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P01 GASTRIC DILATATION AND VOLVULUS INVOLVING MORTALITY IN MALAYSIA MILITARY DOGS FROM 1990 TO 2008

Leong Yim FongWar Dog Wing, Army Combat Training Center of Malaysian Army, MALAYSIA

This study of gastric dilatation and volvulus (GDV) cases in the Malaysian military working dogs (MWDs) of various ages, breeds, sexes, utilities and food types involved a total of 15 out of 140 dead cases over a period from 1990 to 2008. GDV mortality for 1992 (2 cases), 1993 (1 case), 1997 (1 case), 2003 (2 cases), 2004 (4 cases), 2005 (1 case), 2007 (1 case) and 2008 (3 cases). The study looks into the possible etiology, clinical signs, diagnosis, prophylaxis and treatment for the control, management and total eradication of these occurrences. There is a significant linkage at p=0.01 of GDV cases with old age, utility and bigger breeds whereas all dogs of both sexes are effected without any significant differences. Of the four food types used during the period, only Science Diet and Purina come out without any significant difference as a possible causal agent. Various regimes of actions can be adopted but should be suitable for the working situations of the MWDs. Gastropexy is also considered as an early preventive measure.

P02WATER ANALYSIS IN FIELD OPERATIONS: THE FRENCH APPROACH

Coralie Portelli ClercFRANCE

For an army, the water supply for troops deployed in theatres abroad is not a new problem at all. But, in the present context, where we have many soldiers engaged in a great diversity of military operations at a considerable distance from each other and from France, this problem takes a singular importance. The water issue is a major concern, because of the risk to soldiers’ health in the event of unsafe drinking-water being consumed: cholera, typhoid fever or hepatitis are only some of the various waterborne diseases which present a danger to an army on the move. Over the last four years, a considerable amount of study and research has been conducted by the French army to define a new water supply strategy to be applied during operations. This work resulted in a new approach of the water analysis in field operations.

P03CERVICO-FACIAL CELLULITIS IN THE MILITARY : ABOUT 100 CASES

Benzarti Sonia 1, Mardassi Ali 1, Chebbi Ghassen 1, Ben Mhammed Rania 1, Akkari Khemis 1, Brahem Hichem 1, Miled Imed 1 & Chebbi Mohamed Kamel 1

1 Department of Otolaryngology, Military Hospital of Tunis, TUNISIA

Introduction: Cervico-facial cellulites is an infection of the face and neck cellulo-fat tissues caused generally by a dental pathology and that require an early diagnosis and an appropriate therapy. They have sometimes extensive potentialities and can endanger the patient’s life. Patients and Methods: The goal of this work is to study the epidemiologic and paraclinic profiles of our patients to evaluate their evolution and therapeutic features. We achieved a retrospective study over a period of 6 years (2003 -2008), concerning 100 cases of cervico-facial cellulites in the department of otolaryngology of the Military Hospital of Tunis. Results: Our study was about 70 men and 30 women. The average age was 30 years (2-73). Thirty-five per cent of the patients had received treatment before consulting us (antibiotics and/or steroids). The main complaint was a cervical mass noted in 78% of cases. Panoramic radiographies were done in 94% of cases. The cause of the cellulites was dental in 73%, cutaneous in 22% and pharyngeal in 5%. Treatment was medico surgical based on the aetiology. Evolution was favourable in 99% of cases. Only one patient had an extensive cellulites complicated by a mediastinitis necessitating to be transferred to the intensive care unit. Conclusion: The cervico facial cellulites of dental origin is a serious pathology the treatment of which is expansive and with a heaving the socio-professional and economic repercussion. A prevention policy is necessary to reduce the morbidity related to these infections.

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P04 A CLINICO-MYCOLOGICAL STUDY OF FUNGAL FOOT INFECTIONS AMONG ALGERIAN MILITARY PERSONNEL

A Djeridane ¹ & A Ammar-Khodja ²¹ Service de Dermatologie Hôpital Central de l’Armée Algiers, ALGERIA² Clinique de Dermatologie C.H.U Mustapha Algiers, ALGERIA

Purpose: Limited studies on fungal infection of the feet in military personnel are available. The aim of this study was to determine the prevalence and etiologic factors of the superficial mycoses of the feet among Algerian military personnel. Subjects/Methods: A total of 650 male military subjects (32 superior officers, 90 officers, 63 brigadiers, 212 noncommissioned officers, and 253 troop soldiers) were recruited among individuals attending the Department of Dermatology of the Central Hospital of Army in Algiers, Algeria, and examined between November 2007 and November 2008. The youngest subject was 18 years old, the oldest was 68. A complete dermatological examination was performed in the 650 male military subjects. Cultures of skin and nail specimens of the feet were done in each subject. Results: Fungal infection of the feet (including tinea pedis and Candida interdigital infection) was clinically diagnosed in 147 and confirmed in 119 by positive cultures, resulting in a global prevalence of 18.3%. According to military rank, fungal infection of the feet was prevalent in troop soldiers, while concerning years of service to the army, the infection was frequent in military recruits. The dermatophyte species Trichophyton rubrum (20.9%) and the yeast species Candida parapsilosis (18.7%) were shown to be the major causal agents isolated. Conclusions: Tinea pedis and Candida interdigital infection are the most prevalent (68%) superficial fungal infections among the Algerian military personnel. Analysis of the potential risk factors for acquisition of foot fungal infections in the Algerian military personnel as well as patient education and hygiene preventive measures (drying the feet thoroughly after bathing or swimming is known to be the best means to prevent the disorder) could reduce the prevalence of fungal infections and consequently lower the cost of treatment.

P05 DENTAL RELATED PATHOLOGIES IN OTOLARYNGOLOGY IN THE MILITARY: ABOUT 204 CASES

Benzarti Sonia 1, Mardassi Ali 1, Chebbi Ghassen 1, Ben Mhammed Rania 1, Akkari Khemis 1, Brahem Hichem 1, Miled Imed 1 & Chebbi Mohamed Kamel 1

1 Department of Otolaryngology, Military Hospital of Tunis, TUNISIA

Introduction: Various diseases in otolaryngology are related to a dental pathology. In militaries, these infections are increasing. They can be serious and sometimes life-threatening. Patients and methods: The authors present the results of a retrospective study over a period of 10 years (1997-2006), concerning 204 cases of dental-related-ORL diseases in the Department of Otolaryngology of the Military hospital of Tunis. Results: The sex-ratio in our study was 2, 8 and the average age was 31 years. We noted that 38.7% of the patients received a treatment before consulting us (antibiotics and steroids). Dental care, before the beginning of the symptoms was found in 28% of cases. The patients complained of dental pain in 75%, cervico-facial mass in 45% of cases, temporo-mandibular articulation pain in 25% and otalgia in 5% of cases. A stomatologic examination was conducted in all the patients revealing various dental lesions. The lower teeth were concerned in 68% of cases. A dental abscess was found in 18 cases. Leucocytosis and elevated sedimentation rate were noted, respectively, in 42, 6 and 86% of cases. Panoramic radiographies were done for all the patients. Maxillary sinusitis was diagnosed in 28 cases. CT-scan was performed in only 3 patients. The treatment was based on antibiotics, surgery and hyperbaric oxygen therapy in two cases of gangrenous cellulites. Conclusion: The cervico-facial pathologies of dental origin are frequent diseases in militaries causing sometimes severe complications. They necessitate an adequate therapy including the treatment of the causal tooth.

P06 LOCKING IMPLANTS – STATE OF THE ART FOR OSTEROSYNTHESIS

Juan Jose LasaMontevideo Military Hospital, URUGUAY

Uruguay contributes with the 4% of 66.000 total personnel deployed by United Nations in humanitarian and peacekeeping missions around the globe. The Armed Forces Medical Unit has the obligation to provide the best medical care for the personnel during deployment, with equivalent quality to domestic health care standards.”To secure the health and well-being of members of United Nations peacekeeping operations” (UN Mission Statement) “The current challenges require enhance mission’s capacities to deal with medical contingencies” (Dr Benjamin Seek UN - PKO). The Troop-Contributed Clinics, sometimes working in pre - fabricated of Mass Casualties, extremities and multiply injured patients accounted for almost 50% of total wounds. The quality of final morphological and functional bone and joint surgical results depends on proper protocol and implant selection. External Fixators are widely used for severe open and closed fractures treatment. Osteosynthesis indications are changing actually for Internal Fixators using Locking Implants. Locking plate’s designs started with conical threaded holes to secure the screw head, and actually improve with combi and variable angle holes models, enhancing the importance and increasing application of these new devices.

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P07ANIMAL AND PUBLIC HEALTH RISKS GENERATED BY PATHOGENS IMPORTED FROM OPERATIONAL MISSIONS: FRENCH APPROACH OF SANITARY CONTROL PLANS

Jean-Paul DemoncheauxFRANCE

French Armed Forces are deployed all over the world, particularly in countries suffering from war, civilian crisis or disaster. During missions, troops are submitted to drift downward environmental conditions, especially in tropical countries. Soldiers and equipment are in contact with the ground, local fauna and flora. Sometimes troops have to use local water and food resources. Regarding to the consequences of pathogens importation from operations, a military veterinary expert group re-evaluated the French pre-existing procedures. Three steps of reasoning were used. First step, a joint defense-agriculture ministry agreement was established, for being in coherence with the ministry of agriculture policy. The second step consisted of writing a flexible, evolutionary and adaptable plan for each operation. The third step was to submit this plan to the national staff for validation and implementation. The French sanitary control plan aims to determine appropriate measures to avoid identified hazards when military units return from operations. According to an International Organization for Standardization norm, we realized a risk assessment based on hazard sources identification and risk significance evaluation for each French mission. Risk significance was obtained by a combination of (1) hazard presence, (2) its capacity of transfer to France and (3) the consequences of such an importation. The animal and public health risks were taken into account by selecting measures concerning soldiers and materials. Each instruction for cleaning and disinfecting materials, for rats and insects control was improved. Adapted information brochures and specific training were created in order to improve soldiers’ awareness. Furthermore, two levels of control were used to have a secure risk management. The role of each actor was defined, from field unit to national staff. The final plan is meant to correspond to the future NATO STANAG goal concerning this type of risk.

P08ALUMINIUM POISONING RISK IN CHRONIC RENAL FAILURE IN TUNISIA

Jenane F 1, Ghorbel H 2, Hedhili A 2 & Hmida J 2

1 General Direction on Military Health, TUNISIA2 Dialysis Center, Tunisian Military Hospital, TUNISIA

Aluminum intoxication constitutes a permanent threat to every patient suffering from chronic renal insufficiency and subject to repeated dialysis sessions.Aim: The aim of this study is to determine serum aluminum level and the risk of aluminum intoxication in dialysis patients coming from various centers all over the country, and try to find a correlation on the hand between this parameter and dialytic age, and on the other hand between the serum aluminum levels found in used water.Patients and methods: The population under study was made up of 591 women and 855 men (age ranging from 5 to 82 years). As for the dialystic age it ranged from 3 months up to 19 years. In general, such patients were subjects to three dialysis sessions per week. Only 734 out of 1446 carrying serum aluminum were studied.Results: The aluminum was determined in blood and in water by using furnace atomic absorption spectrophotometer. The results of our study showed that 83% of the patients a serum aluminum level superior to 40 mg/ml. Besides, we noticed on the one hand the absence of correlation between the serum aluminum level, and the quality of water used with might explained = the noticeable improvement in water treatment (Reverse Osmoses System).Conclusion: The serum aluminum levels which are considered as high among dialysis patients are independent of the centers, dialystic age of the possible contribution of aluminum through the used water. In addition, these rations are still under the values which may expose dialysis patients to aluminum risk.

P09 DOGS AS CHAGAS DISEASE SENTINEL IN THE ENVIRONMENT OF SOLDIERS IN FRENCH GUYANA

Charles-Arnaud de BroukerFRANCE

Background: Chagas disease, a zoonosis that can be fatal, is caused by Trypanosoma cruzi, a protozoan parasite, mainly transmitted via the bite of insects (Triatominae). In French Guyana, the risk of emergence of an endemic situation is considered real. In July 2007, this disease was diagnosed for the first time on a French soldier. Objectives: A study was conducted on dogs of French Guyana to assess the prevalence of a T. cruzi infection and the sentinel role of this species. Methods: Between 2006 and 2008, serological screening was carried out on 76 residential dogs and 18 military dogs. Several tests were used for the detection of antibodies against T. cruzi: particle gel immuno-assay (ID-PaGIA Chagas® antibody test), immunochromatographic assay (Chagas Stat-Pak® assay) and Onsite Chagas Ab® rapid test cassette. Since 2007, real-time PCR has also been applied to detect T. cruzi DNA.Results: All PCR results are negative. Depending on tests, serological prevalence of Trypanosoma spp. varies from 15.4 to 35.7 % for residential dogs and from 5.6 to 11.1 % for military dogs. No serological conversion was noticed during the stay of military dogs. However, serodiagnosis was positive for 3 dogs at their arrival in French Guyana, although they had never stayed on the American continent before.Discussion: The absence of infection of military dogs during their detachment in French Guyana could be explained by good housing condition, short stay (4 months), diet mode (fed during the day while Triatominae are active at night) and an effective flea control with deltamethrine impregnated collars. However, serological screening in dogs seems to be limited by a lack of specificity (3 false-positives) or sensitivity with the tests used. In French Guyana, T. evansi and T. rangeli could be responsible for positive serological reactions with the rapid tests used to detect T. cruzi. Nowadays, molecular biology makes it possible to carry out epidemiological surveillance in dogs which could be reservoir and sentinel of T. cruzi infection as they live in the same environment as humans.

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P10 THE MEDICAL BATTALION AND ITS FIELD HEALTH SERVICES SUPPORT IN MALAYSIA

Rozali Ahmad 1, Khairuddin Husain 1,Muhamad Hatta Manis 1, Mohd Zin Bidin 1 & Sulaiman Abdullah 1

1 Health Services Division, Malaysian Armed Forces, MALAYSIA

The Medical Battalion (Med Bn) of the Royal Medical and Dental Corps (RMDC) is a Combat Service Support Element of the Malaysian Army. It provides Field Health Services Support (FHSS) during military operations. The present organizational structure of the Med Bn was first established in 1983 after a series of development, reorganization and restructuring of the RMDC which was required to meet the demands of the concurrent expansion and modernization of the Malaysian Army. New assets such as shelters and medical equipments were acquired to enhance its FHSS capability. At present, there are two Med Bns in Malaysia, one each in Peninsular Malaysia and East Malaysia. The services provided by the Med Bn have been expanded tremendously since the 1990’s to include services not only during military exercises and operations, but also in the United Nations (UN) Peace Keeping Missions, Civic Action Programs (CAP), and Disaster and Humanitarian Missions, as well as providing medical cover in major local and international sports events. The objective of this poster is to provide a brief report on the Medical Battalion and its FHSS in Malaysia, as well as to provide some thoughts for its future direction and challenges.

