A review of recent developments affecting COBRA rights

Due to the high cost of health care claims and COBRA's status as remedial legislation, COBRA has generated a significant amount of litigation in recent years. While the early COBRA decisions tended to broaden the law in order to provide a remedy to an otherwise uninsured qualified beneficiary, the recent trend in the case law has been to limit the expansion of COBRA rights based on a narrower construction of the statute. Even so, COBRA still represents a legal minefield for employers. As a result, a careful employer will minimize its exposure by monitoring changes in the law and its interpretation and making appropriate modifications to its COBRA documentation and administration. This article discusses some of the more significant recent changes in the law affecting qualified beneficiaries' COBRA rights--and therefore, employers' exposure.     

Pathological myophosphorylase reaction in malignant hyperthermia

In malignant hyperthermia, myophosphorylase reaction shows characteristic changes that take place within minutes: (1) a generally strongly weakened reaction; (2) numerous negatively reacting fibres; (3) frequently, fibre sections that show spotty and/or striatal weak or negative reactions and fibre sections with strong striatal reactions with relatively narrow sarcomere spacings (a "sign of hypercontraction"). Obviously, the morphological findings that show characteristic "striated fibres" are typical of the malignant hyperthermia syndrome! It is important to note that the muscular fibres showing such changes are, as a rule, inconspicuous when using other stains and reactions. These pathological myophosphorylase reactions were observed in five deceased patients (one independently of anaesthesia after an extended walk) and in 19 pigs (18 times after halothane testing and once in an experimental animal with clinical evidence of the presence of malignant hyperthermia). These reactions were not noted in pigs with negative halothane reactivity or prior to halothane testing. They were also not seen in a large number of very different healthy and diseased control and reference cases from our biopsy and autopsy material. Myophosphorylase reaction enables convincing demonstration of malignant hyperthermia, past or present. Hence, it is possible to elucidate puzzling deaths or verify apparently clear death occurring during or subsequent to anaesthesia or simply following stress ("human stress syndrome"). Many of these deaths doubtlessly escape the attention of clinicians using the usual morphological examination methods. However, the reaction cannot be used to identify potential victims.     

Reviews

Vojtech Mastny, Russia's Road to the Cold War: Diplomacy, Warfare, and the Politics of Communism, 1941–1945. New York: Columbia University Press, 1979. xix + 409 pp. $16.95.

Hugh Seton‐Watson, The Imperialist Revolutionaries: Trends in World Communism in the 1960s and 1970s. Stanford, California: Hoover Institution Press, 1979. x + 157 pp. $6.95.

Egbert Jahn (ed.), Soviet Foreign Policy: Its Social and Economic Conditions. London: Allison and Busby, 1978. 160 pp. £6.50.

Stephen White, Political Culture and Soviet Politics, London: Macmillan, 1979. xi + 234 pp. £10.00 and £4.95.

Donald R. Kelley (ed.) Soviet Politics in the Brezhnev Era, New York: Praeger Publishers, 1980, vii + 269 pp. £14.25.

Morton Kaplan (ed.), The Many Faces of Communism, New York: The Free Press, 1978. x + 366 pp. $14.95.

David H. Howard, The Disequilibrium Model in a Controlled Economy, Farnborough: Lexington Books, 1980. x + 112 pp. £9.50/$20.50.

Felicity Ann O'Dell, Socialisation through children's literature: The Soviet example, Cambridge: Cambride University Press, 1978, x + 277 pp. £14.00.

Martin McCauley, Marxism‐Leninism in the German Democratic Republic. The Socialist Unity Party (SED), London: Macmillan, 1979. xix + 267 pp. £12.00.

R. W. Makepeace, Marxist Ideology and Soviet Criminal Law, Croom Helm, Barnes & Noble, 1980. 319 pp. £13.95.

Jan Tomasz Gross, Polish Society under German Occupation: The General‐gouvernement, 1939–1944, New Jersey: Princeton University Press, 1979. xviii + 343 pp. £11.00