Malpractice Woes: Here Is What You Should Do if You Get Sued.

This article relates the first-hand experience of a surgeon who faced 2 medical malpractice actions separated by 30 years and how each of those experiences affected him. The first episode occurred early in his career and caused anxiety, fear, and anger. The importance of getting support during a medical malpractice event, and the opportunities to do so, are discussed. The timeline of a typical medical malpractice lawsuit and phases of the litigation process are detailed. The authors provide guidance on how to make this process less stressful. The article summarizes medical malpractice lawsuits involving otolaryngologists.

A new mutation of E-cadherin gene in familial gastric linitis plastica cancer with extra-digestive dissemination.

Over a 12-month period, we diagnosed poorly differentiated infiltrative independent-cell gastric adenocarcinoma in two brothers and one sister aged 41 to 47 years. Their father had died from antral cancer at the age of 34 years. These cancers had two characteristic clinical features: rapid course and distant malignant dissemination. In all three patients, polymerase chain reaction-sequencing of the E-cadherin (CDH1) gene of white blood cells identified a heterozygous nonsense mutation of exon 3, producing a stop codon at position 95 (Q95X), resulting in a truncated protein. The alteration of this protein, which plays a crucial role in epithelial cell adhesion, probably explains the clinical expression in this type of familial diffuse gastric cancer.

Prognostic value of histopathological parameters in 51 supraglottic squamous cell carcinomas.

The prognosis for supraglottic squamous cell carcinomas is difficult to establish. A study of 19 histopathological parameters (14 from the primary tumor and 5 from the lymph node metastases) was undertaken in 51 supraglottic epidermoid carcinomas. All patients were subjected to supraglottic horizontal laryngectomy with bilateral functional neck dissection and postoperative radiotherapy. A discriminant analysis was performed to relate the different histopathological variables to 5-year survival. Capsule rupture and the number of metastatic lymph nodes were the only two parameters significantly related to survival (P < .01). Histopathology (in particular, lymph node metastases) proved more effective in predicting patient evolution than TNM staging.

[Application of the gel test using and anti-IgA antiglobulin for the immunologic diagnosis of autoimmune hemolytic anemia with a negative direct Coombs test]. / Application du gel test utilisant une antiglobuline anti-IgA au diagnostic immunologique d'anémie hémolytique auto-immune à test de Coombs direct négatif.

Autoimmune hemolytic anemias (AIHA) are characterized by hyperhemolysis associated with the presence of the immunoglobulins IgG, IgM or IgA on the red cell membrane. These immunoglobulins react as auto-antibodies against the red cell auto-antigens of the patient. The diagnosis is supported by clinical and biological signs of hemolysis, and by the identification of the auto-antibodies using the direct antiglobulin test (DAT). Here we report 14 cases of patients who showed the clinical and biological profile of AIHA, but who gave a negative DAT. We therefore tried to determine the presence of IgA on the red cell membrane with a method more sensitive than the DAT: the gel test using anti-IgA. With such a gel test, we demonstrated that there were IgA auto-antibodies on the red cell membrane in the 14 cases, therefore confirming the diagnosis of AIHA. We discuss the interest of performing a gel test with anti-IgA in each case where AIHA is suspected, but in which a negative DAT has been observed.

[Evaluation of adherence to the regulations for declaration of notification of transfusion reactions with fever and chills. A study of the Association Inter-Régionale du Sud-Est d'Hémovigilance (AIRSEH)]. / Evaluation de la conformité à la réglementation des déclarations d'incidents transfusionnels pour frissons-hyperthermie dans des établissements de santé du sud-est de la France (groupe AIRSEH).

Febrile non-hemolytic transfusion reactions (FNHTR) are the most frequently reported acute adverse effects of blood products, and should be notified within 48 h according to the hemovigilance regulation. In order to study the conformity of these notifications and to search for factors associated with non-conformity, we retrospectively studied all FNHTR notified by voluntary centers of the AIRSEH group from 1st September 1994 to 31st December 1999. Seven hundred and sixty-one FNHTR were registered by 10 centers, most of them were benign (grade 1); 67.8% were non-conform. The non-conformity was associated with the number of biological investigations performed (median number, respectively, 4.24 and 2.94--P = 0.038--in non-conform and conform notifications--P = 0.038) in univariate analysis. Using a logistic regression model, center and severity were the only two factors significantly associated with non-conformity. Different center practices, and in particular the interface between the hospital and the blood bank, may be responsible for the effect center. Moreover, the non-conformity concerns first of all benign FNHTR. A stronger separation between alert and epidemiological surveillance is proposed in order to improve the notifications' conformity.

