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Temporary pace marker (TPM) usually has been used in emergency conditions. Insertion of TPM is accompanied with vein thrombosis and pulmonary Emboli. TPM was inserted via right femoral vein in 73 years male due to complete heart block. Thereafter, he was suffered from deep vein thrombosis. Echocardiography revealed multiple mobile clots in right atrium, ventricle and impending pulmonary thromboemboli following insertion of permanent pacemaker. Despite of contraindication for the application of thrombolytic agents due to surgical incision for permanent pacemaker and presence of patent foramen oval, the patient survived from massive pulmonary thromboemboli and death due to rapid diagnosis and on time treatment with anticoagulation agents without performing surgery.

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Cogan's syndrome is a chronic inflammatory disorder of unknown cause affecting mostly young adults. Two main observation of the disease are bilateral interstitial keratitis and vestibuloauditory dysfunction. Association between Cogan's syndrome and systemic vasculitis as well as aortitis are exist. The diagnosis of the disease is based upon the presence of inflammatory eye disease and vestibuloauditory dysfunction . In this article, the classic Cogan's syndrome has been reported in a 47-year-old woman. Two months prior to admission, the patient had been suffering from headache, vertigo, nausea, vomiting, right leg claudication, musculoskeletal pains, bilateral hearing loss and blindness. Ophthalmologic examination revealed that visual acuity was 0.1 bilaterally and on slit lamp examination, there was a conjunctival hyperemia, bilateral cataract and interstitial keratitis. Pure tone audiogram (PTA) and auditory brain stem response (ABR) showed bilateral sensorineural hearing loss. The patient was initially treated with pulse intravenous methylprednisolone and was followed by oral prednisolone and cyclophosphamide, which in follow-up showed partial improvement.

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Penetrating atheromatous ulcer is the condition in which ulceration of an aortic atherosclerotic lesion penetrates the internal elastic lamina into the media. Differentiation of penetrating atheromatous ulcer from other causes of acute aortic syndrome such as intramural haematoma and aortic dissection is difficult. The main symptom is a severe, acute chest pain radiating to the inter-scapular area, similar to classical acute aortic dissection of the thoracic aorta. In present article a case of a 52 years old woman with long- standing retrosternal chest pain and with penetrating atherosclerotic aortic ulcer in descending aorta was reported. Unlike the predominant picture of this disease,associated intramural hematoma was not seen.

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Airway pressure release ventilation (APRV) is a new mode of ventilation. APRV is used in the acute respiratory distress syndrome when the low tidal volume strategy was not responding to assisted controlled mandatory ventilation (ACMV). Four cases of acute respiratory distress syndrome and severe life threatening hypoxia with ACMV whom were successfully managed with APRV are reported in this article. Although hypoxemia patients were treated by APRV method but eventually two patients died.

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Borreliosis or recurrent fever is a spirochete disease which is caused by various species of borrelia and characterized by recurrent episodes of fever, chills and spirochetemia that could lead to multiple organ involvement and even death. In this case report, a 23 years old man was presented with shaking chills, fever and abdominal pain from a week before hospital admission. Borrliosis was confirmed following observation of Spirochete in peripheral blood smear. The patient was treated with doxycycline orally and one week after treatment discharged with a good general condition. Coincidence of borreliosis with underlying haemolysis in this patient was misled clinical presentation.

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There is not comprehensive information available about the control, complications and treatment methods of factor VII deficiency. Online registry system called seven treatment evaluation registries (STER) has been created which investigated the disease as an international multi-center prospective observational project in order to provide information about the effect and immunity of available therapies. In this report, five patients with factor VII deficiency were diagnosed and registered in Golestan Province, Northern Iran, during 2010-11. All treatment protocol, demographic charectristic of patients were collected and registered in www.targetseven.org on the basis of STER´s protocol.

