Nephrectomy

Definition

A nephrectomy is a surgical procedure for the removal of a kidney or section of a kidney.

Purpose

Nephrectomy, or kidney removal, is performed on patients with severe kidney damage from disease, injury, or congenital conditions. These include cancer of the kidney (renal cell carcinoma); polycystic kidney disease (a disease in which cysts, or sac-like structures, displace healthy kidney tissue); and serious kidney infections. It is also used to remove a healthy kidney from a donor for the purposes of kidney transplantation .

Demographics

The HCUP Nationwide Inpatient Sample from the Agency for Healthcare Research and Quality (AHRQ) reports that 46,130 patients underwent partial or radical nephrectomy surgery for non-transplant-related indications in the United States in 2000. Patients with kidney cancer accounted for over half of those procedures. The American Cancer Society projects that an estimated 31,900 new cases of renal cell carcinoma will occur in the United States in 2003.
According to the United Network for Organ Sharing (UNOS), 5,974 people underwent nephrectomy to become living kidney donors in 2001. The majority of these donors—43.9%—were between the ages of 35 and 49, and 58.8% were female. Related donors were more common than non-related donors, with full siblings being the most common relationship between living donor and kidney recipients (28.5% of living donors).

Description

Nephrectomy may involve removing a small portion of the kidney or the entire organ and surrounding tissues. In partial nephrectomy, only the diseased or infected portion of the kidney is removed. Radical nephrectomy involves removing the entire kidney, a section of the tube leading to the bladder (ureter), the gland that sits atop the kidney (adrenal gland), and the fatty tissue surrounding the kidney. A simple nephrectomy performed for living donor transplant purposes requires removal of the kidney and a section of the attached ureter.

Open nephrectomy

In a traditional, open nephrectomy, the kidney donor is administered general anesthesia and a 6–10 in (15.2–25.4 cm) incision through several layers of muscle is made on the side or front of the abdomen. The blood vessels connecting the kidney to the donor are cut and clamped, and the ureter is also cut between the bladder and kidney and clamped. Depending on the type of nephrectomy procedure being performed, the ureter, adrenal gland, and/or surrounding tissue may also be cut. The kidney is removed and the vessels and ureter are then tied off and the incision is sutured (sewn up). The surgical procedure can take up to three hours, depending on the type of nephrectomy being performed.

Laparoscopic nephrectomy

Laparoscopic nephrectomy is a form of minimally invasive surgery that utilizes instruments on long, narrow rods to view, cut, and remove the kidney. The surgeon views the kidney and surrounding tissue with a flexible videoscope. The videoscope and surgical instruments are maneuvered through four small incisions in the abdomen, and carbon dioxide is pumped into the abdominal cavity to inflate it and improve visualization of the kidney. Once the kidney is isolated, it is secured in a bag and pulled through a fifth incision, approximately 3 in (7.6 cm) wide, in the front of the abdominal wall below the navel. Although this surgical technique takes slightly longer than a traditional nephrectomy, preliminary studies have shown that it promotes a faster recovery time, shorter hospital stays, and less post-operative pain.
A modified laparoscopic technique called hand-assisted laparoscopic nephrectomy may also be used to remove the kidney. In the hand-assisted surgery, a small incision of 3–5 in (7.6–12.7 cm) is made in the patient's abdomen. The incision allows the surgeon to place his hand in the abdominal cavity using a special surgical glove that also maintains a seal for the inflation of the abdominal cavity with carbon dioxide. This technique gives the surgeon the benefit of using his hands to feel the kidney and related structures. The kidney is then removed by hand through the incision instead of with a bag.

Diagnosis/Preparation

Prior to surgery, blood samples will be taken from the patient to type and crossmatch in case transfusion is required during surgery. A catheter will also be inserted into the patient's bladder. The surgical procedure will be described to the patient, along with the possible risks.

Aftercare

Nephrectomy patients may experience considerable discomfort in the area of the incision. Patients may also experience numbness, caused by severed nerves, near or on the incision. Pain relievers are administered following the surgical procedure and during the recovery period on an as-needed basis. Although deep breathing and coughing may be painful due to the proximity of the incision to the diaphragm, breathing exercises are encouraged to prevent pneumonia. Patients should not drive an automobile for a minimum of two weeks.

Risks

Possible complications of a nephrectomy procedure include infection, bleeding (hemorrhage), and post-operative pneumonia. There is also the risk of kidney failure in a patient with impaired function or disease in the remaining kidney.

Normal results

Normal results of a nephrectomy are dependent on the purpose of the procedure and the type of nephrectomy performed. Immediately following the procedure, it is normal for patients to experience pain near the incision site, particularly when coughing or breathing deeply. Renal function of the patient is monitored carefully after surgery. If the remaining kidney is healthy, it will increase its functioning over time to compensate for the loss of the removed kidney.
Length of hospitalization depends on the type of nephrectomy procedure. Patients who have undergone a laparoscopic radical nephrectomy may be discharged two to four days after surgery. Traditional open nephrectomy patients are typically hospitalized for about a week. Recovery time will also vary, on average from three to six weeks.

Morbidity and mortality rates

Survival rates for living kidney donors undergoing nephrectomy are excellent; mortality rates are only 0.03%—or three deaths for every 10,000 donors. Many of the risks involved are the same as for any surgical procedure: risk of infection, hemorrhage, blood clot, or allergic reaction to anesthesia.
For patients undergoing nephrectomy as a treatment for renal cell carcinoma, survival rates depend on several factors, including the stage of the cancer and the patient's overall health history . According to the American Cancer Society, the five-year survival rate for patients with stage I renal cell carcinoma is 90–100%, while the five-year survival rate for stage II kidney cancer is 65–75%. Stage III and IV cancers have metastasized, or spread, beyond the kidney and have a lower survival rate, 40–70% for stage III and less than 10% for stage IV. Chemotherapy, radiation, and/or immunotherapy may also be required for these patients.

Alternatives

Because the kidney is responsible for filtering wastes and fluid from the bloodstream, kidney function is critical to life. Nephrectomy candidates diagnosed with serious kidney disease, cancer, or infection usually have few treatment choices aside from this procedure. However, if kidney function is lost in the remaining kidney, the patient will require chronic dialysis treatments or transplantation of a healthy kidney to sustain life.

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

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If nephrectomy is required for the purpose of kidney donation, it will be performed by a transplant surgeon in one of over 200 UNOS-approved hospitals nationwide. For patients with renal cell carcinoma, nephrectomy surgery is typically performed in a hospital setting by a surgeon specializing in urologic oncology.

Read more: http://www.surgeryencyclopedia.com/La-Pa/Nephrectomy.html#ixzz2jE8Bwpz0

POSTED BY ATTORNEY RENE G. GARCIA

Some of our clients have suffered these kinds of injuries due to a serious accident or malpractice. The Garcia Law Firm, P.C. was able to successfully handle these types of cases. For a free consultation please call us at 1-866- SCAFFOLD or 212-725-1313.

