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  Hydatic cyst is caused by Echinococus worm, that involves any part of the body, sometimes it is presented in organs such as thyroid, breast and other organs. Axillary that may be consider adenopathy or metastasis and do biopsy, which so there is danger of leakage, anaphylaxis or relaps.

 The reported case was 39 years old female presented with painless axillary mass without inflammation since 19 years ago that slowly enlarged. Physical findings suggested hydatid cyst which was confirmed with ultrasonography and IHA for Echinococus granolosus and other diseases ruled out. She was operated and she had no relapses after 1.5 years follow up.

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 Endometriosis is a gynecologic disease. The prevalence of endometriosis in the reproductive age of women varies between 3-10%. Cesarean scar endometriosis is a rare event and rare cases have been reported in gynecologic and surgical articles. The incidence of cesarean section scar endometriosis is not accurately determined but ranges from 0.03% to 0.15% and in some other articles the incidence up to 1% has been reported. Frequently the cesarean scar endometriosis is not diagnosed until before surgery (80%) and usually the patients are operated on the basis of some pre-operative diagnoses such as kelloid, hematoma, suture granuloma, incisional herina and neoplasm. The most common symptom is cyclic and periodic pains in the area of operation which appear approximately 1-7 years after cesarean section. The accurate diagnosis is made by pathology. In this article a patient with cyclic and severe pain in cesarean scar area for 8 years is reported. The patient had been treated with anti- inflammatory drugs for several years without any diagnosis. The patient was operated with diagnosis of subcutaneous mass and probably suture granuloma and the final pathologic report was Endometriosis. The choice treatment for cesarean scar endometriosis is surgery, and awareness about this unusual complication of it will increase the probability of preoperative diagnosis.

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  Temporal arthritis (TA) is a systemic inflammatory vasculitis with unknown etiology, which involves large and medium sized arteries. A wide spectrum of systemic, neurological and ophthalmological complications appears in the course of the disease the most serious of which is visual impairment leading to permanent blindness in 60% of the cases.

  TA is diagnosed through an elevated ESR (>60 mm/Hg) and pathological findings of arterial biopsy. It is considered as one of the urgent neurological cases in which the patient should be treated with corticostroid immediately after diagnosis. The subject of this research was a 62-year-old male who had had headache associated with fatigue, night sweats and low mood for four month. The diagnosis of TA was made considering an elevated ESR and temporal artery biopsy findings. Treatment with prednisolone was initiated and continued for 19 months resulting in complete recovery.

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  Paraplegia can be caused by different factors like rupture or repair of the aortic aneurysm or aortic thrombosis, aortic dissection, anterior spinal cord artery emboli, coagulation disorders and lupus disease, all of which cause impaired spinal cord blood flow and spinal cord ischemia. In addition, hypotension may be the cause of spinal cord infarction but Medline researches have reported a few cases of spinal cord infarction in patients laparotomized for the reasons other than aortic lesions. In this paper we report one case of paraplegia who had experienced spinal infarction and paraplegia after internal bleeding and two times laparatomies due to long lasting hypotension. In this case regarding the patient ’ s age, occupation and physical health, the possibility of cardiovascular lesions and consequent thromboembolism seems very unlikely. Furthermore, considering the two operations performed and the temporal space between them, the only factor that could have led to ischemia and infarction of the spinal cord in this patient is long-standing hypotension.

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 Renal poly cystic sinus is a rare disease which is bilateral and has benign course. It usually breaks out after the fifth decade of life. The cysts in this disease are mainly of lymphatic origin. They can be associated with inflammation, stone or obstruction. Unlike the multicystic and polycystic kidney in which the cysts are formed in the cortex, in this disease they are seen in the sinus of the kidneys. What makes this case unique and necessery to report is its rareness and differentiation from other renal cystic lesions. The author could not find any previous report about the coexistance of edema of mons pubis with renal polycystic sinus. This study reports a bilateral poly cystic sinus which exists with intermittent edema of mons pubis. The patient is a 24-year-old female who complained of a mild pain in the flank area with intermittent edema of the mons pubis. The patient underwent urologic and gynecologic examinations which lead to the final diagnosis of renal bilateral poly cystic sinus disease. The disease had a benign course and the patient is under observation after the biopsy.

