Military medicine
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Case Reports
Early diagnosis of Hurler's syndrome with the aid of the identification of the characteristic gibbus deformity.
This case study describes the clinical evaluation and diagnosis of Hurler's syndrome in a 7-month-old child who was noted to have a thoracolumbar kyphosis (gibbus deformity), coarse facial features, and possible evidence of gross motor delay. The diagnosis of Hurler's syndrome was aided specifically by the identification of the gibbus deformity. ⋯ Because of the characteristic progression of neurological and intellectual deterioration found in children with Hurler's syndrome, early diagnosis and treatment are critical to the preservation of long-term intellectual development. The pathophysiology of Hurler's syndrome and the causes of kyphosis in infancy and childhood are discussed.
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A 60-year-old woman with chronic progressive fatigue, diurnal somnolence, proximal muscle weakness, and dyspnea developed acute respiratory failure when given supplemental oxygen. Hypoventilation secondary to neuromuscular dysfunction was suspected by the critical care specialist. ⋯ The discussion includes a literature review that describes the pathophysiology and treatment of this rare muscle enzyme deficiency disorder. Acid maltase deficiency should be suspected in any adult presenting with hypoxemia, fatigue, and acute respiratory failure.
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The Regional Trauma Network was launched in 1996 to provide trauma training opportunities for Army surgeons in the Southeast Regional Medical Command. Training directors at eight civilian level I trauma centers agreed to allow military surgeons to function at the fellowship level of responsibility for up to 30 days at a time. In the first year, 7 surgeons participated in rotations at five different centers and 13 surgeons attended nationally recognized trauma symposia. ⋯ Significant lessons were learned in providing good clinical training experiences, administering a regional program, and measuring the costs and benefits of additional readiness training. Although the data collection processes were devised to capture both the actual and the opportunity costs of training at civilian centers, more participants are needed before a conclusive analysis can be made. A joint services effort on a regional basis and support throughout the chain of command are key to strengthening the surgical readiness training program.
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We prospectively analyzed our experience with operative videothoracoscopy (OVT) performed in a field military hospital in cases of penetrating firearms wounds of the thorax (PFAWT) sustained in Chechnya. From February to April 1996, we treated 206 wounded patients, of whom 37 (18.0%) had sustained chest injuries. PFAWT were present in 23 soldiers, accounting for 62.2% of all chest injuries. ⋯ Patients were able to stand in 10 to 12 hours and to walk by the end of the first postoperative day. All patients who underwent OVT were evacuated without drains by the third or fourth postoperative day, all tolerating sitting and standing positions. We conclude that early OVT in the military field hospital for continued bleeding, clotted hemothorax, and continued major air leakage has several advantages in military patients with PFAWT: early definition and management of organ injury; identification and control of bleeding in most instances; earlier and more accurate assessment for thoracotomy; vigorous lavage and removal of projectiles such as bone fragments and evacuation of clotted hemothorax; early debridement with suture closure of the thoracic wall canal; and minimal postoperative pain with dramatically reduced suppurative sequelae and bronchopleural fistulae.
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Comparative Study
Effects of volume control, pressure control, and pressure-regulated volume control on cardiopulmonary parameters in a normal rat lung.
The purpose of this study was to investigate the differences in diaphragm shortening and cardiopulmonary parameters at varying tidal volumes during volume control (VC), pressure control (PC), and pressure-regulated volume control (PRVC). A miniaturized ultrasonic sensor attached to the inferior surface of the upper costal surface of the right hemidiaphragm of 16 Sprague-Dawley rats provided a direct assessment of diaphragm shortening. Within each control mode of mechanical ventilation, the tidal volume was increased from 3 to 12 ml in increments of 3 ml. ⋯ At equivalent tidal volumes, diaphragm shortening was less during PRVC than during VC or PC. This finding suggests that differences in diaphragm shortening may be caused by shorter resting (end-expiratory) diaphragm muscle length. The cardiopulmonary data obtained in this study provide new information for clinicians to consider when using various modes of ventilation, particularly PRVC.