MEDICAL JOURNAL OF TABRIZ UNIVERSITY OF MEDICAL SCIENCES
Year:2004 | Volume:- | Issue:60|Papers Count:24

Background and Objectives: Mental retardation is a behavioral syndrome, that its cause, mechanism of development, and symptoms differ from individual to individual. This syndrome which is observed in people with mental problems, has an effect on intellectual function, efficiency of patients; as compared with the same age and social groups, in aspects such as social skills, responsibilities, establishing relationship with others, personal routines, independence, and self-sufficiency. These functions may be detoriated or significantly decreased. As a result of the influence of retardation on learning different concepts such as personal hygiene, it is expected that the prevalence of infectious diseases such as urinary tract infections among these people, as compared with peers and homogenous sex groups, would be high. The aim of this study was to investigate the urinary tract infections among mentally retarded children, and to compare their frequency with normal individuals. Materials and Methods: In this study, urine samples of 200 (45% males and 55% females) mentally retarded individuals under the age of 14, which had been under different treatments at private rehabilitation centers, and 60 (30 males, 30 females) normal peers, were examined by microscopy and culture methods for facultative bacteria. Results: The results show the presence of urine infections in 5% of individuals among mentally retarded group, while no positive culture was obtained amongst normal control group. Among isolates, E.coli was the most prevalent organism, detected in 6 (60%) cases; this microorganism was sensitive to ciprofloxacin, gentamicin and nitrofurantoin, but was resistant to ampicillin. The highest percentage of infections (5.45%) was seen in females and among illiterate families. Conclusion: Prevalence of urinary tract infections amongst mentally retarded group was same as that observed in normal people, but the incidence of these infections was higher (5%) than that found in normal peer and homogenous sex groups (0%).    

Background and Objectives: Intraaortic Balloon Pump (lABP) is a device for improving circulation of heart. IABP uses the principle of diastolic counterpulsation which augments diastolic coronary perfusion pressure, reduce systolic afterload, favorably affects the myocardial oxygen supply-demand ratio, and augments cardiac output. The aim of this study is evaluating application of IABP and complication of this method in Shahid Madani Heart Hospital. Materials and Methods: This retrospective study was performed in Shahid Madani Heart Hospital from 1998-2000 in 1134 patients, underwent coronary bypass surgery. In Forty-three patients in this period, IABP had been used during surgery. Collecting data has been performed through filling a questionnaire consisting of age, sex, results of angiography, MI history and IABP complications and mortality rate. The statistical analysis is based on the SPSS software and has been done through descriptive statistical method. Results: In this study, 72% of patients were male and 28% were female. Mean age of patients in both groups was 57.4±7.8 years old. 46.5% of patients were in emergency condition at the time of surgery. 76.74% of patients had a history of pervious myocardial infarction. In 67.5% of patients IABP was implanted in Operating Room (OR) due to difficult weaning from Cardiopulmonary Bypass (CPB) or immediately after Coronary Artery Bypass Graft (CABG) due to homodynamic instability and only in 32.5% patients it was implanted in a prophylactic manner before surgery. Overall in-hospital mortality rate was 32.5%. Persistent limb ischemia despite balloon removal, was reported in 4.65% of patients. Controllable local bleeding was reported in 11.6% of patients. Conclusion: The results of this study show that complication rate associated with IABP implantation in Shahid Madani Hospital, is comparable with those of other reports. IABP implantation in our hospital was usually preserved for very high risk patients with homodynamic impairment. It is important to note that in the past, patients had been deprived form potential benefits of IABP, possibly due to restricted facility, in Shahid Madani Hospital.    