P11 EVALUATION OF HUMAN RESOURCES PRODUCTIVITY INDICATORS IN BAQYATALLAH UNIVERSITY OF MILITARY SCIENCES

Mohammad Karim Bahadori 1, Shahram Tofighi & Ahmad Ameriun 1

1 Baghyatallah University of Military Sciences, Tehran, ISLAMIC REPUBLIC OF IRAN

Introduction: Productivity sounds to be main and ultimate goal for most of organizations. Nowadays, healthcare organizations need a serious investigation and study of their human resources’ productivity more than any other time. This issue can be an important concern for health care managers who are striving to improve quality and contain costs. This study aims to measure human resources’ productivity indicators in Baqyatallah University of Medical Science.Methods: The study has been conducted in a cross-sectional time frame. The target group included 150 members of the university’s administrative staff and a questionnaire was utilized for collecting data based on “ACHIEVE” model. Three main statistical tests; namely, Z test, Freedman and Kendal ranking test, were used for analyzing the data. Results: The studied group was ranked high in terms of ability, job clarity, motivation, feedback, environmental causes and conditions indicators with the scores of 3.66, 3.34, 3.38, 3.25, and 3.29, respectively. It was ranked intermediate from the perspective of organizational support indicator with the score of 3 and low for decisions credibility with 2.96 score.Discussion: Most of human resources’ productivity indicators scored higher than intermediate in the studied group, albeit far away from ultimate level. The most important problems in this regard consisted of weakness and failure in taking advantage of staff’s views, incongruence of staff’s job and specialty education, non-written duties, non-proportionality of payment with workload, low payments as opposed to other departments, and inappropriateness of workplace. To sum up, suitable organization, participative management, staff job rotation, job enrichment, and similar payments to similar skills and work seem necessary in order for promoting human resources’ productivity.

P12A TRAUMATIC GIANT PERICARDIAL CYST MIMICKING PERICARDIAL TUMOR

Bilal Kaan Inan 1, Alper Ucak 2, Veysel Temizkan 1, Murat Ugur 1, Burak Onan 1,Ibrahim Alp 1 & Ahmed Turan Yilmaz 1

1 Gulhane Military Medical Academy, Haydarpasa Training Hospital Cardiovascular Surgery Department, TURKEY1 GATA Haydarpasa Training Hospital Crdiovascular Surgery Service, TURKEY

Objective: Pericardial cysts are very uncommon and benign lesions. They are generally asymptomatic but sometimes cause symptoms due to the pressure to the adjacent structures. Surgical resection is mandatory when they are symptomatic. We present a surgical treatment procedure and removal of a pericardial cyst which caused pressure symptoms to right ventricle.Case: A 20 year old patient admitted to internal medicine clinic with complains of lack of appetite and abdominal discomfort. During etiological investigation abdominal USG revealed ascites. While searching for the etiology of the ascites echocardiography revealed a pericardial cyst causing the collapse of the right ventricle (Figure 1). All hematological and laboratory findings were normal. Patient had a history of a severe trauma to his chest two years ago in a sports competition. CT revealed a thin walled pericardial cyst restricting the expansion of right ventricle with septation and calcification. There weren’t any disseminated pathology. We planned an operation for excision of a giant pericardial cyst. After induction of general anesthesia and sternotomy we found a cyst with 10X8 cm dimension. External wall was fibrotic and when we opened the cyst we aspirated hemorrhagic material with fibrin. We resected the cyst. All tissue cultures and microbiological tests were negative for the operative specimens (tuberculosis, echinococcus granulosis). Pathological examination revealed inflammatory changes and fibrosis. There were no granulomatosis and necrosis.Result: Etiological factors for pericardial cysts are, congenital, infectious or lymphogenic. Traumatic late pericardial cysts are very uncommon. In young sportsmen with pericardial cyst should be kept in mind as an etiologic factor.

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P13EVALUATING CORONARY ARTERY DISEASE RISK FACTORS AMONG IRANIAN POLICE FORCES IN A CROSS SECTIONAL STUDY

Ali Majidi 1, Esmail Asdaghpour 1, Hadi Shirzad 1 & Hamd Aghdam 1

1 ISLAMIC REPUBLIC OF IRAN

Introduction: Atherosclerosis is the process in which deposits of fatty substances, cholesterol, calcium and other substances build up in the inner lining of an artery Method: In this study we conduct a cross sectional study for evaluating demographic and risk factors that are present in police force personnel admitted for myocardial infarction (MI) or Coronary artery disease. Results: Patients include in study was 120, mean age 48.54±7, with only 1 (0.8%) female The major sign at admission was chest pain (66.6%), dyspnea (11.7%), MI (15%) and other signs (6.7%). Risk factors include smoking (24.3%), diabetes (27.7%), and hyperlipidemia (44.9%), Hypertension (38.3%).in the past heart specific problem there was previous MI in 51.7% of patients, 2.5% had valve surgery, 0.8% had coronary artery bypass graft (CABG) and 14.3% had stent surgery. Angiography data showed mean artery occlusion number was 2.12±0.971 from which 7.6% had no artery occlusion, 18.6% had one, 28% had two and 45.8% had three arteries occlusion or three vessel diseases. Main occlusion was in Left Anterior Descending (LAD) in 55% of cases, Right Coronary Artery (RCA) in 15%, left Circumflex (LCX) in 5.8%, Left Coronary Artery (LCA) in 1.6%. Mean ejection fraction (EF) after MI was 47.93±9. There was significant correlation between number of risk factors and coronary artery number occlusion (p value=0.048). Conclusion: Risk factors of CAD are common and controllable. This study shows that CAD risk factors among police personnel in Iran are not low and there is correlation between these risk factors and number of coronary arteries occlusion. Better education and intermittent check up for risk factors would be beneficial for better health and work of police personnel.

P14MEDICAL ASPECTS IN MILITARY MISSIONS IN IRAQ Kamen Kanev 1, Stoyan Tonev 1, Evgeni Belokonski1 & Krum Katzarov 1

1 Military Medical Academy, Sofia, BULGARIA

The medical support in peace keeping operations has the obligation to provide adequate medical care for the participating military forces. Preventive medical measures are necessary in order to reduce the medical risk. The aim of the article is to present the required analyses concerning host nation healthcare system in the military medical assessment of deployed Bulgarian contingent area of responsibility in Afghanistan. The article reveals the main health risk factors to the deployed military personnel in Iraq. The organization of the healthcare system in the country is outlined and recommendations for the personnel healthcare during mission are described. In conclusion it is stated that the health care system in Iraq does not meet the European and USA standards and is not suitable for the medical needs of the military missions.

P15INDICATIONS FOR BRAIN CT SCAN IN PATIENTS WITH MINOR HEAD INJURY

Ali Majidi 1, Mohammad Alizadeh 1, Reza Khazaee, 1 Hadi Shirzad 1 & Hamed Aghdam 1

1 ISLAMIC REPUBLIC OF IRAN

Background: Minor head injury is the most common type of head injury. Despite its high prevalence and a lot of studies, there are many controversies about the management of these patients. We performed this study to find indications for brain CT scan according to clinical signs and symptoms. Methods: We did this prospective cohort study in the hospital (sadjad) for one year enroll-ing 198 consecutive patients with minor head injury (GCS = 15) and recording all clinical signs and symptoms to find which could be used as predictors for brain injuries. X2 and logistic regression with 95% confidence interval were used for analysis. Results: Of 198 Patients, 46 (6.7%) had brain injuries in CT scan. All patients with abnormal CT scans had at least one of the following risk factors: post traumatic amnesia, post traumatic unconsciousness, post traumatic seizure, head-ache, confusion, vomiting, focal neurological deficit, skull fracture, coagulopathy or history of taking anticoagulants and age more than 60 years. We did not find any abnormality in brain CT scan of patients who did not have any of these factors on admission. Confusion, Vomiting, skull fracture and age > 60 years had significant correlation with brain injuries. We also found those patients who had more than one risk factor had more abnormalities in CT scan. Conclusion: Not all patients with minor head injury need brain CT scan. Clinical factors can be used as indications for brain CT scan in these patients.

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P16SURGICAL TREATMENT OF A RETROGRADELY MIGRATED ENDOSTENT DURING EVAR:A VERY UNCOMMON COMPLICATION

Alper Ucak 1, Bilal Kaan Inan 1, Veysel Temizkan 1, Murat Ugur 2, Murat Velioglu 3, İbrahim Alp 2 & Ahmet Turan Yilmaz 2

1 GATA Haydarpasa Training Hospital Cardiovascular Surgery Service, TURKEY2 Gulhane Military Medical Academy, Haydarpasa Training Hospital Cardiovascular Surgery Department, TURKEY3 Gulhane Military Medical Faculty, Haydarpasa Training Hospital Radiology Service, TURKEY

Background: Endovascular treatment of AAA is very effective and has less morbidity and mortality rates. But the most common complications are; antegrade migration, rupture, kinking of the graft and endoleak. Here, we presented a case in which the deployed AAA stent graft had migrated retrogradely during the right iliac leg extention which caused bilateral renal orifice occlusion and subsequent successful treatment by aorto-birenal bypass.Case: A 79 year old patient admitted to our clinic with abdominal pain and a pulsative mass in the abdomen. CT evaluation revealed a 78 mm AAA extending to the iliac arteries in which; left iliac 19mm and right iliac was 18 mm, 13 mm below the renal arteries (figure 1). In patient has a 50 smoking history, COPD for 12 years, and a prior CABG operation 9 years ago. We planned an EVAR procedure. After epidural anesthesia; we explored both common femoral arteries and deployed a 32 mm aortic endograft (Anaconda, Vascutec/Terumo) with left iliac extention (17X130mm) down to the orifice of left hypogastric artery. Control angiography was normal (Figure 2.A). Then we deployed a flared leg 21X130mm right iliac extension. The control angiography showed bilateral renal artery orifice occlusion due to the retrograde migration of the graft (Figure 2.B). Then we took patient emergently to a aorto-birenal bypass operation. After induction of general anesthesia and conventional transperitoneal approach we made a aorto left renal bypass with 10 mm PTFE graft. Then we anastomosed another 10 mm PTFE graft to right renal artery end-to-side fashion and the proximal anastomosis to the aortoleft renal graft by end-to-side fashion. (Figure 3). Postoperative course was uneventful and patient was discharged at 7th postoperative day. Result: Retrograde migration of a stent graft during EVAR is a very uncommon complication. Due to the level of the migration renals, SMA and celiac artery could be occluded causing severe ischemia of the territory of the occluded vessel. This complication necessitates emergency revascularization. That is why we advise these procedures must be done in operation rooms (not angiography suites) under the supervision of vascular surgeons

P17FREQUENCE DES PATHOLOGIES DU SUJET AGE EN CONSULTATION DE MEDECINE INTERNE A L’HOPITAL MILITAIRE D’ABIDJAN.

Jacko Abodo 1, Adama Sanogo1, Ndri Arthanase Yao 1, Alain Nibaud 1, Yves Omer Binan 2, Souhalio Ouattara 1, Tiemoko Bleu 1, Vincent Kouame 1, Bernard Ngoran Koffi 1, Loukou Yobouse 3 & Jacques Soubeyrand 4

1 Hospital Militaire d’ Abidjan, COTE D’IVORE2 Service de Gériatrie Hôpital Sainte Marguerite de Marseille, FRANCE3 Ministere de le Defense, COTE D’IVORE4 Service de Médecine Interne et Gériatrie Hôpital Sainte Marguerite de Marseille, FRANCE

Introduction : avec le progrès de la médecine et le développement de l’hygiène l’espérance de vie augmente partout dans le monde. En Afrique, le nombre de personnes âgées estimé à 38 millions devra atteindre 212 millions en 2050 soit 6 fois plus en l’espace de 5 générations. La Côte d’Ivoire n’échappe pas à cette logique car, de 1988 à 1998 la proportion des personnes âgées est passée de 3% à 4%. But : présenter les pathologies les plus fréquemment retrouvées chez les gérontes suivis à la consultation de Médecine Interne de l’hôpital Militaire d’Abidjan. Patients et Méthodes : à travers une étude rétrospective, nous avons exploité les 289 dossiers des sujets âgés de 65 ans et plus sur les 5 800 dossiers des patients suivis à la consultation de Médecine Interne de janvier à décembre 2000. Résultats : les sujets âgés représentaient 5% des patients. L’âge moyen était de 70,64 ans et les hommes étaient les plus nombreux (sex-ratio à 1,4). L’HTA était la plus fréquente des pathologies (37,71%) suivie des pathologies rhumatologiques (15,91%). Les affections respiratoires et digestives représentent chacune 7,65% des cas. Conclusion : les sujets âgés constituent une frange sensible de la population. Leur prévalence de 5% à l’HMA est superposable à celle de la population générale. Il est donc indispensable de bien connaitre leur pathologie les plus fréquentes afin de leur faire bénéficier d’une prise en charge adéquate par une Evaluation Gériatrie Standardisée.