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Acute necrotizing encephalopathy (ANEC) is a rare illness with high incidence in East Asia. It is accompanied with respiratory infection, gastrointestinal infections, and high fever with quick impaired consciousness, and convulsion. In this case report, Turkmen 6 month's girl that was introduced after an infection with no disease or clinical abnormalities. She was vaccinated accordingly; initially she had fever with generalized tonic-clonic convulsion (seizures) for 5 to 10 minutes level of consciousness decreased later on. She was transferred to Talghani Medicat Education center in nortern Iran. At the time of admition her vital signs were as below: RR: 30, GCS: 8-9, RP: 110, BP: 90/80. In the patient's history, there was neither Trauma history, nor food or drug poisoning, also no clinical history. After convulsion, the level of consciousness decreased and serum biochemistry showed normal electrolytes concentration. In further follow - up, AST increased to 98 units, ALT to 58 units, and ammonium to 215 units. In CSF Sample, protein level increased to 330 units, without any avidences of pleocytosis, blood, or Serum glucose drop. In CT without contract, hypodensity the cornea in thalamus and caudate cores were seen in 2 sides. The ventricles were normal and there were no signs of bleeding and pressure. In brain M.R.I, abnormal signal in 2 sides, blood samples cultivation, CSF, and testing urine for bacterial infection were negative. The patient was diagnosed with necrotizing encephalopathy and subsequently was treated with metyle prednisolone (20 mg daily). During hospitalization, level of consciousness increased and fever stopped. There was not recurrence of convulsion, but the patients still had some problems in moving, verbal and communication.

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Visceral leishmaniasis, also known as Kala-azar, is one of the main parasitic vector borne diseases, which transmitted by sand fly. The current study reported the seven positive cases of Kala-azar in Maravetapeh county in Golestan province, Iran from 2007-15. Using geographic information system, villages which had confirmed cases of Kala-azar were identified and their geographical information was registered. Villages with confirmed cases of Kala-azar were introduced as at risk villages for visceral leishmaniasis. All of these cases were aged under 6 years and in all of them fever and splenomegaly was reported. All subjects had lower normal range of hemoglobin and plateles. These cases were reported from 6 villages in 3 districts of Maraveh Tapeh County. All of these villages are in hot and dry areas of county and they have mountainous and semi-mountainous geographical status with higher altitude compare to other villages. Fifty two villages of county were recognized as at-risk villages for Kala-azar. Kala-azar presented in sporadic condition in Maravetapeh County. Continuous case finding of Kala-azar for early diagnosis and treatment is necessary.

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Neurofibromatosis type1 (NF1) with the incidence of 1 in 3500 births, is the most common disorder which affects skin and peripheral nervous system. NF1 results from mutations in NF1 gene. The NF1 gene spans 350kbp and to date, nearly 2434 mutations in it were reported. The gene with 100 percent penetrance is located on chromosome 17 encoding neurofibromin protein. Recently, many challenges of its genetic analysis have been overcome through the application of new sequencing techniques. In present study patients with neurofibromatosis type 1 have been characterized from clinical symptoms such as presence of café au lait spot, plexiform neurofibroma, optic nerves involvement, presence of several patients in first degree relatives. These patients were in different ages including 73, 63, 44, 20 with different symptoms and severities of disease. In this communication, a NF1 family with 4 cases in 3 generations has been presented.

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Fibrodysplasia ossificans progressiva (FOP) is an extremely rare autosomal dominant disorder having variable expressivity with complete penetrance. FOP incidence has been estimated to be 1 per 2 million. FOP caused by mutations in ACVR1 gene encoding bone morphogenetic protein type-1 receptor. To date, 15 types of mutations have been reported. The majority of cases were determined to be the rsult of a new mutation occuring sporadically. Here we report a 20 years old girl who's suffering FOP for 11 years.

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Obsessive-compulsive disorder is manifested by a group of symptoms including intrusive thoughts, rituals, mental obsessions and compulsions which creates great distress for the individual. Traumatic brain injurie known as one of the rare reasons of obsessive-compulsive disorder. This report is about 3 patients that suffer from obsessive-compulsive disorder after a traumatic brain injury and loss of consciousness. All 3 patients had no sign of obsessive-compulsive disorder before the trauma. Information on these reports, examine the relationship between obsessive-compulsive disorder and traumatic brain injury. Findings from the neuroimaging methods for these patients have been reported. In this study, all the reported cases that had sever traumatic brain injuries were assessed by neuroimaging methods and brain injuries were obsereved in the right temporal in first case, in the right temporal and both frontal sides in second case, in the splenium corpus callosum and the right brain tegmentums and diffused axonal injury and extra-axial hematoma in the left temporal lobein the thirtd patient. Based on the findings of this study obsessive-compulsive disorder can rarely be developed after a traumatic brain injury and by assessing the neuroimaging findings, we can conclude that there is a relationship between the brain injuries and the symptoms of obsessive-compulsive.

