BACKGROUND: Bilateral vasectomy is the most effective method of male contraception but there are still some reports on its failure. This study was undertaken to determine the failure rate of the no-scalpel vasectomy in Shiraz Vasectomy Center, Southern Iran. METHODS: From 2001 to 2003, 3900 no-scalpel vasectomies were done in Nader Kazemi Health Center. The records were studied for any failure in the method. Presence of any live sperm 6 months after surgery or any report of pregnancy post-vasectomy were considered as vasectomy failure. RESULTS: Among 3900 cases, 2928 patients had a complete follow up file while failure in the method was visible among 109 (3.72%) cases. CONCLUSION: The low failure rate of no-scalpel method indicated its high efficacy to control the fertility in males but there is still need of performance by expert surgeons in well organized centers.

Purpose: To report a case of butterfly-shaped macular dystrophy.Patient and Findings: A 34-year-old woman presented with metamorphopsia in both eyes from 2 years ago. Visual acuity was 9/10 in right eye and 10/10 in left eye. There was no pathologic finding on slit lamp biomicroscopy and funduscopy other than mild macular retinal pigment epithelium mottling. Visual fields and electroretinogram were normal but electrooculogram showed sub-normal results. Fluoresce in angiography showed black, non-fluorescent butterfly-shaped macular structures.Conclusion: Butterfly-shaped macular dystrophy occurs in middle aged subjects and presents with mild visual loss and metamorphopsia. It is slowly progressive and leads to marked visual acuity reduction in older ages. Considering the paucity of clinical findings, fluoresce in angiography and/or electrophysiological tests are recommended for making a correct diagnosis.

Purpose: Presentation of one case with keratoconus and granular corneal dystrophy. Patient and findings: This report is the third histopathological report of keratoconus associated with granular corneal dystrophy in the world and the first one from Iran. In this patient there were both clinical and histopathology findings of keratoconus and granular corneal dystrophy. Due to severe visual loss, corneal transplantation was performed in left eye.Conclusion: Coexistence of granular corneal dystrophy and keratoconus may affect the management of the patients, so it should be considered.

It has recently been demonstrated that merosin-deficient CMD (Congenital Muscular Dystrophy) patients have a more severe clinical phenotype compared with merosin-positive ones. We have undertaken a detailed clinical study of 6 patients (20% of CMD patients followed) with severe CMD who have never been able to stand or walk unsupported and in whom we have determined merosin status in skeletal muscle. Immunohistochemical staining demonstrated total absence of merosin in only one patient who was also found to have abnormal myelination on brain MRI. The patients first biopsy at 4 weeks of age revealed only scattered degenerating and regenerating fibers without other changes of muscular dystrophy. Second muscle biopsy at 7 months revealed severe muscular dystrophy. Merosin was absent in both biopsies. All other 5 merosin-positive severe CMD cases had normal brain imaging. In 3 cases there was no family history of the disease, but the mother of the 4th female patient had a milder form of muscular dystrophy with hypotonia since birth, suggesting an autosomal dominant mode of inheritance. Although merosin was present in all 5 patients, there were occasional fibers in 3 of them with only partial staining. This was seen predominantly in the degenerating fibers probably representing secondary rather than primary merosin deficiency. This study implies heterogeneity within a phenotypically homogeneous group of patients with a severe form of CMD. The merosin-deficient CMD appears to be less common in the studied population than in France, Turkey or England. Perhaps the increased incidence in those countries suggests a distant founder mutation, which would explain the scarcity of merosin-deficient CMD in a more heterogeneous population like studied one. Furthermore, absence of merosin in a neonate with hypotonia and weakness should lead to the diagnosis of merosin-deficient CMD, although the dystrophic process may not be evident on muscle biopsy yet.

Background and Purpose: Lipodystrophy is potentially a clinical adverse effect, associated with insulin therapy and is believed that usage of human recombinant insulin's is associated with decreasing prevalence of Lipodystrophy. The objective of this study was to determine the prevalence of insulin induced Lipodystrophy, among diabetic out-patients referred to Imam Khomeini Hospital, in Sari during 2007.Materials and Methods: In this cross sectional descriptive study, 220 diabetic patients referred to the Diabetes Center at Imam Khomeini Hospital, in Sari, who under treatment by insulin at least three months prior to referral was evaluated.First, the demographic and clinical characteristics of the patients were recorded in a questionnaire; then all patients were examined clinically to evaluate lipodystrophy. In all subjects, glycated hemoglobin (HbA1C) was measured to assess the range of blood glucose level control. Recorded data were analyzed by statistical methods, such as descriptive T-test and X2.Results: Of 220 diabetic patients studied, thirty-five (15.9%) showed clinical evidences of insulin induced Lipodystrophy; 32 out of 35 cases of Lipodystrophic patients (14.5%) had Lipohypertrophy, while 3 cases (1.4%) had Lipoatrophy.The factors included Age, Sex, Education, BMI (Body mass index), type of Diabetes, The duration of insulin consumption and injection site had statistically significant effects on development of insulin induced Lipodystrophy (P<0.05).Conclusion: The results of this study demonstrated that despite using human recombinant insulin's, the prevalence of insulin induced lipodystrophy, especially Lipohypertrophy, has remained high up to present. Therefore, regular examination of patients for this side effect is necessary, especially in subjects without good control of blood glucose level.

Purpose: To report concomitant keratoconus and macular corneal dystrophy in two siblings.Patients and findings: Two brothers presented with similar clinical findings of keratoconus and macular corneal dystrophy. Computerized videokeratography in both patients confirmed keratoconus. One patient underwent penetrating keratoplasty in both eyes sequentially. Histopathologic examination of excised corneal buttons with special stains was performed which revealed typical staining characteristics for macular dystrophy in addition to changes compatible with keratoconus.Conclusion: To our knowledge, this is the first report of such a concurrence and could lead to further studies on the possible biochemical or genetic link between these two entities.