A new chart to assist with advanced trauma life support.

Many studies have drawn attention to deficiencies in the management of major trauma, both in the UK and elsewhere. One area that has received little attention is the documentation of such cases in the Emergency Room. When outcome may be sub-optimal, documentation assumes greater importance if advances are to be made in the organisation of trauma care.

Arterial embolisation of a facial haemangioma.

Non-invasive investigations in the diagnosis of highly vascular lesions are without doubt a sound principle. A case is presented however, in which the clinical diagnosis of a haemangioma was confirmed by ultrasound and magnetic resonance imaging (MRI) but required further investigation by angiography to facilitate treatment. Embolisation is a well established technique available in most large radiology departments, but may not be well known by general dental practitioners.

Oesophageal foreign body: an unusual cause of respiratory symptoms in a three-week-old baby.

Impaction of a foreign body in the oesophagus is common in children. If the event is not witnessed by an adult or the object is radiolucent the diagnosis is difficult as respiratory symptoms may predominate. We report a three-week-old child with respiratory symptoms who had both a respiratory syncytial virus infection and a radio-lucent oesophageal foreign body.

Typhoid Vi: a less reactogenic vaccine.

A typhoid vaccine derived from the purified Vi capsular polysaccharide (CPS) antigen of Salmonella typhi was compared with a heat-killed whole-cell typhoid vaccine in 637 healthy male volunteers. The individuals were placed in three groups: group 1 received two doses of heat-killed whole-cell typhoid vaccine, at an interval of 28 days; group 2 received a single dose of typhoid Vi CPS vaccine followed after 28 days by water for injection; and group 3 received water for injection on the first occasion and a single dose of typhoid Vi CPS vaccine 28 days later. Local and systemic adverse reactions were recorded for 5 days following each injection.

Gulf medical audit--an analysis of medical casualties evacuated to the UK from the Gulf during Operation Granby.

The 61 personnel, 60 male, evacuated from the Gulf to Queen Elizabeth Military Hospital on medical grounds between late October 1990 and mid March 1991 are reviewed with particular regard to previous medical history, previous medication, and appropriate PULHHEEMS grading. The percentage evacuated was 0.24% of Army personnel involved in "Operation Granby" which is considered acceptably small.

Complications in the use of compression plates in the treatment of mandibular fractures.

The use of internal rigid fixation with plates in the treatment of facial fractures continues to increase in popularity. The principal advantage is in avoiding the use of maxillary mandibular fixation (intermaxillary fixation), thus enabling early return of function. However, there are clear guidelines for their use and technique of placement.

Anterior cruciate ligament reconstruction using the Gore-tex ligament.

Twenty two Army patients with synthetic (Gore-tex) anterior cruciate ligament (ACL) reconstructions were reviewed (mean follow up 18 months). Reconstruction appeared to abolish the pivot shift sign in all cases, but some subjective instability persisted in all but 6 patients. Outcome was also assessed by medical (PULHHEEMS) grading: 6 patients were fully fit (graded L2), 7 returned to moderate activity but not full fitness (L3), and 9 remained severely incapacitated (L7 or L8) with 4 of this group being medically discharged.

Pleomorphic adenoma of the parotid gland.

A case of pleomorphic adenoma arising from the deep lobe of the parotid gland is presented. Controversy often surrounds the management of a parotid lump, and many investigations are of little help. The first operation cures most salivary tumours and the patient usually has no residual disability.

Pilomatrixoma: a rare condition in the differential diagnosis of a parotid swelling.

Pilomatrixoma is an uncommon tumour arising from hair follicles. It is more common in the hair bearing areas of the upper region of the body, but is relatively rare. A case is presented in which clinical examination, ultrasound and computed tomography suggested the presence of a pleomorphic adenoma arising from the superficial lobe of the parotid gland, but at operation the mass was found to be separate from it and subsequent histological examination revealed a pilomatrixoma.

Tattoo removal by surgery in a bloodless field.

Tattoo removal from the forearm often requires excision and split skin grafting. The authors propose the use of a bloodless field to facilitate accurate dermal peeling, to ensure complete removal of the pigment, and to reduce operative time.

Third-degree heart block developing in an HLA-B27-positive individual with a family history of ankylosing spondylitis.

