Idiopathic small bowel ulceration occurring beyond the duodenum is rare, and less than 5% of all the reported cases have occurred in children. In most of the cases, single ulcer of unknown cause is observed in jejunum or ileum. The diagnosis is difficult and usually made at the time of surgical exploration for the complications, such as perforation, hemorrhage or obstruction. We experienced a case of perforation of idiopathic ileal ulceration due to blunt abdominal trauma in a 11-year-old boy. The ileal segment including the lesion was resected and the pathologic findings were compatible with idiopathic small bowel ulceration. The clinical and pathological aspects are discussed, and the literatures were reviewed.
Child* ; Diagnosis ; Duodenum ; Hemorrhage ; Humans ; Ileum ; Jejunum ; Male ; Ulcer*

No abstract available.

Nine-month-old female infant was seen with a 7-month history of a nodule on the right temporal scalp, which had gradually increased in size. Stroking of the lesion resulted in urtication and blistering and there were no other cutaneous lesions. The histology showed subepidermal bulla formation and a dense infiltration of mast cells in the papillary and reticular dermis. We present an infant with solitary mastocytoma on the scalp, a rare site.
Blister ; Dermis ; Female ; Humans ; Infant ; Mast Cells ; Mastocytoma* ; Scalp* ; Stroke

No abstract available.
Female ; HELLP Syndrome* ; Pregnancy

PURPOSE: This paper introduces an improved classification approach which adopts a deterministic relaxation method and an agglomerative clustering technique for the classification of MRI using neural network. The proposed approach can solve the problems of convergency to local optima and computational burden caused by a large number of input patterns when a neural network is used for image classification. MATERIALS AND METHODS: Application of Hopfield neural network has been solving various optimization problems. However, major problem of mapping an image classification problem into a neural network is that network is opt to converge to local optima and its convergency toward the global solution with a standard stochastic relaxation spends much time. Therefore, to avoid local solutions and to achieve fast convergency toward a global optimization, we adopt MFA to a Hopfield network during the classification. MFA replaces the stochastic nature of simulated annealing method with a set of deterministic update rules that act on the average value of the variable. By minimizing averages, it is possible to converge to an equilibrium state considerably faster than standard simulated annealing method. Moreover, the proposed agglomerative clustering algorithm which determines the underlying clusters of the image provides initial input values of Hopfield neural network. RESULTS: The proposed approach which uses agglomerative clustering and deterministic relaxation approach resolves the problem of local optimization and achieves fast convergency toward a global optimization when a neural network is used for MRI classification. CONCLUSION: In this paper, we introduce a new paradigm to classify MRI using clustering analysis and deterministic relaxation for neural network to improve the classification results.
Classification* ; Magnetic Resonance Imaging ; Relaxation*

Clinical observations were made on 349 cases of acute drug intoxication who were visited to emergency room of Yeungnam University Hospital during recent 7 years from January 1984 to December 1990. The following results were obtained. 1) Total number of cases of acute drug intoxication was 349 which was 0.39% of the total patients of the emergency room during the same period. 2) The ratio of male to female was 1.1:1. The age incidence was highest in the third decade (26.7%). The monthly incidence was highest in May. Higher frequency was observed in summer season. 3) The most common drug of the intoxication was pesticides and herbicides (71.9%), the remainders were miscellaneous drugs (11.2%), sedatives (7.7%), rodenticides (6.3%) and unknown drug (3.2%) in orders. 4) The most common cause of drug intoxication was suicide (69.1%) and the others were accident, unknown cause, intention in orders. 5) Main clinical manifestations were the impairment of consciousness, nausea, vomiting and convulsion. Physical examination revealed increased pulses, increased blood pressure, miosis of the pupil and sweating. Above symptoms and signs were more prominent in pesticide intoxication. Leukocytosis, glycosuria and abnormal LFT were common findings in acute intoxications. 6) The complications were developed in 18.3% among 349 cases and the most common complication was respiratory failure, pneumonia, cardiovascular collapse and pulmonary edema in orders. 7) Overall mortality rate was 8.3% of total cases and mortality rate was highest in herbicide intoxication (22.2%).
Blood Pressure ; Consciousness ; Emergency Service, Hospital ; Female ; Glycosuria ; Herbicides ; Humans ; Hypnotics and Sedatives ; Incidence ; Intention ; Leukocytosis ; Male ; Miosis ; Mortality ; Nausea ; Pesticides ; Physical Examination ; Pneumonia ; Pulmonary Edema ; Pupil ; Respiratory Insufficiency ; Rodenticides ; Seasons ; Seizures ; Suicide ; Sweat ; Sweating ; Vomiting

