Study of psychological effects of deployment at extreme high altitude area on soldiers.

BACKGROUND: The Indian Armed Forces are fighting the battle at extreme High Altitude, the most inhospitable terrain in the world, for the last thirty five years. The stress of being isolated under harsh environmental conditions on a daily basis can have an adverse effect on their mind. However, so far, no study has been undertaken to assess the psychological effects of deployment at extreme High Altitude. METHODS: Three hundred thirty-four troops selected for deployment were initially evaluated using the General Health Questionnaire-12 (GHQ-12) and Armed Forces Medical College Life Events Scale (AFMC LES) as screening tools to assess mental health status after obtaining ethical clearance and informed consent. On deinduction after a deployment for more than three months, they were reassessed. The data collected were statistically analysed. RESULTS: As per GHQ-12 evaluation, after the deployment score increased from 0.2574 to 0.9162, but remained lower than the 'caseness' level of 2. Among the 79 troops with a score of 2 and more, the majority were married and had past history of tenures at high-altitude areas. There was statistically significant increase in the AFMC LES scores also on deployment. CONCLUSION: Deployment at extremely high-altitude areas for even three months produces significant psychological morbidity among troops.

Thoracoscopic sympathectomy for palmar hyperhidrosis and Raynaud's phenomenon of the upper limb and excessive facial blushing: a five year experience.

Primary hyperhidrosis of the palms, face, and axillae has a strong negative impact on social and professional life. A retrospective analysis of 40 laparoscopic transaxillary thoracic sympathectomies performed in a district general hospital over a five year period was undertaken in order to determine the effectiveness of this procedure. A postal questionnaire was sent to all patients to assess the benefit from the operation; postoperative pain and time off work were collated. Immediate failure was noted in three patients, of whom two later underwent successful reoperation. Recurrence was noted in three patients (8%). Though immediate complications were minimal, the major long term postoperative morbidity was compensatory hyperhidrosis on the back, chest, and thigh (77%) along with gustatory sweating over the face (22%). Thoracoscopic sympathectomy is a safe, effective, and minimally invasive surgical treatment for hyperhidrosis, Raynaud's phenomenon of the upper limb, and excessive facial blushing; however, the chance of long term compensatory hyperhidrosis is high.

Preoperative axillary ultrasound scan: its accuracy in assessing the axillary nodal status in carcinoma breast.

The aim of this study is to report the accuracy of ultrasound scan in axillary node staging in breast carcinoma. Eighty-four patients with breast cancer attending a breast clinic were entered in this study and axillary ultrasound scan was performed using a 7.5 MHz probe. The sensitivity of ultrasound scan in detection of axillary nodal metastasis was 74% with a specificity of 89%, positive predictive value of 87%, negative predictive value of 84% and overall accuracy of 83%. The sensitivity was low (38%) when nodes were small or non-palpable. The Likelihood Ratio (LR) for the test positive was 6.37 and the LR for the test negative was 0.29. The combined assessment (Clinical Examination+Ultrasound scan+FNA) of axillary node status was very sensitive--88%, with a specificity of 100%, positive predictive value of 100%, negative predictive value of 88% and overall accuracy of 92%. Ultrasound scan of axilla is a valuable method of preoperatively assessing axillary nodal status, and may prove useful in managing patients with breast cancer.