Contingency: the likely spectrum of injuries based upon a review of three recent undeveloped theatres of operations--CORPORATE, TELIC 1 and HERRICK 4.

Contingency operations are by their nature unpredictable and high-risk, with undeveloped logistical support, and medical provision is no exception. Can the contingency experiences of the last three decades help to predict the type of casualties that may be seen in future contingency operations? By reviewing published casualty statistics available from Operations CORPORATE, TELIC 1 and HERRICK 4 it can be demonstrated, unsurprisingly, that gunshot wounds and blast injuries dominate battle injuries, but that disease non-battle injuries also constitute a significant draw on medical provision, particularly gastrointestinal illness in hot environments. Planning for medical support for future contingency operations should anticipate this. Disease non-battle injuries have the potential to render a large proportion of a force combat-ineffective, requiring preventative measures to avoid overwhelming the available medical facilities. When operations occur in populated areas civilian casualties are likely to pose difficulties to medical support, due to issues with onward evacuation and a wider case mix, such as paediatrics.

The UK defence anaesthesia experience with the Zambia Anaesthesia Development Programme.

For 18 months UK military anaesthetic trainees have been travelling to Zambia for a 3-month fellowship under the auspices of the Zambia Anaesthesia Development Programme. In this article we will discuss the history, current state and future intent of the fellowship in order to better inform the anaesthetic cadre and wider UK Defence Medical Services.

Measurement of IgA-alpha 1 anti-trypsin (alpha 1 AT) complex in the sera of patients with IgA myelomatosis.

The level of IgA-alpha 1 anti-trypsin (alpha 1 AT) complex in a relatively large number of IgA myeloma sera has been determined, and compared with their content of polymerised forms of IgA. The level of the complex was the same in sera containing only monomeric IgA, some polymer and more than 50% polymer (as determined by SDS-PAGE). There was, however, a highly significant inverse correlation between the amount of IgA-alpha 1 AT complex in the myeloma sera and their content of 10S dimer (as determined by analytical ultracentrifugation). High levels of IgA-alpha 1 AT complex were also found in the small number of myeloma sera examined which contained paraprotein of the minor allotypic form of (Am2+) of the IgA2 sub-class, indicating that the lack of disulphide bonds between the heavy and light chains of this isotype has no influence on its ability to complex with alpha 1 AT.

Anti-viral antibodies in HIV (HTLV-III) infection possess auto-antibody activity against a CH1 domain determinant in human IgG: possible immunological consequences.

Two regions of the envelope glycoprotein gp120 of the human immunodeficiency virus were shown to have a significant degree of homology to human immunoglobulin-gamma heavy-chain constant domains. We have now synthesized three short linear peptides, the first representing a sequence within the CH1 domain, the second an analogue of it, and the third representative of a region within the viral gp120. Polyclonal antibodies against these peptides were raised in rabbits and used to demonstrate that they all reacted well with human native IgG. Vice-versa, we observed the reaction of these antisera to the virus in an ELISA system. The proportion of sera reacting with the human gamma-chain peptide was significantly higher in HIV-positive individuals than in HIV-negative individuals, suggesting production of anti-viral antibodies in AIDS patients with auto-antibody activity against a CH1 domain determinant in human IgG.

The impact of missile warfare on self-reported sleep quality. Part 1.

During the 1991 Gulf War, we investigated the effect of missile attacks through two telephone surveys of a large sample of an urban population that evaluated self-reported sleep quality, stress, fear, depressed mood, fatigue and power of concentration. We surveyed 1,045 people during the Gulf War itself, and we interviewed them again (excluding the chronic insomniacs) 30 days after the war. During the war, 51% of the subjects claimed to be suffering from disturbed sleep. Whereas 13% of the survey population had been chronic insomniacs before the war, 38% developed insomnia during the war. The war provoked reported stress (67.5% of subjects), depressed mood (50.9%), difficulties in concentration (39.7%) and increased fatigue (25%). Four weeks after it ended, 19% of the previously normal subjects were still suffering from insomnia; 5% of the cases of insomnia were developed postbellum. Stress, depressed mood and impaired concentration were found to correlate significantly with subjectively evaluated insomnia. We concluded that modern missile warfare may induce long-lasting insomnia in one-third of the population under threat. A small percentage may develop insomnia postbellum. The risk of developing long-lasting insomnia is higher in those who reported experiencing prolonged stress and depressed moods.

Hypoglycemia during adrenergic beta-blockade: evidence against mediation via a deficiency of lactate for gluconeogenesis.

Acute hypoglycemia was induced using intravenous inulin in three groups of normal volunteers: (1) seventeen control subjects, (2) six subjects under beta-adrenergic blockade with propranolol, and (3) eight subjects given propranolol plus sodium lactate as an exogenous substrate for gluconeogenesis. Under propranolol blockade the recovery from hypoglycemia was significantly impaired. This impairment was not prevented by the infusion of sodium lactate despite the production of an adequate elevation of blood lactate concentrations. These findings suggest that the impaired recovery from hypoglycemia during beta-adrenergic blockade is not mediated via a deficiency of lactate as substrate for hepatic gluconeogenesis.

Levels of substance P and IgE decapeptide in nasal polyp fluid and matching sera: a preliminary study.

Sixteen unselected patients with nasal polyps had the levels of substance P and IgE decapeptide measured by ELISA in the oedema fluids and their matched sera. All 16 samples had low levels of substance P in their sera and had high level of substance P in eight samples of nasal polyp oedema. There was a considerable variation in the values of IgE decapeptide found in the sera but 14 polyp oedema fluids had high levels of IgE decapeptide. This study supports the idea that there is a linkage between the cellular and neurovascular responses. High levels of IgE decapeptide suggest that mast cell reactions occur in the majority of cases and that IgE may be implicated in the process of mast cell degranulation.

Multifocal idiopathic fibrosis presenting as facial pain and trismus.

An unusual case of idiopathic sclerosing fibrosis is described in which there was involvement of the face, neck, mediastinum and lungs with sparing of the thyroid and retroperitoneal tissues. In contrast to previous cases, facial pain and limitation of jaw movements were the presenting complaints and major causes of disability. Prednisolone treatment failed to arrest the disease.

Internal versus external references with respect to perception of stimuli on the body surface.

Previous studies on the determinants of locus of perception of stimuli on the body have suggested that the position of the stimulus has a significant effect whether a subject perceives a tactile pattern as seen from inside or outside the body. However, it is possible that previous investigators confounded stimulus location--dorsal or frontal--and experimenter's position--behind or in front of the subject. Using 42 male subjects in a 2 X 2 design, the effects of experimenter's position and stimulus location were studied by a new technique for inferring locus of perception. Experimenter's position, rather than stimulus location, affects subjects' locus of perception. Perception of stimuli on the body involves three independent factors, the demand characteristics of the experiment, the manner in which an individual perceives the boundaries of his own body, and an individual's ability to adopt the experimenter's perceptual standpoint.

REM and dreaming.

4 subjects were awakened after long REM periods and 12 other subjects after short REM and after NREMs. The mean numbers of words, dream episodes, and spontaneous remarks about being interrupted in the middle of a dream were significantly different in the reports of the three groups. It is suggested that the present view of the relationship between REM and dreaming is not conclusive.