Common Medicolegal Problems Faced by Medical Officers of Armed Forces Medical Services

Many a times medical officers of Armed Forces Medical Services face problems concerning policy as well as policy matters la connection with their medico-legal duties and responsibilities. This is particularly so with hospital administrators, pathologists and surgeons. Over and above, the lack of Army Orders and DG Memoranda on this topic makes one feel at a loss. The consequences of mistakes committed while performing medicolegal duties may include strictures from the courts. This article tries to list the common medicolegal problems encountered by medical officers of Armed Forces Medical Services working at different levels and in different capacities, and provides solutions for the same.Key Words: Armed Forces Medical Officers, Investigating Officer, Medico-legal Problems     

Gel electrophoresis-autoradiographic image analysis of radiolabeled protein drug concentration in serum for pharmacokinetic studies

INTRODUCTION: The purpose of this study was to evaluate the feasibility of using gel electrophoresis combined with autoradiographic image analysis for quantitating protein drug concentrations in biological fluid for pharmacokinetic studies. METHODS: Protein drugs were iodinated using the Iodogen reagent and injected into Sprague-Dawley rats for pharmacokinetic evaluation. Serum samples were analyzed using trichloroacetic acid (TCA)-precipitable counts or sodium dodecylsulfate-polyacrylamide gel electrophoresis (SDS-PAGE). Commercially available precasted Bis-Tris gradient gels were used for SDS-PAGE. Autoradiography of gel samples was performed using phosphoimager and quantitated using the ImageQuant software. RESULTS: The maximum loading volume for protein drugs with molecular weight close to that of albumin ( approximately 70 kDa) was about 1 microl, whereas for protein drugs with larger or smaller molecular weight (i.e., >80 or <40 kDa), the maximum loading volume was up to 20 microl/lane. The optimal exposure time was about 18 h or overnight. Standard curves were constructed using serially diluted dosing solution, which was linear over a 10-fold concentration range with a correlation coefficient of.98. Comparing to the soluble human interleukin-13 receptor (shIL-13R) pharmacokinetic profiles from TCA-precipitable counts, the quantitative gel analysis revealed lower concentrations at later time points and a lower bioavailability from intraperitoneal injection. DISCUSSION: This study provided the first systemic evaluation of gel electrophoresis technology for quantitative protein drug determination in serum and its application in pharmacokinetic studies. The combination of gel electrophoresis with autoradiographic image analysis provided accurate and specific quantitation results. The overnight turnover time allowed routine application in preclinical pharmacokinetic studies.     

Distant metastases in nasopharyngeal carcinoma

Three hundred and fifty-two consecutive cases of nasopharyngeal carcinoma were analysed to determine the pattern of distant metastases. Diagnosis of distant metastases was made wholly on clinical signs and radiography. Ninety-nine patients developed distant metastases, an incidence rate of 28.1%. There did not appear to be any difference in "risk" by age or sex. The predilection of this cancer to develop skeletal metastases is further confirmed. Pulmonary and hepatic involvement were the next commonest. Both extent of primary tumour (T) and cervical lymph node status (N) exerted a significant influence on the probability of metastases developing. Thus significant differences in metastatic rate were observed between T0/T1, T2 and T3/T4 and N0, N1, N2 and N3 groups. 65.6% of metastatic cases had control of local disease (nasopharynx and cervical lymph nodes). When metastases are diagnosed the prognosis is gloomy with a median survival under four months and a fatality rate of 91% within a year of first metastasis.     

Randomized trial of conservative laparoscopic treatment and methotrexate administration in ectopic pregnancy and subsequent fertility

Methotrexate treatment was compared to laparoscopic salpingotomy for conservative management of ectopic pregnancy in a prospective randomized study. One hundred patients were randomized into two groups using random numbers. Inclusion criteria were an ectopic pregnancy visualized by ultrasound with a pre-therapeutic score <13 as assessed by the following six criteria, graded from 1 to 3: gestational age, human chorionic gonadotrophin (HCG) concentration, progesterone concentration, abdominal pain, haemoperitoneal volume and diameter of the haematosalpinx. The treatments were either 1 mg/kg of methotrexate injected transvaginally into the ectopic pregnancy without anaesthesia or administered i.m. when the pregnancy could not safely or easily be punctured (group 1), or laparoscopic salpingotomy (group 2). Success was defined as the return to normal (<10 mIU/ml) of HCG concentrations. Treatment was successful for 45 of 51 patients in group 1 (88.2%) and 47 of 49 in group 2 (95.9%). Medical treatment was significantly (P < 0.05) associated with shorter postoperative stay (24 compared with 46 h), but HCG returned to normal more quickly after laparoscopic treatment (13 compared with 29 days). Spontaneous reproductive performance was similar in both groups, but overall intrauterine pregnancy was higher, and repeat ectopic pregnancy lower, after methotrexate treatment. In selected cases of ectopic pregnancy, with a pre-therapeutic score <13, methotrexate treatment appeared as safe and efficient as conservative treatment by laparoscopy and was associated with improved subsequent fertility.