[Development of the rehabilitation system for wounded during the late hospital stage]

The current article deals with the main methods of development of the rehabilitation system for wounded during the late hospital stage. The problems of specialized rehabilitation for injured, patients of cardiology and neurology and the application of the newest rehabilitation techniques used to optimize medical aid in order to promote professional qualities recovery experience are also considered.

Israeli Defense Forces Medical Corps Humanitarian Mission for Kosovo's Refugees

In April 1999, during the crisis in Kosovo, the Israeli government launched a medical, field hospital in order to provide humanitarian aid to the Albanian refugees that fled from their homes in Kosovo. This facility was set up by the Medical Corps of the Israeli Defense Forces, in a refugee camp located in Northern Macedonia. During the 16 days during which the hospital functioned, the medical staff treated 1,560 patients and hospitalized >100. The field hospital served as a referral center for all of the other primary clinics that were hastily erected in the camp and its surroundings. This communication elaborates on the various aspects of the humanitarian medical aid that were provided by this medical facility and the conclusions that learned from such a mission.

[A catamnestic study of psychiatric consultations of patients with somatic diseases]

The aim of the study was to analyse diagnoses made during psychiatric consultations in somatic wards of the multi-profile hospital, as well as the catamnestic analysis of their causes and determinants. The authors intended to estimate the needs for psychiatric consultations in a multi-profile hospital, to analyse a growth or decrease in demand for psychiatric consultations within two years, the analysis of psychiatric diagnoses made in the course of consultations qualifying a patient for transfer to the psychiatric clinic.

MATERIAL AND METHODS

Personal experience from work as a consultant psychiatrist as well as data from the literature were used in the study. The collected research material in the form of psychiatric consultations concerned the case histories of the Archive of the 10 Military Clinical Hospital with Polyclinic in Bydgoszcz from 2006-2007. A total of 735 consultations in 630 patients were carried out.

RESULTS

The results of the study indicated that in a multi-profile hospital there is a great demand for psychiatric consultations. The most frequent cause of reporting the need for consultation by doctors in somatic wards were depressive disorders. The results obtained also showed that the fact of alcohol intoxication at admission is an important factor which can potentially have an effect on the need for a psychiatric consultation as well as a later decision to transfer the patient to other hospital departments. Additional psychological consultations commissioned in patients moved to psychiatric clinic were carried out in an amount higher than average, and the largest number of them were carried out among those refusing the transfer.

CONCLUSIONS

The most often diagnoses made during consultations were: dysphoria and affective disorders secondary to organic changes, adaptive disorders and delirium.

Pandemic influenza A(H1N1)2009 in Morocco: experience of the Mohammed V Military Teaching Hospital, Rabat, 12 June to 24 December 2009

On 12 June 2009, Morocco was the first country in North Africa to report a laboratory-confirmed case of influenza A(H1N1)2009 virus infection. This study describes the epidemiological and clinical characteristics of 240 laboratory-confirmed cases among 594 outpatients with influenza-like illness at the Mohammed V Military Teaching Hospital, Rabat, from 12 June to 24 December 2009. Real-time reverse transcription-PCR was used to confirm the infection. The epidemic peaked in weeks 47 to 49 (16 November to 6 December 2009). The mean age of cases was 23 years (standard deviation: 14 years). Cough was the most common symptom in 200 cases (83%), followed by fever (≥38 °C) in 195 (81%). Diarrhoea or vomiting was reported in 12 (5%) patients. None of the cases developed any complications and no deaths occurred during the study period.

Is it safe? Appendectomies at night at a low-volume center

OBJECTIVE

Recent literature reports an increased risk of morbidity and mortality in nonemergency operations performed during nonregular duty hours at large institutions. Of the nonemergency operations performed after regular duty hours, appendectomies remain the most common. The study seeks to answer the question as to whether it is safe to continue performing appendectomies during non-normal duty hours at a low-volume institution.

DESIGN

The study is a retrospective cohort review examining 102 appendectomies for suspected appendicitis over a 46-month period from July 2005 to May 2010. The total number of cases, gender, type of procedure, start and stop time, and complications were recorded and analyzed.

SETTING

Keesler Medical Center, located on Keesler Air Force Base, Mississippi.

PARTICIPANTS

All patients with appendectomies for presumed appendicitis observed between July 2005 and May 2010.

RESULTS

No statistical difference was found between complication rates during off-duty hours and normal duty hours at our institution (p = 0.619; odds ratio = 0.34722, 95% confidence interval = 0.035-2.45).

