Tehran University Medical Journal

---

With the intention of research of various methods of epithelial tissue culture we've studied five French Albino rabbits with an average of 8 weeks. In order to evaluate and control growth and proliferation of autologus cultured tissue samples were obtained on 1st, 5th and 8th days. After fixation of these samples and passing them through various processes, histologic sections were prepared. These sections were stained with H-E and studied by light microscope, we succeeded in developing the original donor surface by 18 times.

---

With the intention of research about culture and autologus graft of epithelial tissue we used 4 french Albino Rabbits with an average age of 2 months. After reproduction on the support in EMEM (Eagle's Minimum Essential Medium) we used this for graft after 4 weeks. This region which grafted total replaced. After fixation of this sample and passing them through various process, histological sections were prepared. These sections were stained with H & E and masson's trichrome and studied by light microscope. We succeeded in graft. We hope in the near future by using the method of epithelium tissue culture improving to treat burned patients.

---

Psoriasis is a chronic, inflammatory scaling disorder of the skin. Different patterns of psoriasis exist including plaque type, erythrodemic, pustular, palmoplantar and guttate. The most commonly involved sites are the elbows, knees, lumbosacral area and scalp. PUVA (Psoriasis Plus UVA) therapy [administration of oral psoralen followed by exposure to UVA (320 to 440 nm)] is widely used to treat severe psoriasis. Oral PUVA produces some adverse effects that may limit its applicability in a number of patients. The carcinogenic potential limits its use in patients with psoriasis who probably receive other carcinogenic treatments. Oral PUVA may induce complications such as nausea, vomiting and headache. In light of these problems Bath PUVA therapy is an important alternative to oral PUVA therapy. Bath PUVA is a kind of photochemotherapy in which UVA radiation after administration of topical psoralen in a warm water bath is used. We treated 30 patients with generalized plaque type psoriasis with 8-Mop Bath PUVA in Razi hospital. Bath PUVA cleared psoriasis more rapidly than oral PUVA and required fewer treatments (mean number of sessions: (17.6±2.1) and lower cumulative UVA dose. (49.2±15.4 J/cm²). 83.3 percent of our patients showed complete response to treatment and 13.4 percent showed good response.

---

The objective of this study was to determine the reference range for Creatinine in children<8 years old among Tehran citizens on the selectra 2 analyzer and manually with Jaffee alkaline picrate method. Pediatric reference ranges are important in order to determine whether a patient's result is normal or abnormal. Reference range on the selectra 2 system over this age are currently unavailable. The study used serum obtained from children admitted in diagnostic and health centers and the SPSS program T-test and Chi-square were used to analyze data. The results are given below: Creatinine: Age (Y): 0-2, Male: N=71, 0.46 mg/dl, SD=0.1 Female: N=61, 0.47 mg/dl, SD=0.1 Total: N=92, 0.467 mg/dl. Age (Y): 3-6, Male: N=89, 0.52 mg/dl, SD=0.001 Female: N=50, 0.53 mg/dl, SD=0.1 Total: N=139, 0.529 mg/dl. Age (Y): 7-8, Male: N=50, 0.58 mg/dl, SD=0.11 Female: N=37, 0.55 mg/dl, SD=0.11 Total: N=89, 0.572 mg/dl. Total: Male: N=210, 0.52 mg/dl, SD=0.11 Female: N=108, 0.53 mg/dl, SD=0.1 Total: N=318, 0.52 mg/dl. Serum Creatinine significantly increased with increasing in age and total body surface (P<0.05, 0.0001 respectively), while there has been no significant difference by sex, diet and fasting.

---

Asymptomatic bacteriuria is prevalent during pregnancy. It can lead to pyelonephritis, premature pregnancy and low birth weight. In this prospective study, to determine prevalence and risk factors of asymptomatic bacteriuria, 205 consecutive pregnant women who visited our prenatal care clinic in Mirza-Koochakkhan Hospital and had no urinary symptom were entered. Patients data were recorded using a questionnaire and urine samples were obtained for urinalysis and urine culture. We analysed data by using fisher exact and chi-squared test. 14 cases had positive urine culture (6.8%). Significant correlation was seen between asymptomatic bacteriuria and age, parity, past history of kidney stone, pyelonephritis, urinary tract infection, preterm delivery and pyuria pvalue <0.05. We suggest routine urine culture in first visit of high risk and 16th week of low risk pregnancies.

