Tracheal injuries are relatively rare,however, their mortality rate is relatively high. Complete disruption of the trachea is extremely rare, and a systematic approach is required for early DIAGNOSIS and favorable outcomes. This is a case report of a 17-year-old male admitted to the emergency room after a motor vehicle accident. He was agitated and in respiratory distress with labored breathing and urgently intubated orotracheally. In the first flexible bronchoscopy, the DIAGNOSIS of the tracheal transaction was missed. Due to saturation drop and high peak ventilator pressures on the seventh day, the flexible bronchoscopy examination was performed in the operating room. This measure revealed complete tracheal transection in midportion. Neck exploration demonstrated complete tracheal transection. The area was debrided, and primary end-to-end anastomosis was performed. The patient was extubated at the end of the surgery.

Objective: One of the primary factors in managing patients with retinoblastoma is early DIAGNOSIS. The main idea of this study was to recognize the consequences of delay in DIAGNOSIS on therapy of the disease.Methods: A retrospective review of all children with proven retinoblastoma, who had presented to MAHAK hospital in Tehran, from April 2007 to Dec 2011, was performed. Grouping of intraocular tumors was applied as A to E according to International Classification of Retinoblastoma.Findings: There were 157 (91 boys) children eligible for study. The mean age was 1.21±0.11 years with average delay in DIAGNOSIS of 3.4±0.53 months. Classification of D group in both unilateral (93 patients) and bilateral tumors was the largest category. A significant relation (P=0.05) between DELAYED DIAGNOSIS time and tumor grouping was evident. The most frequent symptoms were leukocoria and strabismus. Age was significantly lower in the subgroup of bilateral tumors than in unilateral retinoblastomas (0.6±0.12 year vs 1.6±0.15 years). The DIAGNOSIS was DELAYED in subgroup of extra ocular retinoblastoma more than in intraocular tumors (8.7±2.9 months vs 2.9±0.52 months).Conclusion: The authors recommend early referring of suspected cases to ophthalmologists and pediatric oncologists and to organize educational programs to publisize signs and symptoms of the disease such as leukocoria, strabismus and ocular inflammatory disorders through national media. In conclusion, early DIAGNOSIS of retinoblastoma can be the primary factor in managing the patients as the delay in DIAGNOSIS accounts for highly advanced disease and poor prognosis.

Alport syndrome is a progressive hereditary disease caused by mutations in the genes encoding type IV collagen. Persistent microscopic hematuria is the hallmark of Alport syndrome, occurring in almost all boys according to previous reports. We report the case of a 20-year-old man presented with proteinuria but no hematuria that was initially misdiagnosed with refractory nephrotic syndrome and was eventually diagnosed with Alport syndrome following kidney and skin biopsy. During the followup period, he experienced a rapid progression to end-stage renal disease. Timely DIAGNOSIS of Alport syndrome is important, because patients may benefit from early intervention and avoid suffering from unnecessary nephrotoxic drug use.

Introduction: Hypothyroidism is the most common endocrine disorder in children and presented with various sign and symptoms; its DIAGNOSIS needs a high index of suspicion.Case Presentation: We report 3 cases with unusual presentations of hypothyroidism and with delay in DIAGNOSIS that referred to Pediatric Endocrine Outpatient Clinic in Mashhad University of Medical Sciences, Mashhad, Iran with different clinical manifestations. They had decreased Thyroxin (T4) and increased thyroid stimulating hormone (TSH) levels. One case had mental retardation and deafness, but the other two cases had normal neurodevelopment. Some additional interesting findings were as follows: short stature, DELAYED bone age, teeth eruption impairment, hair loss, anemia and hypercholesterolemia, persistent and long-term constipation that had led to several abdominal surgeries. After a year of hormonal replacement therapy, their growth parameters and hematological values improved.Conclusions: We recommend thyroid hormonal evaluation for any children with short stature, especially with DELAYED bone age, in order to detect and treat hypothyroidism at the right time. It seems that more attention to pediatric growth is necessary.

Brown tumor is an osteolytic lesion caused by excessive production of parathyroid hormone. We present a 20 year old man with symptoms of severe muscle weakness and multiple fractures of shoulder and hip that the Brown tumor was observed in most of his bones.

Introduction: In contrast with victims of major trauma, patients who suffer minor injuries receive little specialist input. In most cases, this causes no difficulty, but there are situations where minor trauma results in persistent disability affecting the quality of life. Case Presentation: A young man sustained a perineal puncture wound resulting from a fall onto a bush. Following an initial delay, he sought medical advice for a continual pain in his right leg, and a discharging perineal wound. A computed tomography (CT) scan and flexible sigmoidoscopy failed to identify the cause, and he was subsequently discharged from hospital. One year after his initial presentation, a magnetic resonance imaging (MRI) scan identified a retained foreign body consistent with a fragment of wood. Conclusions: Penetrating trauma from wooden fragments provides a diagnostic challenge. A stubborn discharge from a wound must always raise the suspicion of retained fragment. Early and appropriate surgical exploration is imperative.