A Case of Ileal Duplication with Intestinal Hemorrhage

Duplications of the alimentary tract are uncommon congenital anomalies that usually present in childhood. They are cystic or tubular in shape, and composed of muscular walls with gastrointestinal mucosal lining. These lesions are almost invariably adjacent to the alimentary tract, most often found in the ileum, may communicate with the lumen, and may be multiple. We experienced an unusual case of a 18-month-old male patient who presented with intermittent blood-tinged stool as an initial manifestation of ileal duplication. The lesion was revealed by bleeding scan and Meckel's scan and was suspected to be a bleeding Meckel's diverticulum due to peptic ulceration of the ileum adjacent to the ectopic gastric mucosa. At laparotomy, a 3-cm-sized cystic mass communicating with the adjacent bowel lumen and multiple conglomerated lymph nodes were identified at the mesenteric side of the distal ileum. Resection of the lesion and adjacent ileum containing enlarged lymph nodes was done. In microscopic findings, the unilocular cystic structure lying in the mesenteric border showed an intestinal wall lined in part by gastric fundic mucosa with a small ulcer, especially at the blind end, and in part by small intestinal mucosa. Muscularis propria and serosa were also present.

Effects of Calcium Channel Blocker In Renal Allograft Recipients Receiving Cyclosporine / 대한이식학회지

Calcium channel blockers are used for the management of hypertension or heart disease after organ transplantation and are known to increase in blood cyclosporine A(CsA) levels through an effect on the hepatic cytochrome P450 system resulting in reduced CsA clearance. Authors reviewed and analyzed 154 CsA-treated renal allograft recipients at Yeungnam University Hospital from Mar. 1985 to Mar. 1996 to evaluate the effects of calcium antagonists on renal recipient. Among 154 recipients, 60 recipients were received triple immunosuppressive drugs (CsA+Prednisolone+ Azathioprine) only (Control group), 43 recipients with diltiazem (D group) and 51 recipients with Nifedipine (N group). Blood pressure(systolic and diastolic), creatinine level, CsA blood level and CsA dose had been checked at 1 week, 1, 3, 6, 9 and 12 months, after renal transplantation serially and compared the results with each groups. CsA blood levels of all groups had been adjusted to 100-150 ng/ml after 3 month of immunosuppression. There was no difference in CsA blood levels among 3 groups at all follow-up periods. Dose reduction of CsA had been noted 18%, 27%, 29%, 32%, and 28% in D group at 1, 3, 6, 9 and 12 months respectively(p0.05). Incidence of primary nonfunction, graft loss, acute rejection, chronic rejection and CsA nephrotoxicity were not different statistically among 3 groups. In conclusion, the use of diltiazem was associated with a markedly reduced requirement for CsA without any adverse effect on graft function or graft outcome. but the use of nifedipine may not associated with repuirement for CsA statistically.