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Arachnoid cysts have primary and secondary types. The prevalence of Arachnoid cysts is about 1% of all tumors in cranial cavity. Based on anatomic position, arachnoid cyst can cause different clinical manifestations including hemiparesis, increase intracranial pressure, macrocephaly and isolated headache and stop body growth. The natural course of the disease is not exactly clear. Some of patients have no symptoms during life and some of them may show some symptoms after a while. This case report is about a 10 years boy who had no sign except generalized headache. Anatomic position of the cyst was in right temporal lobe of the brain on the temporal, parietal and the great wing of sphenoid bones. Arachnoid cyst diagnosed through MRI and CT-Scan. Patient treated with ibuprofen for three days and then patient followed up to treat with surgery method when other clinical symptoms appeare in the patient.

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Trazodone is a weak inhibitor of serotonin reuptake and a potent antagonist of serotonin 5HT2A and 5HT2C receptors. Urinary incontinence is a rare side effect of anti-depressant drugs. Side effects of antidepressants can cause delay in treatment of patient and ultimately non-compliance in patients who take this medicinal drug. Here we present a case of trazodone induced urinary incontinence in a woman at menopause period. The patient was a retired woman with 63 years old. She reported a history of bladder prolapsuse and history of consumption of quetiapine and propranolol. But the patient had no history of other somatic illnesses, drug and urinary incontinence before administering the medicinal drug. Psychiatrist prescrided trazodone with dose of 50 mg, orally per day when appearence of the depression, anxiety and insomnia. But, the patient suddenly suffered from urinary incontinence, despite this situation the patient had continued taking the drug for three days. Due to the uncertainty of the above complications patient, was forced to discontinue the drug and follwoing drug discontinuation the side effect disappeard. After the improvement of the urine incontinence and full recovery, re-treatment was began with the same dose of 50 mg trazodone for the patient, but immediately after drug administration to the patient, urinary incontinence appeared once again. Trazodone can be considered as important factor to cause urinary incontinence. Therefore, this issue should be considered whenever this pharmaceutical drug is prescribed.

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The proximal radioulnar joint plays an important role in elbow and forearm movements. Radial head fracture involves about 20% of the elbow fractures, which is most often accompanied by other damage to the soft or bone tissue. Isolated form is about 2% and bilateral form is rare. Most radial head fractures are the result of low energy and falling down with outstretched hands. Heavy sports injuries, high energy trauma and crashes cause a breakdown with displacement and the possibility of further complications.In this article we  reported a woman  nurse with 35 years old whom suffered pain and swelling of both elbows due to simple falling down with outstretched hands. In the clinical examination, there was a bilateral tenderness and swelling of the elbows. Movements were decreased in right side. There was no nerve defect. In the Xray radiography, bilateral radial head fractures, Mason-type 3 at right and type 1 at left elbow were observed. Right elbow treated by open reduction and internal fixation by mini plate and screws and left side treated by conservative method. The patient was discharged with indomethacin 25 mg 3 times a day for 6 weeks and bilateral long arm splint for 5 to 7 days, active movements were begun. Subsequently, the patient was not adviced for physiotherapy. Complete movements of elbow joints were obtained in right side and left side after 8 and 4 weeks due to teratment. Precise clinical examinations and correct radiographs are necessary to diagnose the bilateral radial head fractures. Early diagnosis and proper treatment and, if necessary, physiotherapy leads to proper improvement and acceptable movements and function.