---

Background: Vitiligo is an acquired pigmentary disorder that affects 1% of population. It presents as depigmented patches. One of the most probable theories regarding the pathogenesis of vitiligo is autoimmunity. Systemic corticosteroids may arrest the progression of vitiligo and lead to repigmentation by suppressing immune system. The objective of this study is to assess the clinical efficacy of low-dose oral corticosteroids in actively progressing vitiligo.

Materials and Methods: Seventy four patients with vitiligo were evaluated. The patients took daily doses of oral prednisolone (0.3 mg/kg) initially for 2 months. Then the dosage was halved monthly, for the five subsequent months of treatment. The effects of treatment were evaluated using photography&aposs before and after the study. Side effects were assessed at the first, second, third and fourth month of the treatment.

Results: Arrested progression of vitiligo and repigmentation were noted in 74.3% and 62.1% of patients respectively. The mean pigmentation was 26.8%. The localized form, lower age of disease onset, no hair whiteness on the lesions and less affliction percent showed increased repigmentation with statistical significance. There was no significant difference between sexes and positive family history of vitiligo in patients. The best therapeutic results were obtained for facial lesions and the worst for mucosal lesions. The side effects of treatment were minimal and did not affect the course of the treatment.

Conclusion: Low-dose oral corticosteroids are effective and have few serious side effects in preventing the progression of actively progressing vitiligo but regimentation is not significant and this regimen is effective in patients who are refractory to topical corticosteroids or phototherapy.

---

Background and Aim: Anxiety is the most common psychological distress in cancer patients. Many studies have been conducted to assess the prevalence of anxiety and depression and the predisposing factors of psychological morbidity in cancr patients. Patients knowledge of disease, their desire for more information, their satisfaction of given information and their attitudes’ towards communication of information about cancer are among issues that have not been well anddressed in assessment of psychological morbidity of cancer patients in Iran.

Materials and Methods: 250 cancer patients of 15-75 age group who were referred to Cancer Institute entered the study. The patients’ knowledge of disease, their desire for more information, their attitude and satisfaction were assessed by Questionnaire n1. patients’ anxiety and depression scores were assessed by Hospital Anxiety and Depression Scale (HADS).

Results: 30 of patients had severe anxiety symptoms and 17% suffered severe depression most patients’ knowledge of disease was “low” (32%) and “intermediate” (54%). There was no significant correlation between knowledge and anxiety and depression. Most patients (69%) believed that the information given by physicians had been “insufficient”. Depression score was significantly higher in this group of patients compared to other patients. Most patients (59%) had a high level of desire for gaining more information and 64% believed that physicians should inform patients of different aspects of disease as much as possible. There was no significant correlation between patients’ desire and attitude and anxiety and depression. Level of satisfaction was “low” in 29% of patients and “intermediate” in 39%. Depression and anxiety scores were significantly higher in patients who were less satisfied with given information.

Conclusion: Low level of knowledge in most cancer patients, their high desire for gaining more information, their dissatisfaction of given information and their positive attitudes towards full disclosure of information about cancer in this study, all indicate that complete and honest disclosure of information to cancer patients by physicians should be improved and encouraged. Although it seems that amount of information given doesn’t influence the psychological morbidity in cancer patients the patients’ satisfaction of given information, which has implications for the quality of patient-physician communication, plays a far more important role in occurance of psychological morbidity in cancer patients. Meanwhile, negative public opinion of cancer and its prognosis greatly influences the physicians functions and the quality of communication process, and also has negative effects on cancer patients’ psychological adjustment.

---

Background: Bone marrow transplantation (BMT) is the treatment of choice for many patients with malignant and nonmalignant diseases. Long-term complications such as osteoporosis should be considered, because it is directly associated with the morbidity and mortality. The purpose of this study is to assess the bone mineral density after allogenic or autologous bone marrow transplantation in patients with leukemia or lymphoma.
Methods: We prospectively investigated 63 patients undergoing BMT for acute and chronic leukemia and lymphoma. At the end of the study, a total of 28 patients were assessed. Bone mineral density (BMD) was measured prior BMT, and 6 and 12 months after BMT. Osteocalcin, bone alkaline phosphatase and C-terminal telopeptides of type 1 collagen (ICTP) were assessed. Serum concentration of calcium, phosphorous, vitamin D, PTH and sex hormones (FSH, LH, testosterone and estradiol) were also measured.
Results: There was a significant decrease in the bone mineral density of the femoral neck six months after BMT (p<0.001), 1.01±0.13g/cm² prior to BMT and 0.96±0.13 g/cm² at six months, but no considerable changes were seen in lumbar vertebrae. Bone loss between the 6th and 12th months was not observed. The levels of ICTP and phosphorus increased significantly by the 12th month (p=0.04). The level of calcium was higher at the 6th month (p=0.002) but the level of vitamin D and PTH decreased by the end of the study (p=0.04 and p=0.01, respectively) and the average of osteocalcin did not increase significantly. In women, the level of estradiol decreased by the 6th month (p=0.01), but the testosterone changes were not significant.
Conclusion: The risk of bone loss in both allogeneic and autologous BMT is higher in the femoral neck than the lumbar vertebrae, occurring mainly in the first six months after BMT. Preventive and clinical procedures should be considered.

