Background: Hydatid disease is a parasitic infestation by a tapeworm of the genus Echinococcus. Man is an intermediate or accidental host of this parasite, and is infested by consuming contaminated plants or vegetables, or by contact with dogs. The larvae travel through the gut wall and 60-75% are filtered by the liver, and a few travel directly to the lungs to produce a hydatid cyst there. Growth of hydatid cysts has been reported in the spleen, muscles, bones, and brain. Hydatid cyst embolism to peripheral limb arteries is extremely rare.

Case: A 41-year-old gravided woman presented with sudden pain, erythema and warming of the olden infra-inguinal mass which existed from 1 year ago. The notable findings at physical examination included 40*20 mm diameter soft mass with warming and erythema in 4 cm below inguinal ligament of right lower limb. She didn’t mentioned any previous history hydatid cyst. Intraoperatively, Percutaneous aspiration of the mass was performed which demonstrate white turbid fluid. after the surgical incision we saw the white colored subcutaneous hydatid cyst and completely remove it and send it to pathological examination which confirmed hydatid cyst diagnosis. further liver ultrasound and chest radiography hasn’t shown any evidence of liver or lung involvement.

Conclusion: Cystic echinococcosis may affect all organs, but mostly settles in the liver and lungs. We do not have data on the means by which the larvae of echinococcosis reach the inguinal area without liver and lung involvement. Considering the anatomy of the groin and its lymphatic tissue, we can make an assumption about how the hydatid cysts settle in the groin space. Although it occurs rarely, larvae in the gastrointestinal tract may pass to the lymphatic circulation, and then settle in the groin space through the rich lymphatic flow of inguinal area.

Background: Peripheral nerve injures are common in clinical practice that includes from compression injury to complete disruption of nerve trunk. After injury nerves can grow and repair spontaneously, early end to end anastomosis is first choice for repair but only 50% of nerve fiber would be physiologically accurate and effective, thus several techniques for repair of nerve injury are introduced including combination of nerve transplant with silicon tubes, use of biologic and synthetic tubes for nerve conduit.

Materials and Methods: In this Exprimental study, 20 rats with the same weight were selected and kept in the same condition .The left sciatic nerve of them was cut and were divided in two groups.In the first group the facial flap method for repair of nerve injury was used .In the second group vein conduit method was used as standard method. Histological nerve repair was assessed after 45 days and the intact right sciatic nerve was used as control.

Results: Repair of nerve injury in proximal, mid and distal portion of nerve in facial flap method was more effective than vein conduit (P<0.05). Repair of nerve injury in proximal, mid and distal portion had no difference compared with control group (p>0.05).

Conclusion: Repair of nerve injury with facial flap method is more effective than standard method and can be used as a new method for nerve repair.

Background: Radiocephalic arteriovenous fistula (AVF) at wrist is the vascular choice for dialysis. In the absence of a suitable vein in the wrist, elbow brachiocephalic fistula is the next choice. In this study to create an arteriovenous fistula in antecubital area, we turned to the proximal radial artery in comparison to brachial artery in antecobital area for dialysis.

Materials and Methods: We reviewed 124patients in clinical trial study that candidated for placement of AVF for dialysis in antecubital area .To create AVF ,proximal radial artery in 62 patients and brachial artery in 62 other patients selected as the artery of choice,then patients followed based on complications ,steal syndrome ,primary failure and mean time to prepare for dialysis.

Results: The mean time of maturation of AVF in brachial group was 41 days and in radial group was 43 days. Primary dysfunction in brachial group was 6 cases (10%) and in radial group was 5 cases (8%). Steal syndrome in radial group was not seen but in brachial group 2 cases (3%) were seen.

Conclusion: According to the primary success, steal syndrome and mean time of maturation of these two arteries had no significant statistic differences, but like other previous studies, this study emphasizes on usefulness and less complications. On the other hand, due to the anterior anatomical position and allowing the release of the artery, it causes easy technique for creating AVF anastomosis to the antecubital arteries and its branches.. Therefore, this study recommends use of this artery in creation of AVF in antecubital area.

