Complexities of autonomy in military medical ethics: A brief report.

The first Fallen Surgeons Military Educational Symposium was convened in conjunction with the the American Association for the Surgery of Trauma (AAST) 23 meeting, under the guidance of the AAST Military Liaison Committee. The daylong session included a 1.5-hour segment on military medical ethics in combat and its unique challenges.

Commentary-A Military Health Care Ethics Framework.

Ethical practice within military health care is a significant topic of professional and academic debate. The term "military health care ethics" enfranchises the entire health care team. Military health care professionals are subject to tension between their duties as military personnel, and their ethical duties as health care professionals, so-called "Dual Loyalty.

Analysis of Listeria using exogenous volatile organic compound metabolites and their detection by static headspace-multi-capillary column-gas chromatography-ion mobility spectrometry (SHS-MCC-GC-IMS).

Listeria monocytogenes is a Gram-positive bacterium and an opportunistic food-borne pathogen which poses significant risk to the immune-compromised and pregnant due to the increased likelihood of acquiring infection and potential transmission of infection to the unborn child. Conventional methods of analysis suffer from either long turn-around times or lack the ability to discriminate between Listeria spp. reliably.

Determination of Carboxypeptidase Activity in Clinical Pathogens by Gas Chromatography-Mass Spectrometry.

A novel method for the determination of benzoic acid has been employed to identify carboxypeptidase activities in clinically relevant pathogens. Benzoic acid was determined after chemical derivatization by gas chromatography-mass spectrometry (GC-MS). N-Benzoyl amino acid substrates were evaluated for the detection of carboxypeptidase activities in a number of clinical pathogens.

Feasibility and Impact of a Combined Supervised Exercise and Nutritional-Behavioral Intervention following Bariatric Surgery: A Pilot Study.

Background: Lifestyle intervention programs after bariatric surgery have been suggested to maximise health outcomes. This pilot study aimed to investigate the feasibility and impact of an 8-week combined supervised exercise with nutritional-behavioral intervention following Roux-en-Y gastric bypass and sleeve gastrectomy.

Methods: Eight female patients (44 ± 8 years old, BMI = 38.

Exercise-based rehabilitation for heart failure: systematic review and meta-analysis.

Objective: To update the Cochrane systematic review of exercise-based cardiac rehabilitation (CR) for heart failure.

Methods: A systematic review and meta-analysis of randomised controlled trials was undertaken. MEDLINE, EMBASE and the Cochrane Library were searched up to January 2013.

Exercise-based rehabilitation for heart failure.

Background: Previous systematic reviews and meta-analyses consistently show the positive effect of exercise-based rehabilitation for heart failure (HF) on exercise capacity; however, the direction and magnitude of effects on health-related quality of life, mortality and hospital admissions in HF remain less certain. This is an update of a Cochrane systematic review previously published in 2010.

Objectives: To determine the effectiveness of exercise-based rehabilitation on the mortality, hospitalisation admissions, morbidity and health-related quality of life for people with HF.

Off-pump versus on-pump coronary artery bypass grafting outcomes stratified by preoperative renal function.

Clinical trials of off-pump coronary artery bypass grafting (CABG) have largely excluded patients with CKD. Here, we sought to determine whether pump status affects outcomes in patients with CKD. Using a nonrandomized cohort of 742,909 non-emergent, isolated CABG cases, which included 158,561 off-pump cases, in the Society of Thoracic Surgery Database from 2004 through 2009, we evaluated the association between pump status (off-pump versus on-pump) and in-hospital death or incident renal replacement therapy (RRT) across strata of preoperative renal function.

Exercise training for systolic heart failure: Cochrane systematic review and meta-analysis.

Aims: To determine the effect of exercise training on clinical events and health-related quality of life (HRQoL) of patients with systolic heart failure.

Methods And Results: We searched electronic databases including Medline, EMBASE, and Cochrane Library up to January 2008 to identify randomized controlled trials (RCTs) comparing exercise training and usual care with a minimum follow-up of 6 months. Nineteen RCTs were included with a total of 3647 patients, the majority of whom were male, low-to-medium risk, and New York Heart Association class II-III with a left ventricular ejection fraction of <40%.

