مجله دانشکده پزشکی اصفهان
پیاپی 398 (هفته دوم آبان 1395)

This study aimed to determine the effect of bowel preparation on bleeding in spinal fusion surgery.
In this clinical trial study, 110 patients who were candidates for lumbar fusion operation were randomly divided in two groups. The first group underwent bowel preparation with solution of polyethylene glycol in water for 16 hours and 8 hours fasting and the second group underwent routine surgical preparation that was at least 8 to 12 hours of fasting. Hemoglobin level, hemorrhage volume and complications during and after the surgery were compared between the two groups.
Findings: The mean (± standard deviation) of hemorrhage volume during the surgery in the two groups of with and without bowel preparation was 780.4 ± 290.5 and 931.9 ± 475.0 ml, respectively (P = 0.046). The mean hemorrhage volume in the two groups of with and without bowel preparation was 97.3 ± 45.7 and 110.7 ± 55.6 ml (P = 0.170) during 24 hours after the surgery and 118.2 ± 74.3 and 138.6 ± 101.5 (P = 0.230) during 48 hours after surgery, respectively.
Bowel preparation in patients undergoing spine fusion surgery likely tends to reduce of complications during and after the surgery, particularly bleeding. Therefore, it is suggested in spine surgery and spinal fusion surgeries, to use with bowel preparation for patients.

It is stated that in the absence of angiogenesis, the tumoral tissue will not grow beyond 2 mm3. Vascular endothelial growth factor (VEGF) plays a pivotal role in angiogenesis and blockade of this process could be applied as a novel strategy for immunotherapy of cancer.
Peptide sequences of VEGF-A isoforms were retrieved from protein databases and aligned. Immunodominant epitopes were determined and the selected one was rechecked for dissimilarity with other human proteins. The selected conserved peptide sequence was synthesized and conjugated with Keyhole limpet hemocyanin (KLH). Then, it was applied for immunization of mice. The polyclonal anti-VEGF antibody titer was measured using an indirect peptide-enzyme-linked immunosorbent assay (ELISA) with a Bovine serum albumin (BSA)-conjugated peptide.
Findings: According to bioinformatic findings, the selected 41-aminoacid sequence did not show any similarity with other human proteins and revealed enough antigenicity to stimulate anti-tumor specific responses. A substantial increase of specific antibody titer was observed in vaccinated mice. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) analysis of the BSA-conjugated peptide showed efficient coupling of the molecules. Optimization steps in ELISA procedures revealed that coating of microtiter plates with BSA-conjugated antigen provided more reproducible outcome than unconjugated peptide.
Our results reinforce the potential of KLH-conjugated peptides for immunization and production of specific polyclonal antibodies against VEGF-A. Production of high-titer antibodies against this antigen indicates that the designed peptide-vaccine could be used as a potential immunogen for stimulation of humoral immune system in animal model.

Multislice computed tomography (CT) angiography is a robust imaging method for noninvasive assessment of coronary artery diseases, which is associated with high radiation dose. Having knowledge of the various parameters used to estimate the dose plays an important role in increasing the understanding of dose delivered to patients and help operators and technologist to reduce the dose. In this research, the amounts of Weighted Computed Tomography Dose Index (CTDIW) for coronary CT angiography exams were measured in Isfahan city, Iran.
To calculate the dose, an ionization chamber (Piranha, X-ray Analyzer, RTI Electronics and Sweden) and acrylic body phantom were used. Common conditions of coronary CT angiography used in two centers were applied for this project. Finally, CTDIW of all the scans were calculated using the related formulation.
Findings: The amount of mean CTDIW for calcium score exams in Sina and Alzahra hospitals were 0.468 ± 0.190 and 2.354 ± 0.610 mGy, respectively (P = 0.007); and for coronary CT angiography scans in Sina and Alzahra hospitals were 6.221 ± 1.290 and 5.299 ± 0.840 mGy, respectively (P = 0.860).
CTDIW for the calcium score was significantly different in the two centers, but there was not significant difference in the two centers for coronary CT angiography scans. In this study, the amount of CTDIW was much lower than the measured in other centers. Since scan parameters have an important effect on the dose value, training and precision of technologist result in dose reduction and patient radiation protection.

End-stage renal disease is increasing and kidney transplantation is the treatment of the choice; before kidney transplantation, patients undergo on hemodialysis and peritoneal dialysis. Digestive problems such as peptic ulcer, cholecystitis, diseases of the colon, and digestive tract malignancies increase the risk of post-transplantation problems. This study aimed to evaluate endoscopic findings and their association with treatment before kidney transplantation.
In this cross-sectional study, 334 kidney-transplant candidates in the years 2006-2011 were entered via census sampling and their information was extracted from patient files in Alzahra and Noor hospitals, Isfahan, Iran, using a questionnaire.
Findings: The most common finding was hiatal hernia with prevalence of 29%, and then, gastric erosions (17.1%), duodenal erosions (15.9%), and antral erosions (15.6%), respectively; there was no angiodysplasia. Comparing the prevalence of endoscopic findings showed no significant different between the patients on hemodialysis and peritoneal dialysis. In our study, hemoglobin levels were 10.8 and 10.5 g/dl in patients on hemodialysis and peritoneal dialysis, respectively; which was not significantly different.
It seems that there is no relationship between the type of replacement therapy before transplantation and the prevalence of endoscopic findings as well as hemoglobin concentration; but additional studies to clarify this issue are advised.

Spontaneous pneumothorax occurs without any predictable factor. This leads to accumulation of air in pleural cavity, which can cause dyspnea and in severe cases even death.
This census, descriptive-retrospective study was conducted on patients with spontaneous pneumothorax treated with pleurodesis chest tube in which tetracycline capsules were saluted, in Isfahan city, Iran, during 2013-16. After completion of treatment, patients were assessed in terms of dyspnea. In case of normal chest X-ray and pulmonary expansion, chest tube was removed. Demographic information and complications were evaluated as well. Data were analyzed using descriptive analytics and chi-square test. P-value Findings: Among 108 patients, 6(5.5%) reported recurrence pneumothorax in a year. 48 patients mentioned smoking that was not in association with pneumothorax recurrence (P > 0.05). 38 patients (35.1%) reported chest pain after chest tube removal and 8 patients (7.4%) reported fever of more than 38°C.
Due to comparing the results of current study with previous similar studies, treatment of spontaneous pneumothorax with tetracycline capsule causes fewer complications and fewer recurrences.