United States Department of the Army

About: United States Department of the Army is a government organization based out in Arlington, Virginia, United States. It is known for research contribution in the topics: Poison control & Population. The organization has 32668 authors who have published 42453 publications receiving 947075 citations. The organization is also known as: DA & U.S. Department of the Army.

Complications in endoscopic sinus surgery for chronic rhinosinusitis: a 25-year experience.

Abstract: Objectives/Hypothesis: The aim of this study was to review complications occurring as a result of endoscopic sinus surgery by one surgeon in an academic practice during a 25-year period. Study Design: Retrospective clinical study. Methods: A register of complications was tabulated during a period of 25 years for endoscopic sinus surgery performed for chronic rhinosinusitis in 3,402 patients (6,148 sides). All complications were reviewed as a whole and were not divided into major or minor categories. Results: A total of 105 patients were found to have complicated endoscopic sinus surgery, for an overall patient complication rate of 0.031, or 0.017 per operated side. The most common complications were hemorrhage (n = 41), orbital complications (n = 29), and CSF leak (n = 19). The following factors were noted to have increased risk for complications: age, revision surgery, nasal polyps, anatomic variation, extensive disease, overall health, medications, and underlying factors. Certain types of instrumentation such as powered instrumentation placed patients at greater risk. The use of image guidance or surgical experience did not eliminate complications from occurring. Conclusions: Complications of endoscopic sinus surgery still occur 25 years after the initial introduction of the surgery in 1985. Many complications can be managed without a bad outcome. The key to prevention is knowledge of anatomy, preparation, anticipation, and experience. Even then, complications can occur in the most experienced hands. Patients most at risk for complications include those with revision surgery, extensive disease, skull base anatomic or radiologic variations or dehiscences related to disease or previous surgery, and the use of powered instrumentation.

Hydration for recreational sport and physical activity

Abstract: This review presents recommendations for fluid needs and hydration assessment for recreational activity. Fluid needs are based on sweat losses, dependent on intensity and duration of the activity, and will vary among individuals. Prolonged aerobic activity is adversely influenced by dehydration, and heat exposure will magnify this effect. Fluid needs predicted for running 5-42 km at recreational paces show that fluid losses are <2% body mass; thus, aggressive fluid replacement may not be necessary. Competitive paces result in greater fluid losses and greater fluid needs. Fluid needs for recreational activity may be low; however, carbohydrate consumption (sport drinks, gels, bars) can benefit high-intensity (≤ 1 h) and less-intense, long-duration activity (≥ 1 h). Spot measures of urine color or urine-specific gravity to assess hydration status have limitations. First morning urine concentration and body mass with gross thirst perception can be simple ways to assess hydration status.

Battlefield trauma care then and now: a decade of Tactical Combat Casualty Care.

Abstract: : Maughon reported in 1970 that 193 of a cohort of 2,600 casualties that were killed in action in Vietnam died of isolated extremity hemorrhage. The percentage of fatalities that resulted from exsanguination from extremity wounds was 7.9%; this was the leading cause of preventable death among US military casualties in the Vietnam War. Maughon commented at the time that little progress had been made in battlefield trauma care in the last 100 years. A sobering postscript to Maughon s observations in 1970 is found in the preventable death analyses done by Holcomb et al.2 and Kelly et al.3 in the current conflicts. Holcomb et al. found a 15% incidence of potentially preventable fatalities in his article that reviewed all Special Operations deaths in Iraq and Afghanistan from the initiation of hostilities until November 2004. He found that 25% (3 of 12) fatalities with potentially survivable injuries might have been saved by the simple application of a tourniquet. The larger causes of death analysis by Kelly et al. studied 982 fatalities from the first 5 years of the conflicts in Afghanistan and Iraq. He documented that 77 of 232 potentially preventable deaths from the Armed Forces Medical Examiner records resulted from failure to use a tourniquet; exsanguination from isolated extremity wounds thus caused 7.8% of the combat-related deaths reported in the article of Kelly et al.. The failure to make progress in addressing the leading cause of preventable deaths on the battlefield in the 30 years between the Vietnam and Afghanistan wars, despite the ready availability of the requisite technology, dramatically underscores Maughon s point about the lack of progress in battlefield trauma care.