Emergency medicine in the Persian Gulf War--Part 3: Battlefield casualties.

STUDY OBJECTIVE: To report the type and frequency of battlefield casualties and the procedures performed to treat them. STUDY DESIGN: A prospective analysis of trauma record data incorporating anatomic categories and the Revised Trauma Score. SETTING: Two military field trauma centers during the primary ground assault into Kuwait. TYPE OF PARTICIPANTS: Four hundred two trauma admissions of coalition and enemy forces. MAIN RESULTS: Forty-eight percent of casualties suffered fragmentation wounds, including 43 land mine injuries. Only 10% sustained gunshot wounds. Forty-four percent of casualties had injuries limited to the extremities; 29% had combined extremity injury and injury to another anatomic region. Extremity wounds occurred nearly twice as frequently in the lower extremities as in the upper extremities. Surgical procedures were undertaken in 164 patients, with 108 debridements for major soft tissue injuries or open fractures. CONCLUSION: The composite casualty admitted to US Navy-Marine trauma facilities was injured by shrapnel in the lower extremity and required surgical debridement only. Soldiers with land mine injuries, as in other wars, were among those in greatest need of emergency resuscitation.

Autosomal dominant tetramelic postaxial oligodactyly.

Postaxial limb deficiencies are most frequently unilateral and sporadic with deficiencies of the ulnar ray about one-third as common as those affecting the radial ray. Postaxial deficiency occurs in a number of genetic and sporadic syndromes, but isolated inherited tetramelic, postaxial oligodactyly has to our knowledge not been described. We report an affected mother and her 3 affected children from a 4-generation family with apparent autosomal dominant, non-syndromic, tetramelic, postaxial oligodactyly. The affected individuals manifest a very uniform pattern of postaxial deficiency ranging from complete absence of the 5th metacarpals, metatarsals, and phalanges to complete absence of the 5th metacarpals and metatarsals, but with some residual distal 5th phalanges. Limb buds may be considered a single developmental field with development proceeding rostral to caudal. Digit formation is apparently controlled by the zone of polarizing activity which releases a diffusible morphogen specifying positional information along the anterior/posterior axis. Recent investigations using chick and mouse embryo models suggest that 5' members of the Hox-4 gene cluster are responsible for interpreting this positional information to effect digit formation. The present family may represent a defect in Hox-4 gene patterning of hand and foot formation, an abnormality in morphogen gradient formation or alternately an inability of the most ulnar rays to respond to morphogen (receptor defect).

Cat scratch disease associated with neuroretinitis in a 6-year-old girl.

Cat scratch disease is a subacute regional lymphadenitis usually preceded by a history of being scratched by a cat or young kitten. The spectrum of illness ranges from mild self-limited adenopathy to severe systemic disease, including hepatosplenomegaly, encephalopathy, osteolytic lesions, splenic abscesses, mediastinal masses, and neuroretinitis. Vision loss is a rare complication of the disease. The authors report a patient with cat scratch disease associated with acute febrile illness, lymphocytic meningitis, and acute vision loss secondary to neuroretinitis. To their knowledge, this is the first ophthalmic case reported in which the diagnosis is supported by both a positive skin test and positive histopathology.