Background and Objectives: Combined spinal-epidural (CSE) anesthesia, has gained increasing popularity since its introduction in 1937. The major advantages of this method, are the rapid onset, reliability of the spinal anesthesia, and possibility of extending anesthesia and analgesia into the postoperative period via the epidural catheter. Materials and Methods: In a prospective and double-blind study, 60 patients scheduled for elective urologic and pelvic surgeries, were allocated randomly in tow groups: in the control group, in.30 patients spinal anesthesia was performed with 25 G spinal needle and in the second group, also consisted of 30 patients, combined spinal-epidural anesthesia was used with a special needle. All patients were in ASA (American society of anesthesiologists) classes I, II and III, without any contraindications for regional anesthesia. Results: In control group (spinal anesthesia), failure rate was 13.2% (p=0.04) and incidence of headache was 6.6% (p=0.05). In combined group (Spinal-epidural anesthesia), failure rate and incidence of headache, were 0%. The mean time of onset in spinal group was 4 seconds and in combined group was 3.77 seconds. In combined group, epidural space measured 5.44 mm. Conclusion: This study showed the following advantages for combined group: rapid onset of effect, low incidence of failure and headache, enabling surgeon for prolonging the duration of anesthesia or extending the level of sensory block, and feasibility of post-operative analgesia through epidural catheter. Combined spinal and epidural anesthesia, has become the technique of choice for most procedures performed under regional anesthesia.    

Background and Objectives: Haloperidol, chemically belongs to the group of butyrophenone derivatives, is used as a sedative drug. This drug interferes with embryo implantation in endometrium and causes malformations such as phocomelia as well as low birth weight Materials and Methods: To evaluate effects of haloperidol on developing limb budds and weight loss in the mouse embryo, 5-10 mg/kg haloperidol was injected intra-peritoneally to the mice on the 8th gestational day. Thirteen days after gestation, the fetuses were removed from uterine and were examined macroscopically and microscopically. Results:' This study revealed that haloperidol can result in weight loss in embryos. The greatest reduction, was observed in embryos located at the either ends of uterus. Delay in growth of limbs, was also observed as outpocketings from the ventrolateral body wall. In microscopic sections, limbs are observed as a mesenchymal axis covered by ectodermal cells. Conclusion: Haloperidol effects are reflected as increased levels of corticosteroids specially glucocorticosteroid, decreased levels of growth hormone and bone formation, and increased absorption of minerals by bones. In addition, the administration of this drug at the primary stages of gestation, should be prevented.    

Background and Objectives: Pulmonary hydatid disease has various radiographic manifestations that can be misinterpreted as other disease entities. Ozvaran et al, studied the pitfalls of chest x-ray in the diagnosis of both complicated and uncomplicated cases of pulmonary hydatid disease, but they didn't determine the sensitivity and specificity of chest x-ray in this regard. The purpose of the this study, is to determine the pitfalls as well as sensitivity and specificity of chest x-ray in the diagnosis of hydatid disease. Materials and Methods: Fifty chest radiographs with suspected pulmonary hydatid disease were reviewed by 3 radiologists, while they were unaware of the history (blind study), the results of other diagnostic modalities and final diagnosis. The results were compared with final operative diagnosis and pathological reports. Results: The results shown in the tables 1, 2 and 3, revealing pitfalls in the diagnosis of pulmonary hydatid disease. These results have been integrated in the table 4 to determine sensitivity and specificity of this diagnostic modality. The sensitivity of chest x-ray in pulmonary hydatid disease was 73% in complicated cases and 78% in uncomplicated ones. The specificity was 72.5% and 72.4%, respectively. Conclusion: Hydatid disease may present in various forms in chest x-ray; therefore, in endemic area it should be considered as a probable diagnosis in every pulmonary lesion. For accurate diagnosis, CT scan, sonography and bronchoscopy, are recommended.  