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  Serious vascular complications of IV drug abuse are being encountered with increasing frequency. These patients often present with cellulitis, abscess and endocarditic. Due to having viral infections these people can be a hazard to health care workers. Medical intervention is usually conducted after the emergence of one of the dreadful complications of IV drug abuse. The subject is a 40-year old male prisoner who referred to Emergency Department with 24 hours history of chill and fever, intermittent bleeding from a painful ulcerated lump in right groin along with hypotension and severe edema of right lower extremity necessitating packing and initial resuscitative measures. It was clinically diagnosed as ruptured infected pseudo aneurysm and urgent exploration was undertaken. Excision of common femoral artery was conducted by interpositioning of saphenous graft between external iliac and superficial femoral artery along with ligation of deep femoral artery drainage of abscess and debridment of necrotic tissue. The patient recovered with limb salvage except seroma on original site of vein graft.

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Recurrent meningitis is a rare incident and is likely to have multiple etiologies, which could lead to repeated admissions to the hospitals. A detailed investigation of congenital and anatomic anomalies facilitating bacterial entry into the subarchnoid space is mandatory in these patients. A proper diagnosis can often be obtained through taking a complete history, previous admissions, and complete clinical and radiological examinations. The present case is a 25-year-old woman with 8 admissins because of meningitis. After being hospitalized for a long time and relative improvement, she was operated for the first time. The surgery was repeated due to rhinorrhea and the diagnosis of mondini congenital dysplasia in direct relationship with intranasal space. This led to the complete recovery of the patient. Anosmia her only problem at the present time.

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Ulnar nerve involvement is the second most common local mononeuropathy. The ulnar nerve consists of motor and sensory fibers that arise in C₈-T₁ roots and extends to the lower trunk and medial cord of brachial plexus. Manifestations of this nerve involvement range from elbow pain and intermittent hand paresthesia to marked sensory loss, wasting and weakness  of hand muscles and a claw hand. Ulnar nerve lesion in the elbow region commonly follows surgery in which general anesthesia is used (particularly in patients with coronary artery bypass graft surgery). The patient presented in this article was a 56-year-old male who was involved in left ulnar nerve lesion after undergoing coronary artery bypass graft. In electrodiagnostic study we noticed diffused demyelination lesion of the ulnar nerve with dominancy in elbow region along with secondary axonal degeneration. Therefore, suitable positioning of elbow is recommended to avoid the  nervous complications of these operations.

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  Background & Objectives: Patients in unstable condition with blunt abdominal trauma require rapid evaluation of abdominal organs to assess the need for laparatomy. Ultrasonography is a fast technique which can be used in the resuscitation area to detect free intraperitoneal fluid as an indication of intraabdominal injury. This prospective study was designed to determine the efficiency of emergency abdominal sonography for evaluating patients with blunt abdominal trauma and to compare the accrurcy of ultrasonography with the results of diagnostic peritoneal lavage and CT scan.

  Methods: Emergency sonography was performed prior to diagnostic peritoneal lavage and CT scan on 174 patients with blunt abdorminal trauma. Sonography was performed with FAST ( Focused Abdominal Sonography for Trauma) technique and six area of the abdomen where examined to detect free intraperitoneal fluid.

  Results: The results of this study revealed that ultrasonography has a sensitivity of 95% a specificity of 80.8%., and an overall accuracy of 89.4% for detecting free intraperitoneal fluid. The positive and negative predictive value of sonography was 89.4% and 90.1% respectively.

  Conclusion: Ultrasonography is a reliable method for the emergent evaluation of blunt abdominal trauma and can be used instead of diagnostic peritoneal lavage.

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  Background & Objectives: In modern civilization, community participation is considered to be the most important way of development in different parts of the society. Establishing social development and health promotion centers (SDHPC) is the first step which is taken in this regard. In these centers, social development is implemented along with health promotion. During some planned activities people practice participation and having sense of responsibility while they move towards development and health. They understand that the key for solving majority of health problems are in their own hands.