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P18THE EFFECTIVENESS OF REVERSE ‘C’ STERNOTOMY FOR MINIMALLY INVASIVE CARDIAC SURGERY

Bilal Kaan Inan 1, Alper Ucak 2, Veysel Temizkan 1, Murat Ugur 1, Gokhan Arslan 1, Ibrahim Alp 1 & Ahmet Turan Yilmaz 1

1 Gulhane Military Medical Academy, Haydarpasa Training Hospital Cardiovascular Surgery Department, TURKEY2 GATA Haydarpasa Training Hospital CArdiovascular Surgery Service, TURKEY

Objectives: Partial sternotomies for minimally invasive cardiac surgery (MICS) have gained a wide acceptance due to, postoperative patient comfort, better cosmetic results and lower comorbidity rates. In this study we compared our technical results for routinely used reverse ‘C’ versus ‘J’ sternotomies for surgery of atrial septal defect and aortic valve pathologies. Material and Methods: Between March 2007 and April 2009 we performed open heart surgery in 27 patients (Group A) (AVP:19, ASD:8) with reverse ‘C’ sternotomy, (Figure 1,2) and 28 patients with ‘J’ sternotomy (Group B) (AVP:21, ASD:7). The ‘J’ sternotomy was between incisura jugularis to 4th intercostal space (ICS) and in reverse ‘C’ sternotomy with oscilating was between 2nd- 4th ICS. Patient demographic data was; mean age; 27.22 (20-72), gender; M/F:50/5. In AVP the routine cannulation sites were femoral artery and RA with two stage single venous cannula. In ASD cases we used endoluminal aortic clamp via femoral artery under TEE guidence and selective bicaval cannulation with distal tip ballooned venous cannulae.Results: Patient data were compared for; intubation period, lenght of hospital stay , drainage , respiratory function and visual analogue scale and there were no statistical significant difference. There were no conversion to median sternotomy. The mean pericardial drainage was 350cc. All patients in both groups were discharged from ICU at 14th postoperative hour and discharged from hospital at 4th postoperative day.Conclusion: The main advantage of reverse ‘C’ sternotomy was the preservation of the manubrioclavicle joint which is essential for sternal stability. By this way postoperative pain was lower and respiratory functions return to normal in the very early postoperative period. Another advantage is the no limitation in the position of lying in the bed.In elderly patient due to osteopenic bone structure healing of the sternum is faster and better. For young patient group returning to daily activity and strengthful excercise is possible and also with less pericardial adhesions further reoperation could be more easier and uncomplicated ( 24 of the patients were between the age 20-22) We concluded that in selected cases reverse ‘C’ sternotomy would be the routine sternotomy route for better postoperative patient comfort in AVP and ASD

P19DETECTION OF PSEUDOMONAS AND LEGIONELLA IN THE DENTAL UNIT WATER LINES OF MALAYSIAN ARMED FORCES DENTAL CENTRES

Ahmad Razi Mohamed Yunus 1, Zalini Yunus 1, Liana Ma Abdullah 2, Haryanti Toosa 1 & Zukri Ahmad 1

1 STRIDE, Main Complex, Ministry of Defence, Taman Bukit Mewah Fasa 9, 43000 Kajang, Selangor, MALAYSIA2 Armed Forces Dental Center, Kem KEMENTAH, Jalan Padang Tembak, 50634 Kuala Lumpur, MALAYSIA

Introduction: Dental unit waterline systems (DUWLs) are used to irrigate oral cavities during dental treatment. These tubes connect the high-speed hand piece, three way syringe and ultrasonic scaler to the water supply. The water delivered from these devices is not steriled and has been shown to contain high numbers of bacteria, including opportunistic pathogens, in general dental practice (Schel et. al, 2006). Various microorganisms, including bacteria, fungi and protozoans, have been shown to colonise and replicate, resulting in the formation of biofilms in DUWLs . In the study conducted by Barbeau et al. (1996), it was found that more than 10% of water samples taken from DUWLs were contaminated with Pseudomonas aeruginosa. Aims: To determine the microbiological quality of water from dental unit at Malaysian Armed Forces (MAF) Dental Centres Objectives: To provide suggestions and recommendations for improving the quality of water from dental units in these centres.Materials and Method: 250 ml water sample were collected from high speed handpiece, scaler, 3 –ways syringe , cup filler and water reservoir respectively in a sterile thiosulphite bag. As a control, water sample was collected from the tap in the same surgery. All the samples were transported to lab within 24 hours and kept in 40 C refrigerator. 100ml of the water sample was filtered with 0.45 micron polycarbonate, poured to plate count agar and incubated at 370 for 24 hours. The colonies formed were enumerated. A separate 100ml of sample was poured on Buffered Charcoal Yeast Exctract Agar and Pseudomonas Cetrimide Agar respectively to culture for Legionnella pneumophilia and Pseudomonas aeruginosa. Presence of these bacteria were confirmed by Polymerase chain reaction (PCR) and sequencing.Results: The results indicate that 9.47 % of samples were contaminated with Pseudomonas aeruginosa. A total of 23.16 % of the samples contained more than 200 colony forming unit (CFU) /100 ml TVC, which exceeded the accepted value in the DUWL samples. There was no contamination of Legionella pneumophilla in all samples. It was observed that 6 of the 11 centres were free from the contamination of Pseudomonas aeruginosa and Legionella pneumophilla. From the samples, 4 of the 11 centres were contaminated with Pseudomonas aeruginosa It was confirmed via PCR technique that all positive colonies obtained from specific media were Pseudomonas aeruginosa. DNA sequencing determined that they were closely related to Pseudomonas aeruginosa strain R285, and a few were related to Pseudomonas aeruginosa PA7.Conclusion: While the results show a low prevalence of pathogen bacteria obtained from the DUWL samples, proper maintenance of DUWLs should be conducted.

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P20EVALUATION OF 57 PATIENTS WITH POLAND’S SYNDROME

Turgut Isitmangil 1, Rauf Gorur 1, Nurettin Yiyit 1, Fatih Candas 1 & Erdogan Kunter 1

1 Department of Thoracic Surgery, GMMA Haydarpasa Training Hospital, Istanbul, TURKEY

Poland’s syndrome is a rare congenital chest wall deformity. It has incidence of 1 in 30.000. Poland’s syndrome includes agenesis or hypoplasia of the pectoralis major and minor muscles, agenesis of costal cartilages and absence of anterior parts of ribs, abnormalities of breast, hypoplasia of subcutaneous tissue and unilaterally brachysyndactyly in hand. The diagnosis of Poland’s syndrome was identified in 57 patients between January 1990 and December 2008. Fifty-six patients were male and their mean age was 21.62 (19-28). Other patient was 6 year-old girl. Poland’s syndrome was localized at right side in 37 patients and at left side in 20 patients. There were pectoral agenesis in 45 patients and pectoral hypoplasia in 12 patients. In all of the patients there were hypoplasia of subcutaneous tissue. There were amastia or hypomastia in 29 patients, athelia or hypothelia in 30 patients, agenesis of costal cartilages and absence of anterior parts of ribs in 17 patients, lung herniation via chest wall defect in 10 patients, paradox respiration in 5 patients, brachydactyly in 10 patients and syndactyly in 9 patients. Most common presenting symptoms were restriction of upper limb movement, chest pain with effort and dyspnea. In pulmonary function studies there was mild decreasing in 5 patients and moderate decreasing in 2 patients. There were dextracardia in three patients and patent foramen ovale in other one. Transposition of latissimus dorsi flap to anterior chest wall was performed to five patients with rib defects in our clinic. For protection of visceral organs in patients with multiple rib agenesis and for stabilization of chest wall in patients with rib agenesis accompanying paradox respiration, we suggest surgical procedure.

P21WHICH SYSTEM SHOULD BE USED IN THE BATTLEFIELD: “SCOOP AND RUN” OR “STAY AND PLAY”

Mehmet Eryilmaz 1 & Ergun Ozkan 2

1 Deparment of Emergency Medicine, Gulhane Military Medical Academy, Angkara, TURKEY2 Diyarbakir Military Hospital, TURKEY

Objective : The biggest and most important reason of surviving is the efficiency and the speed of the pre hospital health services. The discussions on whether to use “scoop and run” approach or “Stay and Play” approach progressed and now the topic of discussion is the SAVER method.Material and Methods: During the last 15 years, dramatic progress has gone through in Turkey in the field of pre hospital health services. Contrary to many countries, doctors are on duty in our ambulances. Results: Regarding the approach to the patient/injured in the field, firstly life saving interventions are applied (SAVE) and then, very swiftly (RUN), the patient/injured is transported to a center where the most effective treatment can be applied. In penetrating injuries, every possible medical intervention is realized within the ambulance during transport. In blunt traumas, stabilization procedure is also applied as well as vital interventions and transport is ensured. The controversy between Advanced Trauma Life Support (ATLS) and Basic Life Support (BLS) in the prehospital care of trauma patients has not been resolved yet. The purpose of this study was to examine the literature with respect to the type of prehospital care applied to the trauma patients. A total of 76 papers on ATLS and/or BLS for trauma were reviewed regarding the variables such as intravenous catheter application, prehospital fluid resuscitation, transport time, intubation and mortality. Conclusion: As a conclusion, the data in the literature do not support the routine use of on-field ATLS in trauma patients. Prospective randomized trials comparing ATLS and BLS in prehospital management of trauma patients are needed to clarify this issue. Our country constitutes a good and successful example in terms of emergency health services in pre hospital field.

P22ENERGY REQUIREMENTS OF MALAYSIAN COMBAT PATROL GROUP

Maznorila Mohd 1 & Ismail Mohd Nor 2

1 Health Services Division, Malaysian Armed Forces, MALAYSIA2 Nutrition and Dietetics Department, Universiti Kebangsaan Malaysia, MALAYSIA

The soldiers in a highly mobile combat situation need a ration that can provide their nutritional need adequately. An optimal nutrition has been known to be helpful in delaying fatigue, improve performance and to avoid injuries. Appropriate nutrition during military mission is a continuous challenge due to many factors. If soldiers do not consume enough calories, they will be in a state of negative energy balance. The consequences of being in these conditions vary from weight loss to fatigue, to physical and mental impairments. The aim of this study was to determine the energy intake and energy expenditure of soldiers involved in a combat patrol. 30 healthy Commandos aged ranging from 27 to 35 years took part in this study. Each soldier was subjected to a 7-day comprehensive protocol involving anthropometric, food intake, and activity pattern and energy expenditure measurements. The percentage average of body fat and body mass index were 18.0 ± 5% and 22.7 ± 2.5 % kg/m2 respectively. The mean daily energy intake was 2077 ± 258 kcal while the mean daily energy expenditure was 2813 ± 266 kcal with a negative energy balance of 736 kcal a day. The results suggested that there is a need to do further studies on the current military rations to determine the factors that might affect soldiers’ food consumption to ensure that the foods provided are meeting with the their nutritional need.

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P23THE PREVALENCE OF COMBAT STRESS REACTION: AN OVERVIEW OF COMBAT STRESS REACTION CASES IN AN ARMED FORCES HOSPITAL IN MALAYSIA

Mohd Badli Mahmud94 Armed Forces Hospital, Terendak Camp, Melaka, MALAYSIA

The aim of the study was to determine the prevalence of Combat Stress Reaction (CSR) among the troops in Terendak Camp, Melaka. The samples of the study were patients referred to the psychiatric clinic. All patients were seen and evaluated by a psychiatrist. Out of 204 cases seen at the clinic from June 2003 till August 2004, 15.7% (n= 32) presented with CSR. Another 84.3% (n= 172) were psychiatry cases which received appropriate diagnoses based on the DSM-IV. Majority of the CSR were from the younger age group (19 to 25 year old; 76.3%), recently joined the services (duration within six months), poor motivation, lack of experience and from the lower education level. A total of 75% were male (n= 24). Most of them were Malays, 93.8% (n= 30) as compared to other races. All cases of CSR were from the other ranks, mainly private soldiers (n= 22, 75.9%). Majority of them, 84.4% were single as compare to 15.6% were married.

P24INVESTIGATION ON THE CONSTRUCTION OF MEDICAL SUPPORTING FORCES IN CONDUCTING MARITIME DIVERSIFYING MILITARY TASK

Chen Yaozhong1 & Cai Jianming 1

1 Faculty of Navy Medicine Second Military Medical University, Shanghai, CHINA

Introduction : Maritime diversifying military operations include war, anti-terrorism operations, maritime rescue and relief work, disposal of maritime and aerial emergency events, peacekeeping activities, actions of safeguarding national rights, etc. Maritime crisis may arise at any time and shows characteristics of burstiness, linkage, disaster and normalization. Objective : Due to the diverse means of military force, wide goal area, frequent converting operations, complex inside and outside environment, difficulty in coordination and command in conducting maritime diversifying military task, we should do further research on constructing maritime medical supporting forces.Methods and Sampling: Fully participate in the maritime training and practice work of dozens of emergency medical support units including seven categories during the past four years. Propose the countermeasures and proposals through development, assessment, verification, improvement, and summarization of various types of medical supporting plans.Results and Conclusions: (1) Subdividing goals and tasks. Clarify the supporting tasks, operation procedures and service requirements of the emergency medical service units; set up and accomplish the medium and long-term planning of medical supporting forces construction in conducting diversifying military tasks. (2) Being familiar with characteristics of the task. Since diversifying military operation has its own characteristics in goal accomplishment, operation manner, implementation objectives, command arrangement and battle environment, deeply understanding and accurately grasping its characteristics and disciplines should be of important practical significance to improve the military response to a variety of security threats and the ability to accomplish diversifying military tasks. (3) Improvement of the operation procedures. In accordance with international common practice, formulate and improve related regulations and policies of military operations, so as to ensure that a war is waged under a good pretext and an action is carried out with a sound basis. Implementation of law enforcement and security mission during maritime diversifying military tasks should follow the relevant laws, regulations, international conventions and agreements. (4) Clarification of element of security. The security elements of maritime medical supporting force can be divided into four parts including the organizing and commanding capacity, the emergency mobility, the injury-treatment capacity in naval battle, and the adaptive capacity for maritime environment. Among these four parts, the injury-treatment capacity is the key element. Marine salvage and casualty transfer are influenced greatly by maritime situation, which is also our weakness in maritime medical and service support. (5) Building training mode. Insist on theoretical innovation of medical and service support, and promote the rapid transformation of combat effectiveness generation mode; formulate practical maritime training plans and implementation programs; reform the training methods and modes, improve the rules and regulations, inspecting (pre-)programs , and procedures of medical combat readiness; further strengthen the education foundation construction for maritime training. (6) Developing special equipment. Develop the working platforms and special equipments for maritime medical support. Make the security elements adapted to the actual combat conditions as soon as possible in various aspects including the training environment, implementation units, rescuing objectives, equipments and materials, and the security scope. Special attention should be paid on the development and equipping of the maritime rescuing helicopters and communications facilities. (7) Innovating supporting mechanism. Speed up the integration of combined service force and medical supporting theory. Accelerate the integration of supporting resources, supporting forces and supporting means.