Background and Objectives: Presence of microorganisms in places with crowded population, is associated with potential risk of infection transmission. This study was carried out in girls' accommodation (Fajr 2) in Tabriz University of Medical Sciences. Disinfectant halamide (0.5%) was used to eliminate microorganisms when the building was changed to university accommodation. The aim of this study, was to evaluate the efficacy of halamide in different areas of this accommodation and to compare microorganisms with those isolated from another accommodation, Fajr 1. Materials and Methods: Samples were collected using sterile. swabs impregnated with salin, and were immediately placed into trypticase soy broth. After incubation for 24h at 37 C, blood agar and EMB plates were inoculated. For detection of fungi, Sabouraqs dextrose agar with and without chloramphenicol and cyclohexamide were inoculated, and incubated at 25º C. Results: Our results indicated the presence of potential pathogenic organisms such as: 1) P. aerouginosa; 2) bacteria often isolated from nosocomial infections such as E.coli, klebsiella spp., and proteus spp; and 3) opportunistic bacteria such as staphylococcus epidermidis and bacillus subtilis. Fugi isolated in this study, included candida and saprophytic mycelial fungi. Comparison of isolated microorganisms revealed greater prevalence and diversity of gram-negative bacteria and fungi in the university accommodation Fajr 2, compared with Fajr 1 accommodation. Conclusion: Results obtained in this study, showed inefficacy of halamide (0.5%) in eliminating gram-negative bacteria and spores of saprophytic fungi and indicate the need for more effective disinfectants.    

 Background and Objectives: The most important body control systems are endocrine glands which have ability to regulate cell functions by different ways. Multiple factors can affect this regulation, such as effects of endocrine hormones on each other. In this study, we evaluate effects of thyroid hormones on adrenal cortex secretion. Urine 17-0HKS as glucocorticoid metabolie and urine 17-CS as androgen metabolite, were measured. Materials and Methods: This study was done on 100 healthy volunteers and results compared with 100 hyperthyroid patients. D, T4, TSH, 17-Ketosteroids and 17-0H steroids were measured. There was a positive correlation between D and T4 and urine 17-KS in patients with hyperthyroidism (r=0.64-0.72) and a negative correlation between TSH and urine 17-KS (r=0.74). Results: Urine 17-0HKS levels in healthy volunteers were 2-9.6 µg/mg creatinine (mean 5.4±1.87) and in hyperthyroid patients was 9.2-17, µg/mg creatinine (mean 12.5±3.2) (p<0.0l). Urine 17-KS levels in healthy volunteers were 1.5-15µg/mg creatinine (mean 5.85±2.1) and in hyperthyroid patients were 15.1-23 (mean 17.9±2.87) (p<0.01). In statistical analysis by regression line method in these two endocrine glands hormones, there was a positive correlation between T3 and 17-OHKS (r = 0.72) and D and 17-KS (r=0.74) and a negative correlation between TSH with 17-OHKS and 17-KS (r=0.74). However there were not any correlation between T4 with 17-OHKS and 17-KS in healthy volunteers. Conclusion: These results indicated that increase of thyroid hormones have some effects on adrenal cortex secretion, which may suggest different ways for treatment of adrenal cortex secretion disorders.      

Background and Objectives: Hemophilia is a hereditary bleeding disorder. It is divided to hemophilia A, B and C depending on deficiency of clotting factors involved. Hemophilia A is due to deficiency of factor VIII, hemophilia B is result of factor IX deficiency and hemophilia C is due to factor XI deficiency. Genetic abnormality resides in chromosome X in 80% of the cases. The women are carriers only, while men experience full picture of the disease. Materials and Methods: In this study, experiments were carried out on 241 patients. All patients with coagulation deficiency, who were referred to Shahid Gazi Hospital, were examined by imaging technique. In patients with joint hemorrhage, plain films were taken, however when extra joint hemorrhage were seen, CT scan or ultrasonography were techniques of choice. In some cases all of these techniques were performed. Results: We report radiological findings observed in 241 patients. Of these, 192 were hemophiliacs, 164 suffering from hemophilia A, and 28 from hemophilia B. Knee joint was involved in 160, ankle in 62, elbow in 28, wrist in 34, shoulder in 26 and hip in 29 patients. Pseudo tumor was seen in 3 patients. Conclusion: Sometimes death may results from hemorrhage. Treatment is mandatory, but treatment with factor or frozen serum is very expensive. Because hemophilia is X linked, birth control in these patients is very important. Although the prevention of child bring in carriers and patients seem to be difficult by instruction, instruction can be helpful in preventing birth of male infants.    

