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Biomedical subjects

K A Kern

Publications and source records attributed to K A Kern.

At least 19 recordsLinked to original sources
PubMed1994

Medicolegal analysis of the delayed diagnosis of cancer in 338 cases in the United States.

OBJECTIVE: To define the frequency, clinical characteristics, and legal outcomes of the delayed diagnosis of cancer leading to negligence litigation. DESIGN: Retrospective review of 338 jury verdict reports from 42 states in the United States. SETTING: State and federal civil court decisions, as reported to litigation survey services, in a 5-year interval from 1985 to 1990. RESULTS: Of 338 cancers divided into 13 major organ sites, breast (38%, n = 127), gastrointestinal (15%, n = 51), lung (15%, n = 50), and head and neck cancers (10%, n = 33) accounted for 80% (270/338) of lawsuits. The average diagnostic delay for 212 cases was 17 months. The median age of patients with delays was 15 years younger than the age of patients presenting with cancer in the general population. For cancers in nine major organ sites, the ratio of mortality for patients filing lawsuits to that for patients with cancer in the general population averaged 3.4:1. The total known indemnity payout was $140.2 million, with an average payout per case of $64,600. At 1 to 3 months of diagnostic delay, jury verdicts largely favored the defense (seven of 11 [65%] defense verdicts); after 6 months of delay, jury verdicts were almost evenly divided between defense verdicts, plaintiff verdicts, and out-of-court settlements. CONCLUSIONS: The delayed diagnosis of cancer leading to negligence litigation is associated with significant indemnity payments, often involves middle-aged patients far younger than the expected age in the general cancer population, and is defensible only in the minority after 6 months of diagnostic delay.

Adolescent↗
PubMed1994

Medicolegal analysis of bile duct injury during open cholecystectomy and abdominal surgery.

To understand the medicolegal impact of bile duct injury, we analyzed 68 cases of biliary injury resulting from open cholecystectomy and abdominal surgery. Cases were litigated within the US civil justice system between 1970 and 1991. Operations resulting in bile duct complications included cholecystectomy for cholelithiasis in 49 patients (72%), common bile duct exploration in 5 patients (7%), and other abdominal operations in 7 patients (10%); 7 operations were of unknown type. The average delay in recognition of injury was 16 days (range 3 to 42). The mortality rate was 18% (12 of 68). Median jury verdict awards in successfully litigated cases were twice that of out-of-court settlements ($500,000 versus $250,000, P = 0.01). Bile duct injury after open cholecystectomy and abdominal surgery has a high mortality rate when diagnosed late, and is expensive to litigate. This review may be useful in defining the medicolegal outcome of similar injuries from laparoscopic cholecystectomy.

Adult↗
PubMed1994

Comparative analysis of complications from I-131 radioablation for well-differentiated thyroid cancer.

BACKGROUND: The decision to extend thyroidectomy to the opposite lobe during resection of well-differentiated thyroid cancer should include an analysis of complications of I-131 radioablation directly related to the thyroid remnant. If significant, then contralateral resection would be indicated. To clarify this issue we studied the incidence of complications of I-131 radioablation in 63 cases of well-differentiated thyroid cancer. METHODS: Retrospective reviews of operative notes, pathology reports, office records, and physician interviews were made. We analyzed operations, complications, and radiation dosing. RESULTS: Procedures included unilateral thyroidectomy, 10 (15.9%); subtotal thyroidectomy, seven (11.1%); near-total thyroidectomy, 25 (39.7%); and total thyroidectomy, 21 (33.3%). The average ablative dose was 101 mCi (range, 30 to 208 mCi). Nineteen percent (12 of 63) of patients had complications including radiation thyroiditis (eight), chronic sialoadenitis (one), odynophagia (one), facial edema (one), and shingles (one). Near-total or total thyroidectomy resulted in significantly fewer complications compared with lesser resections (8.7% versus 47.1%, p < 0.005). CONCLUSIONS: The incidence of complications of I-131 radioablation after thyroidectomy for well-differentiated thyroid cancer is related to the extent of thyroidectomy performed. We recommend contralateral thyroid resection (resulting in a near-total or total thyroidectomy) in patients likely to receive postoperative I-131 radioablation.

