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PubMed1990

Testing of adsorbed diphtheria-pertussis-tetanus (DPT) vaccine for freedom from abnormal toxicity.

A total of 112 samples of adsorbed DPT vaccine were tested in mice for freedom from abnormal toxicity by three procedures: (a) single human dose by intraperitoneal route; (2) single human dose by subcutaneous route; and (3) half the single human dose by intraperitoneal route. The percentage of samples passing by the three methods was 25, 90 and 54.5, respectively. Method 3, which is being recommended now by the World Health Organization, is supported by the results of this study to be neither very stringent nor very lenient to pass the adsorbed DPT vaccine for freedom from abnormal toxicity.

Animals↗
PubMed1992

An assessment of nicotine gum as an adjunct to freedom from smoking cessation clinics.

The Freedom from Smoking clinic programs offered by the American Lung Association are in widespread use. These programs were developed in the 1970s prior to the availability of nicotine gum in the United States. It was hypothesized that the addition of nicotine gum to these clinics (thereby including both behavioral and pharmacologic intervention) would boost abstinence outcome significantly. Two-hundred and seventy-three persons were randomly assigned to Freedom from Smoking clinics with or without prescription of nicotine gum. Abstinence outcomes at one week favored the nicotine gum conditions (86.3% of nicotine gum subjects were abstinent as opposed to 70.9% of comparison subjects, chi 2(1) = 9.79, p = .002). Effects for gum were no longer significant at later follow-ups, however, Overall duration and level of nicotine gum use were considerably less than optimal. In the absence of a placebo gum control group, expectancy cannot be eliminated as a possible explanation of the short-term results.

Adult↗
PubMed2004

Significance of kinetic degrees of freedom in operation of the actomyosin motor.

The actomyosin motor as a principal functional component of cell motility is highly coordinated in regulating the participating molecular components. At the same time, it has to be flexible and plastic enough to accommodate itself to a wide variety of operational conditions. We prepared two different types of actomyosin systems. One is a natural intact actomyosin system with no artificial constraint on the kinetic degrees of freedom of the actin filaments, and the other is a regulated one with actin filaments supplemented by intra- and intermolecular crosslinking to suppress the kinetic degrees of freedom to a certain extent. Crosslinked actomyosin systems were found to remain almost insensitive to calcium regulation even when intact troponin-tropomyosin regulatory component was incorporated. Both the ATPase and the motile activities of the actin filaments sliding on myosin molecules were markedly lowered by the crosslinking. In contrast, once the crosslinking was cleaved, both properties returned to the normal as with intact actomyosin systems.

Actomyosin↗
PubMed2006

More degrees of freedom by using chimeric concept in the applications of anterolateral thigh flap.

For obliterating a dead space, especially deep and slender, it is more challenging for a reconstructive surgeon to design a musculocutaneous flap by conventional technique. Tethering at the midway of a musculocutaneous flap while inset is not unusual, and trimming of excess muscle may jeopardize the perfusion of the skin. Based on the lateral femoral circumflex system (LFCS), introducing a chimeric concept into the reconstruction of these difficult wounds will simplify the flap design and give more degrees of freedom to inset the flap. Technique of intramuscular dissection of perforators is frequently demanded. Vastus lateralis muscle based on the distal runoff of the LFCS can be included with sharp dissection. Using chimeric concept in the application of anterolateral thigh flap, the muscle and skin can be considered as individual units although they base on a single pedicle. The dimension of skin and the volume of muscle can be tailored as adequate as desired. While insetting the flap, the lengthy pedicles distal to the bifurcation enhance a three-dimensional reconstruction without difficulty. Chimeric concept of anterolateral thigh flap affords more degrees of freedom for difficult reconstructions.

Adolescent↗
PubMed2005

Neurology in Operation Iraqi Freedom: risk factors for referral, clinical presentations and incidence of disease.

