Physiology and Anatomy

Normally, the adult archetype aortic arch branching variations was due to the deviation in the growth pattern of the aortic or branchial arch arteries and their associated “migration” and “merging” of their branches. Recently, it is well identified that the suspicion exists with the “bovine arch” and “Truncus bicaroticus” trunk Aortic arches, leads to sudden severe neurological complications due to the wide range of atheromatous plaques and congenital aneurysms, cause medical emergencies. Radiology reports are advised to overlook for the Bovine and Truncus bicaroticus Aortic arches, as the true silent killers for the precautionary efforts to rule out the TAA.

In this research, a descriptive study was done and 190 individual samples as questionnaire forms were collected from general physicians who attended in hospitals, educational and private centers in Kermanshah and Tehran cities, Iran. After collecting the questionnaires, data were analysed using SPSS 13 software and chi-square test. The results showed that in 74.2 % and 68.4 % of cases, nasal x-ray film was requested in patients with the prior history of cosmetic nasal surgery and medicolegal reasons, respectively which is in line with the work done by some researchers [2,3]. There were significant correlations among old nasal fracture, medicolegal reasons and prior history of cosmetic nasal surgery with requesting of nasal x-ray films (P-value <0.01), whereas there were not any significant correlations between requesting of nasal x-ray films and sexuality of physicians or type of centers (private and educational). The causes of nasal x-ray film requesting based on the viewpoint of physicians were: 1) medicolegal reasons, 2) the prior history of cosmetic nasal surgery and 3) old nasal fracture, respectively. According to these results, the frequency of nasal x-ray film requesting is relatively high and more studies in a longer time period are necessary to clarify the causes.

The embryologic growth of the vagina is still uncertain. The urogenital sinus and the mesonephric (wolffian) and paramesonephric ducts possibly all play a part in the development of the vagina. Duplication, agenesis, mesonephric duct remnants, and hymen abnormalities are amongst the more common congenital anomalies of the vagina. Due to close developmental correlation between the genital and the urinary tracts, relations of anomalies in both systems are common. Mullerian malformations are normally associated with abnormalities of the renal and axial skeletal systems, and they are frequently the first encountered when patients are originally inspected for related conditions.

Pericardial effusions are frequent conditions, there etiologies are dominated by: acute infarction of the myocardium, myocarditis, metabolic disorders, certain neoplasias, inflammatory or infectious diseases, traumatisms and cardiac surgery. The dissection of the aorta is one of the rare conditions; it is primarily due to a rupture of the ascending aorta and presents diagnostic difficulties.We report the case of an 80 years old male, with a medical history of chronic smoking stopped since 2 years, a recently discovered of hypertension, a surgery for an inguinal hernia and appendicitis. Presented in our formation with an expansive pericardial effusion; clinical examination found an asymmetry of upper extremity blood pressures, thoracic radiography showed an unrolled aorta. Thoracic CT scan has allowed the diagnosis of aortic dissection type 1 of De Bakey classification and type A of Stanford. The patient was referred to a cardiovascular surgical center where he benefited of the replacement of the dissected aorta by a prosthetic tube while preserving his native valve, with positive outcomes.Our clinical observation aim to discuss diagnostic of dissection to any pericardial effusion or pericarditis, even in the absence of usual symptoms, in order to avoid any diagnostic delay. In our methodology we have overview a systemic review included PuBMed; all of our results in discussion are not based to basis recommendations because of the uncommun presentation having problem in extrapolating strong evidence but we have reporting somes basis of experts’ opinion.

Arrhythmogenic right ventricular dysplasia also known as arrhythmogenic Right Ventricular Cardiomyopathy is one of the leading causes of arrhythmic cardiac arrest in young people and athletes, but is probably under diagnosed in the older population. The clinical course of arrhythmogenic right ventricular dysplasia is characterized by the occurrence of arrhythmic events, which can cause sudden death, and the impairment of ventricular systolic function, which can lead to death from heart failure. Diagnosis has been facilitated by a set of clinically applicable criteria. The treatment is aimed at reducing the risk of sudden cardiac death properly risk-stratifying patients that would benefit from an implantable cardioverter defibrillator .Antiarrhythmic drugs and catheter ablation are also commonly used to improve quality of life by preventing ventricular arrhythmias, exercise restriction to prevent disease progression. This report presents case of elderly man with newly symptomatic arrhythmogenic right ventricular dysplasia.