Court Affirms Pain and Suffering Award in Wrongful Death Car Crash Case – Passenger Conscious for 39 Minutes

By John Hochfelder

On August 11, 2008, Elvia Collado was 22 years old and working  as a counselor for developmentally disabled kids while attending college at night. That was the day she died when Waldo Vargas, her boyfriend of three years, crashed his car while driving intoxicated on the Belt Parkway at Springfield Boulevard in Queens. He lost control, hit a tree and killed Elvia who was a front seat passenger wearing a seat belt.
The Crash Scene:

Ambulance personnel responded quickly. Elvia was extricated from the car and rushed to Jamaica Hospital where doctors intubated her and prepared her for surgery to explore what appeared to be massive internal injuries. Tragically, she could not be saved and Elvia was pronounced dead about three hours later.
As administrator of her daughter’s estate, Elvia’s mother brought a lawsuit against Vargas seeking damages for her daughter’s pre-death conscious pain and suffering.The defendant answered the lawsuit denying liability and asserting nine affirmative defenses.
Liability was not a serious issue as Vargas pled guilty to vehicular homicide and eyewitnesses estimated he was traveling at as much as 100 miles per hour. The trial judge therefore directed a verdict in plaintiff’s favor.
At trial, the Queens County jury awarded $549,000 as follows:

1. $250,000 for pain and suffering
2. $275,000 for punitive damages and
3. $24,000 for economic loss

The entire award has been affirmed in Espinal v. Vargas (2d Dept. 2012).
Plaintiff was able to prove that there was pre-death conscious pain and suffering based upon the following testimony of an expert pathologist, William Manion, M.D.:

• EMS personnel at the scene within minutes recorded a Glasgow Coma Score (“GCS”) of 4 and observed that Ms. Collado moaned and groaned in response to questions about pain
• upon arrival at the hospital, it was noted that Ms. Collado was “in acute distress,” her GCS was 5 and she had a low level of consciousness
• the car accident caused various painful injuries including rib fractures, disarticulation of the clavicle, lacerations and hemorrhages to the lungs and abdominal bleeding, all of which, he said, resulted in sharp, terrible pain
• Ms. Collado was conscious for about 39 minutes until she was placed under general anesthesia before surgery

 Inside Information:

• The defendant did not testify, nor did he offer any witnesses.
• In closing arguments, plaintiff’s attorney suggested a pain and suffering damages award of between $500,000 and $1,000,000; defense counsel argued that Ms. Collado was unconscious and unresponsive to pain and therefore he suggested an award of zero.

Read more: http://www.surgeryencyclopedia.com/Ce-Fi/Corneal-Transplantation.html#ixzz2Ym1XPbNh


 POSTED BY ATTORNEY RENE G. GARCIA

Some of our clients have suffered these kinds of injuries due to a serious accident. The Garcia Law Firm, P.C. was able to successfully handle these types of cases. For a free consultation please call us at 1-866- SCAFFOLD or 212-725-1313.