Six hundred and sixteen patients were referred for consultation to the author who served as the neurologist on the 252nd Neurosurgical Team in Kuwait in support of Operation Iraqi Freedom between April and October, 2003. Demographic and military data were collected. The cohort of neurologic patients showed significant differences from the total population of the United States Army contemporarily deployed to Operation Iraqi Freedom. Versus the deployed personnel, the neurologic cohort was older in age (p<0.001), had a greater percentage of females (p<0.00001), had an excessive representation for the military rank of sergeant (p<0.00001), with a deficit of other ranks (junior enlisted and officers), and were more likely to soldiers from the Reserves (p<0.00001) and National Guard (p=0.0021) than from the Regular Army. Seven categories of chief complaints and ten categories of diagnoses constituted some 80% of patients. The incidence of neurologic disease was calculated to be 634 per 100,000 people/year. This information provides valuable information for military neurologists concerning their anticipated duties in future deployments and for non-neurologists by focusing their skills in the evaluation of common neurologic presentations, yet further research is needed to optimize the neurologist's role in a field environment.

Adult↗
PubMed2005

Influence of patient characteristics and arterial grafts on freedom from coronary reoperation.

OBJECTIVE: Arteriosclerosis is a progressive disease, and many patients require repeat coronary intervention after coronary artery bypass grafting. We sought to identify patient characteristics and operative factors that predict the need for or bias toward reoperative coronary artery bypass grafting. METHODS: From 1971 to 1998, 48,758 patients underwent primary isolated coronary artery bypass grafting, and 1000 per year were followed every 5 years (n = 26,927). A multivariable time-related analysis was performed to model freedom from coronary reoperation and to identify patient and operative variables associated with occurrence of coronary reoperation. RESULTS: Freedoms from reoperative coronary artery bypass grafting were 99.6%, 98.4%, 93%, 82%, 72%, and 65% at 1, 5, 10, 15, 20, and 25 years, respectively. Risk of reoperation (hazard function) demonstrated a short, rapidly declining early phase, followed by a long, slow-rising late phase. Patient variables that increased the likelihood of coronary reoperation included younger age (P < .0001), higher total cholesterol (P = .0004) and triglyceride levels (P = .0005), lower high-density lipoprotein (P = .0002) level, diabetes mellitus (P < .0001), and more extensive coronary artery disease (P = .01). Increasing extent of arterial grafting performed at primary coronary artery bypass grafting decreased occurrence of coronary reoperation (P < .0001). CONCLUSION: Patient factors associated with arteriosclerosis progression and type of bypass conduit influence the need for or bias toward repeat coronary artery bypass grafting. Aggressive patient risk-factor reduction and extensive arterial coronary revascularization at primary coronary artery bypass grafting should result in fewer coronary reoperations.

Coronary Artery Bypass↗
PubMed2006

Prosthesis-patient mismatch after aortic valve replacement predominantly affects patients with preexisting left ventricular dysfunction: effect on survival, freedom from heart failure, and left ventricular mass regression.

