Tehran University Medical Journal

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Relationships among lipids, hormones and anthropometric indices of patients in a reproductive endocrinology outpatient clinic were investigated. Subjects were divided into 2 groups according to their hirsutism score (Hirsute score>=8, N=102 And non-hirsute score<8, N=83). Weight (Wt), height (Ht), waist (W) and hip (H) circumferences were measured in all women and serum levels of lipids, hormones and glucose were determined in about one half of them. Hirsute women were heavier and had higher waist to hip ratio (WHR) and waist to height ratio, increased LDL and decreased progesterone levels (In all cases, P<0.04). In 26 subjects with a high serum androgen level (Testosterone, and"or androstenedione and/or DHEAS) there was a significant correlation between triglyceride and testosterone levels (P<0.02). Multiple regression analysis showed that WHR was an independent variable for cholesterol and LDL Age for triglyceride Glucose for HDL And androstenedione for the LDL/HDL ratio. It is concluded that altered blood lipid profiles in women with hirsutism and"or hyperandrogenism may be the result of obesity, testosterone or androstenedione blood levels.

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Ultrasonography is a useful procedure in evaluation of spleen size in different clinical conditions. In this study, we used it to evaluate spleen size in patients with various heptologic, hematologic and autoimmune diseases. To express spleen size, a spleen index (SI), the product of the transverse diameter and its perpendiculr diameter measured on the maximum-sectional image of the spleen, was used. Splenomegaly was present in high percentages of patients with liver, blood, collagen or autoimmune diseases, even though a majority of these spleens were not large enough to palpate. By grading the SI, characteristic distributions of SI were obtained for patients with different types of diseases. Obtaining and grading the SI by the use of ultrasound appears to be a significant supplemental aid for evaluating spleen size, especially in patients whose spleen are not palpable.

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Background: Cephalometry is one of the important branches of anthropometry that has wide uses in identification, forensic medicine, plastic surgery, orthodontics, archeology and determining the origins of races. This research was investigated to determine the head and face phenotypes among one-day newborn boys in two aborigines of Sistani and Baluchi who were resident in Zahedan.

Materials and Methods: The investigation is based on cross-sectional analytical descriptions of 420 newborn aborigine boys (216 Sistani & 204 Baluchi), who were clinically healthy, in Quds hospital in summer 1381, in Zahedan. In this study cephalic and prosopic indices were determined by classical cephalometric.

Results: The mean and the standard deviations of cephalic index were 83.67±4.80 and 83.64±4.77 and prosopic index 86.79±5.87 and 86.53±6.76 for Sistani and Baluchi subjects respectively. Based on the cephalic index, the dominant head types in sistani group were hyperbrachycephalic (37%) and brachycephalic (37%). In Blachui group, the hyperbrachycephalic (37.3%) and brachycephalic (35.3%) type were the dominant one. Furthermore, according to the prosopic index. The dominant face type among sistanis was euryprosopic type (42.6%). In Baluchi group, the dominant face type was also euryprosopic (39.2%).

Conclusion: This research showed no statistically significant differences in terms of head and face type indices between two aborigines of Zahedan. Based on this cross-sectional study, it seems that there is similarities between the aforementioned groups

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Background: To evaluate the ability of Ankle/Brachial Index (ABI), that is a sensitive and specific test for detection of PAD, to foretell the possibility of ischemic heart diseases in diabetic patients.

