Increased rate of cholecystectomies performed with doubtful or no indications after laparoscopy introduction: a single center experience

Background During recent years laparoscopic cholecystectomy has dramatically increased, sometimes resulting in overtreatment. Aim of this work was to retrospectively analyze all laparoscopic cholecystectomies performed in a single center in order to find the percentage of patients whose surgical treatment may be explained with this general trend, and to speculate about the possible causes. Methods 831 patients who underwent a laparoscopic cholecystectomy from 1999 to 2008 were retrospectively analyzed. Results At discharge, 43.08% of patients were operated on because of at least one previous episode of biliary colic before the one at admission; 14.08% of patients presented with acute lithiasic cholecystitis; 14.68% were operated on because of an increase in bilirubin level; 1.56% were operated on because of a previous episode of jaundice with normal bilirubin at admission; 0.72% had gallbladder adenomas, 0.72% had cholangitis, 0.36% had biliodigestive fistula and one patient (0.12%) had acalculous cholecystitis. By excluding all these patients, 21.18% were operated on without indications. Conclusions The broadening of indications for laparoscopic cholecystectomy is undisputed and can be considered a consequence of new technologies that have been introduced, increased demand from patients, and the need for practice by inexperienced surgeons. If not prevented, this trend could continue indefinitely.

The Blue Highway

The Blue Highway is a collection of eleven literary short stories and ten miniatures that depict men in trouble, searching for a code to live by. The miniatures are repressed memories, appearing suddenly like the tips of ice bergs and act as stepping stones (tension bridges) between the larger works. The stories begin at the end with "Time Out", the story of Frank, a down and out homeless vet at the end of his rope. Then we begin the journey along "The Blue Highway" with Danny and his gang of teenage bandits, taking themselves to Disney World to see if they can recapture their lost dream. On our journey we will meet Mark, the ex-killer, an old Cuban fisherman who will not give up his honor, a young man on a way to a war who discovers a fantastic treasure, a soldier on his way home again, two MP's who nearly kill the wrong man, we will spend a night on an African savannah with wild hyenas and finally, meet a grandfather who discovers the one gift which might save his family. The same gift which might save Frank as well. ^

La ciudad, el poeta y su familia melancolica (Poesia Chilena de los ultimos 50 anos)

This dissertation explored the relationship among poets, cities, and the construction of nation-ness. It was an interpretive reading of Chilean poetry and Chilean-ness as a way of inventing the nation from its very origins, starting with the colonial epic poem La Araucana and the founding of Santiago, its capital city. In this dissertation, poetry not only dealt with cities or "city poets" but also with the very conception, drafting, and systematic invention of cities as a "dream of order". The construct of a "community" of Chileans has maintained family ties with "Melancholy" in the collective imagination. This structure of melancholy reinforced the idea of "an order and a community" passed along by poets through generations. This dissertation also explored the moment when this melancholic family was fractured, divided, and Santiago was darkened by the events of September 11, 1973 and the rise of dictatorship, brutality, and censorship. ^ The methodology employed to examine different aspects of the construction of the city-nation included theoretical approaches such as Benedict Anderson's idea of nations as "imagined communities," Ángel Rama's analysis of Latin American urban rationality in his book The Lettered City , and the idea of the poet as an urban seer or visionary, the "flâneur" studied by Walter Benjamin in Charles Baudelaire's poetry. A central finding was that this "imagined community" have been severely transformed since 1950. In Chilean poetry, two works served as major referents: Pablo Neruda's Canto General, a totalizing idea of collective identity carved from the stones of the ruins of Machu Picchu, and Nicanor Parra's Poemas y Antipoemas (1954), which begun to illustrate the slow "decomposition" of the "The Lettered City." Among such conflicting images of (post-)modernity, poet Enrique Lihn became the central counter-figure who put an end to a long tradition of producing canonical nation-building cultural artifacts. His book El paseo Ahumada (1983) impacted the new generations of Chilean poets. The conclusion brought together the five-century history and diverse poetic experiences of the traditional Lettered City with the latest currents of marginalized urban poetry (1987-2003), the so-called "barbarians," flâneurs who were (re)inventing Chilean-ness in the globalized, and anti-Utopian city of "Sanhattan." ^

The political economy of poverty alleviation strategies. The initiative for heavily indebted poor countries in Bolivia: More of the same

In the year 2000, approximately 1.1 billion people lived in extreme poverty while developed countries spent US$600 billion a year on defense. The Heavily Indebted Poor Countries (HIPC) Initiative is a recent component of a larger poverty reduction strategy supported by the International Financial Institutions, as well as many developed and developing countries. By implementing lessons of the past fifty years, this program attempts to diminish misery around the globe. As such, it provides debt relief while seeking to enable the poorest countries to simultaneously attain sustainable debt and promote human development. Interest in poverty reduction around the globe reemerged in the 1990s. This study contributes directly to this recent effort by presenting a nuanced approach that builds on the stepping-stones generated by other poverty scholars. To fulfill its goal, this investigation applies a political economy framework. Within this framework, the author conducts an actor-specific analysis. This dissertation addresses the following question: How do domestic and international actors respond to the implementation of poverty alleviation strategies? The author assumes actors desire to maximize their utility calculation and suggests these calculations are based on the player's motivations and external influences. Based on their motivations, the external influences, and the initiative's guidelines, each actor develops a set of expectations. To fulfill those expectations, stake holders utilize one or several strategies. Finally, the actors' ability to achieve their expectations determines each player's assessment of the initiative. The framework described is applied in an in-depth, actor-specific analysis of the HIPC in Bolivia. Bolivia's National Revolution represents the country's first attempt at reducing poverty. Since then, all governments have taken specific steps to combat poverty at the local and national levels. The Initiative for Heavily Indebted Poor Countries (HIPC) is one of the most recent macro strategies of this kind. The case study demonstrated that three factors (national ownership, effective sponsorship and the local context) determine the success levels of poverty reduction strategies from abroad. In addition, the investigation clearly shows that poverty reduction is not the sole motivation in the implementation of poverty alleviation strategies. All actors, however, share the dream of poverty reduction.

The blue highway

The Blue Highway is a collection of eleven literary short stories and ten miniature that depict men in trouble, searching for a code to live by. The miniatures are repressed memories, appearing suddenly like the tips of ice bergs and act as stepping stones (tension bridges) between the larger works. The stories begin at the end with "Time Out", the story of Frank, a down and out homeless vet at the end of his rope. Then we begin the journey along "The Blue Highway" with Danny and his gang of teenage bandits, taking themselves to Disney World to see if they can recapture their lost dream. On our journey we will meet Mark, the ex-killer, an old Cuban fisherman who will not give up his honor, a young man on a way to a war who discovers a fantastic treasure, a soldier on his way home again, two MP's who nearly kill the wrong man, we will spend a night on an African savannah with wild hyenas and finally, meet a grandfather who discovers the one gift which might save his family. The same gift which might save Frank as well.