Wilford Hall USAF Medical Center Research Articles

J. Marcus Downs, MD

Dr. J. Marcus Downs is a colon and rectal surgeon and program director of the Colon and Rectal Surgery Residency at the Parkland and Presbyterian Hospitals, Dallas, TX. Marcus was born in East St. Louis, IL, and received a bachelor of science in biology from the Washington University in St. Louis and a MD degree from the University of Missouri, Columbia. He did 3 years of General Surgery Residency training at the University of Missouri, Columbia, then completed his residency at Wilford Hall USAF Medical Center, San Antonio, TX. Marcus then completed a Colon and Rectal Residency at the Presbyterian and Parkland Hospitals, Dallas, TX. After finishing his training, he served as a deputy chair in the Department of Surgery, USAF Medical Center Scott, at Scott AFB, IL. In 1993, Dr. Downs left the USAF and joined the staff at the Texas Health Presbyterian Hospital in Dallas, TX. He has been a member of the teaching faculty since returning to Dallas and has been program director of the Residency Program in Colon and Rectal Surgery since 2007. Dr. Downs is an assistant clinical professor of surgery at the University of Texas Southwestern Medical School, Dallas, TX, and is board certified in General and Colon and Rectal Surgery. He teaches surgical residents and medical students on a daily basis and is an active participant in multiple surgical societies. He is the former president of the Texas Society of Colon and Rectal Surgeons. His contributions to the medical literature include two peer-reviewed publications and several presentations at regional and national meetings. In 1994, he and his associates formed Texas Colon and Rectal Surgeons had a single specialty group, which now includes 13 surgeons. Marcus, his wife Carol Lee, and children, Colleen (27 years old) and Brian (24 years old), live in Dallas, TX. When not working, Marcus enjoys swimming with Dallas Aquatic Masters, and playing polo with Dallas Water Polo Club. On behalf of the readers and staff of Clinics of Colon and Rectal Surgery, I sincerely thank Dr. Downs for serving as a guest editor and for providing us with a superb issue on fecal incontinence.

Introduction to Guest Editor

Dr. David E. Beck is Chairman of the Department of Colon and Rectal Surgery at the Ochsner Clinic, New Orleans, Louisiana. Dave was born in Geneva, Illinois. He received a BS degree as a distinguished graduate from the United States Air Force Academy and his MD from the University of Miami in Florida. He completed his general surgery residency at Wilford Hall USAF Medical Center at Lackland AFB, Texas. After spending a year as an Air Force general surgeon at a small base in Florida, he completed a fellowship in Colon and Rectal Surgery at the Cleveland Clinic. Dr. Beck then returned to Wilford Hall to serve as the Chief of Colon and Rectal Surgery and eventually as Chairman of the Department of General Surgery. During his Air Force career, he served as the Air Force Surgeon General's Consultant in Colon and Rectal Surgery and during the Gulf War served as Chief of Surgery at the 81 Contingency Hospital located at Little Rissington, United Kingdom. In 1993, he joined the colorectal staff at the Ochsner Clinic and in 1995 became Chairman of the Department of Colon and Rectal Surgery. In 2005, he was elected to the Board of Governors of the Ochsner Clinic. Dr. Beck maintains a busy clinic practice in New Orleans with an emphasis on inflammatory bowel disease, anal cancer, stomas, adhesions, bowel preparation, sphincter-saving surgery for cancer, and laparoscopic surgery. He also sees many patients with functional bowel disease. Dr. Beck educates medical students, residents, and colorectal surgery trainees on a daily basis and mentors trainees and junior faculty. He is a Professor of Surgery at the University of Queensland, Australia and is on the clinical faculty at the Louisiana State University and the Uniformed Services University Schools of Medicine. Dr. Beck assumed the duties of Editor in Chief of Clinics in Colon and Rectal Surgery in January 2000. He has previously served on the Editorial Board of Diseases of the Colon and Rectum and is also currently the Editor in Chief of The Ochsner Journal. Dr. Beck has been a guest editor of several previous issues of Clinics and is the author and editor of seven textbooks, including the first and second editions of the American Society of Colon and Rectal Surgery (ASCRS) Textbook of Colon and Rectal Surgery and the ASCRS Manual of Colon and Rectal Surgery, as well as the third edition of the Handbook of Colon and Rectal Surgery. He has published more than 100 book chapters and monographs and more than 150 peer-reviewed articles. Dr. Beck is the immediate past president of the ASCRS and serves on multiple committees of the ASCRS, and is a member of multiple medical associations. An active researcher, Dr. Beck received the ASCRS Outstanding Young Investigator's Award in 1992, and is a member of the board of trustees of the ASCRS Research Foundation. He is also listed in Best Doctors in America, Who's Who in America, and was selected as one of Good Housekeeping's Top 318 Cancer Doctors for Women. David Beck and his wife, Sharon, live in Madisonville, Louisiana. When not working, he enjoys fishing, gardening, and woodworking. On behalf of the readers of Clinics in Colon and Rectal Surgery, the editorial board thanks Dr. Beck for serving as Guest Editor and for providing an important issue on functional bowel disease.