A case of complete heart block is presented in a patient whose brothers were known to have ankylosing spondylitis. Uveitis and sacro-iliitis are well recognised among HLA-B27-positive siblings of ankylosing spondylitis. However, heart block is a rare occurrence as a sole presentation in siblings of patients with ankylosing spondylitis.

Screening for squints and amblyopia in pre-school children in a service community.

A screening programme designed to detect visual defects in pre-school children was mounted in a Service community in West Germany. This showed the feasibility of screening and demonstrated that the results produced were superior to those of routine referral. The methods of findings are discussed.

Importance of histological assessment of dental follicles following extractions.

A case is reported of actinomyces being isolated histologically from an enlarged dental follicle surrounding a partially erupted, impacted third molar. This allowed prophylactic therapy to prevent the possible development of cervicofacial actinomycosis.

Medical aspects of recruiting for the Brigade of Gurkhas.

The medical aspects of recruiting for the Brigade of Gurkhas are discussed with particular emphasis to the medical examination being the first sieve in the recruiting process. In 1987 there were 248 medical failures of a total of 913 recruits examined. The commonest causes of failure were an abnormal chest X-Ray and chronic middle ear disease with or without defective hearing.

Intermittent axillary vein obstruction in a competitive canoeist.

The case is reported of a competitive canoeist with intermittent axillary vein obstruction secondary to shoulder girdle muscle hypertrophy. The anatomy of the axilla, pathology of the axillary vein, and reported cases of sports injuries involving the axillary vein are discussed. This would appear to be the first report of such an occurrence in a canoeist.

Rehabilitation after coronary artery by-pass grafting and improved quality of life.

Long waiting lists for coronary artery by-pass grafting often mean that patients have to endure a prolonged period of pre-operative disability, a known poor prognostic factor for their future quality of life and employment prospects. A survey of 60 patients who attended a post-operative rehabilitation course designed to restore their fitness and self-esteem, and hence their quality of life, has shown encouraging results. When questioned a mean 16 months later, 85 per cent are working and significant improvements have been seen in all four quality of life indicators assessed: job satisfaction, family life, social life and sex life.

The use of ultrasound in the management of primary psoas abscess.

Whereas psoas abscess secondary to many local intra- and extra-peritoneal septic processes is well recognised, primary psoas abscess is much less common and the diagnosis is often delayed, leading to significant morbidity and mortality. A case of primary psoas abscess is described and the role of ultrasound in the investigation and management is discussed.

Use of ultrasound in Nepal.

Although for a Third World country like Nepal the provision of an ultrasound machine may represent a considerable capital outlay, once installed it is a versatile diagnostic tool, non-invasive, relatively inexpensive to run and requiring very little patient preparation and no in-patient beds. Ultrasound, in the hands of a skilled ultrasonographer, can provide immediate, accurate and invaluable diagnostic information to the clinicians in a range of bizarre and advanced clinical conditions.

Management after coronary by-pass graft surgery: a rehabilitation course induces life style changes which may improve long term graft survival.

Too many coronary artery by-pass grafts block within 10 years. Smoking, one risk factor is well managed with over 80% giving up peri-operatively, but hyperlipidaemia is not. Only 27% of such patients on a rehabilitation course knew their cholesterol and 32% had received no dietary advice.

Calcium alginate dressing accelerates split skin graft donor site healing.

A prospective controlled trial of calcium alginate compared with traditional dressing of paraffin gauze on split skin graft (SSG) donor sites had to be abandoned after 15 patients as there was consistently better healing under the calcium alginate. The study was continued, on every patient requiring split skin grafting, to assess calcium alginate from the point of view of patient comfort, ease of dressing and quality of regenerated skin. In 107 patients with 130 SSG donor operations, there was a statistically highly significant decrease in average time to complete healing (from 10 down to 7 days), and also significantly better patient comfort.

Outboard motor propeller injuries.

Seven cases of injury from an outboard motor propeller are reported and the literature reviewed. The injuries are uncommon, but appear to have a high rate of morbidity and mortality. Wound contamination at the time of injury is discussed.

The value of routine radiology in young psychiatric patients.

The current policy of obtaining routine skull and chest X-rays on all psychiatric admissions to military hospitals has been examined by scrutiny of the radiology reports on all such admissions during one calendar year. No clinically unexpected finding was demonstrated in any of the 352 patients so examined. Routine radiological investigation of these patients may safely be abandoned.