Caesar Goodson Jr. set the pieces for a bench trial in motion this morning after such proceedings worked in the favor of fellow officer Edward Nero last month. 3 In Marschel v. Dean Witter Reynolds, 609 So.2d 718 (Fla. 2d DCA 1992), the Second District Court of Appeal also opined that the use of language such as "any controversy" and "shall be settled by arbitration" also identifies a "broad arbitration clause." Id. at 721. See also, Mastrobuono v. Shearson Lehman Hutton, Inc., 514 U.S. 52, 115 1212,2d 76 (1995). 4 The term "property" defined and discussed at page 16-17, infra, and includes "all improvements constructed on the land." 12 Peter M. Schosheim, MD, FACS and Robert Sheperd, MS, CMI, FAMI McCrory 43756. Pathology refers to the study of disease, specifically as it presents in tissue. Oral pathologists, then, are responsible for studying the diseases that affect the tissue of the mouth and other surrounding muscle groups. These experts are considered to be true specialists, having focused their work on very niche areas of both dentistry and pathology. Though oral pathology is rather specialized, it's a vital component of the oral health industry. By analyzing tissue taken from biopsies, oral pathologists can help diagnose and eventually treat a number of oral diseases, including leukoplakia, cementoma and squamous cell carcinoma, among others. It will be based upon different regions and different states in order to keep it truly competitive, but some of those details have yet to be fully worked out. But just because all of the details haven't been worked out yet, it doesn't mean that the central ideas and the main points aren't still evident and in place. A health exchange specifically can mean a few different things, but one of the most prevalent throughout the case is definitely something that everyone should know. A health exchange in itself is where individuals can receive the choice to purchase healthcare at an affordable rate to cover themselves and their small business. Los Angeles Medical-Legal Collaborative for Education 205 S. Broadway, Ste. 1008 Los Angeles, CA 90012 Cohn Lifland Pearlman Herrmann & Knopf LLP was founded in 1924. Over the years, our New Jersey law firm has earned a reputation for excellence in the practice of law and has recently been named to the Martindale-Hubbell Bar Register of Preeminent Lawyers. We offer clients both depth and breadth of representation in the state and federal courts at the trial and appellate levels as well as in tax, estate planning and transactional matters.
In 1989, in State of Florida v. Musikka, a woman charged with cultivation of six marijuana plants asserted the medical necessity defense at trial in Broward County, Florida. The woman testified that she suffered from glaucoma, had already lost sight in one eye after a failed medical procedure, and used marijuana to keep from going blind in the other eye. If you would like to speak to one of our experienced dental negligence solicitors, please contact us on 01-5313800 or email Kathrin Coleman or Marguerite Baily to discuss further. As the birthplace of California citrus, Riverside has attracted newcomers for many years. To keep everyone smiling, West Coast Dental Group of Riverside boasts an outstanding team of general dentists, orthodontists and specialists. Our spacious, state-of-the-art office is designed to put you at ease while our talented professionals provide excellent general dentistry and advanced specialty care. Along with routine exams and cleanings , we offer children's dentistry, cosmetic dentistry and beautiful veneers , crowns and restorations The specialists who practice in our office include periodontists and orthodontists. The FDA has also recently required that post-market surveillance studies be undertaken by all transvaginal mesh manufacturers. AMS, in response, has begun enrolling patients in an Embrace study for two of its mesh products. 1,000 patients are expected to be included in the two studies, which are expected to take two years of enrollment and three years of follow-up for a full five years of data. The studies are expected to shed light on how the company can improve their mesh products. "THE PEOPLE'S CHOICE." Quality representation in the fields of Workers' Compensation; Personal Injury including Automobile Accidents; Medical Malpractice; Criminal Defense Call for Free Initial Consultation - 1-866-271-1398. Law Firm For Dental Negligence McCrory AR 43756
