Military medicine
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Functional gastrointestinal syndromes are chronic disorders of the abdomen with an absence of organic findings. The aim of this study was to compare the frequency and symptomatology of functional abdominal syndromes in soldiers during an out-of-area mission versus during peacetime at home. We examined 124 soldiers who sought medical care for abdominal symptoms at the German Field Hospital Trogir, Croatia. ⋯ At home, the frequency of functional gastrointestinal disorders was 50%, significantly greater than the rate during the out-of-area mission (p < 0.0001). We conclude that functional gastrointestinal disorders are more rare during out-of-area missions than during peacetime. They are probably as frequent away from home as at home, but "health care seeking" is less frequent under the stressful conditions of out-of-area missions.
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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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The optimal training of physicians should prepare them for the environment in which they will practice. During the past several years, the practice of internal medicine has shifted from a focus on the inpatient setting to one that includes an emphasis on the ambulatory clinic. Military internists must be further prepared to practice medicine with forward units, at field hospitals, and in other operational settings. ⋯ The program is driven by the residents and chief resident and requires little additional funding. Resident research continues to increase, morale remains high, and the first class to complete the 3-year operational curriculum achieved a 100% pass rate on the American Board of Internal Medicine certification examination. We describe our 3-year experience of implementing this program, with an emphasis on curriculum design and execution, qualitative assessment, and initial lessons learned.