Materials and Methods: All of diabetic patients who visited in our diabetes research center between May 2000 and May 2001 and were confirmed diabetics since 2 or more years ago were enrolled in the study. The ABI was calculated for all of the patients and their demographic specifications and ischemic heart disease risk factors were recorded. All of the patients refer to perform an exercise test, but 279 patients were conferred to performing stress test. They were containing: 127 patients with ABI =<1.1(group I) and 47 patients with ABI>=1.4(group III) as case groups and, 105 patients with 1.1 60 years (P = 0.02). 238 patients were in group I (25.1 %), 625 patients in group II (65.9 %) and 85 patients in group III (9 %). 52.8% of 125 patients in Group I, 19.6% of 107 patients in group II, and 44.7% of 47 patients in Group III had positive exercise test. I, II (P  0.00)- II , III (P = 0.05) A total of 108 patients from among the 279 patients had positive exercise test (38%), and most of them were from groups I &III. 72.2% of group I , and 52.5% of group II had high blood pressure (P  0.00). Both hypertensive and normotensive patients with ABI =<1.1 & >=1.4 had positive exercise test significantly more than patients with 1.1=1.4 is an independent predictor of coronary artery diseases in diabetic patients especially in those who are hypertensive.

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Background and Aim: Cardiovascular disease is one of the main causes of mortality and morbidity around the world and because of insidious and chronic progression of arterioscleroses and coronary artery disease (CAD) and also correlation between peripheral arterial disease and CAD we evaluated ankle brachial index (ABI) as a predictive factor for early diagnosis of CAD.

Materials and Methods: Evaluation of ABI performed in patients who referred to cardiology department of Imam Khomeini Hospital for coronary angiography from April 2003 to May 2004. 100 patients selected for the study, 50 patients with CAD (at least one vessel significantly involved) and 50 patients with normal coronary arteries as control cases. Relation between ABI and CAD studied in the patients, also other variables such as age, sex, family history of CAD, diabetes mellitus, hypertension, hyperlipidemia, cigarette smoking and claudication were evaluated.

Results: The mean age in patients with coronary artery disease was 56±16 years old (66% male, 34% female) and in normal coronary patients was 52+15 years old (48% male, 52% female). The mean ABI in patients with abnormal coronary arteries was 1.07±0.028 and in cases with normal coronary arteries was 1.12±0.016 that was not significant (P= 0.128). In addition there was no significant value between ABI and other variables mentioned above. All patients with ABI≤ 0.9 (14% of patients) had CAD.

Conclusion: This study revealed that although an ABI≤ 0.9 has a high predictive value for CAD, the ABI itself can not be a sensitive predictor of CAD diagnosis because a large numbers of CAD patients had ABI more than 0.9. Hence this level of ABI can not rule out the presence of CAD in many patients.

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Background: We aimed to demonstrate the mechanism of fracture and functional outcome of patients with hip injury in our clinical setting.
Methods: In a historical cohort, all women 50 years of age and older admitted to three university hospitals of Tehran University of Medical Sciences (Shariati, Imam Khomeini and Sina) with the diagnosis of hip fracture from 21 March 2003 to 21 March 2004 were included in this study (n=115). Follow up was conducted via telephone post and even home visit to record the functional status of the patients at the time of study (5 Jan 2005) measured with Barthel index in addition to the exact mechanism of injuries.
Results: The mean and standard deviation of age were 76.3 ± 10.6 years. About 88.7% of injuries had occurred at home (65.2% on the carpet), the remaining happening in the streets. Mean length of hospitalization was 11 ± 7.9 days. Among our patients, 71% could mobilize spontaneously without aids before injuries. This had reduced to 20% at the time of follow-up. The mean Barthel index was 97.2 ± 8.2 before fracture and 75 ± 21.1 at the present. Among our patients, five cases died during hospitalization and 29 of them died afterwards (total: 34 or 29.6%).
Conclusion: The most common external cause of injuries in our cases was stumbling at home especially on carpeted surfaces. This necessitates preventive measures aimed at physical standards of houses and education of elderly on healthy locomotion, indoors.

