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.

Thyroid hormone concentrations in Nepal: a study of potential Gurkha army recruits. The effect of changes in diet.

A group of non goitrous, potential Gurkha army recruits were tested in Nepal for serum free triiodothyronine (fT3), free thyroxine (fT4) and thyrotropin (TSH) concentrations. Twenty-five percent of the men were recruited into the army and urine samples taken for analysis of iodine and creatinine. Twenty per cent of the recruits underwent thyrotropin releasing hormone (TRH) stimulation tests. After ten months basic training on a diet considered to be iodine sufficient, the tests were repeated on the same men. The results were also compared to army recruits in the UK. All the potential Gurkha recruits had higher serum levels of thyroid hormones than the UK recruits. Some regional differences were found with those men from the Western recruiting depot having lower fT4 and higher TSH concentrations. Urinary iodine and creatinine concentrations showed evidence of slight relative malnutrition and iodine deficiency which was more pronounced in the Western depot. TRH stimulation tests showed no evidence of thyroid dysfunction but highlighted the differences between the Eastern and Western groups. After ten months on an iodine sufficient diet the serum thyroid hormone concentrations became closer to those of the UK recruits, showing any differences to be reversible. The results from the two Gurkha groups became similar which was reflected in the urine analysis results.

Diabetes mellitus in the services--a review 1978-88.

The incidence of diabetes mellitus in the Services for 1978-88 is reviewed. Its influence on the Serviceman's career in the long and short term is discussed. Mortality and morbidity rates are low in the Services when compared with the general population, primarily because of the service demographic distribution. Problems with the discovery of asymptomatic diabetes and possible recommendations are discussed.

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.

Upper gastro-intestinal endoscopy in Nepal.

The indications for and results of 243 upper gastro-intestinal endoscopies performed in the British Military Hospital in Dharan are reviewed. The simplicity of the technique in experienced hands is stressed. It is a very cheap investigation after the initial outlay for the necessary equipment.

Amoebic disease precipitated by corticosteroids prescribed for tuberculous pleural effusions.

One case of ameobic abscess of the liver and one case of amoebic dysentery are described in two patients who were prescribed corticosteroids as part of the intreatment for tuberculous pleural effusion. In both cases routine stool examinations prior to steroid therapy were negative for cysts or trophozoites of E. histolytica.

The evaluation of radioiodine therapy for thyroid patients using a fixed-dose regime.

Ninety-six patients with toxic diffuse goitre (Grave's disease) in whom rapid control of disease was necessary were treated with an "ablative" dose of 550 MBq of radioiodine (131I) with the intention of inducing hypothyroidism. Outcome was established in 93 cases (mean follow-up 37 months), 45 patients (48%) becoming hypothyroid, 30 (32%) remaining euthyroid and 18 (19%) with persistent thyrotoxicosis requiring further 131I therapy. It is thus apparent that a fixed dose of 550 MBq 131I cannot be considered ablative, with less than 50% of patients developing hypothyroidism.

Radioiodine treatment of solitary functioning thyroid nodules.

Forty-eight patients with hyperthyroidism due to a single toxic nodule have been treated with radioiodine (131I). The mean follow-up period is 37 months. All patients were rendered euthyroid and no cases of hyperthyroidism have been observed. Forty patients required only one dose of 131I to render them euthyroid, six patients required more than one dose and two patients initially rendered euthyroid relapsed during follow-up and required further 131I treatment. It is concluded that a single fixed dose of 131I is a simple, effective treatment for a solitary toxic thyroid nodule and does not cause hypothyroidism.

Medicine in the Falklands. A review of the medical services in the Falkland Islands before and after the war of 1982.

As a result of the Argentinian invasion of the Falkland Islands in April 1982 and the reoccupation of the Islands by the British Task Force, certain inevitable changes in the Medical Services of the Islands have occurred. This paper describes the Medical Services pre and post-war.

Clinical indications for optimal use of the radionuclide brain scan.

427 radionuclide brain scans, performed in 1981 at Guy's Hospital Nuclear Medicine Department, were reviewed retrospectively to define clinical circumstances in which the study provided useful information. It was concluded that the radionuclide brain scan was the appropriate first line investigation in patients with known non-cerebral malignancy, in whom the possibility of cerebral metastases exists; and in patients with a low to moderate probability of subdural haematoma. The radionuclide brain scan can provide a valuable alternative to computed tomography studies:--(1) in patients without known underlying disease who develop localising signs; (2) in patients with focal fits; (3) in patients with underlying vascular disease and gradual onset of localising signs; and (4) in patients with suspected inflammatory conditions of the central nervous system. Outside these groups, the radionuclide brain scan rarely provided useful information.

An assessment of the potential role of routine radionuclide thyroid scanning in the differentiation between solid and cystic lesions in the solitary thyroid nodule.

The value of the conventional 99mTc-pertechnetate scan, to differentiate cystic from solid solitary or dominant non-functioning nodules in the thyroid was investigated in 104 patients. Although these nodules are thought to be non-functioning, a low level of radioactivity can be detected in some of the nodules. The assessment was based on the level of radioactivity in the nodules. The nodules with higher activity were considered to have a higher probability of being solid. This diagnosis was confirmed either by ultrasound, or by histological examination, or both, and sensitivity and specificity evaluated with ROC curve analysis which reached 81% sensitivity with a specificity of 44%. The method was more reliable for larger than for smaller nodules reaching a sensitivity of 81% with a specificity of 84%. The results indicate that 99mTc-pertechnetate scanning can provide a useful procedure to distinguish between cystic and solid lesions in the thyroid.