Stop the One-Time Money Grabbing

May 17, 2011

Representative Brett Geymann (R-Moss Bluff) has authored a House Resolution (HR27) that prohibits our legislators from using one-time money to pay recurring operating expenses without a two-thirds vote.  One-time money is prohibited from being used in that way according to our Louisiana Constitution yet our legislators have found ways to move that money into funds that are accessible.

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One-time money is money that, once spent, will not be replaced.  For example, it may be money made from the sale of a prison or other state property.  This is not regular income for the state and many believe should not be relied on for regular expenses but should go toward roads, etc..

 

Using one-time funds has created the financial mess we’re in now and continues to contribute to the growing state budget.

 

By passing this resolution, Geymann expects to force our lawmakers to become “more accountable.”  He has stated that they rely on that money now and it’s become an addiction to use it to cover recurring expenses.

 

Governor Jindal has opposed this resolution because spending this money is an easy fix to some of our budget woes.  In his campaign, he promised that he would stop this bad habit in Baton Rouge.  He’s currently stating that this money would help cushion the state’s deficit but other lawmakers believe it’s got to stop and spending has to be brought under control.

 

Please contact your representative today and ask him/her to vote “Yes” on HR27 which goes to the House Floor tomorrow, Wednesday, May 18th.  You can find your representative and contact information by visiting the Louisiana Legislature website.

The early days of gall bladder surgery.(EARLY DAYS)(Clinical report)

The Journal of Perioperative Practice April 1, 2010 | Ellis, Harold Interestingly, it was a physician, not a surgeon, who first suggested operative treatment for this condition. John Thudichum, physician and lecturer on pathological chemistry at St Thomas’s Hospital, London, studied the chemical composition of gall stones and published a treatise on this subject. In 1859 he published a paper in which he suggested that the surgeon could fix the fundus of the gall bladder to the anterior abdominal wall through a small incision, allow adhesions to form between the two, then open the gall bladder, extract the calculi and the resultant fistula would then heal spontaneously. Eight years later, in 1867, this was to be carried out by John Stough Bobbs, who was apparently unaware of Thudichum’s article.

Bobbs was the foundation Professor of Surgery in the Indiana Central Medical School, Indianapolis–then pretty well at the extremity of the American Far West. The operation was carried out, not in a hospital operating theatre, but in a third floor room above a drug store, which Bobbs would hire when he needed somewhere to operate. gallbladdersurgerynow.com gall bladder surgery

The surgery was performed under chloroform, the use of which Bobbs had become expert during the American Civil War, but without any regard to antiseptic precautions; Joseph Lister was to publish his paper on antisepsis that very same year.

[ILLUSTRATION OMITTED] The patient was a lady of 30 years of age who presented with a large painful mass in the right side of the abdomen, thought to be an ovarian cyst. At laparotomy, a cystic mass was found, with adherent omentum. When opened, it yielded clear fluid and between 40 and 50 calculi were evacuated. (Obviously it was mucocele of the gall bladder). Apart from a good deal of trouble with urinary retention and some superficial wound infection, she made a good recovery and outlived not only her surgeon, but six of the eight doctors who were present at this historic operation!

Bobbs published a detailed account of his success the following year, (1868), in a local journal, the Transactions of the Indiana State Medical Society, but another 10 years were to pass before there were further reports of the procedure. Marion Sims, of New York, published a successful case and introduced the term ‘cholecystotomy’ for the operation, (Sims is best known for his pioneer work on the surgery of vesicovaginal fistula). This was followed by reports of the operation by a succession of famous surgeons – Theodor Kocher of Berne, Switzerland, W W Keen in Philadelphia and Lawson Tait in Birmingham. It was only after many years that John Bobbs received the well-deserved accolade for his surgical ‘first’.

The operation of cholecystotomy, although relatively simple and safe, and, indeed, sometimes carried out today to drain an acutely inflammed and adherent gall bladder, had the disadvantages of recurrent infection, residual stones and, often, of a persistent discharging biliary fistula. It was not until 1882 that the first operation for removal of the gall bladder-cholecystectomy -was performed. The surgeon was Carl Johann Langenbuch who had already performed another ‘surgical first’, the first nephrectomy for a renal tumour, in 1877. Langenbuch was born in Kiel, Germany, and qualified in medicine at its university at the age of 23. He must have been an exceptional young man, because he was appointed surgeon to the Lazarus Hospital, Kiel, at the age of 27. here gall bladder surgery

He noted that elephants and horses, (and, indeed, the rat and the deer), do not have a gall bladder and concluded that human beings could also survive without this organ. He set about devising the operation in a scientific manner, by cadaver dissections, and , in the post-mortem room, practised an extensive exposure by means of a T-shaped incision. The transverse limb of this was placed along the inferior margin of the liver, while the vertical component ran along the outer border of rectus abdominis. He tied the cystic duct with silk, dissected the gall bladder from its liver bed, aspirated its contents to prevent spillage, and only then transected the cystic duct and removed the gall bladder. After these preliminary autopsy studies, the time came for the clinical experiment.

His patient was a male aged 43, a magistrate’s secretary, who had had repeated attacks of biliary colic and jaundice. He had lost a considerable amount of weight and was on repeated doses of morphine. The operation was performed under strict asepsis and was carried out exactly as in the autopsy experiments; the gall bladder was found to be thickened and contained two cholesterol stones. Recovery was smooth and the patient, two months later, was enjoying his food and had gained 13.5 kilos in weight! In his report, published that same year, 1882, Langenbuch recommended cholecystectomy, after preliminary ligation of the cystic duct, as a less dangerous and more effective treatment of cholelithiasis than cholecystotomy, something to which we would all agree in the great majority of cases.

Langenbuch died in harness in 1901–of peritonitis due to a ruptured appendicitis.

Acknowledgement Provenance and Peer review: Commissioned by the Editor; Peer reviewed; Accepted for publication December 2009.

No competing interests declared Members can search all issues of the BJPN/JPP published since 1998 and download articles free of charge at www.afpp.org.uk. Access is also available to non-members who pay a small fee for each article download.

Correspondence address: Department of Anatomy, University of London, Guy’s Campus, London, SE11UL.

Professor Harold Ellis CBE, FRCS Emeritus Professor of Surgery, University of London; Department of Anatomy, Guy’s Hospital, London Ellis, Harold


1 comments
Robin Edwards
Robin Edwards

Please also call Speaker Jim Tucker at 504-393-5646 or email at larep086@legis.state.la.us and ask for his support. You might also contact the Republican Delegation at the capitol and ask for their support. They can be reached by phone at 225-342-6287 or by email at peayj@legis.state.la.us. Please also contact these representatives to thank them for authoring the resolution: Representative Brett Geymann at 337-491-2315 or larep035@legis.state.la.us Representative Jim Morris at 318-995-6852 or larep001@legis.state.la.us

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