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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A case is presented of exertional heat stroke in a military setting with numerous complications that have been previously described. In addition, the complication of late rhabdomyolysis with profound elevation of creatine phosphokinase (CPK) is here described for the first time. This rare condition responded to systemic steroids on this occasion. Late elevation of CPK is a rare complication of exertional heat stroke that appears to respond to systemic steroids.
Mil Med 1992 Feb
PMID:A complicated case of exertional heat stroke in a military setting with persistent elevation of creatine phosphokinase. 147 Mar 63

Heat stroke is a medical emergency characterized by sudden loss of consciousness and by failure of the heat-regulating mechanism, as manifested by high fever (usually above 104 degrees F) and cessation of sweating. Fatality rates for patients with heat stroke can vary from 0% to more than 40%. Immediately after heat stroke has occurred or is suspected, aggressive cooling measures should be initiated. This case illustrates a 24-year-old commissioned officer who developed heat stroke while running in PT formation dressed with shorts and a T-shirt. Although this patient was in good shape and the wet bulb was only 74.4 degrees F, he developed the classic symptoms of heat stroke, with a core temperature of 105.9 degrees F. He further developed hepatic and skeletal muscle enzyme abnormalities (SGOT, 4680; CPK, 327; LDH, 821) with hyposphosphatemia (0.8). This patient had no significant risk factors, and after the appropriate treatment, his enzyme abnormalities returned to normal without sequelae. This paper will discuss symptoms, predisposing factors, complications, treatment, and prevention of heat stroke--a topic that is important to all military physicians, especially to those deployed to hot, humid environments.
Mil Med 1990 Mar
PMID:Exertion-induced heat stroke in a military setting. 210 65

This study compares the heart sizes and left ventricular masses of soldiers (n = 11) with age- and body size-matched groups of sedentary men (n = 10) and accomplished athletes (n = 11). Echocardiography revealed that active duty soldiers (A) who met minimal fitness standards and pentathletes (P) had greater average left ventricular (LV) end-diastolic volumes (A = 10%, NS; P = 28%, p less than 0.05), stroke volumes (A = 29%, NS; P = 44%, p less than 0.01), and LV masses (A = 22%, NS; P = 76%, p less than 0.01) than sedentary subjects. Athletes had an average LV wall thickness which was 23% (p less than 0.05) greater than that of soldiers and 32% (p less than 0.01) greater than that of sedentary men. The LV wall thickness to radius ratio (h/r) was similar between soldiers and sedentary men, but in athletes the h/r was greater (p less than 0.01) than in the less conditioned subjects. These data suggest that soldiers who meet minimal standards of fitness exhibit cardiac morphometric features consistent with endurance conditioning. However, the soldiers studied were significantly less (p less than 0.001) conditioned than the competitive athletes. These data suggest that improvements in aerobic and cardiac conditioning could be achieved through a greater emphasis on physical training.
Mil Med 1989 Mar
PMID:Heart size and function of soldiers, athletes, and sedentary men. 249 44

In order to find out whether the sympatho-adrenal system is activated in relation to heat stroke, plasma levels of norepinephrine (NE) and epinephrine (E) were measured using high pressure liquid chromatography in seven patients with heat stroke. The mean NE +/- SD levels on admission and six hours afterwards were 1397 +/- 317 and 717 +/- 239 pg/ml, respectively. The corresponding values for E were 257 +/- 55 and 32 +/- 15 pg/ml. The levels of both NE and E on admission were considerably higher than those of the controls: 328 +/- 62 and 88 +/- 16 pg/ml (12 normal subjects). This increase in both NE and E indicates activation of the sympatho-adrenal system in patients with heat stroke. The alpha-mediated effect of catecholamines may be important in impairing heat dissipation and thus may contribute to the pathogenesis of heat stroke.
Mil Med 1989 May
PMID:Catecholamines in heat stroke. 249 43

The concept of pharmacological intervention for recovery from brain injury is by no means new. However, most rehabilitation physicians still do not incorporate it into their practice. Over the past several years, scientific evidence has begun to reveal that certain medications can limit the extent of cerebral damage and others have the capacity to influence neurological recovery. Rehabilitation medicine emerged in the military out of a desperate need to rehabilitate injured soldiers as quickly and efficiently as possible. Although casualties are much less common in today's post-Cold War military, the need for expeditious neurorehabilitation still remains because of the growing military retired population. In keeping with this view, this paper begins by reviewing the neurobiological basis of spontaneous recovery after cerebral injury. It continues with a discussion about the pharmacological basis of motor recovery after stroke, and concludes by presenting some clinical guidelines useful in helping to expedite as well as maximize neurological recovery.
Mil Med 1995 May
PMID:Neuropharmacological therapy and motor recovery after stroke. 765 9