---

Background: Juvenile xanthogranuloma is a benign, normolipemic, dendrocytic histiocytosis that usually affects young children. It presents clinically as single or multiple yellow-brown papulonodular lesions in the upper part of the body, especially the head and neck. In adults, xanthogranuloma is not common and usually presents as a single lesion. Multiple xanthogranuloma in adults is rare. For the most part, cutaneous lesions are self-limited and seldom necessitate treatment. Here we report an adult patient with multiple xanthogranuloma.

Case: A 45-year-old woman presented with multiple papulonodular lesions around the eyes and over her breasts and back. Biopsy showed giant cells with a wreath-like arrangement of nuclei (Touton giant cell) and diagnosis of juvenile xanthogranuloma was made.

Conclusion: Although juvenile xanthogranuloma is a disease of children, it can rarely occur in adults. These patients should be evaluated for involvement of other organs to prevent complications. With ocular involvement, the risk of morbidity is high, and complications can include glaucoma, retinal detachment, cataract, vascular occlusion, hyphema, and corneal blood staining.

---

Background: Alkaloids are a group of nitrogenous compounds with potential effects on the physiological behavior of human and animals. Some of these compounds are considered important drugs in modern medicine, such as atropine and morphine. Plants are considered the most important source of alkaloids. Therefore, investigating the presence of alkaloids in different plants is very important. Usually, alkaloids in plants are identified by methods such as those of Dragendorf, Wagner and Meyer, among others, which require milligrams of alkaloids for identification. In the present study, a fast and sensitive procedure for detecting of alkaloids in plants is presented.
Methods: Twelve dried plants samples were investigated for the presence alkaloids. After extracting the total alkaloid into methanol using a Soxhlet extractor, a few milligrams of the extract was transferred to a separatory funnel, buffered to pH 4.7, the bromocresol green (BCG) solution (10-4 M) was added, mixed and extracted with CHCl3 until a yellow color was observed in the CHCl3 layer, indicating the presence of the alkaloid. The crude extracts were also investigated by the standard methods of Dragendorf, Wagner and Meyer for the presence of alkaloids.
Results: Investigation of the 12 plant samples for the presence of alkaloids by the standard reagents of Dragendorf, Wagner, and Meyer showed that only Camelia sinensis (flowers), Echium amoenum Fisch & Mey (flowers), and Stachys (aerial parts) are devoid of alkaloids, with all other samples positive for alkaloids. By the BCG procedure, similar results were obtained, except for the E. amoenum flower, which was positive. The minimum detectable limit for alkaloids by the BCG method is the equivalent of approximately 40μg atropine.
Conclusions: According to previous reports, only one of these plants does not contain alkaloids. All studied plants positive for alkaloids by standard reagents were positive by the BCG procedure. Stachys was negative for alkaloids by both the standard reagents and the BCG method, in agreement with previous reports. However, black tea, reported to contain xanthine alkaloids, was negative for alkaloids by both the standard reagents and the BCG method. Therefore, the BCG method is not suitable for the detection of xanthine alkaloids. Nevertheless, the microgram detectable limit for alkaloids indicates that the BCG method is very sensitive.

---

Background: Since the systemic steroids are introduced in Pemphigus Vulgaris treatment, the prognosis of disease improved significantly. This study was designed to evaluate determining factors in the prognosis of pemphigus vulgaris in Iranian patients.

Methods: In this study, 119 patients with documented pemphigus vulgaris who had presented to Razi Hospital from 2001 until 2003 were included. These patients had presented for the first time and treated with prednisolone and Azathioprine. Morality rate, minor and major relapses and duration of first remission had been defined as prognostic criteria and correlation between them and other demographic variables and disease characteristics were investigated.

