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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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.
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We have examined the association between body mass index and the prevalence of low back pain in about a quarter of a million male recruits aged 17-18 years at the time of their medical draft examination. Low back pain prevalence is shown to rise with increasing body mass index. This statistically significant association may suggest a role of body weight and height in the pathogenesis of low back pain and supports the previously reported need for education regarding weight reduction as a useful implement in low back pain prevention.