Military medicine
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A prospective study was conducted to evaluate the use of magnetic resonance imaging (MRI) by orthopedic surgeons and residents versus the use of MRI by non-orthopedically trained health care providers in diagnosing knee pathology. Fifty patients initially evaluated by members of one of these groups who underwent subsequent knee MRI evaluation were selected to participate. Two orthopedic examiners individually examined all patients, recording clinical diagnosis and the merit of MRI evaluation in each case. ⋯ The study examiners observed both groups using MRI equally inappropriately and found 62% of the imaging studies unjustified. We conclude that knee MRI is used inappropriately in the current military setting. An algorithm is proposed to guide the future use of MRI in the diagnosis and management of knee pathology.
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Case Reports
A Naval Academy midshipman with ehrlichiosis after summer field exercises in Quantico, Virginia.
A case of human ehrlichiosis (caused by infection with Ehrlichia chaffeensis) is presented. The patient was a female Naval Academy midshipman with a 26-day history of daily field training with the U. S. ⋯ She did not develop a rash. Laboratory studies were significant for thrombocytopenia, equivocal Lyme enzyme immunosorbent assay with a negative confirmatory western immunoblot, equivocal Rocky Mountain spotted fever acute serology without a convalescent increase in immunoglobulin G, and immunoglobulin G/immunoglobulin M serology positive for human monocytic ehrlichiosis. She manifested known sequelae for this emerging disease, including dyspnea, pedal edema, increased transminases, and nephrotic syndrome.
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The object of this study was to determine the types of noncombat injuries secondary to munitions sustained by U.S. Army soldiers. ⋯ This study demonstrates a distinctive injury pattern for each category of munitions. Military readiness will be improved if we train all personnel to be familiar with the injury patterns and the most common situations associated with injury. By informing unit commanders which activities are associated with increased risk of injury, they may better prepare preventive measures to decrease the number of noncombat injuries.
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Among Army aviators, the incidence of total hip arthroplasty (THA) is unknown. This study analyzes the incidence and aeromedical disposition of THA among Army aviators. The U. ⋯ THA is a rare medical event among Army aircrew members. Most are able to return to full flying duties with a waiver. Aircrew members younger than 50 years with THA are more likely to be suspended from aviation duties.