CONCLUSIONS

Performing appendectomies after regular-duty hours at our institution does not increase the risk of mortality and morbidity.

[The assessment of patient's satisfaction with nursing care on the surgical and non-surgical units with the use of The Newcastle Satisfaction with Nursing Scale (NSNS)]

The article presents research of which the aim was to assess patients' satisfaction with nursing care during the hospitalization in the cardiological deparment (non-surgical department) and the urological department (surgical department) of the 111th Military Hospital (111 Szpital Wojskowy) in Poznar. The questionnaire based on The Newcastle Satisfaction with Nursing Scale (NSNS) was carried out among 200 patients during a period of six months. The results of the questionnaire showed (among other things) that the patients expressed positive opinions about nursing care and had positive experiences connected with their hospital stay.

Cardiac surgery in patients on hemodialysis: eight years experience of the Tunisian military hospital

End-stage renal disease (ESRD) is known to be an important risk factor for cardiac operations performed with cardiopulmonary bypass. We investigated the influence of preoperative status on perioperative mortality and morbidity. We retrospectively analyzed data from 26 patients with ESRD, who were on maintenance dialysis and underwent a cardiac surgical procedure bet-ween 2000 and 2007. Of them, 61.5% of the patients had isolated coronary artery bypass grafting (CABG) and 38.5% had replacement or reconstruction of one or two valves. The perioperative mortality rate was 26% with five deaths occurring in patients undergoing CABG procedure. We found CABG procedure, being female and left ventricular (LV) function < 30% to be associated with a higher relative risk for perioperative death. In conclusion, our data suggest that both indi-cations and referral for surgical intervention for coronary artery disease may be delayed in pa-tients who have ESRD, contributing to the relatively high perioperative mortality.

Methods used to reduce the prevalence of hepatitis C in a dialysis unit

In the present study, we report on the follow-up of the epidemiology of hepatitis C viremia in our dialysis unit after our previous report, over the period from July 1, 2003 to December 31, 2005. The methods to reduce the prevalence of hepatitis C viremia in our center included: strict adherence to universal infection control precautions, separation of hepatitis C virus (HCV) positive patients from the negative patients and using specially designated machines for them, and from July 2003, periodic testing of all patients for HCV-RNA. Following the application of the above mentioned methods, we have not had, since 31 December 2005, any case of sero-conversion from HCV-negative to HCV-positive in our dialysis unit and the only HCV-positive patients present were those who were already positive at entry. The overall prevalence of HCV-RNA positive patients in our unit has presently come down to 6.5%. Although isolation and use of designated machines for HCV-RNA positive patients is not recommended following the latest guidelines of "Kidney Disease: Improving Global Outcomes" (KDIGO, 2008), the present study supports previous reports that these measures might be beneficial, when there is a high prevalence of HCV-RNA positive patients, and in units where due to understaffing or other causes, break in infection control procedures is likely to occur.

[Analysis of the causes and determinants of reaction to severe stress and adjustment disorder patients on mental health clinics]

In everyday life there are many obstacles that prevent the creation of many important needs. They require a skillful adaptation and may be the cause of stress. Stress of considerable intensity can receive the joy of life and even lead to a temporary mental disorder.

THE AIM OF THE STUDY

To present the main causes and frequency of disturbance determined according to the ICD-10 as a reaction to severe stress and adaptive disorders among patients in psychiatric and psychological counseling and to establish whether the causes of the disorder are dependent on factors such as age, sex or level of education.

MATERIAL AND METHODS

Analysis was done on a separate group of 754 persons from among patients seeking psychiatric counseling--Psychological Outpatient Mental Health in the 10th Military Clinical Hospital in Bydgoszcz, in 2005. This group were qualified person, who according to the criteria of ICD-10 were found to respond to severe stress and abnormal adaptation. In addition, during the interview determines whether they are long-term somatic illness. They have not been included in the study group. Also excluded persons who were found difficulties in operation prior to the stressful situation and those that have already been treated with psychiatric or psychological benefit from therapy. The collected data were statistically analyzed.

