Military medicine
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A complex pneumothorax is a loculated pneumothorax due to adhesions. Chest roentgenograms are usually inadequate to assess a complex pneumothorax. ⋯ In addition, if there is a persistent or recurrent pneumothorax after tube thoracostomy, a CT scan can be used to determine the relationship of the chest tube to the pneumothorax. Three cases are discussed to illustrate the use of the CT scan in evaluating patients who have a complex pneumothorax.
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An outbreak of foodborne gastroenteritis affected 648 United States Air Force personnel stationed in Jeddah, Saudi Arabia during Operation Desert Storm. The implicated food source was a locally catered meal. Despite the presence of an aggressive Air Force public health program, foodborne illness had a major impact on manpower and medical resources during a critical phase of military operations. It is the recommendation of the authors that the Air Force not rely on local caterers during future deployments.
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Hyperbaric oxygenation as an adjunct in the treatment of clostridial myonecrosis (gas gangrene) has been used extensively in facilities with hyperbaric chambers. The United States Air Force has had extensive experience in the treatment of clostridial myonecrosis, treating 77 patients since 1965. This study reviews the experience in the treatment of this disease process in military multiplace hyperbaric chambers and provides an in-depth analysis of factors affecting patient survival. A comprehensive review of the literature on the treatment of clostridial myonecrosis with hyperbaric oxygenation is presented in this paper.
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The Army experience with discharges against medical advice (AMA) from 1971 to 1988 is analyzed. AMA discharges have declined in a statistically significant manner in both medical centers and community hospitals. Discharges have decreased among men but increased among women. ⋯ Among clinical services, only obstetrics and gynecology demonstrated statistically significant increases. Among patient categories, only family members showed an increase. The possible sources of these various changes are discussed.
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As a preliminary step to studying the Army's experience with against medical advice (AMA) discharges, the literature was reviewed. Fifty-one articles were found through a computer program search. ⋯ Patients with drug and/or alcohol abuse problems are at significantly higher risk for AMA. No civilian studies have been identified which evaluate long-term trends.