Use of psychological decompression in military operational environments

This article reviews the use of psychological decompression as applied to troops returning from active service in operational theaters. Definitions of the term are considered and a brief history is given. Current policies and practices are described and the question of mandatory decompression is considered. Finally, the evidence base for the efficacy of decompression is examined and some conclusions are drawn. This article highlights variations in the definition and practice of decompression and its use. Although there is, as yet, no evidence that decompression works, there is also no evidence to the contrary. Given the lack of knowledge as to the balance of risks and benefits of decompression and the absence of any definitive evidence that decompression is associated with improved mental health outcomes or that lack of decompression is associated with the reverse, it is argued that the use of decompression should remain a matter for discretion.     

Automated laser light scattering system for assessemnt of sperm motility

An automated apparatus for the objective estimationin vivo of human sperm motility using quasielastic light scattering is described. Computer control removes tedious and repetitive aspects of such studies. Typical results demonstrate the potential of such a system for routine assessment of percentage motility and sperm swimming speed.     

Cardiovascular effects produced by a combination of d-tubocurarine and pancuronium in dogs

The effect on the cardiovascular system of a combination of pancuronium (0.048 mg/kg) and d-tubocurarine (0.288 mg/kg) was studied in five conditioned dogs anesthetized with fentanyl. Changes in heart rate, mean arterial pressure, central venous pressure, mean pulmonary artery pressure, pulmonary capillary wedge pressure, stroke volume, cardiac output, systemic vascular resistance and pulmonary vascular resistance were recorded 2, 5, 10, 20, 30, 40 and 50 minutes after administration of the drug combination. Arterial blood samples were assayed for estimation of histamine levels. There was a significant fall in central venous pressure and mean arterial pressure at 2 minutes (p less than 0.05) and a significant rise in heart rate at 2 and 5 minutes (p less than 0.05). These changes were not significant at 10 minutes. There was no significant change in the other parameters measured and no significant release of histamine. It is concluded that the smaller doses of pancuronium and d-tubocurarine used in combination in dogs do not completely attenuate the cardiovascular effects of either drug when used independently, but that the changes are transient and no longer significant at 10 minutes.     

Peripheral thrombolysis for acute-onset claudication. Thrombolysis Study Group.

BACKGROUND: The aim of this study was to determine the outcome of patients who presented with sudden onset of incapacitating claudication of less than 2 weeks' duration and who were treated with peripheral arterial thrombolysis. METHODS: The database of the Thrombolysis Study Group was searched retrospectively for patients who received thrombolysis for acute-onset claudication. Some 108 patients (65 men, median age 69 (range 29-94) years) were treated with intra-arterial tissue plasminogen activator at 14 hospitals. The median duration of symptoms was 72 h (range from 2 h to 2 weeks). There were 52 graft and 56 native vessel arterial occlusions. RESULTS: The immediate outcome of thrombolysis for native vessel arterial occlusion was thrombus clearance in 50 patients (89 per cent) and failed lysis in six (11 per cent). Thirty-six patients (64 per cent) had a secondary radiological or surgical procedure carried out after lysis. After 30 days four patients (7 per cent) had a major amputation, eight (14 per cent) had died, 38 (68 per cent) were symptom free and seven (12 per cent) continued to have claudication. Three patients (5 per cent) suffered a major haemorrhage. The immediate outcome of thrombolysis for graft occlusion was thrombus clearance in 48 patients (92 per cent) and failed lysis in four (8 per cent); 27 patients (52 per cent) had a secondary procedure. After 30 days four patients (8 per cent) had a major amputation, seven (13 per cent) had died, 32 (62 per cent) were symptom free and nine (17 per cent) had persistent claudication. Three patients (6 per cent) suffered a major haemorrhage. CONCLUSION: Patients who presented with acute onset of incapacitating claudication had an outcome similar to that after thrombolysis for critical ischaemia. It is recommended that patients who present in this way should be observed and treated with thrombolysis only if they progress to critical ischaemia. Presented to the Association of Surgeons of Great Britain and Ireland, Edinburgh, UK, May 1998, and published in abstract form as Br J Surg 1998; 85(Suppl 1): 24     

First year of a fast track carotid duplex service.

BACKGROUND: The risk of major stroke is highest in the first three months after a transient ischaemic attack (TIA). Urgent carotid endarterectomy can reduce the risk in patients with a severe carotid stenosis. An express carotid duplex service has been established and this study analyses the effect in the first year. METHODS: Local GPs were offered a new service whereby a carotid duplex scan would be guaranteed within 14 days of referral of any patient who had a recent clearly documented TIA or amaurosis fugax. Referral letters were faxed directly to the Vascular Office where the duplex scan was authorised by a consultant vascular surgeon. Patients with significant carotid disease on duplex were assessed in the out-patient clinic in preparation for surgery. RESULTS: In the first 12 months of the service, 90 fast track duplex scans were performed. In the same interval 490 routine carotid duplex scans were carried out. Some 13 carotid endarterectomies were carried out on patients from the fast track group (13/90, 14%), with a median delay between referral and surgery of 30 days (range 20-45) and median duration between onset of symptoms and surgery of 51 days (range 27-406). In the non fast track group 14/490 (2.8%) scans resulted in carotid intervention, a median 127 days (range 64-184) after referral. CONCLUSION: The fast track service significantly reduced the delay between referral and surgery. Timing of carotid surgery is critical. Performing the surgery at the time of greatest risk increases the benefit of carotid endarterectomy. Urgent and appropriate referral from the GPs is vital for the service to run effectively.