RESULTS

The analysis identifies three main causes of adjustment disorder. The first group of reasons is related to difficulties in the workplace, which represents 59% of all patients with the disorder described. In this group identifies three major stressful situations: bullying, job loss, unemployment. Another reason relates to family problems. They are the reason for the emergence of abnormalities in 23% of patients analyzed group. Among these difficulties was divided into four main types of situation causing disorder presented. There are family conflicts, death of spouse, parent death, divorce. The last group of factors are stressful events or incidents which contributed to the disorder in 16% of patients in the group described. In this category were observed four major groups analyzed the causes of the disorder. This is due to the difficulty of adapting to the compulsory military service, traffic accidents, participation in missions abroad, the situation of rape. Making a detailed analysis by category of difficulty is shown that in this group of subjects, age, educational level and gender are significant factors in influencing the formation of these disorders.

CONCLUSION

The main causes of this disorder are closely related to everyday human activity and especially on employment. Harassment and bad relationships in the workplace, job loss, unemployment are the factors most often causing disorder in question. The analysis made also clear that the situations of family conflict is also a frequent cause of severe reactions to stress and adjustment disorder. Not without significance is the impact of factors such as level of education, age and sex. Analysis by specific categories of causes of reactions to stress and adjustment disorder indicates that these factors significantly correlate with the formation of these disorders in the group of people.

[The occurrence of anemia in small cell lung cancer patients during first-line chemotherapy]

Both the character of disease and its aggressive treatment--including cisplatin-based chemotherapy--reflected to fact that anemia is a frequent problem in SCLC patients. Moreover, the potential prognostic role of anemia is considered in this group of patients. The aim of the study was to analyze occurrence of anemia in SCLS patients subjected to first line chemotherapy with the special attention paid to its potential prognostic role.

MATERIAL AND METHODS

The retrospective analysis included 49 SCLS patients (including 22 and 27 LD and ED ones, respectively) treated in 2001-2004 at the Internal Disease Clinic in 4th Military Academic Hospital in Wrocław Primary chemotherapy (cisplatin + etoposide) was performed in ED cases, whereas sequence treatment: chemotherapy (cisplatin + etoposide) with subsequent radiotherapy (including the elective irradiation of the central nervous system) was implemented in LD patients. Therapeutic results were evaluated in terms of response to treatment graded in accordance with RECIST criteria, time to progression (TTP) and overall survival (OS). Pretreatment anemia was identified based on the WHO criteria. Moreover, the maximal severity of anemia during the chemotherapy and the frequency of erythrocyte mass transfusions were taken into account.

RESULTS

Pretreatment anemia (defined in accordance to WHO) was noted in 3/49 patients only. During the chemotherapy, however, it was noted in 21/49 cases (WHO grade I and II). The transfusion of erythrocyte mass was necessary in 9 patients, whereas the preparations of recombined erythropoietin were given in 3 cases. No prognostic role of anemia was proved in the group studied. The significant association, however, was noted between pretreatment anemia and PS according to WHO (p < 0.001).

CONCLUSIONS

Anemia is a frequent problem during SCLC treatment and requires special therapy in most cases. The prognostic significance of anemia, however, is not fully understood, either in radical or in palliative treatment of SCLC patients. Our study revealed the lack of an association between anemia in prognosis.

Increasing incidence and severity of coccidioidomycosis at a naval air station

BACKGROUND

Increasing rates of coccidioidomycosis among the general population are being described. Given the large number of military personnel stationed and training in endemic areas, data regarding infection trends among military members would be informative.

METHODS

We performed a retrospective epidemiological study concerning the incidence and severity of clinical cases of coccidioidomycosis at a naval base located in an endemic area in California.

RESULTS

Eighty-two military beneficiaries at the base were diagnosed with coccidioidomycosis from January 2002 to December 2006. Among active duty personnel, the rate of coccidioidomycosis rose 10-fold during the 5-year study period: 29.88 to 313.71 cases per 100,000 person-years. The incidence of coccidioidal infections occurring in active duty members was higher than other military beneficiaries at the base. The median age of patients with a coccidioidal infection was 28 years, and 73% were male. Sixty-six had primary pulmonary disease and 14 had disseminated disease; data were unavailable for two cases. The number of disseminated cases increased significantly over time; by 2006, 30% of the diagnosed cases were disseminated disease. Among cases of dissemination, 43% occurred among Caucasian/non-Hispanics. Disseminated disease was associated with high complement fixation titers and a more recent year of diagnosis. Although the sample size was small, we found no differences in rates of disseminated disease by race, likely due to the large number of cases among Caucasians.

CONCLUSIONS

Coccidioidomycosis incidence rates have significantly increased during the last 5 years among military beneficiaries. Active duty members were more likely to develop coccidioidomycosis than dependents or retirees, perhaps related to the number and intensity of exposures in this group.

