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Publications (6)8.14 Total impact

  • The American surgeon 06/2014; 80(6):179-181. · 0.92 Impact Factor
  • The American surgeon 01/2014; 80(6). · 0.92 Impact Factor
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    ABSTRACT: Objectives: Previous analyses have noted perceived deficits in informed consent (IC) in many otolaryngology malpractice lawsuits. However, no comprehensive analysis of IC in malpractice litigation across surgical specialties exists. Our objectives were to 1) examine IC in litigation across surgical specialties and 2) characterize factors in determining legal responsibility.
    Otolaryngology Head and Neck Surgery 08/2013; 149(2 Suppl):P152-P153. DOI:10.1177/0194599813496044a34 · 1.72 Impact Factor
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    ABSTRACT: General surgery is a "high-risk specialty" with respect to medical malpractice rates, and appendicitis is one of the most common diagnoses encountered by practitioners. Our objectives were to detail issues affecting malpractice litigation regarding appendicitis and appendectomies, including outcomes, awards, alleged causes of malpractice, and other factors instrumental in determining legal responsibility and increasing patient safety. Publically available federal and state court records were examined for pertinent jury verdict and settlement reports. Information from 234 pertinent cases was collected, including alleged causes of malpractice and outcomes. Of the 234 cases included in this study, the most common factor noted was an alleged delay in diagnosis (67.1 %), followed by intraoperative negligence (16.2 %). Alleged deficits in informed consent, although only specifically cited as a cause of malpractice in 1.3 % of cases, were found to be an important aspect of many cases. In total, 59.8 % of cases were ruled in favor of the physician, 23.7 % in favor of the plaintiff, and 5.5 % reached a settlement. The average plaintiff award was US$794,152, and the average settlement award was US$1,434,286. An important strategy to decrease liability in a physician's practice is prompt evaluation of an appendicitis patient. An integral part of this is efficient communication between physicians practicing a wide variety of specialties, especially including practitioners in emergency medicine and general surgery. Additionally, completing a thorough informed consent explaining all aspects of the procedure including the factors we outline will not only increase patient awareness of potential risks but also protect the physician in the face of litigation.
    Journal of Gastrointestinal Surgery 08/2013; DOI:10.1007/s11605-013-2248-8 · 2.36 Impact Factor
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    ABSTRACT: Cystic epithelial lesions such as Rathke's cleft cysts (RCCs) and craniopharyngiomas may be difficult to distinguish on a clinical, radiographic, and sometimes histopathological basis. We describe a case of a giant 6.5 cm suprasellar cystic lesion that was presumed to be a craniopharyngioma based on the neuroimaging findings. The lesion extended from the anterior skull base and sella turcica to the lateral ventricle and sylvian fissure resulting in obstructive hydrocephalus. Complete surgical removal of the suprasellar lesion was achieved using an extended frontotemporal transbasal skull base approach. Intraoperatively, the cyst wall was thickened and partially calcified, resembling a craniopharyngioma. However, the histopathological examination revealed findings most consistent with a RCC with additional features of extensive squamous metaplasia, metaplastic bone formation, and chronic inflammation. The case raises the issue of whether there is a pathologic continuum of parasellar ectodermal lesions which may account for the overlap of features and transitional states. In this report, we discuss the possible spectrum between RCCs and craniopharyngiomas, and also emphasize the importance of complete resection of the cyst wall in RCCs that exhibit squamous metaplasia, inflammation, or ossification to minimize the probability of recurrence.
    07/2012; 73(5):324-9. DOI:10.1055/s-0032-1304814
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    ABSTRACT: Pituitary apoplexy in patients with adrenocorticotropic hormone (ACTH) producing tumors is a rare occurrence. We report four patients with Cushing's disease harboring ACTH-secreting macroadenomas who presented with pituitary apoplexy. We report the endocrinologic and visual outcomes of these patients after emergent transsphenoidal surgery. A retrospective chart review was performed in 4 patients who presented with pituitary apoplexy from hemorrhage into an ACTH-secreting pituitary adenoma. The patient charts were reviewed for clinical presentation, neuroimaging findings, intraoperative surgical findings, pathologic findings, and postoperative endocrinologic and visual outcomes. All patients presented with acute headaches, nausea, vomiting, and visual loss from optic compression. MR imaging demonstrated a hemorrhagic macroadenoma that was confirmed at surgery. All patients underwent emergent transsphenoidal decompression (within 24 h of presentation). One of these underwent an additional craniotomy to resect residual tumor. Postoperatively, all patients showed significant improvement in visual acuity and visual fields with biochemical remission confirmed on laboratory testing. Significant weight loss as well as resolution of diabetes and hypertension was noted in all cases. All four patients remained in biochemical remission at their most recent follow-up visit (mean 40 months, range: 24-72 months). Excellent endocrine and visual outcomes can be achieved after emergent transsphenoidal surgery in patients with Cushing's disease presenting with pituitary apoplexy. Although the cure rates of non-apoplectic ACTH macroadenomas are generally poor, higher rates of remission can be achieved in cases of pituitary apoplexy. This may be partly due to the effects of tumor infarction.
    Pituitary 09/2011; 15(3):428-35. DOI:10.1007/s11102-011-0342-z · 2.22 Impact Factor