Exercise based rehabilitation for heart failure.

Background: From previous systematic reviews and meta-analyses there is consensus about the positive effect of exercise training on exercise capacity; however, the effects on health-related quality of life, mortality and hospital admissions in heart failure remain uncertain.

Objectives: To update the previous systematic review which determined the effectiveness of exercise-based interventions on the mortality, hospitalisation admissions, morbidity and health-related quality of life for patients with systolic heart failure.

Search Strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 4).

Preoperative aspirin ingestion increases operative blood loss after coronary artery bypass grafting.

Thirty-four patients were entered into a non-blinded, randomized study to test the effect of preoperative aspirin ingestion on postoperative blood loss and transfusion requirements after coronary artery bypass grafting. Sixteen patients in the aspirin-treated group had significantly increased chest-tube blood loss 12 hours after operation (1,513 +/- 978 versus 916 +/- 482 ml; p = 0.038).

A comparison of patients with endoscopic esophageal perforations and patients with Boerhaave's syndrome.

A review was conducted to ascertain whether patients who suffered spontaneous postemetic esophageal rupture (Boerhaave's syndrome) experienced higher morbidity and mortality than patients who had endoscopic iatrogenic esophageal perforations. Review of the records of three medical centers from 1960 to 1985 identified 11 patients with Boerhaave's syndrome (group B) and 19 with iatrogenic perforations (group E). In group B, four patients were diagnosed greater than 24 h after perforation.

Mediastinal hemangiomas.

Hemangiomas of the mediastinum are rare tumors. Fewer than 100 have been reported. This study reviews the cases of 15 patients with mediastinal hemangiomas confirmed pathologically.

Prevention of ventricular fibrillation after myocardial revascularization.

Ventricular fibrillation during reperfusion after aortic cross-clamping for coronary artery bypass grafting may cause subendocardial injury. We investigated the use of lidocaine to prevent ventricular fibrillation during this period. In a blind, prospective, randomized trial, 91 consecutive patients undergoing elective coronary artery bypass graft procedures were given lidocaine (2 mg/kg) or normal saline immediately before removal of the aortic cross-clamp.

Changes in serum creatine kinase and lactate dehydrogenase caused by acute perioperative myocardial infarction and by transatrial cardiac surgical procedures.

A prospective clinical study was conducted to ascertain if a patient's postoperative elevation in serum creatine kinase MB isoenzyme coupled with determination of the lactate dehydrogenase1/lactate dehydrogenase2 ratio could differentiate whether atrial or ventricular myocardium was the source of these changes. Animal studies have shown that atrial myocardium is as rich a source of creatine kinase MB as is ventricular myocardium. Atrial myocardium has a lactate dehydrogenase1/lactate dehydrogenase2 ratio less than 1.

The use of computed tomography in the evaluation of mediastinal masses.

A retrospective analysis was conducted to ascertain whether computed tomography had increased diagnostic accuracy while decreasing the number of tests needed in the preoperative assessment of patients with mediastinal masses. A total of 42 patients were entered into the study: Fifteen patients were evaluated before the advent of computed tomography (No CT) and 27 patients had computed tomography during their evaluation (CT). The No CT group comprised 10 male and five female patients (2:1 ratio); the age range was 8 months to 61 years.

Acute diverticulitis following cardiac surgery.

Gastrointestinal complications requiring surgical correction following cardiopulmonary bypass most frequently involve the upper gastrointestinal tract. Surgical diseases of the colon are quite unusual in this setting. We recently performed cardiac surgery on three patients who developed acute diverticulitis requiring laparotomy in the early postoperative period.

Results of myocardial revascularization in black males.

The impact of black-white differences in the prevalence of risk factors for coronary heart disease on the outcome of coronary bypass surgery has not been well defined. Preoperative status, coronary anatomy, and surgical results were reviewed in 54 black males operated on between December 1970 and August 1983. With the use of criteria established by the New York Heart Association, five patients were classified in class II, 34 were in class III, and 15 were in class IV.