Epidemiology and antimicrobial susceptibilities of wound isolates of obligate anaerobes from combat casualties.

Data from recent conflicts related to war wounds and obligate anaerobes are limited. We define the epidemiology and antimicrobial susceptibility of obligate anaerobes from Iraq and Afghanistan casualties (6/2009-12/2013), as well as their association with clinical outcomes. Susceptibility against eleven antibiotics (7 classes) was tested.

Randomized, double-blind, comparative-effectiveness study comparing pulsed radiofrequency to steroid injections for occipital neuralgia or migraine with occipital nerve tenderness.

Occipital neuralgia (ON) is characterized by lancinating pain and tenderness overlying the occipital nerves. Both steroid injections and pulsed radiofrequency (PRF) are used to treat ON, but few clinical trials have evaluated efficacy, and no study has compared treatments. We performed a multicenter, randomized, double-blind, comparative-effectiveness study in 81 participants with ON or migraine with occipital nerve tenderness whose aim was to determine which treatment is superior.

Extensor Mechanism Injuries of the Knee: Demographic Characteristics and Comorbidities from a Review of 726 Patient Records.

Background: The purpose of our study was to describe and compare extensor mechanism injuries with regard to age, sex, body mass index (BMI), and comorbidities.

Methods: We identified patients who had undergone surgical management of an extensor mechanism injury at two institutions between 1986 and 2012. Data analyzed included age at the time of surgery, sex, height, weight, and the presence of medical comorbidities.

Effectiveness of the combat pelvic protection system in the prevention of genital and urinary tract injuries: An observational study.

Background: Historically, the incidence of genital and urinary tract (GU) injuries in major conflicts has been approximately 5%. To mitigate the risk of blast injury to the external genitalia, the United States and United Kingdom issued protective overgarments and undergarments to troops deployed in support of Operation Enduring Freedom. These two systems combined constitute the pelvic protection system (PPS).

Early Complications and Outcomes in Combat Injury-Related Invasive Fungal Wound Infections: A Case-Control Analysis.

Objective: Clinicians have anecdotally noted that combat-related invasive fungal wound infections (IFIs) lead to residual limb shortening, additional days and operative procedures before initial wound closure, and high early complication rates. We evaluated the validity of these observations and identified risk factors that may impact time to initial wound closure.

Design: Retrospective review and case-control analysis.

Elective removal of implants after open reduction and internal fixation of Tibial Plateau fractures improves clinical outcomes.

Introduction: Tibial plateau fractures are common injuries often treated with open reduction and internal fixation. We have noted improved patient satisfaction following implant removal for these patients. The purpose of this study was to assess the effect of removal of surgical implants after union on patient reported outcomes.

Dermestid Dermatitis in a 2-Year-Old Girl: Case Report and Review of the Literature.

Dermatitis from contact with carpet, larder, and hide beetles (family Dermestidae) is a seemingly uncommon or underrecognized hypersensitivity reaction to the specialized hairs on the larvae of certain dermestid beetles. The erythematous papulovesicular dermatitis that may result from such contact can be mistakenly construed as evidence of bites of bedbugs or other arthropods or infestation with scabies mites or can be the basis for a diagnosis of delusory parasitosis. We present a case of dermestid dermatitis in a 2-year-old girl and provide a review of the current literature.

Mental Health Medication Use Correlates with Poor Outcome After Femoroacetabular Impingement Surgery in a Military Population.

Background: Femoroacetabular impingement is a common cause of hip pain in young adults. Several preoperative risk factors for poor outcomes with surgery have been identified; however, to our knowledge, no study has attempted to determine the effect of psychiatric comorbidity on outcomes with femoroacetabular impingement surgery.

Methods: A retrospective review was performed on active-duty patients at one institution undergoing surgery for femoroacetabular impingement over five years.

Medial Branch Blocks or Intra-Articular Injections as a Prognostic Tool Before Lumbar Facet Radiofrequency Denervation: A Multicenter, Case-Control Study.

Background: Medial branch blocks (MBBs) and intra-articular (IA) facet joint injections are both used to diagnose facet joint pain and are presumed to be equivalent. No study has sought to determine which has a better prognostic value before radiofrequency (RF) denervation.

Methods: A case-control study was performed at 4 institutions in which RF denervation outcomes in patients who obtained 50% or more pain relief from either MBB (n = 212) or IA injections (n = 212) were compared.

Combat-Related Pythium aphanidermatum Invasive Wound Infection: Case Report and Discussion of Utility of Molecular Diagnostics.

We describe a 22-year-old soldier with 19% total body surface area burns, polytrauma, and sequence- and culture-confirmed Pythium aphanidermatum wound infection. Antemortem histopathology suggested disseminated Pythium infection, including brain involvement; however, postmortem PCR revealed Cunninghamella elegans, Lichtheimia corymbifera, and Saksenaea vasiformis coinfection. The utility of molecular diagnostics in invasive fungal infections is discussed.

The effect of tonsillectomy alone in adult obstructive sleep apnea.