  Methods: In the framework of an action research, interventions based on dynamic, reevaluation activities, were done in two parts: Formation of activity committees and establishment of population laboratory. SDPHC set its programs based on a planned approach to community health and community mobilization was the first practical action in this plan.

  Aiming at presentation and evaluation of community mobilization model, different activities consisting of mobilization of heath volunteers, raising participation of regional stake holders, recognizing social literature to ensure effective and pervasive communication with people, propagation and call for participation along with general enumeration of society was done to find authoritative people.

  Results: Health volunteers helped to recognize 60 key persons. 53 of them accepted participation. Objectives of the center were explained to them in three meetings, and their opinions were collected. A study of community literature showed that this region had a moderate to high cultural behaviors, and moderate to low income level and education with suitable interest in participation. The Evaluation of provincial broadcasting organization, municipality and other organizations was not desirable except for education organization. Publishing a newsletter was not welcomed by people but it created a bright perspective among governmental authorities. 287 persons accepted invitations voluntarily and took membership. After regional census, it was found that 4355 households with a total population of 19652 were living in this region 9305 (48%) of whom were females. Mean age of population was 26 and mean household dimension was 4.5. 8352 persons (42%) were married. Majority of women were house wives and majority of men had self managed job.

  Conclusion : The process of community mobilization in this project was evaluated to be successful but for establishment and continuation of activities in SDHPC most of the organizations and different groups of people should be encouraged to participate.

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  Background & Objectives: Fat embolism syndrome (FES) is mainly due to the obstruction of blood vessels with fat globules, reached to circulation. FES is associated with traumatic and non traumatic diseases. The prevalence is 2-5% in long-bone fractures. The purpose of this study is to evaluate manifestations, laboratory findings and the diagnosed cases of fat embolism.

 Methods: In this retrospective study all the patient records associated with injury were evaluated and those diagnosed with the traumatic fat embolism were selected. The data including sex, age, type of fracture, clinical and laboratory findings and symptom onset time were collected using a questionnaire. These data were then statistically analyzed.

 Results: 17 out of 1660 patients were found to have fat embolism most of which belonged to middle-aged men. The most common clinical features consisted of: respiratory failure, tachycardia and consciousness level alterations. Fat embolism was mainly associated with tibial and femoral shaft fractures. Low level of Pao₂ (Pao₂<60) is the most reliable laboratory test in this study.

 Conclusion: Fat embolism should be regarded as a threarening factor in patients (especially middle-aged ones) with fractures in long bons of lower limbs. Pao₂ Level of can also be used as a reliable laboratory finding.

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 Background & Objectives: Hysterectomy is the most common surgery among nonpregnant women. A review of indications of hysterectomy can provide the specialists with new insights about these patients’ treatments. The aim of this study is to investigate the indications and methods of hysterectomy in patients referring to Alavi hospital.

 Methods: This cross-sectional study was done in Alavi hospital for two years (2002-2003). The data from 257 hysterectomized patients collected through interview and studying their records were entered into previously-designed questionnaires. The collected data were then analyzed using SPSS software.

 Results: The number of hysterectomies decreased 38.4% in 2003 compared to 2002. The mean age of patients was 45.8±8.09. The most common indication of hysterectomy was lyomyoma in 42.2% of cases. Abdominal hysterectomy and vaginal method were done in 93% and 7% of the cases respectively. In patients who were operated for pregnancy and delivery complications, the most common indication for hysterectomy was placenta increta (50%). The most common complication was hyperpyrexia (25.7%). The prevalence of complications of abdominal hysterectomy and vaginal method was 26.3% and 16.6% respectively.

 Conclusion: Lyomyoma is the most common indication of hysterectomy in patients referring to Alavi hospital. Besides, abdominal operation is the most prevalent method of hysterectomy in this hospital. Complications of vaginal method are less than those of abdominal method.

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 Background & Objectives:�Understanding children’s behavior and its affecting factors is the foundation for practicing dentistry for children effectively and, at the same time instilling a positive dental attitude into them. A number of studies have been done in this regard during the last three decades. This study is another attempt to find out proper strategies in order to control and optimize the diagnostic and trearment measures as well as to investigate the effect of mothers ’ personality characteristics on children ’ s behavior.