Court Affirms Increase in Pain and Suffering Verdict for Leg and Wrist Injuries By John Hochfelder on October 27, 2013 Posted in Leg Injuries, Wrist Injuries On August 2, 2007, Anthony Deandino, then a 25 year old ironworker, was a passenger on a motorcycle being driven by his friend Robert Munsen at the intersection of Colonial Road and 78th Street in Brooklyn. Proceeding through the intersection, they were struck by a city bus that failed to stop at a stop sign. Both were ejected from the motorcycle and landed in the street. Deandino was rushed by ambulance to a nearby hospital where he was diagnosed with several broken bones. In his ensuing lawsuit, plaintiff’s motion for summary judgment was granted; the owner of the bus (the city’s transit authority) and its driver were held fully liable for the accident. The matter then proceeded to a trial on damages only. On November 10, 2010, a Kings County jury awarded Deandino pain and suffering damages in the sum of $750,000 ($250,000 past – 3 years, $500,000 future – 46 years). Both sides appealed – plaintiff claimed that the award was inadequate and the defendant claimed that it was excessive. In Deandino v. New York City Transit Authority (2d Dept. 2013), the appeals court ruled that the past pain and suffering award should be increased by $150,000 so that the total for pain and suffering was set at $900,000 ($400,000 past, $500,000 future). Here are the injury details: displaced left femur fracture – requiring open reduction internal fixation surgery with a metal rod, extending from the hip to the knee, implanted and secured with metal screws comminuted, displaced radius and ulna fractures – requiring open reduction internal fixation surgery with two metal pates and 15 screws dislocation of left elbow that ruptured connecting ligaments avulsion of left fingertips requiring surgical repair fractured ribs and pulmonary contusion post-traumatic stress disorder (PTSD) Deandino was hospitalized for three weeks immediately following accident and underwent two years of outpatient physical therapy. Several medical witnesses testified for plaintiff, including his orthopedic surgeon Joseph Walsh, M.D., a physiatrist and a psychologist. They discussed the severity and permanence of plaintiff’s injuries (including weakness, atrophy and the likelihood of arthritis developing in both his leg and arm) as well as his inability to return to work, despite his stoic nature and refusal to complain of pain or disability. In addition to pain and suffering damages, the jury awarded Deandino about $1.7 Million for past and future loss of earnings (including lost pension, health insurance and annuity benefits); the appellate court, though, reduced that sum by $283,000 because the jury disregarded to that extent the testimony and evidence as to the actual amounts for past loss of earnings. The jury determined that plaintiff’s future work-life expectancy was 33 years. Finally, the jury also awarded (and the appellate court affirmed) $465,000 for future medical expenses (over plaintiff’s 46 year life expectancy). The defense denied the legitimacy of all of plaintiff’s future economic damages, insisting that he had recovered from his injuries. Inside Information: Defendant was sanctioned $2,500 for its failure to timely produce a system safety report that included objective data downloaded from the bus’s event recorder showing the bus had passed through the stop sign at 11 m.p.h and continued at full throttle to the point of impact where it had reached 20 m.p.h. It was after production of the event data report on December 24, 2008, that the defendants conceded liability and a judge granted plaintiff’s motion for summary judgment. Despite the severity of his injuries, Deandino began looking for work within months of the accident and in early 2008 he landed a job as an ironworker, albeit on light duty. After about six months, though he was unable to continue and never again returned to any type of employment. Before the accident, Deandino had taken and scored well on the examination to become a New York City fire fighter; in the summer of 2009, he took and passed the FDNY’s grueling candidate physical ability test and, before trial, ran in four 5K road races. It was the FDNY’s examining surgeon that the appellate court mentioned as an expert who was precluded from testifying at the trial. The defense wanted his testimony that when he examined Deandino on August 26, 2008, he was physically capable of being a fireman; however, the plaintiff argued, successfully, that the failure until trial was underway to give notice of this intended expert witness was prejudicial and unfair. Plaintiff’s expert psychologist believed that plaintiff was delusional or at least highly unrealistic as to his ability to return to work. Plaintiff’s attorney agreed stating that it was the jury’s job to protect plaintiff from himself by awarding him enough loss of earnings damages so that he would not need to try to return to work. In open court, the attorney turned to plaintiff and stated: “You will never be a firefighter.” Plaintiff had been examined before trial by an orthopedic surgeon for the defense (Raz Winiarsky, M.D.) and a neurologist (Maria De Jesus, M.D.); however, only the neurologist was called as an expert witness and plaintiff was granted a so-called missing witness charge as to Dr. Winiarsky permitting the jury to regard negatively the failure to call him as a witness. In closing arguments, plaintiff’s attorney asked the jury to award $3,500,000 for past pain and suffering; he did not request a specific amount for the future. Prior to trial, plaintiff’s settlement demand was $5,000,000; defendants’ offer to settle was $350,000. Deandino’s motorcycle driver, Robert Munsen, died from the injuries he sustained in the accident. Munsen was a close friend and as Deandino was on the street screaming in pain, immobilized by his own injuries, he was unable to offer any aid to Munsen who was several feet away, also on the street, unconscious and dying. Tweet Like Email LinkedIn Comments Tags: Femur Fracture, Post-Traumatic Stress Disorder, Radius, Ulna Damage Awards Affirmed in Wrongful Death Medical Malpractice Case By John Hochfelder on October 22, 2013 Posted in Medical Malpractice, Wrongful Death Hermine Browne, a 58 year old nurse’s aide, was experiencing excruciating stomach pain when she went to see her internist on February 17, 2001. The doctor diagnosed her with irritable bowel syndrome and prescribed medication. Unfortunately, the pain continued (and the same diagnosis was made) through March of 2002 when a sonogram and then a CT scan showed a large cancerous tumor, so extensive that only part could be surgically removed. After several years of treatment for the cancer, the tumor led to Ms. Browne’s death in September 2007. After a four week trial in 2011, a Bronx County jury found that the doctor departed from accepted medical practice by failing to timely order a CT scan in February 2001, thereby resulting in growth of the tumor to the point where it was unresectable and only palliative debulking of the tumor could be performed in May 2002. The jury awarded damages in the sum of $880,000 as follows: pre-death pain and suffering – $325,000 economic loss to children – $555,000 The defendant’s post-trial motion to vacate the jury verdict was granted. The trial judge found that the liability finding was against the weight of the evidence, in particular that the testimony of plaintiff’s expert oncologist was prejudicial and unfair and that plaintiff’s presentation of certain evidence resulted in undue surprise and unfairly prejudiced the defendant. On appeal, in Rose v. Conte, (1st Dept. 2013), the jury verdict has been reinstated in plaintiff’s favor, both as to liability and as to damages. The pre-death pain and suffering verdict was based upon the decedent’s six years of pain, fear and emotional stress prior to her passing. During that time, Ms. Browne – a previously independent, hard-working woman who was the matriarch of a large family - could no longer work, was constantly going to doctors, on extensive medication and in unremitting pain. The defense did not challenge the amount of this award. As to economic damages, Ms. Browne was survived by five adult children ranging in ages from 34 to 42 years. They claimed that their mother’s death resulted in economic damages to them from the loss of her nurture, care and guidance. So-called loss of guidance damages are typically awarded to young children; however, New York law (see Gonzalez v. New York City Housing Authority – Court of Appeals, 1991) provides that there is no prohibition to the award of loss of guidance wrongful death damages to adult children (even when they are financially independent) so long as there is adequate proof that the decedent provided more than occasional services to the children such as shelter, meals, advice and guidance. In this case, one of the surviving children, Richard Donalds (46 years old at the time of trial), was handicapped, having been, as plaintiff’s counsel put it, “grossly deformed [hands, feet and torso] as a result of Thalidomide taken by his mother during her pregnancy.” Richard had lived with his mother who provided extensive services to him including helping him get up when he fell due to his deformed feet, helping him to dress himself (he could not use his hands), cooking, shopping, driving and cleaning his clothes. The jury awarded – and the appellate court affirmed – $500,000 for Richard’s economic loss. Inside Information: Before she died, Ms. Browne had started the lawsuit and trial was underway. She died in the middle of that trial in 2007. A