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- Veteran Disability Claims: Nexus and IMO Letters
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- Expediting VA Claims – Can it be done?
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- Understand the New Rating for Back and Neck Spinal Disability
- Winning Your Claim For PTSD Disability Benefits
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- Vascular and Bowel Injuries During Laparoscopy
- Factors for Breast Cancer Prognosis and Survival
Bariatric Surgery – A review by Dr. David Anaise, MD
Obesity is a major health problem approaching an epidemic proportions. An NIH consensus conference on the surgical treatment of obesity recommended consideration of surgery in patients with a BMI of greater than 40 kg/m2 without medical complications or a BMI of greater than 35 kg/m2 if a severe comorbidity were present. Nearly all morbidly obese patients with satisfactory postoperative weight loss, experience substantial improvement in the quality of their lives. At present, Roux en Y Gastric Bypass (RYGB) may be the only bariatric operation that has produced durable long-term weight loss at an acceptable level of risk. Complications, either peri-operative or delayed occur frequently. Early recognition of these complications and meticulous attention to details are thus of paramount importance in this group of high-risk patients.
Complications Of Laparoscopic Surgery
This article is written with an attempt to guide physicians and lawyers through the complications of laparoscopic surgery in the hope that such complications will be avoided in the future. My concern is that the explosive growth in the number of laparoscopic surgery procedures and their diversity coupled with insufficient training by surgeons who now perform this procedure have led to many unnecessary complications.
Factors for Breast Cancer Prognosis and Survival
Interest in factors for breast cancer prognosis and survival has been stimulated by the success of systemic adjuvant therapy for early-stage, cancer of the breast. Patients destined for recurrence can be selected for systemic adjuvant therapy, while patients who will not have a recurrence can be spared the morbidity of a treatment that offers no benefit.
For lawyers these factors may help the lawyer to evaluate whether the delay in diagnosis was material.
2 factors are important doubling time and cancer maturity. Doubling time reflects how fast the tumor grew between the time mammography was erroneously read as benign and the ultimate removal of the tumor. Cancer maturity refers to the tendency of tumors to be less differentiated as they grow bigger. Understanding prognostic factors are thus of prime importance in projecting damages.
The enclosed article is based largely on Tumor-Related Prognostic Factors for Breast Cancer William L. Donegan, MD CA Cancer J Clin 1997;47:28-51 and on Retsky, Swartzendruber, Wardwell, Bame. Computer model challenges breast cancer treatment strategy. Cancer Investigation, 12(6): 559-67, 1994.
Vascular and Bowel Injuries During Laparoscopy
David Anaise MD JD discusses common reasons for vascular and bowel injuries during laparoscopy.
This article is based largely on the following articles. The readers are encouraged to read these excellent articles in their totality.
Paul Lin MD Daniel R. Grow MD COMPLICATIONS OF LAPAROSCOPY Obstetrics and Gynecology Clinics Volume 26 • Number 1 • March 1999
Abdominal access complications in laparoscopic surgery Philips PA, Amaral JF Journal of the American College of Surgeons – April 2001 (Vol. 192, Issue 4)
Trocar injuries in laparoscopic surgery Bhoyrul S, Vierra MA, Nezhat CR, Krummel TM, Way LW
Journal of the American College of Surgeons – June 2001 (Vol. 192, Issue 6)
Major vascular injuries during gynecologic laparoscopy Chapron CM, Pierre F, Lacroix S, Querleu D, Lansac J, Dubuisson JB Journal of the American College of Surgeons – November 1997 (Vol. 185, Issue 5)
Myriam J. Curet MD SPECIAL PROBLEMS IN LAPAROSCOPIC SURGERY Surgical Clinics of North America Volume 80 • Number 4 • August 2000