PURPOSE: We report an initial experience with a retroperitoneal laparoscopic ablation of a peripelvic renal cyst. MATERIALS AND METHODS: Five patients (2 males, 3 females), with a mean age of 47 years (22 to 65) underwent a laparoscopic unroofing of a symptomatic peripelvic cyst. All patients complained of flank pain and an obstruction was observed in 3 patients. A laparoscopic ablation was performed retroperitoneally in all patients. Clinical parameters evaluated included the operative time, hospital stay, analgesic use, oral intake and complication rate. RESULTS: The mean operative time was 179 minutes (160-210 minutes). The mean postoperative hospital stay was 2.8 days (2-3 days). The mean analgesic requirement was 44mg of Piroxicam. Oral intake was started on postoperative day 1.4 (1-2 days). Complications included 1 case of subcutaneous emphysema and 1 case of peritoneal tearing, which were managed conservatively. The mean follow-up was 9.2 months (3-18 months) with no evidence of recurrence. CONCLUSIONS: A retroperitoneal laparoscopic ablation of a peripelvic renal cyst is technically feasible and effective alternative to an open cyst unroofing. However, it should be performed by an experienced urologic laparoscopist because of the location and association of these cysts with vessels of the renal hilum and collecting system.
Flank Pain ; Follow-Up Studies ; Humans ; Laparoscopy ; Length of Stay ; Male ; Operative Time ; Piroxicam ; Recurrence ; Subcutaneous Emphysema

PURPOSE: We report an initial experience with a retroperitoneal laparoscopic ablation of a peripelvic renal cyst. MATERIALS AND METHODS: Five patients (2 males, 3 females), with a mean age of 47 years (22 to 65) underwent a laparoscopic unroofing of a symptomatic peripelvic cyst. All patients complained of flank pain and an obstruction was observed in 3 patients. A laparoscopic ablation was performed retroperitoneally in all patients. Clinical parameters evaluated included the operative time, hospital stay, analgesic use, oral intake and complication rate. RESULTS: The mean operative time was 179 minutes (160-210 minutes). The mean postoperative hospital stay was 2.8 days (2-3 days). The mean analgesic requirement was 44mg of Piroxicam. Oral intake was started on postoperative day 1.4 (1-2 days). Complications included 1 case of subcutaneous emphysema and 1 case of peritoneal tearing, which were managed conservatively. The mean follow-up was 9.2 months (3-18 months) with no evidence of recurrence. CONCLUSIONS: A retroperitoneal laparoscopic ablation of a peripelvic renal cyst is technically feasible and effective alternative to an open cyst unroofing. However, it should be performed by an experienced urologic laparoscopist because of the location and association of these cysts with vessels of the renal hilum and collecting system.
Flank Pain ; Follow-Up Studies ; Humans ; Laparoscopy ; Length of Stay ; Male ; Operative Time ; Piroxicam ; Recurrence ; Subcutaneous Emphysema

