Military medicine
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Case Reports
Iatrogenic pneumomediastinum and subcutaneous emphysema as a complication of colonoscopy with cold forceps biopsy.
A 58-year-old woman underwent outpatient colonoscopy with multiple cold forceps biopsy for evaluation of a presumptive diagnosis of ulcerative colitis. Six hours following the procedure, she developed subcutaneous crepitus and presented to the emergency department, where chest X-ray revealed pneumomediastinum and subcutaneous emphysema. Our case discusses this unusual complication of colonoscopy and its diagnosis and management.
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U.S. military accession mental health screening includes cognitive testing and questions regarding the applicants' past mental health history. This process relies on applicants' knowledge of and willingness to disclose symptoms and conditions. Applicants have a strong incentive to appear qualified, which has resulted in a long history of frequent mental health conditions presenting during recruit training. ⋯ AIM offers the potential to improve screening of military applicants and reduce mental disorders and attrition in new recruits beyond the current process.
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Comparative Study
A 5-year retrospective review of experience with Clostridium difficile-associated diarrhea.
The incidence and virulence of Clostridium difficile-associated diarrhea (CDAD) has increased dramatically from the mid 1990s to the mid 2000s. This research assessed recent CDAD patterns at a major military medical center from 2005 to 2009, by retrospectively reviewing clinical data of each CDAD case identified using the center's electronic medical record system. Two hundred and thirty-two cases were identified. ⋯ Most cases were initially treated with metronidazole, which was associated with a 14% (27/188) recurrence rate versus 9% (2/22) treated with vancomycin (p > 0.05). In contrast to earlier reports, our center has experienced a low and stable rate of CDAD since 2005. Severe CDAD is common and associated with significant mortality.
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Case Reports
Peripartum cardiomyopathy and acute fatty liver of pregnancy: one patient with two zebras.
Peripartum cardiomyopathy (PPCM) and acute fatty liver of pregnancy (AFLP) are rare complications of pregnancy affecting approximately 1/10,000 pregnancies each. We describe a patient who had biopsy-proven AFLP complicated by PPCM. ⋯ AFLP and PPCM are rare complications of pregnancy. We present a patient who had both. Both diseases carry a high mortality rate, and together, are likely fatal.
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Comparative Study
Temporary disability retirement cases: variations in time to final disposition and disability rating by service and medical condition.
Service members undergoing disability evaluation are placed on the temporary disability retirement list (TDRL) when their disabling medical condition(s) may change in severity over time. Information is sparse on the epidemiology of the TDRL population and factors influencing time spent on the TDRL or changes in compensation ratings before final disability outcome. ⋯ Most cases retained the same disability rating and were permanently retired by the first re-evaluation. Important areas of future research include cost-benefit analyses to determine if length of time currently allowable on the TDRL can be shortened or if repeated evaluations are necessary and exploration of specific medical conditions likely to change in severity over time.