By C. Daro. Marymount Manhattan College.

The final outcome is com- ment is demonstrated within hyperemic active inflammatory tissue plete ossification of the annulus purchase 50 mg minocin overnight delivery. The joint is immobi- lized buy 50mg minocin overnight delivery, resorbed, and replaced by bone, with a high risk of fracture. During the course of the different seronegative Reiter’s syndrome, which extend above the vertebral- spondyloarthritides, a variety of changes affect the dis- body margins, are asymmetric, and relatively robust. Another late man- with ankylosing spondylitis and usually begins at the ifestation of ankylosing spondylitis is the advanced, dis- thoracolumbar and lumbosacral junctions. Subsequently, covertebral destructive Andersson’s lesion, of which there the rest of the lumbar, upper thoracic and cervical spine are two types: type A or inflammatory; and type B or are affected. Both types occur after long-term dis- sertion of the outer fibers of the annulus fibrosus is ini- ease. Inflammatory type A is characterized by defects of tially demonstrated as discrete erosions of the superior the vertebral-body endplates surrounded by broad perifo- and inferior portions of the vertebral bodies followed by cal sclerosis with narrowing of the intervertebral discs. Paucity structive and reactive changes are called Romanus le- or absence of syndesmophytes is another feature. Non-in- sions, spondylitis anterior, or spondylitis marginalis flammatory type B may be seen even later, 10 or more (Fig. Typically, an More pronounced inflammatory destruction may cause ankylosed spine with numerous syndesmophytes is “planed-down” corners which, together with anterior pe- riosteal apposition, produce “squaring” or “barreling” of demonstrated. Initial marginal destruction is fol- affected, usually at the thoracolumbar junction. It may be lowed by ossification of the outer fibers of the annulus fi- widened or narrowed with pronounced bone destruction. It represents boring vertebral bodies forming syndesmophytes, which pseudoarthrosis due to trauma or stress and extends from are typical of ankylosing spondylitis. The ra- phytes are delicate and symmetric, and connect the ver- diological differentiation between type A and type B dis- tebral-body margins (marginal syndesmophytes). They covertebral lesions is of practical importance since are different from the parasyndesmophytes (or nonmar- pseudoarthrosis may require spinal stabilization. It has been shown that on Gd-DTPA MRI atic arthritis, pronounced erosive changes may cause ver- seronegative spondylitis has a variable signal pattern and tical subluxation of the axis with basilar invagination of degree of contrast enhancement, which may reflect the the odontoid.

Your goal is to minimize the chances of your patient seeking legal aid to get answers buy minocin 50mg line. Your goal is also to be successful if all that occurred was a complication rather than a deviation from the standard of medi- cal care generic 50mg minocin free shipping. Hopefully, this chapter helps you understand some simple ways of accomplishing these goals. Chapter 4 / Physician As a Witness 41 4 The Physician As a Witness Joel A. Mattison, MD, FACS SUMMARY This chapter is a personal reflection on the role of the physician as an expert witness in medical malpractice litigation. It looks at both the individual experience and professional obligations of the expert from both the medical and the legal perspectives. A number of practical suggestions for courtroom preparation and deportment are presented. Key Words: Expert witness; courtroom strategy; courtroom deport- ment; cross-examination. INTRODUCTION When a physician has either the opportunity or the obligation to testify as an expert witness, the reaction often passes through a cascade of several phases. Teddy Roosevelt once commented that the bravest man he had ever known was the one who followed him up San Juan Hill. Although this came from a hero, the arrogance of such a remark is apparent even, or espe- cially, when subtle. You must be willing to learn this carefully from the attorney who has engaged you. Everything in life has associated risks, and the courtroom is often a battleground. If this vulnerability frightens you, then think twice before you agree to tes- tify or even to review a case. Very little, because most effective experts tend to want to avoid shar- ing their strategies.