Penalty Box or Jury Box--Deciding Where Professional Sports Tough Guys Should Go

To those unfamiliar with the customs of professional hockey, observing a referee stand by while players drop their gloves and duke it out can be a disconcerting experience. Even more disconcerting is watching last week\u27s highlights illustrate in slow-motion detail the bone-crushing force with which one player slams another into the boards. The professional hockey fan, however, knows that acts like these are the byproducts of a fast and furious game that recognizes physical intimidation as a legitimate strategy.2 In McKichan v. St. Louis Hockey Club,3 the Missouri Court of Appeals for the Eastern District of Missouri ruled that severe body checks administered moments after a play are part of the game of professional hockey, 4 and therefore are not actionable as a matter of law. Although McKichan addresses the narrow issue of the liability of professional hockey players, the court\u27s opinion is consistent with a majority of recent cases that have denied recovery to injured sports participants, whatever their level of skill, and it illustrates the more general problems courts face when trying to gauge whether a sports participant has crossed the line dividing enthusiastic competitors from the malfeasant

Assessing the Best Interests of the Child: Missouri Declares That a Homosexual Parent Is Not Ipso Facto Unfit for Custody

In formal child custody disputes, the voices of those at the center of the controversy, the children, are rarely heard.Their parents, who otherwise are presumed to act in their best interests, battle one another in legal proceedings that reward the parent who more persuasively portrays the deficiencies of the other\u27s parenting skills. Because the children, especially the very young, have no adequate basis for making judgments about their long-term well-being, the state acts asparenspatriae while their parents are adversaries.Through its laws and decision makers, the state attempts to ensure that the final custody arrangement is guided by the best interests of the chil

Open ventral hernia repair with a composite ventral patch : final results of a multicenter prospective study

Background: This study assessed clinical outcomes, including safety and recurrence, from the two-year follow-up of patients who underwent open ventral primary hernia repair with the use of the Parietex (TM) Composite Ventral Patch (PCO-VP). Methods: A prospective single-arm, multicenter study of 126 patients undergoing open ventral hernia repair for umbilical and epigastric hernias with the PCO-VP was performed. Results: One hundred twenty-six subjects (110 with umbilical hernia and 16 with epigastric hernia) with a mean hernia diameter of 1.8cm (0.4-4.0) were treated with PCO-VP. One hundred subjects completed the two-year study. Cumulative hernia recurrence was 3.0% (3/101; 95%CI: 0.0-6.3%) within 24months. Median Numeric Rating Scale pain scores improved from 2 [0-10] at baseline to 0 [0-3] at 1 month (P<0.001) and remained low at 24months 0 [0-6] (P<0.001). 99% (102/103) of the patients were satisfied with their repair at 24months postoperative. Conclusions: The use of PCO-VP to repair primary umbilical and epigastric defects yielded a low recurrence rate, low postoperative and chronic pain, and high satisfaction ratings, confirming that PCO-VP is effective for small ventral hernia repair in the two-year term after implantation. Trial registration: The study was registered publically at clinicaltrials.gov (NCT01848184 registered May 7, 2013)

A clinical evaluation of parietex™ composite ventral patch in primary ventral hernia repair: interim results of the PANACEA prospective, multi-central trial

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Open ventral hernia repair with a composite ventral patch - Final results of a multicenter prospective study

BackgroundThis study assessed clinical outcomes, including safety and recurrence, from the two-year follow-up of patients who underwent open ventral primary hernia repair with the use of the Parietex (TM) Composite Ventral Patch (PCO-VP).MethodsA prospective single-arm, multicenter study of 126 patients undergoing open ventral hernia repair for umbilical and epigastric hernias with the PCO-VP was performed.ResultsOne hundred twenty-six subjects (110 with umbilical hernia and 16 with epigastric hernia) with a mean hernia diameter of 1.8cm (0.4-4.0) were treated with PCO-VP. One hundred subjects completed the two-year study. Cumulative hernia recurrence was 3.0% (3/101; 95%CI: 0.0-6.3%) within 24months. Median Numeric Rating Scale pain scores improved from 2 [0-10] at baseline to 0 [0-3] at 1 month (P&lt;0.001) and remained low at 24months 0 [0-6] (P&lt;0.001). 99% (102/103) of the patients were satisfied with their repair at 24months postoperative.ConclusionsThe use of PCO-VP to repair primary umbilical and epigastric defects yielded a low recurrence rate, low postoperative and chronic pain, and high satisfaction ratings, confirming that PCO-VP is effective for small ventral hernia repair in the two-year term after implantation.Trial registrationThe study was registered publically at clinicaltrials.gov (NCT01848184 registered May 7, 2013)

