Military Medicine最新文献

Introduction: All prospective blood donors who report behaviors or conditions that may increase risk of transfusion-transmitted infection (TTI) are temporarily deferred from donating. In this study, we evaluate how deferrals for TTI risk impact future donation attempts, ultimately informing how deferral policy changes may affect the military population.

Materials and methods: This retrospective chart review evaluated all blood donors with pre-donation deferrals at a single site between October 2019 and December 2022. Among the 14 deferral categories, 7 were classified as behaviors or conditions that increase risk of TTI. The rate of donation reattempts within the study period was assessed in donors deferred for TTI risk and compared to that of donors deferred for low hemoglobin matched by sex, age, and military training status.

Results: Six thousand three hundred and fifty two (12.8%) of the 49,613 blood donors identified during the study had a pre-donation deferral. The most common reason for pre-donation deferral was anemia (54.2%), but TTI-risk accounted for a significant fraction of deferrals (10.7%). We found that donors who were deferred for TTI risk were significantly less likely to attempt redonation during the study period compared to those deferred for anemia (P < .001). On multivariate analysis, donors deferred for men who have sex with men and travel or residence in a malaria-endemic area were independently associated with a decreased redonation attempt rate and increased time to reattempt.

Conclusion: Pre-donation deferrals for TTI risk were associated with a decreased rate of redonation and increased time to reattempt compared to donors deferred for anemia.

This case report details the lifelong sequelae and complex management of a shrapnel injury sustained by a 4-year-old male during a 1943 World War II bombing. The initial trauma caused a severe right elbow fracture and complete ulnar nerve transection, resulting in ankylosis and chronic joint dysfunction. Decades later, the patient developed recurrent ulcerations and scar instability over the olecranon. A suspected chronic osteomyelitis was initially managed conservatively with antibiotics and scar revision with lipofilling. However, ulceration recurred, ultimately necessitating aggressive surgical intervention, initially postponed for the patient's heart conditions. This involved fistulectomy, extensive bone debridement, and definitive coverage with a reverse-flow perforator flap based on the posterior interosseous and radial recurrent arteries. The procedure achieved successful healing with no recurrence at five-year follow-up. This case underscores that chronic complications from wartime trauma can manifest over a lifetime. It highlights the necessity of a definitive surgical approach, combining radical debridement with robust soft tissue reconstruction, even after long periods of quiescence. For elderly patients with complex comorbidities, this pedicled flap provides a reliable, single-stage reconstructive option in the challenging elbow region.

Introduction: Endometrial cancer incidence is rising in the United States, including among women younger than 50 years, raising concern for women serving on active duty, retirees, and their dependents. Age-related differences in clinicopathologic features and treatment have been documented in the general U.S. population and the differences may be influenced by access to care. We aimed to study clinicopathologic and treatment features of women within the Department of War (DoW) Military Health System (MHS) to better understand age-related differences in tumor characteristics, surgical management, and adjuvant therapy by age in this universal access setting.

Materials and methods: We conducted a retrospective cohort study using the Military Cancer Epidemiology (MilCanEpi) database, which links the DoW cancer registry and medical claims data. Women diagnosed with endometrial cancer from 2001 to 2014 who underwent hysterectomy within 6 months of diagnosis were included. Modified Poisson regression was used to estimate adjusted risk ratios (ARRs) for advanced tumor stage (II-IV vs. I), aggressive histological subtypes (high-grade endometrioid endometrial carcinoma [EEC] or non-EEC vs. low-grade EEC), surgical approach, and adjuvant therapy (chemotherapy or radiation) by age group: 18-49, 50-64, and ≥65 years.

Results: Among 1,223 patients, 16% were aged 18-49, 61% aged 50-64, and 23% aged ≥65. Compared with women aged 50-64, those aged 18-49 were less likely to have aggressive histologic subtypes (ARR = 0.65; 95% CI = 0.44-0.96), while those aged ≥65 were at higher risk for more aggressive histologic subtypes (ARR = 1.54; 95% CI = 1.25-1.90). No significant age-related differences were observed in tumor stage, time to surgery, surgical approach, or lymphadenectomy. Among patients with aggressive histologic subtypes (n = 287), receipt of adjuvant therapy did not differ significantly by age (18-49 years: ARR = 0.84, 95% CI = 0.58-1.21; ≥65 years: ARR = 0.92, 95% CI = 0.78-1.08) relative to women aged 50-64 years at diagnosis.

Conclusions: Within the MHS, age-related differences in endometrial cancer were confined to tumor histology, with younger women less likely and older women more likely to present with aggressive subtypes. This is consistent with that reported in the general U.S. population. Importantly, no age-related differences were observed in surgical management or receipt of adjuvant therapy when adjusted for tumor features. This may suggest the role of healthcare access in mitigating age-related treatment gaps observed in the general population.

Hepatic fascioliasis is a foodborne zoonosis that can mimic hepatobiliary malignancy and occasionally requires surgery when diagnosis is uncertain or when a focal complicated lesion is not amenable to endoscopic or medical management. We report 2 cases managed at a military-associated surgical center in Ukraine involving civilian employees of the Armed Forces of Ukraine working in rear-area, non-combat facilities. Case 1: a 38-year-old man with more than 1 year of right upper quadrant pain and a subcapsular tract-like lesion in hepatic segment VI. Eosinophils and cholestatic enzymes were not elevated. Laparoscopic segment VI resection was performed, and histopathology demonstrated necrotizing inflammation with degenerated Fasciola fragments. Case 2: a 51-year-old woman with nausea, vomiting, back pain, and a brief episode of jaundice; imaging showed a lesion in segment VII extending into segment VI. Preoperative leukocytosis with marked neutrophilia was present, but eosinophil count and full liver biochemistry were not available in the preoperative record. Laparoscopic segment VII resection was performed, and histopathology showed necrotizing inflammation compatible with fascioliasis-related tissue injury. Both patients recovered without postoperative complications and were discharged; triclabendazole was prescribed postoperatively as a precaution. These cases highlight diagnostic pitfalls, including absent or incomplete "classic" laboratory signs, and support laparoscopic resection as a safe option in selected patients when malignancy cannot be excluded and endoscopic therapy is unlikely to succeed, with particular relevance to military health systems.