mistrial was declared and a new trial ensued four years later. In closing arguments, plaintiff’s counsel asked the jury to award $1,500,000 for pre-death pain and suffering. The economic loss awards to the adult children included the $500,000 for Richard discussed above plus $25,000 to the son who took over caring for Richard and $10,000 each to the other three siblings in consideration of the spiritual guidance provided to each of them by the decedent. Tweet Like Email LinkedIn 1 Comment Tags: Loss of Guidance, Pre-Death Pain and Suffering Carpenter’s Back Injury Pain and Suffering Verdict Affirmed on Appeal By John Hochfelder on September 30, 2013 Posted in Back Injuries On August 24, 2006, Eric Berrios was a union carpenter working on an 80-story condominium construction project at 735 Avenue of the Americas in Manhattan. He was on the second floor deck, on top of a scaffold, cutting wood and laying out plywood when he fell 20 feet below onto a concrete slab. Berrios was helped up by co-workers who took him by taxi to a local hospital where he complained of pain in his back. His pain continued, he was unable to return to work and Berrios sued the project owner under Labor Law 241(6). He was granted summary judgment on the issue of liability and the matter proceeded to a trial on damages only in February 2011. The jury awarded plaintiff pain and suffering damages in the sum of $600,000 ($375,000 past – five years, $225,000 future – three years). The award has been affirmed in Berrios v. 735 Avenue of the Americas, LLC (1st Dept. 2013). Here are the details of plaintiff’s injuries: treated and released from emergency room with crutches and pain medication next sought medical care about two weeks later at a clinic where he was prescribed a doughnut to sit on to alleviate pain and a back brace treated for two years at clinic with physical therapy three times a week trigger point injections once a month; epidural steroid injections herniated discs at C-5 and C-6 bulging discs in lower back at L3-L5 displaced right coccyx fracture at the sacrococcygeal joint line compression fracture at L-1 Berrios testified that he was in constant pain and could not: sit for long periods of time turn his head without pain in his neck return to recreational football or basketball lift heavy objects Plaintiff’s treating physiatrist, Ali Guy, M.D., testified that plaintiff’s injures were permanent and progressive with traumatic arthritis of the spine already present. The defense medical experts, orthopedic surgeon Maurice Carter, M.D. and neurologist Jerome Block, M.D., testified that plaintiff had healed well and had no residual injuries from the accident and he could still be employed as a carpenter (in “less arduous tasks”). In addition to pain and suffering damages, the jury awarded (and the appellate court affirmed) damages for loss of earnings in the sum of $600,000 ($225,000 past – five years, $375,000 future – three years). Plaintiff had been earning about $75,000 a year before the accident and sought over $5 million for future lost earnings based on his inability to work for the next 28 years. He argued, unsuccessfully, that the jury’s earnings award was irrational because it amounted to $45,000 per year until 2011 and then $125,000 per year thereafter. The jurors apparently agreed with defense arguments that plaintiff could return to work as a carpenter in certain capacities and would be able to earn significant wages over the years. Inside Information: The defendant disputed plaintiff’s claim that he fell over 20 feet onto concrete. There was a statement in the emergency room record that Berrios fell feet first onto a wooden box and then fell onto the concrete floor on his back. Plaintiff denied making such a statement but the trial judge allowed this evidence in and the appellate court affirmed agreeing with the defense that the hospital record statement was “germane to his [plaintiff's] medical diagnosis or treatment.” Experts in vocational rehabilitation and economics testified for plaintiff and opined that his future medical expenses related to the accident would exceed $1.3 million based on present rates. The jury awarded nothing at all for future medical expenses, apparently agreeing with the defense experts that plaintiff had recovered well and needed no medical treatment in the future related to the accident. Past medical expenses (i.e., from the date of the accident to the date of trial) were agreed upon in the sum of $32,131. In his summation, defense counsel argued that Berrios should be awarded at most $20,000 for one year of pain and suffering. Tweet Like Email LinkedIn Comments Tags: "loss of earnings", Bulging Disc, Coccyx, Herniated Disc, Post-Traumatic Arthritis Construction Worker’s Hand Injury Pain and Suffering Award Affirmed By John Hochfelder on September 15, 2013 Posted in Hand Injuries On September 15, 2006, Leonel Pinto was carrying boxes of ceramic tiles down an interior staircase at a construction site in the Bronx. He was a laborer working for a subcontractor on the project at which seven residential buildings were being built on Doris Street. After more than seven hours of carrying boxes from the street into the basement, the 29 year old Pinto slipped (the stairs were wet from rainwater being tracked in) and a box fell on and crushed his hand. The accident site at 1432 Doris Avenue, Bronx, NY: Pinto sustained a significant hand injury, was taken to a nearby hospital and underwent surgery the next day. A lawsuit was brought against the property owner and several related entities claiming they negligently maintained the property and breached their duty to keep it reasonably safe. Following the trial judge’s instruction (full jury charge here) that the jury had to decide if there was “sufficient time before the accident to correct the condition or take other reasonable precautions,” a verdict was rendered in plaintiff’s favor on July 6, 2012. The jurors then turned to the issue of damages and awarded Pinto $600,000 for his pain and suffering ($200,000 past – six years , $400,000 future – 40 years). The defense appealed, arguing that the award was excessive; however, in Pinto v. Gormally (1st Dept. 2013), the award has been affirmed. Here are the details of plaintiff’s injuries: compound mid-shaft fracture of the proximal phalanx of the left (non-dominant) middle finger next day surgery: open reduction internal fixation surgery with three K-wires drilled into the bone; extensor tendon repair on 10/24/06: removal of the K-wires series of epidural steroid and trigger point injections on 12/7/08: cervical radiofrequency sympathectomy on 5/13/09: myoblock (type B) Botox injection on 8/3/09: surgery to remove scar tissue and release contractures of the joints of the left middle finger as well as the left ring and pinky fingers continued severe sharp burning pain, decreased range of motion and clawing resulting in inability to use left hand for activities of daily living K-Wires in Finger Plaintiff’s treating doctor, Salvatore Lenzo, M.D. and the defense expert, Martin Posner, M.D., are both highly respected hand surgeons on staff at the world renowned Hospital for Joint Diseases. Plaintiff also treated with a pain management physician, Gary Thomas, M.D. There were significant disagreements as to the exact nature of plaintiff’s injuries as well as his need for future treatment: Plaintiff’s doctor testified that his injuries from the accident included nerve and hyperextension injuries to his third and fourth fingers (the ring and pinky fingers) leading to joint arthropathy, tendon contractures and complex regional pain syndrome; whereas the defense expert opined that the only injury was a fracture of the middle finger and that the 2009 surgery was not needed. Plaintiff’s doctor testified that he required significant future medical treatment for his injuries including regular radio frequency sympathectomies, epidural, trigger point and Botox injections and physical therapy. The defense expert testified that none of the future procedures would be required. Inside Information: Dr. Thomas had previously testified as an expert for the defense law firm on about three occasions; he’d never before testified for plaintiff’s counsel although he’d been retained by plaintiff’s counsel about 20 times over 15 years to examine clients. Here is the transcript of the testimony of Dr. Thomas in this case. Dr. Posner testified that plaintiff was “trying to deceive me” when he (plaintiff) claimed in a pre-trial medical examination that he could not extend his fingers and that plaintiff’s claim of total disability is “incredible.” In summation, plaintiff’s counsel asked the jury to award $700,000 for past pain and suffering plus another $700,000 for the future. Defense counsel stated “you can’t trust his [plaintiff's] claims on pain and suffering because, as Dr. Posner said, he hasn’t been telling the truth” and he argued that if his client were to be found at fault then damages should be limited simply to the fractured middle finger for the past only with no award for future pain and suffering or future medical expenses. The jury’s $40,000 award for future medical expenses was not challenged on appeal. There was no evidence as to plaintiff’s inability to work as he had withdrawn all claims for lost earnings. Tweet Like Email LinkedIn Comments Tags: Complex Regional Pain Syndrome, K-wires, Phalanges, Radiofrequency, Steroid Injections, Tendon Repair Construction Worker’s Back Injury Pain and Suffering Award Affirmed on Appeal By John Hochfelder on August 27, 2013 Posted in Back Injuries On December 4, 2007, Greg Leszczynski was employed as part of a construction