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Background: Both isokinetic testing and functional tests are commonly used to evaluate anterior cruciate ligament reconstructed (ACLR) patients. The object of this study was to evaluate motor performance of the knee and determine the relationship of isokinetic test scores to scores on a variety of lower extremity functional tests.
Methods: Ten healthy subjects and eleven ACLR patients at least six months after surgery performed the following: knee isokinetic tests at 60 and 180 deg/sec three functional tests including leg vertical jump, single hop, and triple cross-over hop for distance. The International Knee Document Committee Subjective Knee Evaluation Form (IKDCSKEF) was used to score the self-assessment of each study participant. Paired T-test was used to compare the involved and uninvolved knee. Pearson correlation coefficients were used to determine the relationship between the scores on the isokinetic test and functional tests. Significance was determined by P<0.05.
Results: IKDCSKEF score was significantly lower in patients than control subjects. Quadriceps peak torque and functional test scores were significantly lower in the involved knee of the ACLR subjects compared to the uninvolved knee. Correlation coefficients of isokinetic peak torque to body weight and functional testing were not significant in patients or control subjects, whi1e the limb symmetry index (LSI) of the quadriceps isokinetics peak torque to body weight and the LSI of the functional tests were significant (r = 0.54 to 0.97).
Conclusion: These results indicate a significant relationship between the LSI of various functional tests and the LSI of isokinetic testing among ACLR patients. Thus, in situations where an isokinetic dynamometer is not available, the LSI of functional tests can be used to estimate quadriceps deficiency for ACLR patients.

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Background: Tetralogy of Fallot is the most common cyanotic congenital heart disease. The systolic and diastolic function in both ventricles is altered even after successful corrective surgery for this defect with a transannular patch. Pulmonary regurgitation, a common complication after this treatment, is usually well tolerated in childhood. The aim of this study was to assess the combined diastolic and systolic function of both ventricles using the Doppler-derived myocardial performance index (Tei index) in patients who underwent surgical repair of tetralogy of Fallot using a transannular patch. In this article we discuss the impact of pulmonary regurgitation on right ventricular function and clinical outcome, the role of echocardiographic imaging, and current management strategies for patients with pulmonary regurgitation after this treatment.
Methods: Sixty eight patients with tetralogy Fallot were studied in Shahid Rajaie referral Cardiovascular Center during 2003-2005. The studied population, 36 male and 32 female with a mean age of 7.5±4 years and a history of corrective surgery for tetralogy of Fallot using a transannular patch. These patients were randomly selected and assessed by Doppler echocardiography.
Results: Fifty-seven patients (84%) had mild to moderate pulmonary regurgitation, whereas 11 patients (16%) had severe pulmonary regurgitation. Right ventricular Tei index was significantly increased in patients with severe pulmonary regurgitation compared those with mild to moderate pulmonary regurgitation (0.54±0.18 vs 0.24±0.11, P<0.01). Left ventricular Tei index was increased in patients with severe pulmonary regurgitation compared those with mild to moderate pulmonary regurgitation (0.46±0.22 vs 0.32±0.14, P<0.05).
Conclusions: The findings of this study suggest that pulmonary regurgitation is a serious complication after repair of tetralogy of Fallot with a transannular patch. Delaying surgery in such patients risks irreversible ventricular function.

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Background: The value of the mandibulo-canine index (MCI) in gender identification has been proved in some studies in various countries. The goal of our study was to determine the utility of MCI in gender identification in Iran.

Methods: This descriptional survey was performed on a group of 18- to 25-year-old Iranian students at the Tehran University of Medical Science. We included 50 males and 50 females that were selected using a single sampling method. Data were statistically analyzed by SPSS (v. 13) and t-test.

Results: No statistically significant difference was found between the mean ages of the two groups. Among men, the MCI ranged from 0.209 to 0.293, with a mean of 0.252. Among women, the MCI ranged from 0.202 to 0.276, with a mean of 0.245. There was significant statistical difference between the two means, (0.007 P value = 0.04). The standard MCI of 0.247 was compared to that of each gender, after which no significant statistical difference was found between the two genders (P value = 0.8).

