[Irretrievable
Jamar Lizarraga
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Background: The advantages of endoscopic retrograde cholangiopancreatography (ERCP) over open surgery have made it the predominant method of treating patients with choledocholithiasis. After sphincterotomy, however, 10%-15% of common bile duct (CBD) stones cannot be removed with a basket or balloon. Methods for managing "irretrievable stones" include surgery; mechanical, intraductal shock wave, and extracorporeal shock wave lithotripsy; chemical dissolution; and biliary stenting. Endoscopic biliary stent insertion, which is frequently used in specific situations, has both advantages and disadvantages. To maximize the advantages and minimize the complications of biliary endoprosthesis, it is important to recognize its proper indications and to apply the technique in proper situations.
Data sources: We reviewed all publications cited in Pubmed and published through July 2011 on biliary endoprosthesis in patients with irretrievable CBD stones. We analyzed the indications, advantages, disadvantages, and long-term follow-up results of this technique.
Results: Despite the occurrence of related complications, such as cholangitis, endoscopic placement of an endoprosthesis may reduce stone size, allowing later clearance of unextractable stones. Permanent biliary stenting may be a definitive treatment in selected elderly patients who are poor candidates for surgery.
Conclusion: Endoscopic biliary stenting remains a simple and safe method for patients with stones difficult to manage by conventional endoscopic methods and those patients unfit for surgery or at high surgical risks.
Background: The value of endoprostheses for long-term management of bile duct stones has not been formally established. We retrospectively compared the results of this method versus surgical approach in elderly patients (>70 years) with endoscopically irretrievable bile duct stones.
Methods: From January 1990 to September 1998, 68 patients over 70 years old underwent endoscopic biliary stenting (group A: 31 patients) or surgery (group B: 37 patients) for endoscopically irretrievable bile duct stones. The groups were similar with regard to gender, age, clinical presentation, ASA score, and number and size of the stones.
Conclusions: For immediate bile duct drainage endoprostheses proved a safe and effective alternative to surgery in elderly patients with endoscopically irretrievable bile duct stones. Because of the risk of subsequent complications, their use as a definitive treatment should be restricted to highly selected cases.
Our goal is to adhere to The Joint Commission (TJC) and the requirements set forth in the #1 Hospital National Patient Safety Goal (NPSG.01.01.01): Identify Patients Correctly. This standard requires two unique patient identifiers and TJC further specifies that the two identifiers be on both the requisition/order AND the specimen label.
Irretrievable specimens are specimens that are extremely difficult or impossible to recollect due to the nature of the specimen or due to unique circumstances under which the specimen was obtained. The following is a current list of irretrievable specimens:
Samples such as clinical blood samples, urine, swabs, and PAP samples, are not irretrievable in nature and specimen rejection due to labeling errors must occur in order to be compliant with regulations and patient safety goals.
Specimens that are obtained under special or unique circumstances also have the potential to be deemed irretrievable and will be evaluated on an "individual case" basis. Special circumstances include:
Please know that we must adhere to these specimen rejection guidelines in order to fully ensure patient safety. As you may know, most laboratory errors are not analytic in nature but rather pre-analytic and often linked back to specimen labeling issues.
Assistance in ensuring the best patient care and adherence to regulatory standards is highly appreciated. Specimen rejection is always difficult, yet if best labeling practices are followed, these situations should be very limited.
After initiation or reinitiation of consultation required under section 7(a)(2) of the Act, the Federal agency and any applicant shall make no irreversible or irretrievable commitment of resources with respect to the agency action which has the effect of foreclosing the formulation or implementation of any reasonable and prudent alternatives which would avoid violating section 7(a)(2). This prohibition is in force during the consultation process and continues until the requirements of section 7(a)(2) are satisfied. This provision does not apply to the conference requirement for proposed species or proposed critical habitat under section 7(a)(4) of the Act.