Background and Objectives: Recovery from anesthesia may be associated with numerous complications. Postoperative shivering is one of these complications that strongly increases body oxygen consumption, and may be dangerous in patients with coronary artery disease and heart failure. The purpose of this study was to investigate the effects of clonidine on the post-operative shivering. Materials and Methods: In a prospective study, one hundred patients were randomly selected in Shohada, AI Zahra and Nicoukary Hospitals and divided in two groups: Group A (study group, n = 50) and Group B (Control group, n = 50). In group A, 0.2 mg clonidine was given before anesthesia and in group B, only placebo was provided. In these patients blood pressure and heart rate were measured preoperatively and intraoperatively. Effect of the type of surgery and duration of operation, was also studied upon post-operative shivering. Results: Occurrence of shivering was decreased in group A (12%) as compared with group B (32%) (p =0.03). There were significant differences between types of operation and duration of operation with shivering incidence. There were also significant differences in intraoperative blood pressure between the two groups. Conclusion: The results of this study suggest that clonidine with its central effects is associated with decreased (approximately 20%) prevalence of shivering in post-operative patients.    

Background and Objectives: Toxoplasmosis is a common zoonotic infection throughout the world. In the congenital from, pathogenic agent is transmitted to the fetus through the maternal placenta. Acquired infection is due to ingestion of the oocysts, which are expected by cats or transmitted through the contaminated meat. Congenital infection can lead to fetal death, pathological changes of CNS or the eye diseases. The acquired form of the disease is often without sign and symptom, or characterized by general lethargy, swelling of lymphatic nodes and chorioretinitis. In the immunocompromised patients and in the patients with malignancy or tissue implants as well as AIDS, lethal and acute infections take place. The purpose of this study, is the investigation for determining the rate of anti-toxoplasma gondii antibody in the sera of patients with malignancy, referred to the Gazi Hospital of Tabriz. Materials and Methods: In this study, a total number of 100 blood samples from the patients with malignancy were collected and tested by indirect immunoflurescent antibody method. Results: Prevalence of anti - toxoplasmosis antibody in patients with malignancy by the titration of 1:20 was found equal to 48%. The highest infection rate was seen in 61-70 years age group with 66.6 percent and the least rate was seen in the above 70 years age group with 14.21%. The highest rat of infection was observed among students and persons with unemployed jobs (61.5% and 59.1% respectively) and the lowest rate was found among government employees (28.6%). A high rate of infection was seen among villagers (53.4%).The most prevalent antibody titration was in the rate of 1:100 (in 16 subjects) and the least of this titer was 1:200 (in 5 subjects). The titration of 1:800 was noticed in 4 patients from 61-70 years old age group. Conclusion: According to the high positive cases observed in these patients, there should be some regular screen programs to recognize chronic infections, and serial titration of antibodies in these patients should be done. Also, these patients should be treated with antitoxoplasmosis regimens.    

