III. Prior Life Change and Illness Onset in an Attack Carrier’s Crew

Approximately one third of the enlisted crew of an attack carrier (N = 687) was studied during a six-month deployment to Vietnam. The Schedule of Recent Experience (SRE), designed to document significant recent life change, was administered at the beginning of the cruise, and the illnesses developed by these men during the cruise were tabulated. This paper discusses the relationship of prior life change to illness onset.

Initially, an item weighting system which was constructed from civilian populations was used in scoring, but this scoring system failed to discriminate future illness. A new weighting system was then derived by stepwise multiple regression analysis, which was done separately for unrated seamen and petty officers. Several different items emerged as unique predictors for these two groups of men. The life change scores based on the regression-derived weighting system clearly and significantly discriminated future illness, indicating that new SRE scoring methods can be useful in illness prediction in small samples.     

Transjugular liver biopsy

Biopsy of the liver is considered the ‘gold standard’ and is often necessary for histopathological characterization of hepatic disease processes.     

Acute abdominal pain in geriatric patients evaluated in the emergency room at a third level hospital

"Background: Life expectancy in México has increased in the last decades with a remarkable increase in geriatric population. Acute abdominal pain (AAP) in elderly people compared with young people has different clinical presentation because of the concomitant chronic diseases, the use of medications, history of abdominal surgeries and decrease in perception of pain and immunity. Objective: To know the cause and associated mortality of acute abdominal pain in geriatric patients who attend the emergency room. Methods: Geriatric patients' files with acute abdominal pain admitted from January 2004 to December 2008 were retrospectively reviewed. Age, gender, presence of chronic diseases, use of medications, history of surgical procedures, definitive diagnosis causative of the symptoms and the associated mortality were recorded. Results: 17 524 patients were admitted, of whom 324 (1.8%) were geriatric patients with AAP: 110 were men (36.9) and 214 were women (66%), with a mean age of 78 years (range 60 to 102 years). The most common causes of AAP were acute cholecystitis in 49 patients (15.1%), irritable bowel syndrome in 42 (12.9%), ulcerative syndrome in 40 (12.3%), intestinal obstruction in 35 (10.8%) and diverticulitis in 23 (10.8%). Nine patients died (2.7%). Conclusions: In our hospital the most common cause of AAP in geriatric patients is related to biliary disease followed by functional gastrointestinal disorder and ulcerative syndrome. Mortality is low."     

Epidemiologic study of asymptomatic men screened by maximal treadmill testing for latent coronary artery disease

A group of 1,390 asymptomatic men screened for latent coronary artery disease by maximal treadmill testing and double Master two-step test were followed up for a mean of 6.3 years. Angina, sudden death or acute myocardial infarction was used as the end point for coronary heart disease. There were differences in testing sensitivity and specificity among age and subject groups, but maximal treadmill testing out-performed the double Master test as a screening technique. Maximal treadmill testing demonstrated a 60.9 percent sensitivity, 92 percent specificity and a 20 percent probability that coronary artery disease would develop in a subject with an abnormal response. A risk ratio of 14.3 was obtained and demonstrated that maximal treadmill testing was a valuable screening technique for latent coronary artery disease. However, limitations of the sensitivity and specificity of the functional S-T segment response were apparent. The abnormal S-T segment response to exercise testing did not absolutely predict the future presentation of coronary artery disease, and a normal response to maximal treadmill testing did not rule out this possibility. Because premature ventricular contractions demonstrated a very low sensitivity, predictive value and risk ratio they were not a practical indicator of increased risk for latent coronary artery disease except when associated with an abnormal S-T segment response.     

Squamous cell carcinoma of the rectum

Summary A case of squamous cell carcinoma of the rectum is reported. This case is of interest because of its unusual histologic type and because it was discovered at a stage in which its pathogenesis could be readily determined. The views expressed are those of the authors and do not necessarily reflect those of the Navy Department or the Naval Service as a whole.     

Chronic groin pain following lichtenstein mesh hernioplasty for inguinal hernia. Is it a myth?

Background  

The Lichtenstein mesh hernioplasty is currently the most popular operative technique for open repair of inguinal hernia. The incidence of chronic groin pain (CGP) following this procedure is reported to be high. However, since our experience did not support this observation, this study was undertaken at our centre, to assess the incidence of CGP following Lichtenstein mesh hernioplasty.