Risk management issues related to the use of contrast agents

The authors reviewed retrospectively 2,100 claims filed over an 11-year period in 12 hospitals in a large metropolitan area covered by a single insurance carrier. One hundred cases (5%) involved radiologists, and 10 of these were related to the use of contrast media. Four of the cases reached financial settlement before trial, three were dropped with no financial settlement before tribunal or trial, one was dropped after a tribunal finding for the defendants, and two were decided in favor of the defendants at trial. Multiple issues were raised by the plaintiffs in all 10 cases. The questions of quality of care and of informed consent were raised in 10 and nine cases, respectively. In the four cases that reached a financial settlement, quality of care was thought to be an important issue in three, whereas informed consent was not a key issue in any. Conversely, adequate informed consent was an important consideration in three of the six cases that were dropped. Screening of patients and documentation of risk factors, adverse events, treatment, and follow-up were also important factors in determining outcome. The authors conclude that legal claims relating to use of contrast agents are unusual, most often involve non-life-threatening outcomes, and in most cases do not result in trial or a financial settlement.     

Anthropometric Studies of Human Subjects Susceptible to Malignant Hyperpyrexia

Height, weight, and skinfold thickness were measured on 82 patients prior to muscle biopsy which was performed to determine their susceptibility to malignant hyperpyrexia. Percentage body fat was calculated from the skinfold measurements. Using AP photographs six coronal diameters of the left thigh. equally spaced between the lower border of the patella and the perineum, were measured on another group of 90 patients referred for biopsy. The subjects were then divided into those who were susceptible to malignant hyperpyrexia (MHS) and those who were normal and acted as controls. Each group was separated into males and females. There was no significant difference in age between the MHS and the control groups. There was no difference between MHS and controls in height or weight but the percentage body fat in the MHS males was significantly lower than in the controls (P<0.02). The upper three thigh diameters in the MHS females were significantly greater than in the control group (P<0.05). There appears to be a difference in the leanness/fatness relationship and in the development of the thigh in MHS subjects compared with controls, but these differences are subtle and appear to vary with sex.     

Active efflux of chloramphenicol in susceptible Escherichia coli strains and in multiple-antibiotic-resistant (Mar) mutants.

The multiple-antibiotic resistance (mar) locus (min 34) regulates a resistance to chloramphenicol in Escherichia coli that does not involve acetyltransferase. Transport studies showed that wild-type cells had an apparent endogenous active efflux of chloramphenicol which depended on the proton motive force. This efflux was not altered by a 39-kb chromosomal deletion which included the mar locus. Nevertheless, mutations at the mar locus led to a stronger net chloramphenicol efflux. Therefore, a gene encoding the putative efflux system cannot be at the mar locus but may be positively influenced by that locus.