Military medicine
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The purpose of this paper is to inquire into the relationship between Al Eskan disease and the probable exposure to chemical warfare agents by Persian Gulf War veterans. Al Eskan disease, first reported in 1991, compromises the body's immunological defense and is a result of the pathogenic properties of the extremely fine, dusty sand located in the central and eastern region of the Arabian peninsula. The disease manifests with localized expression of multisystem disorder. ⋯ We conclude that the microimpregnated sand particles in the theater of operation/Persian Gulf War depleted the immune system and simultaneously acted as vehicles for low-intensity exposure to chemical warfare agents and had a modifying-intensifying effect on the toxicity of exposed individuals. We recommend recognition of a new term, "dirty sand," as a subcategory of dirty dust/dusty chemical warfare agents. Our ongoing research efforts to investigate the health impact of chemical warfare agent exposure among Persian Gulf War veterans suggest that Al Eskan disease is a plausible and preeminent explanation for the preponderance of Persian Gulf War illnesses.
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A significant number of casualties in previous conflicts died from peripheral vascular wounds. A well-designed tourniquet could possibly have prevented these deaths. The objective of this study was the identification of such a tourniquet. ⋯ Of the several successful tourniquets, two were preferred. Tourniquets incorporating a windlass technique take longer to place and often fail when placed with only one hand. New, relatively simple tourniquet devices incorporating bladder and ratchet mechanisms can significantly improve tourniquet performance.
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To assess the influence of protective gear on intubation performance. ⋯ Protective gear causes a significant prolongation of intubation duration; however, endotracheal intubation can be performed effectively. Technical improvements are warranted for tube fixation because it is the critical step.
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Randomized Controlled Trial Comparative Study Clinical Trial
Simplified use of mixed propofol and alfentanil for anesthesia in remote locations.
Total intravenous anesthesia (TIVA) is a useful technique in precarious situations in which anesthesia ventilators and medical gas can be difficult to obtain. The aim of the study is to compare TIVA technique using a simplified infusion scheme for propofol and alfentanil mixed together (45 ml of propofol 1% and 2,500 micrograms of alfentanil in a 50-ml syringe) with an inhalational anesthetic technique (isoflurane/N2O, sufentanil). Thirty-two American Society of Anesthesiologists physical status I patients undergoing orthopedic surgery were studied. ⋯ Only patients receiving TIVA had responses to surgery. In the TIVA group, time to extubation was shorter (16 +/- 5 vs. 25 +/- 7 minutes) and postoperative requirement for morphine was lower (6.2% vs. 25%) than in the inhalation group (p < 0.05). TIVA using a mixture of propofol and alfentanil is a reliable technique of anesthesia in patients without multiple injuries.
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Experience with advanced surgery for the treatment of civilian gunshot injuries supports the changes in approach and indications for the treatment of war gunshot injuries. Eight patients with gluteal gunshot wounds are presented with typical war injuries. ⋯ Complications developed in cases of colonic and rectal injuries for which advanced surgery was performed in the treatment of the war wound. Poor conditions for advanced surgery during war can change the final result, making the outcome of the war wound worse.