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P25 QUALITY OF LIFE AND TOXICITY AFTER SONOBLACE HIFU TREATMENT IN PROSTATE CANCER

Selvalingam Sothilingam 1, Peter Royce 2 & Murali Sundram 2

1 Royal Medical and Dental Corps of Malaysian Armed Forces, Malaysia2 Department of Urology, Hospital Kuala Lumpur

Introduction: Sonablate 500 HIFU (Focus Surgery, IN, USA) was used to treat 46 men with primary and recurrent prostate cancer between November 2005 and June 2007. We present the acute treatment toxicity and QoL outcomes with minimum 12 month review. Patients and Methods: 46 patients underwent prospective, longitudinal assessment of acute HIFU toxicity at 3 months, and pretreatment, 6 and 12 month assessment of QoL using validated questionnaires. Patients completed IPSS (International Prostate Symptom Score and QoL index), MUDI (Male Urogenital Distress Inventory), IIEF (International Index of Erectile Function total version), Modified RTOG Rectal Toxicity and 5 level Incontinence Grading. Results: Acute toxicity included Urinary Retention (beyond initial catheter) 24%,. UTI 12%, Urethral Stricture 9.5%, Grade 1 Proctitis 7%, Grade 1-2 Pelvic Pain 14%, Genital Oedema 26%. Mean IPSS pretreatment 8.32, 6 month 7.43 and 12 month 7.73 (p=0.179) Mean QoL pretreatment 1.85, 6 month 1.53 and 12 month 1.37 (p=0.326). Mean MUDI pretreatment 38.3, 6 month 39.4 and 12 month 37.3 (p=0.133). Mean total IIEF pretreatment 39.75, 6 month 31.85 and 12 month 32.6 (p=0.08). Mean short IIEF pretreatment 13.53, 6 month 9.88 and 12 month 10.8 (p=0.03). No pad status pretreatment 97%, and 6 month 88%. Late Rectal Toxicity All rectal symptoms Grade 2, except 1 patient Grade 3 rectal urgency. No rectal fistulas.Conclusion: HIFU may result in urinary retention or urethral stricture but overall the IPSS, QoL index and MUDI did not alter significantly. Urinary incontinence requiring pads occurred in 9%, but none required surgical treatment. Rectal toxicity was low grade. HIFU did have a significant negative impact on erectile function at 6 months, and did not improve at 12 months

P26THERAPEUTIC IMPLICATIONS OF ADULT MESENCHYMAL STEM CELLS IN SEVERE TRAUMA

Su Yongping 1, Shi Chunmeng 1, AI Guopping 1, Deng Jun 1, Yan Guohe 1 & Cheng Tianmin 1

1 Institute of Combined Injury, State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Third Military Medical University, Chongqing, CHINA

Difficult-to-heal and non-healing wounds are associated with significant morbidity and mortality in severe trauma. In this work, we investigated the therapeutic effects of adult mesenchymal stem cells (MSCs) derived from bone marrow and skin dermis in the management of severe trauma. We first established the optimized procedures for isolation, cultivation and identification of MSCs from the above two sources. Next, we performed a series of experiments to study the effects of MSCs on tissue repair. Our group was one of the earliest to report skin dermis as a new source of adult multi-potent stem cells and the experimental application of MSCs into difficult-to-heal wounds. Our work provided new insights on the molecular mechanisms and established several applicable strategies of multi-potent stem cells to improve wound healing. Moreover, we observed that bone marrow and skin dermis derived MSCs could accelerate the hematopoietic recovery after sub-lethal irradiation. Co-transplantation of bone marrow MSCs with peripheral hematopoietic stem cells significantly increased the survival rate, peripheral blood cells and bone marrow hematopoietic cells in lethally irradiated mice, suggesting that co-infusion of peripheral hematopoietic stem cells and MSCs could accelerate hematopoietic reconstitution after lethal irradiation better than that of peripheral blood stem cell transplantation only. Basing on the above results, we further reported for the first time that systemic transplantation of MSCs from the dermis simultaneously increased the survival rate, promoted wound healing and hematopoietic recovery in combined radiation and skin-wound injury model. In addition to wound healing, we further expanded our study to investigate the efficacy of granulocyte colony-stimulating factor (G-CSF) to mobilize MSCs for the treatment of serious craniocerebral trauma. G-CSF treatment was able to mobilize multi-potent MSCs into peripheral blood with a 4-fold increase. In mice with serious craniocerebral trauma, the regime of G-CSF treatment showed a decreased mortality and improved cerebral tissue repair.

P27SONABLATE HIFU THERAPY FOR PROSTATE CANCER INITIAL CLINICAL OUTCOMES

Peter Royce 1 & Selvalingam Sothilingam 2

1 Department of Urology, Hospital Kuala Lumpur2 Royal Medical and Dental Corps of Malaysian Armed Forces, Malaysia

Introduction: Sonablate 500 HIFU (Focus Surgery, IN, USA) was used to treat 46 men with primary and recurrent prostate cancer between November 2005 and June 2007. We present the clinical outcomes of PSA nadir, repeat prostate biopsy and retreatment with minimum 12 month review.Patients and Methods: The 46 patients were risk stratified based on D’Amico classification into low risk 32%, intermediate risk 49% and high risk/radiation salvage 19%. 9 men were on hormonal therapy prior to HIFU, but all hormonal therapy was ceased after HIFU. 6 men had previous TURP for BPH and 13 men had TURP for HIFU therapy. Results: The mean age was 67 years (55-82), mean PSA prior HIFU 6.7 (0.8-20) and Gleason score range 4-9. The operating room/HIFU treatment time mean 229 minutes (150-350) and hospital stay mean 1.2 days (1-5) The PSA nadir <0.5 was used as surrogate for successful prostate ablation, and repeat prostate biopsy performed if PSA >1.0 after HIFU. Considering the 3 risk groups, the PSA<0.5 outcomes at 3, 6 and 12 months post HIFU were; Low risk: 67%, 60% and 58% 3 repeat HIFU and 1 salvage radical prostatectomy Intermediate risk: 20%, 25%, and 25%. 6 repeat HIFU and 1 salvage radical prostatectomy. High risk: 44%, 17% and 50%. 1 repeat HIFU, 1 salvage HDR Brachytherapy and 2 hormonal therapy. Conclusion: Sonablate HIFU ablation achieved best results in the low risk prostate cancer group and as salvage after previous external beam radiation

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P28MORBIDITIES ANALYSIS OF ACUTE MOUNTAIN SICKNESS AMONG MASS POPULATION NEWLY-ENTERING-PLATEAU

Li Xiaoxiao 1 , You Hai-yan 1 , Gao Yuqi 1 , Huang Zhaohui 1 , Zheng Ran 1, Yang Xiaodong 1 & Chen Guangwei 1 1 Department of Health Services College of High Altitude Medicine～Third Military Medical University, Chongqing, CHINA

Accurate pre-evaluation on morbidities of acute mountain sickness is special important for health service planning for newly-entering-plateau troops. This research investigated the morbidities of acute mountain sickness (AMS) of people who newly entering plateaus of about 2,900~4,700m. The difference among the morbidity under various conditions is determined by chi-square test. Morbidity of benign acute mountain sickness (BAMS) is greatly higher than morbidity of malignant acute mountain sickness (MAMS). The morbidities of AMS influence by transportation means, seasons and the altitude etc.. In general, the higher altitude the higher morbidities there are. At the altitude around 2,900~3,100m, the morbidity of BAMS is around 20%, while the morbidity of MAMS is rare in altitude under 3,500m. As far as transportation means is concerned, gradual transportation can decrease morbidities of AMS. Fast land transportation significantly increases the morbidity of BMAS. Air transportation significant increases the morbidity of MAMS. When land transportation is applied, the morbidity of BMAS is significant influences by seasons. It is lower in summer while higher in winter. However, the morbidity of BMAS does not present obvious difference in seasons when air transportation is applied. In the same transportation means, the morbidity of MAMS does not present obvious difference in seasons.

P29RADICAL LYMPH NODE DISSECTION IN BLADDER CANCER USING THE DA VINCI ROBOT

Selvalingam Sothilingam 1 & Murali Sundram 2

1 Royal Medical and Dental Corps of Malaysian Armed Forces, MALAYSIA2 Department of Urology, Hospital Kuala Lumpur, MALAYSIA

A young 45 year old doctor presented with lower urinary symptoms. Cystoscopy revealed an inflamed bladder and biopsy showed high grade transitional cell carcinoma. Subsequent transurethral resection of bladder showed involvement of prostatic stroma. He then underwent robotic radical cystectomy and had radical bilateral lymph node dissection up to the bifurcation of aorta. The video presentation will highlight the advantage of robotic surgery in performing pelvic surgery and its feasibility in doing extensive lymph node dissection.

P30BLADDER DIVERTICULECTOMY USING DA VINCI ROBOT

Selvalingam Sothilingam 1 & Murali Sundram 2

1 Royal Medical and Dental Corps of Malaysian Armed Forces, MALAYSIA2 Department of Urology, Hospital Kuala Lumpur, MALAYSIA

Case presentations :1st case: A 60 year old gentleman presents with lower urinary tract symptoms and subsequently with acute urinary retention. He had a small prostate but cystoscopy demonstrated large bladder diverticulum with a narrow neck and this was confirmed with a CT scan. He subsequently underwent bladder diverticulectomy and is currently voiding well. 2nd case: A 60 year old gentleman with a diagnosis of early prostate cancer was found to have a large bladder diverticulum and recurrent urine infections. He underwent bladder diverticulectomy , however had cardiovascular problems intraoperatively and could not proceed to have the radical prostatectomy done at the same time.

The video presentation will highlight the technique used to perform large bladder diverticulectomy using the Da Vinci robotic system.

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P31THE RELATION OF EXISTING CO MORBIDITIES WITH THE HISTOLOGICAL TYPE OF LUNG CANCER

Erdogan Kunter, Gulhan Ayhan, Hatice Kaya, Turgut Isutmagil, Zafer KartalogluTURKEY

Introduction: Spatial disorientation (SD) remains one of the flight safety problems in the Japan Air Self-Defense Force (JASDF). In JASDF, only aviation cadets undertake the routine SD training using the Spatial Disorientation Trainer (SDT) (Gyrolab™ Model GL-4000). Safe and effective On-ground SD training is a desired countermeasure against SD accidents. However, the training patterns in JASDF have not yet been well-evaluated. Previous reports have suggested that the reproduction of past severe SD accidents or incidents may be more effective for this SD training, particularly for refresher training of experienced pilots. In this study, we re-created the known flight conditions of a past severe SD incident in a Training profile using the Gyrolab and assessed the student´s responses in order to confirm whether this led to more effective SD training. \Methods: Fourteen fighter training pilots (valid responses:13, age: 27.3±4.9) participated in this study. Subjects experienced the two types of training profiles including; a) typical illusion profiles and b) a replay of an actual severe SD incident. This replay is based on a past severe SD incident we previously reported. In that severe SD incident profile, trainees experienced up to 3Gs with an audio recording of the incident cockpit sounds. The subjects then answered questions about these SD profiles regarding the pilot-evaluated effectiveness and subjective impression with a 5-point scale: 0 (no effectiveness) to 4 (very effective). Results: The results show that the pilot-evaluated effectiveness of the replayed SD incident profile was 3.9±0.3, the highest value of the all profiles. The score regarding subjective impression for the replayed SD incident profile was also the highest value (4.0±0.3) of the all SD profiles. Conclusion: These results suggest that SD training patterns based on actual severe SD incidents may be a more effective method for on-ground SD training.

P32PROSTATE SCREENING IN THE COMMUNITY – A NATION WIDE SURVEY

Selvalingam SothilingamRoyal Medical and Dental Corps of Malaysian Armed Forces, MALAYSIA

In 2005, 12 hospitals located in various states in Malaysia were randomly picked to be included in this survey. Prostate awareness campaigns were held at these hospitals and a total of 2770 men attended the screening. Mean age of participants was 59 years old. The men were evaluated for prostate symptoms and were screened for prostate cancer. The participants were also screened for erectile dysfunction using the IIEF questionnaire. Results : Nocturia was the most common urinary symptom experienced with 40% of the participants having moderate to severe symptoms. 36% of participants were diagnosed to suffer from BPH. Prostate cancer detection rate was 1%. 40% of participants were found to be suffering from moderate to severe erectile dysfunction.Conclusion: Prostate disease and erectile dysfunction is a significant problem in our community.

P33TRAUMATIC AXONAL INJURY INDUCED BY LATERAL HEAD ROTATIONAL ACCELERATION: AN EXPERIMENTAL STUDY

He Xiaosheng 1 , Yang Guitao 1 , Fei Zhou 1 & Zhang Xiang 1 1 Department of Neurosurgery, 2Department of Medical, Teaching and Research Administration, Xijing Hospital, Fourth Military Medical University, Xi’an, CHINA

Objective : Diffuse axonal injury (DAI), in military training or battling, attracted attention for its higher morbidity and mortality than other brain injuries in humans. The instant relative movement between head and neck was associated with biomechanical mechanism for DAI. However pathobiological changes in DAI need to be further identified. In this study morphology of traumatic axonal injury (TAI) in animals by lateral head rotational acceleration was investigated. Methodology: SD rats were divided into injury group (n=9) and sham group (n=3). A device inducing lateral head rotation through 90°was used. Head rotation was finished in 2.09 ms with angular velocity 761 rad/s, angular acceleration 1.87×105 rad/s2. At 30 min, 2 h and 24 h three rats were killed for tissue processing. Sagittal sections were made from medulla oblongata at midline plane and immunolabelled for NF68. Under light microscope, immunolabelled regions were identified and resectioned for transmission electron microscopy (TEM). At 30 min, NF68 immunolabelling showed a few of swollen and irregular axons. Ultrastructurally slightly-separated myelin lamellae and disorderly-arranged neurofilaments occurred. At 2 and 24 h axonal damage became severer. Immunolabelled axonal swellings, disconnected axons and axonal retraction bulbs markedly increased. TEM provided evidence of myelin separation, peri-axonal spaces, blank areas in axoplasm, loss of microtubules, peripheral accumulation of mitochondria and clumped neurofilaments for TAI. A tendency was observed that greater labelling with NF68 appeared as axonal damage deteriorated. Conclusion:: Exposure of NF68 immunoactivity initiates the process of structural damages of NFs in DAI. The disorderly arrangement of NFs occurred at early stage of post-traumatic axonal changes. The relative movement between head and neck by lateral head rotational acceleration caused the damages of function and structure in NFs and it provided experimental and theoretical basis for the prevention and treatment of brain injury in military training or battling time.

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P34THE INFLUENCE OF SLEEP DEPRIVATION ON HEART AND MECHANISM OF ARRHYTHMIA

Zhang Yajing 1 & Lu Caiyi 1

1 PLA General Hospital, Beijing, CHINA

Background : Sleep deprivation (SD) is a common phenomenon in emergency, especially during wartime or conflict, natural disasters, accidents rescue and even SARS happenings that cause exhaustion in members of armed forces and non-combat casualty. In the future, sleep deprivation will become more serious and urgent in various high-tech war. Objective: To observe the changes in rats ECG after sleep deprivation, and to examine the relationship among the level of voltage-gated potassium channels (KV1.5～KV2.1～KV4.3), different SD periods and severity of arrhythmia, and research the mechanism of arrhythmia which is caused by SD, so we could create some prevention strategies or medicines to defend the harm from SD. Method: Rat models of sleep deprivation were established by modified multiple platform method, standard ECG waveform were recorded at 1 day, 3 days, 5 days and 7 days respectively. The level of voltage-gated potassium channels (KV1.5～KV2.1～KV4.3) were analyzed quantitatively after sleep deprivation, using Real-time PCR and Western-Blot. Result: Main changes in ECG waveform after SD were arrhythmia, and showed more serious (even myocardial ischemia), when the period of SD became longer. Overall, the level of voltage-gated potassium channels (KV1.5～KV2.1～KV4.3) were all decreased, and became lower with the increasing length of SD period. Conclusion: Sleep deprivation could cause arrhythmia in rats, besides, the level of voltage-gated potassium channels (KV1.5～KV2.1～KV4.3) could be decreased by SD, and became lower with the increasing length of SD period. So the decreasing level of voltage-gated potassium channels (KV1.5～KV2.1～KV4.3) maybe one mechanism of arrhythmia which is caused by sleep deprivation.

