The strategic genius of Jonathan Letterman: the relevancy of the American Civil War to current health care policy makers.

With expanding health insurance coverage, innovative technologies, improved diagnostic acumen, and pharmaceutical additions combining to increase life expectancy, quality of life, and concomitant costs, the American health care system is under significant stress. However, it pales in comparison to the challenges faced by health care leaders during the American Civil War. As we approach the 150th anniversary of the conclusion of that war, it is appropriate to review key strategic health care decisions faced by military leaders during the Civil War and how their resultant outcomes may provide an appropriate perspective for today's leaders.

Returning to duty from temporary disability in the U.S. Army: observational data and commentary for commanders, providers, and soldiers.

Before 2011, Army commanders were unable to achieve complete visibility of soldiers possessing temporary medical limitations. The creation of time-limited definitions and technical categorization of this group, now known as the medically not ready (MNR) population, eventually allowed its quantification. With heightened visibility of the group, leaders in the Fort Stewart community facilitated its management through soldier medical readiness councils.

The effectiveness of Soldier Medical Readiness Councils in reducing and shaping the population of soldiers not medically deployable.

The population of Soldiers not medically fit for deployment has created readiness problems for the U.S. Army in recent years.

A comparison of open versus closed techniques using the Harmonic Scalpel in outpatient hemorrhoid surgery.

Background: Surgical excision using the Harmonic Scalpel is a modern technique for symptomatic third- and fourth-degree hemorrhoids. The resulting mucosal defect is then left open or sutured closed depending on surgeon preference.

Purpose: The purpose of this study was to compare the open vs.

Caring for non-combatants, refugees, and detainees.

The recently reported abuses at Abu Ghraib prison have brought the issue of medical care for displaced persons (DPs) to greater prominence. Natural disasters in the United States (eg, Hurricane Katrina) and elsewhere also require significant medical resources in situations that lack basic infrastructure. Intimate knowledge of the basic tenets of international law is crucial to the care of DPsin any capacity.

Supporting the Global War on Terror: a tale of two campaigns featuring the 250th Forward Surgical Team (Airborne).

Background: Forward Surgical Teams (FSTs) are 20-person units designed to perform front-line, life-saving combat surgery. This study compares the employment, injuries encountered, and workload of an airborne FST in two widely varying campaigns.

Methods: The 250th FST provided far forward surgery for initial entry assaults and follow-on stability operations in Afghanistan (Operation Enduring Freedom [OEF]) and northern Iraq (Operation Iraqi Freedom [OIF]).

The effect of combat rations on bowel habits in a combat environment.

Background: Combat rations have long been suspected to affect the bowel habits of deployed soldiers by causing significant constipation. This may create morbidity and result in decreased troop readiness. In a uniform population of deployed combat soldiers, we sought to determine the effect of combat rations on changes in bowel habits.

An active duty woman with anal incontinence after vaginal delivery: an elusive diagnosis.

Anal sphincter injury as a result of birth trauma is the leading cause of fecal incontinence in women presenting to surgical clinics. A 36-year-old active duty woman was referred to the Urogynecology Clinic at Madigan Army Medical Center for evaluation of a deficient perineal body. She reluctantly reported a 12-year history of anal incontinence since the birth of her first child, predating her entry into the naval service.

Outcome of HIV-infected patients with invasive squamous-cell carcinoma of the anal canal in the era of highly active antiretroviral therapy.

Purpose: Before the development of highly active antiretroviral therapy for the treatment of HIV infection, HIV patients diagnosed with invasive squamous-cell carcinoma of the anal canal carried a very poor prognosis. This study was designed to determine the outcome in a similar group of patients in the era of highly active antiretroviral therapy.

Methods: HIV-positive patients treated for invasive squamous-cell carcinoma of the anal canal at the University of Texas Medical Center affiliated hospitals from 1980 to 2001 were identified from operative data and cancer registries.

Heterotopic gastric mucosa of the anus: a case report and review of the literature.

Ectopic gastric mucosa has been described at various locations of the body, including all levels of the gastrointestinal tract. However, this finding is rare in the rectum and anus, with 38 reported cases. In only six cases, including the present one, has the heterotopic tissue been located within 2 cm of the dentate line.

In-flight transfusion of packed red blood cells on a combat search and rescue mission: a case report from operation enduring freedom.

Injuries on the battlefield can occur far from the nearest medical treatment facility. This is especially likely for downed pilots and special operations personnel. Some of these injuries lead to significant blood loss requiring transfusion.

Forward surgical team (FST) workload in a special operations environment: the 250th FST in Operation ENDURING FREEDOM.

Purpose: Forward Surgical Teams (FST) deploy to support conventional combat units of at least regimental size. This report examines the injuries and treatments of an FST in an environment of unconventional tactics, limited personal protection, and extended areas of responsibility during Operation ENDURING FREEDOM.

Methods: A prospective evaluation of the personal protective measures, mechanisms of injury, types of injuries, and times to treatment in Operation ENDURING FREEDOM.

Superior mesenteric vein thrombosis following laparoscopic Nissen fundoplication.

This report describes the second case of a superior mesenteric and portal vein thrombosis following an uneventful laparoscopic Nissen fundoplication. The patient presented on postoperative day 10 with acute onset of abdominal pain and inability to tolerate oral food. A computed tomography (CT) scan revealed superior mesenteric and portal venous thrombosis with questionable viability of the proximal small bowel.

Flexible endorectal ultrasound for predicting pathologic stage of rectal cancers.

Background: Endorectal ultrasound (ERUS) is an accurate method for preoperative staging of rectal cancers. Most often, a rigid 360-degree rotating probe is used. We studied whether flexible probes could attain equivalent accuracy for bowel wall penetration.

Diverticular disease.

Diverticular disease is a common finding in Western countries with an increasing prevalence with age. Many patients with the disorder remain asymptomatic. However, up to 30% of those affected may show clinical signs including pain, bleeding, obstruction, abscess, fistulae and perforation.

Gynecomastia: complications of the subcutaneous mastectomy.

Gynecomastia is a benign enlargement of the male breast secondary to gland proliferation. Subcutaneous mastectomy is performed for symptomatic patients and in those desiring cosmetic changes. The aim of this study was to assess the risk factors and complications associated with the operation.