Results: The majority of patients (84.1%) were followed for more than one year. The major recurrence and minor recurrence occurred in 28(23.5%) and 65(54.6%) of patients respectively, no case of mortality was observed. In patients who received treatment six months or less after onset of disease the frequency of major recurrence was less than the others. 18(17.8%) vs. 12(41.4%), (p=0.009). Duration of primary remission more than one year was detected in most of the patients (64.7%). In patients with less than 10 initial cutaneous lesions, period of primary remission was longer than the other patients. (p=0.009). Shorter duration of primary remission were noted in older patients (age>50) in comparison with younger patients (age≤50, p=0.04).

Conclusions: Male gender, old age, interval more than 6 months between onsets of symptoms to initial treatment and more than 10 skin lesions on admission, are associated with poor prognosis of pemphigus vulgaris.

---

Background: Sepsis is one of the most important causes of mortality in severely ill ICU patients. At least, a part of high mortality rate in sepsis patients is due to less specific clinical symptoms for prompt diagnosis. Recently some studies report that serum levels of procalcitonin will increase in these patients but changes of serum levels following treatments is not known. This study was designed to determin procalcitonin levels in patients with bacterial infectious disease in ICU, initially and during therapy and compare the levels during response to treatment.

Methods: This prospective cross-sectional study was conducted on ICU patients with infectious diseases, blood specimen collected on day 1 and then in days 3 and 7 of ICU admission. The semi-quantitative PCT-Q test was performed.

Results: Thirty five patients, 22(62.9 %) men and 13(37.1%) women, were enrolled in this study. 18(51.4%) patients died. Procalcitonin level in most patients in admission day was more than 10 ng/ml [16 (45.7%)] but in patients that react to treatment, decline to lower than 0.5 ng/ml [14(77.8%)]. Mean rank of procalcitonin level from 1.14 ng/ml in first day reached to 2.72 ng/ml in seventh day (p<0.0001).

Conclusions: This study showed that serum procalcitonin levels in ICU patients with bacterial sepsis significantly decrease following response to treatment. The measurement of serum procalcitonin in ICU patients with bacterial infectious diseases at first arrival day and following treatment is recommended.

---

Background: Recently, many cases diagnosed as pediatric autoimmune neuropsy-chiatric disorders associated with group A beta hemolytic streptococcus infection (PANDAS) due to production of autoimmune antibodies. Object of this study was comparison the titer of antibodies against group A beta hemolytic streptococcus (ASOT, Anti-DNase B, and Anti streptokinase) between children with movement disorders (tic and tourett's disorders pediatric autoimmune psychiatric disorders) and healthy control.
Methods: A cross sectional/ cases control study in pediatric neuropsychology ward and clinics in two referral hospitals (Rasoul & Aliasghar) affiliated by IUMS had done in Tehran, Iran (2008-2010). We selected 53 children with tic disorder and 76 healthy controls (age matched children). The antibody titers (IU/ml) in their area were compared and analyzed statistically. The area under ROC, sensitivity, specificity and positive predictive value of tests calculated.
Results: Age of cases was between 4-16 years. All antibody titers had significant difference between two groups (p<0.0001 p=0.05 p=0.002 for ASOT, Anti-DNase and Antihyaloronidase respectively). ASOT (cut off level> 200IU/ml) had 75% sensitivity 84% specificity and 80% PPV Anti- streptokinase (cut off level> 332IU/ml) had 34% sensitivity 85% specificity, and 90% PPV Anti-DNase (cut off level> 140IU/ml) had 70% sensitivity 99% specificity and PPV 90%.
Conclusion: Patients with tic disorder had a significant high antibody titer against streptococcal infection in comparison with healthy children. It presents possible role for streptococcal infection in tic disorders. Treatment of streptococcal infection is achievable by using of long acting Penicillin in our country. Use of aggressive treatment like plasmaphresis etc needs future RCT studies.

