Annual Survey of Virginia Law: Professional Responsibility

This year, like many years, has been marked by increasing public concern over legal ethics. Public attention has been drawn to lawyers\u27 participation in scandals such as the misuse of funds by the Department of Housing and Urban Development, the collapse of the savings and loan industry, and numerous ethical breaches by members of Congress

Economic Policy After a Lost Decade--from Over-Spending to Innovation

In this article, I want to focus on one aspect of our economic recovery-namely, how do we grow an economy without relying upon debt-fueled overconsumption? I argue that the magnitude of the 2007-2009 collapse was based significantly on unsustainable spending that had propped up the previous expansion. National policy during the first years of the last decade turned a sizable national surplus into a huge deficit through war spending, tax cuts, and expansion of public programs that were not paid for.The spending patterns of American families followed a similar pattern in which traditional savings rates shrunk precipitously while family debt expanded. The combination of deficit spending at the federal level and expansion of family spending, fueled by savings reduction and overuse of debt, had a positive effect on economic growth while it lasted. But the trend could not continue.So now, as the economy is once again growing, we have to make sure that growth occurs in a way that is sustainable

Local Franchising: What Role Will Localities Play in the Regulations of the Telecommunications Industry? Will They Become Providers of Telecommunications Service to the Public?

Good morning, everybody. I am Tony Gambardella with the firm of Woods, Rogers & Hazelgrove in Richmond--formerly with the State Corporation Commission. We started yesterday\u27s discussion with the promise of the Telecommunications Act of 1996. The main promise was, as of February 8, 1996, Congress had deregulated the telecommunications industry. The problem with the promise is that Congress retained some regulation within the industry. We have regulation at the federal level. We have a huge state role and this morning we are going to add another level--local government. Local governments have a role under the Act. There is some dispute now about what the role is and how big it is or how small it is. We have a panel this morning that will discuss those issues and I hope they will give you a good feel for where that controversy is and how it might be resolved

Case Reports1. A Late Presentation of Loeys-Dietz Syndrome: Beware of TGFβ Receptor Mutations in Benign Joint Hypermobility

Background: Thoracic aortic aneurysms (TAA) and dissections are not uncommon causes of sudden death in young adults. Loeys-Dietz syndrome (LDS) is a rare, recently described, autosomal dominant, connective tissue disease characterized by aggressive arterial aneurysms, resulting from mutations in the transforming growth factor beta (TGFβ) receptor genes TGFBR1 and TGFBR2. Mean age at death is 26.1 years, most often due to aortic dissection. We report an unusually late presentation of LDS, diagnosed following elective surgery in a female with a long history of joint hypermobility. Methods: A 51-year-old Caucasian lady complained of chest pain and headache following a dural leak from spinal anaesthesia for an elective ankle arthroscopy. CT scan and echocardiography demonstrated a dilated aortic root and significant aortic regurgitation. MRA demonstrated aortic tortuosity, an infrarenal aortic aneurysm and aneurysms in the left renal and right internal mammary arteries. She underwent aortic root repair and aortic valve replacement. She had a background of long-standing joint pains secondary to hypermobility, easy bruising, unusual fracture susceptibility and mild bronchiectasis. She had one healthy child age 32, after which she suffered a uterine prolapse. Examination revealed mild Marfanoid features. Uvula, skin and ophthalmological examination was normal. Results: Fibrillin-1 testing for Marfan syndrome (MFS) was negative. Detection of a c.1270G > C (p.Gly424Arg) TGFBR2 mutation confirmed the diagnosis of LDS. Losartan was started for vascular protection. Conclusions: LDS is a severe inherited vasculopathy that usually presents in childhood. It is characterized by aortic root dilatation and ascending aneurysms. There is a higher risk of aortic dissection compared with MFS. Clinical features overlap with MFS and Ehlers Danlos syndrome Type IV, but differentiating dysmorphogenic features include ocular hypertelorism, bifid uvula and cleft palate. Echocardiography and MRA or CT scanning from head to pelvis is recommended to establish the extent of vascular involvement. Management involves early surgical intervention, including early valve-sparing aortic root replacement, genetic counselling and close monitoring in pregnancy. Despite being caused by loss of function mutations in either TGFβ receptor, paradoxical activation of TGFβ signalling is seen, suggesting that TGFβ antagonism may confer disease modifying effects similar to those observed in MFS. TGFβ antagonism can be achieved with angiotensin antagonists, such as Losartan, which is able to delay aortic aneurysm development in preclinical models and in patients with MFS. Our case emphasizes the importance of timely recognition of vasculopathy syndromes in patients with hypermobility and the need for early surgical intervention. It also highlights their heterogeneity and the potential for late presentation. Disclosures: The authors have declared no conflicts of interes

Local Environmental Regulations and Property Value

联邦、州和地方政府保护环境的立法将在20世纪90年代呈现连续爆炸性增长趋势。（20世纪）70-80年代，联邦和州政府通过了大量旨在保护空气、水、土地及濒危物种的法规。在接下来的10年里，地方政府将更加主动积极地使用地方权力，对那些州或联邦法律保护不足的方面提供环境保护。译者单位：厦门大学评估研究中心（361005