Articles Categorized: Case Studies

Diagnosis and management of acute promyelocytic leukemia in an active duty Air Force space operator

Abstract

A 38 year-old United States Air Force active duty male in excellent health presented to the flight medicine clinic with a two week history of shortness of breath, fatigue, and unexplained bruising. Initial laboratory analysis was significant for pancytopenia with evidence of immature cells suggestive of leukaemia. The patient was admitted to hospital for emergency workup. Bone marrow biopsy and molecular analysis confirmed the diagnosis of acute promyelocytic leukaemia (APL). Induction therapy consisting of all-trans retinoic acid (ATRA) plus arsenic was promptly initiated and complete remission achieved after 35 days of treatment. Acute promyelocytic leukaemia, an extremely aggressive subtype of acute myeloid leukaemia, was considered to be one of the most deadly forms of cancer prior to the introduction of effective ATRA- based therapy in the late 1990s. Drawing parallels with the aviation environments’ crew resource management (CRM), we discuss the importance of team work and collaboration in military medical resource management (MMRM). Because the military health care infrastructure in the United States is complex and relies heavily on civilian medical services, the implementation of MMRM is important to ensure good outcomes in cases that require rapid diagnosis and treatment such as APL.

By Benjamin Eovaldi , Harry Albaugh , John Hyman and Daniel Greenwald In   Issue Volume 22 No. 3 .

Post-exposure Prophylaxis for Hepatitis B Virus after Exposure to a Person-Borne Improvised Explosive Device

Abstract The case of a member of the Australian Defence Force exposed to a person-borne improvised explosive device is presented. Indications for post-exposure prophylaxis against  blood-borne viruses in this context are discussed, with specific focus on  the ‘non-response’ to prior hepatitis B vaccination of this individual. This case received post-exposure prophylaxis against hepatitis B only,… Read more »

By Csongor Oltvolgyi and Duncan Wallace In   Issue Volume 21 No. 2 .

Management of severe trauma in an austere environment with limited kit on Pacific partnership 2010 deployment

Abstract Management of trauma is a challenging process which can be made worse in the austere environment. Austere medicine is essentially the provision of medical care without access to modern investigations or technology. This case review will discuss the management of a 38 yr old female involved in a motor vehicle accident (MVA), car vs… Read more »

By Danny O'Neill In   Issue Volume 18 No. 4 .

Case report of a patient with high flow priapism serving in the Middle East

Abstract This report outlines the management of a soldier serving in the Middle East who suffered a perineal injury while on out of theatre leave. He presented to a medical officer when he returned to theatre. Fortunately a urologist was in theatre and the patient was moved forward for review at a United States Army… Read more »

By Rob Parkinson , Richard Stack , Melissa Fernance and Darrell Duncan In   Issue Volume 17 No. 3 .