Manifestations of hemorrhagic fever with renal syndrome in a military unit stationed in a combat zone

Since it has been recognized as a separate disease during the Korean war, hemorrhagic fever with renal syndrome (HFRS) has often been discovered among the members of different armies in various countries, military personnel being the highest risk group for the disease. In the period from March to May 1999 we treated 6 soldiers coming from the military formation stationed at Kosovo and Metohia. The reaction of indirect hemagglutination test proved the presence of antibodies against Hantavira in each of them. They were infected during the stay in a dugout in the area with great population of field rodents. Only one patient was slightly ill, on the admission to the hospital. The others had severe clinical and laboratory findings: several days lasting fever, strong abdominal pain, as well as the pain in the loins, dyspeptical discomfort, manifold increased blood urea nitrogen and serum creatinine values, thrombocytopenia, etc. Oliguria occurred in 4 patients. Hemorrhagic manifestations were slight (epistaxis, petechial rash, conjunctival injection), or absent. Because of the aggravation of the acute renal failure, hemodialysis was performed in 3 patients, while other 3 underwent conservative treatment. Two of the patients had severe anemia because of which transfusions of erythrocytes and plasma were performed. Complications occurred in 2 patients (convulsive crises and lung infections). All patients recovered completely.     

Anger in the combat zone

A U.S. Army Reserve Combat Stress Control prevention team was dispatched to Afghanistan in support of Operation Enduring Freedom to provide preventative mental health care to a U.S. Army airborne division and Special Operations forces. The team's mission was to ensure mental health readiness of units in the area of operations. In Bagram, Afghanistan, the Combat Stress Control team identified anger as a very prevalent emotion in the combat zone. Anger management interventions with individual and group counseling were implemented to help soldiers cope with anger. Of 7,000 military personnel stationed there during the team's rotation, there was not one completed suicide or homicide. This article describes how the 113th Medical Company identified, treated, and controlled anger at Bagram Airbase, Afghanistan, between June 20, 2002, and December 20, 2002, with anger management interventions. This article does not address the psychophysiological features of anger.     

Treatment of urinary calculi in the combat zone

Renal colic is a common condition among deployed soldiers in the Middle East. Eight percent of all admissions to the jump package of the 21st Combat Support Hospital in Mosul, Iraq, during Operation Iraqi Freedom involved patients with renal colic and urinary stones. The majority of patients were treated successfully with primary care measures. Fourteen percent of patients required urologic interventions; however, many of these soldiers were treated with ureteral stents and returned to duty. Aggressive management of urolithiasis resulted in 92% of soldiers remaining in the combat zone, preserving the fighting strength of supported units.     

Disease and nonbattle injury in the combat zone

Given the current tempo of military operations in the global war on terror, the military radiologist must be prepared to diagnose surgical and medical conditions. The imaging of blunt and penetrating trauma remains the critical mission. However, a more challenging part of the day’s work involves the imaging of medical diseases encountered in the third world. The majority of such entities are infectious in nature, but unusual presentations of congenital diseases are common. It is important for the deployed radiologist to have knowledge of diseases and conditions not ordinarily seen in the USA and to have a high index of suspicion for unusual processes.     

Dehydration in extreme temperatures while conducting stability and support operations in a combat zone

This analysis reports the effects of extreme temperatures (temperatures exceeding 100 degrees F) on the hydration of infantry-men conducting stability and support operations during phase IV Operation Iraqi Freedom in the months of June and July 2003 in An Nasiriyah, Iraq. Fifty-three infantrymen were evaluated for signs of dehydration after completing questionnaires regarding their activities during the previous 24 hours. We conducted an analysis comparing these activities and their state of hydration. The most significant factors contributing to dehydration in extreme environments proved to be the individual's level of exertion and exposure to the sun while levels of water and caffeine consumed showed no correlation to one's level of hydration. We conclude that integrating a proactive, field-expedient means to monitor a unit's level of hydration can increase the combat effectiveness of units in training and combat alike.     

Utility of ultrasound in the combat theater: experiences of a gynecologist during Operation Iraqi Freedom/Operation Enduring Freedom

OBJECTIVE: The purpose of this study was to evaluate the utility of ultrasound in a combat theater. METHODS: A retrospective review of gynecology visits was evaluated at Camp Doha, Kuwait, from August 2003 through April 2004. Of the 1,737 visits, 237 required pelvic ultrasound. Demographic information, as well as the indications, diagnosis, and disposition of the patients, was compiled. RESULTS: The average age of the patient requiring ultrasound was 28 +/- 8 years. The primary presenting complaint was pelvic pain. Forty percent with pelvic pain had no identifiable cause. The most common final diagnosis was pregnancy. Of the 237 visits, the use of ultrasound resulted in 136 return-to-duty dispositions. Of the 31% who were administratively redeployed, the majority were secondary to pregnancy. CONCLUSION: Gynecologic ultrasound was found to be a very useful tool in the combat theater. Ultrasound resulted in improved diagnostic ability and enhanced reassurance to both provider and patient.     