P35PLATELET PARAMETERS IN MALIGNANT PLEURISY

Erdogan Kunter, Dilaver Tas, Alex Akyol Erikci, Gulhan Ayhan, Hatice Kaya, Turgut Isitmangil, Zafer KartaloghuTURKEY

Platelets are heterogeneous with respect to their size, density, and reactivity. Large platelets are more active and platelet volume has been found to be increased in patients with infection and/or inflammation. Malignant pleurisy represents an advanced stage of lung cancer and it is expected to be associated with increased inflammatory response and procoagulant activity. The aim of the current study was to investigate if platelet parameters of total platelet count (TPC), mean platelet volume (MPV), and platelet distribution width (PDW) were different in lung cancer patients with or without pleurisy. Eighty-six lung cancer patients (65 male, 21 female and mean age 68.44 -/+ 1.48) diagnosed in our institution in a one-year period and 32 healthy controls were included. Distribution of the cancer cases according to cell types were as follows; squamous cell carcinoma 25, adenocarcinoma 10, small cell carcinoma 10, combined cell type 13, miscellaneous cell types 7, and undefined non-small cell type 21. Malignant pleurisy was present in 34 patients. TPC, MPV, and PDW of lung cancer patients were significantly (for each comparison p < 0.05) higher than controls (281.59 -/+ 98.51 109/l vs 227 46 109/l; 9.16 -/+ 1.94 fl vs 7.8 1.5 fl; 16.47 -/+ 0.98 fl vs 14.4 1.3 fl; respectively). On the other hand TPC, MPV, and PDW of patients with pleurisy were higher than patients without pleurisy (292.84 -/+ 113.66, 9.73 -/+ 1.57, 16.54 -/+ 0.99 versus 274.72 -/+ 88.55, 8.80 -/+ 2.08, 16.43 -/+ 0.97, respectively). But, only the difference in MPV was significant statistically (p < 0.05). Some certain percentage of pleurisy cases remain undiagnosed despite of the use of all available diagnostic tools. Sometimes cytological examination of pleural fluid cannot differentiate malignant effusion from a non-malignant pleurisy. We suggest that platelet parameters may be potentially helpful in the diagnosis and/or follow up of the lung cancer patients with or without pleurisy. However, clinical usage and significance of these findings need to be defined with further studies.

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P36ANALYSIS STRATEGY FOR SCREENING AND IDENTIFICATION OF CHEMICAL WARFARE AGENTS AND RELATED CHEMICALS IN COMPLICATED MATRICES

Liu Qin 1, Lin Ying 1, Chen Jia 1, Wu Bidong 1, Feng Jianlin 1, Li Chunzheng 1 & Xie Jianwei 1

1 Institute of Pharmacology and Toxicology, Academy of Military Medical Science, Beijing, CHINA

To achieve the requirement of the civil and military antiterrorism as well as the Beijing 2008 Olympic Games security, an analysis strategy for screening on chemical warfare agents and related chemicals in a series of complicated matrices and for their unambiguous identification were developed. The analysis strategy has been established according to the physical chemical properties of chemical warfare agents and related chemicals, and their existing characteristics in different matrices. In general, the strategy involves sample preparation, screening analysis, data evaluation and identification, and can be used to screen and analyze various types of target chemicals in a relatively short time. It can be outlined in following sections. Sample preparation methods applied to different complicated matrices. According to the type of the target compounds, their possible forms in different matrices, the type of the matrices, and the potential interfering substance existing in the specified matrices, multiple sample pretreatment methods, including liquid-liquid extraction, solid phase (micro) extraction, column eluting, chelating cleansing, solvent exchange, derivatization and so on, have been employed to clean up the samples, separate and concentrate the target chemicals, and meet the requirement of different of analytical techniques. These methods have been proved to be effective for the removal of the background chemicals and the enrichment of the target compounds in complicated sample matrices. Screening and analysis methods using instrumental techniques. A series of instrumental analysis methods were optimized for screening and analysis target chemicals in samples, including GC analysis with element selective detectors (FPD, NPD, AED), GC/FTIR analysis, GC/MS analysis, LC/MS analysis and NMR analysis. A combination of these analytical techniques was used in order to obtain element information and structural proposals for the unknown chemicals in samples, such as the presence of any nitrogen-, phosphorus-, sulfur-, arsenic-, and/or fluorine-containing compounds, retention indices, functional group, molecular weight (even accurate mass), fragment ions, isotope ratio, and element composition. All data and spectra obtained in the screening process should be analyzed and checked carefully to ensure no missing of any target chemicals. Supplementary methods for structure identification and in-house mass spectral databases. Electron impact ionization (EI) and chemical ionization (CI) mass spectrometry were employed to obtain the spectra of chemical warfare agents and related chemicals, which were used for structure retrieval. The basic fragmentation rules of some particular groups of compounds were studied, and some structure-specific fragment ions that are characteristic for them were concluded as search mode of selective ions on EI mass spectra. Retention indices information was also used as a supplementary method for the identification of unknown compounds in the groups. Based on these studies, in-house databases were established, which involved hundreds of the mass spectra of chemical warfare agents related chemicals that were not included in OCAD (OPCW Central Analytical Database) and any other commercial mass spectral databases. The in-house databases were coupled with NIST and AMDIS software to search target chemicals automatically so as to greatly improve the efficiency of the spectra retrieval. Directional micro-synthesis approaches to obtaining authentic reference chemicals. In order to obtain an unambiguous identification, the analytical data of the unknown compound have to be compared with those authentic reference chemicals. For quick synthesis of chemicals not commercially available, directional micro-synthesis approaches were used which employed several synthesis techniques such as phase-transfer catalysis, microwave accelerated reaction, production twice-catalysis reaction, etc. The reference chemicals could be synthesized directionally and rapidly, and the in-house reference chemicals library was also established. The analytical strategy developed can ensure the general screening and unambiguous identification of chemical warfare agents and related chemicals. It has been successfully applied in analyzing OPCW ～Organization for the Prohibition of Chemical Weapons～ proficiency test samples and suspicious unknown samples during the period of Beijing 2008 Olympic Games, and was proved to be effective.

P37BEHAVIORAL RESPONSE AND CELL MORPHOLOGY CHANGES OF CAENORHABDITIS ELEGANS RECEIVING MILLIMETER WAVE IRRADIATION

Ren Changhong 1, Gao Yan 1, Wu Yonghong 1, Xu Zhiwei 1, Zhao Na 1 & Zhang Chenggang 1

1 Beijing Institute of Radiation Medicine, State Key Laboratory of Proteomics, Beijing, CHINA

Objective: To investigate the effects of millimeter wave (MMW) exposure on the behavioral response and cell morphology changes of C. elegans. Methodology: C. elegans were individually exposed to the millimeter wave with different mean power densities. The time-course photomicrography system was used to record the behavioral changes of C. elegans. The behavioral response and cell morphology changes were further observed by stereoscopic microscopes. Results: The freely moving C. elegans could escape from the MMW irradiation region quickly. After exposure to MMW with mean power densities of 10W/cm2 and 12W/cm2, the bending speed of the animals was increased significantly, while the movement being slowdown until the body got rigidity. However, after exposure to 5W/cm2, the C. elegans showed a distinctive tolerant reaction because of the thermal effect. In addition, after MMW irradiation, cell morphological observations showed that the epidermis contained multiple strikingly swollen-like necrotic cells, and the nuclear structure of the eggs inside the uterus disappeared. Conclusions: Our results showed that power MMW significantly affects the behaviors of C. elegans and Cell morphology, which suggested that C. elegans could be used as a typical model species to study the biological effects of MMW irradiation.

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P38STUDIES ON THE DIAGNOSTIC TECHNIQUES FOR THE RADIATION INJURY

Chen Ying 1, Zhou Ping-Kun 1, Wu Ke 1 & Wu De-Chang 1

1 Institute of Radiation Medicine, The Academy of Military Medical Sciences, PLA, CHINA

The biological dose estimation of radiation injury is a critical issue and basis for the clinical diagnosis and treatment of the acute radiological syndrome (ARS) as well as the risk assessment of late and stochastic effects. In the present paper, we introduce the achievements on the studies of the techniques for biological dose estimation of radiation injury and the clinical practice in ARS in our Institute. The techniques of radiation biological dose estimation include the bio-dosimetry based on chromosomal aberrations and its automatic analysis system, micronucleus count of lymphocytes, and the ESR dose measurement. A series of novel molecular biomarkers have also been identified, based on the DNA lesions and radiation-inducible genes, which could be used for the purpose of biological dose estimation. We have also expanded the dose-effect curve of ionizing radiation-induced chromosomal aberrations to more than 10Gy for the dose estimation of acute supra-high doses exposure and protracted exposure. The biological dose estimation has been successfully applied in more than ten of radiation accidents happened in China.

P39RETROSPECTIVE AND FOLLOW UP STUDY ON THE CLINICAL, PATHOLOGICAL AND EPIDEMIOLOGICAL DATA FROM 1448 CASES OF MILITARY PERSONNEL WHO HAD UNDERTAKEN LIVER BIOPSY

Zhao Jingmin 1, Sun Yanling 1, Zhou Guangde 1, et al. 1 Department of Pathology , 302 Hospital of PLA , Beijing, CHINA

Objective: To investigate the spectrum, morbidity, clinical epidemiological features and prognosis of liver diseases in Chinese military personnel, so as to lay a foundation for precaution, diagnosis and treatment of liver diseases in army. Methods: The clinical data of 1448 cases of military personnel , admitted from Jan. 1981 to Dec. 2007 and had undertaken liver biopsy, were reviewed retrospectively according to the update diagnostic and therapeutic criteria or guideline. 541 of the 1448 cases (37.36%) were followed up for 6 months to 5 years, among them 84 cases (5.80%) had undertaken liver biopsy twice at one to five years interval. All the clinical, laboratorial, pathological and epidemiological data reviewed were statistically analyzed or evaluated. Results :～For all the 1448 cases, the ratio of male to female was 13.63 to 1 , and soldier to officer was 1 to 0.42, with an average age of 26.22 ±8.98 years old ( ranged from 18 to 73 years old). All the cases were from land force (98.27%), navy (0.62%), air force (0.21%), missile troops (0.41%) and armed police (0.35%), respectively, and the majority of the cases were Shandong, Henan, Hebei, Sichuan and Jiangsu province by origin. The diagnosed spectrum covered more than thirty kinds of liver diseases, and the ratio of acute to chronic liver diseases was 0.46 to 1.The coincidence of clinical and pathological diagnosis was 62.02%, and 37.98 % of cases failed in diagnosis before liver biopsy and then got definite diagnosis by liver biopsy. The incidences of viral hepatitis, nonalcoholic fatty liver disease, liver injury induced by drug or environmental poisons, autoimmune liver disease, inherited and metabolic liver disease, alcoholic liver disease and the miscellaneous liver disease in all the patients were 69.75%, 5.73%, 2.35%, 1.73%, 1.66%, 1.31% and 17.47%, respectively. The clinical epidemiological data showed that the infection routes in the infectious liver diseases included soldier to soldier (26.85%), family member to soldier (12.14%), food and beverage (3.70%), blood transfusion (0.85%) and the miscellaneous (56.45%). The comparing analytic results for the main liver function indexes between viral liver disease group and non-viral liver disease group were: alanine aminotransferase(ALT): 390.83±218.95 vs.232.30±135.97U/L (P<0.05); aspartate minotransferase (AST): 306.28±223.32 vs.153.2±120.13 U/L (P<0.01); total biliru-bin: 40.75±15.68 vs.129.57 ±59.70 μmol/L (P<0.01); alkaline phosphatase(ALP): 137.9±55.38 vs.175.53±42.63U/L (P>0.05); γ-glutamyltransferase (GGT): 107.468 ±53.73 vs.115.7±60.78U/L (P>0.05). For the cases when discharge, the ratio of curing, improve, inefficiency and death were 67.47%, 29.01%, 2.00% and 1.52%, respectively; for the cases followed up, the ratio of restoration,improve,aggravation and death were 74.31%, 23.84%, 1.11% and 0.74%, respectively. Conclusions: It has been revealed that the main liver diseases affecting the Chinese military personnel’s health in the past three decades include viral liver diseases, fatty liver diseases and liver injuries induced by drug and environmental factors, and the incidence of non-viral liver diseases has gone up in the last decade. Some epidemiological characteristics have emerged in Chinese military personnel with liver disease in age, sex, army service branch, rank and place of origin. The epidemiological data have shown that the main infectious routes of liver diseases in Chinese military force include inter-soldiers in group living, family members to soldier, and food and beverage. To make a definite diagnosis, the liver biopsy examination should be a very useful choice to the majority of hardly diagnosed liver diseases in clinics. The serological examinations for several main liver diseases have shown some special features, and most of the soldiers with liver diseases have recovered well after regular treatments.

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P40PRIMARY AND METASTATIC OCCULT CANCERS OF THE LUNG PRESENTING WITH TRANSUDATIVE PLEURISY

Erdogan Kunter TURKEY

The distinction between pleural transudates and exudates is the first step in the study of pleural effusion and transudative pleurisy (TP) usually refers to diseases acting outside the pleural space. In general, defining an effusion as a transudate limits the differential diagnosis to a small number of disorders and ends the need for further diagnostic evaluation especially if there exists a possible etiology. We retrospectively evaluated the last 100 (78 male and 22 female; mean age 44.32 -/+ 16.1) patients who were admitted to our clinic with pleurisy. All means of diagnosis such as thoracentesis, pleural biopsy, video-assisted thoracoscopy, tomography, magnetic resonance imaging, positron emission tomography, microbiological and biochemical methods, etc. had been used as needed. We separated the cases into two groups according to the transudative (19 patients) or exudative (81 patients) characteristics of the pleural fluid at presentation. The final diagnoses of the patients with exudative pleurisy were; tuberculosis (27), malignancy (23), parapneumonic effusion (19), pulmonary embolism (2), multiple possible etiologies (7), and undefined (3). Diagnostic distribution of TP cases were; congestive heart failure (9), uremia and other renal diseases (3), liver diseases (1), hypothyroidism (1), and undefined (5). It has been found that, in the search of the outcomes of the patients without a definite diagnosis, pleurisy was resolved in 6 patients while 2 patients with TP turned out to have malignancies (primary lung cancer and metastasis from carcinoma of the thyroid gland). In the patient with hypothyroidism metastasis of breast cancer to the periphery of lung was detected later in the course. The results of this observational study suggest that, sometimes a TP may associate or hide an exudative etiology and even a malignancy. We found that primary and metastatic occult cancers of the lung may present with TP.

