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*

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.
Pulmonary Atelectasis*

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

40 cases of bile duct carcinoma gathered over a 6-year period at Kosin Medical College were reviewed and theirclinical and cholangiographic findings were as follows: 1. There were 29 males and 11 females (the ratio of men towomen, 2.6:1) ranging from 37 to 74 years of age. The majority (70% of cases) were in 4th & 5th decades. 2.Clinical symptoms and signs: jaundice in 95%, RUQ or epigastric pain in 75%, pruritus in 52.5%, dark urine in 35%,weight loss in 32.5%, fever and chills in 22.5%, clay colored stool in 12.5%, and palpable mass in 12.5%. 3.Lab,findings: elevated serum total bilirubin(above 20.0mg% in 45%, 10.0-19.0mg% in 22.5%, 5.0-9.9mg% in 20%,1.3-4,9mg% in 5%), elevated alkaline phosphatase in 95%. Clonorchiasis were noted in 17.5%. 4. Histologic findingswere adenocarcinoma in most cases. 5. The location of bile duct carcinoma were common hepatic duct in 35%, commonbile duct in 32.5%, porta hepatis in 12.5%, junction with cystic duct in 10% and diffuse form in 10%. 6. In 33cases, PTC or post-operative cholangiographic examination were done. And the most frequent findings weredilatation of the proximal bile duct and abrupt narrowing or complete obstruction of distal lumen. In 27cases(82%), complete obstruction of bile duct was noted. Attempts were made to analyze the type of obstruction:Constricted type in 39%, Nipple type in 18%, round or flat type (smooth or slightly irregular) in 15%, andserratd type in 9%. Incomplete obstruction were noted in 6 cases(18%). Among them, abrupt narrowing of lumen wasnoted in 9% and diffuse narrowing in 9%. 7. ERCP was done in 7 cases. Findings were constricted type in 42.6%,constricted and slightly irregular type in 14.3%, downward convexity in 14.3%, diffuse irregular narrowing in14.3% and intraluminal filling defect in 14.3%.
Adenocarcinoma ; Alkaline Phosphatase ; Bile Ducts ; Bile ; Chills ; Cholangiopancreatography, Endoscopic Retrograde ; Clonorchiasis ; Cystic Duct ; Female ; Fever ; Hepatic Duct, Common ; Humans ; Jaundice ; Male ; Nipples ; Pruritus

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*

The change of arising site of branches from the axillary artery determines it's topographic relationship with the brachial plexus because of closeness between the artery and the plexus. Variation of the subscapular artery (SSA) should be concerned when it is used for the source artery of some flaps, especially focusing on the variation of branching pattern and site of origin and relationships with the brachial plexus. In some cases of absence of SSA, if the circumflex scapular and the thoracodorsal arteries arise from the variable portion of the axillary artery separately, they might change the relationships with the brachial plexus. This study was performed to clarify the relationships between the subscapular artery and the brachial plexus according to the variation of the origin of the SSA and its branch. Two hundred seventeen axillae from 110 Korean cadavers were used for this study. SSA was found in 87.1% of cases, while in 12.9%, the circumflex scapular and the thoracodorsal arteries arose from the axillary artery (AA) seperately. SSA arose most frequently from the third part of the AA (63.6%), and in 4/5 of these cases, it ran behind the radial and ulnar nerves. When it arose from the second part (18.9%) or from the first part (4.6%) of AA, it mostly ran over anterior to the medial cord or/and the ulnar nerve. In 41.9% of the cases, a posterior circumflex humeral artery made a common trunk with the SSA or came from the circumflex scapular artery. In 28.1% of the materials, the SSA made a common trunk with a lateral thoracic artery especially when it arose from the first or second part of AA. After running a mean distance of 2.2 cm from AA, SSA was divided into the circumflex scapular and the thoracodorsal arteies. The SSA gave off the branches to the subscapularis in 68.7% of the cases, and the branches to the serratus anterior in 76.0%.
Arteries* ; Axilla ; Axillary Artery ; Brachial Plexus* ; Cadaver ; Running ; Thoracic Arteries ; Ulnar Nerve