We present a case of an anomalous pancreaticobiliary junction (a long common channel) that was clearly demonstrated by extraductal ultrasonography with a transduodenoscopic miniprobe placed in the duodenal lumen. The present case suggests a potential indication for the ultrasound miniprobe, in extraductal ultrasonography, in the pancreatobiliary region. In this method, the position of a miniprobe can readily be adjusted under endoscopic guidance, unlike ordinary endoscopic ultrasonography.

Aged↗

PubMedDate not supplied

The chloride-dependent depression by GABA in the frog spinal cord.

Spontaneous activities from ventral and dorsal roots of the isolated perfused spinal cord of the bullfrog were inhibited by GABA. beta-Alanine showed a strong and glycine a weaker inhibitory effect. The inhibitory effect of GABA was markedly reduced in a chloride-free medium, whereas glycine and beta-alanine still showed an inhibitory effect similar to that seen in normal medium. Employing the sucrose-gap method, a marked depolarization in the dorsal root and a small but obvious hyperpolarization in the ventral root were found by the application of GABA. These results support the view that GABA is one of the transmitters involved in pre- and postsynaptic inhibition of the spinal cord. The postsynaptic hyperpolarizing effect of GABA on motoneurones would be caused directly through increased permeability of the membrane to chloride ion. The depolarizing effect of GABA on primary afferent terminals is discussed in connection with chloride dependency.

Alanine↗

PubMedDate not supplied

End of life in the NICU. A study of ventilator withdrawal.

PURPOSE: Withdrawal of ventilator support occurs commonly in the neonatal intensive care unit (NICU), but few studies have examined the process surrounding this event. This study reviewed the charts of 18 infants who died after ventilator withdrawal. Documentation of process of ventilator withdrawal, medication administration, parental participation in the decision making, and support of the family were examined. DESIGN AND METHODS: Retrospective chart review of all neonatal deaths during the years 1997 to 1998 in two urban hospitals with Level II and Level III NICUs. Seventy-two neonates died during that time period; 18 had died after ventilator withdrawal. Descriptive statistics were used for analysis. RESULTS: We found a lack of clarity and consistency in the documentation in charts of infants who died after ventilator removal. Twenty-two percent of the charts had no written orders for ventilator removal; only two-thirds of the infants were receiving pain medication in conjunction with ventilator removal; 83% of the charts had a notation about parental participation in the ventilator removal. Regarding support, most charts documented support from family or clergy; however, no charts documented the emotional or social support given by nurses to the families. CLINICAL IMPLICATIONS: Improved provision of and documentation of pain and symptom management upon ventilator withdrawal are needed. More clearly written orders for ventilator termination are suggested. Improved documentation of the support provided by nurses to parents of dying infants is recommended.

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PubMedDate not supplied

Evaluation of low level laser therapy on primary healing of experimentally induced full thickness teat wounds in dairy cattle.

OBJECTIVE: The purpose of this study was to evaluate the effect of low-level laser therapy (LLLT) on sutured wounds of the teat in dairy cattle. STUDY DESIGN: By using the Latin square design, the effect of LLLT was evaluated by radiography, measurement of microcirculation flow, histopathology, tensiometry, and hydroxyproline analysis. ANIMALS OR SAMPLE POPULATION: Sixteen teats of four dairy cattle. METHODS: Full thickness wounds were made on the cranial surface of the teats. Teats were distributed into four groups; group A and B wounds were closed with a Gambee pattern, group C and D wounds were closed with three-layers of continuous suture pattern. Group B and D wounds were treated with 3.64 J/cm2 of LLLT using a helium-neon system continuous wave (632.8 nm) output of 8.5 nW. RESULTS: The teat wall in non-LLLT groups was significantly thicker than in LLLT groups on day 7, 14 and 21. The mean blood flow differences between control and sutured sites in LLLT groups were significantly lower than those in non-LLLT groups. The morphology of the epidermis in LLLT groups more closely resembled the normal epidermis than that of non-LLLT groups. Collagen fibers in LLLT groups were denser, thicker, better arranged and more continuous with existing collagen fibers than those in non-LLLT groups. The mean tensile strength was significantly greater in LLLT groups than in non-LLLT groups. CONCLUSION: The LLLT affects various aspects of the healing process, including minimizing inflammation, formation of edema, improvement of skin regeneration and enhancement of collagen synthesis. CLINICAL RELEVANCE: The LLLT could accelerate healing of sutured wounds of the teat in dairy cattle.

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