Direct visualization of bile and pancreatic duct pathology is proving to be beneficial in patients where previous techniques have failed. Recent advancements in technology and the development of the SpyGlass system have led to an increased use of cholangioscopy. It is already known that SpyGlass is beneficial in patients with difficult bile duct stones and indeterminate biliary lesions through the use of targeted lithotripsy and visually guided biopsy. Cholangioscopy allows the visualization of hidden stone and guide wire placement across difficult strictures and selective cannulation of the intrahepatic and cystic ducts. It is also demonstrating its utility in investigational applications such as post-liver transplant and primary sclerosing cholangitis stricture treatment, evaluation of hemobilia, and guided radiofrequency ablation of ductal tumors. In addition to having clinical utility, cholangioscopy may also be cost-effective by limiting the number of repeat procedures. Cholangioscopy overall has similar complication rates compared to other standard endoscopic retrograde cholangioscopy (ERCP) techniques, but there may be higher rates of cholangitis. This could be mitigated with prophylactic antibiotic use, and overall, cholangioscopy has similar complication rates compared to other techniques.

Indices of cellular immunity in postpartum Holsteincows with the normal (n = 9) and prolonged (n = 4) uterine involution time were evaluated. Peripheral white blood cells were isolated by lysis from postpartum animals. An indirect immunofluorescence method for staining and flow cytometric analysis was employed to determine the cell subpopulation of lymphocytes. The function assays were also used to examine the activity of lymphocytes and phagocytes. A significant decrease in the lymphocyte absolute number, and subpopulation of T (CD2+, CD4+, CD8+), and B (IgM+) cells in dams with postparturient complications and prolonged uterine involution time was observed. The quantitative changes of immune cells were accompanied by a significant decline of phagocyte functional activity in an iodo-nitro-tetrazolium reductase test and polyclonal lymphocyte activation to phytohemagglutinin in a leukocyte migration-inhibition assay. In conclusion, a significant decrease in the lymphocyte absolute number and subpopulation of T (CD2+, CD4+, CD8+), and B (IgM+) cells was observed and the host defense role of phagocytes and lymphocytes was impaired in cows with prolonged uterine involution, which can increase their susceptibility to infections.

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