Immotile cilia syndrome: nasal mucociliary function and nasal ciliary abnormalities.

We present 17 patients with a typical symptomatology of immotile cilia syndrome, seven of them with complete situs inversus. Firstly, a study of the nasal mucociliary transport was made by means of the radioisotopic technique with serum albumin-Tc99m. In all cases there was absence of transport. Secondly, we studied the ultrastructure of the nasal cilia. Defects in the dynein arms were frequently found (65%). In two cases (11%) there were no cilia; in two other cases the cilia were normal, and in another two cases alterations of the central pair of microtubules were seen. Ciliary complexes were detected in all cases. We conclude that in patients with chronic or recurrent infections of the airways without known cause we must initiate a study of the nasal mucociliary transport. If this is absent or decreased, study of ciliary ultrastructure should be carried out. If mucociliary transport is normal, immotile cilia syndrome is ruled out and ultrastructural study of the cilia is not required.

[Laryngocele. Report of a case of giant laryngocele associated with occult papillary carcinoma of the thyroid]. / El laringocele. A propósito de un caso de laringocele gigante asociado a carcinoma papilar de tiroides oculto.

This gross laryngocele caused a chronic obstruction of the upper respiratory airway. Diagnosis become obvious because the aggravation of a chronic bronchopathy slightly developed, which run into a cor pulmonale chronic as well. Incidentally linked with a neck metastasis spread out from a hidden papillary carcinoma of the thyroid gland. The laryngocele was treated by extramucous lateral thyrotomy and the carcinoma removed through subtotal thyroidectomy.

[The influence of age, sex and circadian rhythms on the nasal mucosal in the mucociliary clearance]. / Influencia de la edad, el sexo y los ritmos circadianos sobre el aclaramiento mucociliar nasal.

We have studied the nasal mucociliary transport in 115 normal persons between 5 and 85-years-old. Using vegetable charcoal powder method the transport time varies between 5 and 18 minutes. The mean transport time was 8.35 +/- 2.6 min. Transport time is not variable with age until sixty years, when transport slow down. The mucociliary clearance is faster in female (p = 0.018). In these individuals the transport time is less in the evening-hours (p = 0.01). In men no differences has been noted (p = 0.57).

[Kniest syndrome. An audiological study]. / Síndrome de kniest. Estudio audiológico.

In this syndrome there is a disproportionate dwarfism with kyphoscoliosis, stiffness of the joints, minor facial dysmorphia, myopia and both conductive and sensorineural deafness in 50 percent of patients. It is a dominant autosomic heritable malady of unknown incidence, but both sexes seems equally affected. The patient's condition is diagnosed at birth, because of the short limbs and the enlargement of the joints. In the presented case, diagnosed at birth, the deafness was suppose to be transmissive, owing to the coexistence of a cleft palate, and consequently a grommet was inserted in the tympanum. Only afterwards, when the girl was 12 years old, the cochlear component of the hypoacusis fell in consideration.

[Determination of the phase of synthesis by means of bromodeoxyuridine. Its clinical application in oncology of the head and neck]. / Determinación de la fase de síntesis mediante bromodesoxiuridina. Aplicación clínca en oncología de cabeza y cuello.

Tumour cell kinetics properties studied by the bromodeoxyuridine method, are useful in the prognosis and therapeutic planning of oncologic patients. In this paper the AA. review some clinical applications of this method, with special emphasis on head and neck tumours.

[Melanoma of the nasal cavity]. / Melanoma de fosa nasal.

Presenting a case of nasal Melanoma, in a patient previously diagnosed and treated from Rhabdomyosarcoma of the same nasal cavity. In our Department has been treated with surgery plus thymostimulin (TP-1 Serono) after surgery. Subject reviewed and clinic features, diagnostic difficulties and nowadays immunotherapy commented.

[Granular cell tumor (Abrikossoff's tumor). A review and our experience]. / Tumor de células granulares (tumor de Abrikossoff). Estudio de revisión y nuestra experiencia.

