مجله دانشکده پزشکی اصفهان
پیاپی 417 (هفته اول فروردین 1396)

Diagnostic invasive coronary angiography is known as an important tool for identifying patients with obstructive coronary heart disease. Angiography performance is recommended in patients with high risk of ischemic heart disease.
Coronary arteries angiography data of 1100 subjects from a large population of patients referred to four main heart disease centers in Isfahan city, Iran, were collected during 2016 January-March. Demographic information, cardiac noninvasive test results, body mass index (BMI), smoking habits, hypertension, diabetes mellitus and family background of ischemic heart disease were recorded in using a questionnaire. Data were analyzed using ANOVA and chi-square statistical tests in SPSS software to determine the association between angiography results and cardiovascular risk factors.
Findings: In angiography, 40% of patients did not show any significant obstructive coronary disease and normal angiography was approximately two times more in women than men in the studied populations. 26% and 44% of subjects had a history of diabetes mellitus and hypertension, respectively. 19% of patients had past history of myocardial infarction (MI) and 21% had history of cigarette smoking. Most of the subjects (72%) had overweight and obesity (BMI > 25%). Non-invasive testing, including exercise test and heart scan, was performed in only 42.0% and 2.7% of patients, respectively.
Due to significant economic cost of angiography for the national healthcare system, beside the importance of angiography performance in diagnosing coronary artery diseases, we recommend more studies to clear patient need to angiography.

This study aimed to determine hippocampal absorbed dose in radiotherapy of high-grade brain glioma using dose painting method and to compare it with intensity-modulated radiation therapy (IMRT) and three-dimensional conformal radiotherapy (3D-CRT).
In Milad hospital radiotherapy section in Isfahan, Iran, images from 24 patients with high-grade brain glioma were acquired. All radiotherapy volumes for patients were defined and then, at risk organ was contoured. There were 4 planning target volumes (PTVs) defined for each patient. PTV4 just has been defined for dose painting method and the given dose was increased up to 72 Gy in this method. Finally for each patient, by using treatment planning system characteristics, 3 methods were simulated and the optimal technique was represented.
Findings: The average hippocampus-received dose was 4.772, 4.174, and 5.668 Gy in 3D-CRT, IMRT, and dose painting methods, respectively. Increasing the dose in dose painting method by 1.2% than in IMRT method resulted in 1.357% increasing in hippocampal-absorbed dose; considering the hippocampal tolerance dose, it would not cause serious injury and in return tumors, would be controlled more effectively.
In this study, the importance of multi-parametric magnetic resonance imaging (MRI) in dose painting method was achieved. As by using these images for determining the different parts of tumor, tumor-received dose significantly increased; while the organs around the tumor received no serious damage.

The aim of this study was to compare the central corneal thickness measured by Orbscan II, ultrasound and Pentacam in patients undergoing photorefractive keratectomy (PRK).
This descriptive-analytic study was carried out during one year in Feyz hospital, Isfahan city, Iran in 2013. The sample included 84 eyes of 84 patients undergoing photorefractive keratectomy with no history of corneal or intra-ocular surgery. Each patient's corneal thickness was measured and recorded using 3 devices of Orbscan, ultrasound and Pentacam. The obtained data were analyzed using SPSS software.
Findings: Central corneal thickness (CCT) measured by Orbscan II had good correlation with those measured by ultrasound (r = 0.077, P Pentacam and Orbscan II showed good correlation with ultrasound in central corneal thickness measurement; however, in peripheral corneal thickness measurement, Pentacam had better correlation compared to Orbscan II in patients undergoing photorefractive keratectomy.