Adolescent↗
PubMed1994

Medicolegal perspectives on laparoscopic bile duct injuries.

Information from medical litigation serves as an important educational tool for surgeons. We believe that clinicians should be actively involved in a medico-legal analysis of bile duct injuries because it is the clinical expert witness who is called on to educate the lay jury regarding the standards of care in laparoscopic surgery. Ultimately, the strengths or weaknesses of the experts' arguments, as interpreted by the injury, determine the legal outcome of malpractice claims. Although the civil justice system proscribes the method by which litigation is adjudicated, it does not dictate the medical standards serving as benchmarks for treatment. Indeed, clinicians themselves dictate standards of medical care in surgical injuries accompanied by litigation. For this reason, clinicians are justified in their intense interest in the medicolegal aspects of these cases. At the same time, the reader is forewarned that this review focuses on medical factors of bile duct injury and on ideas that are empirically derived from analysis of past negligence litigation. As befits the role of an interested clinician only, no attempt is made to be advisory or complete on matters of case law.

Bile Ducts↗
PubMed1993

Changing role of splenectomy for hematologic disease.

In the past decade the development of accurate imaging and the evolution of the medical management of hematologic diseases has led to changes in the indications for splenectomy for these disorders. To assess the impact of these developments, a multi-institutional, retrospective review was undertaken. One hundred fifty-six splenectomies were performed for hematologic disorders between July 1, 1979 and June 30, 1991. Patients were divided into 2 groups: those undergoing splenectomy from 1979-1985 (Period I), and those undergoing splenectomy from 1986-1991 (Period II). Diseases were classified into 3 groups: cytopenic/anemic conditions, symptomatic splenomegaly, and Hodgkin's disease. Data was compared between the two periods using chi-square analysis. More splenectomies were performed for hematologic disorders during Period II than Period I (P < .005). This increase is secondary to a rise in the number of splenectomies performed for cytopenia/anemia during Period II. In contrast, splenectomies for splenomegaly and Hodgkin's disease decreased during Period II (P < .005 and < .05). More Hodgkin's patients were upstaged on the basis of positive laparotomy findings in Period II, compared to Period I (40% versus 10%, P = .01). Surgeons are now performing more splenectomies for cytopenic/anemic diseases, and fewer for splenomegaly and Hodgkin's disease. These results are consistent with recent trends: (1) earlier splenectomy in patients with cytopenia/anemia; (2) earlier medical intervention in infiltrative splenic disorders; and (3) more reliance on radiologic staging in Hodgkin's disease and widespread use of combination chemotherapy, leaving surgical staging for those cases in which treatment would be changed by laparotomy findings.

Adult↗
PubMed1993

Medical malpractice involving colon and rectal disease: a 20-year review of United States civil court litigation.

To determine objectively the causes of malpractice litigation involving colon and rectal disease, a retrospective review was undertaken of all cases tried in the U.S. federal and state civil court system over a 21-year period from 1971 through 1991. Ninety-eight malpractice cases were identified from a computerized legal data base, involving 103 allegations of negligence. Allegations fell into five major categories: 1) failure to timely diagnose disease, principally colorectal cancer and appendicitis (n = 44/103; 43 percent); 2) iatrogenic colon injury (n = 25/103; 24 percent); 3) iatrogenic medical complications during diagnosis or treatment (n = 16/103; 15 percent); 4) sphincter injury with fecal incontinence, resulting from anorectal surgery or midline episiotomy (n = 10/103; 10 percent); and 5) lack of informed consent, especially regarding extent of procedures or risk of endoscopy (n = 8/103; 8 percent). These data may aid in design of risk prevention strategies related to the diagnosis and treatment of colorectal disease.

Anal Canal↗
PubMed1993

Medicolegal analysis of errors in diagnosis and treatment of surgical endocrine disease.

