Military medicine
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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.
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Case Reports
Left coronary artery anomaly: an often unsuspected cause of sudden death in the military athlete.
More than 300,000 cases of sudden cardiac death (SCD) occur in the United States each year. Left coronary artery anomaly (LCAA), although rare, is second only to hypertrophic cardiomyopathy as the most common cause of SCD associated with structural cardiovascular abnormalities. This case illustrates SCD secondary to LCAA in a military athlete. ⋯ A substantial proportion of these individuals experience prodromal symptoms of exertional chest pain, syncope, and/or sudden collapse. Early recognition and intervention are key to survival. Rapid, early imaging and invasive therapeutic measures leading to surgical correction may be the difference between life and death.
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The purpose of our study was to investigate possible risk factors and mechanisms for the development of pelvic stress fractures in female Navy recruits. We used a case-control retrospective study of female Navy recruits undergoing basic military training. ⋯ In addition, recruits with pelvic stress fractures reported marching in the back of their training division, were road guards, and felt that their stride was too long during training activities more often than recruits without injury. Self-reported fitness, activities before recruit training, or a history of amenorrhea was not found to be associated with the development of a pelvic stress fracture in our population.