Ultrasonic angioplasty may be a useful clinical method for recanalization of total occlusions in patients with peripheral vascular disease. Ultrasonic energy appears to cause controlled injury to the atherosclerotic intima by selectively disrupting the ultrasound-sensitive occlusion.

The achievement of the same clinical effect with a significantly lower (about 1/5) dosage of betahistine can be explained by the inhibition of the MAO-B by selegiline leading to higher serum concentrations of betahistine. This approach is in line with recent developments to bypass the first-pass effect of betahistine by transbuccal or intranasal application. Despite the substantial methodological limitations of such an observational study, this combined pharmacotherapy could be an alternative to a high-dosage monotherapy with betahistine of MD.

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occurs among children, but the condition is rare.l-3 In the literatÜre,4 118 cases of perforated duodenal ulcers in children have been reported, and of these, only 50 survived.The four infants we treated were aged two months, 20 days, 18 months, and five years.Three underwent siirgery successfully. In one case, the child with Hirschsprung's disease, the perforated ulcer was not recognized until postmortem. Case ReportsCase 1 A two-month-old baby girl was admitted for uninterrupted crying, refusal to eat for three days, and repeated vomiting. On admission she appeared very ill. She was afebrile. Her abdomen was distended and tender, but no masses were palpated. An x-ray film of the abdomen showed gaseous distention of small and large bowel, with a noticeable distance between the coils of the small bowel.The child's condition deteriorated and an abdominal operation was performed. In addition to acute peritonitis, a perforated ulcer, 1.5 cm in diameter, was found in the lesser curvature of the stomach. The perforation was oversewn and covered with omentum. Cultures of the peritoneal fluid and blood stream yielded streptococcus beta henolyticus A. With vigorous antibiotic therapy, the infant recovered without complications. Case 2 . A 2f~-day-c~ld male infant had had intermittent distention of the abdomen since the second day after his birth. For two days prior to admission, his abdomen had become very distended and he had liquid stools. On admission, we could not palpate the abdominal organs because of the distension. The rest of the physical examination was normal. X-ray studies showed bowel changes suggestive of Hi~~schsprung's disease. A rectal biopsy showed no ganglions, On the fifth day after an intestinal operation, the infant died of pulmonary symptoms. The postmortem revealed a perforated ulcer 0.7 cm in diameter in the anterior wall of the duodenum. Case 3 A 19-month-old girl was hospitalized for severe burns of second to third degree covering 40 per cent c~f' her body surface. Laboratory findings were: Hbg. 21.2 gm/100 ml; Htc 65 per cent, WBC 27,600. The burns were treated mostly by open method. The clinical course in the first two days was uneventful. On the third day, the patient had a minor hematemesis. Tachycardia and gallop rhythm appeared on the fourth day. On the fifth at Karolinska Institutets Universitetsbibliotek on May 26, 2015 cpj.sagepub.com Downloaded from

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