Spring 2006 Issue

It is estimated that 3-5% of the school-age population in the present day United States has been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and that approximately 60 percent of those so identified will continue to have symptoms throughout their adult life. It is important to understand the underlying causes and potential treatments of this disorder since it has a significant effect on one's ability to participate in society; those diagnosed with ADHD often have difficulty in completing college, maintaing employment, being an effective spouse or parent, and following societal norms. This paper examines the question of whether ADHD is a biologically or environmentally based disorder and the social implications of supporting only one of the two arguments. Support of one approach over the other depends on popular culture, societal values, and the vested interests of those making the assessment at any given point in time. It is concluded that there can be both biological and environmental factors involved in the development of ADHD. By focusing on only one argument, valuable insight into other causes and alternative treatments may be ignored. Consequently, all aspects of the underlying origin and effective management of the disorder should be considered.

As the leading cause of deaths of infants of one month to one year of age, the exact etiology of Sudden Infant Death Syndrome (SIDS) remains uncertain. The initial emphasis on environmental factors such as infant sleeping position and second-hand smoke as the primary cause of SIDS has been replaced by a new focus on the low levels of adult hemoglobin in infants as a biological precursor to this fatal occurrence. Adult hemoglobin is a tetramer protein molecule in red blood cells whose specific structural conformation enables it to carry oxygen from the lungs and release it to the rest of the body. With an altered structure, fetal hemoglobin has an increased affinity for oxygen, facilitating the maternal transfer of oxygen in utero, but decreasing its ability to relinquish oxygen to tissues after birth. Therefore, delayed transition between fetal and adult hemoglobin can hinder the perfusion of oxygen in infants, leading to possible respiratory depression or an increased reliance on passive immunity, conditions that have been shown to increase infant susceptibility to SIDS. Research continues to study the differences in protein structure between each of these molecules as it relates to gene expression, but in the meantime, analysis of fetal hemoglobin levels remains a promising tool in the diagnosis of SIS.

Medicinal bloodletting or venesection is the removal of bloodfrom the body try opening a vein so as to reduce the volume of blood within the body. There were two main bloodletting techniques used during antiquity: venesection, the cutting open of a vein; and cupping. With the advent of more modern times, the methods used in antiquity, though not entirely supplanted by leeching, became less widely practiced. During the Middle Ages 500-1500 AD, barber surgeons were known to use bloodletting as a cleansing and purifying process in bathhouses, sometimes using leeches; the red and white stripes of the barber pole began as bloody and clean rags from bloodletting with a sliver-like bleeding cup on the top. Beginning in the late 1700s, lhe leech became more popular because it caused less pain to tbe patient and was more reliable in regulating the amount of blood removed. However, due to the advent of physiology, pathology, and microbiology in the late 19th century, the leech fell out of favor. In 1960, however, M. Derganc and F. Zdravic, two Slovenian surgeons, revived the leech's use, and it was brought back to the medical field for reconstructive surgeries and microsurgeries. Leeches were and still are used in reattachment surgeries of fingers, toes, legs, ears, noses, and scalps - even in breast reduction. Through the ages, bloodletting bas evolved from bleeding people almost to death, as in George Washington's case in 1799, to the mania of letthing in the 19th century to the controlled use of leeches in microsurgery today. The leech is no longer ubiquitous, but wormed its way back into tbe medical field. Altbough it is doubtful tbat the demand for leeches will ever again place them on the endangered species list, they've assumed a valuable role in the treatment of human disorders.

Atrial fibrillation (AF), a heart rhythm disorder characterized by irregular, fluttering contractions of the atria, causes about 15 percent of the strokes every year in the Unittd State!. Therefore, aggressively treating atrial fibrillation and its underlying causes is a crucial step towards preventing strokes. In recent years, anger and hostility have been suspected to have a direct correlation to the development of atrial fibrillation. One study found that these personality trails were significant predictors of AF. Animal studies on stress and arrhythmias also agree with these findings.

Use of the human growth hormone (hGH) has become surprisingly popular among children of normal height in the United States. Many supporters of hGH believe that taking the hormone can remarkably improve a child's self-confidence and social interactions with others. However, some argue that the long-term physical and psychological effects of taking hGH could be rather harmful. This paper assesses the benefits and risks of giving "normal" children human growth hormones. Strong support is shown against giving "normal" children hGH, due to its potentially dangerous effects. In addition, emphasis is placed on the need of society to rid itself of the idea that shortness is sickness. Instead of changing short individuals to fit a norm, it is essential that society changes its perceptions of what is normal. Ultimately, it is important that individuals become aware themselves of the effects of giving hGH to "normal" children, especially as further research is conducted on the hormone.

This paper discusses the responsibilities of medical professionals in the field of neurosurgery, specifically ethical decisions. Neurosurgery is a very difficult and demanding profession that requires precision of technique and careful planning for success. It also requires an all-encompassing plan for patient care, beginning with diagnosing the patient, recommending imaging studies, planning treatment, operating, determining pathology, and monitoring patient progress. The nervous system is extremely delicate, and intensive six-year residency programs incorporate rigorous study of a vast amount of physiological, surgical, and medical knowledge to obtain proficiency in neurological surgical procedures. At the same time, neurology interns must also learn fundamental ethical practices including proper bedside manner, the equal treatment of all patients, discussion of neurological procedures informatively and professionally with patients, and delivery of bad news to family members in a professional and compassionate manner. The ethical duties of neurosurgeons also include serious issues such as determining brain death, paralysis, and vegetative states, and making decisions regarding treatment plans for inoperable tumors located in areas that contribute to higher thought in the brain. Because the ethical demands on neurosurgery residents are so high, these residents are specifically trained to deal adeptly with difficult ethical dilemmas involving a variety of medical situations.