P41SURGERY OF ACUTE RUPTURE OF ACHILLES’ TENDON IN MARATHON MEN : RESULTS OF THE PLASTY BY PLANTARIS TENDON

Lotfi NouisriDepartment of Orthopedic Surgery, Military Hospital of Tunis, 1008 Tunis, TUNISIA

Aims: For the marathon men, the rupture of the Achilles’ tendon can condition their professional future ending in a decline of their competition level and military activity.There is no consensus on the treatment of acute ruptures of the Achilles’ tendon. We have chosen surgical treatment of the tendon using plantaris tendon plasty (Chigot’s procedure). This study analyses possibilities of functional recovery and complications in athletes.Patients and Methods : Between 1996 and 2005, we treated surgically 31 adults all males with a mean age of 37 years (range 28 to 51) for acute Achilles’ tendon rupture treated by plantaris tendon plasty to increase the tendon after it was suture. Two patients suffered from a superficial hematoma which had been desorbed. There was no deep vein thrombosis or pulmonary embolism and no recurrence.Results: The results were evaluated after an average of 4 years and 7 months, mean value of the calf atrophy was less than 2 cm: 93,5 % patients returned to previous activity levels and 80,6% returned to their usual sport activity.Conclusion: We insist on the respect of infallible rigor during surgery to reduce cutaneous complications, risks and the necessity of an early and progressive rehabilitation in post-operation.

P42GIANT MASS LESION RESULTING IN ACUTE RESPIRATORY GIANT SCHWANNOMA

Turgut Isitmangil, Saban Sebit, Oryal Erdik, Habil Tunc, Erdogan Kunter & Sukru Yi;dirimTURKEY

Tumors originating from the Schwann cells of the peripheral nerve sheath are called schwannoma. Schwannomas may also originate from the cranial or spinal nerve roots. Frequently they are located in the paravertebral sulcus of the upper posterior mediastinum and associated with an intercostal nerve or sympathic ganglion. A 63 years old female patient without a known systemic or pulmonary disease, except for morbid obesity (150 kg), admitted with acute respiratory failure and mechanical ventilation was initiated. Plain radiography showed a large homogeneous opacity in the right lower zone. Magnetic resonance imaging revealed a 13x12x12 cm mass lesion at the posteromedial of the right lower lobe, which was tightly contacting with the diaphragma, resulting in the atelectasis of the right lower lobe. Despite of 3 days of mechanical ventilation, respiratory function did not improve and emergency surgical intervention was indicated. The giant mass was totally resected through anterolateral thoracotomy and the diagnosis of schwannoma was established histopathologically. In the postoperative period cardiac and multi-organic problems evolved along with respiratory distress and efforts of weaning from ventilator were not successful. She died at the 5th day of the surgical procedure. Intrathoracic schwannomas are usually benign in nature and grow slowly. Symptoms may show up late in the course and increase gradually. To avoid unexpected complications and bad prognosis, as it was the case in our patient, early diagnosis and intervention is crucial.

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P43EVALUATION OF LUNG CANCER PATIENTS WITH SKELETAL METASTASIS

Erdogan Kunter, Orhan Turken, Gokhan Kandemir,Turgut Isitmangil, Zafer KartaloghuTURKEY

In general, cancer metastasis to the skeletal muscle is rare and metastasis of bronchogenic cancer is even rarer. In lung cancer, chest wall muscle invasion is relatively common but hematogenous skeletal muscle metastasis is not. In this study, we reviewed the published literature in English, including our two cases, to evaluate the clinical characteristics of the lung cancer patients presented with muscle metastasis. In the 38 reported cases, 28 male and 10 female, the age range (46-89) seemed not to be different from the age distribution of lung cancer patients in general, except for a 28 years old woman who developed juvenile lung cancer. Majority of the primary tumors were non-small cell, mostly squamous cell carcinoma and adenocarcinoma, in histological type. Although histological subtypes were not reported in some patients, the numbers of squamous cell carcinoma and adenocarcinoma cases were close to each other (14 and 12, respectively). Only one small cell and one large cell carcinoma had been reported. Regardless of the size of the lesion, all patients had the complaint of local pain due to muscle metastasis, except for a patient who had isolated asymptomatic skeletal muscle metastasis of small cell carcinoma. Lower extremities, thigh, upper extremities and paravertebral muscles were the most common sites for metastasis. The survival of the patients varied widely and seemed not to be different from other metastatic lung cancer patients. We suggest that pain in a skeletal muscle, with or without a palpable mass, may be the presenting sign of a metastatic lung cancer. Differential diagnosis between metastatic skeletal muscle carcinoma and primary soft tissue sarcomas is difficult. Imaging studies is not sufficient and histological examination is needed. In selected cases, wide excision with combined chemotherapy yielded unexpectedly good results.

P44MILITARY PHYSICAL THERAPY: RECENT COLLABORATION EXPERIENCE OF THE UNITED STATES ARMED FORCES WITH LATIN AMERICAN PARTNER NATIONS

Jose M FonsecaInternational Health Division, Office of the Command Surgeon, United States Southern Command, UNITED STATES OF AMERICA USA

This presentation will review and describe the growing military-to-military exchange and collaboration in the field of physical therapy and wounded warrior rehabilitation in support of combat and operational missions of partner armed forces within the Western Hemisphere. Topics to be discussed include description, discussion, and outcomes of exchange activities between forces that are: 1) facing the devastating effects of improvised explosive devices and strikingly similar associated poly-trauma injuries; 2) seeking to adopt or refine the application of the concept of the “soldier as tactical athlete” in military rehabilitation; and 3) searching for evidence-based approaches to maintain a fit and healthy personnel, prevent occupational injuries, and provide for the prompt and effective management of musculoskeletal injuries.

P45LEIOMYOSARCOMA OF PULMONARY ARTERY

Turgut IsitmanggilTURKEY

Pulmonary leiomyosarcoma (PLS) is a malign tumor originating from lung parenchyma, bronchial structures, or pulmonary vasculature. PLS may mimic primary lung cancer in clinical and radiological presentation. We present a case of PLS, which is a rare disease, in order to discuss its presentation, diagnosis and treatment. A 24 years old male patient presented with the symptoms of cough and right-sided chest pain. On physical examination respiratory sounds were diminished at the right lower zone and plain chest radiography showed a homogenous opacity at that site. Computerized thorax tomography showed a 10x7 cm mass lesion with a fluid density located at the superior segment of the right lower lobe (RLLSS). Thoracotomy revealed a cystic mass lesion originating from RLLSS and extending to the diaphragm. Since the frozen section examination of the specimen reported to be benign the lesion was resected. However, histopathologically the diagnosis of leiomyosarcoma of the pulmonary artery was established and right pneumonectomy was performed. At the 18th month, after a six course of postoperative chemotherapy, metastasis to liver and bone was detected. Chemo radiotherapy was performed. His quality of life was quite favorable until the 25th month after the surgery when he passed away. In general, the prognosis of PLS is poor and the primary treatment is surgery. However, we suggest that adding chemotherapy and/or radiotherapy to the surgery may be beneficial in some patients.

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P46IS IT IDIOPATHIC PULMONARY ARTERIAL HYPERTENSION DEVELOPED ON THE GROUNDS OF A FIBROTIC LUNG?

Erdogan Kunter et alTURKEY

Clinical classification of pulmonary arterial hypertension (PAH) may identify candidates for different treatment regimes, which might affect the prognosis. Here we present a case that looks like PAH associated with fibrotic lung whereas the clinical presentation and course suggest idiopathic PAH in nature. A 65 years old nonsmoker woman had been thoroughly investigated for the interstitial pattern and fibrotic changes seen in chest radiology and diagnosed with idiopathic interstitial pneumonia, via open lung biopsy 24 years ago. She had been followed up for 5 years without any radiological or clinical deterioration. Since, her laboratory and physiological findings were within normal limits, no treatment had been prescribed. She did not experience any difficulty in daily life and she could even go to long walks and jogging. In the year 2006, her complaints of fatigue, dyspnea and palpitation emerged and grew progressively. The diagnosis of PAH was established and she was put on supplemental oxygen, diuretics, calcium channel blockers, and warfarin treatment. Despite of rigorous treatments her pulmonary arterial pressure (PAP) increased gradually (80 mmHg, 95 mmHg, 105 mmHg in the years 2006, 2007, and 2008, respectively). Laboratory investigations showed no evidence of an autoimmune disease, vasculitis, sarcoidosis, atopy or any systemic disease. Radiological findings did not worsen during this period and were quite similar with the earlier reports. Her functional class was considered as NYHA III and oral bosentan (2x125 mg) treatment was added (it is now 9th month). She responded well and improved in terms of PAP (65 mmHg), oxygenation, 6 minutes walk distance, and brain natriuretic peptide levels. This case suggests that in some patients idiopathic PAH pathogenesis may take effect while other possible contributory factors are still present.

P47PREVALENCE OF CARDIOVASCULAR RISK FACTORS AMONG MILITARY PERSONNEL OF THE GARRISON OF KINSHASA M Mundu 1, K Kabanda 1, I Kakudji 1, S Munyampara 1, K M’buyamba 2, M Bodika 1, E Nzuka 1 & B Nsinga 1

1 Army Medical Service2 University of Kinshasa, CONGO

Objective: This study has evaluated the frequency of cardiovascular risk factors among Congolese military personnel, more particularly the prevalence of hypertension, fatness, tobacco addiction, physical inactivity, as well as consumption rates for alcohol, vegetables and fruits. Methods: The study has been targeted on 5000 militaries, of which 3471 (69.4%) have been examined in their military units. Socio-demographic and behavioral data have been collected thanks to the WHO standard questionnaire (STEP 1 and 2) adapted to the Army’s features. Calculation of mass corporal index and mean of blood pressure electronic measurements have been performed. The criteria for hypertension was a blood pressure ≥ 140/90mmHg and/or a notion of anti-hypertensive treatment.Results: In a population aged of 44±11 years, with 5% of females, the different prevalence rates of cardiovascular risk were: hypertension 30.6%, fatness 27.4%, addiction to tobacco 24.3%, physical inactivity 40.4%. Hypertension prevalence is directly linked to fatness. They both increase, as physical inactivity, according to the age and are predominant among generals and high-ranked officers, contrarily to tobacco addiction among low ranked personnel. Consumption of alcohol, vegetables and fruits were reported respectively for 60.9%, 75% and 15.9%.Conclusion: This heavy burden of cardiovascular risk factors among Congolese militaries underlines the emergency for implementing the available strategy applied for the prevention of non-transmissible diseases and their environment of morbidity, mortality and disability among Armed Forces.

P48A NEW PREDICTIVE EQUATION TO CALCULATE BASAL METABOLIC RATE IN MALAYSIAN ARMED FORCES PERSONNEL

Razalee Sidik 1, Poh Bee Kun 2 & Ismail Mohd Nor 2

1 Science Technology Research Institute for Defence, Ministry of Defence, MALAYSIA2 Department of Nutrition & Dietetics, Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia, MALAYSIA

Basal metabolic rate (BMR) is an essential element to derive estimates of energy requirements of a population. However, BMR values calculated from existing predictive equations usually differ from those measured by indirect calorimetry. This cross-sectional study was carried out to assess the BMR and to derive a BMR predictive equation for Malaysian Armed Forces (MAF) personnel. The subjects comprised of 79 trainees of the Royal Malaysian Navy (RMN) aged between 18 to 25 years, from a training centre (Group A) and on board a ship (Group B). The measurements taken include body weight, height, body fat, fat free mass and BMR as measured by indirect calorimetry using a canopy metabolic monitor system. The mean height, weight and body fat were 1.67 ± 0.04 m, 61.0 ± 3.9 kg, and 12.7 ± 2.5% respectively for Group A; and 1.67 ± 0.05 m, 62.3 ± 6.2 kg and 14.0 ± 3.5% respectively for Group B. The mean BMR for Group A (6.28 ± 0.40 MJ/day) did not differ significantly (p>0.05) from Group B (6.16 ± 0.67 MJ/day). The FAO/WHO/UNU (1985) and Henry & Rees (1991) equations overestimated the measured BMR by 9% (p<0.001) and 0.5% (p>0.05) respectively; while the Ismail et al. (1998) equation underestimated the measured BMR by 5.6% (p<0.001). A predictive equation for BMR was derived, that is, BMR = 3.316 + 0.047(W), where BMR is expressed in MJ/day and W is body weight in kg. We recommend that the predictive equation derived from this study be used to estimate energy requirements for MAF personnel.

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P49 MONITORING PERFORMANCE CHANGES WITH ON-BOARD DATA RECORDING SYSTEM

Grosz A 1, Hornyik J 2, Toth E 2 & Szatmari Á. 2

1 State Health Centre, Budapest, Hungarian Defence Forces, HUNGARY2 Institute For Aviation Medicine, Military Fitness and Research, Kecskemet, Hungarian Defence Forces, HUNGARY

Introduction: An important character of the aviation environment is psycho physiological stress which always changes the pilots’ cognitive performance. Its analysis also requires the monitoring of the parallel physiological events/phenomena.Method: As an objective variable, we monitored the changes in the medium frequency range of heart rate variability in 28 subjects with an on-board data recording system developed by our team. The subjects were tested with Schuhfried’s two hand coordination test in a laboratory environment. Heart rate variability was calculated from the recorded ECG and the RR-distances. As a subjective variable, the values of NASA’s TLX questionnaire were used to evaluate the results.Results: Our heart rate variability index significantly decreased during work activities with mental efforts.Conclusion: By using further psychological tests with different difficulty levels, stress tolerance and, partially, the individual’s psychological fitness-for flight can be determined from the changes of this parameter.