A multicenter prospective study of patients undergoing open ventral hernia repair with intraperitoneal positioning using the monofilament polyester composite ventral patch: Interim results of the PANACEA study

Frederik Berrevoet,1 Carl Doerhoff,2 Filip Muysoms,3 Steven Hopson,4 Marco Gallinella Muzi,5 Simon Nienhuijs,6 Eric Kullman,7 Tim Tollens,8 Mark R Schwartz,9 Karl LeBlanc,10 Vic Velanovich,11 Lars Nannestad J&oslash;rgensen12 1Department of General and Hepatopancreaticobiliary Surgery, Ghent University Hospital, Ghent, Belgium; 2General Surgery, Surgicare of Missouri, Jefferson City, MO, USA; 3Department of Surgery, AZ Maria Middelares Ghent, Ghent, Belgium; 4Bon Secours Hernia Center, Mary Immaculate Hospital, Newport News, VA, USA; 5University Hospital Tor Vergata, Rome, Italy; 6Catharina Hospital, Eindhoven, the Netherlands; 7Medicinskt Centrum Link&ouml;ping, Link&ouml;ping, Sweden; 8Imelda Hospital-General Surgery Imelda Hospital, Bonheiden, Belgium; 9Monmouth Medical Center, Long Branch, NJ, 10Our Lady of Lakes Regional Medical Center, Baton Rouge, LA, 11Tampa General Hospital, University of South Florida, Tampa, FL, USA; 12Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark Purpose: This study assessed the recurrence rate and other safety and efficacy parameters following ventral hernia repair with a polyester composite prosthesis (Parietex&trade; Composite Ventral Patch [PCO-VP]).Patients and methods: A single-arm, multicenter prospective study of 126 patients undergoing open ventral hernia repair with the PCO-VP was performed. Patient outcomes were assessed at discharge and at 10&nbsp;days, 1, 6, 12, and 24&nbsp;months postoperative.Results: All patients had hernioplasty for umbilical (n = 110, 87.3%) or epigastric hernia (n = 16, 12.7%). Mean hernia diameter was 1.8 &plusmn; 0.8&nbsp;cm. Mean operative time was 36.2 &plusmn;15.6&nbsp;minutes, with a mean mesh positioning time of 8.1 &plusmn; 3.4&nbsp;minutes. Surgeons reported satisfaction with mesh ease of use in 95% of surgeries. The cumulative hernia recurrence rate at 1&nbsp;year was 2.8% (3/106). Numeric Rating Scale (NRS) pain scores showed improvement from 2.1 &plusmn; 2.0 at preoperative baseline to 0.5 &plusmn; 0.7 at 1&nbsp;month postoperative (P &lt; 0.001), and this low pain level was maintained at 12&nbsp;months postsurgery (P &lt; 0.001). The mean global Carolina&rsquo;s Comfort Scale&reg; (CCS) score improved postoperatively from 3.8 &plusmn; 6.2 at 1&nbsp;month to 1.6 &plusmn; 3.5 at 6&nbsp;months (P &lt; 0.001). One patient was unsatisfied with the procedure.Conclusion: This 1-year interim analysis using PCO-VP for primary umbilical and epigastric defects shows promising results in terms of mesh ease of use, postoperative pain, and patient satisfaction. Recurrence rate is low, but, as laparoscopic evaluation shows a need for patch repositioning in some cases, an accurate surgical technique remains of utmost importance. Keywords: intraperitoneal mesh, epigastric hernia, umbilical hernia, pai