---

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: The goal of this study was to compare the efficacy of botulinum toxin type A (BTX-A) injection in the hamstring and calf muscles with and without ankle serial casting in the improvement of gait in children with cerebral palsy (CP).
Methods : This double-blind prospective clinical trial was performed on 25, 2 to 8-year-old children with hemiplegic or diplegic CP in Tehran, Iran in 2010. The participants were chosen by simple randomized sampling and were matched for age, gross motor function classification system (GMFCS) and type of CP and were randomly divided into two groups: children in the first group (13) only received BTX-A injection, but the second group (12) received BTX-A and serial foot casting starting one week after the injection.
Results : Comparison of the gross motor function, right and left knee spasticities and passive ROM of both knees between the two groups before and 1, 3, 6 and 12 months after the injections were not statistically significant (P>0.1). Furthermore, comparison of the right and left ankle spasticities and passive ROM before the injections and in1 and 3-month follow-ups did not show a statistically significant difference (P>0.1), but the differences were significant in 6 and 12-month follow-ups (P<0.05).
Conclusion: BTX-A injection with serial foot casting vs. BTX-A alone was more effective in decreasing spasticity and improving passive ROM in the ankle of children with CP, but such injections in the hamstrings were not useful in these regards.

---

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Recent evidence suggest that group A ß-hemolytic streptococcal (GABHS) infection may increase the risk of pediatric autoimmune neuropsychiatric disorders (PANDAS) composed of the clinical signs of obsessive-compulsive and attention deficit hyperactivity disorders. The objective of this study was to compare the titer of antibodies against GABHS between children with PANDS and the controls.
Methods : This cross-sectional, case-control study was done in Hazrat Rasoul Hospital, in Tehran, Iran during 2008-2010. We compared serum antibodies streptolysin O, deoxyribonuclease B, and streptokinase against GABHS quantitatively in 79 cases with PANDAS and 39 age-matched controls. The area under ROC curve, sensitivity, specificity and positive predictive value (PPV) of tests were calculated.
Results : Most cases were studied in summer (57%) and spring (23%). The three aforesaid antibodies were higher in the cases (P=0.001). Antisterptolysin O (cut-off point 195) had a 90% sensitivity, 82% specificity and a 92% PPV, (CI=95%, 0.99-0.91). Anti streptokinase (cut-off point 223) had an 82% sensitivity, 82% specificity and a 95% PPV, (CI=95%, 0.934-0.735). Anti-DNase (cut-off point 140) had an 82% sensitivity, 82% specificity and a 95% PPV, (CI=95%, 0.99-0.91).
Conclusion: The study demonstrated a possible role for streptococcal infection in PANDAS. We found a significantly higher antibody titer against GABHS in OCD and ADHD cases in comparison with healthy children. Treatment of streptococcal infection is achievable by the use of long-acting penicillin. Use of aggressive treatment schedules like plasmaphresis, IVIG, etc needs further RCT studies.

---

Background: Stretching exercises and massage therapy are both suggested for pain relief in fibromyalgia syndrome. Previous studies have not proved their superiority over each other. This study compared the therapeutic effects of friction massage, stretching exercises, and analgesics on pain relief in patients with fibromyalgia syndrome.
Methods: We evaluated 129 female patients with the diagnosis of primary fibromyalgia visited at the physical medicine clinics of Baqiyatallah Hospital in Tehran, Iran during 2010- 2011. Patients were randomly divided into three groups: the first group received 400 mg ibuprofen P.O. (3 times per day) and 25 mg nortriptyline (daily) P.O. as analgesic, the second group was treated by friction massage and the third group performed stretching exercises. Patients were assessed three times (initially, after one and four weeks) by visual analogue scale (VAS).
Results: The mean age of participants was 60.46 years. The mean age in each treatment group was 46.66 years in medication group, 46.73 years in stretching group and 46.65 years in friction massage group. Changes in VAS score over 4 weeks were 2.4, 3.1 and 1.9, in the first, second, and third groups, respectively. The changes in VAS were significantly different in the first and second groups rather than the controls (P<0.05).
Conclusion: The effect of stretch exercise on pain relief was similar to analgesics, but it was more effective than friction massage. Moreover, the therapeutic effect of stretching exercise on pain relief upon four weeks was more permanent than friction massage but it was similar to analgesics.

