[Comparison between primary PCI and thrombolytic therapy results in patients with acute st-elevation MI]

Early revascularization is the main step in treatment of patients with acute MI which since a few years ago has been done via P-PCI. Since thrombolytic therapy is performed as a standard method of therapy of acute MI in all centers not equipped with angiography and angioplasty systems, we decided to compare these two methods in the university centers in Iran. This prospective study was conducted on STEMI [ST Elevation MI] patients referred to emergency department of Shohadaye Tajrish and Shahid Modarres Hospitals, in Tehran, for early revascularization using thrombolytic therapy or Primary PCI. We compared these two methods of revascularization based on the effects on ejection fraction, ST-resolution and complications. 287 patients [144 in T.T group and 143 in P-PCI group] were enrolled in our study. There were no differences in ejection fraction between the two groups, but STresolution was significantly better in the P-PCI group [P< 0.001]. The rate of complications was similar in both groups. It seems the P-PCI is more effective than T.T in patients with STEMI

Expression of green fluorescent protein [GFP] using in vitro translation cell free system

One of the major concerns about recombinant protein production is its possible toxicity for the organism. Purification of the recombinant protein is another challenge in this respect. Recently In Vitro translation cell free system that provides a coupled transcription-translation reaction for protein synthesis to overcome the above mentioned problems has been emerged. The aim of this study was expression of GFP as a marker for gene expression and protein in In Vitro translation system. pIVEX2.3-GFP plasmid was cloned to E. coli and the plasmid DNA extracted. In Vitro translation was performed with RTS 100 E. coli Hy kit according to manufacture's instructions. Expression of recombinant fusion protein, His- GFP, was determined by SDS-PAGE, ELISA and western blot analysis. Expected size of recombinant protein was detected in SDS-PAGE and further confirmed by western blot analysis and ELISA. Results showed that In Vitro translation is suitable for expression of recombinant protein and fusion of the recombinant protein with His-tag facilitates the purification

[ diagnostic accuracy of fine needle aspiration [FNA] in thyroid nodules]

Thyroid nodules are a common clinical problem and Fine Needle Aspiration [FNA] is the principal method used for preoperative diagnosis. This study was designed to evaluate the diagnostic accuracy of FNA for detection of malignancy in thyroid nodules. In this retrospective study, 1016 patients with thyroid nodule were evaluated over a six year period [1999-2005]. FNA was done for all of these patients by two expert pathologists. Thyroidectomy was performed on 104 patients and the cytologic and pathologic diagnoses were compared. For evaluation of diagnostic value of FNA, malignant and suspicious diagnoses of FNA were considered as positive cytologic results and the final malignant cases [excluding microscopic carcinoma] as positive pathologic results. In addition, risk of malignancy in thyroid nodules was calcuated based on the cytologic results documented in our patients. There were 884 females and 132 males [f/m: 7:1], with an age range of 9-81 years. The cytological results of 1016 specimens were as follows: 85% benign, 7% suspicious, 0.9% malignant and 7% inadequate. One hundred and four patients underwent surgery, [85 females and 19 males, f/m: 4.5:1], with an age range of 13-56 years. Preoperative cytologic results in this group were as follows: 62.5% benign, 35.5% suspicious and 2% malignant. Final pathologic results were 83.6% benign and 16.3% malignant. FNA sensitivity was 93.8%, specificity 72.7%, diagnostic accuracy 75.9%, positive predictive value 38.4% and negative predictive value 98.4%. False positive rate was 27%, and false negative rate 6%. Among patients with a suspicious cytology who were operated, malignancy in pathologic results was 35% [13 cases of 37 cases]. While the incidence of malignancy in thyroid nodules was 3.8% in all patients, this rate was 6% in solitary thyroid nodules and 2% in multinodular goiters. Because of its high sensitivity and low false negative results, FNA seems a reliable method for the diagnosis of cancer in thyroid nodules, a method however that is useful only as an adjunct to clinical judgment and not as a replacement

[Results of descemet`s stripping with endothelial keratoplasty [dsek] in patients with bullous keratopathy after cataract surgery]

To evaluate the anatomical and visual outcomes of Descemet`s stripping with endothelial keratoplasty [DSEK] in patients with bullous keratopathy after cataract surgery. The study was performed on 20 eyes of 20 patients [13 male, 7 female] with bullous keratopathy [pseudophakic=15, aphakic=5]. Donor lenticule was prepared using a micro keratome [n=12] or manual dissection [n=8]. Patients were excluded in case of extensive corneal scarring and/or vascularization. DSEK surgery was performed by removal of recipient endothelium and Descemet`s membrane, and replacement by the donor lenticule. Patients were followed at least for 6 months. Mean age at surgery was 64.6 +/- 6.7 years and mean follow up was 7.3 +/- 2.1 months. At final follow up 15 grafts were clear. Failure was seen in 5 cases. Visual acuity LogMAR was 1.96 +/- 0.38 before and 0.52 +/- 0.09 after the procedure [P<0.0001]. Mean topographic keratometry was 46.0 +/- 2.9 D before surgery which reached 44.4 +/- 1.7 D postoperatively [P=0.219]. Preoperative astigmatism was 2.5 +/- 1.7 D which decreased to 1.1 +/- 2.3 D at final follow up [P=0.229]. Mean pre- and postoperative surface regularity index [SRI] were 1.47 +/- 0.60 and 0.43 +/- 0.17, respectively [P=0.006]. No case of endothelial rejection was observed. DSEK surgery is an effective treatment modality in cases of bullous keratopathy after cataract surgery with acceptable anatomical and visual outcomes

