Objective: Small-bowel intussusception (SBI) for pediatric patients is unusual and difficult to diagnose preoperatively. This study sought to determine the sonographic findings of pediatric SBI. Methods: The sonographic features and surgical findings of 13 pediatric patients (7 boys, 6 girls; age range 4 months-15 years; average age 4 years and 2 months) with SBI encountered in the authors' hospital over a 12-year period were retrospectively reviewed. Results: Most of the patients presented with nonspecific symptoms , including vomiting, abdominal pain, and/or irritable crying. Sonographic screening in the emergency department revealed a doughnut or crescent-in-doughnut sign, or a multiple-concentric-rings sign for 11 of the 13 patients, and the lesions appeared short. Eight lesions were found in the paraumbilical or left abdominal regions. Sonographic measurement of the size of the lesions from these 11 patients ranged from 2 cm to 3.7 cm (average 2.77 cm). Subsequent barium enemas were performed for these 11 patients, none of which revealed colon lesions. Surgery revealed ileoileal intussusceptions for eight cases, jejunoileal for three, and jejunojejunal for the remaining two. Bowel ischemia or necrosis and pathologic lead points were demonstrated for seven and six patients, respectively, although none were recognized preoperatively. Conclusions: Small-bowel intussusception is often overlooked due to nonspecific clinical presentations. Sono-graphic demonstration of a 2-3-cm sized, short, doughnut-like lesion, especially in the left abdomen or paraumbilical regions, should lead to strong suspicion of SBI.

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We report an unusual case of mesenteric cystic lymphangioma presenting as a large multilocular mass with a well-enhanced solid component and a central cleft, which were were pathologically correlated to the prominent stromal myxoid degeneration interspersed with abundant capillaries and the central fibrosis, respectively. The findings of computed tomography and magnetic resonance imaging are illustrated. Recognition of the multilocular configuration of the enhanced stroma may help to make the correct preoperative diagnosis.

The incidence of postoperative cholangitis has changed very little despite progressive improvement in the treatment of biliary atresia. The role of the bilioenteric conduit in its pathogenesis is still uncertain. A retrospective study of 39 patients undergoing either a conventional Kasai operation (group 1, n = 20) or with placement of an antireflux valve (group 2, n = 10) or lengthening (group 3, n = 9) of the jejunal conduit from 40 to 60 cm was performed to compare the incidence of cholangitis. Postoperative cholangitis developed in 18 of the 39 patients (46%). The incidence was 10/20 (50%) in group 1, 5/10 (50%) in group 2, and 3/9 (33%) in group 3 (P = 0.679). An animal experiment was conducted concomitantly to compare quantitative bacterial cultures of the bilioenteric anastomosis and the liver before and 1 week after Roux-en-Y hepaticojejunostomy (HPJ) in piglets without (group A, 25 cm) and with (group B, 50 cm) lengthening of the jejunal conduit in a porcine model of extrahepatic biliary obstruction. The growth of bacteria in both the bilioenteric anastomosis and the liver was not affected by lengthening the jejunal conduit from 25 to 50 cm (P = 0.612 and 0. 057, respectively), despite a geometric increase in bacterial concentrations in both groups after HPJ. It is concluded that neither bacterial growth in the liver nor cholangitis following bile-duct reconstruction was affected by valving or lengthening the bilioenteric conduit.

We analyze the acceleration records of a vertical array to study the linear and nonlinear behavior of the soft soil layers at LSST site, Lotung, Taiwan. This array includes five triaxial accelerometers deployed at depths of 0, 6, 11, 17 and 47 m. During a 6-year operation from 1985 to 1990, 30 earthquakes (4.0 s; ML s;6.5) triggered this array. The maximum PGA value is 258 gals recorded at the surface station. Spectral analyses show that the strong motion (PGA>150 gals) causes the peaks of ratios to shift to lower predominant frequencies. The averaged spectral ratios of 15 well-recorded weak motion data (PGA <100 gals) are selected as a reference; the shift of the maximum predominant frequency can reach 20%. Compared with the weak motions, the strong motions also decrease the amplification factor. The maximum reduction of the amplification can reach 50%. The results of waveform simulation show that the linear model based on the Haskell method can well predict the weak motions at various depths. However, this linear model does not work for the strong motion data. Here a nonlinear numerical scheme, such as DESRA-2, is required and can significantly im prove the simulation results although the PGA value at the surface station is still underestimated. Overall, the nonlinear numerical calculation is fea sible to predict the strong motions for a horizontal layered structure.