Two patients aged 6 and 5 years old with Mutism after posterior fossa surgery are presented. One of them has vermian medulobastoma and the other one has vermian asteroeytoma.

Postoperative, both of them were mute without distorbance of consciousness, language comprehension, or lower motor cranial nerve function. The disorder lasted 1 month in one case and about 3 month in the other one. Speech was regained after a period  of dysarthria, but both of them gradually became fluent. The mechanism of cerebellar Mutism is briefly discussed.

I report my experience in the treatment of minor recurrent aphthous stomatitis with doses of to 50 to100 mg daily for 3 months a cure was obtained in 21% of cases and marked improvement was evident in the rest.

The follow up period varied from 8 months to 2 years. Four patients experienced Neurophathy and other side effects which disappeared when theme dication was stopped. Thalimide can not be prescribed to women of child bearing potential because of  itsteratogenic potentia.

In order to evaluate the educational status of basic sciences in Medical School. Hamadan University of Medical Sciences, a comprehensive survey was made in the results of the fourth & sixth (March 1991 & 1992) comprehensive examinations.

In these examinations 19 & 17 Universities with 50 or more students have been participated, respectively.

The percent of students who passed the exams were 86.67% & 95.72% respectively. Although the students who passed the exams have been proved 8% in the sixth than fourth exams, there was no significant difference in the result of two successive exams.

Mean & Standard deviation of the grades of Hamadan students in two successive exams were 105.54 + 19.79 & 122.74 + 14.74 respectively; there was significant difference between the mean grades of two exams. The maximum grade which has been received in the exams were 154 & 161 out of 200 respectively.

Between 15 courses which were been examined, the students of this university in the course of parasitology & Mycology have received the second grade between all universities in Iran, in two successive examinations.

In all courses which have been examined, students of this university have received the grades between 1 & 10 in 3 & seven course in two exams between the universities.

Pulmonary cancer is primary cancer which originates from different tissues. It s the  most common cause of death in developed countries. It usually Present first as an abnormal shadow in the CXR and when the Patient becomes symptomatic, the disease is advanced and inoperable. Clinically, the most common symptom is cough and hemoptysis, other symptoms are rare, and dysphasia as a presenting symptom has not been mentioned in the reference textbook, in this article, while discussing about different clinical signs at this cancer, we represent a patient with proved bronchogenic carcinoma whose first presentation has been dysphasia.

A retrospective analysis of 147 brochoscopies performed at Imam Khomeini Medical Center, for foreign bodies over a 5 years period, 1989 to 1994 is reported.

Children under 5 years accounted for 81.57% of the cases in brochoscopy 67.54% of foreign bodies were extracted, from right main bronchos and most of the patients were male (56.2%) the commonest foreign body in Hamadan was the watermelon seeds.

Rice tablets which are also with trade names of “Celphos” and / or “Quick phos”, will release dangerous gas of phosphine (PH3), after ingestion and contact with gasterointestinal and even environmental humidity.

The resulting ghosphine as a non-visible gas with garlic or decaying fish odor; which its allowed non-toxic ratio in environment is 0.3 PPM, and a 3 gum tablet of which will release 75 PPM gas. Maximum human tolerance is around 100-190 PPM in one hour and 2000 PPM of it will end to death in few minutes.

Recently this tablet has been used by youth in suicidal attempts.

Acting through inhibition of protein synthesis this gas eventually alters permeability of cell membranes to vital Ions, so that cell functions ceases.

Due to unknown reasons these drangments are for the most part limited to carliac respiratory and terminal vessels cells, occasionally same changes has been observed in liver and kidneys. In this report two cases is presented in whom accidental intoxication occurred following in halation of released phosphine gas in their sleeping room, although other rare cases of accidental intoxication has been published in medical literature.

Dietamoebia fragilis is protozoan parasite of the large intestine which, nulike most other ameba, has trophozoite but no cyst stage in its life cycle. How this parasite is transmitted from one host to another is still an unsolved problem; whether or not the parasite is still a matter of  debate. There is some suggestions about the role of an intestinal nematode in the its transmission.