Conclusions: Despite some studies performed in other countries displaying the usefulness of MCI in sex determination, our data did not support this conclusion. Perhaps this difference can be explained because of the variety ethnic groups from various cities of Iran represented in this research had some influence on the results.

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Background: This study attempts to examine the relationship between several dismension of organization climate and medical facutly's job satisfaction in Tehran University of Medical Sciences.
Methods: A survey composed of demographic items and job satisfaction indexes were mailed to a stratified random samples of medical faculties (n= 405).
Results: The overall response rate was 45.1%.
Conclusion: The study indicates that score of job satisfaction was 56.5 with SD= 16.96. In general 47.4% of the medical faculties were highly satisfied. A significant statistical correlation have been found between sex (p= 0.008), administrative position (p= 0.044), faculty rank (p= 0.007), marital status (p= 0.001), employment status (p= 0.003) and job satisfaction. The findings of this survey have implications for university administrative.

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Background: Surgery operations are the fearful events among all other medical procedures. This fear causes anxiety and stress which affects the outcome of treatments, recovery from surgery and some maladaptive behaviors. To cope with surgery worries and minimize the fear, it is important to study these fears and its associated factors. This study attempts to explore the surgery worries and the associated factors among Iranian high school adolescents.
Methods: To measure surgery worries, high school adolescents of age 11-15 completed the Child Worries Questionnaire (CPCI) adolescent form, and also answered the questions about the 14 independent variables (sex, age, parents education and occupation, previous hospitalization experience of child and immediate family and friends, number of hospitalization during Child’s life long, previous surgery experience of child and her or his immediate families, death of close friends in hospital). Multivariate regression method was used for statistical analysis to determine the effective factors.
Results: The results of this study showed that the Iranian Adolescents have most worries about the “Not being able to do the same things as before” and least worries about “What I will feel during the anesthesia”. The factors associated with Surgery worries are parent’s education (P=.021 for father and 0.049 for mother), adolescent previous experience and number of hospitalizations (P=0.025 and P=0.008, respectively), the number of previous hospitalizations (P=.003), previous experience of hospitalization of immediate family and friends (P=0.035). The findings of this study have implications for parents, family, hospitals’ staff and care given.
Conclusions: It seems, according to the findings of this study, there should be a special educational program for children who are going to be operated in a hospital ward to reduce their worriships.

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Background: Whatever its etiology, the inflammatory reactions of preeclampsia lead to the activation of endothelium and result in vascular damage. CRP is considered a sensitive index of systemic inflammation, so it is used as predictive factor for disease. This study was carried out to test the screening and predictive abilities of the CRP test in order to detect and diagnose pregnant women prone to preeclampsia prior to the onset of symptoms.

Methods: In this prospective cohort study, conducted in Arash Hospital between 2005 and 2006, we determined the CRP levels of 201 pregnant women at 10-16 weeks of pregnancy. Based on exclusion criteria and illness, 31 patients were excluded and 170 patients were followed until the end of their pregnancies.

Results: In this study, the mean serum CRP values of those who had preeclamptic and those who had normal pregnancies were compared and the statistical differences were significant: 6.18 mg/L for preeclamptic patients compared with 4.12 mg/L for normal patients (p=0.003). Using a chi-square test, we found that patients whose CRP level was ≥4 were six times more likely to have preeclampsia than those with CRP levels <4 (k=9.4 p=0.002 OR=6.15 95% CI=0.69-22.28).

Conclusion: This study confirms the results of previous reports indicating a significant relationship between rising serum CRP in the first trimester of pregnancy and preeclampsia at third trimester. More studies consisting of other inflammation factors are necessary to find an acceptable and reasonable screening test to diagnose pregnant women who are prone to preeclampsia.

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Background: Sleep has a major role in daily cycles and reconstruction of physical and mental abilities. Regarding the importance of this feature, we decided to determine sleep quality in medical students.