[Interventional therapy for structural heart diseases in People's Liberation Army hospitals between 2005 and 2006]

OBJECTIVE

To evaluate the efficacy and safety of interventional therapy in structural heart diseases in 38 PLA hospitals.

METHODS

Data including patient number underwent interventional therapy for structural heart disease, procedure details, immediate procedural complications were retrospectively collected in all the military hospitals between January 2005 and December 2006.

RESULTS

Successful interventional therapy was achieved in 8692 out of 8862 patients (98.08%) with structural heart disease. Transcatheter closure of ventricular septal defect (VSD), atrial septal defect (ASD) and patent ductus arteriosus (PDA), and percutaneous balloon dilatation of mitral valve stenosis (MS) and pulmonary valve stenosis (PS) were the most performed procedures (97.99%). Up to 91.23% patients underwent transcatheter closure with domestic devices. The incidence of procedure-related complications was 4.33% (n = 384) which were most frequently associated with VSD closure. The commonest procedural complications included conduction blockades (n = 260), residue shunt (n = 42), device detachment (n = 30) and tricuspid incompetence (n = 22). Although the procedures performed in 2005 and 2006 increased 57.32% compared with those in 2003 and 2004, the success rate and the incidence of complications remained unchanged.

CONCLUSION

Percutaneous treatment of structural heart disease is a safe and feasible alternative to surgery. Simulate complications arise long after the treatment, which suggests the importance of long-term follow-up for those patients who hare undergone interventional therapy.

[Trauma management under military conditions. A German field hospital in Afghanistan in comparison with the National Trauma Registry]

BACKGROUND

The German armed forces run a role-III field hospital in Kabul, Afghanistan. Emergency room (ER) management is of utmost importance as a link between pre- and in-hospital treatment.

PATIENTS AND METHODS

Prospective data were acquired of all patients admitted to the ER over a 3-month period. The quality of ER management was tested using established audit filters and comparing the results with those of the National Trauma Registry.

RESULTS

A total of 353 patients were admitted to the ER (48.4% trauma cases). Fifty-nine patients were major trauma cases, and the proportion of combat-related injury was 33.2%. In comparison to the National Trauma Registry, significant differences were observed regarding age (25.2 vs 41.7 years, P<0.0001) and injury severity (NISS 18.8 vs 28.8, P<0.0001). The demands on the quality of ER management have increased. Using the audit filters of the National Trauma Registry, significant differences were observed regarding ER management.

CONCLUSION

In a military setting, medical treatment of major trauma victims is influenced by multiple adverse factors significantly affecting the quality of trauma management.

The impact of race on outcomes of autologous transplantation in patients with multiple myeloma

Multiple myeloma is the most common hematologic malignancy in African-Americans, with twice the mortality of Caucasians according to population based data. In the pretransplantation era, comparable conventional therapy has resulted in similar outcomes between African-Americans and Caucasians. However, there has been limited data on outcomes after high dose chemotherapy with autologous stem cell transplantation (ASCT). A retrospective analysis of Caucasian (n = 55) and African-American (n = 36) myeloma patients who underwent ASCT in an equal access health care system in the Department of Defense was performed. Presenting demographic variables, pre/post ASCT characteristics, overall mortality and relapse rates after ASCT were obtained. Progression-free survival (PFS) and overall survival (OS) were calculated by Kaplan-Meier, and compared via log-rank testing. The median age at diagnosis for African-Americans = 52 years, Caucasians = 56 years (P = 0.009). There were no differences in presenting ISS stage, hemoglobin, calcium, or creatinine. African-Americans presented with higher CRP levels (P = 0.005), and a trend for less skeletal involvement (P = 0.10). Response to induction and ASCT was similar. Median PFS was 60.5 months (95% CI: 31.3-89.8 months) for African-Americans, 43.7 months (95% CI: 33.9-53.5 months) for Caucasians, HR of 1.3 (95% CI: 0.7-2.4), P = 0.46. Median OS was 95.2 months (95% CI: N/A) for African-Americans, 68.5 months (95% CI: 14.2-122.9 months) for Caucasians, HR of 1.4 (95% CI: 0.7-2.9), P = 0.41. In a cohort of myeloma patients who received autologous transplantation in an equal access health care system, there was comparable survival between African-Americans and Caucasians, suggesting that the historical increased mortality for African-Americans may be due to inequalities in access to care.