We found an outbreak of D. fragilis infection in a family that all of 5 members were infected. They were complained a vague intermittent abdominal pain that remission and repalse were observed repeatedly. We examined stool specimens with permanent staining (with Gomori’s staining technique) and also samples inocculated to culture medium (Boeck Drbohlav’s medium) and found abundant trophozoites of D. Fragilis. With self ingestion we were not able to establish infection successfully. Repeated scotch tape examination of subjects for E. vermicularis showed ova in 4 individuals. 4 of % individuals had some sympoms intermittently, including diarrhea with mucos, abdominal pain, hungry pain, and pruritus and anorexia. Two persns had low grade esinophilia. Treatment with metoronidazole results resolution in 3 subject and 2 persons resolved without therapy, but relapse occurred and drug therapy became necessary. E. vermicularis infection eliminated with a single dose of 100mg of mebendazole. Follow up all of members not showed presence of any parasite. This findings show some evidences which support this suggestion E. vermicularis probably has an important role i D. fragilis transmission, and dietamoebiasis can occur as outbreak in the limited communities. Also we can say dietamoebiasis is a familiar disease.

Sarcoidosis, a multysystem granulomatous disease, begin most frequently in people between 20 and 40 years old. The etiology is unknown, but alteration in the Immune system are clearly involved in its pathogenesis. Organ involvement is usually asymptomatic, and the disease most frequently regress spontaneously, but it may progress to a more chronic state of fibrosis with sever functional impairment of various organ.

We report two cases of sarcoidosis with different presentation, a 32 years old woman with acute sarcoidosis or loeffgren’s syndrome (pulmonary hilar enlargement, uveitis, peripheral arthitis, Erythema Nodosum), and a 47 years old man with eskletal involvement mainly.

Splenogonadal fusion is a rare anomaly to be included in the differential diagnosis of testicular masses. It is often associated with cogenital defect, including; peromelia; and micrognathia; there are two anatomic type continuous ; and discontinuous.

This is an 138 th case in the literature. In this report a case, a male aged 2/5, with a mass in left testis, removed it and was examined pathologically.

Hemophogocytic syndrome is a reactive disorder of the mononuclear system. Most of the cases are complication of common infection and neoplastic diseases although there may be an understanding immune disorder predisposing to this syndrome. In this report a case after D.T.P vaccination and presented with anemia and hepatoplenomegaly and signs of liver dysfunction with severe jaundice is described with a review of pertinent literature the patient died 12  day, after onset of disease.

The term “inflammatory” bowel disease” applies to idiopathic, chronic inflammatory bowel disease (IBD): Crohn’s disease and ulcerative colitis. They occur among all age groups but a peak incidence in the second and third decades.

Most of IBD occur as ulcerative colitis, but the incidence of Crohn’s disease has risen over the past 20 years.

These disorder are seen most commonly in Northern Europe and North America. IBD is rare in central America, South America, Africa, Middle East and Asia.

Most of IBD in Iran also occur as ulcerative colits, but Crohn’s disease is rare. There are no pathogonomonic clinical, endoscopic, or histologic features of the idiopathic IBD’s. Many gastrointestinal disorders may mimic the broad spectrum of feature in IBD. So it is particularly important to exclude other disorders, and much attention applies to rare disorders of gastrointestinal tract.

Ischemic disease of the colon (Ischemic colitis) describe a more focal type of damage in the large intestine, increasingly recognized in the elderly. It is related to occlusion of the mesenteric artery, ligation during vatcular surgery, embolic episode, diabetes melitus, arthero sclerosis, polyarteritis nodosa, rheamatoid arthritis, systemic lupus erythematosus and amyloidosis.  Clinical manifestations are acute bloody diarrhea and abdominal pain. A patient had referred to the emergency department with bloody diarrhea, at first, she considered a case dysentryor ulcerative colitis. Progression of clinical course ischemic and inflammatory colitis had considered as differential dingnosis. In rectosigmoidoscopy there were neumeric blood clots in the lumen and three biopsies  was taken. In the absence of active inflammation and parasite, the mucosal atrophy and fibrosis extended to muscularis mucosa, guid pathlogist to ischemic colitis. The patient treated with supportive therapy and there is not complication and recurence already.

