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Tibiotalar dislocation without concomitant fracture in the surrounding bones is a rare injury. We report one of them presenting unreduced after a 10 month interval. A 23 y/o female presented to our clinic 10 months after Bam earthquake, during which she had sustained an anterior tibiotalar dislocation without any associated fracture. Open reduction was tried two times, but both attempts were unsuccessful because of the very poor quality of bone. Although ankle dislocation has been reported to be associated with good prognosis, it was not the case with our late presenting patient.

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The brachial plexus is the plexus of nerves that supply the upper limb. Anomalies in the formation of lateral cord of brachial plexus and communication between its branches are commonly observed but the variation of the course of lateral cord is very rare. We observed that lateral cord of brachial plexus and its branch had a different configuration in dissecting room in Bandar Abbas medical school. Here, the lateral cord pierced the coracobrachialis muscle and then divided into the musculocutaneus and the lateral root of median nerve. After a distance , the lateral root of median nerve joined the medial root of median nerve, and median nerve formed anterior to brachial artery. The rest of the course of the median nerve and the musculocutaneous was normal in arm region.

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Endoscopic sinus surgery can cause orbital and intracraniol complications. Anisocoria is one of sings of orbital complication. We report a case with anisocoria during endoscopic sinus surgery. Patient was a 42 years old female that was operated because extensive polyposis in right nose and sinuses and retention in otherwise under general ansthesia. A half on hour after the surgery was started, we found dilatation of pupil in left eye which unresponsed to light. Also, as far as the eye symptoms returned to normal after 8-10h after and there was not any veridence of orbital trauma. It seems difiusion of local injection of adrenalin in surgery nasal cavity can probably case of pupil dilatation.

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Granuloma faciale is an uncommon cutaneous lesion characterized by asymptomatic skin nodules and plaques without any systemic presentation. The lesions mainly seen in middle aged males. We report an uncommon presentation (multiple cutaneous lesions) in trunk,upper arm and face)of a 32 years old male.

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Adrecortical virilizing tumors are rare in the pediatric age group. There is 1% incidence for adneral cancer. In comparison with adult patients , there is function adrenalectomy tumor in pediatric group. The patient in this report was a 20 months old female presenting with clinical signs of virilizition that were characterized by increased bone mass, pubic hair growth external genitalia. The laboratory test showed: High level of testosterone (400 ng/dl) , andrestandion (3.6ng/ml) and progestron (19.9ng/ml) and very high level of (8000ng/ml) dehydroepiandrosterone. In CT scan there was right adrenal mass with size>5 cm. The diagnosis of right an adrenocortical functional tumor led to the choice of open surgical adrenal with flank apreach between 10 and 11 ribs. Pathologic examination showed carcinoma of the adrenal. Patient discharged 5 days after operation. Surgery was done via lumbar incision and follow up was carreid out for 10 years, and there was not any pathological lesion.

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Brucellosis is a zoonosis with a variety of clinical syndromes including spondylitis. Spondylitis and sacroiliitis are the most frequent complications of skeletal system involvement in brucellosis, but muscle infection and abscess formation are a rare complication and frequently secondary to spondylitis. In this article two cases of brucella spondylitis are presented which has led to abscess formation in one of them, these patients referred with back pain, fever, and with subsequeint MRI examination, wright positive test, were diagnosed as spondylitis. The antibiotic regiment including Doxycycline, Refampin, were prescripted for four months. The clinical signs were disapeared subsequently.

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Adrenocarcinoma is a rare disease with a poor prognosis. As a practical classification, adrenal carcinomas divide to two categories: functional and nonfunctional. Adjurent radiotherapy and chemotherapy is useful for palliation. The aim of this report is to introduce one case of large nonfunctional adrenocarcinoma. A 46 years old-male with ambiguous abdomen pain and orchidoepididymitis reffered to clinic in 2006. Physical examination revealed grade III fixed varicocele with left orchidoepididymitis. Sonography and computed tomography scan showed a massive lesion on left adrenal. Adrenal function test was normal, therefore nonfunctional adrenocarcinoma is diagnosed. This patient underwent open adrenalectomy. Then the patient introduced to chemoradiotherapy in oncology center. After six months, the patient suffered from multiple liver metastasis and one year later was expired.

