Hand injuries at a British Military Hospital on operations.

The nature of military medical support necessarily changes in the transition from war fighting to the post-conflict phase. This paper examines the activity in the only British Military Hospital serving a multi-national divisional area in Iraq over 2004 during this post-conflict phase. Hand injuries were common and formed a large proportion of the workload seen at the military field hospital on operations.

Knowledge and use of periconceptual folic acid supplements by British Forces Germany personnel and dependents.

Periconceptual dietary folic acid supplementation reduces the incidence of neural tube defects (NTDs). Their use has been advocated by the Chief Medical Officer (CMO), the Consultant Advisor in Obstetrics & Gynaecology (O&G), the Senior Consultant in O&G British Forces in Germany (BFG) and by Medical Administration & Technical Instruction (MA&TI) in all NAAFI outlets. An audit of awareness of the recommendations and use of such supplements amongst pregnant women in BFG was performed over a 12 week period in BMH Rinteln.

Communication following a stillbirth or neonatal death: room for improvement.

Objective: To assess the extent of knowledge which mothers had about a previous stillbirth or neonatal death, their satisfaction with the information and advice given them, and their degree of anxiety during a subsequent pregnancy.

Design: Personal interview.

Setting: Antenatal clinic of a British military hospital in Germany.

Perinatal death: worse obstetric and neonatal outcome in a subsequent pregnancy.

A retrospective case-control study was undertaken of women with a history of a previous stillbirth or neonatal death, who subsequently delivered in BMH Rinteln. Their obstetric and neonatal outcome was compared to that of a control group of women of similar age and parity and its relationship to specific socio-economic factors assessed. Index patients had a worse obstetric and neonatal outcome.

First trimester fetal nuchal translucency: problems with screening the general population. 1.

Objective: To evaluate the feasibility of measuring first trimester nuchal translucency in an unselected population, to assess the relationship with gestation and maternal age and to measure reproducibility.

Design: A prospective observational study.

Setting: University College Hospital, London.

Taped imaginal exposure as a treatment for post-traumatic stress reactions.

The efficacy of taped imaginal exposure as a treatment for Post-Traumatic Stress Reactions (PTSR) was assessed in eighteen consecutive outpatients, including Gulf War veterans. Detailed present-tense scripts of their personal traumatic experiences were prepared and in all but two cases audio-taped and listened to regularly. The severity of PTSR and standard questionnaire scores (including the IES, BDI, GHQ8 and the SCL 90) all showed statistically significant improvements post treatment and at three month follow-up.

The respiratory depressant effect of morphine. A comparative study in three ethnic groups.

The respiratory response to carbon dioxide was measured in 130 ASA 1 adult male patients from three ethnic groups, European, Nepalese, and Chinese, both before and after premedication with intramuscular morphine sulphate (200 micrograms.kg-1 body weight). Satisfactory results were obtained from 125 patients.

Automatism and post-traumatic stress disorder.

A soldier with post-traumatic stress disorder (PTSD) who committed a criminal act during a dissociative episode is described. This report and other published cases indicate that criminal acts can occur during dissociative episodes among people who suffer from PTSD. However, the evidence suggests that such incidents are rare and may be overemphasised.

An ethnic comparison of the sympathetic response to tracheal intubation.

The sympathetic response to orotracheal intubation was examined in five Europeans, 15 Chinese, and seven Nepalese male patients. Plasma adrenaline and noradrenaline concentrations were assayed using high performance liquid chromatography with colorimetric detection. There was a significant rise in noradrenaline concentrations following intubation in the Chinese and the concentrations decreased over 5 min.

Minimum alveolar concentration of halothane: an ethnic comparison.

The minimum alveolar concentration (estimate of spread) of halothane which was determined in 42 Chinese, Nepalese or European patients was found to be 0.70% (0.66-0.

Biotransformation of pethidine: a comparative study of 24 h urine in three ethnic groups.

219 surgical patients of either Caucasian, Chinese or Nepalese origin were given pethidine 1 mg/kg by intramuscular injection as pre-operative medication. Urine was collected for 24 h and analysed for pethidine, pethidinic acid, pethidinic acid conjugates, norpethidine, norpethidinic acid, and norpethidinic acid conjugates. The mean proportion of the percentage of metabolites attributable to oxidative demethylation, hydrolysis and conjugation was almost identical in each ethic group (P > 0.

