Reprioritization of research for combat casualty care

Since the beginning of the conflicts in Iraq and Afghanistan more than a decade ago, much has been learned with regard to combat casualty care. Although progress has been significant, knowledge gaps still exist. The seventh Extremity War Injuries symposium, held in January 2012, reviewed the current state of knowledge and defined knowledge gaps in acute care, reconstructive care, and rehabilitative care in order to provide policymakers information on the areas in which research funding would be the most beneficial.     

Low reproducibility of many lactate markers during incremental cycle exercise

Reports on reproducibility of lactate markers usually considered only two trials. The authors assessed reproducibility of power output at seven markers in 11 fit subjects over at least six trials under tightly controlled conditions. Subjects undertook incremental exercises (50 W start, +50 W every 3 min to exhaustion) on a cycle ergometer. At each trial blood lactate concentration was determined at rest and within the final 30 s of each stage. The Rest+1, 2.0 and 4.0 mmol/l markers were determined by interpolation, the D-max and nadir using a quadratic model and the lactate slope index using an exponential plus constant model, and a visual turnpoint was determined empirically. Intraclass correlations and coefficients of variation assessed reproducibility. Power output at all markers differed significantly between subjects, but not between trials. Intraclass correlation coefficients were respectively 0.799, 0.794, 0.807, 0.903, 0.677, 0.769 and 0.648, and corresponding standard errors of measurement 11.9, 9.2, 9.1, 2.5, 9.2, 10.8 and 24.7 W. Statistical powers of detecting a 30 W increment at these markers were 0.30, 0.43, 0.42, 0.98, 0.58, 0.38 and 0.18 respectively. These results indicate that only the D-max marker has good reproducibility and that it alone can identify small but meaningful changes in training status with sufficient statistical power.     

Placenta increta; conservative management – a successful outcome. Case report and literature review

Placenta increta, a rare complication of pregnancy, is associated with significant postpartum hemorrhage often requiring emergency hysterectomy. We report a case of conservative management, with a combination of parenteral methotrexate, serial ultrasound and Doppler assessment, followed by interval manual removal of placenta.     

Bone marrow disorders: characterization with quantitative MR imaging

Thirty patients with various hematologic disorders and 15 healthy control subjects underwent quantitative magnetic resonance (MR) imaging of the lumbar spine with spin-echo techniques. Images of patients with infiltrative bone marrow disorders showed significantly more prolonged T1 times than those of control subjects (P less than .001). It was not possible to distinguish different diffuse infiltrative bone marrow disorders on the basis of T1 values. Aplastic anemia could be distinguished from normality because of significantly shortened T1 (P less than .001). A significant correlation was seen between T1 and bone marrow cellularity (r = .74, P less than .001). T2 was of no value in the characterization of bone marrow disorders. Quantitative MR imaging dose not improve the diagnostic potential of bone marrow imaging in the detection of diffuse marrow infiltrates.