Operation shadow warrior: a quantitative analysis of the ultraviolet radiation protection demonstrated by various headgear.

In the last 10 years, the scientific community and the media have highlighted the depletion of atmospheric ozone and the subsequent increase in ultraviolet radiation (UVR) that penetrates to the earth's surface. This UVR is associated with problems such as sunburn, photoaging, cataracts, and skin cancer. In the United States, skin cancer is among the top three reported cancers, and its incidence is increasing rapidly. Physicians agree that human exposure to UVR should be controlled by protecting the skin or limiting its exposure to UVR. As military physicians, our mission is to protect the fighting force and educate the command on the best possible course of action to accomplish this mission. In this paper, I quantitatively demonstrate that wearing the inventoried sun, woodland, type III cover is a far superior course of action when a commander desires a UVR counter measure for the fighting force.

Azithromycin eruption in infectious mononucleosis: a proposed mechanism of interaction.

The penicillin family of antibiotics may induce drug eruptions when prescribed to patients with infectious mononucleosis. Very similar phenomena have also been cited with other antibiotic families. We report the first case of a cutaneous reaction in a patient with infectious mononucleosis treated with azithromycin. We propose an immune-based hypothesis to explain the transient sensitivity resulting in this secondary cutaneous eruption.

Effort-related chronic compartment syndrome of the lower extremity.

Effort-related chronic compartment syndrome (ERCCS) of the lower extremity is often misdiagnosed, requiring repeated visits to the physician and subsequent delay in definitive treatment. The most significant causes of chronic leg pain in physically active individuals are stress fractures, shin splints, and "exercise-induced" or effort-related chronic compartment syndrome. In patients susceptible to ERCCS, the fascial compartments are too small to accommodate the associated 20% increase in muscle mass that typically occurs with heavy exercise. The increased pressure within a small unyielding compartment limits circulation and subsequent muscle function. The only appropriate conservative treatment is cessation of the offending activity. Early suspicion of the condition is paramount, because the definitive treatment is fasciotomy. ERCCS has only recently been recognized, and therefore it may be underdiagnosed. Family physicians and general medical officers caring for otherwise healthy soldiers and athletes should be aware of ERCCS so that prompt orthopedic referral for evaluation and definitive treatment will not be delayed.

Esophagitis dissecans superficialis associated with pemphigus vulgaris.

The extension of bullous lesions in pemphigus to the esophagus is relatively uncommon, especially in patients who appear to be in clinical remission. Very rarely, pemphigus vulgaris may affect the entire esophagus, resulting in complete sloughing of the mucous membrane. A 20-year-old man with pemphigus vulgaris presented to the emergency room with acute onset of dysphagia, odynophagia, and hemoptysis. There were no cutaneous or oral findings of pemphigus on presentation, since he was being maintained on corticosteroids and azathioprine with excellent results. During initial evaluation in the emergency room, the patient was observed to vomit a cast of the mucosal lining of the esophagus. The morphologic description of such an esophageal cast is termed esophagitis dissecans superficialis. This is the third case of esophagitis dissecans superficialis in pemphigus vulgaris recorded in the medical literature.

Pityriasis amiantacea.

Pityriasis amiantacea is an easily recognizable cutaneous disease that is characterized by scaling of the scalp and temporary alopecia. The scaling, described as thick and asbestos-like, binds down tufts of hair. The alopecia may be temporary or scarring. Despite a well-established clinical description, no definitive etiology has been uncovered. This disease may represent seborrheic dermatitis, superficial fungal or pyogenic infections, lichen planus, or psoriasis. Histologically, the disease is characterized by eczematous features. We report a case of pityriasis amiantacea in an 11-year-old girl with simultaneous findings of psoriasis as well as review the literature on the etiology of this disease.

Road rash with a rotten odor.

As military physicians, our mission is to support the fighting force and keep our soldiers mission capable. One group of disorders that can quickly cripple a fighting force is disorders of the foot. A complete survey of dematologic conditions of the foot is quite extensive, but only one comes with its own distinctive odor. This foul rash is pitted keratolysis.

Elephantiasis nostras verrucosa.