Background and Objectives: Edema is one of the common clinical signs with many complications, and considerable attention is directed at which in first aid and therapeutic rehabilitation programs. Edema is defined as the presence of abnormal amounts of fluid in the extracellular tissue spaces in the body. Vasortrain, one of the clinical modalities in physical therapy, is used to reduce the accumulation of edema. The purpose of this study, was to assess the effects of vasotrain in reduction of lower limb edema. Materials and Methods: Thirteen patients (11 women and 2 men) with lower limb edema were selected with simple nonrandomly assignment from the patients referred to orthopedic clinics, regardless of sex or age. Mean age of these patients was 45.54 (with the range of 17 to 63 years) and their chief complaint was edema due to varicose veins, lymphedema or post-immobilization edema. They were treated with vasotrain. Treatment parameters were: Positive pressure: 0.05 Bar with 30 seconds hold time; and Negative pressure: 0.03 Bar with 10 seconds hold time. Treatment time was 30 minutes for 10-15 sessions (3 times a week). Results: Data were analyzed with software SPSS version 6. The results of this study revealed that reduction in the amount of edema (p=0.02), pain (p<0.001) and tenderness (p<0.001) as well as increase of fatigue time after walking (p< 0.001), were statistically important. Conclusion: These results showed that vasotrain with above-mentioned parameters can improve he lower limb edema and its complications.    

Background and Objectives: Natural menopause is commonly defined in the epidemiological literature as the time when a woman has experienced 12 consecutive months of amenorrhea without an obvious intervening cause, such as exogenous hormone use, dietary deficiencies, or surgical removal of the uterus or ovaries. In this period, women face endocrine, somatic and psychotic changes. These changes are due to aging of ovaries and estrogen deficiency. The eventual cessation of menstrual periods is attributed to the loss of ovarian follicole. Mean age of menopause is not the same in different societies and is influenced by various factors. Some of these factors are well understood and others are not. This research was carried out to determine he mean age of natural menopause in Tabriz women and their attitude to this phenomenon and the related factors. Materials and Methods: This cross-sectional study was carried out to determine mean age of menopause in Tabriz women and their attitudes toward natural menopause. 448 post-menopause women and 256 non-menopause women were studied using randomized clustered sampling technique. Questionnaires were filled by menopause and non-menopause subjects and the data were analyzed with SPSS using ANOV A and t-test. Results: Findings of this study indicated that the mean age of menopause was 47.38. The highest frequency (43.75%) was in 46-50 years. Positive attitude was collected from 25.45% of women, while negative and neutral attitudes were recorded in 55.13% and 19.42% , respectively. No significant correlation was found between age of menopause and age at menarche, oral contraceptive use and cigarette smoking. The most prevalent sings associated with menopause, were vaginal discharge, post-menopausal bleeding, reduced libido, osteoporosis, anxiety, insomnia and hot flushes. Conclusion: Tabriz women showed relatively low age of menopause and they mainly had negative attitudes to this phenomenon. There were no statistically significant differences between the two groups studied, before and after menopause, regarding their positive or negative attitudes.    

Background and Objectives: A simple and universally available marker of inflammation is the white blood cell (WBC) count. Previous studies of patients with acute myocardial infarction (AMI) had revealed that patients with elevated WBC counts were at higher risk of mortality and recurrent AMI. The objective of this study was to find a correlation between increased WBC count and rate of in-hospital complications and mortality in unstable angina (UA) and AMI. Materials and Methods: 1840 patients admitted with AMI and UA in Shahid Madany Heart Center of Tabriz from early 1377 to second half of 1380, were studied. Half of the patients (n=920) had AMI (with average age of 63 years and male / female ratio of 618/302), and other half (n=920) had UA at admission (with average age of 57 years and male / female ratio of 436/484). WBC count was assessed in first 48 hours of hospitalization in all patients. We detect the association between WBC count and rate of complications & mortality in UA and AMI. Results: The typical chest pain was the most prevalent complaint (in 51.6% of patients). The most common abnormality at electrocardiogram (ECG) was ST changes (70.6%) in AMI and T-inversion (47.8%) in UA. Both enzymatic analyses (CPK, CPK-MB, LDH) and ECG changes, were used to detect UA or AMI. Most of patients with UA (86%) had WBC < 10000 mm3, but WBC> 10000 mm3 were frequently seen in AMI patients, specially in whom subsequently expired. Conclusion: WBC count is a potent predictor of in-hospital morbidity and mortality in patients with AMI and UA.    

