Gary D. Davis

The relation between stress fractures and bone mineral density: evidence from active-duty Army women.

OBJECTIVE To determine if bone mineral density (BMD) is associated with the probability of stress fractures in premenopausal women. DESIGN Case-control study. SETTING Large Army post, Fort Lewis, WA. PARTICIPANTS Twenty-seven active duty Army women with documented stress fractures within the last 2 years and 158 female controls. METHODS AND MAIN RESULTS All subjects were examined and interviewed. BMD of the femoral neck and posteroanterior lumbar spine (L2-L4) was measured using dual energy X-ray absorptiometry. Univariate comparisons revealed no significant differences in BMD of the femoral neck or lumbar spine between groups. Women with stress fractures had a significantly higher exercise intensity (428 vs 292 minutes per week, p<.05) and were more likely to be entry-level enlisted soldiers (63% vs. 44%, p<.05) than those without stress fractures. Multivariate analyses revealed a strong negative association between femoral neck BMD and the probability of stress fractures (lower BMD, higher risk). Exercise intensity and body mass index had a significant positive effect on BMD of the femoral neck and lumbar spine, yet both were associated with an increased probability of stress fractures. CONCLUSIONS Femoral neck BMD was significantly associated with the probability of stress fractures. Optimal training programs should balance the beneficial indirect effect of increased exercise (through increased BMD) with its detrimental direct effect on stress fractures.

The natural history of pelvic organ support in pregnancy.

Abstract Little is known about the anatomic and physiologic changes in the pelvic floor that occur during pregnancy. The purpose of this study was to prospectively document pelvic organ support throughout pregnancy using the standardized system of the International Continence Society, also known as the Pelvic Organ Prolapse Quantification (POPQ) Staging System. Pelvic organ support evaluations were performed in nulliparous pregnant women presenting for routine obstetric care during each trimester. POPQ stage assignments and POPQ component measurements were compared for first-, second- and third-trimester examinations. Overall POPQ stage was significantly higher in the third trimester than in the first (P=0.001). Individual POPQ points which showed significant differences between the first and third trimesters include Aa, PB, Ap, Ba, Bp, TVL and GH. These findings probably represent normal physiologic changes of the pelvic floor during pregnancy, but suggest that significant changes may be objectively demonstrated prior to delivery.

A microlaparoscopic technique for Pomeroy tubal ligation

Objective To evaluate the efficacy of performing Pomeroy tubal ligation using microlaparoscopic techniques. Methods Thirty-eight consecutive women desiring permanent sterilization underwent laparoscopic Pomeroy tubal ligation using small (2 or 5 mm) transumbilical laparoscopes and secondary midline sites (5 mm and 14 gauge). The procedures were performed under general anesthesia (n = 28) or local anesthesia with conscious sedation (n = 10). Results The mean operative time ± standard deviation (SD) in minutes was 33.0 ± 10.3. The mean recovery time ± SD in minutes was 104.3 ± 41.6. There were no operative complications, and no cases required conversion from the microlaparoscopic technique to a traditional method. Conclusion The results of this study indicate that the Pomeroy tubal ligation may be performed using microlaparoscopic techniques. Furthermore, in selected cases, this technique can be performed under local anesthesia in an outpatient setting.

Microlaparoscopic tubal ligation under local anesthesia

Local anesthesia to perform laparoscopic tubal ligation is of increased interest due to potential safety and cost benefits. We performed tubal ligation using microlaparoscopic techniques with local anesthesia and continuous intravenous sedation in 16 women desiring sterilization. Operating and recovery times and patient satisfaction were recorded and compared with values for 30 similar women undergoing microlaparoscopic tubal ligation under general anesthesia. Mean +/- SD operating and recovery times for local and general anesthesia were 29.3+/- 8.1 versus 33.6 +/- 11.1 minutes, and 83.9 +/- 59.4 versus 114.5 +/- 69.8 minutes, respectively. Patient satisfaction was high. The potential for cost savings when performed in an outpatient or clinic setting is significant.

Lessons Learned From Casualty Statistics in Health Care System Development: Afghanistan 2008–2009

A retrospective study of Afghanistan National Army casualty rates for a 1-year period was completed to assist in health care system assessment and further development during a period of rapid force expansion. Battle and disease nonbattle injuries by Corps area were determined from data on soldier visits from all military health care facilities. The number of fielded forces in each Corps was used to calculate the populations at risk. Total manpower losses from all casualties were tabulated. The 15,336 casualties (175 per thousand fielded soldiers) resulted in the loss of 146,986 duty days (average 9.5 days per casualty). Battle casualties were 739 (8.4 per 1,000) and nonbattle casualties were 14,597(166 per 1,000) with 72% secondary to infectious diseases. Casualty rates from both battle and disease nonbattle injuries were high, but casualty rates were particularly high from infectious diseases. Rapid force expansion in developing countries requires early consideration for resourcing and implementation of preventive medicine programs.

Nonpuerperal Uterine Inversion in an Afghan Woman

OBJECTIVE Nonpuerperal uterine inversion is a rare but serious condition which is often associated with polypoid benign or malignant tumors of the uterus. Timely diagnosis and intervention may prevent long-term sequelae. METHODS This report presents an unusual case of nonpuerperal uterine inversion which was diagnosed 14 months after an uneventful vaginal delivery, the longest period of time reported in world literature. RESULTS The patient was successfully treated for uterine inversion and was discharged home in good condition. CONCLUSION Nonpuerperal uterine inversion can be successfully treated in a low-resource environment, but may require utilization of elements from several standard techniques before reversion is accomplished.