Methods: A questionnaire containing demographic data, Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index was prepared. We distributed the questionnaires using a census method to every student at the Zanjan Faculty of Medicine. The completed questionnaires were collected and the data was analyzed using SPSS.

Results: A total of 224 students answered the questionnaire, with 133 (59.4%) students evaluated to have good sleep quality and 91 (40.6%) poor sleep quality. Of these 91 students, 38% were female and 44.8% were male (p=0.307). The prevalence of poor sleep quality according to the four stages of medical training was 24.6% of those in basic sciences, 42.9% of those in physiopathology, 41.7% of externs, and 53.5% of interns (p=0.008). According to residential status, the prevalence of poor sleep quality was 61.5% among students living with their spouse, 44.6% for students living in their own private homes, 37.6% among students living in the dormitory, and 20.8% for those living with their parents (p=0.024). According to marital status, 35.8% of singles and 64.9% of married students had poor sleep quality (p=0.001). According to financial status, 57.9%, 46.9%, and 33.9% of those from low, moderate and high economic classes, respectively, were sleep deprived (p=0.049). Among those with average grades of under 16 and over 16 out of 20, 47.5% and 32%, respectively, were suffering from poor sleep quality (p=0.047). There was no obvious relationship between sleep quality and BMI, sex, or history of depression or anxiety.

Conclusion: Poor sleep quality was significantly associated with lower grades, economic status, living arrangement and type of training. A large number of students quality of life and work may suffer because sleep deprivation.

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Background: Identification of the best screening measure for the risk of chronic disease is essential. This study aims to comparatively assess the ability of waist circumference (WC), body mass index (BMI), waist-to-hip ratio (WHpR) and waist-to-height ratio (WHtR) to predict hypertension among women in Tehran.

Methods: In this population-based cross-sectional study, a representative sample of 926 adult women aged 40-60 years were selected using a multi-stage cluster random sampling method. Demographic data were collected and anthropometric measures including weight, height, WC and hip circumference were assessed according to a standard protocol. BMI was calculated as weight in kilograms divided by the square of the height in meters. Cut-off points of 80 cm for waist circumference, 25kg/m² for BMI, 0.87 for WHpR and 0.5 for WHtR were used. Blood pressure was measured and hypertension defined according to the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 6).

Results: In this study, the mean age of women is 48.7±5.6 years. Mean WC, BMI, WHpR and WHtR are 85.1±9.9cm, 29.4±4.6kg/m², 0.82±0.06 and 0.55±0.06, respectively. Although all anthropometric indicators have a significant association to hypertension, WC has the highest sensitivity, specificity and accuracy in predicting hypertension in both age groups of 40-50 and 50-60 years. This measure also has the greatest area under the ROC curve compared to other anthropometric measures: 0.70(0.69-0.71) for WC, 0.65(0.62-0.67) for BMI, 0.62(0.60-0.64) for WHpR and 0.65(0.63-0.67) for WHtR.

Conclusions: Among this group of women in Tehran, waist circumference is the best screening measure for hypertension. However, no data are available regarding similar patients who have emigrated thus similar studies on Iranian women who have emigrated are recommended.

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Background: To evaluate the association between age, sex, BMI, waist/hip ratio, smoking, religion, ethnicity, education and knee osteoarthritis.

Methods: Eligible subjects were randomly included from participants of Tehran COPCORD study, of whom 480 subjects with knee osteoarthritis were compared to 490 subjects without (case-control study). Using a questionnaire developed by COPCORD group (Asia & Oceania), we enquired about the risk factors of knee osteoarthritis i.e. age, sex, BMI, Waist/Hip ratio, religion, ethnicity, education and smoking. Knee osteoarthritis was defined using ACR criteria. Each knee was unit of analysis using GEE technique to evaluate these associations.