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Child abuse as an ominous and abnormal phenomenon was scold in every community. In attention to severity of non - accidental injuries that inflict by parents or guardian and chance of death is considerable, intervention is necessary for life saving at early stage. A large number of child abuse fatality occur in world wide, that usually does not recognize at routine visits. Therefore the need for a program to recognize and intervent is an inevitable task. This study consider child abuse case with fatal abdominal injury with subsequent death.

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Cervicogenic headache (CEH) is a chronic, hemicranial pain syndrome in which the sensation of pain originates in the cervical spine or soft tissues of the neck and is referred to the head. Cervicogenic headache is a relatively common but often overlooked disorder. There is sufficient evidence to support this category and the existing diagnostic criteria are adequate. The purpose of this case report was to describe an intervention approach consisting of release and muscle energy techniques for an individual with cervicogenic headache. Clinical examination revealed myofacial trigger points in trapezius, sternocliedomastoid and upper cervical spine erectors. Visual analogue scale (VAS) identified severe pain. Range of flexion and rotation was reduced. Complete pain relief was seen following three times treatment sessions. The results indicating definite diagnosis and appropriate treatment of cervicogenic headache.

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The prevalence of struma onset in uterine tube is lower than ovary’s stuma. In this report a 63 year old woman was referred to main hospital in the city of Yazd, Iran in 2008. The patient referred with abdominal swelling in pre-umbilical and supra pubic region associated with losing weight and frequent constipation since 5 years ago. After the hospitalization the patient underwent the laparatomy. in pathology report the masses was struma ovarii and mature cystic teratoma associated with struma salpingi and peritoneal steremosis. Special demonstration accompanied struma salpingi in this case are struma ovarii and multiple vesicular vegetasion in choledosac, Peritoneum and bladder. This report was a very rare case of struma salpingi accompanied with struma ovarii and steremosis.

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Vulvar melanoma is a very rare tumor with the rate of 0.1-0.19/100000. It mostly occurs during post menopausal period. In this case report, our patient was a 43 years old woman, her symptom was a small pruritic lesion noticed two months earlier when she was referred to the clinic. This lesion was a 5mm diameter dark brown and flat on her left labialis minor. Malignant melanoma with 3-5mm thickness was diagnosted following biopsy. Wide local excision with more than 2cm free margin and inguino femoral lymphadenectomy at the site of the lesion was done. The recurrence of tumor was not abserved during four months follow-up.

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Buschke–Lowenstein Tumor (BLT) or Giant Condyloma Acuminatum (GCA) is a slow-growing, locally aggressive, cauliflower-like tumor of great size that usually arises in the perineal region. Buschke–Lowenstein Tumor is triggered by human papilloma virus (HPV), usually either genotype 6 or 11. Buschke–Lowenstein Tumor is usually preceded by condyloma acuminatum and occurs at any age after puberty, usually between the 4th and 6th decades. Invasive overgrowth and recurrence after treatment are its characteristics and malignant transformation is also possible. Here, we have reported a case of a 33 year-old man with penile Buschke–Lowenstein Tumor arising from common genital warts.

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Aspiration pneumonia is a critical disease and can result from a various causes. Epiphrenic diverticula is a rare disorder, which can cause aspiration of food material contained in it. Mediastinal tuberculosis can also cause traction diverticula at mid-esophagus, which usually are asymptomatic and induce no complication. In this article we describe a case, suffering of all these three disorders and after seven years of surgery and medical treatment any symptom was not found in the patient.

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Celiac disease is one of the most common cause of malabsorbtion syndrom. The symptom of this disease associated secondary to malabsorbtive problems. Celiac can be accompanied with liver enzyme dysfunction with various extra intestinal findings. This case was a 27-year old man presented with abnormal liver function test over period of 1 year. He did not have another symptom such as diarrhea, weight loss or skin lesion. In medical examination, there was no ascites, peripheral edema or jaundice. Diagnostic re-examination of the paitent include serology tests and Viral hepatitis, Wilson disease and auto Imuune respones showed to be normal. Abdominal and biliary sonography had normal results. Liver biopsy revealed no sign of any pathology, but duodenal biopsy and serologic findings were compatible by Celiac disease. The symptom improved on a gluten-free diet and his liver enzyme function tests became normal subsequently.