David E. Beck, M.D.

Dr. David E. Beck is Chairman of the Department of Colon and Rectal Surgery at the Ochsner Clinic, New Orleans, Louisiana. Dave was born in Geneva, Illinois. He received a BS degree as a distinguished graduate from the United States Air Force Academy and his MD from the University of Miami in Florida. He completed his general surgery residency at Wilford Hall USAF Medical Center at Lackland AFB, Texas. After spending a year as an Air Force general surgeon at a small base in Florida, he completed a fellowship in Colon and Rectal Surgery at the Cleveland Clinic. Dr. Beck then returned to Wilford Hall to serve as the Chief of Colon and Rectal Surgery and eventually as Chairman of the Department of General Surgery. He has also served at the Air Force Surgeon General's consultant in Colon and Rectal Surgery and during the Gulf War was Chief of Surgery at the 81 Contingency Hospital located at Little Rissington, United Kingdom. After leaving active military service in 1993, he joined the colorectal staff at the Ochsner Clinic and in 1995 became chairman of the department in 1997. In 2005, he was elected to the Board of Governors of the Ochsner Clinic.

Academy of Operative Dentistry Hollenback Memorial Prize

John Burgess is distinguished as a leader in research and education in restorative dentistry techniques and materials. His contributions in those areas have been enormous. He is also a genuinely fine person who has generously dedicated much of his professional life to helping others become valuable teachers and researchers. He is a devoted husband, father and churchman.He is currently Professor and Assistant Dean for Clinical Research at the University of Alabama at Birmingham (UAB) School of Dentistry and Director of UAB's Biomaterials Graduate Program. He was Assistant Dean and Chairman of the Department of Operative Dentistry and Biomaterials at Louisiana State University School of Dentistry. His first civilian academic position was at the University of Texas Health Science Center Dental School, where he headed the Division of Biomaterials.Dr Burgess has contributed more than 400 papers, research abstracts and book chapters related to all aspects of restorative dentistry. He has presented hundreds of lectures and continuing education courses in this country and abroad. He has also lectured for several annual meetings of the Academy of Operative Dentistry. His impact on the quality of patient care worldwide cannot be measured but is undoubtedly extremely significant.A Fellow in the American College of Dentists, Dr Burgess is also a member in the International College of Dentists and the Academy of Dental Materials. He holds elected memberships in the American Academy of Restorative Dentistry and the American Academy of Esthetic Dentistry. He is a member of the Academy of Operative Dentistry, the American Dental Association, the American and International Associations for Dental Research, the American Dental Education Association and Omicron Kappa Upsilon.Dr Burgess is currently a member of the Council of Scientific Affairs of the American Dental Association; the Scientific Investigation Committee, Essay Committee and Clinic Committee of the American Academy of Restorative Dentistry; the Constitution Committee of the American Association for Dental Research and the Research Committee of the American Academy of Esthetic Dentistry. In the past, he has served many professional organizations in a variety of roles.He is a member of the editorial boards of the American Journal of Dentistry, Lasers in Surgery and Medicine and Inside Dentistry. Dr Burgess also serves as a manuscript reviewer for the Journal of the American Dental Association, the Journal of Dental Research, Dental Materials and General Dentistry.After receiving his DDS from Emory University in 1975, Dr Burgess joined the United States Air Force Dental Corps. He completed a one-year general practice residency in 1976. In 1982, he completed a two year general dentistry residency at Wilford Hall USAF Medical Center and received his MS degree in General Dentistry from the University of Texas Dental Branch in Houston. While in the Air Force, Dr Burgess served in several academic positions, including directorship of a general practice residency and Chief of Research and Dental Materials for the large general dentistry residency at Wilford Hall.John Burgess epitomizes the terms Gentleman and Scholar. His contributions to the profession are enormous. The Academy of Operative Dentistry is honored to name Dr John O Burgess winner of the 2011 Hollenback Memorial Prize.