OBJECTIVE: The effect of prosthesis-patient mismatch on clinical outcome and left ventricular mass regression after aortic valve replacement remains controversial. Data on whether the clinical effect of prosthesis-patient mismatch depends on left ventricular function at the time of aortic valve replacement are lacking. This study examined the long-term clinical and echocardiographic effects of prosthesis-patient mismatch in patients with and without left ventricular systolic dysfunction at the time of aortic valve replacement. METHODS: Preoperative and serial postoperative echocardiograms were performed in 805 adults who underwent aortic valve replacement between 1990 and 2003 and who were subsequently followed up in a dedicated valve clinic (follow-up, mean +/- SD, 5.5 +/- 3.5 years; maximum, 14.2 years). Preoperative left ventricular function was defined as normal (ejection fraction > or =50%) in 548 patients and impaired (ejection fraction <50%) in 257 patients. RESULTS: Patients with impaired preoperative left ventricular function and prosthesis-patient mismatch (indexed effective orifice area < or =0.85 cm2/m2) had a decreased overall late survival (hazard ratio, 2.8; P = .03), decreased freedom from heart failure symptoms or heart failure death (odds ratio of 5.1 at 3 years after aortic valve replacement; P = .009), and diminished left ventricular mass regression compared with patients with impaired preoperative left ventricular function and no prosthesis-patient mismatch. These effects of prosthesis-patient mismatch were not observed in patients with normal preoperative left ventricular function. CONCLUSIONS: Prosthesis-patient mismatch at an indexed effective orifice area of 0.85 cm2/m2 or less after aortic valve replacement primarily affects patients with impaired preoperative left ventricular function and results in decreased survival, lower freedom from heart failure, and incomplete left ventricular mass regression. Patients with impaired left ventricular function represent a critical population in whom prosthesis-patient mismatch should be avoided at the time of aortic valve replacement.

Aged↗
PubMed2005

Intraocular foreign body injuries during Operation Iraqi Freedom.

OBJECTIVE: To evaluate the number of intraocular foreign body (IOFB) injuries that occurred in Operation Iraqi Freedom, and to determine the cause of injury, the type of foreign body, and the associated injuries to other body systems. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Fifty-five United States military personnel with an IOFB injury during Operation Iraqi Freedom. INTERVENTION: Pars plana vitrectomy, foreign body removal, and additional surgical procedures as the clinical situation dictated. MAIN OUTCOME MEASURES: Cause of injury, size of corneal/scleral laceration, number of foreign bodies, type of foreign body, time to foreign body removal, visual acuity, number of enucleations, and injuries to other body systems. RESULTS: The foreign body was caused by a propelled explosive in 20 patients (36%) and a nonpropelled explosive in 31 patients (56%), and the cause of the foreign body was not known in 4 patients (7%). The size of the laceration of the cornea and/or sclera averaged 5.4 mm (range, 0.2-18). There were an average of 1.7 foreign bodies in the injured eye (range, 1-6). The size of those foreign bodies measured ranged from <1 mm to 12 x 14 mm. The most common type of foreign body was metal (68%), followed by glass (14%), stone/cement (14%), bone (5%), and cilia (3%). The time from injury to foreign body removal averaged 20.6 days (range, 0-90). No cases of endophthalmitis were seen. The most common associated injury was to the upper extremity, face, lower extremity, and neck. CONCLUSIONS: Unlike trauma in the civilian sector, IOFB injuries in a military setting tend to be caused by explosive devices, which often result in multiple foreign bodies and simultaneous injuries to other body systems. Because of the lack of availability of specialty care in the combat theater, there is often a delay in removal of the foreign body.

Adolescent↗
PubMed2005

Seizure freedom with different therapeutic regimens in intellectually disabled epileptic patients.

