مجله دانشکده پزشکی اصفهان
پیاپی 140 (هفته چهارم تیر 1390)

The carcinogenic effect of radiation is directly related to the exposure rate and the risk is even more in infants. The scope of the present study is to evaluate of the average of cumulative radiation dose in neonates in the neonatal surgery ward due to diagnostic and therapeutic radiologic procedures during the admission period, in Alzahra hospital of Isfahan, Iran. This investigation was a descriptive study on 168 neonates. It was done in neonatal surgery ward during last 9 months of 2009 in Alzahra hospital of Isfahan, Iran. The patients were selected randomly and with no attention to age, sex, diagnose and admision time. Thermo luminescent dosimeters (TLD GR200), were used for dosimetry and each chips was putted in a plastic envelope on the neonate sternum during the admission period. The cumulative absorbed dose by each patient was stored during the admission by TLD and followed by reading by TLD reader. For using of TLDs, they were calibrated and two calibration factors (individual and batch) were performed in radiotherapy section of Seyed Al-shohada hospital of Isfahan, Iran. After checking the accuracy of calibration, the absorbed dose by each patient was achieved by using of calibration factors. The average of admission time for each patient was 7.64 days and the average of cumulative absorbed dose was 3.13 Millisievert (mSv) during this time. The maximum absorbed dose in one patient was 42.83 mSv. The average number of conventional radiography for each patient was 2.77. The average of conventional radiography and cumulative absorbed dose in patient with no examination or just simple x-ray examinations was 2.58 and 0.863 mSv, respectively. Chest x-ray examination was the most examination used here (338 person). The average dose for each chest x-ray examination was 0.313 mSv. The average of cumulative absorbed dose among patients with fluoroscopic examination was about 12.6 mSv. The cumulative absorbed dose in 19 patients was more than 10 mSv. The average of cumulative absorbed dose was not more than the dose limit according to reference levels, but in comparison with other medical centers in the world is very high. Therefore, it is necessary to pay more attention to reduce radiological imaging procedures, particularly about fluoroscopic procedures.

Pulmonary resection is the most common Thorax surgery. Many complications that occur after pulmonary resection may lead to increased morbidity and mortality in these patients. One of the most imporatant comlpication is bronchopleural fistula (BPF). This complication is associated with numerous deaths and side effects.

This was a cross-sectional study. Statictical society were the patients who underwent pulmonary resection by the year 2008 to 2010 in Alzahra hospital of Isfahan, Iran and the sample size was 147 patients. The results have been analyzed with Kendall's Correlation Coeffienct and χ2 test.

In 7.3 percent of the studied patients, BPF has been found. Based on our finding we can say the incidence of Bronchopleural fistula after pulmonary resection are related with the extent of resection, side of resection and the need for mechanical ventilation.

Based on our finding it seems that patients with right lung resection and also patients with pneumonectomy need more supervision in compare to other patients with pulmonary resection.

Ocular motor disturbances occur as the presenting or relapsing sign/symptom of multiple sclerosis (MS). In this study we sought to asses the frequency of isolated ocular motor nerves palsy in patients with in Isfahan, Iran.

Our study was a retrospective study on 3522 patients with definite MS (based on McDonald’s criteria), who had experienced isolated ocular motor nerves palsy as a presenting or relapsing sign. All of these patients were resident within Isfahan province until the end of July 2010 and they were registered in Isfahan MS society. Data were obtained retrospectively by analyzing patients’ regular follow-up records.

76 patients (2.15) had history of isolated ocular motor nerves palsy, in whom 32 cases (0.91%) and 44 cases (1.24%) had represented it “at the onset” and “during the course” of MS, respectively (P = 0.19). Abducens nerve palsy was seen in 56 patients (1.59%) and was the most common isolated ocular motor nerves palsy. The second prevailing palsy was pertaining to oculomotor nerve which was seen in 18 patients (0.51%). The least prevailing palsy was of Trochlear nerve that occurred in 2 patients (2.6%). Among 76 cases, only 30 had plaques in their brainstem MRI.

According to our current experience, the frequency of isolated ocular motor nerves palsy (2.15%) in MS is relatively low

Fractional Co2 laser is a good procedure to treat acne scar, surgical scar and senile wrinkles but it is almost painful and if we provide a good pain relief the patient will have a good cooperation during laser, so we can use higher fluence with better results. To determine the safety and efficacy of piroxicam gel in the control of pain and erythema caused by fractional Co2 laser compared with lubricant gel. In this clinical trial we chose 122 patients who refered to Novin laser clinic for fractional Co2 laser. The patients used gel A (piroxicam gel) on one side of the face and gel B (lubricant gel) on the other side of the face as placebo an hour before laser. To determine pain level we used VAS (Visual analogue scale) score from one point to ten. Each patient scored the pain during, immediately after, 1 hour later and 24 hours after laser. To determine the severity of erythema during, immediately after, 1 hour later and one week after laser we compared the erythema of both side of the face with each other. We also compare the prevalence of Post-inflammatory pigmentation (PIP) after 1 month of laser with both gels. At the end we analyzed the data with SPSS18. Piroxicam gel can provide better pain relief during laser, immediately after laser and 1 hour later compared with lubricant gel but pain score was the same 24 hours later with both gels. The severity of erythema with both gels was the same during laser, immediately after, 1 hour later and after one week. In fact piroxicam gel has no effect on the erythema caused by fractional Co2 laser.The prevalence of PIP was the same for both gels after one month so piroxicam gel can not prevent PIP caused by fractional Co2 laser. As a result piroxicam gel can use as a safe and effective drug before fractional Co2 laser to decrease the pain but has no effect on erythema and PIP caused by fractional Co2 laser.

Takotsubo syndrome is a transient apical or midventricular dilation with reducuction in left ventricular ejection fraction that mimic an acute myocardial infarction symptoms in the absence of atherosclerosis. There are important differences between its treatment and the treatment of acute myocardial infarction. In this study, we reported a case with Takotsubo syndrome. Case Report: The case was a 40 years old woman with a surgery for urinary incontinence. After the surgery she suffered from chest pain. In her electrocardiogram ST elevation was seen but there is not any obstructive lesion in her coronary angiography. In her ventriculography an apical dilation with a Takotsubo syndrome appearance was reported. She was treated conservatively but she died after 3 days due to sepsis.