crew digging trenches and installing sewer lines in Grahamsville, New York. He was standing in a trench about nine feet deep where pipe was being laid when a frozen lump of stone, about 18 inches in diameter weighing about 60 pounds, came out of a loader bucket, bounced into the trench and then struck him in the head. Worker in Trench Leszczynski, then 31 years old, was injured and he sued three parties in Sullivan County Supreme Court – the Town of Neversink (the street site owner), the project’s engineering firm (dismissed prior to trial) and IMS Safety, Inc. (the project’s safety consultant). The town settled during the liability phase of the trial and IMS was then found vicariously liable under Labor Law 241(6) due to the negligence of plaintiff’s employer (the general contractor that hired IMS) . At a separate trial on damages, a new jury awarded plaintiff pain and suffering damages in the sum of $175,000 ($25,000 past – four years, $150,000 future - 35 years). On appeal in Leszczynski v. Town of Neversink (3d Dept. 2013), the $175,000 award has been affirmed despite plaintiff’s claim that it was inadequate. Here are the injury details: herniated disc at L5-S1 three epidural steroid injections in 2008 L5 hemilaminectomy (surgical removal of one of the two laminae in a vertebra) and foraminotomy (surgical decompression of nerve roots) on May 25, 2009 back pain causing inability to lift or bend, do chores around the house, cut grass or shovel snow, or engage in previously enjoyed recreational activities such as swimming, snowboarding and weightlifting concussion with severe headaches, continuing through trial Defense counsel argued, persuasively, that plaintiff’s injuries were not as severe as he claimed, his complaints were subjective, he had significant prior related injuries and he had recovered quite well by the time of trial. In support of these claims and to attack plaintiff’s credibility, testimony was adduced and arguments were made by the defense as follows: plaintiff continued to work on the day of and for the two days after the accident before seeking any medical treatment for back pain and headaches within a few months of the accident plaintiff resumed working at a pre-trial deposition, plaintiff testified that the only treatment he ever had for any pre-existing back condition was one emergency room visit 10 years earlier; at trial, though, a chiropractor testified that he treated plaintiff 37 times for lower back pain in 1998 there was no causal relationship between the trauma and the headaches (according to a defense medical expert), an MRI of plaintiff’s brain was normal and headaches are the “quintessential subjective complaints” plaintiff’s herniated disc was treated successfully with surgery which was “minimally invasive,” he was able return to his former employment and had no permanent injury to his back Inside Information: Plaintiff settled with the Town of Neversink for $25,000. In closing arguments, plaintiff’s counsel asked the jury to award $300,000 for past pain and suffering plus $500,000 for the future; defense counsel suggested $150,000 for the past plus $25,000 for the future. The appellate court affirmed awards for loss of earnings in the sums of of $143,700.50 (past) and $100,000 (future – 20 years). After the accident, plaintiff left his heavy duty laborer job for a less demanding one operating a 65 ton loader in a quarry. Tweet Like Email LinkedIn Comments Tags: Concussion, Foraminotomy, Laminectomy Appellate Court Reduces Foot Injury Pain and Suffering Award By John Hochfelder on August 13, 2013 Posted in Foot Injuries, Medical Malpractice On February 8, 2008, Carol Sokol underwent podiatric surgery for bunions on both of her feet. Her doctor, a podiatrist, performed an Austin bunionectomy, a surgical procedure to excise, or remove, a bunion (a bony overgrowth in the foot that causes the big toe to curve outward). Here is a short video showing an Austin bunionectomy with screw fixation, similar to the procedure Ms. Sokol underwent. Unfortunately, Ms. Sokol’s condition was not improved – after surgery her big toe was unable to land on the ground, her second toe curled up like a claw and she could not walk normally. She sued, claiming malpractice. The case went to trial in Manhattan in April 2012 and the jury found that the doctor had been negligent. Ms. Sokol, then 57 years old, was awarded pain and suffering damages in the sum of $900,000 ($300,000 past – four years, $600,000 future – 25 years). The trial judge denied the defendant’s post-trial motion to set aside the future pain and suffering award as excessive The defendant then appealed, again arguing that the damages award was excessive. In Sokol v. Lazar (1st Dept. 2013), the future damages award has been reduced by $150,000 and now stands at $450,000. The past damages award was not challenged with the result that the total award approved by the appellate court is $750,000. Here are the injury details: two additional surgeries required by new physician (to correct the problem with the big toe not landing) development of intractable plantar keratosis – calluses with a deep seated core that are often quite painful to pressure development of cylindrical callus requiring excision permanent foot pain and discomfort limiting exercise (cannot run) and walking continued need for silicone sleeve to pad toes likelihood of arthritic joint in the future causing more pain and requiring surgery to fuse the fifth metatarsal phalangeal joint Inside Information: The defense failed to call an expert so was unable to refute the claims of plaintiff’s expert, Sloan Gordon, D.P.M., as to prognosis. In summations, plaintiff’s attorney asked the jury to award $250,000 for past damages and at least $500,000 for future damages; defense counsel made no suggestions as to damages until the appeal when he argued that the future damages award should be reduced to $100,000. Tweet Like Email LinkedIn Comments Tags: Bunionectomy Court Affirms Pain and Suffering Award Despite Pre-Existing Injury By John Hochfelder on August 4, 2013 Posted in Back Injuries On October 18, 2000, Olga Ortiz slipped on a concrete step on the top of the staircase leading to the Number 6 train at the 28th Street subway station at Lexington Avenue in Manhattan. Ms. Ortiz, a nurse’s aide then 59 years old, fell down the entire staircase and landed at the bottom. A police officer arrived and called for an ambulance. Paramedics placed Ortiz on a stretcher and transported her to Bellevue Hospital where she received minor treatment before being released that day. Claiming that she sustained a permanent back injury due to a broken and unsafe step that was missing a piece of cement, Ortiz sued the New York City Transit Authority (the subway station operator). The defendant, however, contended that the stairway was safe and properly maintained and that the accident was caused by plaintiff’s failure to watch her steps. In September 2011, the jury found that the transit authority was liable for the accident and awarded pain and suffering damages in the sum of $400,000 ($300,000 past – 11 years, $100,000 future – 10 years). On appeal in Ortiz v. New York City Transit Authority (1st Dept. 2013), the defendant’s claim that the award was excessive has been rejected and the $400,000 damage award has been affirmed. Here are the injury details: herniated disc at L3-4 bruised coccyx lumbar radiculopathy epidural steroid injections and 12 months of physical therapy and chiropractic treatment permanent back and coccyx pain inability to bend, walk, sit or lift without severe pain The defense argued that plaintiff’s pain and limitations were due to a prior incident when, two years earlier, she sustained two herniated discs in her back attempting to lift a 200 pound patient at a nursing home. She’d undergone extensive chiropractic treatment and had continuing pain that was managed with injections up to and including the day of (but prior to) her subway fall. Plaintiff’s treating orthopedic surgeon (first seen by her two weeks after she fell) acknowledged that she had prior problems with her back but he noted that her prior injury had not significantly interrupted her ability to work. He testified that her condition was “significantly exacerbated” by the subway stairs accident which, he said, caused compression of her disc which in turn caused it to expand into the nerve and led to radiating pain down her leg. He concluded that she was completely disabled. Plaintiff’s doctor had suggested that plaintiff be seen by a spinal surgeon “for possible excision or removal of the coccyx” and he opined that plaintiff will need continued care and that laminectomy and lumbar fusion surgery was “[certainly] … an option.” Inside Information: Before trial, plaintiff would have accepted a settlement of $50,000; however, the defendant’s offer was only $1,000. In summation, plaintiff’s counsel asked for $1,000,000. After examining plaintiff but before trial, defendant’s medical expert died. Over plaintiff’s objection, a new orthopedic surgeon was allowed to examine her; however, the defense did not call the new doctor to testify (his report concluded that plaintiff suffered from a residual disability) and the judge gave a so-called missing witness charge to the jury. At the time of trial, Ms. Ortiz had not had any treatment for the injuries alleged in the subway accident for three years (though she’d returned to her orthopedic surgeon shortly before trial for consultation and review). Tweet Like Email LinkedIn Comments Tags: Coccyx, Herniated Disc, Laminectomy, Lumbar Fusion Appellate Court Upholds $2,100,000 Pain and Suffering Award in Medical Malpractice Case

