Management of patients with symptomatic gallstones: a quantitative analysis

Article Abstract:

The risk of death associated with different approaches of managing patients with gallstones, stone-like structures in the gallbladder or bile ducts, was evaluated. One approach consisted of immediately using cholecystectomy, surgical removal of gallstones, to treat patients who experienced symptoms such as biliary pain. Another approach, the expectant management strategy, was to delay cholecystectomy until pain recurred or the patient developed a biliary complication such as pancreatitis, inflammation of the pancreas, or cholecystitis, inflammation of the gallbladder. Using the expectant management strategy, death from gallstone disease in a 30-year-old man was estimated at two percent, with most deaths occurring after the age of 65 years. With immediate cholecystectomy, it was estimated that death due to gallstone disease was only 0.1 percent, but all deaths would occur at age 30 years. The average amount of life expectancy gained by immediate cholecystectomy compared with expectant management was 23 days. This gain could be improved by using nonsurgical therapies, such as dissolution of gallstones by drugs or lithotripsy, a method for crushing gallstones. Similar results were obtained for women. The life expectancy gain of immediate cholecystectomy and nonsurgical therapy is small, and the risk of complications due to gallstones may be so low that an expectant management approach may be acceptable. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Patient outcomes, Mortality, Gallstones

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Wanted: a contract for home ownership

Article Abstract:

The Republican Party's 'Contract With America' has fueled a debate on what the 'American Dream' is really all about. It is widely acknowledged that homeownership is a vital part of this dream. Unfortunately, owning a house by age 34 is no longer possible for many Americans. According to the Harvard Joint Center for Housing Studies' 'The State of the Nation's Housing' report, only 1.28 million out of the total 11.1 million renter households with household heads between the ages of 25 and 34 have the financial resources to buy their own houses. This means that nearly 90% of all young American renters are being denied their dream of homeownership. To address this problem, the Livelihood Systems Institute has proposed the Home Ownership Plan. This program would enable young renter to become homeowners with the help of their employers' voluntary contributions.

Planning, Home ownership

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France

Article Abstract:

White Bordeaux, Champagne, Languedoc-Roussillon/Corbieres, Languedoc-Roussillon/Vin de Pays d'Or and other wines are rated on a scale of one to 100, with prices and tasting notes provided. A 1995 Chateau Laville Haut Brion Pessac-Leognan is rated 91.

Evaluation, Buyers Guide, Wine

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