Gallbladder Duplication: Case Report of a Rare Congenital Anomaly Treated by Single-Incision Laparoscopic Cholecystectomy in a Pediatric Patient

Introduction: Gallbladder duplication is a rare congenital anomaly. Preoperative diagnosis is essential for prevention of intra operative complications. Based on our review of the literature, this is the first description of gallbladder duplication treated with single-incision laparoscopic surgery (SILS) in a pediatric patient. Case Presentation: A 14 year-old girl presented to the pediatric surgery clinic with a 4-month history of right upper quadrant abdominal pain, nausea, and low- grade fevers. Preoperative imaging revealed gallbladder duplication. The single incision laparoscopic technique was employed. Intra operative ndings included two gallbladders that appeared to share a common wall. There were two parallel cystic ducts that inserted separately into the common hepatic duct. Gross pathology revealed two adjacent gallbladders separated by a thin septum, each with its own cystic duct. The postoperative course was unremarkable, and the patient was without symptoms at the 1 month follow-up visit. Conclusion: Gallbladder duplication is a rare congenital anomaly. This case report demonstrates successful treatment by excision using the single incision laparoscopic approach

Medical Concerns About Physician-Assisted Suicide

The November 8, 1994 passage of Oregon\u27s Measure 16, which permits physicians to comply with the request of a competent adult patient with less than six months to live for a prescription for lethal drugs, has intensified the debate over the legalization of physician-assisted suicide following the defeats of similar initiatives in Washington and California. Subsequent legal challenge to Measure 16 and the present preliminary injunction3 has shown that passage and popularity of a public initiative does not ensure its legality. The issue of physician-assisted suicide is most likely headed for the United States Supreme Court. This Article is intended, however, to review the medical concerns of the legalization of physician-assisted suicide and its potential impact on physicians and patients. The issue merits careful study not simply because of the unique concerns of legalized euthanasia, but also because of its critical relationship to physicians and their care of dying patients

Medical Concerns About Physician-Assisted Suicide

The November 8, 1994 passage of Oregon\u27s Measure 16, which permits physicians to comply with the request of a competent adult patient with less than six months to live for a prescription for lethal drugs, has intensified the debate over the legalization of physician-assisted suicide following the defeats of similar initiatives in Washington and California. Subsequent legal challenge to Measure 16 and the present preliminary injunction3 has shown that passage and popularity of a public initiative does not ensure its legality. The issue of physician-assisted suicide is most likely headed for the United States Supreme Court. This Article is intended, however, to review the medical concerns of the legalization of physician-assisted suicide and its potential impact on physicians and patients. The issue merits careful study not simply because of the unique concerns of legalized euthanasia, but also because of its critical relationship to physicians and their care of dying patients

What Supports Supportive Therapy?

Think of 1896, the year Jacob Freud died, kindling a depression in his son Sigmund which led to The Interpretation of Dreams. To a raucous convention in Chicago, William Jennings Bryan declaimed against the gold monetary standard: You shall not press down upon the brow of labor this crown of thorns, you shall not crucify mankind upon a cross of gold (I). Years later the monetary gold standard was abandoned during the New Deal, but Freud\u27s newly mined pure gold of analysis continued to be an object of adulation and emulation, despite Freud\u27s prediction that its exoteric application would require alloys with the copper of direct suggestion (2). One such alloy is supportive psychotherapy. Wallerstein (3) defines it as an ego-strengthening therapy which uses means other than interpretation or insight to help the patient suppress mental conflict and its attendant symptoms. Bloch deems it a form of treatment for patients with chronic psychiatric conditions for whom basic change is not seen as a realistic goal, and its aim is to sustain a patient who can not independently manage his or her own life (4). Werman describes it as a substitutive form of treatment, one that supplies the patient with those psychological functions that he or she either lacks entirely or possesses insufficiently (5). Until recently, however, supportive therapy was like a neglected patient who had been coming to clinic for many years, but never received the courtesy of a psychodynamic formulation. Only in this decade has it been appreciated as a distinct type of therapy with its particular patients, goals, and techniques, defined by its own ground rules and theory of psychopathology. This paper presents the rationale which underlies supportive psychotherapy and the basis on which it constitutes a distinct type of treatment

Los secanos oleícolas del Bajo Aragón: ¿abocados al abandono?. Primeros resultados del análisis de la cadena de valor

La Denominación de Origen Protegida (DOP) Aceite del Bajo Aragón tiene registradas 22.000 ha, califica en torno a 5,5 millones de litros de aceite de media anual provenientes mayoritariamente de explotaciones tradicionales en secano, en un territorio aterrazado y distribuido entre 77 municipios de Zaragoza y Teruel. El objetivo del trabajo es analizar la rentabilidad del olivar y de las almazaras de la DOP estudiando las cadenas de valor del aceite a granel y envasado con y sin la marca de calidad de la DOP y en producción ecológica. Los primeros resultados muestran que en la mayoría de las explotaciones tradicionales, los ingresos que genera la venta del aceite coinciden con los costes de producción, reduciéndose la rentabilidad de esas explotaciones a la cuantía de las subvenciones que reciben de la PAC.Publishe

Passing of the TORCH: A Medical, Historical, and Social Comparison between Rubella and Zika