---

Background: Gestational diabetes is associated with increased risk of congenital heart disease in neonates. The study was performed to evaluate the cardiac parameters in neonates of mothers with abnormal glucose tolerance test (GTT) and compare them with data of normal newborn. Methods: In a cross-sectional study in Amiralmomenin Hospital, Semnan City, Iran from April to October 2013, two groups of infants were eligible for the study. Sampling was performed in succession for the infants who were eligible. Echocardiography was performed for the babies on the second day, and cardiac parameters including interventricular septal diameter, left ventricular shortening fraction and mass, left ventricular posterior wall thickness, aortic and left atrial diameter were measured. Maternal glycemic control and HbA1c were measured indicators. Analysis with the SPSS software version 16, the Student’s t-test, Mann-Whitney and Chi-square test were performed. Results: Thirty five newborn infants of mothers with impaired GTT and newborn of 33 healthy women were studied. Birth weight, maternal age and HbA1c among infants of mothers with impaired GTT were greater than the control group (P=0.003 and P=0.000 and P=0.000 respectively). Diastolic and systolic ventricular septal thickness, ratio of diastolic ventricular septal thickness to diastolic diameter of the left ventricular posterior wall, the aortic diameter and left ventricular outflow tract diameter in infants of mothers with impaired GTT were significantly increased in comparison to data of the normal group (P=0.008, P=0.034, P=0.016, P=0.017 and P=0.020 respectively). No significant difference was reported in other diameters. Conclusion: Gestational diabetes mellitus results in changes of echocardiographic findings particularly relevant in diastolic ventricular septal thickness. The increase in wall thickness especially during diastole, is associated with pathological cardiac hypertrophy. Based on the results of the present study, cardiac hypertrophy can be related to gestational diabetes. Poor control of disease may cause or aggravate the process.

---

Background: Chronic spinal cord injury has an important role in sensorimotor disor-ders which is associated with many complications and the rate of these complications should be certainly considered. The most important complications are the changes in bones and joints which come with pain and lead to increase in their motor disability. In this paper, the radiographic images were studied and the ossifications of spinal cord and pelvis were described and also the type of changes and their prevalence was eval-uated. Methods: In this study, 500 patients and veterans with spinal cord injuries who were hospitalized in Khatam-Ol-Anbia Hospital were examined. The spinal and pelvis x-ray of the patients have been studied for spinal cord ossification, the hip joint narrowing, sacroiliitis, heterotopic ossification, osteophyte and the presence of quiver in the graph. Results: Among the patients, 485 cases were males and 15 cases were females, the av-erage age was 50.26 and the mean duration of injury was 26 years. Four hundred and forty six patients were paraplegic and 54 cases were quadriplegic. There was a signifi-cant relationship between age and the number of involved vertebrae (P= 0.000), psori-asis like ossifications (P= 0.048) and large osteophytes (P= 0.037), also between the du-ration of the injury and the hip joint narrowing (P= 0.008), the number of involved ver-tebrae (P= 0.008). In addition the presence of shrapnel in the graph is correlated with large osteophytes and more heterotopic ossification. Conclusion: The most frequent cause of chronic spinal injuries of our patients has been the injury by quiver, it seems our results may not be extended to all patients with spinal cord injury. In lumbar spine radiography of the patients, osteophytes, the quiver and psoriasis like ossifications were mostly seen. In the pelvis x-rays the most changes were hip joint narrowing, sacroiliitis and the heterotopic ossification.

---

Background: Anode heel effect refers to reduction of radiation intensity in the anode side of X-ray tube. This variation in radiation intensity across the anode-cathode of X-ray tube can be benefited for decrease radiation exposure in some radiological examinations. The aim of this study was to evaluate the effect of anode heel orientation on the radiation dose received by the testes in male patients undergoing pelvic radiography.

Methods: This is a cross-sectional study, conducted at one of the teaching hospitals of Ahvaz, Jundishapur University of Medical Science Ahvaz, Iran, from September 2015 to March 2016. In order to measure the profile of radiation intensity variation, 13 paired sets of high radiosensitive cylindrical lithium fluoride thermo-luminescent dosimeters (TLD) aligned on the cathode-anode central axis upon the table and then irradiated using routine exposure parameters. The anode of X-ray tube was positioned toward the feet for 40 patients and toward the head for 39 patients undergoing pelvic radiography. For measure the entrance skin dose (ESD), 8 TLD chips were located on the central point of the radiation field and 5 TLDs were located on the testes position to measure the dose received.

Results: Radiation intensity profile showed that radiation intensity decrease from the cathode to the anode side. Discrepancy of radiation intensity on central axis of cathode-anode was calculated about 35%. The radiation dose received by the testes was 26.74% lower for patients the anode directed toward the feet, compared to the patients in which the anode directed toward the head (FTC: 1.260±0.296 mGy, FTA: 0.923±0.167 mGy, P<0.05). There was no meaningful difference for the measured ESD of pelvis between two groups of patients (FTC: 1.256±0.315 mGy, FTA: 1.195±0.205 mGy, P=0.788). Conclusion: In pelvic radiography, positioning of testes directed to the anode of X-ray tube can decrease the receive dose.

---