Familial Colocalization of Lichen Planus and Vitiligo on Sun Exposed Areas

Lichen planus and vitiligo are common skin disorders. Colocalization which is rarely reported may consider the koebner phenomenon related to the photo damage causing initiation of lichen planus over vitiliginous skin. We report a 37-year-old mother and her 23-year-old daughter, both farmers and known cases of vitiligo with subsequent gradual onset of pruritic skin lesions of lichen planus starting first over previous vitiliginous skin on sun exposed areas. Coexistence and colocalization of lichen planus and vitiligo in two members of a family is very rare and has not been reported previously according to our knowledge. Predominant colocalization was on vitiliginous areas which may explain actinic damage as a triggering factor for inducing lichen planus in long-standing vitiligo and supports its pathogenic relationship.     

Comparison of Prevalence and Risk Factors of Acute Coronary Syndrome in Patients with Different Ethnicity: A Cross-sectional Study

BackgroundAlthough the main risk factors of acute coronary syndrome (ACS) have been previously identified, there is not yet strong and consistent evidence about the ethnical differences of these risk factors. The aim of this study was to identify and compare the distribution of risk factors of ACS among two ethnic groups in northern Iran.MethodsThis cross-sectional study was done on a total of 250 patients (100 Fars and 150 Turkmen ethnics) with ACS admitted in coronary care units (CCU) of medical centers in Gonbad-e Kavus, a city in the Northeast of Iran. The demographic characteristics, clinical parameters and anthropometric indices of patients in two ethnic groups were recorded. In addition, Beacke''s questionnaire and Cohen''s scale were used to evaluate and compare the patients'' level of physical activity and perceived stress, respectively.ResultsThe mean age of the patients was 60.9±11.9 years and they were mostly males (54.8%) and married (84.8%). Findings showed that the prevalence of myocardial infarction in Fars patients was significantly higher than Turkmens (24% versus 15.3%; P=0.04). In addition, there was a significant difference in terms of the history of using opium (P=0.07) and opium sap (P=0.03), socioeconomic status (P=0.009), the place of residence (P=0.001) and type of health insurance services (P=0.001) between two groups. However, the clinical parameters and anthropometric indices and the level of physical activity and perceived stress were not significantly different between two groups (P>0.05).ConclusionThis study showed a significant difference in the prevalence and risk factor of ACS in patients with different ethnicity in northern Iran. This finding points to the importance of paying attention to the ethnicity-based difference in ACS prevalence and risk factors, especially in patients who are at high to intermediate risk for ACS, such as Turkmens.     

Comparison of the Outcome of Low Dose and High-Dose Corticosteroid in the Treatment of Idiopathic Granulomatous Mastitis

Background: Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory breast condition with unknown etiology. Different treatments including corticosteroids have been recommended with no universal consensus. In this study we evaluated the efficacy of low dose vs. high dose prednisolone in treatment of IGM. Methods: In this randomized clinical trial, 30 female patients with IGM were randomly allocated to receive low dose or high dose prednisolone. First group received 5 mg daily prednisolone, while the second group received 50 mg for three days, 25 mg for the next three days and then 12.5 mg for further three days and 5 mg daily afterwards, both for two months. Patients were evaluated 2, 3, 6 and 12 months after treatment. The success and recurrence rate was compared between groups. Results: High dose group had significantly higher rate of remission compared to low dose group (93.3% vs. 53.3%, p=0.03). One patient in high dose group and 5 patients in low dose group underwent lumpectomy due to persistent symptoms. Two other patients in low dose group received high dose treatment after three months due to no change in symptoms. Among patients with remission, recurrence was also significantly lower in high dose compared to low dose prednisolone (0% vs. 37.5%, p=0.04). Conclusion: High dose prednisolone has high success rate with lower recurrence in the treatment of IGM and could reduce the need for surgery. However, further studies are necessary to confirm these findings.     