Objective: The purpose of this study was to determine the effect of tonsillectomy as a single procedure in the treatment of adult obstructive sleep apnea (OSA).

Study Design: Prospective multi-institutional study evaluating adults with tonsillar hypertrophy scheduled to undergo tonsillectomy as an isolated surgery.

Setting: Tertiary care medical centers within the US Department of Defense.

Reducing secondary insults in traumatic brain injury.

Objectives: To determine the alterations in intracranial pressure (ICP) during U. S. Air Force Critical Care Air Transport Team transport of critically injured warriors with ICP monitoring by intraventricular catheter (IVC).

Percutaneous CT-guided drainage of a postoperative intra-abdominal abscess in a combat environment.

Combat medical care results in limited resource availability, which can prompt creativity in treatment of otherwise common conditions. A postoperative intra-abdominal abscess is not an uncommon occurrence following traumatic hollow viscous injury in the deployed environment, but treatment is often limited to surgical drainage only. Herein, we describe a novel use of a dual-lumen central venous catheter to obtain percutaneous drainage of a postoperative intra-abdominal abscess.

Combat-related intradural gunshot wound to the thoracic spine: significant improvement and neurologic recovery following bullet removal.

The vast majority of combat-related penetrating spinal injuries from gunshot wounds result in severe or complete neurological deficit. Treatment is based on neurological status, the presence of cerebrospinal fluid (CSF) fistulas, and local effects of any retained fragment(s). We present a case of a 46-year-old male who sustained a spinal gunshot injury from a 7.

A comparison of computed tomography measures for diagnosing cervical spinal stenosis associated with myelopathy: a case-control study.

Study Design: Retrospective comparative study.

Purpose: To assess differences in computed tomography (CT) imaging parameters between patients with cervical myelopathy and controls.

Overview Of Literature: There is a lack of information regarding the best predictor of symptomatic stenosis based on osseous canal dimensions.

Renal failure following hospitalization for heart failure.

Purpose/goal: The purpose of the study is to evaluate the number of patients with heart failure readmitted for renal failure to IU Health Bloomington within 30 days of hospital discharge in 2010, and to determine whether there are factors that might have been identified before the original discharge that would have prevented the readmission. The goal of the research is to identify factors from previous admissions of patients with heart failure that would have possibly predicted a subsequent admission for renal failure, so that interventions can be developed to prevent such readmissions.

Primary Practice Setting(s): The results from this study are applicable to all primary care settings.

Visual field dysfunctions in warfighters during different stages following blast and nonblast mTBI.

Objectives: Traumatic brain injury (TBI) is the leading injury coming out of the past decades' two major military conflicts, with mild TBI (mTBI) being the most commonly diagnosed form. The aim of this study was to assess the frequency and types of visual field (VF) defects seen at different testing stages following nonblast and blast-induced mTBI.

Methods: A comprehensive retrospective review was performed on 500 electronic health records for military personnel sustaining an mTBI during deployment, of which 166 patients were tested with both confrontation VF and 30-2 Humphrey Matrix Frequency Doubling Technology (FDT) perimetry.

Safe administration of a gelatin-containing vaccine in an adult with galactose-α-1,3-galactose allergy.

Immunoglobulin (Ig) E antibodies to galactose-α-1,3-galactose (α-Gal) are associated with delayed anaphylaxis to mammalian food products and gelatin-based foods (Commins et al., J Allergy Clin Immunol 2009;123:426; Caponetto et al., J Allergy Clin Immunol Pract 2013;1:302).

Esophageal perforation and pneumothorax after routine intraoperative orogastric tube placement.

Orogastric and nasogastric tubes are routinely inserted in anesthetized patients to both reduce the volume of stomach contents and decrease the incidence of postoperative nausea. We present a case of esophageal perforation and subsequent pneumothorax after insertion of an orogastric tube in a patient undergoing routine shoulder arthroscopy.

Pathogens present in acute mangled extremities from Afghanistan and subsequent pathogen recovery.

Given the changing epidemiology of infecting pathogens in combat casualties, we evaluated bacteria and fungi in acute traumatic wounds from Afghanistan. From January 2013 to February 2014, 14 mangled lower extremities from 10 explosive-device injured casualties were swabbed for culture at Role 3 facilities. Bacteria were recovered from all patients on the date of injury.

Clinical relevance of mold culture positivity with and without recurrent wound necrosis following combat-related injuries.

Background: Invasive fungal wound infections (IFIs) are a recognized threat for personnel who sustain combat-related blast trauma in Afghanistan. Blast trauma, particularly when dismounted, has wounds contaminated with organic debris and potential for mold infection. Trauma-associated IFI is characterized by recurrent wound necrosis on serial debridement with histologic evidence of invasive molds and/or fungal culture growth.

Anterior lumbar interbody fusion: two-year results with a modular interbody device.

Study Design: Retrospective case series.

Purpose: To present radiographic outcomes following anterior lumbar interbody fusion (ALIF) utilizing a modular interbody device.

Overview Of Literature: Though multiple anterior lumbar interbody techniques have proven successful in promoting bony fusion, postoperative subsidence remains a frequently reported phenomenon.