By John Hochfelder 

On October 19, 2007, Kelly Butterfield underwent a unilateral oophorectomy -  laparascopic surgery to remove one of her ovaries.

Ms. Butterfield, a 46 year old unemployed woman from Syracuse, was advised by her doctor that the surgery would be routine, take about an hour and she’d be discharged to home on the same day.
Unfortunately, none of that was to transpire; the surgery was complicated by the presence of extensive adhesions, it took over four hours and her bowel was perforated during the surgery requiring a nearly two month hospital admission and several additional surgeries.

Butterfield sued the hospital and her surgeon claiming that they failed to properly perform the oophorectomy, the procedure should have been converted to an open surgery and their post-operative care was negligent.
On February 20, 2012, after a two week trial, an Onondaga County jury agreed that there was medical negligence and awarded plaintiff pain and suffering damages in the sum of $360,000 ($300,000 past – four and a half years, $60,000 future – 30 years).
Additional damages awarded included loss of consortium damages for Ms. Butterfield’s husband in the sum of $100,000 (past only) and $164,306 for future medical expenses (an amount stipulated to by the parties).
After trial, at the Syracuse-Louisville college basketball game on March 3, 2012, plaintiff’s lawyer and the jury foreman met by coincidence. The juror told the lawyer that the jury had intended to award plaintiff $1,800,000 for 30 years of future pain and suffering (not $60,000 – the figure they filled in on the verdict sheet).
The crowd at the Carrier Dome in Syracuse on 3/3/12:

Following post-trial motions, the presiding judge ordered the verdict to be corrected to reflect the jury’s actual intent to award $1,800,000 in future pain and suffering damages.
The defendants appealed but the verdict has now been upheld in Butterfield v. Caputo (4th Dept. 2013).
Here are the injury details:

• intra-operative bowel perforations with leak of gastrointestinal matter and development of sepsis
• emergency surgery for perforated bowel plus additional surgeries including ileostomy, reversal of ileostomy, reconstruction of abdominal wall and hernia repair
• seven day coma inducement
• 50 day initial hospital admission with two weeks in ICU and five weeks unable to get out of bed
• home care assistance from visiting nurses, daily for almost two years for wound cleaning and IV therapy
• colostomy bag for four months
• several additional hospitalizations between 2008 and 2010 for bowel obstructions, each time requiring IV therapy for three days, supplemental fluids and consumption of nothing but ice chips
• inability to resume sexual relations with her husband
• extensive medication regime
• extensive abdominal scarring
• constant pain with burning sensation in bowels

Inside Information:

• Ms. Butterfield had a long-standing history of abdominal problems and had undergone laparoscopic surgery for lysis of adhesions in 1994. Additionally, she had other pre-existing medical issues including chronic pain complaints, fibromyalgia and a significant pain medication regime.
• Defense counsel argued on appeal (unsuccessfully) that by the time of trial plaintiff’s life “had returned to largely where she had been” before the initial surgery and, therefore, $60,000 for 30 years of future pain and suffering was reasonable. Plaintiff’s counsel argued that her life is now “reduced to being ruled by bathrooms and medications.”
• The jury found that both the hospital and the surgeon were negligent but that only the hospital’s negligence was a substantial factor in causing plaintiff’s injuries. The appeals court upheld that finding.
• Before trial, plaintiff had demanded $1,500,000 to settle; the defense made no offfer.
• Trial lasted 10 days and the jurors (five men, one woman) deliberated for seven hours.

Read more: http://www.surgeryencyclopedia.com/Ce-Fi/Corneal-Transplantation.html#ixzz2Ym1XPbNh


 POSTED BY ATTORNEY RENE G. GARCIA

Some of our clients have suffered these kinds of injuries due to a serious accident or malpractice. The Garcia Law Firm, P.C. was able to successfully handle these types of cases. For a free consultation please call us at 1-866- SCAFFOLD or 212-725-1313.

Court Affirms Pain and Suffering Award Despite Pre-Existing Injury

By John Hochfelder

On October 18, 2000, Olga Ortiz slipped on a concrete step on the top of the staircase leading to the Number 6 train at the 28th Street subway station at Lexington Avenue in Manhattan.

Ms. Ortiz, a nurse’s aide then 59 years old, fell down the entire staircase and landed at the bottom. A police officer arrived and called for an ambulance. Paramedics placed Ortiz on a stretcher and transported her to Bellevue Hospital where she received minor treatment before being released that day.
Claiming that she sustained a permanent back injury due to a broken and unsafe step that was missing a piece of cement, Ortiz sued the New York City Transit Authority (the subway station operator).  The defendant, however, contended that the stairway was safe and properly maintained and that the accident was caused by plaintiff’s failure to watch her steps.
In September 2011, the jury found that the transit authority was liable for the accident and awarded pain and suffering damages in the sum of $400,000 ($300,000 past – 11 years, $100,000 future – 10 years).
On appeal in Ortiz v. New York City Transit Authority (1st Dept. 2013), the defendant’s claim that the award was excessive has been rejected and the $400,000 damage award has been affirmed.
Here are the injury details:

• herniated disc at L3-4
• bruised coccyx
• lumbar radiculopathy
• epidural steroid injections and 12  months of physical therapy and chiropractic treatment
• permanent back and coccyx pain
• inability to bend, walk, sit or lift without severe pain

The defense argued that plaintiff’s pain and limitations were due to a prior incident when, two years earlier, she sustained two herniated discs in her back attempting to lift a 200 pound patient at a nursing home. She’d undergone extensive chiropractic treatment and had continuing pain that was managed with injections up to and including the day of (but prior to) her subway fall.
Plaintiff’s treating orthopedic surgeon (first seen by her two weeks after she fell) acknowledged that she had prior problems with her back but he noted that her prior injury had not significantly interrupted her ability to work. He testified that her condition was “significantly exacerbated” by the subway stairs accident which, he said, caused compression of her disc which in turn caused it to expand into the nerve and led to radiating pain down her leg. He concluded that she was completely disabled.
Plaintiff’s doctor had suggested that plaintiff be seen by a spinal surgeon “for possible excision or removal of the coccyx” and he opined that plaintiff will need continued care and that laminectomy and lumbar fusion surgery was “[certainly] … an option.”
Inside Information:

• Before trial, plaintiff would have accepted a settlement of $50,000; however, the defendant’s offer was only $1,000. In summation, plaintiff’s counsel asked for $1,000,000.
• After examining plaintiff but before trial, defendant’s medical expert died. Over plaintiff’s objection, a new orthopedic surgeon was allowed to examine her; however, the defense did not call the new doctor to testify (his report concluded that plaintiff suffered from a residual disability) and the judge gave a so-called missing witness charge to the jury.
• At the time of trial, Ms. Ortiz had not had any treatment for the injuries alleged in the subway accident for three years (though she’d returned to her orthopedic surgeon shortly before trial for consultation and review).

  Read more: http://www.surgeryencyclopedia.com/Ce-Fi/Corneal-Transplantation.html#ixzz2Ym1XPbNh


 POSTED BY ATTORNEY RENE G. GARCIA

Some of our clients have suffered these kinds of injuries due to a serious accident or malpractice. The Garcia Law Firm, P.C. was able to successfully handle these types of cases. For a free consultation please call us at 1-866- SCAFFOLD or 212-725-1313.

