Mass Index [BMI], and to verify the prevalence of zinc deficiency among Iranian adult population in Shiraz, southern Iran. Serum samples from 374 randomly selected healthy individuals living in Shiraz, Iran, aged 19-82 years [143 males, 231 females] were collected and the serum zinc concentration was measured by Flame-Atomic Absorption Spectrometry. We considered the subjects with serum zinc concentration less than 100 microg/dl as zinc deficient. The serum zinc levels in females were lower than those of males with no statistically significant difference. Serum zinc concentrations were unrelated to age and BMI. It also did not change among different ages and BMI intervals. About 42.5% of our cases had serum zinc concentration below the cut off value of 100 microg/dl in the serum. Designing appropriate strategies for overcoming this public health problem is necessary

Comparing the effects of three selected exercise patterns on the equilibrium of patients with parkinson

Background and Purpose: Parkinson's disease is one of the common debilitating factors in the elderly. It is caused by disorders in the nucleus of cerebral base which control body movements such as walking and body balance. The present research is intended to study and compare the effects of three exercise patterns [rhythmic, medical ball exercising and stretching exercise] on Parkinsonian patients' equilibrium

Methods and Materials: This quasi-experimental study involved the population of Parkinsonian patients in Kashan and Aranobidgol, Iran. Thirty five male patients [61 +/- 3 years old] with minor Parkinson's disease [Stage 3 in Y and H scale] were selected and randomly assigned into one of the three groups: rhythmic group [N=11], medical ball exercising group [N=12] and stretching exercising group [N=12]. All participants took their medications under medical supervision in the study period. Each group performed the assigned pattern for 10 weeks [three onehour sessions each week]. Berg Balance Scaling [BBS] was used for measurements, and dependent t-test, one-way ANOVA and LSD tests were used for data analysis. All analyses were done in SPSS 16

Results: The results showed that the three different exercising patterns [Rhythmic, medical Ball and stretching exercises] had significantly improved patients' equilibrium by 15.7 %, 5.58% and 4.28% respectively [P=0.001]. It also revealed that rhythmic exercises had more considerable effects on Parkinson patients' equilibrium recovery than medical ball [P=0.03], and stretching exercise [P=0.008]. The effect of exercising with medical ball and stretching exercises on Parkinson patients' balance recovery is almost identical, with no significant difference [P=0.530]

Conclusion: Rhythmic exercise patterns cause more considerable effects on the improvement of equilibrium in Parkinson's patients than other patterns

[Correlation of body mass index and chronic pain in hospital personnel]

The last two decades have witnessed a remarkable increase in the number of people suffering a variety of painful syndromes. The goal of this study was to determine the correlation between body mass index and chronic pain in hospital workers during 2006. In this prospective descriptive study 210 cases were enrolled during 2006 at Beheshti and Ayatollah Kashani medical centeres. Variables such as demographic information, BMI, clinical presentations of chronic pain, and VAS were included. The data were analyzed using regression and correlation coefficient statistical tests. All cases were female. Most cases aged between30-39 years. The most common types of chronic pain were low back pain, knee pain, headache, and a combination of these discomforts. Nearly 65% of cases had severe pain. BMI range was at 19-24. There was no significant difference between BMI and VAS for chronic pain. Many workers suffer chronic pains leading to economical damages. Decrease in chronic pain could be achieved by considering the association between an individual's bodily strength and the person's physical activities and also vocational psychology hygiene

Doppler ultrasound assessment of well-functioning native hemodialysis access: comparison with sufficient dialysis

Malfunction of vascular accesses is a common cause of morbidity in hemodialysis patients. The purpose of the present study was to evaluate the flow volume and the diameter of the feeding artery in asymptomatic, well-functioning hemodialysis access with Doppler ultrasound. From March 2006 to February 2007, we examined the functioning mature arteriovenous fistula [AVF] of 69 hemodialysis patients by Doppler ultrasound in Imam Reza hospital, Mashhad. The measured flow volume, primary renal disease, AVF type and location, and the demographic data were recorded. All statistical analyses were performed with the Chi square test, the Student's t test and one-way ANOVA. Pearson correlation coefficient was also calculated. Of the 69 patients, 30 [43%] had an antecubital AVF. Overall, the mean +/- SD flow volume was 1665 +/- 554 mL/min. The majority of accesses [n = 52] had normal flow volume [500-1200 mL/min], 15 patients had high-flow fistulas [>1200 mL/min] and 4 had critical flow rates of < 500 mL/min. The flow volume was significantly higher in the antecubital AVF than that placed in more distal positions. The mean diameter of the feeding artery at the measurement site was 6.0 mm. There is a linear correlation between the diameter of the feeding artery and the mean flow rate [r = 0.76, p < 0.001]. No significant difference was observed between the type of anastomosis and the flow rate [p = 0.14]. There is a high level of abnormalities, especially high flow volume, in well-functioning mature AVFs. Color Doppler ultrasonography makes early detection of the patients with a higher risk possible and it can also guide the surgeon to select the surgical procedure

survey on current methods of carpal height ratio measurement and suggestion of a new method

