Percutaneous transhepatic biliary drainage (PTBD) is an established procedure for biliary obstruction. However, duodenobiliary or jejunobiliary reflux of the intestinal contents through a PTBD catheter sometimes causes recurrent catheter obstruction or cholangitis. A 64-year-old female patient with a history of choledochojejunostomy was referred to our department with acute cholangitis due to choledochojejunal anastomotic obstruction. Emergent PTBD was performed, but frequent obstructions of the catheter due to the reflux of intestinal contents complicated the post-PTBD course. We therefore introduced a catheter with an antireflux mechanism to prevent jejunobiliary reflux. A commercially available catheter was modified; side holes were made at 1 cm and 5 to 10 cm (1 cm apart) from the tip of the catheter, and the catheter was ligated with a nylon thread just proximal to the first side hole. Using this novel "antireflux PTBD technique," jejunobiliary reflux was prevented successfully, resulting in a longer patency of the catheter.
Catheter Obstruction ; Catheters ; Cholangitis ; Choledochostomy ; Dioxolanes ; Drainage ; Female ; Fluorocarbons ; Gastrointestinal Contents ; Humans ; Nylons

Endoscopic ultrasound (EUS)-guided intervention has been established as a safe, effective and minimally invasive procedure for various diseases in adults, but there have been limited reports in pediatric patients. Herein, we report our experience with successful EUS-guided drainage of an intra-abdominal abscess in a 1-year-old infant concomitant with disseminated intravascular coagulation. The abscess was punctured via the stomach using a standard, convex-type echoendoscope, and the patient's condition improved after naso-cystic catheter placement. Although the clinical course was complicated by delayed hemorrhage from the puncture site, the bleeding was successfully managed by endoscopic hemostasis using a standard forward-viewing endoscope.
Abdominal Abscess* ; Abscess ; Adult ; Catheters ; Disseminated Intravascular Coagulation ; Drainage* ; Endoscopes ; Hemorrhage ; Hemostasis, Endoscopic ; Humans ; Infant* ; Punctures ; Stomach ; Ultrasonography

Objective:
There have been a few reports on the specificity of the meridians and Acupuncture-points. In order to identify the specific effects of the meridians and Acupuncture-points, the functional relations between “the gallbladder Meridian and gallbladder” were investigated using the gallbladder's form as an index.
Materials and Methods:
Ten healthy male adult volunteers participated in the experiments in fasting conditions. The target organ was the gallbladder, and its form was measured with the ultrasonic diagnostic apparatus (Toshiba SSA-90A). The images of the gallbladder form were taken at the point when the major long axis of the cross-section of the gallbladder reached the peak. The cross-sectional area of the gallbladder was measured with the image analyzer. The measurement of the gallbladder form was conducted after 15 minutes lying on the back, taking images for 10 minutes before stimulation, for 30 minutes during and after stimulation, every two to five minutes. The acupuncture stimulation was given at the points of G34, G36, G37, G40 and G44 on the right side of the body. After getting the deqi, 1 minute of sparrow pecking needle technique and 1 minute of leaving needle technique were conducted three times. The effect of the G40 under the egg yolk loading were also investigated.
Results:
1) The stimulation of the G34, G36, G37, and G44 showed no effects on the gallbladder form. 2) The stimulation of the G40 caused the distension of the gallbladder form. 3) The stimulation of the G40 showed the suppressive effect on the contraction of the gallbladder due to the load of egg yolk.
As described above, the results of this study showed that there is an acupuncture-point on the gallbladder meridian to cause the distension of the gallbladder specifically. It suggests the existence of the specificity of acupuncture-point.

A rare case of an unruptured sinus of Valsalva aneurysm (SVA) in a 2-month-old male Maltese terrier weighing 1.0 kg with a heart murmur is presented. A right SVA and a ventricular septal defect (VSD) were diagnosed by echocardiography and cardiac catheterization. The dog died due to a worsening of his condition. The necropsy revealed the sinus of Valsalva to have a diameter of 7 mm and a VSD hole was on the opposite surface. This report is the first to describe an unruptured SVA in the right coronary cusp of a small dog.
Aneurysm ; Animals ; Cardiac Catheterization ; Cardiac Catheters ; Dogs ; Echocardiography ; Heart Defects, Congenital ; Heart Murmurs ; Heart Septal Defects, Ventricular ; Humans ; Infant ; Male ; Sinus of Valsalva