Court Affirms Increase in Pain and Suffering Verdict for Leg and Wrist Injuries

By John Hochfelder

On August 2, 2007, Anthony Deandino, then a 25 year old ironworker, was a passenger on a motorcycle being driven by his friend Robert Munsen at the intersection of Colonial Road and 78th Street in Brooklyn.

Proceeding through the intersection, they were struck by a city bus that failed to stop at a stop sign. Both were ejected from the motorcycle and landed in the street. Deandino was rushed by ambulance to a nearby hospital where he was diagnosed with several broken bones.
In his ensuing lawsuit, plaintiff’s motion for summary judgment was granted; the owner of the bus (the city’s transit authority) and its driver were held fully liable for the accident. The matter then proceeded to a trial on damages only.
On November 10, 2010, a Kings County jury awarded Deandino pain and suffering damages in the sum of $750,000 ($250,000 past – 3 years, $500,000 future – 46 years).
Both sides appealed – plaintiff claimed that the award was inadequate and the defendant claimed that it was excessive.
In Deandino v. New York City Transit Authority (2d Dept. 2013), the appeals court ruled that the past pain and suffering award should be increased by $150,000 so that the total for pain and suffering was set at $900,000 ($400,000 past, $500,000 future).
Here are the injury details:

• displaced left femur fracture – requiring open reduction internal fixation surgery with a metal rod, extending from the hip to the knee, implanted and secured with metal screws
• comminuted, displaced radius and ulna fractures – requiring open reduction internal fixation surgery with two metal pates and 15 screws
• dislocation of left elbow that ruptured connecting ligaments
• avulsion of left fingertips requiring surgical repair
• fractured ribs and pulmonary contusion
• post-traumatic stress disorder (PTSD)

Deandino was hospitalized for three weeks immediately following accident and underwent two years of outpatient physical therapy.
Several medical witnesses testified for plaintiff, including his orthopedic surgeon Joseph Walsh, M.D., a physiatrist and a psychologist. They discussed the severity and permanence of plaintiff’s injuries (including weakness, atrophy and the likelihood of arthritis developing in both his leg and arm) as well as his inability to return to work, despite his stoic nature and refusal to complain of pain or disability.
In addition to pain and suffering damages, the jury awarded Deandino about $1.7 Million for past and future loss of earnings (including lost pension, health insurance and annuity benefits); the appellate court, though, reduced that sum by $283,000 because the jury disregarded to that extent the testimony and evidence as to the actual amounts for past loss of earnings. The jury determined that plaintiff’s future work-life expectancy was 33 years.
Finally, the jury also awarded (and the appellate court affirmed) $465,000 for future medical expenses (over plaintiff’s 46 year life expectancy).
The defense denied the legitimacy of all of plaintiff’s future economic damages, insisting that he had recovered from his injuries.
Inside Information:

• Defendant was sanctioned $2,500 for its failure to timely produce a system safety report that included objective data downloaded from the bus’s event recorder  showing the bus had passed through the stop sign at 11 m.p.h and continued at full throttle to the point of impact where it had reached 20 m.p.h.
• It was after production of the event data report on December 24, 2008, that the defendants conceded liability and a judge granted plaintiff’s motion for summary judgment.
• Despite the severity of his injuries, Deandino began  looking for work within months of the accident and in early 2008 he landed a job as an ironworker, albeit on light duty. After about six months, though he was unable to continue and never again returned to any type of employment.
• Before the accident, Deandino had taken and scored well on the examination to become a New York City fire fighter; in the summer of 2009, he took and passed the FDNY’s grueling candidate physical ability test and, before trial, ran in four 5K road races. It was the FDNY’s examining surgeon that the appellate court mentioned as an expert who was precluded from testifying at the trial. The defense wanted his testimony that when he examined Deandino on August 26, 2008, he was physically capable of being a fireman; however, the plaintiff argued, successfully, that the failure until trial was underway to give notice of this intended expert witness was prejudicial and unfair.
• Plaintiff’s expert psychologist believed that plaintiff was delusional or at least highly unrealistic as to his ability to return to work. Plaintiff’s attorney agreed stating that it was the jury’s job to protect plaintiff from himself by awarding him enough loss of earnings damages so that he would not need to try to return to work. In open court, the attorney turned to plaintiff and stated: “You will never be a firefighter.”
• Plaintiff had been examined before trial by an orthopedic surgeon for the defense (Raz Winiarsky, M.D.) and a neurologist (Maria De Jesus, M.D.); however, only the neurologist was called as an expert witness and plaintiff was granted a so-called missing witness charge as to Dr. Winiarsky permitting the jury to regard negatively the failure to call him as a witness.
• In closing arguments, plaintiff’s attorney asked the jury to award $3,500,000 for past pain and suffering; he did not request a specific amount for the future. Prior to trial, plaintiff’s settlement demand was $5,000,000; defendants’ offer to settle was $350,000.
• Deandino’s motorcycle driver, Robert Munsen, died from the injuries he sustained in the accident. Munsen was a close friend and as Deandino was on the street screaming in pain, immobilized by his own injuries, he was unable to offer any aid to Munsen who was several feet away, also on the street, unconscious and dying.

  Read more: http://www.surgeryencyclopedia.com/Ce-Fi/Corneal-Transplantation.html#ixzz2Ym1XPbNh


 POSTED BY ATTORNEY RENE G. GARCIA

Some of our clients have suffered these kinds of injuries due to a serious accident or malpractice. The Garcia Law Firm, P.C. was able to successfully handle these types of cases. For a free consultation please call us at 1-866- SCAFFOLD or 212-725-1313.

Corneal transplantation

Definition

In corneal transplant, also known as keratoplasty, a patient's damaged cornea is replaced by the cornea from the eye of a human cadaver. This is the most common type of human transplant surgery and has the highest success rate. Eye banks acquire and store eyes from donors to supply the need for transplant corneas.

Purpose

Corneal transplant is used when vision is lost because the cornea has been damaged by disease or traumatic injury, and there are no other viable options. Some of the conditions that might require corneal transplant include the bulging outward of the cornea (keratoconus), a malfunction of the cornea's inner layer (Fuchs' dystrophy), and painful corneal swelling (pseudophakic bullous keratopathy). Other conditions that might make a corneal transplant necessary are tissue growth on the cornea (pterygium) and Stevens-Johnson syndrome, a skin disorder that can affect the eyes. Some of these conditions cause cloudiness of the cornea; others alter its natural curvature, which also can reduce vision quality.
Injury to the cornea can occur because of chemical burns, mechanical trauma, or infection by viruses, bacteria, fungi, or protozoa. The herpes virus produces one of the more common infections leading to corneal transplant.
Corneal transplants are used only when damage to the cornea is too severe to be treated with corrective lenses. Occasionally, corneal transplant is combined with other eye surgery such as cataract surgery to solve multiple eye problems with one procedure.

