Abstract Background Postoperative biliary strictures are commonly related to accidental bile duct injuries or occur at the site of biliary anastomosis. The first-line treatment for benign biliary strictures is endoscopic therapy, which is less invasive and repeatable. However, recanalization for biliary complete obstruction is technically challenging to treat. The present report describes a successful case of treatment by extraluminal recanalization for postoperative biliary obstruction using a transseptal needle. Case presentation A 66-year-old woman had undergone caudal lobectomy for the treatment of hepatocellular carcinoma. The posterior segmental branch of the bile duct was injured and repaired intraoperatively. Three months after the surgery, the patient had developed biliary leakage from the right hepatic bile duct, resulting in complete biliary obstruction. Since intraluminal recanalization with conventional endoscopic and percutaneous approaches with a guidewire failed, extraluminal recanalization using a transseptal needle with an internal lumen via percutaneous approach was performed under fluoroscopic guidance. The left lateral inferior segmental duct was punctured, and an 8-F transseptal sheath was introduced into the ostium of right hepatic duct. A transseptal needle was advanced, and the right hepatic duct was punctured by targeting an inflated balloon that was placed at the end of the obstructed right hepatic bile duct. After confirming successful puncture using contrast agent injected through the internal lumen of the needle, a 0.014-in. guidewire was advanced into the right hepatic duct. Finally, an 8.5-F internal–external biliary drainage tube was successfully placed without complications. One month after the procedure, the drainage tube was replaced with a 10.2-F drainage tube to dilate the created tract. Subsequent endoscopic internalization was performed 5 months after the procedure. At the 1-year follow-up examination, there was no sign of biliary obstruction and recurrence of hepatocellular carcinoma. Conclusions Recanalization using a transseptal needle can be an alternative technique for rigid biliary obstruction when conventional techniques fail.
Abstract. The authors have developed a system for the Antarctic stratospheric aerosol observation and sample-return using the combination of a rubber balloon, a parachute, and a gliding fixed-wing unmanned aerial vehicle (UAV). A rubber balloon can usually reach 20 km to 30 km in altitude, but it becomes difficult for the UAV designed as a low-subsonic UAV to directly glide back from the stratospheric altitudes because the quantitative aerodynamic characteristics necessary for the control system design at such altitudes are difficult to obtain. In order to make the observation and sample-return possible at such higher altitudes while avoiding the problem with the control system of the UAV, the method using the two-stage separation was developed and attempted in Antarctica. In two-stage separation method, the UAV first descends by a parachute after separating from the balloon at stratospheric altitude to a certain altitude wherein the flight control system of the UAV works properly. Then it secondly separates the parachute for autonomous gliding back to the released point on the ground. The UAV in which an optical particle counter and an airborne aerosol sampler were installed was launched on January 24, 2015 from S17 (69.028S, 40.093E, 607 m MSL) near Syowa Station in Antarctica. The system reached 23 km in altitude and the UAV successfully returned aerosol samples. In this paper, the details of the UAV system using the two-stage separation method including the observation flight results, and the preliminary results of the observation and analyses of the samples are shown.
To prevent cardiovascular events in hyperlipidaemic patients, plaque stabilization by inhibition of localized inflammatory reactions in the blood vessels is important in addition to cholesterol lowering. Cerivastatin, a 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor (statin), has more potent enzyme-inhibitory effects than other statins and has also been reported in vitro to inhibit, at low concentrations, various inflammatory reactions due to plaque instability. Cerivastatin was therefore administered over 12 months to five patients with hypercholesterolaemia and atherosclerotic plaque diagnosed by ultrasonography of the carotid artery, and changes in the plaque composition were determined. The mean cholesterol level decreased over the study period, although not significantly. However, the mean percentage of fibrous matrix of the plaque increased significantly from a mean of 11.2 ± 7.7% at study entry to 18.3 ± 5.9% at the end of the study. Additionally, the mean maximum plaque height was significantly reduced from 3.7 ± 0.9 mm to 3.0 ± 0.7 mm. These results indicate that cerivastatin induces plaque stability independently of cholesterol lowering.
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