A survey of infection control practices in the delivery room and nursery to investigate and control the high rate of neonatal sepsis: an experience at a secondary care hospital

OBJECTIVE

To survey the infection control practices in the delivery room and the nursery so that the ongoing high rate of neonatal sepsis can be controlled.

METHOD

A prospective study was conducted at the Department of Pathology, Paediatrics and Gynae/obst Combined Military Hospital, Gujranwala. Situation analysis was carried out, according to which a total of 56 cases of neonatal sepsis were diagnosed on the basis of clinical and lab criteria during a six month period from November 2005 to April 2006. The routine being followed in relation to neonates was observed by a team of doctors in the delivery room and the nursery. Certain observations were made regarding breach of infection control practices and specimens were collected from suspected sources of infections for cultures. Recommendations were made in the light of observations and the results of cultures of the specimens to interrupt the chain of infection and to eradicate the source/reservoir of infections in the delivery room and the nursery environment. The gynaecologist and the paediatrician in charge of the delivery room and the nursery respectively remained involved during the whole process and the paramedical staff was given necessary training in the light of recommendations.

RESULTS

After the implementation of the control measures, the rate of neonatal sepsis was drastically reduced from 63/1000 to 14/1000 live births over the next 3 months.

CONCLUSION

Survey of the delivery room and nursery regarding infection control practices and training of the paramedical staff helped in reducing the nosocomial neonatal sepsis.

Quality of life and emotional functioning in selected psychosomatic diseases

BACKGROUND

Disease and its treatment may affect a patient not only in the physical, but also in the psychological and social spheres. Quality of life (QOL) is a global concept which should include mental and social actions, physical activities, and the beneficial aspects of a good physical and mental condition as well as negative ones caused by disease and infirmity. The aim of this study was to assess the relationships between emotional functioning and QOL among people diagnosed with coronary disease, hypertension, or gastric and/or duodenal ulcer.

MATERIAL/METHODS

A group of 180 male patients hospitalized during 1999-2002 at the Military Medical Academy Hospital in Łódź was subjected to examinations. The Emotional Control Questionnaire by Brzeziński was applied together with the SF-36 Quality of Life Test. The psychometric techniques used in the examinations allowed determining statistically significant relationships between QOL level and emotional excitability, emotional expression control, and situation control.

RESULTS

1) The QOL level of the psychosomatic patients was essentially lower compared with that of healthy people. 2) QOL was strictly related to the emotional functioning of the subjects. 3) There was no essential diversity in the range of emotional functioning among the patients. 4) QOL of the patients suffering from gastric ulcer was on average a little higher than that of patients with coronary disease.

Causes, types and severity of injury among army soldiers hospitalized with alcohol comorbidity

AIM

To examine the relationship between alcohol use and the cause, type and severity of hospitalized injuries.

DESIGN/SETTING

We used the Total Army Injury and Health Outcomes Database (TAIHOD) to conduct cross-sectional analyses of the association between alcohol comorbidity and the cause, type and severity of soldiers' non-combat injuries requiring hospitalization.

PARTICIPANTS

Subjects were active-duty US army soldiers (n = 211 790) hospitalized with a primary diagnosis of injury between 1980 and 2002.

FINDINGS

Alcohol comorbidity was positively associated with hospitalized injuries resulting from fights and falls and negatively associated with sports injuries; positively associated with hospitalized cases of head injury, open wounds and poisonings and negatively associated with musculoskeletal injury; and, overall, associated with shorter length of stay. Controlling for demographic factors did not moderate the association between alcohol and cause, type or severity of injury.

CONCLUSION

Alcohol comorbidity is specifically associated with injuries related to impairment and antisocial behavior.

Modeling hospital response to mild and severe influenza pandemic scenarios under normal and expanded capacities

William Beaumont Army Medical Center conducted quantitative modeling with FluSurge 2.0 (Centers for Disease Control and Prevention) to determine hospital capabilities in responding to patient arrival surges of the Fort Bliss population in mild 1968-type and severe 1918-type influenza pandemics. Model predictions showed that William Beaumont Army Medical Center could adequately care for all intensive care unit (ICU) and non-ICU patients during a mild pandemic, particularly if hospital capacity was expanded using the emergency management plan, excess surge plan, or activation of a contagious disease outbreak facility. For a severe influenza pandemic, model predictions showed that hospital beds, ventilators, and other resources would be exceeded within 2 or 3 weeks. Even at maximal hospital expansion, for a 12-week severe pandemic with a 35% attack rate there would be peak demand for 214% of available non-ICU beds, 785% of ICU beds, and 392% of ventilators. Health care planners and decision-makers should prepare for resource challenges when developing plans for the next influenza pandemic.

