Diet in the Treatment of Hypertensive Disease

The occiput posterior position has been considered a serious complication of labor. Evidence is presented that it is a normal, frequently occurring position and that the outlook for mother and child is normal. Difficulties arise with the occiput posterior mainly at midpelvis. Indications for midpelvic study, their recognition and their interpretation are discussed.     

Bacillus cereus septicemia attributed to a matched unrelated bone marrow transplant

BACKGROUND: Hematopoietic cell transplantation (HCT) is performed in more than 25,000 patients annually. Clinically significant bacterial transmission from HCT products is rare. CASE REPORT: A 36‐year‐old male of Asian descent with chronic myelogenous leukemia developed sepsis leading to acute renal failure and disseminated intravascular coagulation during infusion of matched unrelated donor bone marrow. This product later tested positive for Bacillus cereus. DISCUSSION: This HCT product traveled 31 hours at room temperature before arriving at the transplant center. Reducing transport times, transporting at 4°C, and enhancing bacterial surveillance of HCT products may increase the ability to detect bacterial proliferation from transport. CONCLUSION: To prevent a similar case in the future, we will begin Gram staining all HCT products in transit more than 24 hours to alert physicians of the need for prophylactic antibiotic therapy.     

Dengue Fever With Hemorrhagic Features in a Special Forces Soldier

Military operations are conducted in a variety of settings. Some settings provide significant U.S. resources for preventive, primary, urgent, andemergency or trauma care. Other operations consist of small numbers of personnel relying on limited internal, improvised, and/or host nation resources. Special Forces often conduct their missions in rural, austere, andremote settings with a small “medical footprint.” Often the supported government has difficulty providing essential services, including medical care. To address this, U.S. Special Forces select andtrain highly motivated individuals to perform medical duties in an exceptionally austere environment devoid of resources. This case highlights those services andthe medical decision-making process required to provide medical care to approach the standard of care in the United States. In this case, the affected individual had dengue fever.