Background and Objectives: The prevalence of tympanic membrane retraction in cases of chronic otitis media who undergo tympanomastoidectomy operation, is high. Diagnosis and treatment of these patients, is one of the major problems in Otolaryngology and it's etiology is prolonged malfunction of austachian tube. This problem needs to more investigated and evaluated. The purpose of this study, was to diagnose and treat these patients and prevention of other retraction. Materials and Methods: A total of 400 cases who had tympanomastoidectomy operation in department of Otolaryn.gology in Imam Khomeni Hospital, were reviewed. Forty cases had tympanic membrane retraction. In all of patients, otoscopic and microscopic examination was done before operation. In 19 cases of this group, depth of pocket was visible and amount of conductive hearing loss was 35-45 db. In 21 cases of this group, depth of retraction was not visible by otoscopic and microscopic examination and during operation it was noted that pocket extended to antrum and attic; conductive hearing loss in them was 45-60 db. Audiotympanometry was done in all of the patients and it's type was type B, with hearing loss in the range of 35-60 db. Results: In 40 cases who underwent operation, 28 had ossicular necrosis and their operation was done in two stages. First stage was eradication of pathology and second stage was ossicular reconstruction for recovery of conductive hearing loss. In 12 cases, in which the cholesteatoma was present in posterio-superior portion of tympanic membrane and there was no ossicular necrosis, tympanoplasty performed by temporalis fascia. UnfortunatIy, in all of 40 cases there was some degrees of malfunction in austachian tube. In 8 cases, retraction of tympanic membrane relapsed, in whom graft of perichondrium of tragus was used. During and in follow-up after second stage up to 18 months, no retraction was observed. Conclusion: Prolonged malfunction of austachian tube, is the major cause of tympanic membrane retraction in posterio-superior portion, in which middle ear should be examined carefully and cleaned from pathology, so that the function of austachian tube is returned to normal.    

Background and Objectives: The aim of this study was to evaluate the prevalence of pseudoexfoliation syndrome (PXS) and its relation with senile cataracts and comparison of complications of cataract surgery in patients with PXS and without PXS. Materials and Methods: In this retrospective study, 1850 eyes with senile cataracts who had undergone extracapsular cataract extraction & posterior chamber intraocular lens (ECCE & PCIOL) in Alavi Eye Hospital, were evaluated for prevalence of PXS in eyes with senile cataracts in both males and females (uni-and bilaterality) and its preoperative and intraoperative complications. Results: Of 1850 operated eyes, 422 (22.8%) eyes were affected by PXS; in 224 (53%) eyes PXS was bilateral. 247 (58.53%) patients were male and 175 (41.47%) were female. Results were as follow: pupil rigidity, 21 (5%) eyes; phacodonesis, 52 (12.4%) eyes; increased IOP, 40 (9.5%) eyes; sector iridectomy, 42 (10%) eyes; sphincterotomy, 4 (1%) eyes; and vitreus loss, 23 (5.3%) eyes. Conclusion: PXS is a common finding in patients who had undergone senile cataract surgery in Tabriz Alavi Eye Center and is more common in males. Preoperative and operative complications, more frequently observed in eyes with PXS. Therefore, preoperative evaluation and operative considerations, are necessary for ophthalmologists.  

Background and Objectives: Perinatal morbidity and mortality are increased as much as 10 times in pregnancies complicated by IUGR, in comparison with normal pregnancy. For doing valid management decisions, accurate diagnosis is essential. Materials and Methods: In order to evaluate the accuracy of ultrasonography compares with clinical examination for detection of IUGR, we retrospectively reviewed medical records in pregnant mothers, who admitted to Taleghani and Al-Zahra Hospitals during 12 months and who had singletone deliveries. Results: We found that with one sonographic examination in second trimester, comparing with clinical examination, no significant differences were observed in diagnosis of IUGR, but with two sonographic examinations, one in second trimester and one in third trimester, there was a significant advantage upon clinical examination for detection of IUGR. Conclusion: This study provides strong evidences that at least two sonographic examinations, one in second trimester and one in third trimester, are essential for accurate diagnosis of IUGR, in order to reduce perinatal mortality and morbidity.    