Two famous methods are commonly used for the measurement of carpal height ratio. Both methods are performed on anteroposterior radiogram and have some shortcomings. We are going to introduce a new method for measuring this index in lateral view of the wrist radiogram. This cross-sectional and case-control study was conducted on 100 anteroposterior and lateral radiograms of asymptomatic individuals and then 20 radiograms of patients with Kienbock disease in various stages of the disease. After determining new reference points on the radiograms of the [normal] group, it was tried to define the ratio by new method. In the next stage the interobserver and intraobserver agreement of the new index was assessed along with previous defined indices. All three methods had some limitations, but overall it seems that the new method has more precise reference points. With regard to inter and intraobserver variability the new index was better than the Natrass group index, but not than the Youm group index. The new index can be used as a substitute or an alternative in carpal height measurement

role of ulnar variance in kienbock's disease

The etiology of Kienbock's disease is not clear definitely. Lunate blood supply, its shape and ulnar variance have been counted as the etiologies of this disease. For years, ulnar variance supposed to be an important predisposing factor for Kienbock's disease. There are controversies on the role of ulnar variance in Kienbock's disease and it has recently been stated that negative ulnar variance is not a risk factor for Kienbock's disease. The aim of this study was to elucidate the role of the negative ulnar variance in Kienbock's disease in Iranian patients. In this study, ulnar variance was measured in standardized condition in 90 normal wrists and in 67 patients with Kienbock's disease who had undergone surgery over the past 15 years. The correlation between age, sex and ulnar variance was assessed. We tried to determine the role of ulnar variance in the development of Kienbock's disease. Mean ulnar variance in the control group was 0.477 millimeter and in the group with Kienbock's disease, it was -0.995 millimeter. Regarding age, both groups were similar and after stratification by sex, we found that sex had no role in the development of disease. The correlations between age and ulnar variance, and sex and ulnar variance in the control group were not statistically significant. However, comparing case and control groups, we found statistically significant correlation between negative ulnar variance and Kienbock's disease. In spite of recent reports, negative ulnar variance is a predisposing risk factor for the development of Kienbock's disease

impaired fasting glucose associated with increased risk of coronary atherosclerosis?

Impaired fasting glucose identifies individuals at high risk of progression to diabetes but the role of IFG as a coronary artery disease risk factor, independent of its progression to diabetes and its association with other coronary artery disease risk factors, is unclear. A cross-sectional study was conducted to evaluate the hypothesis that impaired fasting glucose increased the likelihood of atherosclerotic plaque formation. Blood chemistry data as well as traditional coronary artery disease risk factors from 812 patients referred for coronary angiography to heart centers in Shahid- Chamran and Sina hospital, Isfahan, Iran were recorded. The population were stratified into three groups according to American Diabetes Association criteria: normal fasting glucose [n=608], impaired fasting glucose[n=92] and diabetes mellitus[n=112].We use extent, Vessel and stenosis scores to indicate the coronary artery involvement. KrusKal-Wallis test showed that the means of extent, Vessel and stenosis scores are not significantly different between three groups[P> 0.05]. Multivariate linear regression analysis, using extent score of coronary artery disease as dependent variable and traditional risk factors and impaired fasting glucose as independent variables did not show any significant difference either. Our data suggested that impaired fasting glucose is not associated with increased risk of coronary atherosclerosis

[Bilateral simultaneous posterior elbow fracture / dislocation: a case report]

Elbow dislocation, though not a rare injury has been only occasionally reported to occur bilaterally. An extremely rare case of upper extremity trauma is reported in which bilateral simultaneous posterior elbow dislocation associated with bilateral radial neck fractures had occurred. To the best of our knowledge, this hasn't been reported previously. Although radial head excision has been reported to be associated with good outcome in cases of elbow dislocations with fracture of radial neck, the trend has been toward preservation of the head and it seems that this is a more logical approach

effect of ischioanal fossa block with bupivacain on decreasing post hemorrhoidectomy pain