Concomitant Optic Nerve Transection and Chorioretinitis Sciopetaria

To report the first case of concomitant optic nerve transection and chorioretinitis Sclopetaria. A 12-year-old boy with history of BB gun injury to his right eye was referred for loss of vision 8 months after the accident. Visual acuity in the right eye was counting fingers at one meter with 3+ RA PD. On slit lamp examination, right eye seemed normal except 1+ anterior vitreous reaction. Fundus exam of right eye revealed a pale disc with superior retinal scar and diffuse submacular fibrosis compatible with chorioretinitis sclopetaria and advanced optic atrophy. Orbital CT-scan showed transection of the optic nerve by the BB gun pellet at the orbital apex.BB gun injury may cause concomitant optic nerve transection and chorioretinitis sclopetaria

[Keratectasia after LASIK versus PRK: a case report]

To report a case who had undergone LASIK in his right eye and PRK in the fellow eye for correction of equivalent myopia but developed progressive post-operative keratectasia only in the right eye. A 30-year-old man had undergone LASIK in right eye 3 years ago for correction of refractive error of - 1.75 - 1.50@48[degree] and PRJS in left eye 2 years ago for correction of refractive error of -1.00 - 1.75@ 100[degree]. Preoperative pachymetry was 447 [micro]m in the right eye and 446 pm in left eye. However, post-operative pachymetry decreased to 341 [micro]m in the right and 384 [micro]m in the left eye, but only the right eye revealed progressive corneal ectasia that led to severe visual loss [20/400]. PRJS may be a better choice for surgical correction of low amounts of myopia due to lack of flap creation; a factor that may weaken the anterior corneal structure and subsequently lead to progressive keratectasia. However, it is prudent to avoid any refractive surgery in eyes with central corneal thickness less than 500 [micro]m

[Chronic and delayed onset mustard gas keratitis: report of 48 patients]

Purpose: to report the clinical features of 93 eyes with chronic and delayed onset mustard gas keratitis in 48 patients

Methods: forty-eight Iranian survivors of Iraqi chemical warfare with chronic or delayed onset mustard gas keratitis were enrolled. We reviewed the symptoms, signs, clinical course, and treatment of our patients. In 5 cases, histopathologic features of corneal and conjunctival specimens are presented

Results: of 48 patients, 3 1 [64.6%] had chronic symptomatology whereas 17 [3 5.4%] experienced delayed onset lesions. Visual acuity at referral ranged from hand motions to 20120. Ocular surface changes included chronic blepharitis and decreased tear meniscus in all, limbal ischemia [81.3%] and conjunctival vascular abnormalities [50%]. Corneal signs in order of frequency were: scar/opacity [87.5%], neovascularization [70.8%], thinning [58.3%], lipoid deposits [52. I%], amyloid deposits [43.8%], and epithelial defects and irregularity [3 1.3%]. Twenty patients received conservative treatment; others underwent allograft stem cell transplantation [20 eyes of 17 patients], penetrating keratoplasty [12 eyes of 12 patients], and lamellar keratoplasty [4 eyes of 3 patients]. Conjunctival specimens were evaluated by light microscopy. Decreased goblet cell density, attenuated or thickened epithelium, scarring in the substantia propria associated with plasmacytic and lymphocytic infiltration, and dilated lymphatic vessels were noted. Excised corneal buttons disclosed absence of epithelium and Bowman's layer, firbrovascular pannus, stromal scarring, and vascularization

Conclusion: mustard gas may cause chronic and delayed destructive lesions in the ocular surface and cornea leading to progressive visual deterioration and ocular irritation. The pathophysiology of these changes is not clearly identified. Excised conjunctival and corneal specimens revealed a mixed inflammatory response without any specific features. Based on the clinical appearance of the lesions and histopathologic findings, an immune-mediated component seems possible

[Exudative retinal detachment secondary to choroidal metastasis of breast cancer: a case report]

Purpose: to report a case of exudative retinal detachment [ERD] secondary to bilateral choroidal metastasis of bilateral adenocarcinoma the breast

Patient and findings: a 50-year-old woman with history of decreased visual acuity [OD] since for 3 months had multiple visits and history of subtenon Depomedrol injection. Visual acuity was counting fingers at 2 meters and 6/10 in the right and left eyes, respectively. Relative afferent pupillary defect was 3+ [OD]. On slit lamp, 2+ anterior chamber and vitreous reaction was detected. On funduscopy, advanced ERD of the right eye and multiple subretinal masses in the left eye were noted. On systemic work up, bilateral multiple breast masses were found on mammography. Her breast biopsy showed advanced invasive intraductal adenocarcinoma

Conclusion: any patient with exudative retinal detachment of undetermined cause should undergo a thorough systemic work up. Prompt intervention is imperative and may be life saving