BACKGROUND: The medicolegal impact of adverse events in surgical endocrine disease has not been described previously. This study was undertaken to determine the causes, costs, and outcomes of endocrine malpractice litigation. METHODS: Jury verdict reports from the U.S. civil court system from 1985 through 1991 were reviewed. Sixty-two malpractice cases were identified from 21 states. RESULTS: The 62 cases were classified into three categories, totaling 63 adverse events: (1) complications (n = 34, 54%) from thyroid (n = 32, 51%) or parathyroid (n = 2, 3%) surgery; (2) delayed diagnosis (n = 22, 35%) of thyroid cancer (n = 11, 18%), adrenal tumors (n = 9, 14%), and hyperparathyroidism (n = 2, 3%); and (3) medical morbidity (n = 7, 11%) from radioactive iodine (n = 5, 8%) or from propylthiouracil (n = 2, 3%). Surgical injuries, mostly recurrent nerve injuries by general surgeons, accounted for the greatest number of cases and the highest cost of litigation. CONCLUSIONS: Medical malpractice involving endocrine disease results in expensive litigation, a result of serious harm. Technical misadventures account for most cases, followed closely by delays in diagnosis. These data may aid design of risk prevention strategies in endocrine disease.

Costs and Cost Analysis↗
PubMed1992

Causes of breast cancer malpractice litigation. A 20-year civil court review.

To determine objectively the patient and physician factors that lead to breast cancer malpractice litigation, a review was undertaken of all cases tried in the US federal and state civil court system over a 20-year period from 1971 through 1990. Forty-five cases were identified and all involved a delayed diagnosis of breast cancer (the mean delay was 15 months). The patients were young (mean age, 40 years). Of 45 cases studied, the majority of patients (37 [82%]) found a painless mass by self-examination of the breast. Only 22 patients (49%) had further workup, mostly by mammography (20 [44%]). The results of 16 mammograms (80%) were read as normal. Obstetricians and gynecologists were involved in the greatest number of cases (21 [50%]), followed by family practitioners and internists (17 [41%]), general surgeons (12 [28%]), and radiologists (4 [10%]).

Adult↗
PubMed1991

[14C]deoxyglucose uptake and imaging in malignant melanoma.

Since malignant tumors utilize more glucose than normal tissues, tumor uptake and autoradiographic imaging studies using the 14C-labeled glucose analog 2-deoxyglucose (DG) provide a useful preclinical system to determine if similar human tumors will image in vivo with positron emission tomography (PET) using 18F-labeled DG (FDG-PET). We studied B16 murine melanomas of increasing metastatic potential (F1, low; BL-6, intermediate; F10, high) as a feasibility study to determine the potential for human melanoma imaging using FDG-PET. Male C57BL-6 mice (50 g) were implanted sc with 1-mm3 fragments of B16 melanomas. Fourteen days later mice were injected ip with 1.25 muCi of [14C]DG. Sixty minutes later tumor (T) and gastrocnemius muscle (M) were harvested, solubilized, and counted for [14C]DG dpm/mg to estimate glucose utilization. Autoradiographic imaging was carried out similarly, using 2.0 muCi or [14C]DG with 30-day exposure of T and M tissue sections (20 microns thick) to X-ray film. The uptake of [14C]DG (expressed as dpm/mg; % injected dose/g; and tumor-to-muscle uptake ratios) was 6 to 10 times higher in tumors than in muscle tissue (P less than 0.001). All three melanoma cell lines imaged successfully with [14C]DG autoradiography. Tumor uptake of [14C]DG did not correlate with increasing metastatic potential. The experimental B16 murine melanomas F1, BL-6, and F10 extract glucose at higher rates than muscle tissue, a property necessary for successful PET imaging of cutaneous melanoma. The lack of correlation between glucose extraction and metastatic potential suggests that the demands for glucose during tumor growth and metastasis are not related. This is the first laboratory study to predict that human malignant melanoma will image with FDG-PET.

Animals↗