Case Report: Common bile duct perforation has been reported in adults after invasive procedures, spontaneous common bile duct perforation is a rare entity as a cute abdomen in adults. A few cases due to choledocholithiasis have been reported as a cause of spontaneous perforation. We report an adult patient who presented with acute abdomen after spontaneous common bile duct perforation due to unknown etiology who was treated successfully.

We describe a large functioning non metastasizing ACC in 8 years old boy who presented with a history of precocious puberty noticed by his parents since 3 months .Ultrasound of the abdomen showed a large well defined right suprarenal mass with calcification and necrosis . MRI  showed  the mass to be hypojntense to liver on T1 and   hyperintense  to liver on T2, and  dynamic CT scan revealed a large hetrogenous  enhancing right suprarenal mass with calcification and necrosis , clear chest .Histopathology done after surgical removal reveal adrenocortical carcinoma,so we recommend to do an abdominal ultrasound to any child with precocious puberty because it is easy,cheap and non invasive , if any suprarena

In this case report we discuss essential issue to be considered with regard to the clinical genetic testing in the epilepsies. The identification of genes that influence risk for the epilepsies has extremely important implications for both research and clinical practice. In a research context, information obtained may lead to the development of new treatments targeted to specific mechanisms, or even to ways of preventing epileptogenesis. In clinical practice, the use of genetic information can either clarify the diagnosis in people already known or suspected to have epilepsy (diagnostic testing), or to predict onset of epilepsy in people at risk of developing epilepsy because of a family history (predictive testing). This 8-year old girl

Locking of the knee is a one of the commonest orthopedic outpatient presentation. This patient usually need magnetic resonance imaging (MRI) when there is suspected lesion in the soft tissue clinically. Meniscal tears is the first differential diagnosis when accompany with painful knee. (1, 2)Giant cell tumor (GCT) is benign a localized nodular tenosynovitis often occur in the tendon sheath , Mostly involve the hand tendons in middle age group between 30 and 50 years old , female affect more than male.(3,4) The WHO defines two well-known kinds of giant cell tumor: (1) pigmented villonodular synovitis ( generalized type), which mainly involve the joints of the lower limb and (2) giant cell tumor of the tendon sheath ( localized type)

Locking of the knee is a one of the commonest orthopedic outpatient presentation. This patient usually need magnetic resonance imaging (MRI) when there is suspected lesion in the soft tissue clinically. Meniscal tears is the first differential diagnosis when accompany with painful knee. (1, 2)
Giant cell tumor (GCT) is benign a localized nodular tenosynovitis often occur in the tendon sheath , Mostly involve the hand tendons in middle age group between 30 and 50 years old , female affect more than male.(3,4) The WHO defines two well-known kinds of giant cell tumor: (1) pigmented villonodular synovitis ( generalized type), which mainly involve the joints of the lower limb and (2) giant cell tumor of the tendon sheath ( localized type)

A case of systemic lupus erythematosus like induced by carbamazepine therapy in a 27 year old female patient with left sided trigeminal neuralgia had been recorded, 9 years from starting carbamazepine therapy. The patient condition improved clinically 3 days after withdrawal of
carbamazepine , the titer of antinuclear antibodies dropped from 1/640 to 1/80 after 3 weeks, and disappear completely after 6 months follow up.

Fibro-adenoma is the most common lesion of the breast, it occurs in25%of asymptomatic women (1,2 )
It is usually a disease of early reproductive life, the peak incidence is between the ages15 and 35 years.(3,4) It presents as firm highly mobile, non tender mass .(5)
Less than 5% of fibro-adenomas grow rapidly and display the clinical and histologic characteristics of giant fibro-adenoma which is defined as a-tumour either having a diameter greater than 5 cm. And /or amass weighing more than 500 grams, and are conventionally a benign tumor of breast.(6)
Giant fibro-adenomas appear as well-circumscribed but not encapsulated masses on mammography and solid and the texture is homogenous and hypoechoic with low level echoes on U/S. (

We describe here a case of a 70 yr old man with long-standing rheumatoid arthritis who presented with low grade fever, fatigue, loss of appetite and weight, bluish discoloration of the fingers and patches of gangrenous skin on the fingers. There was intense pain in the fingers which prevented him from sleep. Along with these symptoms he developed loss of sensation in the dorsum of left foot, then left foot drop. We give below full account of the case and review of the causes of vasculitis. We want to emphasize on the importance of identifying vasculitis as one of the complications of rheumatoid arthritis and intensive treatment of this complication, as it is a life-threatening complication.

Baghdad: