Death investigations on military installations.

The authority to conduct a death investigation, including an autopsy examination, on a military installation depends upon the type of jurisdiction on the installation and the decedent's military connection. Exclusive federal jurisdiction gives the military authority to investigate deaths of active duty military members and, under specific conditions, of civilians with a military connection. Concurrent or shared jurisdiction gives the local civilian medical examiner the right of first refusal as to military members. Thus, the civilian medical examiner may waive jurisdiction to the military. This is not the case when a civilian dies under the same circumstances.

Jurisdiction on military installations.

The death of an individual on a military installation often raises the question of who has the authority to investigate that death and perform an autopsy. The answer to this question depends upon whether jurisdiction is exclusively federal or is shared by the state and federal governments. Jurisdiction can be determined by contacting the installation's Directorate of Engineering and Housing or the legal office. When there is exclusive federal jurisdiction, the installation commander or the Armed Forces Medical Examiner may authorize an autopsy on a military member. Under certain conditions, the installation commander may authorize an autopsy on a civilian, especially where a legitimate connection exists between that civilian and the federal government. When jurisdiction is concurrent (that is, shared by the state and federal governments), the civilian medical examiner may waive jurisdiction to the military, but only as to the death of a military member. The authority to investigate the death of a civilian (whether a military dependent or not), to include autopsy examination, is exclusively civilian when jurisdiction is concurrent. Overseas locations are controlled by special agreements that in general, give the U.S. government jurisdiction over military members, their dependents, and U.S. civilian components of the assigned force.

Group G streptococcal bacteremia in a healthy young man.

Group G streptococcal bacteremia was detected in a 20-year-old man in association with bilateral epididymitis and orchitis. This patient showed none of the predisposing risk factors for group G streptococcal bacteremia which have been documented previously.

The legal aspects of medical school admissions and dismissals.

Implementation of the recommendations made in 1982 by the Council on Medical Education of the American Medical Association which emphasize the importance of evaluating noncognitive abilities in both admission to and dismissal from medical school will become a source of litigation unless adequate guarantees of due process are afforded the medical school applicant and student. In this article, the authors review the law as it applies to medical school admissions and dismissals and offer recommendations intended to reduce the potential liability of medical schools using noncognitive evaluations.

Graduate medical education and the law.

The law can become involved in graduate medical education in several contexts: (a) when applicants are denied admission to residency programs; (b) when residents are dismissed from programs; and (c) when residents, hospitals sponsoring residency programs, or attending physicians are sued for malpractice. A knowledge of the rights and responsibilities of residents, hospitals, and attending physicians is crucial if they are to avoid unnecessary litigation. The authors here review the law in this area and recommend guidelines to be followed by those areas of graduate medical education.

In vitro activity and pharmacokinetics in patients of cefamandole, a new cephalsoporin antibiotic.

Cefamandole nafate, a new cephalosporin for parenteral use, was evaluated in vitro against 231 recent clinical isolates and in 12 patients. Cefamandole had activity equivalent to cefazolin against Staphylococcus aureus, Escherichia coli, and Klebsiella pneumoniae. Cefamandole was more active than cephalothin or cefazolin against Proteus mirabilis. Both cefamandole and cefazolin were as active as cephalothin against S. aureus, were slightly more active against K. pneumoniae, and were considerably more active against E. coli. All strains of indole-positive Proteus sp. were inhibited by 6.3 mug of cefamandole per ml but only 20% were inhibited by 25 mug of cefazolin or cephalothin per ml. Eighty-eight percent of Enterobacter sp. was inhibited by 25 mug of cefamandole per ml, but only 20 and 5% were inhibited by the same concentration of cefazolin and cephalothin, respectively. Peak levels of cefamandole ranged from 6.0 to 110 mug/ml in serum and levels ranged from 440 to 16,800 mug/ml in a 4- to 6-h collection of urine after a 500-mg or 1-g intramuscular dose (6.1 to 17.3 mg/kg) in patients with endogenous creatinine clearances of >/=31 ml/min. These levels were done after the first dose, at mid-therapy, and at the end of therapy. There was no evidence of accumulation with the 500-mg or 1-g dose given every 4 to 6 h. The percentage of the dose excreted in the urine within the first 4 to 6 h after administration of cefamandole was >/=43%. The half-life of cefamandole in serum was 49 to 126 min.

Double-blind comparison of phlebitis produced by cefazolin versus cephalothin.

In a double-blind study with each patient as his own control, 1 g of cefazolin and 2 g of cephalothin were administered intravenously every 6 h to 20 patients in opposite arms for a period of 48 h each. The degree of phlebitis was significantly more severe with cephalothin than with cefazolin (P < 0.05); however, neither the incidence of phlebitis nor the time of onset of phlebitis was significantly different between the two drugs.