Alteration of consciousness is a common problem in clinical practice. Many of pathologic and metabolic disorders can decrease the conciousness level, transient or permanently.

Hypolycemia is one of the most common metabolic disorders. Hypoglycemia is a biachemical abnormality, not a disease. An abnormally low glucose concentration can be caused by a number of factors, such as, drug, tumors, altered gastrointestinal anatomy nad, failure of both endoctrine and nonendoctrine tissues.

Although Insulinomas are rare tumors, the correct diagnosis is extremely important. Not only they are usually curable, but also if patients remain undiagnosed for long periods, they may develop, permanent neuropsychiatric sequelas.

In this article, while discussing about clinical presentation of Insulinoma and how to approach it, we represent a patient with proved insulinoma.

Precocious puberty may be classified as true precocious puberty or precocious pseudopuberty. The latter one in females may be in sexual (feminization) or hereto sexual (virilization). Ovarian tumors may be iso sexual call tumor, teratoma, etc, are among the etiologic factors of precocious psudopuberty. This paper presents a 4-year girl was admitted to the hospital with severe abdominal pain. Physical examination revealed generalized pertonitis and signs of precocious pseudo puberty including bilateral breast development, appearance of hair in face, trunk, external genitalia and lower extremity. Laparatomy confirmed the diagnosis of a right ovation tumor measuring 15x20cm and pathologist report stated granulosa cell tumor with intraparenchymal necrosis and hemorrhage. The age and clinical presentation of this patient, with regard to rare occurrence of G.C.T in pre-pubertal years (5%) make her as an unusual case.

Meniere’s syndrome is the most common cause of true vertigo that in 75-90% of the cases can be acceptably controlled by various methods of medical treatment. But in this case in spite of 13 years medical therapy, recurrent attacks of vertigo continue to occur and the patient completely become disable. During the last month, six severe vertigo attacks recorded by patients before surgery. So the patient was labeled as “intractable Meniere’s Disease” and accepted as good candidate for endolymphatic sac enhancement.

During 8 month after only 4 attacks of vertigo were recosded by the patient and recent audiogram show 20 dB raise in speech reception threshold and 12% improvement in speech discrimination score. Tinnitus is subjectively better and mild positional vertigo on rapid movements of head and mild sensation of imbalance in walking are only present complains of the patient. In this way, we can take patients back with meniere’s syndrome to near life by meticulous patient using this technique of surgery.

Patients with speech disorders suffer from psychologic problems. In some of them motor nerve disorder cause incompetency of velopharyngeal closure mechanism. Thus during oral voices the sound will exist thoroughly through nasal cavity. With the aids of palatal lift prosthesis, this passage will obturated.

 In this article, while discussing about flaccid dysartheria of the palate, the treatment of the disorder has been explained.

Primary adernal insufficiency, the so-called Addision’d disease rarely and few cases have been reported due to tuberculosis. The case, a 55 years old man , complaining of severe malaise & anorexia, was admitted in 22 sept,1996. One week before admission, antituberculosis therapy had been started with a previous diagnosis of cervical lymphadenitis documented by pathologic examination of a suspended cervical lymph node. On the second day of hospitalization the patient became hypotension with reduced of consciousness & brady cardia.

Specific laboratory tests were reguested with suspended diagnosis of addison’s disease and hydrocortisone therapy started immediately. Hyponatremia, hyperkalemia & an early morning low level serum cortisol of 5.73 mg 100 ml was reported. On abdominal C.T. Scan bilateral adrenal enlargment with calcification & spenomegaly was reported. The patient with addison’s disease due to T.B has been treated with antituberculosis drugs plus prednisolone 7.5 mg per day  & fludrocortison 0.05 mg per day.