Background: Glaucoma is the second most common cause of blindness and it is one of the main causes of irreversible blindness. Multi-drug regimens usually recommended in reducing intraocular pressure (IOP) in patients with glaucoma. This study was aimed to compare the effect of combination therapy with Timolol and Latanoprost vs. Timolol and Dorzolamide in reducing IOP in patients with open-angle glaucoma.

Materials and Methods: In this blind randomized clinical trial study, 60 eyes with glaucoma were randomly assigned to two treatment groups including Timolol and Latanoprost vs. Timolol and Dorzolamide. Required variables were measured before and 6 weeks after the intervention. The data was analyzed by running the Stata software (version 12) at a significance level of 0.05.

Results: The mean age in groups of Timolol-Latanoprost and Timolol and Dorzolamide was 72.6 and 67.6 years old, respectively. Analysis of the data revealed that there was no significant difference between groups in terms of intraocular pressure (IOP), visual acuity and cup to disc ratio.

Conclusion: According to our findings, there were no statistical significant differences in the IOP lowering effect between both treatments in open angle glaucoma patients.

Background: Catamenial recurrent pneumothorax is spontaneous pneumothorax in women of reproductive age, which includes 1-30% of spontaneous pneumothoraces in women and is associated with the menstrual cycle.

 Case: A 39-year-old woman with sudden onset dyspnea, respiratory distress and decreased right side respiratory sounds with a history of spontaneous pneumothorax and chest tube placement one month ago. The patient's symptoms improved after chest tube placement and within less than 24 hours after onset, she began menstruating. Treatment was performed with chemical pleurodesis with tetracycline and oral danazol.

Conclusion: Catamenial pneumothorax and thoracic endometriosis should be considered in all women of childbearing age with spontaneous recurrent pneumothorax. Early detection of this syndrome can result in reduction of morbidity and mortality with recurrence episodes.

Background: Allergic rhinitis is a common disease which is present in 20% of general population. Major symptoms include sneezing, rhinorrhea, nasal congestion, and nasal pruritus. It seems that tricyclic antidepressants blocking histamine receptors may be used as an effective treatment in allergic rhinitis.

Materials and Methods: In this clinical trial study, 84 patients with allergic rhinitis entered the study and randomly divided into two groups. Patients of 1st group received cetirizine and 2nd group received doxepin for 2 weeks. After 2 weeks patients were evaluated about sneezing, rhinorrhea, nasal congestion, and nasal pruritus.

Results: The results of our study showed that clinical score of patients after 2 weeks was not different in both groups (p=0.261). The only symptom that was affected by the kind of treatment and was significantly different between groups was sneezing (p=0.005).

Conclusion: It seems that there is not much difference in using cetirizine and doxepin in treatment of seasonal allergic rhinitis sympotoms. It is recommended that future studies use TCAs with more potent blocking anti-histamine receptors feature and on more samples.

Background: Despite advances in surgical techniques and risk management practices in recent years, wound dehiscence following abdominal laparotomy has still high prevalence. The purpose of this study is to evaluate the effect of retention sutures on wound dehiscence of emergent abdominal laparotomy.

Materials and Methods: In this randomized clinical trial study, 160 patients scheduled for emergency laparotomy for peritonitis or trauma were enrolled. Half of the patients randomly underwent retention suture and the other half underwent routine sutures. Finally, the amount of surgical wound dehiscence and complications were assessed. 

Results: Three patients (3.7%) in retention group and 11 patients (13.7%) in the control group developed wound dehiscence which there was a significant difference between them (p=0.025). It was determined by multivariate logistic regression that wound dehiscence is correlated with hemodynamic status, type of trauma and injury to the abdominal organs, and sex. The incidence of wound dehiscence, early hemodynamic instability, penetrating abdominal trauma and damage to the intestines were higher in males. 

Conclusion: In general, it seems that the preventive use of retention sutures in patients with multiple risk factors for postoperative wound dehiscence can be useful.