Elephantiasis nostras verrucosa is a rare, chronic, deforming disorder characterized by hyperkeratosis and papillomatosis of the epidermis with underlying woody fibrosis of the dermis and subcutaneous tissue. Chronic lymphedema, either congenital or secondary to infection, surgery, radiation, neoplastic obstruction, obesity, portal hypertension, or chronic congestive heart failure, plays a pivotal role in the pathogenesis. Without appropriate intervention, the slowly progressive cutaneous changes will culminate in massive and grotesque enlargement of the affected body region. In the following case report, the natural history and the management of elephantiasis nostras are discussed.

Cold weather injuries in an arctic environment.

The cases of eight Special Forces soldiers who sustained cold weather-related injuries while conducting winter training as part of Operation Arctic Saber in the Northwest Territories and Arctic Circle are reported. Environmentally related injuries can represent difficult diagnostic and treatment challenges in the field. Moreover, they may compromise the overall mission if they are not identified and treated early. Cold weather injuries can also result in long-term disfigurement and disability that may limit a soldier's future worldwide deployability. Mission requirements, equipment utilization, and environmental exposure place soldiers at particular risk for cold weather-related injuries in such austere settings. Nonetheless, with appropriate education and safety precautions, these potentially life-threatening risks can be greatly minimized.

Topical 5-fluorouracil treatment for psoriatic trachyonychia.

Psoriatic nail involvement is common and usually accompanies other associated cutaneous or systemic lesions. The occurrence of psoriatic nail involvement has been noted in up to 50 percent of patients. There is no consistently effective therapy for psoriatic nail involvement. We report a beneficial response following a short course of topically applied 5 percent 5-fluorouracil cream.

Lichen planus associated with hepatitis C.

The cause of lichen planus is unknown. Oral erosive lichen planus has been reported in association with liver disease. We describe a patient with chronic hepatitis C acquired through a blood transfusion with subsequent development of widespread hypertrophic lichen planus.

Achilles tendon nodule: inflammation, rupture, or tumor?

When an active patient has a mass on the Achilles tendon, fibroma of the tendon sheath should be in the differential diagnosis along with other tumors and benign conditions like inflammation or rupture. A case report demonstrates how the clinical characteristics of fibromas resemble other common tendon tumors, such as giant cell tumor of the tendon sheath. A histologic exam is needed to distinguish a fibroma of the tendon sheath from other tumors. Plain films should be considered to rule out bony involvement. Surgical excision is required. Patients should know that fibromas recur in 25% of those who have them removed.

Tumor-elicited polymorphonuclear cells, in contrast to "normal" circulating polymorphonuclear cells, stimulate invasive and metastatic potentials of rat mammary adenocarcinoma cells.

Circulating polymorphonuclear cell (PMN) levels rise in proportion to the metastatic potential of the tumor in 13762NF mammary adenocarcinoma tumor-bearing rats. These tumor-elicited PMNs (tcPMNs) secrete high levels of the basement-membrane-degrading enzymes, type IV collagenase and heparanase, suggesting that metastatic tumor cells stimulate neutrophilia so that the tcPMNs might assist tumor cell extravasation during metastasis. To test this hypothesis, purified proteose peptone-elicited PMNs from peritoneal exudate, circulating normal PMNs, and tcPMNs were evaluated for their effects on in vitro invasive and in vivo metastatic potentials of syngeneic 13762NF mammary adenocarcinoma tumor cells. tcPMNs caused a dose-dependent increase in invasion through a reconstituted basement membrane barrier in an in vitro invasion assay. At PMN:tumor cell ratios of 30:1, invasion potential significantly (P less than 0.05) rose to 26-fold, 40-fold, and 37-fold for poorly metastatic MTLn2 cells, highly metastatic MTLn3 cells, and moderately metastatic MTF7 cells, respectively. In contrast, purified proteose peptone-elicited PMNs and circulating normal PMNs did not significantly alter invasive potential. Intravenous coinjections of purified proteose peptone-elicited PMNs did not change the number of experimental lung metastases, but tcPMNs at ratios to 50:1 significantly raised the mean number of metastases 23-fold for MTLn2, 3- to 4-fold for MTLn3, and 1.6- to 1.8-fold for MTF7. These results demonstrate that tcPMNs contribute to the metastatic propensity of mammary adenocarcinoma clones by increasing efficiency of invasion through basement membrane.