The Factors Affecting Length of Stay of the Patients Undergoing Appendectomy Surgery in a Military Teaching Hospital

The principal objectives of this study were to identify the main predictors of the length of postoperative hospital stay for patients undergoing appendectomy in a military training hospital in Turkey, to examine the effects of each significant predictor, and to justify to hospital health care managers the reasons why an increase in effective use of hospital utilization resources is needed and so important. This study gives the results of a 2-year retrospective study conducted at Gulhane Military Medical Academy between January 2003 and January 2005. The medical files of 417 patients undergoing appendectomy during this 2-year period were reviewed. A number of demographic and clinical patient characteristics were examined to determine their significance in lengthening the post-operative and total hospital stay. After taking all demographic and clinical patient characteristics into account, it was determined that those patients who were temporary or short-term service members and whose medical complications were more severe were more likely to stay in the hospital for longer periods. Despite its limitations, the study reveals that factors affecting variations in resource utilization can be minimized by following very simple administrative procedures. Furthermore, the results could increase awareness among hospital managers of the significant factors involved for health care providers in modifying their behavior concerning resource utilization decisions.

The complete management of extremity vascular injury in a local population: A wartime report from the 332nd Expeditionary Medical Group/Air Force Theater Hospital, Balad Air Base, Iraq

BACKGROUND

Although the management of vascular injury in coalition forces during Operation Iraqi Freedom has been described, there are no reports on the in-theater treatment of wartime vascular injury in the local population. This study reports the complete management of extremity vascular injury in a local wartime population and illustrates the unique aspects of this cohort and management strategy.

METHODS

From September 1, 2004, to August 31, 2006, all vascular injuries treated at the Air Force Theater Hospital (AFTH) in Balad, Iraq, were registered. Those in noncoalition troops were identified and retrospectively reviewed.

RESULTS

During the study period, 192 major vascular injuries were treated in the local population in the following distribution: extremity 70% (n=134), neck and great vessel 17% (n=33), and thoracoabdominal 13% (n=25). For the extremity cohort, the age range was 4 to 68 years and included 12 pediatric injuries. Autologous vein was the conduit of choice for these vascular reconstructions. A strict wound management strategy providing repeat operative washout and application of the closed negative pressure adjunct was used. Delayed primary closure or secondary coverage with a split-thickness skin graft was required in 57% of extremity wounds. All patients in this cohort remained at the theater hospital through definitive wound healing, with an average length of stay of 15 days (median 11 days). Patients required an average of 3.3 operations (median 3) from the initial injury to definitive wound closure. Major complications in extremity vascular patients, including mortality, were present in 15.7% (n=21). Surgical wound infection occurred in 3.7% (n=5), and acute anastomotic disruption in 3% (n=4). Graft thrombosis occurred in 4.5% (n=6), and early amputation and mortality rates during the study period were 3.0% (n=4) and 1.5% (n=2), respectively.

CONCLUSIONS

To our knowledge, this study represents the first large report of wartime extremity vascular injury management in a local population. These injuries present unique challenges related to complex wounds that require their complete management to occur in-theater. Vascular reconstruction using vein, combined with a strict wound management strategy, results in successful limb salvage with remarkably low infection, amputation and mortality rates.

Ocular Diseases and Nonbattle Injuries Seen at a Tertiary Care Medical Center during the Global War on Terrorism

We retrospectively reviewed the records of 107 U.S. military personnel referred to the Walter Reed Army Medical Center ophthalmology service with eye diseases and nonbattle injuries diagnosed during Operation Enduring Freedom and Operation Iraqi Freedom. Ocular diseases and nonbattle injuries ranged from minor to vision-threatening, represented a broad variety of conditions, and required the expertise of a number of ophthalmic subspecialists. The most common diagnoses were uveitis (13.1%), retinal detachment (11.2%), infectious keratitis (4.7%), and choroidal neovascularization (4.7%). Eighty-four patients (78.5%) met Army retention standards and were returned to duty. Twenty patients (18.7%) were referred to a medical evaluation board, seven (6.5%) of whom failed to meet retention standards for eye and vision; the retention status of three patients (2.8%) remains to be determined.