Sjogren syndrome and fibromyalgia after radioiodine therapy in cancer thyroid patients

Salivary and lacrimal gland dysfunction is relatively frequent after radioiodine therapy. An association of Sjogren's syndrome [SS] and other autoimmune rheumatic diseases as fibromyalgia syndrome [FMS] has been reported. Thyroid autoimmunity in FMS patients is higher than normal subjects. To detect the occurrence of Sjogren syndrome [SS] and any rheumatologic association in cancer thyroid patients after radioactive iodine therapy [I -131] and evaluate the salivary and lacrimal glands function. Thirty-one patients with post-surgical differentiated thyroid carcinomas with a mean age 40.13 +/- 9.82 years, were referred for I-131 therapy [mean dose 212.9 +/- 101.63 mCi] and continued the follow-up study. All patients had no symptoms or signs of SS. Thorough rheumatological examination was performed for any musculoskeletal manifestation or associated fibromyalgia syndrome [FMS]. Before and 8-12 months after I-131 therapy, salivary glands function was estimated by sequential scintigraphy, while lacrimal gland function was assessed by Schirmer's test. Antinuclear antibody [ANA], anti-Ro [SS-A], anti-La [SS-B] and rheumatoid factor [RF] were performed. All patients had a normal salivary glands scintigraphy and Schirmer's test before I-131 therapy. On follow up, primary SS occurred in 8 patients [25.81%] while a significant decrease in salivary function occurred in 18 [58.1%] patients and significantly correlated with the I-131 dose. Schirmer's test was significantly abnormal in those with SS. Serum Anti Ro and Anti La levels became significantly higher in SS patients [18.25 +/- 11.61 and 25 +/- 13.06 U/ml] compared to the others [6.57 +/- 1.8 and 7.35 +/- 1.8 U/ml], respectively, [p 0.025 and 0.006]. Fibromyalgia syndrome was present in 12 patients [38.71%] and 6 of them developed SS. Assessment and follow up of salivary and lacrimal glands function is essential in patients receiving radioiodine therapy. Abnormal level of anti-Ro and Anti-La increase the risk for SS that should be closely monitored and fibromyalgia is a common association

Myocardial perfusion scintigraphy [Gated-SPECT] and coronary disease risk factors in Behcet's disease with metabolic syndrome

Behcet's disease [BD] is a multi-system vasculitis that can have a wide range of effects on the cardiovascular system. To determine the existence of myocardial perfusion defects caused by coronary microvascular dysfunction in asymptomatic BD patients with and with out metabolic syndrome and to evaluate coronary arterial distribution and left ventricular systolic function by gated single-photon emission computed tomography [G-SPECT]. The study population consisted of 20 [17 men and 3 women] patients with BD and 20 healthy controls of age and sex match. Technetium-99m methoxyisobutylisonitrile [Tc-99m MIBI] gated SPECT studies were performed using a 1-day rest-stress protocol. Stress and rest left ventricular ejection fraction [LVEF] were calculated. Using gated SPECT images myocardial perfusion scores [summed stress score [SSS], summed rest score [SRS] and summed difference score [SDS]] were determined. Echocardiography was performed for comparison. Carotid intima-media thickness [1MT] was recorded to detect the macrovascular involvement in BD and to detect if there is any possible correlation with the microvascular myocardial affection. Abnormal myocardial perfusion scintigraphy [MRS] was detected in 15 patients [2 with infarction, 13 with perfusion defects], 5 patients had normal perfusion pattern. Scmiquantitative scores [SSS, SRS and SDS] were significantly higher in the BD patients compared to control [p 0.000]. There was a statistically significant difference between BD patients and control regarding the carotid artery IMT by ultrasonography being increased in the patients. On the other hand, the G-SPECT and echocardiographic LVEF was significantly lower in the BD patients [p 0.001 and p 0.002 respectively]. On comparing the results of the BD patients with and without metabolic syndrome, the studied parameters for coronary risk factors as blood pressure, cholesterol, triglycerides and fasting blood sugar they were significantly higher in the metabolic syndrome group. On the other hand, the HDE was significantly lower in the metabolic syndrome group. Both the disease activity [BDCAF] and the myocardial perfusion gated SPECT [SSS] were significantly higher in those BD patients with metabolic syndrome [p 0.03]. On the contrary, the differences in results of the carotid artery IMT and the echocardiographic LVEF% in BD patients with and without metabolic syndrome did not reach significance. There was a tendency to increased disease duration in BD patients with more severe myocardial perfusion defect. The difference was only significant between patients with perfusion defect and those with old myocardial infarction involving the antero-septal wall [p 0.04]. There was a statistically significant difference among the three myocardial perfusion scan subgroups as regards the level of triglycerides, systolic and diastolic blood pressure [p 0.29, 0.38, 0.13 respectively]. The CRP level was higher in the infarct patients followed by the defective perfusion. A significant difference was only found when comparing the level of those with history of infarction [severe ischemia] with those with normal myocardial perfusion scan [p 0.047]. On comparing the carotid artery IMT, echocardiographic LVEF%, and myocardial perfusion G-SPECT parameters, they were all significantly different among BD patients with infarction, defective and normal myocardial perfusion. A significant positive correlation was present between the SRS and the disease duration [p 0.04]. CRP significantly correlated with both the SSS and SDS [p 0.04 and 0.00 respectively]. Furthermore, the SSS and SRS significantly correlated with the blood pressure, triglycerides and cholesterol levels. The BDCAF significantly correlated with the SSS and SDS [p 0.009 and 0.007 respectively]. Carotid artery IMT significantly correlated only with SRS [0.02]. However, the echocardiographic LVEF% significantly correlated with all the myocardial perfusion gated SPECT parameters. Myocardial perfusion and function are disturbed owing to influenced coronary microvascularity in BD with silent myocardial ischemia [SMI]. Gated SPECT is a non-invasive more reliable method compared to echocardiography that simultaneously evaluates the existence, extent and severity of myocardial ischemia or infarction in cardio-Behcet. Myocardial perfusion defects increase with increased disease activity and carotid artery IMT. Metabolic syndrome risk factors account for an augmented perfusion defect and should be considered a high risk group in BD patients