P50ANTHROPOMETRIC INDICES AND DEMOGRAPHIC PROFILE OF SMOKERS IN THE ROYAL MALAYSIAN NAVY PERSONNEL

Razalee Sidek 1, Poh Bee Koon 2 and Ismail Mohd Nor 2

1 Science Technology Research Institute for Defence, Ministry of Defence, MALAYSIA2 Department of Nutrition & Dietetics, Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia, MALAYSIA

Tobacco use continues to be a significant public health issue. Despite the alarming data concerning smoke-correlated health risks, the smoking habit is still widely present among Malaysian Armed Forces (MAF) personnel. The aim of this cross-sectional study was to determine the prevalence of smokers in a sample of 909 Royal Malaysian Navy (RMN) personnel, and to explore their association with anthropometric indices and demographic factors. This study, involving male personnel aged 18-50 years, was conducted at the three RMN bases in Peninsular Malaysia. Anthropometric measurements included height, body weight, waist circumferences (WC) and body composition measured using bio-impedance method, Tanita Body Fat (TBF-300A), Japan. Demographic data included age, bases, educational level, officer/enlisted status, and years of service in the RMN. Smoking measures included smoking status, which classified individuals as nonsmoker and current smoker. Results showed that the prevalence of smokers was 60 %. This study also revealed that subjects with smoking habits tended to be leaner than nonsmokers. The mean age, height, body weight, body mass index (BMI), body fat, free fat mass (FFM) and WC were 27.4 ± 6.0 years, 1.67 ± 0.05 m, 60.2 ± 6.6 kg, 23.5 ± 3.6 kg/m2, 21.9 ± 6.7%, 51.1 ± 5.7 kg and 81.2 ± 10.9 cm respectively for the smokers group; and 29.6 ± 6.8 years, 1.68 ± 0.05 m, 79.4 ± 8.9 kg, 24.5 ± 3.9 kg/m2, 23.4 ± 7.1%, 51.7 ± 5.89 kg and 83.6 ± 11.8 cm respectively for the nonsmokers group. Smokers had significantly lower body weight (p<0.001), BMI (p<0.001), percentage of body fat (p<0.05), FFM (p>0.05%) and WC (p<0.05) than nonsmokers. Univariate statistical analyses were employed to test whether the overall distribution of smokers and nonsmokers was similar across various demographic categories. Older subjects and officers, were more likely to be nonsmokers (p<0.001) while less educated subjects, particularly those with lower qualifications, were more likely to be smokers (p<0.05). The length of time a person had been in the RMN was also associated with smoking (p<0.001). Those who had been in the service for 16 or more years were more likely to be nonsmokers, while those in for one year or less were somewhat more likely to be smokers. Based on this study and the possibility of similar or perhaps higher smoking prevalence in other armed forces units, we propose that a special program aimed at decreasing the prevalence, with the long-term goal of smoking cessation, be instituted. Successful antismoking interventions are needed to help the MAF to maintain a physically fit force.

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P51ESTIMATION OF LABOUR CONDITIONS OF AVIATION SPECIALISTS BY ACTIVITY WITH NOISE AND MEASURES OF PROPHYLAXIS

I.V. Buchtiyarov 1, S.K. Soldatov 1, V.N. Zinkin 1 & V.N. Filatov 1

Russian Federation Defense Ministry, State Research Testing Institute of Military Medicine, Moscow, RUSSIA

Introduction: The problem of noise control is actual for Air Force. The actions spent for this direction still are insufficiently effective. In especially adverse conditions there is a technical-engineering personnel participating in service of flight vehicles by engine operation and an aircrew. Questioning of aviation specialists has shown, that the most adverse factors for them are acoustic noise (100% interrogated), exhaust gases of automobiles (81%), activity with fuels and lubricants oils (65%), microclimatic conditions (55%), microwave range of electromagnetic radiation (EMR) – 20%.Methods: Research of acoustic conditions on workplaces of aviation specialists conducted at service of flight vehicles during preflight preparation and during flights.Results: The level of a sound on workplaces of a technical-engineering personnel was in a range 95 dBA, an aircrew – 81-103 dBA. The sound pressure level (dB) in all octave bands at all types of airplanes exceeded EPL, except for an octave band with compound frequency of 31,5 Hz. The maximum of spectral density of sound pressure depends on type of flight vehicles. At bombers it fell to a range of octaves with compound frequencies of 2000-4000 Hz, at fighters – 500-4000 Hz, at helicopters and transport airplanes – 250-4000 Hz, at airplanes of a long-range aviation – 31,5-63 Hz. The equivalent noise level changed from 94 up to 121 dBA, that exceeds EPL (85 dBa). The noise dose changed from 8 to 4112 con. units.Conclusion: Necessary measures on perfection of flight vehicles as source of generation of noise and infrasound, means of protection from them and prophylaxis of adverse action are proved. Preliminary tests of developed samples of individual protective devices (IPD) from noise (anti-noise headphones and anti-noise helmets) have shown their good acoustic efficiency in the field of sound frequencies and an infrasound.

P52SIGNAL DETECTION UNDER TIME CONSTRAINT: AN INTERESTING RESULT

Grosz A 1, Hornyik J 2, Toth E 2 & Szatmari Á 2

1 State Health Centre, Ministry of Defence, Budapest, HUNGARY2 Institute For Aviation Medicine, Military Fitness and Research, Kecskemét, Hungarian Defence Forces, HUNGARY

Introduction: In flight and on the ground, the pilots’ actions are fundamentally influenced by the complex visual stimuli extracted from the actual environment.Method: In the signal detection test, which simulates a complex environment of visual stimuli and expects decisions under time constraint, subject has to recognize a geometrical shape in the white dot pattern in the four black screen quadrants. It also measures the number of correct and incorrect reactions, detection time, and the number of crucial stimuli not detected. We chose 5500-m hypobaric hypoxia in a darkened pressure chamber as a stressor. 42 subjects performed the task in 14-member control and test groups at 0 and 5500-m altitudes in two runs. Results: The performance indices recorded at 5500 m did not differ significantly from those taken at 0 m. The pilots preferred accuracy to speed. Their majority preferred the top left quadrant of the screen, and neglected the lower right one.Conclusion: In the helicopter type they fly, the most frequently checked flight instruments are located in the top left quadrant of the instrument panel, while the bottom right one includes indicators emitting acoustic signals. This non-pathological result occurred due to habitual fixation and not due to a decrease in performance caused by hypoxia.

P53EFFECT OF COUNSELLING ON EXERCISE PRACTICES AMONG MALE SOLDIERS WITH TYPE 2 DIABETES

Maznorila Mohd 1, A.Fatimah 2 & Idris Mohd Nor 3

1 Health Services Division, Malaysian Armed Forces, MALAYSIA2 Nutrition and Dietetics Department, Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia, MALAYSIA3 Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, MALAYSIA

A beneficial effect of regular exercise in patients with type 2 diabetes has been proven in many clinical publications. It has been shown to improve insulin sensitivity and assist in controlling blood glucose level and hence it becomes important in treatment and prevention of diabetic complications. A cross sectional study was carried out in Malaysian Armed Forces clinics to evaluate the effect of counselling on exercise practices among male soldiers with type 2 diabetes. A total of 52 subjects were involved in this study which was conducted in three phases. The duration in between phases was 3 to 4 months. Data was obtained using anthropometric measurement, blood analysis and questionnaires. Subjects were asked questions based on the prepared questionnaires using face to face interview techniques. Exercises were defined as suggested by Laakso et al (1985). The result revealed that at the beginning of the study only 59.6% of the subjects exercise regularly. The effectiveness of the counseling was evident when there was an increment in the percentage of subjects involved in the exercise. There was a rise in phase II to 67% and continue to rise at the end of the study to 73%. However, the differences did not achieve statistical differences at the 0.05 level. This may be due to the duration of the study which is too short to see any significant changes in the attitude of the diabetic patients toward exercise. Nevertheless, the subjects had shown a good glycaemic control at every phase. The mean of HbA1c at the beginning of the study was 8.2 ± 4.0% then reduced to 6.8 ± 3.3% and to 6.6 ± 2.6% in phase II and phase III respectively (p < 0.05). However, there was no statistical test done to see the correlation between exercise and glycaemic control due to a limitation in getting the correct value of exercise duration and its intensity. The improvements in HbA1c in this study perhaps were confounded by lifestyle changes.

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P54ENERGY AND NUTRIENT INTAKES: A SURVEY ON SOLDIERS ENGAGING IN PATROLLING ACTIVITIES

Maznorila Mohd 1 & L.Maurice 2

Health Services Division, Malaysian Armed Forces

Activities of the soldiers could be as sedentary as in civilian life or as heavy as in combat activities. In the course of their duties, they may be exposed to extreme heat or cold. The soldiers’ diet requires a careful planning for the maintenance of health and well-being under a wide range of activity and environment (Freidemann, 1959). The purpose of this study was to evaluate the soldiers’ energy and nutrient intake when performing security surveillance’s duty. A total of 50 soldiers from 4 islands in the east coast of Sabah were selected for this study. Due to a logistic limitation, data on anthropometric, food intake and activity pattern were recorded during a one day stay on each island. No measurement was taken on subjects’ weight or height as an anthropometric data was collected by interviewing the subjects. Dietary intake was assessed using the 24-hour dietary recall. Subjects recorded their one day activities in the 24-hour physical activity form. The mean age of the subjects was 28.5 years. The mean weight, height and body mass index were 63.2 kg, 1.70 m and 22.0 kg/m2 respectively. Average energy intake was 2498 kcal/day. 60% of the calories came from carbohydrates whereas protein and fat contributed about 15% and 25% of the calories intake. The proportions of calories derived from macronutrients were within the recommendations for a healthy diet for Malaysian. On average, the energy spent by the subjects in a day was 2462 kcal. The finding of this study revealed that the energy intake and expenditure were balanced. This is not a surprise considering 79% of the day subjects were in sedentary activities. The finding of this study indicate that the present military ration provide enough energy for the surveillance activity on the islands.

P55CAPABILITIES OF THE RUSSIAN ENGINEERING MEANS OF AERO MEDICAL EVACUATION ON RENDERING EMERGENCY MEDICAL AID IN EXTREME SITUATIONS

I.V. Buchtiyarov 1, V.R. Medvedev 1, N.V. Stremedlovsky 1, I.V. Kova 1 , A.I. Ivanyus 1, V.I. Saltan 1 & L.V. Karas 1

1 Russian Federation Defense Ministry, State Research Testing Institute of Military Medicine, Moscow, RUSSIA

In conditions of absence of medical establishments near the region of emergency situations (ES), absence and/or damage of transport communications at liquidation of medico-sanitary consequences of ES mobile medical complexes on modern technical base, with necessary equipment have crucial importance. Teamwork of leading experts of the Ministry of Emergency Situations of Russia, Russian Federation Defense Ministry, the Ministry of Health and Social Development and the industries has allowed to develop in the shortest terms special medical modules (further - Modules) to equip additionally helicopter MI-8 and an airlane IL-76 TD to conduct ground and special flight tests of Modules to form packages of the design and operational documentation. Definite steps are made in simplification of a medical evacuation of the Russian citizens from abroad, overcoming of passports and visas barriers, customs execution of medical equipment. So, during short time tens damaged in ES, occurred at the end of 2008 in Egypt, Israel, Russia and in the beginning of 2009 - in Vietnam, have received a well-timed exhaustive medical care in medical establishments of the country. As have shown the conducted calculations and small already practical experience, the medical brigade rendering qualified reanimation help of the evacuated persons directly onboard of the flight vehicle, should consist as a minimum of the doctor reanimatologist and two medical nurses. Mean duration of stay the wounded on evacuation transport means makes not less than 6 hours, i.e. medical experts should be ready to a long-period operation, is especial at an evacuation airplanes like IL-76 TD.Maximum available time of Modules for activity: helicopter - up to 20 min., airplane -up to 40 min. It is necessary to note, that Modules possess their own technological systems of maintenance: an electrical power system and the medical system of oxygen supply. The medical equipment is certificated and allowed to application onboard of flying vessel, stable to climatic effects, including tropical climate regions in an atmosphere of any types, provides electric safety, electromagnetic compatibility with airplane’s and helicopter’s equipment.

P56INTRAOSSEOUS INFUSION DEVICES FOR VASCULAR ACCESS IN COMBAT CASUALTIES: SPANISH MILITARY HEALTH CORPS EXPERIENCE IN AFGHANISTAN

Carlos R. Moro 1, Ricardo Navarro 1

1 Health Military School. Spanish Health Corps, SPAIN

The most affected anatomical locations of the wounds of combat casualties are the extremities where the usual insertion sites may be involved in the injury. For the military, such observations have important implications toward the development of optimal fluid resuscitation strategies under austere battlefield conditions for stabilization of the combat casualty.Objectives: The goal is to show the Spanish Military Health Corps experience in the use of intraosseus infusion devices in combat area. Patient and methods: This is a case series n=25 patients with n=30 introsseus infusion devices. The (BIG Bone Injection Gun) was the employed device.Patients: Casualties with firearm or explosive wounds or trauma patients in Regional Command West, Afghanistan between March 2007 and June 2008. Results: This technique was employed over 19 of the 25 patients in pre-hospital evacuation (during flight). 30 needles were used. We got a good peripheral intraosseus line in 76% cases. Conclusions: In our experience, the use of intraosseus infusion devices is advisable for the military in the management of the traumatic patient. The complications observed in our case series were similar to others registered in literature about the use o intraosseus infusion devices in military.

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P57HUMANITARIAN AND CIVIC ASSISTANCE IN THE AMERICAS: THE EXPERIENCE OF OPERATIONS CONTINUING PROMISE 2009 AND 2010

Miguel A. CubanoUnited States Navy, Medical Corps, UNITED STATES OF AMERICA

For the last 3 years the United States of America has engaged in large scale humanitarian and civic assistance operations from both its West and East Coasts with the use of naval vessels geographically located in the Western Hemisphere. This brief will focus on OPERATION CONTINUING PROMISE 2009 and OPERATION CONTINUING PROMISE 2010, humanitarian missions involving the hospital ship USNS COMFORT and the USS WASP respectively. Finally, the brief will highlight the growing importance (and participation) of partner nations and non-governmental organizations in executing these high-visibility deployments. Data and preliminary assessments of the impact of these operations in the region will be presented and discussed

P58A SIMPLE BLOOD PRESERVATION TECHNIQUE IN ABDOMINAL AORTIC ANEURYSM REPAIR

Ibrahim Alp 1, Ahmet Turan Yilmaz 1, Bilal kaan Inan 1, Alper Ucak 1, Oral Hastaoglu 1 & Murat Ugur 1

1 Gulhane Military Medical Academy, Haydarpasa Training Hospital, TURKEY

Objective: Allogenic blood transfusion has many morbidity and mortality risks in all surgical era. Many different blood preservation techniques were tried and taken place in the literature. Especially autotransfusion with the use of cell saver devices strikingly decreases allogenic blood transfusion. But cell savers are not used routinely in elective AAA surgery. Here, we present a blood preservation technique that we used in an elective huge AAA surgery. Case: In a 68 year old patient with a 8 cm infrarenal AAA, we calculated that a 350cc blood within the aneurysm sac by PXr2Xh formula. Operation was done with a conventional transperitoneal approach. For blood preservation after systemic heparin administration and vascular clamps, with a 14G needle and a 50 cc syringe about 350 cc blood was aspirated within the aneurysm sac. This blood was transfused to the patient from the central jugular route by the anesthesiologist.We did not use any other blood products during the operation. The postoperative course was uneventful and the patient was discharged at 7th postoperative day.Result : During this procedure the choice of the aspiration site should be plaque and thrombus free. The surgeon must be sure about the lumen. During puncture destroying a plaque could result cholesterol embolization. Transfusion via a central venous route would lower the risk of systemic embolization of any kind of particulate. We believe that this preservation technique could be safely used in all kind of suitable AAA cases for lowering the need for blood transfusion.