Removal of traumatic cyclitic membranes: surgical technique and results

Background As most patients with a history of open globe injury and judged to have cyclitic membrane are denied further surgery because of poor prognosis, a technique for creating radial cuts in traumatic cyclitic membranes and its results are described. Method This is a retrospective non-comparative interventional case series of eight eyes with history of penetrating eye injury with fibrovascular membrane over the pars plicata observed during vitrectomy. All eyes were hypotonic; two had undergone previous vitrectomy and had developed RD. During vitrectomy after penetrating trauma, lens and its capsule or IOL was removed, fibrovascular membrane was visualized over pars plicata with the aid of external compression and after removal of the center of anterior hyaloid face, radial cuts were placed over the membrane. The resulting pieces were removed with vitrectomy probe. An encircling buckling element was placed in all eyes. Best corrected visual acuity, IOP, and postoperative complications are described. Results Eight eyes of eight patients (F: 3, M: 5) with an age range of 2–22 years (median: 11.5) with traumatic cyclitic membranes treated with the above technique were included in the study. They were followed for 6–18 months (median: 12 months). Seven patients had visual acuity of light perception to hand motion before operation .Preoperative IOP was low in all eyes (2–5 mmHg, median: 4 mmHg). One eye with a history of large foreign body removal was finally visually lost due to PVR. The other eyes had visual acuity of more than 20/100 (more than 20/60 in six eyes) and a normal IOP (8–20 mmHg, median 11 mmHg) in the last visit. Conclusion Placement of radial cuts over traumatic cyclitic membranes followed by removal of the pieces is well tolerated by the ciliary epithelium with good retaining of its secretory function and normalization of IOP. This work was presented as a poster at the 20th Congress of APAO, Kuala Lumpur March 2005. The authors have no proprietary interest in the materials and instruments mentioned in this article.     

Retinal artery macroaneurysms: clinical and fluorescein angiographic features in 34 patients

AIM: To describe the clinical and fluorescein angiographic features of patients with macroaneurysms (MAs) attending an ophthalmology department over 8 years. METHODS: All the patients between 1997 and 2004 with a diagnosis of retinal artery MA were identified from hospital records. Photographs and fluorescein angiograms were examined, and the MAs classified according to their clinical (haemorrhagic or exudative) features, and angiographic (saccular or fusiform) features. Baseline data of the patients were taken including visual acuity and associated ocular and medical conditions. RESULTS: A total of 38 MAs were identified in 34 patients. The age at presentation ranged from 36 to 93 years, with a mean of 73.7 years. Of them, 24/34 (70%) were female patients, and 10/34 (30%) were male patients. There was a history of hypertension in 9/14 patients (64.3%). Of 38 MAs, 32 were identifiable as either saccular or fusiform. Of these, 22/32 (68.75%) were saccular, the rest fusiform. In all, 72.7% of the saccular MAs showed haemorrhage as the predominant feature. Of the 10 fusiform MAs, 90% showed haemorrhage as the predominant feature. CONCLUSION: Retinal artery macroaneurysm is a rare condition that may mimic a variety of other conditions. Most MAs do not require treatment. We suggest guidelines for diagnosis and propose a treatment algorithm for this condition.     

Ocular injuries caused by mustard gas: diagnosis, treatment, and medical defense

Sulfur mustard has been used as a vesicant chemical warfare agent. To investigate the ocular damage it causes, we studied the effects on chemical casualties in the Iran-Iraq War. The patient population consisted of more than 5,000 chemical casualties, both military and civilian. The range of ocular damage was wide. The most common ocular effects were conjunctivitis and photophobia. Patients with significant corneal involvement are at risk for corneal ulceration and rarely for anterior chamber scarring and neovascularization, any of which would result in prolonged disability. In conclusion, the eye is the organ most sensitive to sulfur mustard vapor. Ocular injuries generally heal completely. In severe cases, blindness may occur. The need for corneal transplantation is rare.