David E. Beck, M.D.

Dr. David E. Beck is Chairman of the Department of Colon and Rectal Surgery at the Ochsner Clinic, New Orleans, Louisiana. Dave was born in Geneva, Illinois. He received a BS degree as a distinguished graduate from the United States Air Force Academy and his MD from the University of Miami in Florida. He completed his general surgery residency at Wilford Hall USAF Medical Center at Lackland AFB, Texas. After spending a year as an Air Force general surgeon at a small base in Florida, he completed a fellowship in Colon and Rectal Surgery at the Cleveland Clinic. Dr. Beck then returned to Wilford Hall to serve as the Chief of Colon and Rectal Surgery and eventually as Chairman of the Department of General Surgery. He has also served at the Air Force Surgeon General's consultant in Colon and Rectal Surgery and during the Gulf War was Chief of Surgery at the 81 Contingency Hospital located at Little Rissington, United Kingdom. After leaving active military service in 1993, he joined the colorectal staff at the Ochsner Clinic and in 1995 became chairman of the department in 1997. In 2005, he was elected to the Board of Governors of the Ochsner Clinic.

Pegylated interferon alfa 2B (PEG-IFN) and ribavirin for hepatitis C patients who were previous nonresponders to standard combination therapy: 24 week viral clearance: Eric J Lawitz, Brooke Army Medical Ctr, SanAntonio, TX; Mark A Jeffries, Wilford Hall USAF Medical Center, San Antonio, TX; Norma S Cantu, Shailesh C Kadakia, The Alamo Study Group, Brooke Army Medical Ctr, San Antonio, TX

Pegylated interferon alfa 2B (PEG-IFN) and ribavirin for hepatitis C patients who were previous nonresponders to standard combination therapy: 24 week viral clearance: Eric J Lawitz, Brooke Army Medical Ctr, SanAntonio, TX; Mark A Jeffries, Wilford Hall USAF Medical Center, San Antonio, TX; Norma S Cantu, Shailesh C Kadakia, The Alamo Study Group, Brooke Army Medical Ctr, San Antonio, TX

Richard E. Karulf, M.D.

Dr. Richard E. Karulf is an Adjunct Associate Professor of Surgery, University of Minnesota, Minneapolis, MN, and President and CEO of Colon and Rectal Associates, based in St. Paul, MN. Rick was born in Wichita, KS, and received his undergraduate degree from the United States Air Force Academy. After 2 years serving as a missile launch officer, he earned his medical degree from the University of Minnesota Medical School in Minneapolis. He completed a general surgery residency at Wright State University in Dayton, OH, and fellowship training in colon and rectal surgery at the Lahey Clinic in Burlington, MA. Following his fellowship, Dr. Karulf served in the Air Force at Wilford Hall USAF Medical Center, San Antonio, TX. He advanced to become Chairman and Program Director of the Department of General Surgery. He left the active duty USAF in 1997 and retired from the Air Force Reserve with the rank of colonel. Rick returned to Minnesota and joined the large colorectal surgery group in Minneapolis-St. Paul. He was elected to his first term as President and CEO of Colon and Rectal Surgery Associates in 2002. Dr. Karulf has authored or coauthored over 25 book chapters and peer review publications. He is a member of several medical societies and serves as the webmaster of the American Society of Colon and Rectal Surgeons. Dr. Karulf is an active researcher but still maintains a busy clinical practice in which the management of diverticular disease plays a major role. He also makes time to educate fellows, residents, and medical students. Rick, his wife Deb, and his son Erik, live in Eden Prairie, MN. When not working, Rick enjoys reading mysteries, playing golf, and spending time with his family. On behalf of the readers and staff of Clinics of Colon and Rectal Surgery, I thank Dr. Karulf for serving as a Guest Editor and for providing us with a superb issue on diverticular disease.