In May 1999, Greene performed a cervical biopsy on Deluvina Gonzalez, a seamstress who lived in Seattle. She received written after-care instructions that said: "Dr. Greene will call you." Critical physical exam maneuver for muscle based piriformis syndrome: The patient's foot is placed lateral to the contra lateral knee. Resisted abduction or adduction against the examiner's hand may reproduce the symptoms. Straight leg rising is typically negative. There is often relief obtained by traction on the involved leg, particularly by pulling upwards at a ten to twenty degree angle and towards the contra lateral side by a similar amount. The distribution of symptoms typically involves both L5 (big toe) and S1 (small toe) components because this a pan-sciatic syndrome. The symptoms often progress no further than the ankle in distinction to sciatica from a lumbar disk which typically radiates into the toes. Link - SEARCH Receive Spine News patient>conditions>other Piriformis Syndrome Spine Universe Chiropractic Link Piriformis Syndrome is caused by an entrapment (pinching) of the sciatic nerve as it exits the Greater Sciatic notch in the gluteal region. There are two normal variations for the exit of the sciatic nerve in this region. The first places the sciatic nerve inferior (below) to the Piriformis muscle and superior (above) the gemellus muscle. Entrapment in this area is likely due to a myospasm or contracture (tightening or shortening respectively) of either of these two muscles. The second common site of entrapment is when the sciatic nerve actually pierces the piriformis muscle itself. This can occur in about 1% to 10% of all humans. In this case myospasm and or contraction of the piriformis muscle itself can lead to pain along the back of the thigh to the knee, loss of sensation or numbness and tingling in the sole of the foot. This particular syndrome can often mimic its more notorious counterpart known as sciatica, and that being the case, it is often misdiagnosed as sciatica. The main difference between sciatica and piriformis syndrome is in the cause. Sciatica is directly due to a lumbar disc pressing on the sciatic nerve as it exits the intervertebral foramen in the lumbar spine. What both of these complaints have in common is that both can produce pain, numbness and tingling below the knee and into the foot. The main diagnostic tests performed by your doctor of Chiropractic is what distinguishes one from the other. With piriformis syndrome your chiropractor will not get positive tests results that indicate lumbar spine involvement. Often the patient may not be aware that there is a problem. Some cases won't show up until a complete neurological exam is performed on the lower extremity. The patient may have chief complaints ranging from no pain to pain in the lower back to gluteal pain to numbness and tingling in the foot. As can be seen the symptoms in this condition can vary widely making the doctor who is not used to differentially diagnosing this condition from sciatica confused as to the cause of the condition. Many weekend athletes and people who spend long hours sitting are prone to this syndrome. The athlete's cause is primarily due to improper stretching and warm-up exercises as well as overuse during activity. In this case it is most likely that the piriformis muscle is irritated and usually in spasm. For the patient who sits for extended periods of time, their primary cause is due to contracture of the piriformis muscle. In this case the piriformis muscle is shortened and does not allow for the smooth movement of the sciatic nerve during leg motion. A one-time direct trauma to the pelvis is very rarely a cause for piriformis syndrome due to the protection afforded the pelvis by the overlying musculature and fat. The causes of myospasm are many. Over use as during excessive fast walking without proper warm up and stretching (as during exercise), prolonged sitting, as for your treatment, many variables can hamper your successful recovery. Smoking, obesity, job and exercise as noted above in prolonged sitting and not warming up and stretching. Any treatment plan must include stretching of the gluteal muscles as well as stretching of the piriformis muscles. Your Chiropractor can help you by instructing you on the proper exercises and stretches to perform. Many Chiropractors may also prescribe some form of massage be performed to the piriformis muscle in the gluteal region in order to relax these muscles. Your chiropractor may also prescribe certain herbals remedies such as valerian root and passion flower to help relax the associated muscles during your recovery phase. Spinal adjustment as well as hip adjustment may also be required to relieve your symptoms. -------------------- Dynamic Chiropractic June 21, 1991, Volume 09, Issue 13 Printer Friendly Version Email to a Friend Alternative Health Acupuncture Piriformis Syndrome: Part I Link -------------------- The patient with an unrelenting sciatica may be suffering with a piriformis