The most serious complication of sickle cell trait (SCT) is sudden death during exertion. SCT often remains unrecognized in the 2.5 million African Americans affected. Exertional collapse and sudden death associated with SCT is characterized by rhabdomyolysis, heat stroke, and cardiac arrhythmia. There is a 40-fold increased risk of sudden death in affected soldiers during military basic training and there are many cases reported in athletes during preseason training. There have been no cases reported in soldiers beyond basic training. In the case presented, a soldier with 3 years of military service succumbed to SCT-associated sudden death during physical fitness testing.
Mil Med 1996 Dec
PMID:Exertional collapse and sudden death associated with sickle cell trait. 912 56

Guidelines for preventing heat injury (HI) among military personnel are not directly applicable to civilian personnel. Military guidelines call for relatively large volumes of prophylactic water consumption and physical activity limitations depending on the wet bulb globe temperature. However, in civilian populations, there is an increased prevalence of HI risk factors: older age, medication use, especially anticholinergic and psychotropic medications, obesity, previous HI, and skin disorders. Although dehydration is a major contributor to HI in military situations, it is unlikely in classical heat stroke among civilians. Civilian guidelines are based on the heat index. Activity levels must be restricted more for civilians, and prophylactic water consumption (beyond replacing loss from sweat) is not necessary. This review discusses the pathophysiology of heat injury, contrasts the military and civilian approach to prevention of HI, and describes appropriate field intervention for HI.
Mil Med 1997 Jan
PMID:Preventing heat injury: military versus civilian perspective. 900 5

The purpose of the present study was to delineate a health profile of professional Danish army personnel. Two-hundred twenty officers, noncommissioned officers, and gunners on active duty at Varde Barracks, housing the South Jutland Artillery Regiment and the Danish Army Artillery School, were asked about their physical and psychological health, interpersonal relations, and working conditions as well as their dietary, drinking, and smoking habits. Measurements were made of resting pulse rate, blood pressure, height, weight, waist and hip girth, and pulmonary function. The ratio of waist-to-hip girth and body mass index (BMI) were calculated. Psychological well-being was evaluated using the 12-item version of the General Health Questionnaire (GHQ). Psychosomatic symptoms were frequently reported, but very few of those surveyed appeared to have psychiatric disorders as measured by the GHQ. Also, somatic health problems were frequently reported, the most frequent being lower-back pain, mild chest pain, and sensory disorders. Differences in interpretation and reporting of "lasting health problems" may explain the relatively high score for this question. The interpersonal relations, both upward and downward in the hierarchy rank order, received high scores. Compared with the general population, alcohol consumption was very low, whereas smoking-in particular heavy smoking-was much more frequent among professional Danish army personnel. Lung function testing showed significantly poorer mean values of forced expiratory volume in 1st second of expiration and mean forced expiratory flow 25 to 75% of forced vital capacity among smokers compared with nonsmokers, although the mean values for the whole group of both smokers and nonsmokers were well above reference values for all lung function parameters. The frequency of moderately overweight individuals (25 < BMI < or = 30) was significantly higher among the male army personnel than in the general population, whereas this was not the case for obesity (BMI > 30). Abdominal obesity, regarded as an independent risk factor for the development of ischemic heart disease, stroke, diabetes, hypertension, and all-cause mortality, was present in 5%, and 3% belonged to the highest-risk group by having a low BMI as well as abdominal obesity.
Mil Med 1997 Jun
PMID:Health profile of Danish army personnel. 918 68

The health of women who participated in Operations Desert Shield/Storm was evaluated to better understand the medical requirements of deployed military women and women veterans of the Persian Gulf War. Women's health care needs during the Persian Gulf War were reported to be very similar to those of men, with the exception of gynecologic problems, which generally were not serious and did not require hospitalization. However, insufficient data were obtained to identify specific health care needs among deployed women troops. During the 5 years since the end of the Persian Gulf War, no unique health problems have been identified among women veterans. Whether there will be any exceptional long-term health care requirements currently is unknown. Nevertheless, important medical problems of all women-reproductive issues, menopause, osteoporosis, joint disease, breast cancer, heart disease, and stroke-inevitably will be major considerations when caring for this population of war veterans.
Mil Med 1997 Oct
PMID:Women in the Persian Gulf War: health care implications for active duty troops and veterans. 933 76

The purpose of this paper is to report the demographic characteristics, injury and illness profiles, and dispositions of patients seen at the 249th General Hospital during its month-long deployment in support of Operation Cooperative Nugget '95 at the Joint Readiness Training Center (JRTC), Fort Polk, Louisiana. A descriptive analysis of patient demographic, diagnostic, and disposition data was performed. A total of 769 patient contacts were made, with orthopedic injuries (31%), dermatologic disorders (17%), upper respiratory infections (6%), and heat injuries (5%) accounting for the majority of visits. Because of aggressive preventive medicine interventions, there were no cases of heat stroke despite daily heat indices of 110 to 120 degrees F. In addition to emphasizing the importance of anticipating environmental medical threats, the authors relate some lessons learned, which should be valuable to medical providers tasked for future multinational operations other than war at the JRTC and elsewhere.
Mil Med 1997 Nov
PMID:Medical support for Operation Cooperative Nugget '95: joint readiness training in the post-cold war era. 935 16


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