Spontaneous aortocaval fistula: a case report and literature review

Spontaneous aortocaval fistula is a rare complication of abdominal aortic aneurysms. We describe two cases of spontaneous aortocaval fistula. The first patient is a woman who was admitted with abdominal pain and pulsatile abdominal mass. Another patient was a man admitted with progressive abdominal pain and hypotension. Computed tomography [CT] scan in both patients showed an infrarenal aortic aneurysm and simultaneous contrast enhancement in the inferior vena cava. Both patients underwent an urgent laparotomy in which the diagnosis of an aortocaval fistula was confirmed. We review the literature on spontaneous aortocaval fistula as a consequence of complicated aortic aneurysms

[Classification arthropathies with severe hemophilia type A referred to Ali Asghar pediatric in Zahedan in 2003]

Hemarthrosis is the most common sign of severe hemophilia type A in all ages which leads to irreversible complications in joints. These Complications cause morbidity and high expenses that could be decreased by a good organized therapeutic and prophylactic management. There is not any standard quantitative scoring system to evaluate the complications of joints, used in our country systematically and we have not any published data about it. In this study, Petterson and Gilbert's scoring system has been used to evaluate joints status in a cross sectional descriptive analytic manner. Twenty out 32 cases of the severe hemophilia type A patients who came to Ali Asghar hospital in 1381, were included on our study. Based on Petterson and Gilbert's scoring system, knees, ankles and elbows were selected joints. Physical examination was first done by a pediatrician and confirmed by an orthopedic surgeon PA and lateral X-ray of selected joints were reported by a radiologist .All of the above physicians were fix during the study. Finally we reported our results in tables and charts and analyzed with SPSS [One-way Analysis of Variance, Wilcoxon Matched-Pairs, Kruskal-Wallis]. In this study, the most common radiological pathologic finding was osteoporosis [32.5%] and the rarest one was erosion at joint margin [3.3%]. In physical examination, decreasing in range of motion [35%] and instability [0%] was the most common and the rarest pathologies. The most involved joints in radiology and physical exam were right knee [28.7%] and left knee [19.3%] and the rarest one's were left ankle [13.7%] and left elbow [10.6%]. The severity of complications [both physically and radiologically] has been related with the titer of inhibitor, but there was not any correlation with age [one-way analysis of variance]. There was not any statistically significant difference between radiologic and physical scoring in every joint. Ourfindings showed that the majority of our patients had at least one joint involvement [85% physically and 75% radiologically].On the other hand, 45% of 120 evaluated joints had radiological problems and 55% of them were physically insult. This high prevalence of morbidity explained the cause of high expenses for treatment of patients in this province. To increase in titer of inhibitor is the main factor for increasing of morbidity. Considering high morbidity in our patients, the statistical similarity between joints complications in different age groups, showed the importance of prophylaxis protocols for them obviously. It seems there is no relation between radiological scoring and physical score, except for left elbow joint [Wilcoxon Matched-pairs, P=0.454]. Pain is a good alarm, but it had no effect on scores. Prevalence of involved joints can be dependent on kind of culture