Introduction: Tuberculosis (TB) causes significant morbidity and mortality worldwide. Diagnosing TB in service members can be a challenge given the overall low incidence but increased risk of exposure that accompanies military travel, training and activities. Here we describe clinical features, risk factors, and characteristics of initial diagnoses of TB at the largest Department of Defense hospital.

Materials and methods: Acid-fast bacilli cultures positive for Mycobacterium tuberculosis at Brooke Army Medical Center were reviewed identifying TB cases between 2010 and 2023. Epidemiologic, clinical, and microbiologic data were collected from medical records. Only patients with initial diagnosis at Brooke Army Medical Center (BAMC) were included.

Results: Twenty-nine patients (65% non-U.S. born) were diagnosed with TB, primarily pulmonary. Latent tuberculosis infection was the most common comorbidity (33%), followed by diabetes and lung disease (21% and 17%). Cough and sputum production were the most frequent symptoms (59%, 48%); 24% were asymptomatic at diagnosis. Acid fast bacilli (AFB) smear positive patients were older with higher rates of classic TB symptoms. Median number of sputum cultures was 4; 58% were collected at least 8 hours apart; 41% had one collected before 10 AM. Only 75% of samples included TB nucleic acid amplification testing (NAAT).

Conclusions: Acid fast bacilli smear negative patients tended to be younger, asymptomatic, have more chronic lung disease, extrapulmonary disease, prior latent tuberculosis infection (LTBI), and longer time from symptoms to treatment highlighting the diagnostic difficulty of these cases. Patients with sputum negative disease and extrapulmonary TB had more days between symptom onset and treatment than AFB sputum positive TB cases. Half of AFB smear negative active duty patients were also TB NAAT negative. Care should be taken when evaluating young, asymptomatic active duty patients with high-risk histories and features for tuberculosis. More research is needed to enhance initial diagnostic evaluation and testing and evaluation for TB in civilian and military population.

This case report describes a 46 year old female with complaints of dizziness and decreased ability to complete activities of daily living although aboard a U.S. Navy ship. She was unable to walk unsupported and her ability to work at a computer was severely limited because of the severity of her symptoms. She had a long history of motion sickness, predominantly seasickness (mal de mer), Eustachian tube dysfunction, and bilateral tympanic membrane perforations. Finding minimal benefit from pharmacological interventions, she was evaluated and diagnosed with seasickness by a physical therapist. The initial interventions focused on gaze stabilization exercises, but were limited in efficacy because of the continuous nature of shipboard motion resulting in needing extended times in a supine position with a foot grounding her on the floor for symptom resolution. Through the application of a sensory reweighting system improvised from available clinic supplies, the patient's symptoms reduced to the point of being able to walk unsupported and engage with VOR habituation exercises although on the ship. This case is unique in that the patient's seasickness did not resolve with typical pharmacologic or physical therapy interventions, so innovative strategies were used to modify her sensory weighting to mitigate her symptoms. This case report may provide other clinicians in austere settings (shipboard) with a non-pharmacological option for the treatment of unresolving seasickness.

Introduction: Chronic low back pain (cLBP) is the most prevalent chronic pain condition among veterans, contributing to disability, reduced quality of life, and opioid dependence. Complementary and integrative health (CIH) approaches offer evidence-based, non-pharmacological alternatives that may improve pain management, enhance patient satisfaction, lower healthcare costs, and reduce opioid dependence.

Materials and methods: The objective of the study was to synthesize current evidence on CIH approaches for veterans with cLBP, evaluate their impact on pain, function, and well-being, and identify implications for policy, health system implementation, and future research. The key questions of the study included: what is the effectiveness of CIH modalities in reducing cLBP intensity among veterans, what are their broader effects on health outcomes, opioid use, and quality of life, what barriers exist to implementation within the VA, and what research and policy priorities are needed to optimize veteran-centered CIH care? A narrative synthesis of peer-reviewed literature published between 2010 and 2025 was conducted, prioritizing studies specific to veterans and incorporating systematic reviews, randomized controlled trials, observational studies, and evidence maps. A patient-centered, biopsychosocial, and whole-health framework guided the analysis.

Results: Evidence for CIH in veterans remains limited compared to that in civilian populations, but it demonstrates promise. Battlefield acupuncture demonstrated clinically meaningful reductions in pain, although yoga, Tai Chi, Qigong, and mindfulness offered modest improvements in pain and functional outcomes. Cognitive-behavioral therapy, Chiropractic care, and massage showed mixed results, with low to moderate certainty and limited durability. Multimodal approaches integrating CIH with conventional care have demonstrated the strongest outcomes, including reduced opioid prescriptions, improved coping, and potential cost savings. Barriers to care include provider shortages, administrative challenges, and uneven access across facilities.

Conclusions: CIH approaches represent patient-centered and holistic strategies with the potential to reduce pain, enhance function, and mitigate opioid reliance among veterans with cLBP. Broader, standardized implementation and veteran-specific trials are necessary to strengthen the evidence base and guide the sustainable integration of this approach into the VA health system.