Purpose: Halitosis is defined as an unpleasant odor that emanates from the oral cavity with intra–oral and/or extra–oral origins. The present study assessed factors influenced halitosis using different diagnostic modalities. Methods: 360 patients who attended shiraz dentistry school participate in this study. A total of 100patients aged 10-56years old included 58women& 42men complained of chronic halitosis. Organoleptic assessment was used to measure intensity of halitosis. The patients were divided into 6 groups according to their age & educational levels. Descriptive analysis was carried out regarding the degree of halitosis in each group. The chi-square test was used for the comparison between groups. Result: prevalence of halitosis was 27.8% of all subjects. Halitosis was multi factorial in this group & more than one factor could be seen in these patients. Dental caries was the most common cause of halitosis(62%) followed by periodontal disease (55%), highly protein diet (28%),smoking(13%) , inadequate root canal therapy & filling(12%) xerostomia(9%), Pseudo-halitosis(6% ) ,sinusitis & nasal polyp(4%),constipation & gastric reflux (4%) hormonal factors (%4) medication(4%) dentures(2%).there was no significant correlation between patients age , sex &educational level with halitosis(p=0.05). Conclusion: In this study, intra oral factors were the most common causes of halitosis. This problem can be prevented by appropriate dental care, suitable oral hygiene &increased public awareness.

Cholangiocarcinomas are rare tumors that develop in the bile duct. Their incidence worldwide is <1 out of 100,000 persons per year. Frequent metastatic sites of biliary cancer are the liver, peritoneum, intra-abdominal lymph nodes, and lungs , however , bladder metastasis was never described in the English literature. Here, we present an exceptional case of a 60 year-old male patient with a history of cholangiocarcionoma traited with surgeries and admitted after 2 years to the emergency with hematuria. The investigations with radiological tomography and cystoscopy with transurethral resection confirms a bladder metastasis of cholangiocarcinoma. Our patient was treated with a bladder hemostatic radiotherapy followed by chemotherapy with cisplatin and gemcitabine (cisplatin at a dose of 30 mg/m2 and gemcitabine at 1,000 mg/m2 on days 1 and 8, respectively, every 3 weeks). The prognosis for patients with cholangiocarcinoma is quite poor; the median survival for patients with unresectable cholangiocarcinoma is <1 year.

Hypertrophic Cardiomyopathy is an inherited disorder that affects the muscle of the heart or the Myocardium. This condition results from a mutation to several genes that affects the production of cardiomyocytes proteins and therefore lead to an abnormal thickening and enlargement of the heart walls. That myocardial thickening induces rigidity and stiffness that reduces the heart efficiency of contractility and narrows the capacity of its cavities. Nonetheless it can cause an irreversible damage to the myocardial tissue producing a scar tissue that interferes with the heart electric activity and rhythm which may end with a life-threatening arrhythmia and death.

Patients with (ARSA) are often asymptomatic and discovered accidentally during MRI scans and X-rays ordered by physicians. It is reported that (ARSA) has an incidence of 0.5 % to 2%. The aberrant artery in this anomaly follows a retro esophageal path and it rarely takes a pathway anterior to the the trachea or esophagus. Instead of this artery being the first branch with the right common carotid on brachiocephalic artery, it arises on its own as the fourth branch, after the left subclavian artery. It can be associated with chromosomal defects like trisomy 21 and 18.

The traumatic dissection of the renal pedicle is rarely reported after blunt trauma. Clinical symptoms often fickle and rare. Thus, the diagnosis is based angio- CT; arteriography remains useful when revascularization gesture is considered. Observation: We return a case of a 23-year-old patient referred for a renal’s pedicle traumatic dissection near the aortic ostium imposing a monitoring in intensive care. Management strategies for RAD include surgical revascularization, endovascular intervention, and observation with or without anticoagulation. The late diagnosis and localization delicate forced us not to use the endoscopic embolization: the risk was too high; and with respect to the endoscopic revascularization was not possible due to lack of means. We update through a review of the literature aspects of the diagnostic and therapeutic care of the renal artery's traumatic dissection.