Hemorrhoidectomy is usually associated with severe pain in the immediate postoperative period. Today, a number of local blockages and sedatives are used to reduce this pain. However, so far, no specific method is recommended for this purpose. Therefore, the aim of this study was to investigate the efficacy of the ischioanal fossa block, in reduction of postoperative pain and analgesic requirements. This clinical-trial study was performed on eighty c and idates of elective hemorrhoidectomy. Patients were randomly assigned to either case [receiving ischioananl fossa block] or control [no ischioananl fossa block]. All aspects of surgery and anesthesia were st and ardized. In the postoperative period, analgesia was maintained with pithedine. Pain was assessed using VAS [Visual analogue scale] at 0 [arousal], 4, 12 and, 24 hours after operations. The time interval for the first request of analgesia and the total amount of analgesic consumption were recorded. There was no statistical difference between the two groups with respect to age, sex, weight, and duration of operation. The pain score of the case and the control group was 2.65 +/- 0.92 and 4.93 +/- 1.09, respectively [p<0.05]. Also, the pain score at 0, 4, 12, and 24 hrs post operation was significantly lower in the case than that in the control group [p<0.05]. The time interval for request of the first analgesic was significantly longer in the case group [8 hr versus 1.5 hrs] [p<0.05]. Total dose of pethedine consumption was statistically different between the two groups [p<0.05]. Based on the results, the administration of ischiorectal fossa block and bupivacain before the operation resulted in a significant decrease in postoperative pain and analgesia requirements. Therefore, this method is recommended

Development of a mathematical model for myoelectric activity of small intestine to reach a better understanding of the pathophysiology of Irritable bowel syndrome [I.B.S.]

Since enteric nervous system is a complicated network and calls for more investigations, we decided to develop a model for myoelectric activity of small intestine by use of artificial nerve networks, in order to reach a better underst and ing of I.B.S. According to empirical knowledge concerning I.B.S, serotonin level in enteric nervous system increases and this system becomes more excitable and active. The aim of this study was to prove these issues by use of mathematical models. MTLAB 6.5 soft ware was used in this project. Artificial nerve networks, equivalent to enteric nervous system were designed. By making use of artificial nerve networks, amplitude, time and number of spikes in the myoelectric curve of small intestine were determined which were compatible with empirical information. Using artificial nerve networks, the effect of increased level of serotonin as a pathophysiological factor, on bowel movement in IBS was established. This study can pave the way for designing other artificial networks to assess potential effects of drugs; or developing more effective methods for treatment of I.B.S.

[Knowledge, attitude and practice of elderly towards lifestyle during aging]

This cross-sectional study was carried out to evaluate the healthy lifestyle of 750 elderly people of Tehran 2002. The mean score of the males was significantly higher than in females. Furthermore, the average score of elderly membership in social activities was our findings revealed that the elderly have a low level of knowledge, attitude and performance towards healthy lifestyle. Thus, it seems designing a comprehensive program regarding a healthy lifestyle in this population to be of prime necessity

Intermediate dose and course furazolidone and amoxicillin versus metronidazole and amoxicillin in quadruple therapy for eradication of Helicobacter pylori

H. pylori eradication has been known as an effective measure in the treatment of peptic ulcer disease [PUD], chronic gastritis and gastric malt lymphoma. Furazolidone has recently shown promising efficacy in H. Pylori eradication and has replaced metronidazole in different eradication regimens. The aim of this study was to investigate the efficacy of two quadruple therapies based on furazolidone or metronidazole in the eradication of H. Pylori in Babol. This interventional study was performed on 103 patients with dyspepsia and endoscopic diagnosis of H. pylori infection. H. pylori status was assessed by histologic examination of biopsy specimens and rapid urease test [RUT]. Patients were randomly assigned to one of the two treatment groups: ABRM [amoxicillin 500 mg tid, bismuth subcitrate 120 mg tid, ranitidine 150 mg bid and metronidazole 250 mg tid] and ABRF [with the same regimens but furazolidone 100 mg tid was administered in stead of metronidazole 250 mg tid]. All antibiotics were taken for 10 days, but BR for 20 days. The endoscopy was repeated 4 weeks after the cessation of antibiotics. The efficacy of eradication was assessed by the histologic examinations and RUT. Of 103 patients, 96 [%96.1] completed treatment. Forty-six patients with mean age of 42 years [range: 20-75 years] and 50 with mean age of 40 years [range: 18-71 years] were treated with ABRM and ABRF, respectively. Clinical manifestations were the same in both groups. The per-protocol eradication rates were 54.3% and 60% for the ABRM and ABRF groups, respectively [p= 0.362]. This study show that both quadruple metronidazole and furazolidone have equal effect on the eradication of H. pylori

Fasciotomy versus amputation in patients with compartment syndrome in Bam earthquake victims

