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The military is interested in finding a hemostatic dressing that is effective in controlling hemorrhage from combat wounds, relatively inexpensive, and easy to transport. The fibrin dressing has existed for decades, but the military has been reluctant to use the dressing because it is not Food and Drug Administration approved, fairly expensive, and difficult to apply on certain wounds. Newer dressings such as the microporous polysaccharide hemosphere (TraumaDEX), mineral zeolite (QuikClot), poly-N-acetylglucosamine (HemCon), and microporous hydrogel-forming polyacrylamide (BioHemostat) dressings have addressed these deficiencies in that they are relatively inexpensive, easy to transport, and easy to apply. However, the effectiveness of these new dressings on wounds sustained in combat is still questionable according to studies and anecdotal reports from Operation Iraqi Freedom. More research is needed to draw definite conclusions about the effectiveness of these dressings in a combat setting.

SUMMARY The variability in the orocaecal transit time as measured by the lactulose/breath hydrogen method has been studied for three conditions: lactulose given with a meal, subjects sitting; lactulose given with a meal, subjects semirecumbent; lactulose given in aqueous solution, subjects semirecumbent. Thirty three healthy subjects attended on up to 12 occasions. It was found that administration of the lactulose with a meal significantly reduced the variability (p<005) and that adoption of the semirecumbeut position further reduced variability. A power analysis was used to predict the number of subjects who would be required to show a given percentage change in orocaecal transit time at specified probabilities and powers. A graph and a table for use in the prediction of subject numbers at a probability of 5% and for powers of 50-99% is presented. A dose response curve for metoclopramide using the lactulose/breath hydrogen method is given for doses of 10, 15, and 20 mg.Small bowel transit time may be assessed radiologically, by radioisotope labelling of test meals and by use of intubation techniques, although these methodologies may themselves alter transit times and radiation exposure may present ethical problems. The presence of bacterial flora in the large bowel provides a range of possible alternative approaches. Thus the conversion of sulphasalazine to sulphapyridine by bacterial azoreductase with assay of this metabolite in blood,' the production of hydrogen from the raffinose and stachyose content of a baked bean meal or the hydrogen obtained from sorbitol2 or lactulose (galactosido-fructose) have all been described.The lactulose breath hydrogen (L/BH) test described by Bond and Levitt3'4 is now in widespread use, but only limited application of the method to assess drug activity has been made.5 The orocaecal transit time (OCTT), assessed by the L/BH method, is widely believed to be very variable and so before using this technique as a pharmacological tool, this

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