BACKGROUND: It has been documented that certain prognostic factors may affect the outcomes of the old aged victims by trauma. Considering that trauma is the sixth most common cause of death in people over the age of 65 years and there is a rapid growth of elderly population, it is paramount to understand the prognostic factors when dealing with geriatric trauma patients. Hypothesis and Goals : It can be hypothesized that the prognostic factors should be determined independently between populations being consisted of different races, countries, socio-economic states, cultures, or so on. Thus, study was designed to evaluate the factors affecting the outcomes of elderly Korean trauma patients. METHODS: One hundred forty six patients aged over 65 years were retrospectively reviewed, who visited the Emergency Canter of Korea University from January, 1997 to June, 1998. Of 146 patients, 7 were excluded due to discharge against advice or transfer to the other hospitals. Parameters analysed were age, sex, mechanism of injuries, body region injured, Injury Severity Score (ISS), previous medical illness, hospital morbidity, duration of hospital stay, and cost. Each patient was classified into improved or not-improved groups depending on the outcomes, and young-old or old-old group depending on the age. The factors affecting the hospital stay in improved patients were analyzed in the parameters of previous medical illness, hospital morbidity, multiple injuries, ISS, and age. All statistical tests were conducted with two-tailed levels of 0.05. RESULTS: Of 139 patients, the mean age was 74+/-7.1 years, mean ISS 9.3+/-7.26, mean hospital stay 27+/-27.1 days. Most commonly injured body region was the extremities due to fall from a level surface. Rate of previous illness showed 0.94 medical diseases per person and were aggravated after trauma in 39 patients (60.9%). Hospital morbidity rate was 0.46 incidents per person. There were no differences in age and duration of hospital stay between the improved and the not-improved group. Substantial differences were noted in affected body region, incidence of previous illness, and hospital morbidity between the groups (p=NS). Not-improved group had higher ISS (p<0.05). ISS, previous illness and hospital morbidity affected the duration of hospital stay in the improved group. Hospital stay was 40+/-25.1 days in patients with ISS over 6 while 6+/-8.6 days in those with ISS 5 (p<0.05). Hospital stay in the improved was 26+/-26.9 days while 31+/- 24.8 days in the improved old-old group (P=NS). Hospital stay in the young-old minor trauma (ISS5) patients with previous illness and hospital morbidity was 26+/-10.1 days while 4+/-7.3 days in those without previous illness and hospital morbidity (p<0.05). CONCLUSION: Previous medical illness and hospital morbidity, not age, are predictive of outcomes of geriatric trauma patients with respect to hospital stay. As most of the hospital morbidity was a trauma-induced aggravation of previous medical illness and hospital morbidity contributing poor outcomes can be potentially avoidable, routine aggressive care far the geriatric trauma patients with previous medical illnesses is needed.
Aged ; Body Regions ; Cause of Death ; Continental Population Groups ; Emergencies ; Extremities ; Humans ; Incidence ; Injury Severity Score ; Korea ; Length of Stay ; Multiple Trauma ; Retrospective Studies

This study was designed to compare the percutaneous endoscopic gastrostomy(PEG) tube feeding with the nasogastric(NG) tube feeding for the patients with dysphagia after the stroke, and to find out the most optimal timing for the PEG tube feeding. We monitored the nutritional parameters, the frequency and the timing of complications, and other risk factors in 54 stroke patients with dysphagia. In the group of patients with the nasogastric(NG) tube feeding, a reduction in nutritional parameters was greater than in the group of patients with PEG tube feeding. Especially the reduction in serum hemoglobin and albumin level was statistically significant. Thirteen cases of aspiration pneumonia who had frequent self removal of feeding tubes developed in the group with NG tube feeding. Most cases of aspiration pneumonia in the NG tube feeding group developed within the first 2 weeks. Complications from the PEG tube feeding group were three cases of upper gastrointestinal bleeding and three cases of local infection. There were no correlations between the duration of dysphagia and the location of brain lesions, the history of tracheostomy, the age, the initial mental status, or the artificial ventilation. But, there was a significant prolongation of duration of dysphagia in the group of patients who had a vocal cord palsy, an absence of gag reflex, a paralytic dysarthria and a prolonged intensive medical care. We conclude that the PEG tube feeding is a safer and the more effective method to provide a long term enteral nutrition to patients with neurological dysphagia than the NG tube feeding. Since the most complications developed in the first 2 weeks, the PEG tube feeding should be applied within the initial 2nd to 3rd week for the stroke patients with dysphagia and aspiration risks. Further prospective study will be needed to decide an ideal timing of PEG tube feeding after an acute stroke.
Brain ; Deglutition Disorders ; Dysarthria ; Enteral Nutrition* ; Gastrostomy* ; Hemorrhage ; Humans ; Pneumonia, Aspiration ; Reflex ; Risk Factors ; Stroke* ; Tracheostomy ; Ventilation ; Vocal Cord Paralysis