In this study, a comparison between various types of radiotherapy treatment for parotid gland cancer was performed to achieve the optimal treatment technique.
Treatment planning and countering performed with TiGRT software for 15 patents with parotid gland cancer. Six techniques were performed and compared. Finally, by comparing the dose volume histograms (DVH), average dose received by each organ was determined and the best method was introduced. Techniques were as: 1. an ipsilateral wedge pair technique using 6 MV photons; 2. a 3-field anteroposterior (AP) (wedged) posteroanterior (PA) (wedged) and lateral portal technique using 6 MV photons; 3. a mixed beam technique using 6 MV photons and 12 MeV electrons (1:4 weighting); 4. a mixed beam technique using 6 MV photons and 15 MeV electrons (1:4 weighting); 5: four 6 MV photon beams with different gantry angles; and 6. similar to fifth technique with an additional small ring around the tumor tissue.
Findings: Intensity-modulated arc therapy (IMRT) techniques five and six delivered maximum dose to the target and minimum dose to organ at risks (OAR). Among 3-D conformal radiotherapy techniques (CRT), technique number two delivered more amount of dose to the target than techniques number three and four. The dose delivered to the contrary parotid gland was negligible for intensity-modulated arc therapy techniques.
Intensity-modulated arc therapy techniques are most appropriate methods for treating cancer of the parotid gland and the sixth technique delivered better dose distribution in the tumor and healthy tissues. Second D conformal radiotherapy technique delivered higher average dose to the target.

Electroconvulsive therapy (ECT) is a controlled electrical stimulus that affects central nervous system and leads to convulsion. Such as every other medical procedure, electroconvulsive therapy has some side effects like headache, myalgia, and nausea and vomiting. Patient undergoing electroconvulsive therapy receives deferent anesthetic drugs and some drugs like Midazolam, Atropine etc. to reduce side effects.
This study included 40 patients who were candidates for receiving electroconvulsive therapy. By using convenience sampling, patients were divided into 2 groups of 20 people. Midazolam were given to one group while the other received placebo. Two patients in midazolam group were removed because of short period of convulsion (lower than 20 seconds). The collected data were analyzed using independent t and chi-square tests.
Findings: 16 men (42.1%) and 22 women (57.9%) were studied. The incidence of headache (P 0.050).
Midazolam can reduce convulsion time but in most cases, convulsions last more than 25 seconds, which is in therapeutic range. So, it cannot affect the therapeutic value of electroconvulsive therapy. Preemptive midazolam reduces Post-electroconvulsive-therapy headache, myalgia, and nausea.

We planned a study to investigate the effect of spinal anesthesia in producing low back pain (LBP) in women following Cesarean section.
During a prospective cohort study, 100 women who underwent spinal anesthesia and Cesarean operation were compared with 100 women who underwent general anesthesia and Cesarean operation during a 3-months follow-up as developing later low back pain.
Findings: During 3-months follow-up, 25 and 43 patients in general and spinal anesthesia groups developed low back pain, respectively, which was statistically different according to chi-square test (P = 0.007). So, the prevalence of low back pain was 1.99 times more in spinal anesthesia group. It is important to note that the infant's weight had strong effect in producing low back pain; as increasing every 1 kg in weight increased the chance of low back pain for 2.1 times.
There incidence low back pain was higher in women who underwent Cesarean operation under spinal anesthesia; this high incidence not only depended on the type of anesthesia, but on other factors such as the infant's birth weight. Thus, when planning Cesarean operation, it is necessary to consider the underlying factors in mother and child which can be effective in producing later low back pain and then accept the type of anesthesia.

Sperm motility has a basic role in male fertility. The aim of this study was to assess the changing trend of different types of sperm motility during the storage of normozoospermic men's semen samples in refrigerator (4-6 ˚C)
In this experimental study, 13 washed semen samples of normozoospermic men were kept in refrigerator (4-6 ˚C) for 12 days. At 0 (immediately after sampling as control group), 1st, 2nd, 5th, 7th, and 12th days, the proportions of fast progressive, slow progressive, non-progressive and immotile sperm cells were calculated.
Findings: The percentages of different kinds of motile spermatozoa decreased with a gentle slope (P This study suggests that after 12 days of keeping semen sample in refrigerator, no motile sperm can be found in culture medium and more motile spermatozoa can be retrieved up to first 48 hours.