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The trauma center managed most of the major trauma patients in the trauma system but the triage criteria need to be reconsidered. The level of care of the regional trauma system was shown to measure up to US and UK benchmarks.

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289feelings, not only through social conditioning but also because these feelings are unpleasant. In some cases these "bad" feelings have been inadequately dealt with and cause trouble. Dynamic psychiatry brings out the long-forgotten impulses and experiences underlying a patient's disturbance and makes them available for examination. It might then be possible to resolve the unconscious conflicts and problems, or at least put them away more effectively.Dynamic psychiatry is difficult for both the patient and the worker. For the patient, at first, it seems as if life is being made even more difficult; he is being forced into owning unpleasant -perhaps frightening-feelings, the very thing he has been trying to avoid and hopes to escape from by coming for treatment.For the worker, to grasp and hold on to the value of the concepts used in dynamic work-something that goes so much against his natural tendency-is not easy. To-be touched emotionally by the disturbance of the patient makes him anxious and insecure. It is most difficult for the doctor. Doctors have had a specialised training in treatment based on antidynamic principles in which they have developed confidence over the years. They have also developed a feeling of security and an uncomfortable yet satisfying feeling of near omnipotence as a result of projections on to them from lay people. It is with the greatest difficulty that they abandon the security of these attitudes in the face of all the internal and external forces that work towards their retaining them.Ever since mental illnesses began to be regarded as amenable to treatment attempts have been made to classify them on some rational basis so that treatment could be administered in a simple, logical manner in accordance with such classifications. While efforts at classification continue, I believe that the human mind is increasingly recognised to be too complex and subject to too many variables to permit a simple medical model of mental illness. This is true of adolescent psychiatry more than any other branch of psychiatry.'Any rational and serious attempt to treat adolescent problems must take the causative factors into account. Usually these result from the adolescents' relationships with significant people in their lives. Treatment must take these factors into account and therefore must be on dynamic lines. ReferencesWorld Health Organisation, Glossary of Mental Disorders and Guide to their Classification. Geneva, WHO, 1974. Clinical TopicsValue of a testicular biopsy rating for prognosis in oligozoospermia J H AAFJES, J C M VAN DER VIJVER, P E SCHENCK British Medical Journal, 1978, 1, 289-290 Summary and conclusions Testicular biopsies of 142 oligozoospermic men were used to obtain a testicular biopsy score count. These scores were clearly related to the chance of fertility, in contradistinction to data on hormone concentrations and from analysis of semen. In 36 patients with a score of 9-10 there were 15 pregnancies; in 59 patients with a score of 8-9, 12; and in 47 patients with scores be...

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