Compartment syndrome following the injuries in earthquake is a big problem and may cause amputation and psychological problems. The aim of this study was evaluation of the effects of fasciotomy on the prognoses of these patients, especially for the function of the limbs and the function of the kidneys. In a clinical trial all patients referred to Alzahra hospital in Isfahan city from the Bam earthquake area, were taken part in this study. The compartment pressure were measured and following suitable liquid therapy, they were fasciotomized. Then, the bloodshed, infections, fever and the prognoses of the operation especially the need for amputation were recorded. The kidney function was also evaluated by measuring the creatinin. Twenty patients out of 255 patients referred to Alzahra hospital, from the Bam earthquake had compartment syndrome in 26 limbs. This patients were fasciotomized. The average of their age was 36.1 years and 55% of them were female. 1.1 cases had pulses in their limbs. However, all of them had hardness and inflammations in their limbs, without any function. Before surgery, 5 patients had increased blood creatinin. 2 months after surgery, all patients had normal kidney function. 3 patients had amputation. Fasciotomy in patients with compartment syndrome may rescue patients limbs, without any significant adverse effects on their kidney function, and is recommended for all patients with this particular problem

effect of different doses of intra-articular ketamine on postoperative analgesia in diagnostic arthroscopic knee surgery

Arthroscopic knee surgery is a painful operation and control of its pain causes earlier recovery of the patients. Therefore, the reduction of the post-operative pain is very important. The aim of this study was to evaluate the analgesic effect of intra-articular ketamine injection after knee arthroscopy. In a double blind randomized study, 75 patients with age ranging of 18-60 years who were candidate for elective arthroscopy were chosen and the same anesthetic method was used for all of them. Based on the injected anesthetic drug, they were divided into five equal groups, A-E. Group A received both intra-articular ketamine [0.5 mg/kg] and intravenous placebo. Group B received intra-articular ketamine [0.75 mg/kg] and intravenous placebo. Group C received intravenous ketamine [0.5 mg/kg] and intra-articular placebo. Group D received intravenous ketamine [0.75 mg/kg] and intra-articular placebo. Group E received intravenous and intra-articular placebo. After the operation, if necessary, intra-veouns morphine [0.05 mg/kg] was given for pain relief. Using visual analogue scale [VAS 1 to 10], the pain was evaluated at 4, 8 and 24 hours after the operation. The time of first rescue analgesic request, and the total dose of morphine used was recorded. Statistical analysis was carried out by using SPSS software. The results of this study showed that there was no significant difference in the cases of age, sex, weight and duration of operation among 5 groups studied. Also, the total amount of opioid or the time beginning of analgesic request was not statistically different among the groups during 24 hours observation. Based on our results, intra-articular ketamine injection did not reduce postoperative pain after diagnostic knee arthroscopy and had no sparing effect on total opioid consumption and first postoperative analgesic request

Preemptive effect of low dose of ketamine for cholecytectomy

Preemptive analgesia is one of the pain sedative methods which is based on the blocking of pain receptor before any painful stimulation. Ketamine is a NMDA [N-Methyl D-Aspartate] receptor blocker, which has been used to reduce central sensitization. This study was performed to evaluate the preemptive effect of low dose ketamine [0.5 mg/kg, i.v.] on postoperative pain of cholecystectomy. In this study, sixty patients aged 30-60 years, with Anesthesia Society of America Scoring I or II [ASA I or II], candidate for elective cholecystectomy were randomly divided into two groups. The same operation and general anesthetic methods were used for the two groups. The patients in group 1 received 0.5 mg/kg ketamine, 20 min. before surgical incision and normal saline [the same volume], 20 min. after the operation. The patients of group 2, received normal saline [0.5 mg/kg] 20 min. before surgical incision and ketamine [0.5 mg/kg] 20 min. after that. In the postoperative period, analgesia was maintained with pethidine Using Visual Analogue Scale [VAS], pain was measured at 0 [arousal], 6, 12 and 24 hrs after the operation. The time interval for the first request of analgesia and the total amount of analgesic consumption during 24 hrs were reported. The data was analyzed using t and x2 tests. The mean value of pain intensity at 0, 6, 12 and 24 hrs after the operation in group 1 [3.24 +/- 0.97] was significantly less than that of the group 2 [4.18 +/- 1.09] [p<0.05]. The time interval to request the first analgesic supplement was longer in the group 1 than that in the group 2 [31.12 min versus 18.12 min; p<0.05]. Also, the total pethidine consumption was significantly different between two groups [p<0.05]. Based on our results, using pre-incisional ketamine [1 mg/kg] has more preemptive effect on reducing pain and analgesia requirement after cholecystectomy compared to those of post-operative ketamine