BACKGROUND: Epilepsy is a frequent condition in persons with intellectual disability and is more often difficult to treat than in the average population. Seizure freedom is the primary therapeutic goal which has important implications for the patient's quality of life. The aim of this study was to find out which antiepileptic therapy regimens (monotherapy or combination therapy) are effective in achieving this goal in intellectually disabled epilepsy patients. We were especially interested in the impact of the new antiepileptic drugs (AEDs) which were introduced during the past decade. METHOD: We investigated retrospectively the antiepileptic regimens on which the resident patients of a large epilepsy centre (as a rule with additional intellectual disabilities of different degrees) were seizure free in 2002. Information on antiepileptic medication and seizure frequency was taken out of the individual case documentation. It was also determined whether seizure free patients had already been seizure free in 1992. RESULTS: Two hundred and forty out of 675 patients (35,6%) with epilepsy were seizure free. The proportion of seizure freedom was 43,7% in patients with borderline intelligence, 39,2% in mild, 33,2% in moderate, 31,9% in severe, and 21,9% in profound intellectual disability. One hundred and twenty-two (50,8%) seizure free patients were on monotherapy; 53 of them were on CBZ (PB: 34, VPA: 25, PHT: 7, LTG: 3). Ninety-three patients (38,7%) were on duotherapies, CBZ/PB (27 patients), PB/PHT (17), and LTG/VPA (14) being the commonest. Of 18 (7,5%) triple therapies, LTG/PB/VPA (4 patients) was the commonest. Taken together, the five most frequent therapeutic regimens were CBZ monotherapy, PB monotherapy, CBZ/PB, VPA monotherapy and PB/PHT (a clear preponderance of classic AEDs). A distinction was made between "old seizure free" (seizure free already in 1992) and "new seizure free" (in 1992 still seizures) patients. In the 132 old seizure free patients the classic AEDs prevailed again, monotherapies with CBZ, PB and VPA being the most frequent regimens. In comparison, in the 78 new seizure free patients the novel combination LTG/VPA was the third most frequent, after the classic regimens CBZ/PB and CBZ; PB monotherapies were rare. CONCLUSION: In a majority of intellectually disabled patients with epilepsy (including those who became seizure free since 1992), complete seizure control has been achieved by monotherapy or duotherapy with classic AEDs. Of the new AEDs LTG in combination with VPA appears to be an important innovation.

Adolescent↗
PubMed2006

A miniaturization of the multi-degree-of-freedom ultrasonic actuator using a small cylinder fixed on a substrate.

Multi-degree-of-freedom ultrasonic actuator has been studied for robot arms and multidimensional precision table and so on because of its simple structure, silent operation, and holding force. In this study, we aim to miniaturize multi-degree-of-freedom ultrasonic actuator for fabrication on a substrate. This actuator consists of a stainless steel cylinder and a PZT ring. The cylinder is fixed on a substrate and the PZT ring is glued to the substrate near the cylinder. The 1st longitudinal vibration and the 2nd bending vibration are simultaneously excited in the cylinder to make elliptical motion at the top of the cylinder and a ball rotor placed on the cylinder rotates because of the friction force. Length of the cylinder was decided so as to tune the resonance frequency of the 1st longitudinal vibration to the 2nd bending one. Actuator performances are evaluated experimentally using a 14 mm height and 7 mm diameter stainless steel cylinder with a 0.5 mm thickness PZT ring. The rotation about the cylinder axis is tested using the two orthogonal bending vibrations with 90 degrees phase difference. Also, the rotation about horizontal axes were investigated using the combination of the longitudinal vibration and one of two bending vibrations. We measured the rotation speed of a steel ball and obtained 15.8 rps using a 6 mm diameter ball rotor.

Journal Article↗
PubMed1997

A kinematic-freedom analysis of a flexed-knee-stance testing rig.

The Oxford Rig was designed for biomechanical testing of post-mortem human knee-joint specimens during simulated flexed-knee stance, such as occurs when riding a bicycle, rising from a chair, or climbing stairs. It has been asserted, but never proven, that the movements of the 'ankle' and 'hip' assemblies of the Oxford Rig combine to allow a knee specimen its natural six degrees-of-freedom of movement (6 d.o.f.). This paper investigates this claim mathematically using the general mobility criterion for spatial linkages and the basics of screw theory. It is shown that within the physiological range of knee-joint movement and the physical construction of the Rig, the knee specimen is allowed full spatial freedom (6 d.o.f.). The general approach used in this paper could also be applied to the analysis and, in particular, to the design of other rigs used for biomechanical testing of post-mortem human joint specimens.

Algorithms↗
PubMed1997

Pedal and knee loads using a multi-degree-of-freedom pedal platform in cycling.

