[Origin of left coronary artery arising from the right coronary cusp]

Anomalous coronary artery origin is a rare clinical entity with varied clinical outcomes ranging from asymptomatic to sudden cardiac death. The incidence of anomalous origin of left coronary artery arising from the right coronary cusp is 0.3-1%. CT angiography is the choice method for coronary anomalies, but often coronary angiography in RAO [right anterior oblique] view shows the coronary course. We present a case that referred to our hospital with post myocardial infarction angina for coronary angiography. A resting 12-lead electrocardiogram showed ST-segment elevation in leads v2, v3, v4. A transthoracic echocardiogram indicated LVEF 25% [Left ventricular ejection fraction], septal akinesia and apical dyskinesia. Coronary Angiography showed an anomalous origin of the left coronary artery from the right coronary cusp and significant stenosis in LAD [left anterior descending] and LCX [left circumflex] arteries with poor run off

[Causes and outcomes of treatment for superior oblique palsy during a decade at labbafinejad medical center]

Superior oblique palsy is a common cause of paralytic strabismus. This disorder causes diplopia, head posture and facial asymmetry. This retrospective study reviews patient with superior oblique [SO] palsy operated at Labbafinejad Medical Center from 1997 to 2007. In this descriptive study, records of patients with SO palsy scheduled for surgery were reviewed. Forced duction test [FDT] and tendon laxity was checked in each patient. Patients were divided into congenital and acquired subgroups. During the study period, 83 patients were referred for surgery. Of these 73 patients with complete records [45 males, 28 females] were enrolled into our study, with age ranging from 1.5 to 62 [mean 19.7 +/- 11.7] years. SO palsy was congenital in 56 patients [76%] and acquired in 17 patients [24%]. Most patients [47.9%] had left side and 13.7% had both eyes involvement. The most common chief complaint was ocular deviation [52.1%]. The following abnormalities were noted: positive FDT 7 patients [9.7%], tendon laxity 2 patients [2.7%], amblyopia 14 patients [19.2%], facial asymmetry 5 patients [6.8%], head tilt 10 patients [13.7%], and chin down position 3 patients [4.1%]. Mean preoperative vertical deviation was 16.2 +/- 8.3 which was reduced to 1.9 +/- 4 prism diopters after surgical intervention [P<0.05]. Mean exotropia and esotropia were 15 +/- 9.5 and 13.9 +/- 11.5 prism diopters before operation, respectively and both were reduced to mean horizontal deviation of 1.5 +/- 4.8 prism diopters after operation [P<0.05]. The most common Knapp classification of disease was type 3 [42.5%]. The most common muscle operated was the inferior oblique [83.6%] and the most common type of operation was the inferior oblique myectomy. The most common form of superior oblique palsy leading to operation is the congenital form which occurs most commonly in young men. The most popular surgical intervention at this center was inferior oblique myectomy

[Evaluation efficacy of combination therapy of %0.5 antralin and %2 minoxidil solution in treatment of alopecia areata]

Background: alopecia Areata is a prevalent inflammatory chronic disease which %2 of general population is suffering from it. All current therapies of the disease have their own limitations, so the object of this study is to evaluate efficacy of combination therapy with local %0.5 Antralin and %2 minoxidil solution in treatment of alopecia areata

Materials and Methods: in this placebo-controlled clinical trial, 53 subjects were included. 26 patients received combination therapy for 30 days, they used local %0.5 antralin 20 on their lesions 20 minutes every night, and after washing and drying the area used %2 minoxidil solution the same night and next morning. The rest 27 patients used placebo on their lesions. At the end of study, their hair growth were measured by assessing terminal hair growth

Results: there were 53 subjects with mean age of 18.35±4.23 [%60.4] of the patients were men and the rest %39.6 were women. The drug were more effective than the placebo [%67.9 vs %32.1, P=0.063].Erythema and hyperpigmentation were seen in %96.1 and %100 of patients receiving drug, respectively, while just %29.6 of the placebo group had erythema and no one had hyperpigmentation

Conclusions: most patients who used combination therapy took benefit of the drug and it seems that by increasing number of subjects and continuing the treatment, the rate of efficacy will increase considerably

Nd: YAG laser treatment for premacular hemorrhage

To investigate the effects of drainage of premacular subhyaloid hemorrhage into the vitreous with Nd: YAG laser in 13 eyes of 12 patients in a 3 months followup period. This study was conducted from January 2001 to December 2001. Thirteen eyes of 12 patients had a circumscribed premacular hemorrhage and were treated with Nd: YAG laser to drain the blood into the vitreous cavity. The hemorrhage originated from diabetic retinopathy [8 eyes], retinal macroaneurysm [2 eyes], AML [2 eyes] and branch retinal vein occlusion [1 eye]. The size of the hemorrhage was expressed in disc diameters. Success of laser application was defined as clearing of premacular hemorrhage within 3 months. By this definition drainage of premacular subhyaloid hemorrhage into the vitreous with Nd: YAG laser succeeded within three months is eleven, out of thirteen eyes treated without requiring further membranotomy. One eye had persistent, dense nonclearing vitreous opacity for at least 3 months. One clotted hemorrhage did not drain into the vitreous. Overall visual improvement was best in eyes with AML and macroaneurysm. During the follow-up, neither macular epiretinal membranes nor tractional retinal detachments occurred in any eye. Drainage of premacular subhyaloid hemorrhage into the vitreous with Nd: YAG laser is a viable alternative treatment alternative for eyes with recent bleeding. However, to establish Nd: YAG laser treatment as a routine procedure, the risk and benefits have to be weighed in randomized trials and compared with those deferral of treatment or primary vitrectomy