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.
Pulmonary Atelectasis*

BACKGROUND:To evaluate the efficacy of lamotrigine on bipolar disorder, both manic and depressed episode, the author compared the effects of lamotrigine with lithium and placebo. METHOD: Forty-seven manic patients with bipolar disorder and 43 depressed patients with bipolar disorder were treated with lamotrigine, lithium or placebo during 6 weeks. Their severity of symptoms were rated weekly using Young's Rating Scale for Mania and Hamilton Rating Scale for Depression. RESULTS: In manic patients the therapeutic efficacy of lamotrigine was lower than that of lithium during baseline to week 2, but after week 3, lamotrigine was as effective as lithium. In depressed patients the therapeutic efficacy of lamotrigine was superior to lithium from week 2 to endpoint. Most patients tolerated well except that one patient developed skin rashes. CONCLUSION: Lamotrigine seems to have antimanic and antidepressant effect as lithium in the treatment for acute bipolar disorder.
Bipolar Disorder* ; Depression ; Exanthema ; Humans ; Lithium*

No abstract available.
Diagnosis* ; Ultrasonography* ; Varicocele*

We experienced difficulty in ventilating the lungs of a patient after tracheal intubation. After intubation, an insufficient amount of tidal volume (VT) was delivered to the patient and the fiberoptic bronchoscopic examination identified partial abutment of the endotracheal tube (ETT) orifice against the tracheal wall. After various attempts to correctly place the ETT, a double-lumen endotracheal tube was placed to achieve a sufficient VT. It is important to notice that even an appropriately placed ETT may get obstructed due to the left sided bevel at its tip.
Airway Obstruction ; Bronchoscopy ; Humans ; Hypogonadism ; Intubation ; Lung ; Mitochondrial Diseases ; Ophthalmoplegia ; Tidal Volume

The objective of this study was to evaluate the feasibility and accuracy of estimating the smallest amount of abdominal free gas detectible in a large population of beagles by ultrasonography. Healthy dogs were randomly divided into three groups: group A that received 0.1 mL of air injected into the peritoneal cavity, group B that received 0.2 mL of air injected into the peritoneal cavity, and group C that received 0.5 mL of intraperitoneal air. Randomly, some dogs in each group did not receive air injection for the negative control. All ultrasonographic procedures were performed by individuals blinded to group assignments and the presence of intraperitoneal air. The minimum volume of consistently detectable air with good accuracy and reliability was 0.2 mL. Results of the study demonstrated that the enhanced peritoneal stripe sign (EPSS) can verify cases of pneumoperitoneum if more than 0.2 mL of intra-abdominal free gas is present The EPSS is a reliable and specific ultrasonographic characteristic for diagnosing pneumoperitoneum in dogs.
Animals ; Dog Diseases/*ultrasonography ; Dogs ; Female ; Male ; Pneumoperitoneum/ultrasonography/*veterinary ; Reproducibility of Results ; Species Specificity ; Ultrasonography/standards/veterinary

