Background and objectives: Arterial aneurysm is defined as a dilatation that exceeds 1.5 times the normal diameter. Abdominal Aortic Aneurysm (AAA) frequently involves infra-renal arteries. The common iliac and internal iliac vessels may also be involved. This disease usually involves males with a familial and sex-linked pattern. In this article, a case of abdominal aortic aneurysm (AAA) along with bilateral iliac arteries aneurysm and right ectopic kidney is reported.Case: The patient was a 71-year-old man, smoker, who suffered from vague abdominal pains for 3 months without any changes in bowel habits or other symptoms. The pain was localized in mid-abdomen and upper abdomen, radiating to the back, and aggravating by physical exercise, but it would not change with feeding or position. In past medical history, hypertension was noticed for which the patient was on antihypertensive medications. Physical examination revealed a pulsating palpable mass in mid-abdomen. CT scanning showed dilation of abdominal aorta below the renal arteries, as well as bilateral iliac artery aneurysms. The right kidney was ectopically located in right pelvis and other abdominal organs were found normal.

Background: Behcet's disease is a multisystem disease and mainly classified as a vasculitis. In this disease many organs like skin, mucosa, eyes, joints, vessels, nervous system, gastrointestinal tract, testis, heart and lungs maybe involved.Case Report: This case is a rare presentation of Behcet's disease with multiple saccular ANEURISMs in a 33 year old man. A patient with a permanent pain in back and flanks with radiation to the testis without relationship with position and feeding was admitted in Al-Zahra Hospital, Isfahan. In the abdominopelvic ultrasonography, an abdominal ANEURISM with thick wall borders and 37 mm in total diameter and 15 mm in open lumen diameter was reported. In spiral CT-scan of abdomen and pelvis with contrast, ANEURISM of abdominal aorta (4×4.5 cm in diameter) beginning below the renal arteries was seen, that extended downwardly to the near of the aortic bifurcation. Finally in MRA multiple saccular ANEURISM of the abdominal aorta at the same places was reported. After repairing of ANEURISM by surgical operation. The patient was referred to the clinic of rheumatology. After taking of history and physical and laboratory examination, because of the recurrent oral aphthous, erythemnodosum, positive result on pathergy test and abdominal aorta ANEURISM, the diagnosis of behcet's disease was confirmed and the patient was treated with medical drugs.

Dear Editor, We report a case of 15.4cmabdominal aorta aneurysm, which underwent an emergent open repair. Our patient is a 64-year-old female, with past medical history of Type 2 diabetes, hypertension and hyperlipidemia who presented to the emergency department with a two-day history of constant progressively worsening abdominal pain. Physical exam was remarkable for a distended abdomen with pulsatile tender mass in the right peri-umbilical region...

Introduction: Abdominal aortic aneurysm is a multifactorial condition which associated with aging and atherosclerosis. During aneurysm surgery, hypotension after aortic clamp removing occure commonly that require specific treatments. This case report showes administration of blood and hemodynamic control methods after aortic unclumping during aortic aneurysm surgery.Patient: A 75–years-old woman who complained of back and flank pain, initially diagnosed and hospitalized as pyelonephritis. In ultrasound a pulsatile mass in middle part of the abdomen and the abdominal aortic aneurysm was diagnosed for the patient. After surgery consultation, the patient was diagnosed as ruptured abdominal aortic aneurysm.Following removal of aortic clamp during surgery despite adequate volume administration and reducing the maintenance dose of anesthetic agents, sever hypotension was occurred that only by reclamping the aorta and its gradual opening effectively controlled in normal range.Conclusion: With mixture of therapeutic measures such as intravascular ressusitation, especially with hypertonic solution, we can applying the method of acute normovolemic Hemodilutionthe. By using PEEP and monitoring ETco2, during the aortic clamping phase and gradual opening of aortic clamp, we can anticipate and treat the hypotension after aortic unclamping.

Kawasaki disease is one of the most common vaculity syndromes in children and the most important complication of this disease is cardiac ANEURISM. ANEURISMal involvement of extremities is one of the rarest vascular manifestations of this disease which reveals as Gangrenous fingers. Because of being rare, most physicians report this type of disease when they see and diagnose it especially in children under I year old.Materials & Methods: This case is a 70 day-old infant that was referred with convolution, fever, and pyuria. We admitted this patient in Pediatric Nephrology Service of Imam Hospital and treated him with possible diagnosis of Pylonephritis. During admission period, Necrosis was seen in his toes. In attention to clinical manifestations, laboratory tests, imaging and response to treatment (IVIG and aspirin) Kawasaki disease was diagnosed and the patient was treated with this regimen (IVIG, NSAIDS) and responded well.Conclusion: Kawasaki disease is usually seen in 1-5 year old infants and its prognosis is fairly good (mortality less than 2 percent). The complication and mortality of the disease increases if it is seen in the ages of 1-5, especially those who are under one year old. For example Necrosis of Extremities is one of the rarest complications that is reported only in infants under 7 months old.It seems that in patients with Gangrenous organs especially in extremities without other Necrotizing diseases such as Nephritic Syndrome, Arterial Emboli, DIC, and etc Kawasaki disease should be considered.

