Adam Ostrzenski

What is the role of the medical consultant and expert witness during the litigation process associated with cerebral palsy (CP)? To address this question, a review was undertaken of the world literature published on CP between 1861 and 2004. The appropriate Medical Subject Heading terms were selected and used in a search of the MEDLINE, ACOGNET and Cochrane Library databases. Also, a manual search was performed. A total of 3,168 articles on CP were reviewed. Of them, 143 met the inclusion/exclusion criteria. Analysis of the pertinent articles revealed that this is the first article to address the role of the medical consultant. The literature on CP is predominantly observational studies. At best, they can be qualified as grade C in the ranking of evidence-based medicine. A clinical study on CP cannot be well designed methodologically because of ethical and technical problems. There is no literature available to determine the role of the consultant in CP cases. The appraisal of suboptimal obstetric care should not be omitted or dismissed when present. Preconceived conclusions about causation based simply on the poor outcome of a child should be avoided. A well-documented hypoxic-ischemic brain insult during the antenatal period does not automatically exclude intrapartum suboptimal obstetric care. Lack of uniformity in policies among U.S. hospitals on umbilical cord and newborn blood gas analysis (<1 hour of neonatal life), fetal membrane microbiologic cultures and placental histology creates difficult tasksfor medicolegal reviewers. Lack of vital diagnostic elements will limit the objectivity of a consultant and expert witness. The human emotional aspect plays a significant role in reaching a jury verdict for plaintiffs, regardless of the weakness of a case.

Obstetricians & Gynecologists, Family Physicians After completion of this article, the reader should be able to summarize the reported rates of ureteral injury, to identify the location of the more common laparoscopic ureteral injuries, and to list the various types of laparoscopic ureteral injuries.

To establish the consecutive steps in and evaluate the safety and effectiveness of laparoscopic total abdominal hysterectomy (L-TAH) (hysterectomy completed via laparoscopy, with no transvaginal approach by the suturing technique) in a group of morbidly obese women and to compare the results to a group of nonobese women with clinically similar characteristics and indications for hysterectomy. Eleven morbidly obese women were subjected to a L-TAH with no vaginal approach. The operation was executed by suturing and tying an extracorporeal sliding knot and by using intracorporeal two-turn flat square knot methods. The consecutive steps of the operation were changed from the original to facilitate this procedure. The group of morbidly obese women was compared to a group of nonobese women. All the subjects exceeded their ideal body weight by 100%. Their actual weight ranged from 118.9 to 139.8 kg, and their height ranged from 58 to 69 in. All the planned surgery was completed, and no intraoperative or postoperative complications were observed. There was no conversion from the laparoscopic approach to a laparotomy or transvaginal path. When compared to that in the control group, the mean operating time was significantly longer in morbidly obese subjects. L-TAH is safe and effective for morbidly obese women.