Military medicine
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We present a unique case of chronic peroneal tendon dislocation in a 47-year-old active duty military member with a 2-mo history of acute onset lateral ankle pain due to sports injury. Magnetic resonance imaging revealed superficial peroneal retinaculum (SPR) disruption, a flattened retrofibular groove, dislocation of the peroneus longus tendon, and a tear of the peroneus brevis tendon. ⋯ At their 3-mo follow-up, the patient reported near complete resolution of pain and the ability to ambulate without any brace or support. He returned to running and was able to deploy fit for full duty 4.5 mo from injury.
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The purpose of this study was to explore the effect of low testosterone level on whole-brain resting state (RS) connectivity in male veterans with symptoms such as sleep disturbance, fatiguability, pain, anxiety, irritability, or aggressiveness persisting after mild traumatic brain injury (mTBI). Follow-up analyses were performed to determine if sleep scores affected the results. ⋯ Lower testosterone levels were correlated with lower connectivity of the LPhG. Weaknesses of this study include a retrospective design based on self-report of mTBI and the lack of a control group without TBI. Without a control group or pre-injury testosterone measures, we were not able to attribute the rate of low testosterone in our participants to TBI per se. Also testosterone levels were checked only once. The high rate of low testosterone level that we found suggests there may be an association between low testosterone level and greater post-traumatic stress disorder symptoms following deployment, but the causality of the relationships between TBI and deployment stress, testosterone level, behavioral symptomatology, and LPhG connectivity remains to be determined. Our study on men with persistent symptoms postdeployment and post-mTBI may help us understand the role of low testosterone and sleep quality in persistent symptoms and may be important in developing therapeutic interventions. Our results highlight the role of the LPhG, as we found that whole-brain connectivity in that region was positively associated with testosterone level, with only a limited portion of that effect attributable to sleep quality.
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We present a case of chronic non-communicating hydrocephalus (NCH) in a US military recruit. Non-communicating hydrocephalus is a pathologic obstruction of cerebrospinal fluid (CSF) resulting in enlargement of the ventricles and elevated intracranial pressure. ⋯ The diagnosis and evaluation of hydrocephalus is greatly dependent on clinical history and supported by radiographic imaging. Based on these factors, one can determine if the hydrocephalus is either acute or chronic and communicating or non-communicating.
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Individual critical task lists (ICTLs) are skills identified by the U.S. Army for the maintenance of combat readiness in each military occupational specialty, including physicians. These lists vary by medical and surgical specialties and are being utilized by leaders to determine individual deployment capability. The lists for urologists include broader tasks that are not routinely performed in a urology practice. Our goal was to create a simulation curriculum to train urologists and to perform validation testing. ⋯ The novel urology ICTL curriculum using simulation is a feasible and well-received way to keep competency on these tasks and maintain readiness. Face and content validity was established for the urology ICTL simulation curriculum, and the curriculum is exportable to equip urologists at other facilities for the urology ICTLs and for deployments, where life-saving interventions may be necessary from urologists that may be outside their ordinary scope of practice.
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Because of increased morbidity seen in multiple gestations, the American Society of Reproductive Medicine recommends transfer of blastocysts one at a time for most patients. While cost-effectiveness models have compared single embryo transfer (SET) versus double embryo transfer (DET), few incorporate maternal and neonatal morbidity, and none have been performed in U.S. Military facilities. The purpose of this study was to determine the cost effectiveness of sequential SET versus DET in a U.S. Military treatment facility. ⋯ SET in a system with no infertility coverage saves approximately $3.5 million per 250 patients. Higher personal costs as seen with SET may incentivize patients to seek DET. The total savings should encourage alteration to practice patterns with the U.S Military Healthcare System.