McCurdy Case Study

Appellant John A. McCurdy, Jr., M.D., is a licensed physician practicing cosmetic surgery in the State of Hawaii through the professional corporation of John A. McCurdy, Jr., M.D., FACS, Inc., wholly owned by McCurdy (collectively referred to as ""McCurdy""). McCurdy filed for bankruptcy after a jury awarded a former patient $2 million in her malpractice suit against him. Thereafter, on June 10, 1996, McCurdy filed a complaint in the United States District Court for the District of Hawaii against the American Board of Plastic Surgery (""ABPS"") (the appellee here), the Hawaii Plastic Surgery Society, the American Society of Plastic and Reconstructive Surgeons, Inc., seven individual plastic surgeons, and two professional medical corporations. McCurdy alleged unfair competition, unlawful restraint of trade and various antitrust violations in the field of cosmetic plastic surgery under the Clayton Act, 15 U.S.C. � 15 (1994), the Sherman Act, 15 U.S.C. �� 1-2 (1994), and Haw.Rev.Stat. � 480-13(a)(1). Among the overt acts alleged was the testimony of a California plastic surgeon on behalf of the plaintiff in the malpractice suit. On October 4, 1996, McCurdy filed an amended complaint, pursuant to Fed.R.Civ.P. 15(a), naming an additional defendant, the American Board of Medical Specialties (""ABMS"").

 

Question 1

In the case of anterior spinal artery occlusion is bladder function

preserved or is there urine retention?181

 

Question 2

In the case of anterior spinal artery occlusion, can the patient have intact

sensations in the lower limbs?

Question 3

In the case of anterior spinal artery occlusion, will the paraplegia be of a

spastic or a flaccid type?

Question 4

Can fasciculations occur in radiculopathy or peripheral neuropathy or is

it pathognomonic to anterior horn cell lesion?

Question 5

Is ibuprofen recommended in prophylaxis or treatment of Alzheimer's

dementia?

Question 6

What are the principal causes of frontotemporal dementia and how can

the cause be diagnosed?

Question 7

What are the associated features of meningomyelocele other than

hydrocephalus, urinary incontinence and paraplegia? Do patients have

congenital heart disease and congenital dislocation of hips?

Question 8

Can a patient with neurofibromatosis type I have a neurofibroma arising

from a nerve root or radicle causing cervical or compressive lumbar

radiculopathy?

Question 9

Is there a way to retard the rate of development of cutaneous or other

manifestations of neurofibromatosis type 1? Has a cure for this condition

yet been found?

Question 10

How does neurofibromatosis type 2 (NF2) affect the heart"

Question 1

 Regarding anterior spinal artery occlusion, is bladder function intact, or is there constipation, and urine retention?

 

 Another possible complication of anterior spinal artery occlusion is dysfunction of bladder control; a patient may be unable to urinate or have incomplete control over the process. This condition usually afflicts the grey matter in the AI of the spinal cord that is involved in the regulation of bladder.

 Question 2

 Can the patient have intact sensations in the lower limbs if he/she is suffering from anterior spinal artery occlusion?

 

 On the contrary, in anterior spinal artery occlusion patients may present with paralysis and loss of sensation in the lower limbs only. This type of occlusion operates on the anterior part of the spinal cord where the pathways of pain and temperature are located; these sensations are missing, but the person may be able to feel his body position in space.

 Question 3

 If the anterior spinal artery is occluded, will the resulting paraplegia be of the spastic or the flaccid sort?

 

 Spinal cord injury due to anterior spinal artery thrombosis is of paraplegic nature and spastic in most of the cases. This is attributed to corticospinal tract which influences the motor neuron and results to spastic paralysis.

 Question 4

 Are fasciculations possible in radiculopathy or peripheral neuropathy and therefore not unique to anterior horn cell lesions?

 

 Fasciculations are a feature of radiculopathy and peripheral neuropathy but are more characteristic of the anterior horn cell lesions (for example, amyotrophic lateral sclerosis).

 Question 5

 What about the use of ibuprofen in either prophylaxis or in the management of Alzheimer’s dementian?

 

 Ibuprofen should not be used in Alzheimer’s dementia either in prophylaxis or in the course of the disease. There is no good evidence that NSAIDs such as ibuprofen are effective in treating or preventing Alzheimer’s disease. Experimental studies have not indicated any beneficial role of NSAIDs in the management of Alzheimer’s disease.

 Question 6

 Some of the main causes of frontotemporal dementia are described as follows: How is the cause of frontotemporal dementia diagnosed?

 

 Principal causes of frontotemporal dementia include:Principal causes of frontotemporal dementia include:

 Frontotemporal lobar degeneration (FTLD)

 Some of these include; mutations in the genes such as the MAPT, GRN, or C9orf72 genes.

 Tauopathies

 TDP-43 proteinopathies

 Excludes cases diagnosed clinically, by neuroimaging such as MRI or PET scans, and genetic studies when required.

 Question 7

 What are other manifestations of meningomyelocele with the exception of hydrocephalus, urinary incontinence and paraplegia? Are patients diagnosed with congenital heart disease, and congenital dislocation of hips?

 

 Associated features of meningomyelocele may include:Associated features of meningomyelocele may include:

 Chiari malformation

 Scoliosis

 Musculoskeletal deformities

 Infection to the skin in the locality of the defect

 Both congenital heart disease and congenital dislocation of hips do not commonly co-exist with meningomyelocele though they may exist in other congenital syndromes.

 Question 8

 Can a patient with neurofibromatosis type I have a neurofibroma arising from a nerve root or radicle and produce cervical or compressive lumbar radiculopathy?

 

 Note that a patient with neurofibromatosis type I (NF1) may develop neurofibromas along the nerve root/radicle producing cervical or compressive lumbar radiculopathy through nerve root compromise.

 Question 9

 Can one slow the progression of such cutaneous or other signs of neurofibromatosis type I? Has there been a discovery that leads to a cure of this condition?

 

 Currently there is no known cure for Nf1. Management comprises of treatment of the symptoms and the complications. For cutaneous manifestations as a whole, there is not a strategy for slowing the rate of development, apart from frequent examinations and supportive measures in relation to symptoms and their effects.

 Question 10

 This paper seeks to answer the following question: Does neurofibromatosis type 2 (NF2) have an impact on the heart?

 

 The disease known as Neurofibromatosis type 2 (NF2) occurs in the nervous system and is not related to the heart. But it can cause vestibular schwannomas (acoustic neuromas) and other central nervous system tumours. In contrast, cardiac involvement is not a feature of NF2 and hence would not typically be expected even in the case of generalized disease.