The low incidence of these tumors compelled the AA., after diagnosis of one of laryngeal sitting, to a review of the theme and its literature as well, particularly under the viewpoint of its histogenesis, which has been debatable up to lately. The report is complemented with the study of immunohistochemical tests for NHK, S-100 and specific neural enolase of the specimen.

[Prognostic value of histopathological parameters in epidermoid carcinoma of the vocal cords in T-1 stage]. / Valor pronóstico de los parámetros histopatológicos en el carcinoma epidermoide de cuerda vocal en estadio T-1.

In this paper are studied macro- and microscopically, 14 histopathologic parameters belonging to 37 patients suffering from vocal cord squamous cell carcinoma, stage T-la. All patients were submitted to cordectomy and followed up during a 5 years term, as a minimum. A discriminant analysis was performed in order to establish the relation between histopathologic parameters and local failure. Only two of them were statistically significative (p < 0.01): the structural type and the differential degree of tumor cells. The histopathological study allowed the prediction of 82 percent of local recurrences.

[Study of the vestibulospinal reflex. Clinical applications of posturography]. / Estudio del reflejo vestibuloespinal. Aplicaciones clínicas de la posturografía.

The vestibulo-spinal reflex is of great importance in maintaining balance--hence the interest in evaluating it objectively in patients suffering from vertigo. A review is made of the objective exploratory methods currently available, i.e., static posturography, stimulation posturography, dynamic posturography and craneocorpography. The clinical applications of posturographyare discussed, fundamentally as applied to the diagnosis of central vestibular pathology, treatment planning and evolutive monitoriacion of the patient with vertigo.

[Normal values of nasal mucociliary clearance. Comparison of various techniques and substances]. / Valores normales de aclaramiento mucociliar nasal. Comparación de diferentes técnicas y sustancias.

We have study the nasal mucociliary clearance in 150 normal persons. Four methods have been used: vegetable charcoal powder, saccharin, seroalbumine-Tc99m and pertechnetate-Tc99m. The time and speed of mucociliary nasal transport are related to the solubility of the tracer. The insoluble substances have a faster transport. The mean transport time for charcoal powder is 8.3 +/- 2.6 min. and for the saccharin is 17.4 +/- 5.5 min. The mean velocity for seroalbumine is 8 +/- 1.8 mm/min. and for the pertechnetate is 5 +/- 0.2 mm/min.

[Pathogenic mechanisms of Pseudomonas aeruginosa in chronic suppurative otitis media]. / Mecanismos patogénicos de la Pseudomona aeruginosa en la otitis media crónica supurada.

The increased frequency of Pseudomonas aeruginosa in suppurative chronic otitis media makes this bacillus interesting. We consider the biological pathogenic and biochemical mechanisms, as well as some aspects of the interaction between PA and antibiotic therapy.

[Nasal mucociliary function in children with recurrent infections of the airways]. / La función mucociliar nasal en niños con infecciones recurrentes de las vías aéreas.

Nasal mucociliary function has been studied in 21 children suffering recurrent airway infections. Previously, cystic fibrosis, immune deficits and allergy were discharged. 38 per cent of these patients had alterations in the mucociliary transport and in this group, it was observed an increase of bronchiectasis, permanent rhinorrhea and serous otitis media.

[Comparative study of histology and flow cytometry results obtained in 2 groups of laryngeal tumors, glottic and supraglottic, in T-1 stage]. / Estudio comparativo de los resultados histológicos y de citometría de flujo obtenidos en dos grupos de tumores laríngeos, glóticos y supraglóticos, en estadio T-1.

We studied histophatological parameters and DNA content in 27 supraglottic and 37 glottic T-1 squamous cell carcinoma of the larynx. The DNA content was determined by the Hedley method in paraffin-embedded sections of formalin-fixed blocks in an EPICS Profile flow cytometer. We studied 14 histopathological parameters and only 3 were statistically different in both groups of tumors: Differentiation, infiltrative degree and mitoses. There weren't statistical differences in DNA content (DNA index and proliferation index).

[Endogenous peroxidase activity of the laryngeal epithelium: experimental study]. / Actividad peroxidásica endógena del epitelio laríngeo: estudio experimental.

Twenty vocal cords were studied. The used animals were rabbits. Beta-blockers and beta-stimulants were perfused by the jugular vein. Variations in endogenous peroxidase were observed in electron microscopy. The activity of endogenous peroxidase can be used according to our results as tracer of the autonomic innervation of the vocal cord.