Perioperative Care of the Immunocompromised Patient

2005 ◽  
pp. 217-230
Author(s):  
Sandra Peake ◽  
Dhaval Ghelani
Keyword(s):  
Perioperative Care ◽  
Immunocompromised Patient

Perioperative care of the immunocompromised patient

1993 ◽  
Vol 17 (2) ◽  
pp. 207-214 ◽  
Author(s):  
John Yee ◽  
Nicolas V. Christou
Keyword(s):  
Perioperative Care ◽  
Immunocompromised Patient

Perioperative Care in Cancer Surgery

1987 ◽  
Vol 3 (3) ◽  
pp. 463-471
Author(s):  
Jerry C. Johnson
Keyword(s):  
Perioperative Care ◽  
Cancer Surgery

An analysis of malpractice litigation in the surgical management of carotid artery disease

2020 ◽  
Vol 132 (6) ◽  
pp. 1900-1906 ◽  
Author(s):  
Jack J. Haslett ◽  
Lindsey A. LaBelle ◽  
Xiangnan Zhang ◽  
J Mocco ◽  
Joshua Bederson ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Perioperative Care ◽  
Carotid Artery Disease ◽  
Significant Risk ◽  
Search Terms ◽  
Jury Verdicts ◽  
Procedural Error ◽  
Legal Databases ◽  
The Difference ◽  
Artery Disease

OBJECTIVECarotid artery disease is a common illness that can pose a significant risk if left untreated. Treatment via carotid endarterectomy (CEA) or carotid artery stenting (CAS) can also lead to complications. Given the risk of adverse events related to treating, or failing to treat, carotid artery disease, this is a possible area for litigation. The aim of this review is to provide an overview of the medicolegal factors involved in treating patients suffering carotid artery disease and to compare litigation related to CEA and CAS.METHODSThree large legal databases were used to search for jury verdicts and settlements in cases related to untreated carotid artery disease, CEA, and CAS. Search terms included “endarterectomy,” “medical malpractice,” “carotid,” “stenosis,” “stenting,” “stent,” and combinations of those words. Three types of cases were considered relevant: 1) cases in which the primary allegation was negligence performing a CEA or perioperative care (CEA-related cases); 2) cases in which the primary allegation was negligence performing a CAS or perioperative care (CAS-related cases); and 3) cases in which the plaintiff alleged that a CEA or CAS should have been performed (failure-to-treat [FTT] cases).RESULTSOne hundred fifty-four CEA-related cases, 3 CAS-related cases, and 67 FTT cases were identified. Cases resulted in 133 verdicts for the defense (59%), 64 settlements (29%), and 27 plaintiff verdicts (12%). The average payout in cases that were settled outside of court was $1,097,430 and the average payout in cases that went to trial and resulted in a plaintiff verdict was $2,438,253. Common allegations included a failure to diagnose and treat carotid artery disease in a timely manner, treating with inappropriate indications, procedural error, negligent postprocedural management, and lack of informed consent. Allegations of a failure to timely treat known carotid artery disease were likely to lead to a payout (60% of cases involved a payout). Allegations of procedural error, specifically where the resultant injury was nerve injury, were relatively less likely to lead to a payout (28% of cases involved a payout).CONCLUSIONSBoth diagnosing and treating carotid artery disease has serious medicolegal implications and risks. In cases resulting in a plaintiff verdict, the payouts were significantly higher than cases resolved outside the courtroom. Knowledge of common allegations in diagnosing and treating carotid artery disease as well as performing CEA and CAS may benefit neurosurgeons. The lack of CAS-related litigation suggests these procedures may entail a lower risk of litigation compared to CEA, even accounting for the difference in the frequency of both procedures.

A Unique Case of Cutaneous Cunninghamella infection in an Immunocompromised Patient (Preprint)

2020 ◽  
Author(s):  
Mauricio Portillo ◽  
Shyam Allamaneni ◽  
Richard Goodman
Keyword(s):  
Fungal Infections ◽  
Immunocompromised Patient ◽  
Lymphocytic Leukemia ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Unique Case ◽  
Systemic Complications ◽  
Prompt Treatment ◽  
Mode Of Transmission ◽  
And Control

UNSTRUCTURED Cunninghamella species are an extremely rare cause of fungal infections. The usual mode of transmission is through inhalation however rare cases of cutaneous spread have been reported. The objective of this clinical case report is to highlight the uniqueness of which the patient acquired the infection, the progression, and control of it. A 57-year-old male with chronic lymphocytic leukemia was found to have an abscess next to his peripherally inserted central catheter (PICC) line. The abscess culture grew back Cunninghamella and was debrided and treated with a novel antifungal. The fungal infection was controlled and the total timeframe took 28 days. Rapid recognition and prompt treatment demonstrate the prevention of rapidly progressive angioinvasian and further systemic complications. This case also proves that a novel antifungal may be appropriate in controlling the spread of Cunninghamella species.

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