 Methods: The sample consisted of 104 randomly selected children (53 boys and 51 girls) at the age of 3 to 6 together with their mothers. The children had no previous dental experiences and no mental or physical disabilities entailing special care. Children’s behavior was assessed during three different dental visits according to Frankle ’ s Behavioral Rating Scale, in which four distinctive scales, namely absolutely negative, negative, positive and absolutely positive were precisely defined and scaled. The first visit was dental examination, the second was fluoride therapy and the last one was restorative dental treatment. Meanwhile, their mothers ’ personalities were determined through an interview conducted by a psychiatrist and based on DSMIV criteria and using General Health Questionnaire (GHQ) these personality characteristics were categorized in four groups: Normal, Depressed, Anxious and Obsessional.

 Results:�The findings revealed that 12.5% of children had no cooperation during 3 visits, most of whom were 3 to 4 years old. The difference was significant compared to 4-5 and 5-6 year old children (p<0.05). In addition, sex did not influence children ’ s behavior. This study showed that children of mothers with obsessional personality were the most cooperative ones during the 3 visits compared to mothers with other personality characteristics. This difference was statistically significant at the first visit, (p<0.05).

  Conclusion: Mother ’ s personality has the strongest effect on children’s behavior during the first dental visit.

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 Background & Objectives: Demographic and environmental factors are effective in the pathogenesis and prevention of Parkinson Disease (PD). Sex, family history of PD, farming, literacy, history of head trauma, smoking, well water consumption, overusing oil seeds and contact with herbicides and pesticides are apparently effective in this regard. This study set out to investigate the risk factors of PD.

 Methods: 100 patients with PD and 200 age matched controls refering to Neurology clinic of Birjand UMS were investigated in this case-control study during 2002-2003. PD was diagnosed by a neurologist and the demographic and environmental factors were recorded in a questionnaire. Student T and Chi-Squire tests were used for statistical analysis.

 Results: 68% of the cases and 53% of the controls were male. Family history of PD, farming, literacy, stress and well-water consumption were significantly more frequent in PD group(p<0.05). Smoking and overusing oil seeds were more frequent in control group (p=0.007, p=0.001 respectively). Frequency rate of contact with herbicides, pesticides and history of head trauma were not significantly different in case and control groups. Conclusion: Family history of PD, farming, literacy, stress and well-water consumption are risk factors of PD, while smoking and using oil seeds could be protective factors against PD.

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  Background & Objectives: Neurofibromatosis is a congenital disorder with different kinds of disabling manifestations. There are several types of operations for these manifestations with relative improvement. This study set out to determine age, sex, clinical manifestations and evaluate methods of treatment of these patients.

  Methods: This descriptive, cross-sectional study was conducted through studying the hospital records of patients who had previously undergone surgery. 45 patients with neurofibromatosis who were hospitalized and operated in surgical ward of Firoozgar and orthopedic ward of Shafa hospital from 1995 to 1998 were studied in terms of clinical manifestations and treatment methods. Patients with central nervous system involvement were excluded from the study.

  Results: 55% of the subjects were male and the rest of them were female. Most of the patients were in the second decade of their life. Skeletal abnormalities were seen in 35 patients (77.77%) and 16 patients (35.55%) were suffering from scoliosis which was the most common complication of this disease. With respect to the progression of the disease, brace was used in 2 patients, which led to their improvement. In 13 patients Horington Rod implantation was used, three cases of which developed scoliosis, who underwent surgical vertebral fusion. Pseudoarthrosis was seen in 8 patients (17/77%). Bone graft and plate were used in their operation. In five cases with pseudoarthrosis in lower limbs no ::union:: occurred. Two patients died with malignant shwanoma.

  Conclusion: scoliosis is the most common manifestation of neurofibromatosis which can improve in early stages with surgical treatment but pseudoarthrosis in lower limbs has not improved with bone graft and plate. Operation with pediculated fibula resulted in the improvement of this complication. Surgical intervention would be more effective in the early stages of the disease. 2 of thses 5 cases were reoperated with pediculated fibula graft and 3 others were amputated.