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Pulmonary aspiration of gastric contents during the peri-operative period is rare but with significant morbidity and mortality. A 21 years old pregnant woman with preeclampsia was scheduled for an emergency cesarean section under spinal anesthesia. After 18 hours of operation, epilepticus status was occurred. One day after control of seizure, aspiration pneumonitis was diagnosed and treated with mechanical ventilation and positive end-expiratory pressure (PEEP). In patients with the history of loss, consciousness, complication of aspiration, aspiration pneumonia and pneumonitis particularly should be considerated. In case of onset of pneumonitis, PEEP treated procedure with other mechanical ventilation is recommaded.

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Both fibrocystic change and phyllodes tumor are classified as fibroepithelial tumors of breast which are composed of epithelial and stromal components. Although as the most common benign breast lump fibrocystic lesions are known by symptom such as pain, nipple discharge, heaviness, usually in women’s third decade of life, mammographic and sonographic features often render them almost indistinguishable from phyllodes tumor. In view of the essential differences in terms of therapeutic planning which exist between these two tumors, their early and precise distinction is crucial to avoid problem such as patients’ anxiety and unwarranted tumors operation. In this article a case of fibrocystic change in a 24 year old woman is reviewed in which clinical signs and symptoms and mammographic changes are indication of phyllodes tumor.

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The latest reported incidence of subarachnoid hemorrhage due to aneurysms and arterio-venous malformations (AVMs) is around 15 per 100,000 pregnancies. It is also the third leading cause of maternal death from non obstetric causes accounting for 12% of total mortality. A pregnant woman with 42 years old G5P4Lch4 had vaginal delivery in 12 Aug 2009. One week after delivery she was visited by General Physician due to headache. She was admitted with signs of dizinous, vomiting projectile and painful stimuli, hospital consciousness level 5 and coma. CT scan was demonstrated a massive bleeding inside the brain. Massive hemorrhage into the ventricle was detected following neurosurgery. She was dead due to cardiac arrest after 10 days. Based on this case report, woman with headache following delivery should be recommended for cerebral aneurysm.

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Papillon-Lefevre Syndrome is a rare autosomal recessive disorder. This syndrome accompanied by palmoplantar hyperkeratosis and severe periodontal destruction of primary and permanent teeth. The teeth erupt normally but due to the severe alveolar bone loss both in deciduous as well as permanent dentitions, these teeth are exfoliated within two or three years after eruptions and by the age of 15 or 17. Patients are usually edentulous. Due to periodontal disease, the dentists are often the first ones who diagnose the syndrome. A 15-year-old girl was referred to dental clinic complaining of permanent teeth mobility. All patient’s teeth except 13, 14, 17, 23, 27, 37, 43, 44 and 47 had been extracted. The third molars were impacted. Patient has advanced periodontal disease and all teeth have mobility. There was hyperkeratosis at the palms and soles. The teeth were extracted and treated with complete denture. Early diagnosis of the papillon-lefevre syndrome can help to preserve teeth. Dental treatment included extraction of all deciduous teeth, professional prophylaxis, conventional periodontal therapy, systemic antibiotics, oral retinoid, complete dentures and implants.

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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.

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Helminthic infections were reported from tropical and subtropical locations in the world. The parasitic helminths develop and migrate to different organs. Unusual cases may afflict the gallbladder and the biliary tract. The parasites invade the bile ducts and cause inflammation, fibrotic lesions, acute and chronic cholecystitis. In this article, we reported three unusual cases of parasitic infection in Kermanshah, Iran. The worms were isolated from gallbladder and biliary tract. The specimens were diagnosed by macroscopic features and staining methods. Ascaris lumbricoides, Taenia saginata and adult type fasciola hepatica isolated from gall bladder and biliary duct. Cholecystectomy was done on all patients suffering from gall bladder inflammation and obstruction.