Case 65

HomeRadiologyVol. 228, No. 2 PreviousNext Diagnosis PleaseCase 65Justin Q. Ly, Timothy G. SandersJustin Q. Ly, Timothy G. SandersAuthor Affiliations1From the Department of Radiology and Nuclear Medicine, Wilford Hall USAF Medical Center, 759th MDTS/MTRD, 2200 Bergquist Dr, Suite 1, Lackland AFB, TX 78236-5300. Received January 14, 2002; revision requested March 6; revision received April 3; accepted May 23. Address correspondence to J.Q.L. (e-mail: [email protected]).Justin Q. LyTimothy G. SandersPublished Online:Aug 1 2003https://doi.org/10.1148/radiol.2282012158MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Article HistoryPublished in print: Aug 2003 FiguresReferencesRelatedDetailsRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 228, No. 2 Metrics Altmetric Score PDF download

Magnetic Resonance Evaluation of the Ankle With Persistent Pain or Instability Following Inversion Injury

Dr. Sanders is Assistant Clinical Professor of Radiology, The University of Texas, Health Science Center at San Antonio, Texas, and Chairman, Department of Radiology, Wilford Hall USAF Medical Center, 2200 Bergquist Drive, Suite 1, Lackland AFB, San Antonio, TX 78236; E-mail: [email protected]. The author has disclosed that he has no significant relationships with or financial interests in any commercial organizations pertaining to this educational activity.

Utility of daily head ultrasonography for infants on extracorporeal membrane oxygenation

Background/Purpose: Intracranial hemorrhage (ICH) is a major concern during extracorporeal membrane oxygenation (ECMO). Daily cranial ultrasonography has been used by many ECMO centers as a diagnostic tool for both detecting and following ICH while infants are on bypass. The purpose of this patient review was to look at the usefulness of performing daily cranial ultrasonography (HUS) in infants on ECMO in detecting intraventricular hemorrhage of a magnitude sufficient to alter patient treatment. Methods: The authors reviewed retrospectively all of the records of all neonates treated with ECMO at the Hermann Children's Hospital, Wilford Hall USAF Medical Center, Cincinnati Children's Hospital, The University of Texas Medical Branch at Galveston, and Texas Children's Hospital between February 1986 to March 1995. Two hundred ninety-eight patients were placed on ECMO during this period. All patients had HUS before, and daily while on ECMO, and all were reviewed by the staff radiologists. A total of 2,518 HUS examinations were performed. Results: Fifty-two of 298 patients (17.5%) had an intraventricular hemorrhage seen on ultrasound scan. Nine of 52 patients (17.3%) had an ICH seen on the initial HUS examination before ECMO, all of which were grade I, and 43 of 52 patients (82.7$) had ICH while on ECMO. Of these ICH, 15 were grade I, 10 were grade II, 10 were grade III, and eight were grade IV. Forty of these ICH (93%) were diagnosed by HUS during the first 5 days of the ECMO course. Seven hundred eighty-six HUS were performed after day 5, at an estimated cost of $300,000 to $450,000 (charges), demonstrating three new intraventricular hemorrhages, one grade I, and one grade IV on day 7 and one grade I on day 8. Eight patients were taken off ECMO because of ICH diagnosed within the first 5 days. One patient was taken off ECMO because of ICH diagnosed after 5 days. This patient had clinical symptoms suggestive of ICH. Conclusions: Almost all ICH occur during the first 5 days of an ECMO course. Unless there is a clinical suspicion, it is not cost effective to perform HUS after the fifth day on ECMO, because subsequent HUS examinations are unlikely to yield information significant enough to alter management.

False-positive magnetic resonance imaging of small internal auditory canal tumors: a clinical, radiologic, and pathologic correlation study.

