Military medicine
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In order to best optimize health care, we need the right combination of individuals working on interprofessional health care teams, each joining with the right mindset, in the right places, and at the right times. In this special issue of Military Medicine, Dr. ⋯ Such research is fundamental to advance excellence of military health care by finding, exploring, and addressing existing gaps in what we currently employ and capitalizing on what we know works well. In doing so, we can improve the effectiveness of our care teams and, as a result, optimize care of our wounded on the battlefield.
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Complex regional pain syndrome (CRPS) is a relatively rare, but debilitating condition that may occur after limb or peripheral nerve trauma. Typical symptoms of CRPS include swelling, allodynia, hyperalgesia, and skin temperature changes. Although a variety of pharmacological and non-pharmacological approaches are commonly used in caring for individuals with CRPS, they are frequently ineffective and often associated with side effects and/or additional risks. ⋯ These four patients all reported subjective improvement in their pain, function, and exercise tolerance in association with their DMO use. All patients demonstrated reduced use of analgesic medications. The pre- and post-DMO lower extremity functional scale showed clinically significant improvement in the two patients for which it was obtained.
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Dermatofibrosarcoma protuberans (DFSP) is an uncommon, soft tissue sarcoma with a high rate of local recurrence, low rate of distant metastasis, and infiltrative growth. We report two cases of DFSP in young active duty military personnel. ⋯ Awareness of DFSP in young patients is important for proper diagnosis and treatment and to achieve local control. Complete excision of the tumor with a clear surgical margin and thorough surveillance after surgery are recommended for service members to maintain their active duty status and to prevent ineffective combat conditions.
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Lyme disease is a vector-borne infection that can affect multiple different organ systems. Lyme carditis represents one of these sequelae and is defined by acute onset of high-grade atrioventricular block in the presence of laboratory-confirmed infection. Current guidelines recommend patients with Lyme carditis be admitted for close cardiac monitoring and intravenous antibiotics therapy. ⋯ On follow-up to cardiology clinic, the prior ECG was reviewed and interpreted as complete heart block. A repeat ECG showed resolution of the heart block, and exercise stress testing showed chronotropic competence. This case illustrates the resolution of complete heart block in Lyme carditis with oral doxycycline, suggesting this antibiotic as a possible alternative treatment agent.
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Managing patients with chest pain in deployed and austere environments can be extremely challenging for military health care providers. Limited resources, including access to equipment, emergent cardiac catheterization, and cardiac surgery, can lead to deleterious consequences, including myonecrosis and possible death. ⋯ Most cases in the literature involve the diagnosis and treatment of Wellens syndrome in the civilian, nondeployed hospital setting. We present a case of a civilian contractor who had experienced an episode of chest pain that had resolved with rest and now had new findings on electrocardiogram concerning Wellens syndrome.