syndrome. This syndrome is considered an entrapment neuropathy caused by pressure on the sciatic nerve by an enlarged or inflamed piriformis muscle. The sciatic nerve can be compressed between the swollen muscle fibers and the bony pelvis.1 Pace and Nagle2 estimated that 45 of 750 cases referred to their back clinic were treated for this syndrome. They found that the condition was six times more prevalent in women than men. Because this syndrome is not common it is often overlooked and needless surgery may result. Wyant3 states that the functional test for piriformis syndrome should be a routine part of the physical examination of all patients presenting with lower spinal backache. Besides backache, the piriformis muscle contracture and associated adhesions has been related to radiating pain from the sacrum to the hip joint over the gluteal region to the posterior thigh, coccydynia,4 dyspareunia, male impotency5, and oblique axis rotation of the sacrum with its effect on the total spine up to the atlanto- occipital region.5 According to Gray6 and Freiberg7 the piriformis arises from the anterior sacrum between the second to fourth anterior sacral foramina, from the margin of the greater sciatic foramen and from the anterior surface of the sacrotuberous ligament, the anterior sacrospinous ligament and the capsule of the sacroiliac joint. Freiberg states that the piriformis is the only muscle that bridges the sacroiliac joint. The piriformis passes through the greater sciatic foramen (the upper part of which it fills) and inserts by a rounded tendon into the upper border of the greater trochanter. Pecian8 examined 130 human specimens to determine the anatomical relations of the sciatic nerve and the piriformis. He found that in 6.15 percent of the cases the peroneal part of the sciatic nerve passes between the tendinous parts of the piriformis and a pinching of the nerve can occur. He found at least five other variations of the sciatic nerve in relation to the piriformis muscle. He concluded that when the nerve passed between the tendinous portion of the piriformis the nerve would more likely be pinched during passive medial rotation of the thigh which stretches the piriformis, causing the nerve to be pressed against the extended piriformis. In this case, resisted testing of the piriformis or ordinary active piriformis contraction would separate the tendinous portion of the piriformis surrounding the sciatic nerve and would not compress the nerve. Mizuguche9 felt that before the piriformis could aggravate the sciatic nerve there first had to be a preexisting tension on the sciatic nerve by scarring or arachnoiditis around the nerve roots secondary to laminectomy or some space-occupying lesion such as osteoarthritic spurs. He thought that ordinary walking would cause the piriformis to impinge the shortened nerve. A history of trauma to the sacroiliac or gluteal region has also been blamed10. The straight leg raise may be positive due to a contracted piriformis muscle. In a study by Freiberg and Vinke11 on 10 cadavers it was found that after raising the leg 25 degrees, the sacrotuberous ligament becomes taut because of its attachment to the ischial tuberosity and the hamstrings. A contracted piriformis muscle which originates off the sacrotuberous ligament also tightened during the SLR. The functional tests for a piriformis syndrome is naturally based on the function of the piriformis muscle. One of the main reasons for muscle testing is to determine if a muscle is painful. Since the piriformis muscle is an external hip rotator when the hip is in extension and an abductor when the hip is in flexion,9 external hip rotation should be tested with the patient supine with the legs hanging off the table edge at the knees. The patient then attempts to push his leg medially against resistance. The abduction test for the piriformis could be tested with the patient sitting facing the examiner. The patient attempts to abduct the knee against resistance.2 The patient will complain of pain and possible weakness due to the pain. There may be pain when the patient sits or squats due to external rotation of the thigh and hip.5 Passive internal rotation of the thigh with the patient supine could also aggravate the condition. Pressure on the piriformis by way of rectal or vaginal examination may reproduce the symptoms.3 A positive "piriformis sign" due to piriformis contracture may be seen by the persistent external rotation of one lower extremity when the patient is supine. A contracted piriformis may result in a functional short leg.5 The symptoms of female pain during coitus (dyspareunia) could be due to the externally rotated hips, but female pain and male impotency is also attributed