To provide a scientific basis for the design of bicycle pedals which possibly alleviate over-use knee injuries, two hypotheses were tested in the present study. The two hypotheses were: (1) that the three-dimensional pedal constraint loads; and (2) that the three-dimensional intersegmental knee loads would be reduced more significantly by a foot/pedal platform allowing both adduction/abduction and inversion/eversion rotations simultaneously than by a platform which allowed either rotation individually. To test these hypotheses, pedal load and lower limb kinematic data were collected from 10 subjects who pedaled with four pedal platforms which allowed zero, one, and two degrees of freedom. A number of quantities describing both pedal loads and intersegmental knee loads was computed for each of the four pedal platforms using a previously reported biomechanical model. The quantities included the positive and negative extremes, averages, and areas, as well as the total absolute area and RMS. Quantities were compared using analysis of variance techniques. The key results were that there were significant reductions in the coupled nondriving moments at the pedal for the dual-rotation platform compared to each of the single-rotation cases. The significant reductions in the coupled moments at the pedal were not manifest at the knee. However, a general nonsignificant reduction in both coupled knee moments was evident. Also, the valgus knee moment was significantly reduced by the dual-rotation platform compared to the inversion/eversion only design. Although the axial knee moment was not significantly reduced by the dual-rotation platform over the adduction/abduction design, there was a general nonsignificant reduction. The lack of significance in knee load results occurred because of high intersubject variability. Accordingly, load reduction benefits made by introducing the second degree of freedom need to be considered individually.

Adult↗
PubMed1999

Kinematics of the human ankle complex in passive flexion; a single degree of freedom system.

The restoration of original range and pattern of motion is the primary goal of joint replacement and ligament reconstruction. The objective of the present work is to investigate whether or not a preferred path of joint motion at the intact human ankle complex is exhibited during passive flexion. A rig was built to move the ankle complex through its range of flexion while applying only the minimum necessary load to drive ankle flexion. Joint motion was constrained only by the articular surfaces and the ligaments. The movements of the calcaneus, talus and fibula relative to the stationary tibia in seven cadaveric specimens were tracked with a stereophotogrammetric system. It was shown that the calcaneus follows a unique path of unresisted coupled motion relative to the tibia and that most of the motion occurred at the ankle, with little motion at the subtalar level. The calcaneofibular and the tibiocalcaneal ligaments showed near-isometric pattern of rotations. All specimens showed motion of the axis of rotation relative to the bones. Deviations from the unique path due to the application of load involved mostly subtalar motion and were resisted. The ankle complex exhibits one degree of unresisted freedom, the ankle behaving as a single degree of freedom mechanism and the subtalar as a flexible structure. We deduced that the calcaneofibular and tibiocalcaneal ligaments together with the articular surfaces guide ankle passive motion, other ligaments limit but do not guide motion.

Ankle Joint↗
PubMed1996

Induction androgen deprivation plus prostatectomy for stage T3 disease: failure to achieve prostate-specific antigen-based freedom from disease status in a phase II trial.

OBJECTIVES: There is interest in treating prostate cancer with induction androgen deprivation prior to radical prostatectomy. Data on long-term prostate-specific antigen (PSA)-based survival analyses among patients treated with neoadjuvant hormonal therapy (NHT) and prostatectomy are limited. In 1991 we instituted a pilot study for T3 disease based on endorectal coil magnetic resonance imaging (eMRI), mandatory negative laparoscopic nodal dissection prior to hormonal manipulation, and prostatectomy followed by pathologic and PSA-based outcome determinations. METHODS: Of 26 patients, 21 had negative laparoscopic lymphadenectomy followed by 4 months of NHT (leuprolide +/- flutamide) prior to radical prostatectomy. eMRI was performed at the time of diagnosis and following hormonal treatment. Serum PSA was determined at 3-month intervals. Prostatectomy specimens were evaluated by 3-mm whole-mount step sections. RESULTS: Prior to prostatectomy, biochemical response was documented in all patients and downsizing was observed by eMRI in 57%. Pathologic downstaging to a lower stage (T2c or lower) was achieved in 48%. However, the actuarial 3-year freedom from biochemical relapse rate was only 24%. CONCLUSIONS: Using laparoscopy to exclude node-positive patients and 4 months of NHT appears to result in pathologic and initial biochemical evidence of regression. These factors have not translated into improved freedom from biochemical relapse among patients with Stage T3 disease treated with NHT and prostatectomy. Recent data strongly suggest a beneficial effect in patients with clinical T2 disease treated with NHT and radical prostatectomy. The NGT and radical prostatectomy approach appeared to offer no clear advantage when compared with PSA-based benchmarks achieved with conformal irradiation or NHT followed by external beam treatment among patients with clinical T3 disease.