A historical analysis and comparison between rubella and zika reveals that neither virus became prominent until their respective congenital syndromes were classified. Rubella was first described in the 1750s but took until 1941 when Norman McAlister Gregg characterized Congenital Rubella Syndrome to become medically significant. Similarly, zika virus was discovered in 1947 but only made headlines in 2016 when its infection during pregnancy was associated with fetal microcephaly. An investigation into the response levels that each virus received following the discovery of their respective congenital syndromes reveals a fascinating correlation. Despite zika being primarily a disease of the developing world and rubella historically being a worldwide disease, with a previously high prevalence in developed countries such as the United States (US), zika was found to have been studied and controlled at a much faster rate than rubella. This correlation is further highlighted by the fact that there are currently no available therapies or vaccines for zika. Using the US as a benchmark, the rubella vaccine was available in 1969 following the rubella epidemic of 1964-1965. However, it would take until 2004 before the US was declared rubella free. When compared to zika, following the 2015-2016 outbreak in the Americas, the incidence of zika in the US went from 10 cases in 2015 to a staggering 36,512 cases in 2016. Remarkably, by the end of the following year, the incidence had dropped to just 666 cases in the states. In 2018, there were only 148 zika cases in the US. A review of Thomas McKeown’s work on population growth, the McKeown Thesis, provides insight into the US’s successful zika control. The Thesis posits that broad-based social efforts at the population level are more significant at affecting public health than narrow-based medical interventions at the individual level. The swift control of zika despite the lack of specific therapeutics suggests the McKeown Thesis’s applications. This presentation provides an in-depth analysis and comparison between the medical, historical, and social components of rubella and zika to demonstrate their ongoing implications and influences on society. This presentation will reflect on the progress and history of medicine within the past century and demonstrate the need for continued vigilance within the medical community

Relationship of Homocysteine level and Comorbidities in VA Patients: A Retrospective Chart Review

Introduction: Elevated serum homocysteine is known to be associated with endothelial dysfunction, which is seen in multiple chronic diseases which include, but is not limited to Alzheimer’s, Dementia, and cardiovascular disease. This necessitated our investigation into serum homocysteine levels in VA patients and their associated comorbid disorders. Our study aimed to investigate comorbidities associated with elevated homocysteine levels, defined by being greater than 15 micromole/liter. Methods: Informatics at the VA was used to obtain a list of 654 patients with homocysteine drawn during the period of the study (7/21/2009 through 12/31/2013) at the John D. Dingell VAMC. Subjects were adults over 18 years of age. Patient gender, BMI, vitals, vitamin supplementation, and associated comorbidities were retrospectively analyzed and documented in an Excel file. The data from the excel file were statistically analyzed using SPSS 25. For each comorbidity and patient characteristic, homocysteine levels were compared using Independent Samples Mann-Whitney U test. Results: After completing statistical analysis of comorbidities commonly found in our Veteran population, those with statistically significant elevated levels (P-value \u3c0.05) of homocysteine were found to be Hypertension (P-value 0.001), Chronic Kidney Disease (P-value \u3c0.001), Dementia (P-value 0.004), Alzheimer’s (P-value 0.018), Peripheral Vascular Disease (P-value 0.046), and male gender (P-value 0.037). Of note, psoriasis was not statistically significant (P-value 0.855). Conclusion: Elevated homocysteine levels are known to be pro-inflammatory, which likely plays a role in their elevation in hypertension, chronic kidney disease, dementia, Alzheimer’s, and Peripheral Vascular Disease, necessitating a need to reduce homocysteine levels to improve patient outcomes

Report of the Committee on Craig Colony

The Craig Colony for Epileptics opened in Sonyea, NY, in January 1896 as “a new form of charity, recently adopted by this State, and is based upon the idea of being, as fully as possible, self-supporting.” Indeed, it was only the second such institution in the United States. This brief report, written in November 1896 by Committee members Dr. Enoch V. Stoddard, William P. Letchworth, and Peter Walrath, is an assessment of the Colony’s first year in operation. Their conclusion that “this experiment on the part of the State has proved, during its first and most difficult year of trial, to be not only justifiable, but such as to meet the further expectations of those who have been most interested in it origin and development” was quite prescient, as the Colony (which was eventually renamed Craig Developmental Center) continued to operate until 1988. In their report, the Committee describes the progress made on renovating the existing buildings of the former Shaker site where the Colony is located and makes a case for construction of a new administration building new dormitories for patients (alternately referred to as inmates), a house and office for the Superintendent, and living quarters for employees, most of whom have had to find lodging in Mount Morris, a village some four miles distant. Much praise is given to the doctors at Craig, who have established meticulous record-keeping based on careful and scientific observation and have made advances in classifying, and thus treating, epileptic patients. Treatment includes occupation (patients engage in real agricultural work, earning $14,230.20 for the Colony in its first year, and other household and technical work), diet (very little meat, lots of fruit and vegetables), and “a common school education” (a school was opened in September 1896 to provide “moral and mental treatment” for the patients.) As medical science progressed and treatments for epilepsy evolved, Craig Colony’s useful life came to an end in the late 20th century, but it became the foundation for the Finger Lakes Developmental Disabilities Services Office based in Rochester, NY. (summary written by Liz Argentieri)https://knightscholar.geneseo.edu/historical-reprints/1024/thumbnail.jp