Magnetic resonance imaging with gadolinium facilitates the early diagnosis of internal auditory canal tumors at a small enough stage to permit increasing application of hearing preservation surgical techniques. Surgeons report successful removal of tumors as small as 3 mm, which are diagnosed with enhanced magnetic resonance imaging. A retrospective study was performed to determine the risk of false-positive "tumor" diagnosis with enhanced magnetic resonance imaging. We reviewed the imaging records, office notes, and surgical records of 112 consecutive "tumors" involving the internal auditory canal treated by the Wilford Hall USAF Medical Center Neurotology Service between July 1991 and July 1994. Two categories of false-positive magnetic resonance imaging were identified: (1) surgically confirmed absence of internal auditory canal neoplasm and (2) spontaneous resolution of the internal auditory canal lesions on subsequent, enhanced magnetic resonance images. Overall, eight false-positive scans were identified. Three were surgically confirmed as false-positive, and five resolved on subsequent imaging studies. All cases were smaller than 6 mm and involved the distal internal auditory canal (fundus). The surgically confirmed cases were approached through a middle fossa technique with successful hearing preservation. The overall rate of surgical false-positive results was 3.5% (3 cases in 86 surgeries). However, the overall false-positive rate for intracanalicular "tumors" was 32% (8 cases in 25 intracanalicular lesions). Although hearing preservation is more likely in small lesions, the surgeon must consider the possibility that an internal auditory canal lesion smaller than 6 mm may actually represent a nonneoplastic process. Enhancing lesions limited to the internal auditory canal fundus may be treated by reimaging the patient in 6 months after the first image rather than by prompt surgical exploration.

False-positive magnetic resonance imaging of small internal auditory canal tumors: A clinical, radiologic, and pathologic correlation study

Magnetic resonance imaging with gadolinium facilitates the early diagnosis of internal auditory canal tumors at a small enough stage to permit increasing application of hearing preservation surgical techniques. Surgeons report successful removal of tumors as small as 3 mm, which are diagnosed with enhanced magnetic resonance imaging. A retrospective study was performed to determine the risk of false-positive "tumor" diagnosis with enhanced magnetic resonance imaging. We reviewed the imaging records, office notes, and surgical records of 112 consecutive "tumors" involving the internal auditory canal treated by the Wilford Hall USAF Medical Center Neurotology Service between July 1991 and July 1994. Two categories of false-positive magnetic resonance imaging were identified: (1) surgically confirmed absence of internal auditory canal neoplasm and (2) spontaneous resolution of the internal auditory canal lesions on subsequent, enhanced magnetic resonance images. Overall, eight false-positive scans were identified. Three were surgically confirmed as false-positive, and five resolved on subsequent imaging studies. All cases were smaller than 6 mm and involved the distal internal auditory canal (fundus). The surgically confirmed cases were approached through a middle fossa technique with successful hearing preservation. The overall rate of surgical false-positive results was 3.5% (3 cases in 86 surgeries). However, the overall false-positive rate for intracanalicular "tumors" was 32% (8 cases in 25 intracanalicular lesions). Although hearing preservation is more likely in small lesions, the surgeon must consider the possibility that an internal auditory canal lesion smaller than 6 mm may actually represent a nonneoplastic process. Enhancing lesions limited to the internal auditory canal fundus may be treated by reimaging the patient in 6 months after the first image rather than by prompt surgical exploration. (OTOLARYNGOL HEAD NECK SURG 1995;113:61-70.)

Flow cytometric analysis of primary and metastatic squamous cell carcinoma of the oral cavity and oropharynx.

