Military medicine
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This column explores the inception, challenges, and prospects of robotic surgery in the military. It highlights the military's role in developing early prototypes, current utilization, training struggles, partnerships with civilian organizations, and potential future applications. The military's influence on the evolving landscape of robotic surgery is emphasized.
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Hemoptysis is a rare presenting symptom in pediatric and young adult patients with a highly variable outcome ranging from an isolated mild occurrence to severe illness and death. Exercise-induced pulmonary hemorrhage (EIPH) has several reports in adult literature but has not previously been reported in pediatric patients. A 12-year-old female with a history of trisomy X (47, XXX), obesity, depression, anxiety, and obstructive sleep apnea presented to the pediatric pulmonology clinic after several episodes of hemoptysis. ⋯ The hemoptysis evaluation is important for military providers given the range of severity in presentations, even though it is a rare occurrence. In addition to a novel presentation of EIPH, this case demonstrates the value of collaboration between pediatric and adult specialists in the Military Health System (MHS). Military care providers should be aware of this rare phenomenon in service members and trainees who are at risk during maximal aerobic effort.
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Swimming-induced pulmonary edema (SIPE) is an incompletely understood condition that is often seen in U. S. special operations candidates participating in maritime qualification training courses. We present a case of two monozygotic twins with the simultaneous onset of acute respiratory distress during a crucible event of a maritime assessment and selection course. ⋯ Both candidates recovered with supportive measures but were medically removed from training. Given the near-identical exposures of the candidates to the same ambient and water temperatures, duration of water submersion, magnitude of physical stressors, and viral colonization, this case study suggests that there may be underlying genetic factors, in addition to environmental factors, that predispose individuals to developing SIPE. Further benchtop and clinical research must be performed to identify potential genetic polymorphisms that contribute to the development of SIPE and to investigate safe interventions that address the underlying etiologies of SIPE pathophysiology.
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Surgical treatment of chronic pectoralis major tears presents a technical challenge, as injury chronicity may preclude the ability to perform a direct repair. Many techniques have been described to repair an acute pectoralis tendon rupture, including utilization of unicortical buttons within the humeral footprint. In the chronic setting when direct repair is not possible, reconstruction with allograft tissue can restore strength, improve cosmesis, and yield high functional outcomes; however, literature is limited to small case series. We describe a combined Pulvertaft Weave and onlay technique with dual Achilles tendon allograft in the management of an active duty infantryman with a chronic pectoralis major injury.