Results: Age (OR 1.096 CI95%: 1.091-1.1 P: 0.00) and sex (OR 2.85 CI95%: 2.49-3.28 P: 0.00) showed significant association with knee osteoarthritis. Overweight (OR 1.81 CI95%: 1.28-2.55 P: 0.00) and obesity (OR 3.3 CI95%: 2.34-4.66 P: 0.00) both showed higher risk for knee osteoarthritis. The association between waist/hip ratio and knee osteoarthritis showed an OR of 5.28, CI95%: 0.89-31.44 P: 0.07. However, this association was only borderline significant. People with different religion or ethnicity and smokers had no extra risks for knee osteoarthritis. Higher education is a protective factor for knee osteoarthritis as people who had university education compared to people with no/primary education showed a lower risk for knee osteoarthritis (OR 0.54 CI95%: 0.38-0.78 P: 0.00).

Conclusions: Our study confirmed that elderly, females, overweight and obese people are at higher risk to develop knee osteoarthritis as found in western societies. Higher education is a protective factor against knee osteoarthritis. Ethnicity, religion and smoking showed no extra risk of knee osteoarthritis.

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Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 B ackground: Preterm birth which is defined as delivery before 37 completed weeks was implicated in approximately two thirds of neonatal death. Also preterm labors are the most common cause of mortality and morbidity of infants in recent years and it costs high prices for health system. We evaluate the relationship between prepregnancy maternal body mass Index (BMI) and spontaneous and indicated preterm birth.
Methods: This study included 250 healthy pregnant women, without any risk factors of preterm birth, were classified into categories that were based on their body mass index. Association between BMI, weight gain and rout of delivery were examined. Rates of indicated and spontaneous preterm birth were compared.
Results: Obese women delivered at a more advanced gestational age. (38/34±1/66 weeks vs 37/61±2/44, p=0/006). Obese patients had significantly lower incidence of spontaneous preterm birth at < 37 weeks of gestation (16/8% vs 31/2% p=0/008). Obese women had larger infants (3354/95±596/75 vs 311.24±558/357 p=0/001), and had more frequent cesarean delivery (69/6% vs 52/8%, p=0/006). Weight gain during pregnancy is poorly correlated with prepregnancy BMI (14/41±7/93 kg vs 13/78±4/94kg, p=0/4) and preterm birth.
Conclusion: In this survey, there was adverse correlation between body mass index (BMI) before pregnancy and preterm labor less than 37 completed weeks and we suggest more study for evaluation between spontaneous and induced preterm labor mechanism and in obese and non obese women. However according to this survey obesity before pregnancy is associated with a lower rate of spontaneous preterm birth.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Muscle weakness and fatigue are two factors that cause muscle injuries. The roll of motor control is important in regulation and reduction of this effect. Repetition of motion after muscle fatigue is due to the significant role of motor control system. The aim of this study was to evaluate the quality of roll control of central nervous system following fatigue in order to answer primary questions in therapeutic exercises.
Methods: Twenty voluntary healthy subjects participated in this study. Dominant abductor policis brevis after surface electromyography (SEMG) of maximal voluntary contraction (MVC) fatigued by maximum three minutes isometric contraction in specific hand splint monitored by dynamometer until reduction of activities to 50% MVC. Before and immediately after fatigue test, 5 dynamic full range of motion in abduction direction performed without resistance and muscle activities recorded by SEMG. Three middle muscle activities selected for comparison of Symmetrical Index (SI) as specificity of motor control assessment. Fatigue indicators were percentage of reduction of MVC and median and mean frequency of power spectrum of MVC before and after fatigue test.
Results: Significant reduction of MVC (46.77%), median (13.03%) and mean (12.20%) frequency were showed (p=0.001), whereas significant increase of SI (10.76%) appeared (p=0.000), following fatigue test.
Conclusion: Fatigue reduces muscle contraction velocity, therefore median and mean frequency decrease. Also after muscle fatigue reduces of muscle proprioception sense appears, that can cause slow dynamic joint motion. Upper central control systems try to correct this situation by involving new motor units and changes of muscle timing. Synchronization of primary and new motor units plays an important role in increase of SI.