Demographics

The Eye Bank Association of America reported that corneal transplant recipients range in age from nine days to 103 years. More than 40,000 corneal transplants are performed in the United States each year. The cost is usually covered in part by Medicare and health insurers, although the patient might be required to incur part of the cost for the procedure. All eye tissue is donated. It is illegal to buy or sell human tissue.

Description

The cornea is the transparent layer of tissue at the front of the eye. It is composed almost entirely of a special

In a corneal transplant, the eye is held open with a speculum (A). A laser is used to make an initial cut in the existing cornea (B). The surgeon uses scissors to remove it (C), and a donor cornea is placed (D). It is stitched with very fine sutures (E). (

Illustration by GGS Inc.

)

type of collagen. It normally contains no blood vessels, but because it contains nerve endings, cornea damage can be very painful. In a corneal transplant, a disc of tissue is removed from the center of the eye and replaced by a corresponding disc from a donor eye. The circular incision is made using an instrument called a trephine, which resembles a cookie cutter. In one form of corneal transplant, penetrating keratoplasty (PK), the disc removed is the entire thickness of the cornea and so is the replacement disc.
The donor cornea is attached with extremely fine sutures. Surgery can be performed under anesthesia that is confined to one area of the body while the patient is awake (local anesthesia) or under anesthesia that places the entire body of the patient in a state of unconsciousness (general anesthesia). Surgery requires 30–90 minutes.
Over 90% of all corneal transplants in the United States are PK. In lamellar keratoplasty (LK), only the outer layer of the cornea is removed and replaced. LK has many advantages, including early suture removal and decreased infection risk. It is not as widely used as PK, however, because it is more time consuming and requires much greater technical ability by the surgeon.
A less common but related procedure called epikeratophakia involves suturing the donor cornea directly onto the surface of the existing host cornea. The only tissue removed from the host is the extremely thin epithelial cell layer on the outside of the host cornea. There is no permanent damage to the host cornea, and this procedure can be reversed. This procedure is mostly performed on children. In adults, the use of contact lenses can usually achieve the same goals.

Diagnosis/Preparation

Surgeons may discuss the need for corneal transplants after other viable options to remedy corneal trauma or disease have been discussed. No special preparation for corneal transplant is needed. Some ophthalmologists may request that the patient have a complete physical examination before surgery. Any active eye infection or eye inflammation usually needs to be brought under control before surgery. The patient may also be asked to skip breakfast on the day of surgery.

Aftercare

Corneal transplant is often performed on an outpatient basis, although some patients need brief hospitalization after surgery. The patient will wear an eye patch at least overnight. An eye shield or glasses must be worn to protect the eye until the surgical wound has healed. Eye drops will be prescribed for the patient to use for several weeks after surgery. Some patients require medication for at least a year. These drops include antibiotics to prevent infection as well as corticosteroids to reduce inflammation and prevent graft rejection.
For the first few days after surgery, the eye may feel scratchy and irritated. Vision will be somewhat blurry for as long as several months.
Sutures are often left in place for six months, and occasionally for as long as two years. Some surgeons may prescribe rigid contact lenses to reduce corneal astigmatism that follows corneal transplant.

Risks

Corneal transplants are highly successful, with over 90% of the operations in United States achieving restoration of sight. However, there is always some risk associated with any surgery. Complications that can occur include infection, glaucoma, retinal detachment, cataract formation, and rejection.
Graft rejection occurs in 5–30% of patients, a complication possible with any procedure involving tissue transplantation from another person (allograft). Allograft rejection results from a reaction of the patient's immune system to the donor tissue. Cell surface proteins called histocompatibility antigens trigger this reaction. These antigens are often associated with vascular tissue (blood vessels) within the graft tissue. Because the cornea normally contains no blood vessels, it experiences a very low rate of rejection. Generally, blood typing and tissue typing are not needed in corneal transplants, and no close match between donor and recipient is required. However, the Collaborative Corneal Transplantation Study found that patients at high risk for rejection could benefit from receiving corneas from a donor with a matching blood type.
Symptoms of rejection include persistent discomfort, sensitivity to light, redness, or a change in vision. If a rejection reaction does occur, it can usually be blocked by steroid treatment. Rejection reactions may become noticeable within weeks after surgery, but may not occur until 10 or even 20 years after the transplant. When full rejection does occur, the surgery will usually need to be repeated.
Although the cornea is not normally vascular, some corneal diseases cause vascularization (the growth of blood vessels) into the cornea. In patients with these conditions, careful testing of both donor and recipient is performed just as in transplantation of other organs and tissues such as hearts, kidneys, and bone marrow. In such patients, repeated surgery is sometimes necessary in order to achieve a successful transplant.

Normal results

Patients can expect restored vision after the healing process is complete. In some patients, this might take as long as a year. Patients with keratoconus, corneal scars, early bullous keratopathy, or corneal stromal dystrophies have the highest rate of transplant success. Corneal transplants for keratoconus patients have a success rate of more than 90%.

Morbidity and mortality rates

While there is risk involved with any surgery, corneal transplants are relatively safe. In 2001, there was some concern about cornea donors transmitting Creutzfeldt-Jakob disease, a fatal bone-deteriorating disease, after questions of infection arose in Europe. A study showed the risk of transmission in the United States was small, as was any infection risk from cornea donors. Currently, cornea donors are screened using medical standards of the Eye Bank Association of America. These guidelines restrict donors who died from unknown causes, or suffered from immune deficiency diseases, hepatitis, and other infectious diseases.
Transplant recipients may have to receive another transplant if the first is unsuccessful or if, after a number of years, the disease returns.

Alternatives

An increasingly popular alternative to corneal transplants is phototherapeutic keratectomy (PTK). This technique is now used to treat corneal scars and dystrophies, and some infections. Surgeons use an excimer laser and a computer to vaporize diseased tissue, leaving a smooth surface. New tissue begins growing immediately and recovery takes only a few days. Patients must be carefully selected, however, and success is greatest if damage is restricted to the cornea's top layer.
Intrastromal corneal rings are implantable devices that could be used for some keratoconus patients. The rings are implanted and the procedure is reversible. However, not much is known about long-term stability. Some companies also are developing synthetic corneas that are implanted using synthetic penetrating keratoplasty. This procedure may become more widely used for high-risk patients and those with severe chemical burns.

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

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Corneal transplants are performed by an ophthalmologist, who is a corneal specialist and is expert at transplants and corneal diseases. Patients might be referred to a corneal specialist by their ophthalmologist or optometrist.
Surgery is performed in a hospital setting, usually on an outpatient basis. Some surgeons may also perform the procedure at an ambulatory surgery center designed for outpatient procedures.

Read more: http://www.surgeryencyclopedia.com/Ce-Fi/Corneal-Transplantation.html#ixzz2Ym1XPbNh


 POSTED BY ATTORNEY RENE G. GARCIA

Some of our clients have suffered these kinds of injuries due to a serious accident or malpractice. The Garcia Law Firm, P.C. was able to successfully handle these types of cases. For a free consultation please call us at 1-866- SCAFFOLD or 212-725-1313.