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Pediatric femoral neck fracture is rare and account for less than 1% of all fractures in childhood. The proximal femur in children is extremely strong, and high-energy forces in 80-90%, following the axial force associated with hip rotation or direct blow are necessary to cause fracture. In this report, the method of femoral neck fracture fixation in eight-year-old girl after car accident is reported. During the operation, we noted a severe femoral neck fracture that was irreparable with the available tools (pin, screw, plate and DHS), which inevitably had to be used by Transosseous method with fiber wire #2, used in proximal humeral fracture fixation. Then, we obtained a fairly satisfactory result with a distal femoral pin inserting it into two-sided spica cast. Although, this kind of fracture is rare, but with a qualified clinical examination, early diagnosis, proper treatment, familiarity with surgical techniques and fixation reduces the complications and this method can be effective in obtaining the desired result.

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Osteoid osteoma is benign bone tumor, in which talus bone involvement is rare. This case was a 17 year old man with a right ankle pain and reduced range of motion since one year ago. Following clinical evaluation and radiological studies (X-ray, CT scan, and MRI), a bone tumor was detected in the talus with a possible diagnosis of Osteoid osteoma. The patient was operated with ankle anterior approach and the tumor was resected from the site. The patient was discharged after two days. The patient's pain was eliminated after surgery. Ankle movements are back after two months. Due to the rare nature of the disease and clinical diagnostic problems and its unusual radiographic manifestations, osteoid osteoma in chronic ankle pain in young patients, is included in the list of differential diagnosis.

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Late postpartum hemorrhage (PPH), as an unpredictable obstetrics emergency, is characterized as a leading cause of mortality and maternal complications worldwide. Uterine artery pseudoaneurysm (UAP) is a rare cause of PPH, which may develop after uncomplicated cesarean and Gynecologic surgeries, including dilatation and curettage, hysterectomy, and myomectomy. Uterine artery embolization has become a popular treatment for postpartum hemorrhage. In this case report, we present a patient with PPH due to UAP who was treated by endovascular embolization of the uterine artery. A 39-years-old woman was admitted 55 days after her third cesarean section due to massive vaginal bleeding resulting in severe hemodynamic derangements. After initial resuscitative measures, diagnostic studies revealed the UAP, and soon after, the coil embolization of the uterine artery was performed. When conservative managements fail to control massive late postpartum hemorrhage, angiography and embolization of the uterine artery can be the modality of choice, rather than hysterectomy (with its potential complications) which preserves the patient's fertility.

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Lycanthropy is a delusive belief that the affected person or others transform into a wolf or other animals. Lycanthropy has been known for over 2000 years. This paper introduces a 51-year-old married woman who has had symptoms of depressive disorder for the past four years, following forced marriage and has recently been diagnosed with lycanthropic syndrome. The patient was diagnosed with depression along with lycanthropy symptoms (psychotic depression) and was treated with antipsychotics, antidepressants, and individual psychotherapy. Over a 16-weeks follow-up, her lycanthropy was reduced and symptoms of depression improved relatively.

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Kawasaki disease is a medium-size vasculitis with peak incidence among infants of 9 to 11 month age. This case report represents a female infant of 18-month age whom was admitted to the Taleghani Pediatric Center of Gorgan, Iran; with referral for admission due to persistent fever for roughly 2 weeks despite various outpatient treatments. Upon the admission, Echocardiographic study was performed to assess whether the patient fulfils cardiac criteria of Kawaski disease which was consistent with the diagnosis and also positive for serious coronary complications in the infant. General condition of the patient improved as the treatment with both IVIG and Corticosteroids was initiated and carditis seemed to vanish in echocardiographic studies but as expected aneurysmal growth can last for over 80 days and in this case serial echocardiographic studies confirmed the formation of giant coronary aneurysms. Diagnosis of Kawasaki disease is based on persistent fever and consistency with clinical criteria and the main purpose of this case report was to emphasize the need to consider this disease in cases of persistent fever to avoid the serious following complications.

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Myocardial infarction is characterized by the interruption of blood supply to part of the myocardium, leading to tissue damage. Acute myocardial infarction rarely affects young adults. However, considering the possibility of its occurrence, particularly in the presence of risk factors such as obesity and smoking, can help provide appropriate and timely diagnostic and therapeutic measures. Herein, were present a case of acute myocardial infarction in a young adult male.