Aortic rupture and pseudoaneurysm formation in the anterior arch of congenital double aortic arch anomaly associated with a coarctation is an exceedingly rare complication of aortic vascular ring. This is a case report of a double aortic arch with an anterior arch pseudoaneurysm, presenting with chest pain, respiratory distress, and hypotension. The patient underwent open-heart surgery with resection of the anterior arch pseudoaneurysm and bypassing of the coarctation with ascending aorta to descending aorta connection with a Dacron tube graft. Posterior aortic arch entering to pseudoaneurysm by a vertical artery also connected to the main Dacron tube by another small size of the Dacron tube. The postoperative course was complicated by chylothorax and respiratory distress that managed with prolonged preservation of chest tubes, chest physiotherapy, and low lipid content diet. One year follow-up with C_T angiography revealed the patency of both the Dacron tube and patient was in good condition.

Objective: Kawasaki disease (KD) is an intense life-threatening vasculitis. The diagnosis of Kawasaki disease is made by clinical criteria. This disease is a common rheumatologic disease in Iran. The aim of this study was describe the demographics and clinical features of KD in Iranian patients. Material & Methods: A review was conducted for all cases of KD treated at Pediatric rheumatology department in Children's Medical Center between January 1994 and July 2004. The diagnostic criteria for typical Kawasaki were based on the criteria of the Japan Kawasaki Disease Research Committee. Atypical or incomplete KD has been described in which patients not strictly meeting the diagnostic criteria but have coronary artery changes. Color doppler echocardiograms were done at the time of diagnosis, 14 to 21 days, 60 days, and 1 year after treatment. Findings: One hundred fifty nine patients were identified. One hundred twenty five children (78.6%) fulfilled criteria for typical KD. Echocardiographic abnormalities were found in 30 cases (18.9%), including 9.6% with typical and 46.1% with atypical Kawasaki. The incidence of atypical Kawasaki in our study was about 22%. Coronary arteries aneurysms found in 66.7% and 33.3% was other abnormalities. Male to female ratio was more in patients with cardiac complication (2.3:1).Conclusion: Kawasaki disease should be considered in any infants or child (especially less than 2 years old) with a prolonged febrile illness. Demographic features of our patients were similar to reports from other country. The incidence of atypical Kawasaki in our study was about 22%.

Facial nerve palsy, a very rare complication of Kawasaki syndrome, has been reported in only 25 patents. None of the 25 previous reported cases with this complication was treated with IVIG. We treated a 24-month-old boy with bilateral coronary artery aneurysms due to Kawasaki syndrome. In our patient, whom we treated with Aspirin and IVIG, duration of disease was 7-9 days. He developed marked unilateral peripheral facial nerve palsy on day 3 of illness. This treatment led to complete resolution of facial nerve palsy within 48 hours. Review of pervious cases demonstrates that children with Kawasaki–associated facial nerve palsy have more than twice the risk for coronary artery aneurysm (52% vs 25%) as that of children without facial nerve palsy.Unexplained facial nerve palsy in young children with a prolonged febrile illness should provoke consideration of Kawasaki syndrome and Echocardiography to exclude coronary artery aneurysms. Although facial nerve palsy appears likely to be resolved in all patients surviving the acute phase of Kawasaki syndrome, treatment with IVIG appears to shorten considerably the time for full recovery and provides an important clue to the mechanism of neurological injury in this illness.

Facial nerve palsy is a very rare complication of Kawasaki syndrome and has been reported in only 25 patients world-wide. None of the 25 previous reported cases with this complication were treated with IV immunoglobulin. We treated a 2-year old boy with bilateral coronary artery aneurysms due to Kawasaki syndrome. In our patient, the duration of disease was 7 to 9 days. He developed a marked unlilateral peripheral fascial nerve pulsy on the third day of his illness and was treated with aspirin (80 mg/Kg) and gamma globulin (2 g/Kg), which resulted in complete resolutio; of facial nerve palsy within 48 hours. Review of pervious cases demonstrates that children with Kawasaki-associated facial nerve palsy have more than twice the risk for coronary artery aneurysm (52% vs 25%) as compared with children without facial nerve palsy. Unexplained facial nerve palsy in young children with a prolonged febrile illness should provoke consideration of Kawasaki syndrome and dictates taking an echocardiography to exclude coronary artery aneurysms. Although facial nerve palsy appears likely to be resolved in all patients surviving the acute phase of Kawasaki syndrome, treatment with IVIG appears to shorten considerably the time for full recovery and provides an important clue to the underlying mechanism of neurological injury in this illness.

We describe a case of a 43-year old woman with Marfan’ s syndrome, tricuspid valve regurgitation and severe pectus excavatum who required an aortic root replacement and valvuloplasty for an ascending aortic ANEURISM with aortic valve regurgitation and tricuspid valve regurgitation. There was a severe angulation of the sternum which was close to 1. 5 cm to the column vertebrae. Such cases are quite rare and always a challenge for surgeons to achieve adequate exposure of the heart and prevent excessive cardiac compression. We present our access, a safe and efficient exposure of the heart in order to achieve the best outcome.