Comparison of da Vinci Robotic Cholecystectomy and Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis of Postoperative Outcomes and Cost-Effectiveness.

Robotic cholecystectomy (RC) using the da Vinci surgical system has been introduced as a potential alternative to the gold standard laparoscopic cholecystectomy (LC) for gallbladder removal. This systematic review aims to evaluate and compare the postoperative outcomes (operative time, bile leak, and postoperative complications) and cost-effectiveness between da Vinci RC and LC. A comprehensive search of electronic databases, including EMBASE, MEDLINE, Cochrane Library, and PubMed, used Medical Subject Headings terms and Boolean operators to identify relevant studies.

Dilated Cardiomyopathy, De Novo Heart Failure, and Cardiogenic Shock With End-Organ Failure in a Patient With No Cardiac History Following a Trial of Amitriptyline.

A 69-year-old female with no cardiac history presented with dilated cardiomyopathy and de novo congestive heart failure, with an ejection fraction of less than 20%. This patient had struggled over the prior six weeks with exacerbation of chronic obstructive pulmonary disease complicated by pneumonia and as such had taken several trials of antibiotics. Four days prior to her presentation, she was prescribed amitriptyline by her primary care physician to help with sleep.

Rare Occurrence of a Symptomatic Persistent Sciatic Artery Aneurysm.

Persistent sciatic artery (PSA) aneurysms are a rare cause of gluteal or lower extremity pain. The persistent sciatic artery is an uncommon congenital vasculature anomaly that presents with variable clinical presentation and is prone to cause an aneurysm, thrombosis, rupture, and possible amputation. Thus, early diagnosis is imperative to prevent further complications.

Virchow's node: a case report of an extremely rare presentation of metastasis of adenocarcinoma with mucinous features from the colon.

Colon cancer is one of the most common causes of cancer-related mortality. Adenocarcinoma with mucinous features accounts for 10-15% of colon carcinoma. Distal nodal metastatic colorectal cancer is uncommon, and metastasis of colorectal cancer to the left supraclavicular lymph node is extremely rare without signs of metastatic organ involvement.

Mental health reform: a practical approach.

This paper outlines a practical and pragmatic approach to containing mental health costs, especially when caring for Medicaid recipients. The role of psychiatrists as primary care gatekeepers in the managed care system is also discussed. We conclude that a single-payor system seems to be the best alternative for timely and quality mental health care, and that early detection via education and screening for families predisposed to substance abuse/mental illness is also beneficial in controlling costs.

Alzheimer's disease: a new hope.

Until recently, the diagnosis and treatment of Alzheimer's disease was limited. This article describes the outcome of new research and advances in the pharmacological treatment of this disease, especially the use of Cognex (tacrine). It also reports on a multicenter study of tacrine we participated in with patients at Raleigh Psychiatric Services, Inc.