Necrotising fasciitis of the leg as a complication of ischiorectal abscess.

This case report describes the rare complication of necrotising fasciitis of the right thigh and calf after drainage of an ischiorectal abscess. The important early symptoms and signs of this life threatening infection, and the need for urgent treatment with aggressive surgical debridement and broad spectrum antibiotics, are emphasised in order to facilitate early recognition and prompt initiation of the appropriate therapy in future cases.

Skin biopsies of pigmented skin lesions performed by general practitioners and hospital specialists.

The performance of skin biopsies by general practitioners has been examined in several recent studies. The aim of this study was to examine the difference between skin biopsies of pigmented skin lesions taken by general practitioners and those taken by hospital specialists. Reviewing all histopathology records at one hospital over a five year period revealed that there were 1000 patients who had had skin biopsies.

Suxamethonium myalgia: an ethnic comparison with and without pancuronium pretreatment.

The incidence of myalgia after suxamethonium was determined in 200 fit military male dental patients of European, Chinese and Nepalese descent. Half received pancuronium 1 mg and the other half received saline pretreatment on a randomised double-blind basis. The percentage incidence of postsuxamethonium myalgia after saline or pancuronium was found to be: Europeans 26%, 13%; Chinese 13%, 7%; Nepalese 20%, 14%.

Isolated dislocation of the pisiform bone.

A case is reported of dislocation of the pisiform, successfully treated by conservative means.

The management of quinsy--a prospective study.

A prospective study for the treatment of quinsy was undertaken between January 1989 and September 1991. This was to determine whether abscess tonsillectomy reduces inpatient stay without increasing operative risk compared to incision and drainage combined with interval tonsillectomy. Fifty-three patients were entered into the study.

Vecuronium: an anthropometric comparison.

This study set out to determine if there was any resistance to vecuronium in Nepalese studied in Nepal compared with Nepalese, Chinese and European patients studied in Hong Kong. The four groups, each of 10 male and 10 female patients, were intubated 60 s after administration of 0.1 mg.

Polyorchidism: functional classification and management strategy.

Polyorchidism is rare. We report a recent case and review the literature. A simple classification based on anatomic and functional arrangements of the testes and their drainage systems is described.

Inter-ethnic differences in postoperative pethidine requirements.

A preliminary study of 24 hours' postoperative analgesia using a patient-controlled analgesia technique was undertaken in eight European and fourteen Asian adult patients. All patients had upper abdominal surgery and received weight-related doses of pethidine postoperatively via a Cardiff Palliator. Both groups had a similar degree of analgesia as assessed by visual analogue score but the Asian patients were more sedated in the postoperative period.

Malignant melanomas masquerade--as benign naevi.

Malignant melanoma is becoming more common. 'Curable' early, the prognosis worsens quickly with depth and stage. Publicity in Hong Kong led to an increase in the referral and excision rates for 'benign' pigmented lesions.

Treatment of fractures of the tibial shaft with inter-fragmentary screws and external fixation.

In a prospective trial, 10 patients underwent inter-fragmentary screws and external fixation for unilateral tibial shaft fractures. Anatomical reduction was achieved in all cases and uncomplicated bone union occurred in nine patients with a mean time to union of 122 (SD 20) days. One patient had delayed union and the fracture malunited.

The general practice 'management of otitis externa'.

Clinical confusion, treatment failure and recurrence commonly plague the Management of Otitis Externa. The aim of this study was to investigate the clinical attitudes and habits of army general practitioners and to review the recent literature. The results of a questionnaire survey showed that although all the respondents agreed that aural toilet was important, only 50% felt confident in performing aural toilet and packing.

Determination of contamination of a chemical warfare-proof operating theatre with volatile anaesthetic agents and assessment of anaesthetic gas scavenging systems.

Three types of anaesthetic waste scavenging systems (active antipollution system, Papworth Block passive system and activated charcoal absorber system) were compared with a non-scavenging control to assess their effectiveness in reducing waste halothane concentrations in a chemical warfare-proof operating theatre. All three systems were found to reduce the level of pollution significantly.