Placental permeability for morphine-3-beta-D-glucuronide in the guinea pig.

The fetal Vd and the PS of the major metabolite of morphine, M3G, were studied in pregnant guinea pigs during the last half of gestation. Fetal Vd was determined to be 0.334 ml/g of fetal plus placental weight and did not vary as the gestation progressed. The mean +/- s.e. PS for M3G was 3.7 +/- 0.3 X 10(-5) ml/sec/g and was independent of anaesthesia. This value was consistent with previous studies of other hydrophilic compounds, indicating that diffusion governs the placental passage of M3G. The PS value increased with increasing fetal weight which was consistent with structural changes in the guinea pig placenta as fetal age progresses in late gestation.

U.S. Army surgical experiences during the NATO peacekeeping mission in Bosnia-Herzegovina, 1995 to 1999: lessons learned.

Member countries of the North Atlantic Treaty Organization (NATO) initiated a peacekeeping mission in Bosnia-Herzegovina in December 1995. The U.S. Army has deployed field surgical hospitals to the region to provide ongoing medical and surgical care since December 1995. All surgical cases performed at U.S. Army field surgical hospitals in support of the NATO peacekeeping mission in Bosnia-Herzegovina were reviewed to determine the nature of care delivered. Field surgical hospital operative logs served as primary data sources. U.S. Army field surgical hospitals were established in Bosnia-Herzegovina, Croatia, and Hungary. A total of 676 major operations were performed between December 1995 and September 1999. The mean number of operations performed per surgeon per month during this period was 2.13. Surgical procedures performed during this peacekeeping mission reflect procedures commonly performed in garrison. Other lessons include the need to customize field inventories for peacetime care and the fact that the majority of operations were general surgical or orthopedic.

Whole blood transfusion for exsanguinating coagulopathy in a US field surgical hospital in postwar Kosovo.

An urgent blood drive in which active duty military field surgical hospital personnel volunteered to donate whole blood was conducted, and administration of warm, whole blood prevented the exsanguination of a normothermic coagulopathic patient who had received a massive transfusion. In austere care settings in which full blood banking capability may not be available, physicians should consider that exsanguinating hemorrhage can potentially be controlled surgically, but nonsurgical bleeding requires specific replacement therapy, and whole blood may be the best selection for repleting deficiencies of components that are otherwise unavailable.