This study was conducted to investigate plasma levels of oral methotrexate in rabbits and children receiving maintenance chemotherapy for acute lymphocytic leukemia. Eight New Zealand white rabbits, weighing 2kg in body weight, were divided into 3 groups and 5mg of methotrexate from 3 different manufactorying company was administered to the each group rabbits via nasogastric tube. Time to peak concentration ranged from 30 minutes to 3 hours (mean 1.2+/-0.9 hour)and the peak plasma concentration ranged from 0.08 micro M to 0.21micron M(mean 0.14+/-0.05 micronM)and area under the plasma concentration-time curve ranged from 0.6micron M.hr to 1.66micron M,hr (mean 1.06+/-0.36micronM,hr). There were no statistically significant difference in AUC of methotrexate in 3 groups, but interindividual variability in plasma levels of methotrexate was noted. Twelve patients with ALL who were receiving maintenance chemotherapy at pediatric department of Yeungnam University Hospital from August, 1988 to August, 1991 were studied. Plasma levels of oral methotrexale were monitored following an oral dose of 3.3 mg~10mg/m2 which was modified from recommended dose of 10 mg/m2 due to hepatotoxicity or myelosuppression. Time to peak concentration ranged from 30 minutes to 2 hours(mean 1.2+/-0.4 hour) and the peak plasma concentration ranged from 0.34 micron M to 0.8 micron M (mean 0.58+/-0.18micron M). The area under the plasma concentration-time curve ranged from 1.25micron M,hr to 3.79 micronM,hr (mean 2.71+/-0.84microM,hr)while standard area under the plasma concentration-time curve ranged from 0.13micronM, hr/mg/m2 to 0.54micronM, hr/mg/m2 (mean0.4+/-0.15micronM hr/mg/m2).Interindividual variability in plasma levels following an oral dose of methotrexate was noted. Peak plasma concentrations of study patients were all less than 1 micronM which is necessary for antileukemic effect of methotrexate in vitro. It seems to be necessary to increase the dose of methotrexate for all study patients, however optimal dose increment of methotrexate avoiding hepatotoxicity and myelosuppression need to be investigated further and measurement of plasma level of methotrexate is recommended when dose modification of methotrexate is made.
Area Under Curve ; Body Weight ; Child* ; Humans ; Maintenance Chemotherapy* ; Methotrexate* ; Pharmacology ; Plasma* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Rabbits

No abstract available.
Diagnosis, Differential*

BACKGROUND: The aim of this study was to determine the appropriate target concentrations at the effect site of propofol and remifentanil when deep sedation was achieved by monitored anesthesia care (MAC) anesthesia and related respiratory depression during vein stripping surgery for varicose veins. METHODS: In total, 51 adult patients who were scheduled for varicose vein stripping surgery were sedated with propofol and remifentanil during the surgery, after administration of midazolam. Target concentrations at the effect site of the two drugs were changed based on the patient's status. Respiratory support was applied in the order of oxygen supply, chin lift, and assisted mask ventilation. Target concentrations at the effect site of propofol and remifentanil, the need for respiratory support, and a six-point rating scale satisfaction score were the outcome measurements. RESULTS: Only one patient did not require oxygen, eight patients needed oxygen alone, 22 patients required use of the chin lift technique, and 20 patients were assisted with mask ventilation. There was no significant difference in the target concentration of propofol or remifentanil between the patients who required mask ventilation and those who did not. Fifty of the 51 patients reported a satisfaction score of 6. CONCLUSIONS: Although MAC using low target concentrations of propofol and remifentanil during vein stripping surgery was satisfactory to patients, close observation regarding the need for respiratory assistance was necessary.
Adult ; Anesthesia* ; Chin ; Deep Sedation ; Humans ; Masks ; Midazolam ; Oxygen ; Propofol* ; Prospective Studies* ; Respiration ; Respiratory Insufficiency ; Saphenous Vein* ; Varicose Veins ; Veins ; Ventilation

Congenital coronary arteriovenous fistulas represent abnormal communication between coronary arteries and any cardiac chambers, pulmonary artery, coronary sinus, superior vena cava or pulmonary vein. A 60 year-old male patient presented with severe effort-induced chest pain radiating to left arm. Resting electrocardiogram was normal and anterior ischemia was demonstrated on stress myocardial SPECT. Coronary angiogram reve-aled very long and tortuous coronary arteriovenous fistulas originated from the left circumflex and right coronary artery, which drained into intercostal arteries. Proximal segment of left anterior descending artery stenosed about 50%. Both coronary artery fistulas were ligated and left internal mammary artery was grafted into left anterior descending artery. After surgical correction he has no cardiovascular events on 7-month clinical follow-up.
Arm ; Arteries ; Arteriovenous Fistula* ; Chest Pain ; Coronary Sinus ; Coronary Vessels ; Electrocardiography ; Fistula ; Follow-Up Studies ; Humans ; Ischemia ; Male ; Mammary Arteries ; Middle Aged ; Pulmonary Artery ; Pulmonary Veins ; Tomography, Emission-Computed, Single-Photon ; Transplants ; Vena Cava, Superior