New York has laws that limit how you can get a divorce. There are now seven grounds (reasons) you can use to get a divorce in New York. The divorce judgment will include orders about marital property and marital debts, as well as child custody, visitation, child support, and spousal support.
You must go to the New York State Supreme Court in your county. All divorces in New York State are handled in the county Supreme Courts. Family Court can order child support and/or child custody, but cannot grant a divorce.
We expect that most people will try to use irretrievable breakdown, sometimes called "no fault" divorce, when they file for divorce in New York. This first became a grounds for divorce in NY in 2010. It is not the only way to get a divorce, though.
Number 7 listed above is sometimes called a conversion divorce. Conversion divorces allow divorces based upon a Separation Agreement that you already had in place for a full year. Basically, you change the Separation Agreement into a divorce. Even if you want a divorce on other grounds, a Separation Agreement can make a divorce easier and faster.
Residency requirements give a New York court the power to decide your divorce case. A New York court can only decide a divorce case if at least one of the spouses is a New Yorker. In most cases, one of the spouses must have lived in New York for at least one year before trying to get a divorce.
The law says that property should be divided equitably. This means that the court divides the marital property as fairly as it thinks is possible. Usually the property is divided 50/50, although this does not have to happen. For more information, please read our article called "What Happens to Property after a Divorce?"
If you and your spouse can agree on how to divide the property, pay support, and settle any debts, you will not need a trial, which takes much longer and usually costs you more money. Try to get child support and child custody orders from Family Court before you file for divorce. It is important to try and settle as much as possible with your spouse before going to court. If your spouse is abusive, get the help of a domestic violence advocate before you try to negotiate these important things.
Unless you have a signed Separation Agreement that will become part of the divorce, it is important for you to respond in writing to the court and your spouse if you are served with divorce papers. You usually only have 20 days to send your written response, which is called an Answer. You should get a lawyer to help you if you can. You can ask the court to make your spouse pay for a lawyer if you have less money than your spouse.
For additional facts and information about divorce filings and using irretrievable breakdown of the marriage as a basis for divorce, contact our office today. We can be reached by phone or email, and we offer a free, private consultation to discuss your options.
Our firm serves all courts Boston as well as Bristol County, including the New Bedford, Fall River and Taunton courthouses. We also serve all courts in Plymouth County including the Family and Probate Courthouses in Plymouth and Brockton.
In the state of Alabama when a marriage has broken down to the point where the marriage will no longer continue, it frequently helps for individuals to understand some essentials about the nature of divorces due to an irretrievable breakdown.
Given the lack of ways to measure precisely when a marriage has irretrievably broken down, courts often decide whether a marriage is irretrievably broken by examining all relevant facts and circumstances.The Alabama statute does note that in irretrievable breakdowns, any attempts at reconciliation in the marriage do not work and that is not in the best interests of the spouses to remain together.
It is worth noting that only one spouse needs to feel that the marriage is irretrievably broken in order to commence a divorce. Either spouse may file for a divorce based on an irretrievable breakdown. Once the divorce is initiated, a couple will still need to resolve the same issues as any other divorcing spouses including property division, child custody, child support, and spousal support.
Courts in the state of Alabama consider the fault of spouses when dividing property during a divorce. Because a no-fault divorce is the fault of neither spouse, however, courts often do not analyze the fault of either spouse when determining property division.
There are some advantages for couples who decide to utilize a no-fault divorce. No-fault divorces are often quicker and less expensive than fault-based divorces because parties are not required to go to trial to demonstrate the cause of the divorce. It is important to analyze the various advantages and disadvantages to both types of divorce prior deciding how to proceed with a case.
No matter if your divorce is fault-based or due to the irretrievable breakdown of the marriage, a top Birmingham family law attorney at Alabama Divorce & Family Lawyers, LLC LLC can be helpful to make sure the divorce process proceeds smoothly and that all essential issues concerning the divorce are adequately covered.
795a8134c1