effect of trypan blue anterior capsular stainning on lens epithelial cells: a histopathological study

The aim of the present study is to detect the histopathological impact of trypan blue dye on anterior capsular epithelial cells of the anterior capsules stained with trypan blue dye during phacoemulsification. Twenty cataractous eyes underwent anterior capsule staining using 1 mL typan blue dye 0.5%, under air as apart of a routine phacoemulsification of the cataractous lens. Anterior capsulorhexis was done and the obtained anterior capsule flaps were sent for histopathological examination. As a control group, 20 cataractous eyes underwent phacoemulsification without capsular staining and the flaps were sent for histological examination compareing the findings in both groups. The histopathological examination of the stained capsules demonstrate, focally ragged and irregular outer limit of the capsule with reduction of thickness and considerable loss of cells and change in the viability of the residual epithelial cells compared with the unstained capsules. Staining the anterior lens capsule during cataract surgery using the most popular trypan blue dye appears not only to facilitate capsular visualization but also can attack the lens epithelial cells, the main source for capsule opacification. Further studies and clinical correlation is mandatory to further evaluate the cytotoxic effect of the dye on different ocular structures and its effect on posterior capsule opacification

Preservative-free lidocaine 1%: a new approach for the prevention of posterior capsule opacification [PCO]: a clinical study

The aim of the present study is to detect the effect of preservative-free lidocaine 1% applied into the capsular bag by the end of phacoemulsification on the behaviour of posterior capsule opacification [PCO]. Thirty patients aged from 40-65 years [mean 52.2 +/- 6.38SD] presented by bilateral cataracts were included. Patients were randomly divided into two study groups; Group 1: Comprised 30 eyes in which 1.0 mL preservative-free lidocaine 1% was applied for irrigating the capsular bag before in the bag implantation. Group 2 [control group]: Comprised the fellow eyes [30 eyes] of the first group patients with no application of preservative-free lidocaine 1% during phacoemulsification. The mean follow-up period was 8.7 +/- 2.58 months, however 10 patients could achieved a follow-up period of 12 months. No intra-operative complications reported in both groups. A mild to moderate anterior segment reaction [flare + and ++] was reported in the early postoperative, with no statistical difference between both groups. An immediate spike of increased IOP was reported in 5 eyes [16.6%] of group 1 [Lidocaine group] and 4 eyes [13.3%] of group 2, however the mean postoperative IOP by the end of the follow-up period was 14.26 +/- 1.48 mm Hg and 13.86 +/- 1.5 mm Hg in both group 1 and 2 respectively, with no statistical differences between both groups. No major corneal complications reported in both groups and specular microscopic examination by the end of 6 months follow-up revealed no gross abnormalities. The mean post-operative endothelial cell count was 2742/mm3 +/- 534.81 with no statistical difference between both groups and the pre-operative count. Five eyes of group 1 [16.66%] treated with preservative free lidocaine 1% developed posterior capsule opacity detected by slit lamp examination at the end of the follow-up period with Nd:YAG posterior capsulotomy was applied for 2 eyes with dense PCO, however 10 eyes [33.33%] in group 2 [control group], developed posterior capsule opacification and Nd: YAG capsulotomy was applied to clarify the visual axis. Preservative-free lidocaine 1% might decrease the incidence and density of post-cataract posterior capsule opacification compared with eyes not treated with lidocaine intraoperatively with no major intraocular complications