James M. Goff

Operation Enduring Freedom: the 48th Combat Support Hospital in Afghanistan.

OBJECTIVE To examine the experience of the 48th Combat Support Hospital (CSH) while deployed to Afghanistan, with an emphasis on trauma care. MATERIALS AND METHODS Before redeployment, a retrospective review was performed on the medical records of all patients treated at the 48th CSH from December 6, 2002 through June 7, 2003. RESULTS During the 6-month period, 10,679 patients were evaluated and/or treated. There were 477 hospital admissions (adults, 387; children, 90; trauma, 204) and 634 operating room procedures. The most common mechanisms of injury were land mines/unexploded ordinance (74 = 36%) and gunshot wounds (41 = 20%). Extremities were the most common site. A total of 358 cases was performed on 168 trauma patients (mean, 2 cases per patient; range, 1-12). There were 63 complications in 40 trauma patients and 11 patients died. CONCLUSIONS The 48th CSH supported military and humanitarian operations with an ongoing process of re-evaluation, adaptation, and medical education that resulted in low morbidity and mortality rates.

The Prevalence of Occult Carotid Artery Stenosis in Patients With Head and Neck Squamous Cell Carcinoma

Objectives/Hypothesis Risk factors for atherosclerotic carotid artery disease (ASCAD) and squamous cell carcinoma of the head and neck region (HNSCCA) are similar. This study was conducted to determine whether patients with HNSCCA have an increased rate of occult ASCAD compared with the general population.

Endovascular assisted in situ bypass grafting: a simplified technique for saphenous vein side branch occlusion

The in situ bypass procedure for lower extremity limb salvage requires a long continuous incision or multiple interrupted incisions over the greater saphenous vein to ligate the saphenous vein side branches. This can result in wound complications that frequently prolong hospital stay and threaten the graft. In an effort to reduce the incidence of wound complications, alternate methods of occluding the vein side branches have been used. One method is to deliver coils under angioscopic vision into the saphenous vein side branches. This report details a simplified technique that uses widely available catheter-based equipment to perform saphenous vein side branch occlusion under fluoroscopic guidance.

Endoscopy in a deployed combat support hospital: maintaining military end-strength.

OBJECTIVE The objective was to examine the safety and efficacy of the 48th Combat Support Hospitals use of diagnostic endoscopy in Afghanistan. METHODS A retrospective review was performed on the medical records of all endoscopy patients treated at the 48th Combat Support Hospital in Bagram, Afghanistan, from December 6, 2002 through June 7, 2003. RESULTS Twenty-four patients (male, 21; female, 3; mean age, 35 years) underwent 28 endoscopic procedures as follows: colonoscopy, 14; esophagogastroduodenoscopy (EGD), 13; and flexible sigmoidoscopy, 1. Four patients underwent both EGD and colonoscopy. There were no complications. Of the 18 U.S. military patients, 3 (15%) were evacuated for further evaluation and/or treatment and 1 (5%) patient underwent an elective screening colonoscopy. For 14 of 17 U.S. military personnel (82%), the endoscopic procedures obviated evacuation from Afghanistan. CONCLUSIONS Diagnostic colonoscopy and EGD were valuable and safe adjuncts that precluded evacuations out of theater for 82% of military patients. Endoscopy should be used when U.S. military operations necessitate the deployment of large numbers of forces for protracted periods.

Early recurrent carotid artery stenosis

Abstract Introduction Early recurrent carotid artery stenosis, defined as stenosis occurring within 2 years of carotid endarterectomy, occurs in 4% to 36% of patients. Management of asymptomatic early recurrent stenosis is controversial because of different outcomes in multiple natural history studies. Optimal follow-up post–carotid endarterectomy has not been defined. The purpose of this study was to determine the natural history of early recurrent stenosis and to define the optimal duplex surveillance strategy during follow-up. Methods Patients who underwent carotid endarterectomy between January 1995 and June 1998 at a single tertiary-care institution were reviewed retrospectively. Data were collected regarding degree of stenosis, closure technique, neurologic morbidity, mortality, and the intervals between postoperative duplex studies. These results were compared with accepted rates in the literature. Life-table analysis was done on restenosis-free survival. Discrete variables were tested for significance by chi-square analysis and Fisher’s exact test. A p value less than or equal to 0.05 was considered significant. Results Two hundred thirty-one carotid endarterectomies in 226 patients were evaluated. A total of 57 (24.6%) of 231 carotid endarterectomies had recurrent stenosis. These 57 sites were in 56 patients. Fifty-four (23.4%) of 231 sites had a stenosis of 16% to 59%. All of these lesions were asymptomatic and found within 1 year of carotid endarterectomy on duplex imaging. The 3 (1.3%) remaining sites had a restenosis of greater than 60%. Early recurrent stenosis occurred more frequently in women (women 28/80 [35%] vs. men 28/146 [19.2%]). High-grade stenosis occurred more often with primary (1/5 [20%]) than with patch (2/226 [0.8%]) closure and in patients less than 65 years of age.