Military cold injury during the war in the Falkland Islands 1982: an evaluation of possible risk factors.

Throughout the history of war, there have been many instances when the cold has ravaged armies more effectively than their enemies. Delineated risk factors are restricted to negro origins, previous cold injury, moderate but not heavy smoking and the possession of blood group O. No attention has been directed to the possibility that abnormal blood constituents could feasibly predispose to the development of local cold injury.

Hickman lines inserted and managed by a general surgical team: longevity and complications.

Long-term venous access lines are commonplace in the management of patients requiring continuous intravenous chemotherapy, intravenous nutrition or simply as a means of avoiding repeated peripheral access lines in patients with difficult venous access. The insertion and maintenance of these lines is not without major complication. Four years' experience with the Hickman catheter in a general surgical oncology setting are reviewed.

Surgical audit: do numbers provide good training?

There has been a growing realisation that good resource planning requires effective measurement of surgical workload by good surgical audit. This paper examines the general surgical workload at the Army's tertiary referral centre, utilising the ratio of operative workload expressed as Intermediate Equivalents to total Service Equivalent Value of a Surgical team. A suggested format to enable inclusion of specialist non-surgical therapies is proposed.

How big is a hand?

Use of the patient's hand to estimate percentage body surface area (BSA) of injury is well established in the management of burns. Exactly what constitutes "the palm of the hand' and how large an area this is, depends on whether you follow Advanced Trauma Life Support teaching. United Kingdom teaching, or use a "Lund and Browder chart'.

Atrio-ventricular dissociation in meningococcal meningitis.

A case is presented of meningococcal meningitis, without septicaemia, which was associated with a transient atrio-ventricular dissociation. The need for cardiac monitoring in similar cases is discussed.

Rhabdomyosarcoma arising in teratoma of the testis.

Rhabdomyosarcoma arising in teratoma of the testis is an exceptionally rare occurrence. The rhabdomyosarcomatous element infers a less favourable prognosis and standard treatment regimes well recognised for the treatment of teratoma of the testis may not be effective.

Potential recruits referred for cardiac opinion review of 100 consecutive cases--a waste of time or an investment?

Eighty seven of 100 consecutive recruits referred for cardiac assessment of fitness to serve had heart murmurs. Seven of these were rejected as having significant cardiac disease. One with a diagnosis of hypertrophic cardiomyopathy would have been placed at considerable risk had he been exposed to the physical stress of military training.

Long-term sequelae of Palmar-Plantar erythrodysaesthesia syndrome secondary to 5-fluorouracil therapy.

Palmar-Plantar erythrodyasesthesia syndrome has been reported as a temporary complication of 5-fluorouracil therapy consisting of a debilitating erythema and tenderness of the skin of hands and feet. The syndrome has previously been observed to respond rapidly to either temporary cessation of chemotherapy or pyridoxine with little residual disability. We report a case which was characterized by persistent morbidity necessitating prolonged discontinuation of treatment.

Immunisation of armed service medical personnel against hepatitis B infection.

Clinical and laboratory staff of the Army and RAF medical services at risk of acquiring infection with hepatitis B were immunised against the virus with a recombinant vaccine. Vaccine was administered in Service hospitals and medical centres located throughout the world. After a primary course of vaccine, 73% of personnel developed anti-HBs titres > or = 100 IU/L to hepatitis B surface antigen and were considered protected; 11% were non-responders (anti-HBs < 10 IU/l).

Screening for ischaemic heart disease by maximal exercise testing as part of the extended PULHHEEMS examination--the first 10 years.

Exercise tests have been an integral part of the extended PULHHEEMS examination since its inception in 1983. In the first 10 years a total of 240 individuals have been examined and 180 (75%) have had normal exercise tests. Individuals with an abnormal test who wished further assessment (58) were subjected to an exercise thallium scan.

Penetrating laryngeal injury: two case reports from Bosnia.

Penetrating injury to the larynx is uncommon. We present two cases resulting from the recent Bosnian conflict. It is possible to achieve good laryngeal function by appropriate conservative management once the airway is secured.

Unfinished business: adult immunization against tetanus.

Where effective child immunization schemes have been established virtually all cases of tetanus occur in persons aged over 50 years. Adult immunization programmes should be introduced in order to protect this age group against the disease.

Randomised trial of single-dose ciprofloxacin for travellers' diarrhoea.

Diarrhoea is the most common illness affecting travellers to developing countries. Our study was designed to compare the efficacy of a single 500 mg dose of ciprofloxacin with placebo for treatment of acute diarrhoea in travellers. British troops who were within their first 8 weeks of deployment in Belize and who presented within 24 h of the onset of diarrhoea, were randomized to receive either ciprofloxacin 500 mg or placebo.

An investigation into the accuracy and validity of three points used in the assessment of autorotation in orthognathic surgery.

Objective: To assess the accuracy and validity of three points used in the cephalometric assessment of autorotation in orthognathic surgery.

Design: A retrospective study of 15 cases of maxillary surgery.

Setting: A postgraduate dental hospital in London.

Chronic inflammatory demyelinating polyneuropathy.

Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is a rare neurological disease. Definitive therapy is not yet established. We report our use of intravenous Immunoglobulin (iv IgG) in two cases of CIDP and review the therapeutic options available.

Percutaneous endoscopic gastrostomy in a military hospital.

Percutaneous endoscopic gastrostomy (PEG) is a simple, relatively safe and cost effective means of establishing enteral access for patients requiring long term nutritional support. PEG has several advantages over surgical gastrostomy and should be considered the procedure of choice for long term enteral therapy in appropriate patients. At the Queen Elizabeth Military Hospital (QEMH) between June 1992 and October 1993 thirteen percutaneous endoscopic gastrostomies were successfully performed.

Army Cardiac Unit -- cardiac catheter patients, 1991--a review.

Ninety three cardiac catheterisations were carried out at St Thomas' Hospital on behalf of the Queen Elizabeth Military Hospital in 1991. Fifty-nine (63.4%) of procedures resulted in the patient's being recommended for further intervention.

Prevalence of immunity to hepatitis A in recruits to the British Army and Royal Air Force.

Between 1989 and 1992, 92% of a sample of 2790 Service recruits aged between 17 and 35 years (mean age 19 years 7 months) were found not to be immune to infection by hepatitis A virus. The proportion of males with immunity was consistently greater than that for females. There was a significantly increased probability of immunity if individuals originated from Northern England, the Midlands and Scotland, in particular the suburbs.

A comparison of carbohydrate deficient transferrin with other markers of alcohol misuse in male soldiers under the age of thirty.

The paper describes a study of 58 consecutive male soldiers under 30 years old admitted to an alcohol treatment unit in London, and 51 age- and gender-matched controls to compare the efficacy of isoelectric focusing, a non-quantitative measure of carbohydrate deficient transferrin (CDT), with other markers of alcohol misuse. The Severity of Alcohol Dependence Questionnaire, the Michigan Alcohol Screening Test and the CAGE questions were all more sensitive in detecting alcohol misusers than the laboratory markers measured. At standard cut-off levels, the laboratory markers yielded low sensitivities even in those subjects who admitted to drinking over 80 g alcohol daily for at least 3 weeks immediately prior to the study.

Primary amyloidosis of the larynx.

The history, examination and operative findings of primary amyloidosis of the larynx are very suggestive of carcinoma, indicating the need for careful histological examination. Staining with Congo red shows a characteristic birefringence. Systemic amyloidosis may be present.