Soft tissue coverage using pedicled flap in combat zone:A case series

Background:Soft tissue reconstruction is typically conducted after evacuation from theater of operations.If circumstances do not allow timely evacuation,however,defect site may need to be reconstructed in the combat zone.Case presentation:A total of 41 patients with extremity soft tissue defect were treated using pedicled flaps by a single orthopedic surgeon during four deployments in Chad,Afghanistan and Mali between 2010 and 2017.The mean age was 25.6 years.A total of 46 injury sites in extremities required flap coverage:19 combat-related injuries (CRIs)and 27 non-combat related injuries (NCRIs).Twenty of the injury sites were infected.Overall,63 pedicled flap transfers were carried out:15 muscle flaps,35 local fasciocutaneous flaps and 13 distant fasciocutaneous flaps.The flap types used did not differ for CRIs or NCRIs.Mean follow-up was 71 days.Complications included deep infection (n=6),flap failure (n=1) and partial flap necrosis (n=1).Limb salvage rate was 92.7％ (38/41).Conclusions:Soft tissue defect can be managed with simple pedicled flaps in theatre of operations if needed.Basic reconstructive procedures should be part of the training for military orthopedic surgeons.Trial registration:Retrospectively registered in January2019 (2019-0901-001).     

美军伊拉克和阿富汗战争战伤救治新理念

“战术战伤救治”的概念最早由美海军特种作战部队于1996年首次提出,在伊拉克和阿富汗战争中成为美军战术环境中伤员救治的标准规范,也是美军伊拉克和阿富汗战争中战伤救治取得的一大进展.战术战伤救治的应用使美军达到了有史以来最低的伤亡率.该文梳理了美军战术战伤救治理念的发展,分析了战术战伤救治的阶段划分,探讨了美军战术战伤救治的组织实施,并提出了对我军的启示.     

战伤后急性肾功能衰竭的特点及防治

在现代局部战争中,对战伤的并发症研究是一个重要的课题,探讨战伤后急性肾功能衰竭的发病特点及制定相应的防治措施是保证部队战斗力及在“打得赢”条件下的一项重要任务。1战伤后和急性肾功能衰竭发病特点1.1发病率和死亡率急性肾功能衰竭(ARF)是战伤中严重而复杂的并发症,死亡率极高。在朝鲜战争中,受伤美军送往基地医院后的无尿性ARF发生率是0.5%,死亡率高达70%~90%〔1〕。虽然第一次采用了间隙性血液透析(IHD)技术,但死亡率仍高达80%,原因是当时透析膜采用纤维素膜〔2〕,而纤维素膜的缺点是生物相容性差,易凝血和激活补体引起与血液…     

云南亚热带山岳丛林战伤救治应注意的几个问题

云南边疆与越南、老挝、缅甸接壤,地处亚热带山岳丛林地区,雨量充沛,气温高,无明显季节差异,植物繁茂,有害昆虫动物多,素有“植物王国”、“动物王国”的美称。在这一地区发生战争,气候地理特征对作战部队的影响也十分突出,其战伤救治有其自身规律和特征。在1979年以来进行的自卫反击战,几次战役和近期的训练均在亚热带地区,卫勤保障工作有一定的特殊性。为适应未来战争的作战方式。现就做好亚热带山岳丛林地战伤救治工作的体会报道如下:1战伤救治工作必须思想上重视实战很容易重视,演习也要象实战一样。亚热带山岳丛林地的传染病和常见病发…     

Medical problems of detainees after the conclusion of major ground combat during Operation Iraqi Freedom

After the conclusion of major ground combat operations during Operation Iraqi Freedom, the focus of the mission changed, although intense armed conflict continued. Included in this mission was management of security detainees, including provision of their medical care. We retrospectively reviewed the admission records identified at a short-term holding facility over 2 months and diagnoses of detainees admitted to a combat support hospital over 4 months as a health care service utilization statistics review. Six thousand six hundred thirty-one detainee encounters occurred at the short-term facility with approximately 45% of detainees reporting medical problems during each daily evaluation. Most frequent complaints were neurological (11%), gastrointestinal (10%), and respiratory (8%). Two hundred nineteen detainees' admission diagnoses were retrospectively reviewed from the combat support hospital, 98 (45%) due to gunshot or fragmentary injuries and 121 (55%) to other medical problems. Medical problems included cardiac (29%), gastrointestinal (17%), neurological (14%), musculoskeletal (11%), and pulmonary (6%) disease. Medical problems not traditionally dealt with in a combat theater, including management of transplant recipients, patients with cardiac valve replacement, and cancer patient, were also seen.     

Operation Enduring Freedom: trends in combat casualty care by forward surgical teams deployed to Afghanistan

This study examined the clinical experience of a U.S. Army Forward Surgical Team (FST) deployed to Afghanistan in 2005 and compared the findings with those of 3 previously deployed FSTs. Medical records of all patients evaluated by the FST were abstracted for analysis. Demographically, the cohort (n = 614) was predominantly male (94%), with a median age of 24, and distributed according to the following: disease (8.6%), nonbattle injury (42%), and battle injury (49%). Combat casualties were mostly Afghan National Army or Police (56%) and U.S. military (21%). Predominant wounding instruments were small arms (34%), improvised explosive devices (33%), and rocket-propelled grenades (15%). Anatomical sites of battle injury were extremities (38%), external soft tissue (35%), and head/neck/torso (28%). Operative procedures for combat injury (n = 227) were primarily orthopedic (45%) or thoracic/abdominal (36%). Combat casualty statistics provide insight to trauma epidemiology, patterns, and trends vital for surgical management. Workload statistics guides the structuring, training, and employment of FSTs.