Results of investigations on Gulf War veterans

Abstract

-Investigations were undertaken on veterans of the Gulf conflict of 1990/91 at the Gulf Veterans' Medical Assessment Programme (GVMAP), to determine whether routine investigations should be carried out on these veterans. Blood investigations were analysed of a 10% random sample of veterans and also of two veteran groups -one group was well (asymptomatic) and the other unwell (post-traumatic stress disorder). Neurological investigations were carried out as well as 1,000 ultrasound studies and 3,000 ECGs. Almost all blood tests proved normal. The only significant differences found between the two groups were for the alanine/ aspartate transaminase and gamma glutamyl transaminase values, where there were more abnormal findings in the unwell group. Abnormal, but expected, neurological investigations were found in those referred for these tests. Ultrasound abnormalities were related to known established clinical diagnoses, apart from three cases. ECG abnormalities were only present in those with known clinical diagnoses. It was concluded that reducing the number of investigations would not only be cost effective but should help to lessen veterans' anxieties. KEY WORDS: Gulf War veterans 1990/91, implications, results, routine investigations, way forwardA short time after their return from the Gulf War of 1990/1, some veterans began to complain of symptoms of ill health, which became popularly known as 'Gulf War Syndrome' . There have been unsubstantiated claims in the media and by some veterans' activist groups that Gulf War service is linked to increased rates of mortality, birth defects, pregnancy problems and other more specific illnesses. Elsewhere claims of specific illnesses or unique syndromes have been made 1,2 and carefully reviewed, 3,4 finding little, if any, evidence of these links. In the UK, in response to these symptoms, the Ministry of Defence established in October 1993 the Gulf Veterans' Medical Assessment Programme (GVMAP), which was much heralded by the media. Similarly, in the USA, the Department for Veterans' Affairs Gulf Registry Health Examination Program (VA Registry) also started assessing veterans who had left the armed services in 1992. In 1994, the Department of Defense set up the Gulf veterans Comprehensive Clinical Evaluation Program (CCEP).The GVMAP was never intended as a screening programme but, since it is the only programme available to Gulf veterans, it acted as a surrogate screening programme. Investigations were undertaken to help the medical assessments when it was thought that there may have been a condition specifically related to the Gulf War. Initial research, [5][6][7][8] and that carried out later, 9,10 benefiting from the results of almost a decade of research and assessment, found no evidence to support the concept of 'Gulf War Syndrome' or any unique Gulf War related illness. Similar conclusions have been reached at CCEP. 11 The diagnosis of 'symptoms, signs and ill defined conditions' (SSIDC) has now virtually disappeared in recent literature compared with ea...

Healthcare utilization and mortality among veterans of the Gulf War

“…The first peer-reviewed Gulf War veteran registry report was published by Joseph et al in 1997 as a case series ( Joseph & The Comprehensive Clinical Evaluation Program Evaluation Team 1997). The report's summary of the evaluation of the first 20 000 DoD registry participants at 184 medical institutions is consistent with the findings from other US, UK, Canadian and Australian registry participants evaluations (Robinson 1995;Joseph & The Comprehensive Clinical Evaluation Program Evaluation Team 1997;Coker et al 1999;Murphy 1999;Lee et al 2001;Department of Veterans Affairs 2002;Smith et al 2002b;Australian Department of Defence et al 2003;Lee et al 2005a). Gulf War veterans frequently selfreported symptoms of fatigue, headache, memory problems, sleep disturbances, skin rash, joint pain, dyspnoea, cough and other non-specific symptoms (table 3).…”

Posttraumatic stress disorder and hypertension in Australian veterans of the 1991 Gulf War

“…Many papers that have examined associations between PTSD and blood pressure have considered factors such as autonomic reactivity and acute blood pressure lability following re-exposure to a traumatic stimulus [1]. Others have not primarily considered hypertension, but rather focused on non-specific cardiovascular symptoms [10][11][12], used broad diagnostic categories encompassing several conditions including hypertension [10], or reported on investigations such as electrocardiogram abnormalities consistent with various cardiovascular diagnoses [13,14]. Amongst studies that have examined specifically for relationships between PTSD and hypertension, associations have been reported in both veteran [15][16][17] and civilian [18][19][20] populations.…”

Neurological disorders in Gulf War veterans

“…Four uncontrolled studies focused on small samples of treatment-seeking veterans: 65 ill GWVs in Seattle (Newmark & Clayton 1995); 20 ill GWVs in San Antonio (Amato et al 1997); 12 ill GWVs in San Juan, Puerto Rico (Rivera-Zayas et al 2001); and 33 ill GWVs in London (Lee et al 2005). A fifth small study included 14 ill GWVs and 13 healthy, non-military controls in Glasgow, Scotland ( Jamal et al 1996).…”

“…Among the first 1000 veterans who participated in the UK Medical Assessment Programme, 33 veterans reported possible neurological symptoms, e.g. tingling paraesthesias, muscle twitches or muscle weakness (Lee et al 2005). These veterans were referred to neurology experts in London.…”

“…Among the first 1000 veterans who participated in the UK Medical Assessment Programme, 33 veterans reported possible neurological symptoms and all 33 were evaluated with NCS and EMG (Lee et al 2005). One veteran was diagnosed with mixed motor-sensory peripheral neuropathy and two veterans were diagnosed with carpal tunnel syndrome.…”