Biomedical subjects
Publications and source records attributed to S M Milner.
A false label of penicillin allergy may have important consequences for wartime medical evacuation. This article outlines the antibiotic protocol for war wounds, the current status of tests to diagnose true penicillin allergy and suggests a strategy for the management of personnel with a history of such allergy.
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In the 3 months from October 1990 to January 1991, 110 operations were performed at 33 Field Hospital, Royal Army Medical Corps at Al Jubayl, Saudi Arabia in collective protection against chemical warfare. The evolution of improvements in this environment is presented in the context of the first operative series undertaken.
The use of internal rigid fixation with plates in the treatment of facial fractures continues to increase in popularity. The principal advantage is in avoiding the use of maxillary mandibular fixation (intermaxillary fixation), thus enabling early return of function. However, there are clear guidelines for their use and technique of placement. A case is reported that demonstrates several avoidable complications in the use of compression plates and outlines the principles for the correct use of bone plates in mandibular fractures.
The indications for the ruling for the Gulf Forces that emergency cricothyrotomy is to be performed where the airway is thought to be compromised are reviewed. The advantages of this procedure are outlined and some of the likely consequences regarding the incidence of complications and their management predicted.
Most papers appearing in the surgical literature dealing with wound ballistics concern themselves with wound management in the civilian setting. The pathophysiology of modern war wounds is contrasted with ballistic wounds commonly encountered in peacetime, but it should be noted that even in peacetime the modern terrorist may have access to sophisticated military weaponry, and that patients injured by them may fall within the catchment area of any civilian hospital. Management problems associated with both wound types are highlighted; areas of controversy are discussed. The orthodox military surgical approach to ballistic wounds is expounded and defended.
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A case of liposarcoma of the cord is reported in a patient presenting for vasectomy. This paper discusses such tumours and illustrates the importance of a careful clinical examination during counselling.
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Mouse spleen cells were exposed to a short pulse of the mitogenic lectin concanavalin A (con A). After removal of con A mitogenesis was measured by the incorporation of tritiated thymidine into DNA. It was found: (a) the number of cells responding to con A was proportional to the time of exposure to con A; (b) exposure of cells to con A in the absence of extracellular calcium failed to initiate mitogenesis; (c) for a mitogenic effect an extracellular calcium concentration greater than 10(-5)M was required during the time that the cells were exposed to con A.
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The reduction of burn edema is a common goal in the resuscitation of patients with thermal injury. Initial infusion of a 2400 mOsm hypertonic 7.5% NaCl 6% dextran (HSD) has been shown to reduce volume needs, but elevated serum sodium levels limit the dose that can be safely used. This study tested the hypothesis that a 2400 mOsm solution of NaCl, amino acids, glucose, and 6% dextran (Isosal-D) would reduce similar volume requirements while maintaining normal plasma sodium levels. Hemodynamics, plasma sodium, fluid balance, and tissue water content were measured after an initial baseline period and during resuscitation of a large scald injury in 21 anesthetized sheep. Resuscitation was begun 30 minutes after the scald with infusion of 10 ml/kg of either lactated Ringer's (LR), Isosal-D, or HSD and was continued with LR to restore and maintain baseline oxygen delivery throughout the 8-hour period. Oxygen delivery, cardiac output, and mean arterial pressure were rapidly reestablished by all three solutions, although a persistent tachycardia was noted with Isosal-D. Net fluid requirements of both HSD (35 +/- 13 ml/kg) and Isosal-D (72 +/- 13 ml/kg) were significantly lower than in the LR group (203 +/- 39 ml/kg). Mean serum sodium increased 11 mEq with HSD to a peak after 4 hours of 152 +/- 5 mEq, whereas with LR sodium fell 7 mEq to 132 +/- 4. Isosal-treated animals had minimal change in serum sodium. HSD significantly decreased tissue water content in colon, liver, pancreas, and nonburned skin compared with LR, whereas Isosal-D reduced edema only in the colon. It is concluded that in this protocol Isosal-D was not as effective as HSD at reducing volume needs and edema and had unexpected chronotropic effects.
The fluid resuscitation of burn injuries in mass casualty situations, such as war, presents a formidable challenge. The possibility of overwhelming numbers of patients to be treated by inexperienced personnel dictates the adoption of a safe, simple and effective regimen. In the burn treatment protocol presented here, this regimen is computed in advance and displayed in a simple tabular form.