A retrospective analysis of formalin-fixed, paraffin-embedded tissue from patients with histologically confirmed metastatic squamous cell carcinoma was performed using flow cytometry. Ninety-eight sets of specimens from previously untreated patients with an oral cavity or oropharyngeal tumor and a simultaneous cervical metastatic deposit were analyzed. Normal mucosa and cervical lymph nodes were processed identically and run as controls. All patients underwent surgical resection at Wilford Hall USAF Medical Center or The Eye and Ear Hospital of Pittsburgh between 1980 and 1986. The specimens from 94 patients were technically adequate for interpretation. Diploid histograms in both the primary and metastatic tumors were present in 49 (52%) of 94 patients. Aneuploid histograms in either the primary and metastatic tumors were noted in 45 (47%) of 94 patients. In this group of 45 patients, the primary tumor and cervical metastasis were both aneuploid in 21 (46%), and aneuploid histograms occurred with equal incidence in either the primary or metastasis in the remaining 24 cases. No statistically significant prediction of survival could be made from any correlation with the histograms of either the primary or metastasis. The potential technical problems and limitations of flow cytometry in the determination of DNA content of formalin-fixed, paraffin-embedded tissue and the selection of patients with advanced disease warrant caution in the interpretation of results.

Combination therapy for epidermoid carcinoma of the anal canal

This study was designed to assess results of chemoradiation therapy for epidermoid carcinoma of the anal canal. A retrospective review of records of the prospective database revealed 35 patients who had been diagnosed with anal canal carcinoma and treated with chemoradiotherapy at Wilford Hall USAF Medical Center (tertiary referral hospital) from 1981 to 1991. Patients ranged in age from 35 to 80 (mean, 59) years, and 63 percent were women. Primary tumors ranged from 1 to 8 cm in diameter (mean, 3 cm). The first six patients had an abdominoperineal resection (APR) after chemoradiotherapy, and no residual tumor was identified in the specimens. In the subsequent 29 patients who did not have APR, 5 had moderate problems with anal continence, and one required a diverting colostomy for incontinence. Follow-up ranged from 4 months to 12.9 years (mean, 5.2 years). There were two pelvic recurrences, and three patients developed distal metastasis. Eight patients died during follow-up, including three with recurrent or persistent disease. Five-year survival using life-table analysis was 89 percent. Long-term follow-up confirms that chemoradiation remains the preferred therapy for epidermoid carcinoma of the anal canal.

Clinical Use of Androgenic Steroids at a Major Medical Center: Who Prescribes Androgens and How Well Do They Do It?

To assess prescribing practices for androgens at Wilford Hall USAF Medical Center, the authors analyzed prescriptions for all patients receiving therapy during a 12-month period (n = 201) and reviewed the available outpatient records not maintained elsewhere (n = 105). The most commonly prescribed androgens were testosterone enanthate (144/201; 56.7%), and danazol (52/201; 25.9%). Review of the available outpatient medical records of 73 male patients using testosterone enanthate showed a mean age of 59.5 years, mean frequency of injection of 20 days, mean duration of therapy of 3.5 years, and mean dose of 226 mg. Therapy was initiated by a urologist (34/73; 46.6%), an endocrinologist (33/73; 45.2%), or an internist (6.73; 8.2%). Indications for therapy based on pretreatment laboratory and historical data included hypergonadotropic hypogonadism (24/73; 32.9%), hypogonadotropic hypogonadism (23/73; 31.5%), unspecified hypogonadism (7/73; 9.6%), and empiric treatment of elderly men with erectile dysfunction without evidence of hypogonadism (9/73; 26%). Pretreatment prostate examinations as well as measurement of serum testosterone (66/73; 90.4%) and serum gonadotropins (52/73; 71.2%) were often not performed. The authors conclude that records of patients treated with androgens show: 1) Doses are appropriate; 2) Empiric treatment of erectile dysfunction in elderly men is common despite the associated risks; 3) Laboratory and physical evaluation before treatment is often incomplete; 4) There was no evidence of androgenic substance abuse in patients studied.