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Background: Myelomeningocele is one of the common congenital malformation in childhood that has association with many disorders. in addition to routine management of associated disorders surgical repair of myelomeningocele has been considered in many cases . The aim of this study is to evaluate the role of myelomeningocele surgical repair in prognosis of children with myelomeningocele

Materials and Methods: This is a case-control study from 2001 to 2013 in 60 infants with myelomeningocele in two department of neurosurgery in Arak and Ilam cities (Vali Asr and Imam Khomeni hospitals, respectively). Infants were divided into two groups according to operable and inoperable cases (each group includes 30 cases). The prognosis of two groups was investigated with respect to mortality, and Stark and Drummond disability rating scale. Data were analyzed with SPSS 18 software.

Results: Case group had better prognoses compared to control with respect to handicap (p=0.003), urinary tract disorders (p=0.006), IQ (p=0.001), global disability(p=0.006) and mortality rate, but there was no difference between two groups with respect to hydrocephalus(p=0.3).

Conclusion: According to the results, mortality, disability and prognosis of infants with myelomeningocele that underwent operation were better. In conclusion, early myelomeningocele repair is advised for infants, because it affects the improvement of prognosis and the quality of patients' life.

Background: This essay reports a case about tissue defect of heel due to melanoma excision.

Patient history: The patient was a man 60 years old with a heel ulcer that had reported malignant melanoma in biopsy. Then the ulcer was done under wide local excision.

Materials and Methods: We should use flap for tissue defect coverage that tendon and heel bone are exposed from it. It seems using skin graft is not useful, because skin graft in persistent contact with shoes will get chronic ulcer. Among different flaps (sural flap or medial plantar flap), we decided to use medial plantar flap. The advantage of this flap is its sensority and low volume.

Conclusion: Conclusion with due attention the results, The meial planter flap, as an efficient method, is adviced to teconstruct heed specially after excision of melanoma.

Background: The definite treatment of indicated Hypertrophy of the tonsils is Tonsillectomy. The aim of this study was to compare the efficacy and necessity of diclofenac suppository and simultaneous prescription of acetaminophen alone in controlling and reducing pain and improving swallowing and satisfaction after surgery for tonsillectomy in children.

Materials and Methods: In this clinical trial, 180 children 7 to 14 years Tvnsykltvmy surgery were enrolled. Patients in an improbable way, easy and were divided into three groups of 60. Immediately after the surgery acetaminophen, diclofenac, or a combination of both was used. The cases of pain in the early hours, seventh, thirteenth and nineteenth after surgery were compared.

Results: There was a significant difference between the average pains of all groups in all hours (p<0.05). There was a significant difference between the groups from the point of view of side effects such as Nausea, Vomiting and Pyrexia (p<0.05), But there was no significant difference between the groups from the point of view of After Surgery Bleeding (p>0.05).

Conclusion: We can say that Rectal Diclofenac is a more effective medication for reducing pain after the Tonsillectomy surgery in contrast with Rectal Acetaminophen or a mixture of the two, which may cause the patients to use less Narcotics after the surgery.

Abstract

Introduction: Echinococcosis or hydatid cyst disease is one of the most common infectious diseases between animals and humans (zoonosis) that is endemic in all the countries of the Mediterranean region, including Iran. Pelvic involvement is rare, and the involvement of the uterus is very rare.

Case Report: 26-year-old female patient complained of limb paresis, ataxia and progressive headaches diagnosed with hydatid cyst of the brain was undergone surgery. The pain and slight swelling in the area of the wrist occurred, one year later and with the same diagnosis, surgery was performed again. Abdominal ultrasound showed two cystic lesions in the suprapubic region with a diagnosis of hydatid cyst of the uterus, 3 years later, surgery was performed. In all cases, the diagnosis was confirmed by pathology.

Discussion: Follow-up of patients with radiologic and serologic methods is necessary.

Conclusion: In patients with any clinical manifestation of endemic areas, particularly if there is a previous history of hydatidosis, hydatid cyst should be considered in terms of risk.