Introduction:lthough herbal medicine have been used by traditional healers and physicians for thousands of years, these herbs are still being probed by researchers hoping to unlock their full therapeutic potentials. There is still much to learn about the biochemical and clinical effects of the individual constituents and of the various parts (petals, stigmas, leaves, and roots) of these plants. Many of today’s synthetic drugs originated in the plant kingdom, and less than two hundred years ago, the major pharmacopoeias of the world were dominated by herbal drugs-

The primary hypertrophic osteoarthropathy (PHOA or pachydermoperiostosis) is a rare (5% of total HOA) hereditary disease. One study described that the prevalence of PHOA is 0.16%. PHOA characterized by skin thickening (pachydermia), finger clubbing, and proliferation of periosteum (periostitis) with subperiosteal new bone formation and enlarged extremities secondary to periarticular and bone proliferation. Clinical manifestations are variable; the term complete syndrome is used for the patient with pachydermia, coarsening of the face skin and scalp, periostitis, and cutis verticis gyrata; the incomplete form is used when there is no sparing of the scalp; and the frusted form is used for pachydermia with minimal or absent periostitis. We describe a 29-year-old white man with PHOA, and clinical and radiological characteristics of this syndrome, as well as therapeutic approach of PHOA.

Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma, which often appears in the form of patches, plaques, and tumors as originally described by Alibert and Bazin. The manifestation of MF as annular lesions is uncommon, and herein we report one of those cases. A 54-year-old woman complaining of itchy skin lesions from three years before, came to our clinic with no response to topical steroids. In skin examination, there were annular lesions with erythematous slightly raised borders, and some scattered erythematous thin plaques in trunk and extremities with a predilection to lower extremities. Epidermal and poikilodermic changes were not evident. There were no lymphadenopathy and hepatosplenomegaly. Biopsies were obtained from three different lesions and the diagnosis of all samples was consistent with MF. A diagnosis of stage 1B of MF was made and the patient went under oral psoralen and ultraviolet A (PUVA) therapy. MF has different clinical manifestations that can be confused with other inflammatory dermatological disorders. Until now, less than 10 cases of MF with annular lesions have been reported in the English literatures, and most of them initially were under treatment with other differential diagnosis of annular lesion than MF

Hyponatremia due to syndrome of inappropriate antidiuretic hormone secretion (SIADH) occurs as a rare but clinically important phenomena in various conditions including malignant neoplasms, infections, and central nervous system disorders, and as an adverse effect of numerous drugs. To the authors’ knowledge, there are a few reports on SIADH associated with quetiapine in the literature. This case presents a 58-year-old woman receiving quetiapine for the treatment of bipolar disorder. The patient was hospitalized due to generalized tonic-colonic seizure. After checking her laboratory tests, she was found to be hyponatremic, and the treatment began accordingly. The situation was resolved after discontinuation of quetiapine therapy. Quetiapine was thought to be the cause for the patient’s symptoms, and she was diagnosed with SIADH induced by this medication. Close monitoring of the sodium level is recommended in patients taking quetiapine.

Relapsing polychondritis (RP) is very rare inflammatory disorder characterized by episodic, progressive, and destructive courses affecting cartilages. Renal involvement also is very rare presenting sign in these patients. It has seldom been described in children. We describe an 11-yearold girl with RP and complaint offrequent episodes of hematuria, and dysuria with fever and periorbital edema that auricular cartilage involvement appeared after renal involvement. Renal involvement in the setting of RP is mainly important, and need close observation.

Incisional hernia is defined as dehiscence of fascia and bowel obstruction. The clinical manifestation includes gross disruption of the wound with drainage, presence of a bulging with exertion or Valsalva maneuver, painful continuous bulge if bowel or omentum is incarcerated, and bowel obstruction or infarction. We report a 63-year-old woman with the history of three times cesarean section with a midline incision. She was operated for ovarian tumor. Total laparoscopic hysterectomy and lymphadenectomy was performed. She attended to hospital 5 days after surgery with the chief complaint of abdominal pain, nausea, and vomiting. There was a bulge tender around the umbilical port and patient’s creatinine was 4 mg/dl in laboratory test. The ultrasound confirmed a port site hernia. A strangulated hernia was diagnosed and treated with laparotomy.

Esophageal squamous cell carcinoma (SCC) is a common neoplasm which incidence shows an increasing trend in most populations. This article presents a case of 79-year-old woman with diagnosis of differentiated squamous cell carcinoma of the esophagus as two adjacent mas with metastasis, which invaded the perigastric and distal esophagus lymph nodes. The patient underwent esophagectomy and gastroesophagotomy. The jejunostomy tube was also embedded. The presence of two simultaneous esophageal tumoral lesions is extremely uncommon and requires further assessments. The prognosis and survival of such patients not seems to be worse than those of patients with isolated esophageal neoplasm.

Parry Romberg syndrome is a rare progressive degenerative disease characterized by unilateral atrophy affecting the skin, connective tissue, muscle, and bone, typically occurs in children and young adults. The end result is facial asymmetry associated with other skin, dental, visual, cardiovascular, and neurological disorders that ceases without apparent cause after a highly variable period. Inconsistency in the pattern of atrophy and multisystem involvement make intraoperative anesthetic management of these patients a challenge for anesthesiologists. We present a case of Parry Romberg syndrome and her associated clinical findings with specific attention to the anesthetic consideration of this disease.

Cerebral venous thrombosis (CVT) is an uncommon but fatal type of stroke with a wide spectrum of signs and symptoms. We report a 40-year-old woman who presented with acute intractable neck pain and lateral cervical bending. Investigations with neuroimaging revealed evidence of thrombosis in her right transverse and sigmoid sinuses. The precipitating factors for the thrombosis were consumption of oral contraceptive pills during the month of Ramadan, and dehydration due to fasting. The patient immediately was treated with the therapeutic dose of anticoagulant. We concluded that in patients with severe cervical pain, especially those who are predisposed to thrombotic complications, CVT should be considered in the differential diagnosis.