Effect of Maternal Race on Outcome of Preterm Infants in the Military

Previous studies suggest that low birth weight black infants have less morbidity and birth-weight-specific mortality during the perinatal period than low birth weight white infants. We studied the effect of maternal race on outcome in preterm infants born at a military hospital that offers free access to obstetric and neonatal care. Between January 1, 1986, and December 31, 1991, data were prospectively collected on all 667 infants delivered at Wilford Hall USAF Medical Center with an estimated gestational age of less than 35 weeks. Three hundred ninety-two white infants and 165 black infants were included in the data analysis. The mean (+/- SD) birth weight was 1701 +/- 65 g for white infants and 1462 +/- 66 g for black infants. The mean estimated gestational age was 31.0 +/- 3.2 weeks for white infants and 29.9 +/- 3.8 weeks for black infants. Preeclampsia was more frequent in black mothers than in white mothers for the entire study population (21% vs 14%), but the birth weight differential between races remained after correction for preeclampsia. There were no significant differences between races in stillbirths, gender, maternal age, maternal transfer status, number of prenatal visits, or percentages of mothers with small-for-gestational-age infants, multiple-gestation infants, prolonged rupture of membranes, or initial prenatal visit during the first trimester. Intraventricular hemorrhage was more frequent in white infants at 27 through 29 weeks estimated gestational age (50% vs 13%). There were no significant differences between the two groups in survival or in the occurrence of severe intraventricular hemorrhage or bronchopulmonary dysplasia.(ABSTRACT TRUNCATED AT 250 WORDS)

Strategies of antibody characterization: [formula omitted], EM Menchaca, WW Ward, TM Freeman, Transplant Immunology Section, Immunology Branch, Departments of Pathology and Medicine, Wilford Hall USAF Medical Center, Lackland AFB, TX

Strategies of antibody characterization: [formula omitted], EM Menchaca, WW Ward, TM Freeman, Transplant Immunology Section, Immunology Branch, Departments of Pathology and Medicine, Wilford Hall USAF Medical Center, Lackland AFB, TX

Significance of a B-cell crossmatch over a six-antigen match: [formula omitted], RA Gomez, WW Ward, TM Freeman, Transplant Immunology Section, Immunology Branch, Departments of Pathology and Medicine, Wilford Hall USAF Medical Center, Lackland AFB, TX

Significance of a B-cell crossmatch over a six-antigen match: [formula omitted], RA Gomez, WW Ward, TM Freeman, Transplant Immunology Section, Immunology Branch, Departments of Pathology and Medicine, Wilford Hall USAF Medical Center, Lackland AFB, TX

Safe Storage Times for Sterile Instrument Packs

Military health care facilities are required to place expiration dates on sterile instrument packs. There are few scientific guidelines for determining these dates. This article reports the findings of two studies conducted at Wilford Hall USAF Medical Center, which investigated the potential shelf-life of three packaging materials for sterile instruments. The results of the studies indicate that sterility is maintained for at least 1 year with all three materials. The maximum storage times allowed for sterile instruments at most military facilities appear to be overly restrictive.

Frequency of chronic lung disease in infants with severe respiratory failure treated with high-frequency ventilation and/or extracorporeal membrane oxygenation.

To assess the frequency of chronic lung disease and factors associated with its development in term infants with severe respiratory failure who receive high-frequency oscillatory ventilation, or high-frequency oscillatory ventilation, and extracorporeal membrane oxygenation (ECMO). Retrospective review of pulmonary outcome of all ECMO candidates admitted to Wilford Hall USAF Medical Center between July 1985 and September 1989. A tertiary, level III, neonatal ICU accepting regional referrals for high-frequency ventilation and ECMO. Ninety-four patients who were candidates for ECMO were studied. High-frequency oscillatory ventilation alone was used in 48 infants. Forty-six infants were treated with high-frequency oscillatory ventilation and ECMO. Twenty (24%) of 84 survivors developed chronic lung disease. There were no differences in gestational age, birth weight, or gender between those infants who developed chronic lung disease and those infants who did not. Arterial blood gas and ventilatory settings at initiation of high-frequency oscillatory ventilation were similar between those infants who did and those who did not develop chronic disease. Patients who developed chronic lung disease more often had lung hypoplasia (40% vs. 5%) and more often required ECMO (75% vs. 39%) than those patients who did not. In patients without lung hypoplasia, those patients who developed chronic lung disease were older at initiation of high-frequency oscillatory ventilation rescue than those patients who did not develop chronic lung disease (median 91 vs. 46 hrs). The frequency of chronic lung disease in ECMO candidates is clinically important. Factors associated with chronic lung disease in ECMO candidates are: the presence of lung hypoplasia, delayed referral, and the need for ECMO to support gas exchange.