Moral enhancement and the good life

One approach to defining enhancement is in the form of bodily or mental changes that tend to improve a person’s well-being. Such a “welfarist account”, however, seems to conflict with moral enhancement: consider an intervention that improves someone’s moral motives but which ultimately diminishes their well-being. According to the welfarist account, this would not be an instance of enhancement—in fact, as I argue, it would count as a disability. This seems to pose a serious limitation for the account. Here, I elaborate on this limitation and argue that, despite it, there is a crucial role for such a welfarist account to play in our practical deliberations about moral enhancement. I do this by exploring four scenarios where a person’s motives are improved at the cost of their well-being. A framework emerges from these scenarios which can clarify disagreements about moral enhancement and help sharpen arguments for and against it.

     

Muslin granuloma presenting with speech disturbance diagnosed by endoscopic biopsy

Clinical report  We report the case of a 56 year-old woman who presented with worsening speech and poor seizure control eleven years after undergoing wrapping of a middle cerebral artery aneurysm. Radiological and histological findings were consistent with a muslin granuloma with a large cystic component. The cyst was drained endoscopically and an Omaya reservoir placed. The patient’s speech improved and so did their seizure control. Discussion  This is the first case in which this rare complication of aneurysm surgery has caused speech deterioration. This is also the first case in which neuroendoscopy has been successfully employed to obtain tissue for diagnosis and to treat such a lesion.     

Fate of retained capsule: a pathognomonic for surgery

Since its introduction in 2001, Wireless Video Capsule enteroscopy is gaining acceptance due to its high diagnostic potential and minimal risk. In some centers, it offers an alternative approach to visualize the small intestine and to evaluate patients with suspected small bowel disease. We present a series of known complications of this procedure and call for a more proactive role in the management of retained capsule.     

Quantification of periodontal pathogens by paper point sampling from the coronal and apical aspect of periodontal lesions by real-time PCR

The present study compared the recovery of six periodontal pathogens by paper point samples from two different aspects of periodontal lesions by quantitative real-time polymerase chain reaction (PCR). Twenty patients with untreated chronic periodontitis were randomized into two groups. Before subgingival instrumentation and after 10 weeks samples in group A were taken first with a paper point half length (HP) of the probing depth, then with a paper point full length (FP) at the same site. In group B sampling sequence was reversed. Analysis by real-time PCR enabled quantification of six bacteria as well as total bacterial count (TBC). Statistical analysis included t test, Kappa, and Spearman’s correlations. Higher TBC could be harvested by use of FP than by HP (mean of differences of ln-transformed counts before therapy: ?0.791, CI [?1.515, ?0.068], SD 0.770, p?=?0.034; after therapy: ?0.563, CI [?1.151, 0.024], SD 0.625, p?=?0.059). The plaque composition regarding total target pathogens was similar for both samples. Both, for TBC as well as for single target bacteria a strong positive correlation was found between HP and FP (Kappa, Spearman correlation: Aggregatibacter actinomycetemcomitans 0.807, 0.778; Fusobacterium nucleatum 0.573, 0.772; Porphyromonas gingivalis 0.733, 0.824; Prevotella intermedia 0.480, 0.756; Treponema denticola 0.807, 0.814; and Tannerella forsythia 0.692, 0.695). The recovery of target pathogens was similar following sampling at various depths of the periodontal lesion.     

Initial experience with a new laparoscopic ultrasound probe for guided biopsy in the staging of upper gastrointestinal cancer

Background  Until recently, laparoscopic ultrasound (LUS)-guided biopsy has been difficult with the available probes on the market. This study aimed to present a new laparoscopic ultrasound probe (Hitachi, EUP-OL531) for guided biopsy and describe its impact on the clinical outcome for patients with upper gastrointestinal (UGI) cancer. Methods  Patients referred with confirmed UGI cancer from June 2003 to December 2006 were included in the study. After a standard workup including computed tomography, endoscopic ultrasound, and ultrasound of the neck, operable patients underwent LUS with or without fine-needle aspiration (FNA). Results  From a total of 175 patients, 19 (11%) underwent LUS-guided FNA after a significant lesion was found. The LUS-guided FNA confirmed distant metastasis in 14 of the 19 patients and changed the clinical management for these 14 patients (8%). There were no adverse events due to LUS or LUS-guided FNA. Conclusion   The current results with the new LUS probe for guided FNA are encouraging in terms of its diagnostic ability, safety, and ease of use.     

Laparoscopic donor nephrectomy in the presence of vascular anomalies: evaluation of outcome

PURPOSE: In this study we show the outcome of laparoscopic kidney donation for donors and recipients in cases of donors with vascular anomalies. MATERIAL AND METHODS: We consider donors to have vascular anomalies if they have multiple arteries or venous abnormalities. Fifty-six cases had double renal arteries (left side n = 52, right side n = 4). Three patients had triple renal arteries. Eighteen cases had venous anomalies (retro-aortic renal vein n = 11, double renal vein n = 4, circum-aortic renal vein n = 2, atrophic proximal renal vein, n = 1). Two donors had multiple abnormalities (double renal arteries, double renal veins, and a retro-aortic renal vein in one case, and double renal artery and double renal vein in one case). Donor surgery was done transperitoneally in all cases, using three trocars on the left side and four on the right side. Outcome in these cases is compared to the outcome in cases with no vascular abnormalities (n = 321) performed in our institution. RESULTS: The total number of patients with vascular anomalies in our series is 79 (19.7%). All cases were completed laparoscopically. The mean operative time was 161 +/- 35 minutes. The mean blood loss was 65 +/- 38 mL, and no donor required blood transfusion. Mean warm ischemia time was 2.6 +/- 0.4 minutes, mean renal artery length was 3.1 +/- 0.4 cm, and mean renal vein length was 3.5 +/- 1.2 cm. Donors were discharged on the second postoperative day, and no donor required readmission. Kidneys were transplanted successfully and mean creatinine of the recipients on discharge was 1.3 +/- 0.3 mg/dL. Five patients had acute tubular necrosis; however, only one of them required dialysis (delayed graft function). Kidney function recovered thereafter in all patients. There were no significant differences in blood loss, warm ischemia time, donor hospital stay, or patient creatinine on discharge, between patients with vascular abnormalities in donors and those without vascular abnormalities in donors. However, operative time was significantly longer in donors with vascular abnormalities. CONCLUSION: Laparoscopic donor nephrectomy is safe for donors with vascular anomalies. Donors benefit from a less morbid procedure with no effect on functional outcome.