Background and Objectives: Acute urinary retention (AUR) is an unpleasant, painful experience which requires immediate intervention. Evaluation of relationship between serum prostate specific antigen (PSA) and AUR as a predictor of benign prostate hyperplasia (BPH) is background of this research. Materials and Methods: This study was conducted in 60 men with a mean age of 69.6 who underwent prostatectomy because of BPH diagnosis during 2000-2001. Serum PSA measurement was done in all patients preoperatively. Results: Through analyzing data, it was found that there is a correlation (p=0.015) between serum PSA and AUR in BPH patients and those who have higher levels are at higher risk for AUR. Conclusion: Serum PSA is a good predictor of AUR risk and the need for BPH-related surgery in men with BPH. Measurement of baseline serum PSA, is a useful tool to aid physicians and decision-makers in predicting the risk of BPH-related outcomes and choosing therapy for BPH.    

Abdominal actinomycosis is most commonly found after appendectomy or drainage of an appendicle abscess, nevertheless other organs such as colon, stomach, liver, gallbladder, pancreas, small intestine, anorectal region, pelvic organs or anterior andominal wall may also be involved. Usually a single viscus is affected, and disseminated intraabdominal disease is uncommon. This infection can mimic multiple diseases processes and requires accurate diagnosis for successful therapy. This case of abdominal actinomycosis, is a 45-yrars-old woman who presented with vague abdominal discomfort and a palpable right upper-and right lower-quadrant mass; the patient developed acute abdominal pain with nausea, vomiting and intestinal obstruction. She underwent emergency surgery for intestinal obstruction, Macroscopically, peritoneal mass affecting the ascending colon, mesentery and andominal wall, was observed with tumor-like infiltration of the surrounding tissues, simulated a malignant process and thus required a hemicloectomy. Therefore, en-bloc resection of the mass and a right colectomy was performed. Histological diagnosis revealed andominal actinomycosis that complicated appendicitis and results in formation of an actinomycotic abscess. The patient was treated successfully by surgery and long-term antibiotic therapy. Malignant disease is often simulated by actinomycosis and laparatomy may be required to make an accurate differentiation. In view of common history that is more prevalent in this disease, either inflamed or perforated appendix is to be removed and appendiceal abscesses should be drained, and if a sinus tract persists without obvious reason, this disease should be suspected.    

A 23 years old female patient with diagnosis of main pulmonary artery (MPA) aneurysm is reported. With early diagnosis of pericardial effusion, she had been operated for pericardia I biopsy and drainage. In further studies by chest CT scan, large cyst in anterior mediastinum was found and she became candidate for operation. In surgery via midsternotomy, for releasing excessive adhesions, cardiopulmonary bypass was established. In exploration of mediastinum, MPA aneurysm and patent ductus arteriosus (PDA) were detected. The PDA was closed and after resection of aneurysm, it was repaired by pericardial patch. The postoperative course was uneventful and she was discharged after two weeks. In one year follow-up, she was in good condition.    

Lateral sinus thrombosis in the preantibiotic era, was the common complication of the otitis media and had a mortality rate of greater than 90%. Nowadays, the prevalence of lateral sinus thrombosis has decreased, clinical features of this disease have changed due to antibiotic treatment, and the mortality rate has reached about 10-36%. Now this rare complication occurs merely after chronic middle ear infections in adults. AT this article, a rare case of lateral sinus thrombosis in a child following acute otitis media is presented. Noting to change of clinical presentation of this disease and its low prevalence and high mortality, the importance of early diagnosis and early surgical intervention would be apparent. It emphasized that every patient with middle ear disease don't respond to appropriate medical treatment and do have high or continuous fever and/or neck pain, must be evaluated with MRI.