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 Background & Objectives: Cholangiocarcinoma is a malignant tumor of the biliary tract epithelium. Although it is not a common tumor, it has a high mortality rate so that the five-year survival of the patients is only 5%. Most patients are found to have irresectable tumor on initial presentation. These have led to an emphasis on the role of palliative treatment.

 Methods: 43 patients with Cholangiocarcinoma (from 1996-2003) based on ERCP were included in this study. Demographic aspects, clinical and Para clinical manifestations as well as the risk factors were investigated and survival rates of the patients were compared with or without stenting of the biliary tract.

 Results: 27 patients (62.8%) were male and 16(37.2%) were female with mean age of 65. Ulcerative colitis accompanied with PSC was diagnosed in just one case. Jaundice, weight loss and pruritus were the main complaints of the patients. Twenty-seven cases received stent in biliary tract through ERCP while no treatment was performed in other patients due to technical failure or patients’ disagreement. Mean survival time for all patients was 125 days. There were no statistically significant difference between survival rate of the patients with stent and without it.

 Conclusion: In this study cholangiocarcinoma in our patients was less frequently seen to accompany UC and PSC. Curative surgical resection is not possible in the majority of cases, and palliative treatment only decreases the severity of the symptoms but has no significant effect on survival.

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 Background & Objectives: Yogurt is recommended as a treatment for acute diarrhea. This study was conducted to determine the effect of pasteurized yogurt consumption on acute non-bloody and non-mucoid diarrhea in hospitalized 6-24 month old infants as compared with that of routine treatment.

 Methods: In a clinical trial study 80 children with 6 to 24 months of age with diarrhea for less than four days and were hospitalized in Urmia Imam Hospital, were assigned into two groups. The first group consumed yogurt containing streptococcus thermophilus and lactobacillus bullgaris 5 ml/kg per day while the second group received the routine treatment. Those suffering from malnutrition, bloody stool and diarrhea without GI source were excluded. Reduction of diarrhea frequency to half compared to admission time was regarded as response to treatment. Weight gaining, duration of admission and reduction of diarrhea frequency were compared in two groups.

 Results: The two groups were not significantly different in terms of age, weight and frequency of diarrhea at the time of admission. Mean hospitalization days, weight gaining, reduction of diarrhea frequency were 2.7±0.91 days, 435± 89.30 grams, and 4.30±1.74 times respectively for case group and, 3.1± 0.74 days, 383 ± 98.96 grams, and 3.60±1.23 times for control group respectively. No significant differences were observed between two groups regarding mean hospitalization days (P=0.035), reduction of diarrhea frequency (P=0.049) and weight gain (P= 0.017).

 Conclusion: Consuming pasteurized yogurt as a probiotic agent has a positive effect in treatment of acute nonbloody and nonmucoid diarrhea. Public use of yogurt is recommended.

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  Although mucocele of the paranasal sinuses is rather common, it is rarely seen in maxillary sinuses. If the maxillary sinus is involved, it is presented with destruction of the sinus wall, swelling of the cheek, swelling of the g i ngivobuccal sinus, expansion to the inferior wall of the orbit, and ophtalmic presentation. In this case report a rare and noticeable case with maxillary sinus mucocele is presented. The case was first diagnosed with suspicious sinus malignancy based on CT scan but during the surgery the cyst was found to be a mucocele.

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  Succinylcholine is a depolarising muscle relaxant that is used for rapid tracheal intubation in general anesthesia. It is a short-acting drug which is hydrolyzed by plasma cholinesterase. Some factors can decrease the activity of this enzyme in body. Some patients may have abnormal form of this enzyme that leads to prolonged duration of action and apnea. The subjects of this research were a male (55) and a female (57) who had prolonged apnea after administration of succinylcholine (4-8h), and they improved completely after mechanical ventilation.

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  Kikuchi is a benign inflammatory and self-limited disease which was first and reported in Japan. Females are more commonly affected, in their third decades usually presents itself as a single lymph adenopathy, in the cervical region. The recurrence occurs approximately in 3% of the cases. The subject is a 22 year old female presented with skin rashes and multiple adenopathy one month before admission .The peripheral blood smear shows moderate leukocytosis, with atypical lymphocytes. The ESR show moderate elevation. Finally after lymph node biopsy, the diagnosis of KFD was confirmed.