Military medicine
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Case Reports
Splenic rupture due to extraperitoneal gunshot wound: use of peritoneal lavage in the low-tech environment.
The upsurge in armed conflicts and civil unrest around the world will result in the need to treat gunshot wounds in austere conditions. This report details a splenic injury that resulted from a gunshot of the torso that did not penetrate the peritoneum. The author made the diagnosis using peritoneal lavage, which can be adapted to field conditions.
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Food and drug law requires that the ingredients in most foods be disclosed on their labels, but until recently there was no requirement that nutrition information be provided. The Nutrition Labeling and Education Act of 1990 (NLEA), passed on November 8, 1990, mandated the Food and Drug Administration to establish regulations requiring most foods to have a uniform nutrition label showing the amount of calories, calories from fat, total fat, saturated fatty acids, cholesterol, total carbohydrates, complex carbohydrates, sugars, fiber, protein, and sodium. The Act also establishes the circumstances under which content claims and disease claims may be made about nutrients in food. This paper briefly discusses recent changes in the food label brought about by the NLEA and focuses on health claims on food labels.
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Traumatic injury remains an unfortunate and all-too-common event in the United States military population. Traumatic hemipelvectomy is a rare but devastating injury with few survivors recorded in the medical literature. We report a surviving case of traumatic hemipelvectomy and review an approach to management.
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A 30-year-old black male soldier with sickle cell trait presented with fatal exertional rhabdomyolysis (which was unrecognized during 14 hours at a field clinic). After prompt treatment for heat exhaustion, his symptoms seemed mild and he was afebrile. His clinical course illustrates the potential for severe illness in the absence of fever, the importance of assessing mental dysfunction, indications for laboratory evaluation, the need for comprehensive management of severe dehydration and acidosis, common laboratory features of acute renal failure and exertional rhabdomyolysis, and the increased risk of exercise-related death in those with sickle cell trait.
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Pyridostigmine was first used extensively during Operation Desert Storm for prophylaxis against the effects of nerve agents. After initial reports of asthma exacerbations following its use, we gave 10 asthmatic and 6 non-asthmatic soldiers a 30-mg dose of pyridostigmine. ⋯ Severity of the exacerbation correlated best with severity of asthma in the desert and inversely with body weight. The irritant effect of the dust may predispose asthmatics to worsen after pyridostigmine, an effect not seen in the laboratory.