We encountered a case of sealed perforated duodenal ulcer in a 75-year-old woman with rheumatoid arthritis and chronic renal failure. Abdominal sonography showed a bright linear echo within the thickened anterior wall of the duodenal bulb and the presence of free air at the anterior surface of the liver. We found no signs of direct communication between the duodenal lumen and the peritoneal cavity or any free fluid. On follow-up sonography performed every 2 days during the first week of the patient's hospitalization, no free fluid was found in the abdomen. The use of sonography to diagnose this patient's sealed perforated duodenal ulcer and to monitor the ulcer for the appearance of free fluid allowed us to provide successful nonsurgical management to this patient. We believe that the use of abdominal sonography in all patients suspected of having a perforated duodenal ulcer may help increase the diagnostic accuracy of this modality and may reduce the need for surgery in such patients.

The T1 and T2 relaxation times of bone marrow receiving multiple fractionated irradiation did not change significantly on SE sequences during the early phase. However, dilatation of sinusoids, hemorrhage, decrease in cellularity, and increase in fat content were observed. Single-dose irradiation resulted in marked and early changes in T1 and T2 of the bone marrow.

A 74-year-old man with pain and swelling of the left thigh was transferred from another hospital for further investigation. On admission, a diagnosis of a left femoral vein thrombosis was made and he continued on anticoagulant therapy. However, three and a half hours after admission he suddenly developed hypotensive shock and became unconscious. Rupture of a peripheral aneurysm was suspected in view of a rapid fall in the hematocrit and the images of vascular echography. Rupture of a left popliteal aneurysm was specifically diagnosed following intraarterial digital subtraction angiography. An emergency aneurysmectomy and vascular reconstruction using the great saphenous vein was performed. Interestingly, Klebsiella pneumoniae was cultured from both the wall of the left popliteal artery and the wound. Antibiotic therapy was therefore changed to flomoxef (FMOX) on the 5th postoperative day (POD 5) and treatment continued for a total of 6 weeks in accordance with the therapy of infectious endocarditis. He returned to the previous hospital on POD 61.

No abstract