Cells were recorded in the midbrain central gray neuropil of the cat that responded with action potentials only during fighting behavior and not while the cat was resting or while control manipulations were performed. Some other cells in the same region responded maximally during fighting, and all cells responded to at least one manipulation. Brain stimulation at sites of cells related to fighting caused the animals to hiss.

Action Potentials↗

PubMed1968

The activity of single cells in the midbrain and hypothalamus of the cat during affective defense behavior.

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Animals↗

PubMedDate not supplied

Bile duct complications after laparoscopic cholecystectomy.

A retrospective review and analysis of patients referred to the Division of Gastroenterology and the Section of Gastrointestinal Surgery with common bile duct complications after laparoscopic cholecystectomy was undertaken in order to identify injury patterns, management, and outcome. Sixteen patients were identified over a 20-month period. Twelve patients had major common bile duct injuries and four had minor injuries (cystic duct leaks). Seventy-one percent of injuries occurred with surgeons who had done more than 13 laparoscopic cholecystectomies. Eighty-three percent of patients who had major ductal injury did not have a cholangiogram prior to the injury. Sixteen percent of patients with major common bile duct injuries had findings of acute cholecystitis and 58% of these major injuries were "easy" gallbladders. One-third of major injuries were recognized at operation. Two-thirds of immediate repairs failed. All cystic duct leaks were managed nonoperatively. It appears that bile duct complications after laparoscopic cholecystectomy are more common in the community than is reported. Bile duct complications occur with surgeons who are experienced and inexperienced with laparoscopic cholecystectomy. Common bile duct injuries, unrecognized at laparoscopic cholecystectomy in the majority of cases, usually occur with "easy" gallbladders. Operative cholangiography is not utilized in the majority of common bile duct injuries. When immediate repair of common bile duct injuries is undertaken, the majority are unsuccessful. Endoscopic retrograde cholangiopancreatography (ERCP) is invaluable in the diagnosis and management of bile duct complications. Cystic duct leaks may be managed successfully with endoscopic stents.

Adult↗

PubMedDate not supplied

Reporting of preliminary data: time to take our sonographers "off the hook".

The article by McDonald et al. points out the widespread demand for preliminary reporting of echocardiographic data by sonographers, at least in the setting of physicians in training. Such preliminary reporting is illegal in most states because it constitutes the unauthorized practice of medicine. In most states it is also illegal for physicians to authorize sonographers to do such preliminary reporting because it aids and abets the unauthorized practice of medicine. Such practices also likely violate federal Medicare statutes. Lastly, the practice is simply not fair to patients who are deserving of final diagnostic information. Now that we know the practice is widespread among physicians in training, we can conjecture that the demand for improper reporting of diagnostic data by sonographers is likely widespread among physicians in practice also. Now is the time to check your local statutes, change the way your practice works, and adopt a clear policy for reporting of diagnostic echocardiographic and Doppler data.

Allied Health Personnel↗

PubMedDate not supplied

Interpretation of echocardiographic data: are physicians and sonographers violating the law?

When a sonographer renders diagnostic interpretations from echocardiographic data, the possibility exists that state statutes concerning the unauthorized practice of medicine may be violated. Problems likely exist in this regard when the sonographer renders such interpretations without proper physician interaction or when the physician delegates such responsibilities to the sonographer. In such situations the physician may be guilty of aiding and abetting the unauthorized practice of medicine. Such practices may also violate various reimbursement rules and policies. Given such a situation, even the rendering of preliminary results by sonographers without appropriate supervision by the physician may be in violation of various state statutes and rules governing reimbursement procedures.

Echocardiography↗

PubMedDate not supplied

Hemodynamics for the sonographer.

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Aorta↗

PubMedDate not supplied

Outcome of lateral pancreaticojejunostomy in the management of chronic pancreatitis with nondilated pancreatic ducts.

Lateral pancreaticojejunostomy has demonstrated variable success in the management of chronic pancreatitis associated with ductal dilation, but its role in patients with nondilated ducts is poorly defined. The aim of this study was to assess the outcome of lateral pancreaticojejunostomy in chronic pancreatitis with nondilated pancreatic ducts. The records of all patients who underwent lateral pancreaticojejunostomy with a pancreatic duct measuring less than 7 mm in diameter were reviewed. Seventeen patients underwent lateral pancreaticojejunostomy for chronic pancreatitis and intractable pain between 1995 and 1996. Endoscopic retrograde cholangiopancreatography demonstrated features of chronic pancreatitis that were mild in seven patients, moderate in five, and severe in four. Postoperative complications occurred in two patients (11.7%). There were no deaths. Mean length of follow-up was 10.3 months (range 3 to 16 months). Rehospitalization for recurrent pancreatitis or pain was necessary in 59% of patients. Emergency room visits were reported by 76%. Narcotic use continued in 88%, with 76% of the patients reporting their pain as the same or worse than before the operation, and 65% continuing to view their health status as poor. In chronic pancreatitis patients with a nondilated pancreatic duct, lateral pancreaticojejunostomy appears to be of little benefit with respect to pain relief, subsequent hospitalization, continued narcotic use, or overall health status.

Adult↗