to piriformis compression of the pudendal nerve and blood vessels.5 According to Retzlaff et al.,5 on the side of the piriformis contracture the sacral base will be rotated anteriorly and examination of a prone patient will show a deepened sulcus on that side. The apex of the sacrum will appear posterior on the opposite side at the level of the posterior inferior illiac spine (oblique axis rotation of the sacrum). This may cause rotoscoliosis of the lumbar spine and increased lumbar lordosis which may effect the function of the whole spine. Digital pressure over the piriformis may refer pain along the complaint area. Part II will discuss a variety of conservative treatments for this syndrome. Warren Hammer, M.S., D.C., D.A.B.C Editor's Note: Dr. Hammer will conduct his next soft tissue seminar. You may call 1-800-327-2289 to register. Dr. Hammer's new book, Functional Soft Tissue Examination and Treatment by Manual Methods: The Extremities, is now available. Please see the Preferred Reading and Viewing list on page xx, part #T126 to order your copy. References Jankiewicz JJ, Hennrikus WL, Houkom JA: "The appearance of the piriformis muscle syndrome in computed tomography and magnetic resonance imaging: a case report and review of the literature." Clin Orth & Rel Res:262,205-209. Pace JB, Nagle D: "Piriformis syndrome." West J Med 24:436, 1976. Wyant G: "Chronic pain syndromes and their treatment: III. The piriformis syndrome." Can Anaesth Soc J. 26:305, 1976. Thiele GH: "Tonic spasm of the levator ani, coccygeus and piriformis muscles." Trans Am Pract Soc 37:145-155, 1936. Retzlaff E, Berry AH, Haight AS et al. "The piriformis muscle syndrome." J AM Osteopath Assoc 73:799-807. Gray H: Anatomy of the Human Body. 26th ed. Philadelphia: Lea & Febiger, 1956:541. Freiberg AH: "Sciatic pain and its relief by operations on the muscle and fascia." Arch Surg 34:337m 1937. Pecian M: "Contribution to the etiological explanation of the piriformis syndrome." Acta Anat (Basel) 105:181-186, 1979. Mizughuchi T: "Division of the piriformis muscle in the treatment of sciatica." Arch Surg 111:719-722, 1976. Robinson D: "Piriformis syndrome in relation to sciatic pain." Am J Surg 73:356-358, 1947. Freiburg AH, Vinke TA: "Sciatica and the sacroiliac join." J Bone Joint Surg 16:126, 1934. -0 Diagnosis and Treatment of Piriformis Syndrome Link Piriformis syndrome is estimated to cause 6-8% of sciatica, but is more common in the general population because it has been under diagnosed and under treated. The following outline is intended to present elements of the history and physical findings that suggest piriformis syndrome, and the electrophysiological technique for documenting its presence, injection technique and physical therapy. Finally, there is a section on outcome and alternative treatments and current clinical research protocols. Diagnosis The patient with piriformis syndrome typically complains of sciatic pain, tenderness in the buttock, and more difficulty sitting than standing. The pain usually arises from overuse: athletics, heavy work, or prolonged sitting, though traumatic causes are also reasonably common, including automobile accidents, falls, and penetrating wounds. Physical findings include tenderness of the buttock region, increased pain with adduction, internal rotation and flexion of the affected thigh while the patient is in the contra lateral decubitus position, weakened abduction of the flexed thigh, and iliotibial band syndrome. EMG findings include positive FAIR-test, signs of denervation (acute or chronic) in the pattern of the posterior tibial or the peroneal nerves, as opposed to a radicular distribution, reduced CMAPs and/or SNAPs on the affected side, and a positive FAIR-test. The FAIR-test compares the sum of M-wave plus H-reflex in the anatomical position with the sum of M-wave plus H-reflex in the Flexed, Adducted, Internally Rotated position. Piriformis FAIR-test position (Contra lateral Decubitus) do entertainment lawyers make a lot of money? more than others? In a written opinion filed on December 22, 2005, Judge Harper held that the legal malpractice counterclaim was frivolous. The judge held that Cuyler Burk was a prevailing party because defendant withdrew his complaint after defendant's expert changed his opinion during his deposition. In other words, "the withdrawal of the complaint was done to avoid anticipated defeat, and as such, it is not a voluntary dismissal, but instead an acknowledgement that the Plaintiff would prevail." Usually, these types of dog control laws and ordinances are only found in large Texas cities; however, El Paso has an ordinance requiring that dogs be "restrained" at all times. 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