Military medicine
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As a preliminary step to studying the Army's experience with against medical advice (AMA) discharges, the literature was reviewed. Fifty-one articles were found through a computer program search. ⋯ Patients with drug and/or alcohol abuse problems are at significantly higher risk for AMA. No civilian studies have been identified which evaluate long-term trends.
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The Army experience with discharges against medical advice (AMA) from 1971 to 1988 is analyzed. AMA discharges have declined in a statistically significant manner in both medical centers and community hospitals. Discharges have decreased among men but increased among women. ⋯ Among clinical services, only obstetrics and gynecology demonstrated statistically significant increases. Among patient categories, only family members showed an increase. The possible sources of these various changes are discussed.
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Hyperbaric oxygenation as an adjunct in the treatment of clostridial myonecrosis (gas gangrene) has been used extensively in facilities with hyperbaric chambers. The United States Air Force has had extensive experience in the treatment of clostridial myonecrosis, treating 77 patients since 1965. This study reviews the experience in the treatment of this disease process in military multiplace hyperbaric chambers and provides an in-depth analysis of factors affecting patient survival. A comprehensive review of the literature on the treatment of clostridial myonecrosis with hyperbaric oxygenation is presented in this paper.
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Review Case Reports
Case reports Rhizopus brain abscess: report of a case and review of the literature.
The case of a 34-year-old intravenous drug abuser who survived brain abscess due to Rhizopus arrhizus is presented. The diagnosis was made by brain biopsy. ⋯ Phycomycetes cause venous thrombosis and infarction of brain tissue. Medical versus surgical options are discussed.
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Among 118 young Hispanic (101 Puerto Rican) psychiatric inpatients, somatic complaints, violence, suicidal tendency, hallucinations, sudden onset of symptoms, and dissociative behavior each occurred in 46% or more of patients. There was no difference in clinical presentation between island Puerto Rican patients and Puerto Rican patients raised on the mainland. There was no relationship between these behaviors and any specific psychiatric disorder. Although there is a suggestion that more of these behaviors may occur among Puerto Rican Hispanics, further study with larger control groups is needed.