Aged↗
PubMed1997

Prostate-specific antigen nadir of 0.5 ng/mL or less defines disease freedom for surgically staged men irradiated for prostate cancer.

OBJECTIVES: This report describes treatment results of men with prostate cancer staged with a pelvic lymph node dissection. Disease freedom was defined by a prostate-specific antigen (PSA) level nadir of 0.5 ng/mL or less. METHODS: Since 1984, 363 men with clinical Stage T1 or T2, surgical stage node-negative prostate cancer were simultaneously irradiated with a retropubic iodine 125 prostate implant followed by external-beam radiation. The average pretreatment PSA level was 13.6 ng/mL (median 8.5, range 0.3 to 188). Disease freedom was defined as the achievement and maintenance of a nadir of 0.5 ng/mL or less. Treatment failure was defined as a nadir of more than 0.5 ng/mL or a PSA rise above this level. The median follow-up is 5 years (average 5.5, range 1 to 12.5). RESULTS: For all men, the 5- and 10-year disease-free survival results are 78% and 65%. Of 201 men with a minimum 5-year follow-up, 140 (70%) are disease free. The 5-year disease-free survival rate by pretreatment PSA is 4.0 ng/mL or less, 93%; 4.1 to 10.0 ng/mL, 87%; 10.1 to 20.0 ng/mL, 72%; and greater than 20.0 ng/mL, 45%. CONCLUSIONS: The 10-year disease-free survival results of retropubic implantation, a technique considered a failure by many investigators, followed by external-beam radiation appear to be better than either technique given separately and are comparable to the results following radical prostatectomy. These results are valuable because they form a baseline that may be improved upon in the future by simultaneous irradiation using the transperineal implant technique.

Disease-Free Survival↗
PubMed1999

Post-treatment PSA < or = 0.2 ng/mL defines disease freedom after radiotherapy for prostate cancer using modern techniques.

OBJECTIVES: The prostate-specific antigen (PSA) definition of disease freedom after radiotherapy for prostate cancer is still in dispute. This report focuses on the PSA nadir achieved in men treated by modern radiotherapy techniques. METHODS: From 1984 to 1994, 489 consecutive men with clinical Stage T1 -T2 prostate cancer were treated by simultaneous radiation: prostate iodine-125 implant followed by external beam radiation. A transperineal implant was performed on 143 men with Stage T1-T2NX, the focus of this study; 346 men with Stage T1-T2N0 had a retropubic implant. The median pretreatment PSA was 8.3 ng/mL (range 0.3 to 188). A rising PSA was defined as one that rose on three consecutive occasions above whatever nadir was achieved. A minimum 5-year follow-up (range 5 to 15) was reached by 453 men. RESULTS: After a minimum 5-year follow-up, 336 men had a nonrising PSA, and of this group, 107 had undergone simultaneous radiation by the transperineal implant technique. A PSA nadir of 0.2 ng/mL or less was achieved by 97% of the transperineally implanted men, and 3% had a nadir of 0.3 to 1.0 ng/mL. Of the 489 men, those who had a nadir of 0.2 ng/mL or less had a 92% nonrising PSA rate (P = 0.001) 10 years after treatment compared with a 41% rate for men who had a nadir of 0.3 to 1.0 ng/mL. All men whose nadir was greater than 1.0 ng/mL had recurrence. The median time to achieve the PSA nadir of 0.2 ng/mL was 27 months (range 3 to 102). CONCLUSIONS: Primarily on the basis of the results from men treated with simultaneous radiation using the transperineal technique, the definition of disease freedom for radiotherapy should be men who achieve and maintain a PSA nadir of 0.2 ng/mL or less.