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Background: The sensitivity and specificity of body mass index (BMI) percentiles of CDC2000 standard which is used in determining obesity in Iranian children was compared with child real obesity identified by fat mass index (FMI) and obesity status in these children based on BMI and FMI was compared too.
Methods: Weight, height and triceps skinfold (TSF) thickness were measured in 1800 primary school children in Sabzevar, Iran. Fat mass (estimated from TSF) and weight were divided by height squared to calculate FMI and BMI, respectively. FMI at or above the 90th percentile of age- and sex- specific data in this study was considered as criterion for real obesity, and BMI≥95th and 85thResults: Based on the CDC cut-offs, the prevalence of overweight and obesity in our children were 7.9% and 4.8%, respectively. From the real obese and non-obese children identified by the FMI, 43.3% and 0.6% were identified as obese according to BMI, respectively. In addition, the sensitivity and specificity of 90th percentile of BMI to identify children as obese, were 71.1% and 98% respectively.
Conclusions: The efficacy of BMI in determining childhood obesity may be less than expected and it appears that FMI in comparison with BMI, is a better indicator of obesity in children, but more studies in this area are required.

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Background: The Bispectral Index (BIS) is an EEG-derived value that measures the sedative and hypnotic component of the anesthetic state. The effects of age on the bispectral index have not been well documented. The objective of the present study was to determine the influence of age on hypnotic requirement and bispectral index in awake and in patients with sedation induced by midazolam.

Methods: Eighty patients were enrolled in this prospective observational study. The patients in study group were aged more than 70 years, and the age in control group ranged 20-40 years. Baseline recording of BIS was taken in awake patients in two groups for few minutes. Five minutes after administration of 0.02 mg/kg IV midazolam the BIS value also was taken and recorded.

Results: In the study group, patients had a mean base BIS 94±3 compared with 97.3±1 in the control group (p< 0.0001). Five minutes after administration of 0.02 mg/kg midazolam the value were 80.9±6 and 90.4±3 respectively (p< 0.0001).

Conclusion: When BIS is used as a monitor of hypnosis in the elderly, we recommend that a baseline recording be taken before induction for a few minutes to alert the anesthesia provider to the possibility of low initial values. Further studies are needed to verify if the recommended range of 50-60 of BIS during clinical anesthesia is also adequate in the elderly with low initial baseline BIS or if this range needs adjusting in view of reduced initial BIS value.

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Background: Atherosclerotic vascular disease is a major cause of morbidity and mortality in patients with end-stage renal diseases on maintenance hemodialysis. Early atherosclerotic changes of the arterial wall can be evaluated by measuring intima-media thickness (IMT), and looking for the presence and structure of plaques and parameters of vascular resistance. In this study we investigated the relationship between carotid IMT and pulsatility index (PI) or resistive index (RI) values in hemodialysis patients.

Methods: Sixty hemodialysis patients (27 females and 33 males median age 41.7 years) and 60 healthy volunteers (32 females and 28 males, median age 37.8 years) underwent ultrasonography of common carotid artery for the determination of IMT, PI and RI.

Results: Bilateral IMT was significantly higher in hemodialysis patients than in control group (P<0.001). Left carotid artery RI and PI were found to be significantly higher in hemodialysis patients than in the controls (P<0.001). Right carotid artery RI and PI had no significant statistical differences between the two groups (P=0.18 and P=0.78, respectively). There was a moderately significant negative correlation between the left carotid IMT and left RI and PI in the controls (r= -0.42, P=0.001 and r=- 0.43, P<0.001, respectively).

Conclusion: PI and RI values of the left coronary artery increased as did IMT in hemodialysis patients. Therefore, measurement of RI and PI values together with IMT are recommended for early diagnosis of atherosclerosis in hemodialysis patient.