Aged↗
PubMed2000

Coupling relations between molecular electronic and geometrical degrees of freedom in density functional theory and charge sensitivity analysis

The mapping concepts, reflecting the equilibrium, ground-state coupling between the electronic and geometrical degrees of freedom of both closed and open molecular systems are explored within density functional theory (DFT) and charge sensitivity analysis (CSA). After a brief overview of the principal derivatives and relations, including alternative Legendre transformed representations of molecular states, the explicit transformations are derived for the mapping between the nuclear coordinates Q, specifying the molecular geometry, and the 'electronic' coordinates represented by the electron density rho(r), in the local resolution, or the vector N = [N(alpha)] of the atomic electron populations, in the atoms-in-molecule (AIM) resolution. They fall into two categories: the electron following, transforming a given shift of the nuclear coordinates into the conjugate relaxation of the electronic 'coordinates' rho or N, and the electron preceding, 'translating' a specified displacement of these electronic degrees of freedom into the conjugate geometry relaxation. Algorithms for determining such transformations are discussed with a special emphasis placed upon the semiempirical CSA modeling in atomic resolution. Several additional mapping quantities are identified, which reflect the coupling between molecular electronic descriptors, e.g. the number of electrons or the chemical potential, and the relevant geometry-related quantities, e.g. Q or the forces acting on nuclei. Implications of the mapping concepts for chemistry are briefly examined and possible areas for their application are identified.

Journal Article↗
PubMedDate not supplied

Forward surgical team (FST) workload in a special operations environment: the 250th FST in Operation ENDURING FREEDOM.

PURPOSE: Forward Surgical Teams (FST) deploy to support conventional combat units of at least regimental size. This report examines the injuries and treatments of an FST in an environment of unconventional tactics, limited personal protection, and extended areas of responsibility during Operation ENDURING FREEDOM. METHODS: A prospective evaluation of the personal protective measures, mechanisms of injury, types of injuries, and times to treatment in Operation ENDURING FREEDOM. Additionally, per-surgeon caseloads, operative interventions, and outcomes are examined. The first phase of this deployment involved co-locating with an Air Force Expeditionary Medical Squadron at Seeb Air Base, Oman (SABO). The second phase involved stand-alone operations at Kandahar International Airport (KIA). Participants include U.S. Special Forces, conventional U.S forces, coalition country special forces, and anti-Taliban Afghan soldiers. RESULTS: During the deployment, the FST performed 68 surgical procedures on 50 patients (19 SAB, 31 KIA). There were 35 orthopedic cases (2 to 28 per surgeon), 30 general surgery cases (2 to 10 per surgeon), and 3 head/neck cases. Mechanism of injury included non-battle injury (13), bomb blast (13), gunshot wounds (8), mine (8), and grenades (5). Primary injuries were to the extremities in 27, torso in 9, and head/neck in 11. Three patients had appendicitis. Five patients were wearing body armor, whereas 4 wore helmets. The mean Relative Trauma Score was 7.4. Thirty-one patients were treated at KIA with a mean time to operative treatment of 2.7 +/- 2.7 hours, whereas 19 were treated in SABO with a mean time to operative treatment of 12.4 +/- 15.1 hours. Nine patients received transfusions. Three nonoperative patients died of wounds. CONCLUSION: Despite the lack of personal protective gear, most patients had extremity wounds as their primary injuries. In this special operations environment, time to operative treatment was significantly longer than expected.

Afghanistan↗