P59RECURRENCE AND COMPLICATED SOLITARY FIBROUS TUMOR OF THE PLEURA

Fatih Candas 1,Rauf Gorur 1, Hasan Turut 1, Nurettin Yiyit 1, Onur Sildiroglu 2 & Turgut Isitmangil 1

1 Department of Thoracic Surgery, GMMA Haydarpasa Training Hospital, Istanbul,TURKEY2 Department of Radiology, GMMA Haydarpasa Training Hospital, Istanbul, TURKEY

Background: Solitary fibrous tumor of the pleura (SFTP) is a rarely entity which may have different radiological shape and clinical symptoms. SFTP of the pleura arises from the visceral pleura on a stalk and project into the pleural cavity in a pedunculated manner. The origin of the tumors is now believed not to be mesothelial but rather submesothelial. Complete surgical resection is the optimal treatment but sometimes occurs local recurrences and distant metastasis. Patient: We herein describe a 23 year-old man with local recurrenced SFTP. He had chest pain and dyspnea. The diagnostic work-up including chest x-ray, revealed a large solitary mass of the invaded bilaterally hemithorax. Computed tomography of the thorax confirmed the presence of well delineated, solid mass of 23 x 11 cm. It was adjacent to the vertebral column, oesophagus and descendant aorta. Magnetic resonance imaging showed any vascular and spinal invasion. Surgical resection of the mass was performed through a right lateral thoracotomy. Complete resection was performed. Histological examination of the specimen showed a SFTP. The patient had chylothorax in early postoperative period. The patient had reoperated for ligation of ductus thorasicus but chylous drainage continued after the operation. We performed conservative procedure such as cut oral nutrition and performed parenteral nutrition with intravenous somatostatin. After than radiotherapy performed but chylous drainage continued. At last chylous drainage was stopped and groved encapsulated mass. One month later encapsulated mass resolved spontaneously. At six months follow-up the patient is free from recurrences or complications and without clinical manifestation. Conclusion: Complete surgical resection can achieve at recurrenced SFTP with satisfactory outcomes. But careful dissection need to be performed to avoid postoperative complications.

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P60MITOCHONDRIAL MUTATION IN IRANIAN PATIENTS WITH MULTIPLE SCLEROSIS, CORRELATION BETWEEN HAPLOGROUPS H, A AND CLINICAL MANIFESTATIONS

Mojdeh Ghabaee 1, Motahar Omranisikaroudi 2, Ali Majidi 3 & Hadi Shirzad 1 1 Department of Neurology, Iranian Center of Neurological Research, Tehran University of Medical Sciences,2 Department of Neurology, Iranian Center of Neurological3 Research, Tehran University of Medical Sciences, Neurology, Tehran, IRAN

As multiple sclerosis (MS) has long been known to be associated with Leber, hereditary optic neuropathy (LHON), a disease caused by mitochondrial (mtDNA) mutations, in this study we assessed possible involvement of mtDNA point mutation in MS patients. Fifty-two MS patients whose disease was confirmed with revised McDonald criteria and referred to Iranian Center of Neurological Research of Imam Khomeini hospital during 2006–2007 entered the study. Secondary mtDNA mutations,age, gender, clinical disability according to expanded disability status scale (EDSS), course of the disease, and presenting symptoms were the variables investigated in this study. DNA purification was performed by Diatom DNA Extraction Kit. Analysis of data was done by SPSS V11.5. The prevalent mutations with frequency of 19.2% were J, L, and T haplogroups. Haplotype A was more prevalent in patients with younger age of onset (P-value = 0.012) and high proportion of haplogroup H was associated with optic nerve involvement (P-value = 0.015). No motor symptoms were seen in haplogroup H patients. There is no significant relationship between duration of the disease and EDSS in different mutation of mtDNA.

P61ANALYSIS OF 562 ENDOSCOPIC THORACAL SYMPATHECTOMY OPERATIONS PERFORMED FOR PALMAR HYPERHIDROSIS AND LONG-TERM RESULTS

Rauf Gorur 1, Akin Yidizhan 1, Nurettin Yiyit 1, Huseyin Sen 2, Hasan Turut 1, Fatih Candas 1 & Turgut Isitmangil 1

1 Department of Thoracic Surgery, GMMA Haydarpasa Training Hospital, Istanbul,TURKEY2 Department of Anesthesiology, GMMA Haydarpasa Training Hospital, Istanbul, TURKEY

Background: Palmar hyperhidrosis (PH) is a frustrating condition both physically and psychologically. Presently, endoscopic thoracal sympathectomy (ETS) is the treatment of choice for PH. In this study, we aimed to assess the 562 ETS operations carried out for PH and the long term outcomes with the relevant literature.Methods: Between January 1999 and December 2008, 562 ETS operations were performed to 389 patients (383 male and 6 female) and were retrospectively analyzed. The ages of the patients were from 20-33 years with a mean age of 22.1. Of the 389 patients, 42 of them underwent bilateral sympathectomy in one stage, 347 had seperate procedures as right / left (or bilaterally) hemi thoraces underwent sympathectomy. The resection of T2-3 ganglion and cauterization of Kuntz nerve endoscopically with the aid of two ports. Patients were evaluated with respect to the surgical technique, complications occurred during or after the operation and the patient satisfaction. Patient satisfaction was evaluated according to the data gathered from the answers of the questionnaire via the telephone calls. Results: Early or late operative mortality was not observed. A total of 86 patients had complications with an overall morbidity rate of 22 %. Seventy-seven patients developed compensatory sweating in any part of the body. Nine patients (2.3 %) developed transient Horner’s Syndrome. Operative morbidity rate was 3.2 %. Early postoperative outcomes were excellent with only three recurrences of hyperhydrosis and almost full satisfaction of the patients. Patients were followed-up with an average of 34.6 months (range; 4-91 months). A total of 6 patients declared a partially satisfaction from the operation, whereas 3 patients were dissatisfied.Conclusion: ETS should be the choice of treatment in palmar hyperhidrosis with lower operative morbidity rates and higher postoperative satisfaction. We think that this operation can be performed safely and esthetically with the aid of two thoracoports.

P62SEVEN SEAS MEDICAL EXPERIENCES WITH ROYAL MALAYSIAN NAVY MAIDEN SAIL AROUND THE GLOBE.

Mohamed Zaki Mohamed MokhtarHealth Services Division, Malaysian Armed Forces, MALAYSIA

The prestigious Tall Ships’ Races was conducted again in the Baltic in 2007. The Royal Malaysian Navy (RMN) made a history by taking m challenge and participated for the first time in such a great sailing event. After that, it continued sailing around the world and visited 30 countries.. Two Ship Medical Officers (SMOs) had been entrusted to provide the best healthcare services to the crews onboard Royal Sailing Ship Tunas Samudera of the RMN throughout the 412 days of historical sailing.The role of SMOs included: 1. Pre sailing crews’ medical and dental screening, fitness and BMI assessment , crews’ vaccination and preparation all medical equipment.2. During sailing - taking daily sick report and monitoring of supplement intake for all crews.3. Standby for 24 hours if any medical and dental emergencies throughout the journey including CASEVAC if necessary.4. Conduct official visits to medical counterpart during Port Courtesy calls at the respected Naval Port Hospitals.5. Maintaining daily Ship Medical Officers Log book.6. Advising the Ship Captain on any occupational and safety related issues that may affect the crews’ performance.

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P63STENTLESS BIOPROSTHESIS PROVIDED EXCELLENT HEMODYNAMIC PERFORMANCE IN A MILITARY SCUBA DIVER WITH INFECTIVE ENDOCARDITIS

Mert Dumantepe 1, Ahmed Umit Gullu 1, Gurkan Komurcu 1, Bilal Kaan Inan 1 & Ahmed Turan Yilmaz 1

1 Guhane Military Academy of Medicine, Haydarpasa Training Hospital, TURKEY

Infective endocarditis is a diagnostic and therapeutic challenge that ultimately requires surgical intervention in 20% of all cases. Surgical treatment of active infective endocarditis requires not only hemodynamic repair, but also special emphasis on the eradiation of the infectious focus to prevent recurrence. This goal can be achieved by the combination of aggressive debridement of infective tissue and appropriate and adequate antibiotic treatment. We report a case of Streptococcus viridans induced aortic valve perforation related to aortic valve and root endocarditis, which was successfully treated with aortic root replacement using stentless bioprosthesis. This bioprosthesis thus seems to be a valuable option for active endocarditis, provides excellent hemodynamics with low gradients. Acceptable operative risk can be achieved by full root stentless valve replacement in physically active patients such as military staff.

P64VERTICAL RAMUS DISTRACTION IN SHEEP WITH ‘HEMIFACIAL MICROSOMIA-LIKE’ DEFORMITY

Sharifah Azlin Juliana Syed Zainal 1 , Rumaizi Shaari 1 & Alastair N.Goss 2

1 Armed Forces Dental Center, Kem KEMENTAH, Jalan Padang Tembak, 50634 Kuala Lumpur, MALAYSIA1 Oral & Maxillofacial Surgery Unit, Adelaide Dental Hospital, AUSTRALIA

Purpose: Distraction osteogenesis is a well-known method for correcting facial deformities. However, the method lacks long term data especially on relapse. The aim of this study was to create ‘hemifacial microsomia-like’ deformity on lamb via vertical ramus distraction. The incidence of relapse was then evaluated via direct bony and radiological measurements and related to histological and histomorphometric analysis over variable post-distraction periods.Methods: Thirty ten-week-old Merino lambs were used in this study. A hemifacial microsomia-like deformity was created on the right side via a masseteric myotomy and a condylectomy. Three months later the abnormality was represented by a midline shift to the affected side. Marker screws were placed on both sides of the mandible to investigate the changes in the vertical and horizontal components of the mandible. The left side acted as the control side. Vertical ramus distraction using Mathys distractor was commenced after a latency period of seven days and distraction was performed at a rate of 1mm/day until the distracted gap was 10mm on the radiograph. The sheep were divided into eight groups with different consolidation / remodelling and sacrifice periods. Investigations included radiological analysis and direct measurements of the vertical screws, histological and histomorphometric evaluation of the hard tissue changes.Results: A statistically significant increase in the vertical ramus height of the experimental sides was achieved at post-distraction and at sacrifice. Complete bony maturation was noted at twelve weeks. Relapse was documented in the vertical height when the distractor was removed at two months.Conclusion: This study showed that a model of ‘hemifacial microsomia-like’ deformity in lambs can be created and vertical ramus distraction used to correct it. The results suggest that longer consolidation periods of up to three months are advisable for vertical ramus distraction. The presence of relapse indicates that patients with craniofacial deformities may still require additional surgery even after successful distraction procedures.

P65FUNCTIONAL OUTCOMES AND RETURN TO SPORT AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN A MILITARY GROUP

Rohani Haron 1 , Zainal Othman 2, Hamid Ahmad 2 & Zati Hulwani Ahmad Foa’ad Mathew 2

1 Faculty of Health Sciences, UiTM, MALAYSIA2 94 Armed Forces Hospital, Terendak Camp, MALAYSIA

Introduction: Return to pre-injury activity level in post-ACL reconstruction (ACLr) is common. However, numerous patients still show a decrease in their activity level. This study investigated correlation between functional outcomes and return to sport (RTS) among the military group after 6 months of ACLr, and correlation between functional outcomes and duration from injury to ACLr.Method: Seven military personnel with ACLr at Hospital Angkatan Tentera, Terendak Camp, participated voluntarily in an experimental study involving single-leg hop test, weight bearing test evaluated by using force platform, completing the questionnaires on demographics, ACL injury background, problems and confidence to RTS, Subjective IKDC, Lysholm Knee Score, and Tegner Activity Scale. Results: Five out of 7 had fear of reinjury. Their confidence levels to RTS ranged from 0% to 85%. Significant correlation existed between functional disability and functions as well as symptoms (rs = 0.927, p=0.003), functions as well as symptoms and functional performance (rs = 0.937, p = 0.002), and functional disability and functional performance (rs = 0.901, p = 0.006). No significant correlation between functional outcomes and duration from ACL injury to surgery, and between functional outcomes and RTS.Conclusion: Psychological strength enable majority of them RTS although their confidence level is lowered. Future research on reducing fear in return to work and sports by subjective evaluation and dynamic analysis at different time interval after ACLr is needed.

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P66ORAL HEALTH STATUS AND IMPACTS AMONG FIRST YEAR CADETS OF NATIONAL DEFENCE UNIVERSITY MALAYSIA

Mohd Rosli Majid & Ishak Abdul RazakHealth Services Division, Malaysian Armed Forces, MALAYSIACommunity Dentistry Department, Faculty of Dentistry, University of Malaya , MALAYSIA

The aim of the study was to determine the oral health status and oral health impacts among UPNM first year cadets. The objectives of this study were; (1) to assess the perceived oral health status, satisfaction with oral health and perceived need for treatment among first year cadets in UPNM, (2) to assess their level of caries (DMFS), (3) to assess their level of periodontal disease (CPI) and (4) to assess the oral health impact of oral diseases in the group by using the Oral Health Impact Profile (OHIP). This is a cross-sectional survey of the UPNM first year cadets where data was obtained through oral examination (DMFS and CPI) and self administered questionnaire survey (about demographic, perceived oral health, satisfaction with oral health, perceived treatment need and Oral Health Impact). Three hundred and thirty UPNM first year cadets in Sg Besi campus were involved in this study. The prevalence of caries free and periodontally healthy subjects were 40.6% and 5.8% respectively. The mean DMFS was 3.07 of which 16.3% is accounted for by decayed surfaces. Females had higher DMFS than males. Nine out of ten cadets had calculus present and 16.7% required complex periodontal treatment. Overall, 36.7% of the subjects had often or very often experienced at least one oral health impact due to teeth, mouth, and denture problem in the last one year. The three OHRQoL domains most commonly affected were functional limitation, physical pain and psychological discomfort. Social disability had the lowest domain impact among the cadets. The impacts which were very often or quite often experienced by the subjects were discomfort due to food getting stuck (24.8%), had ulcer (9.7%) and bad breath (5.8%). Cadets who were free from oral diseases (caries and periodontal diseases) had lesser oral health impact. About three quarters of them perceived they needed dental treatment and it is significantly related with caries status and OHRQoL. It is concluded that there is low level of caries, high level of periodontal diseases and moderate oral health impacts among the cadets. It is recommended that hygienist be stationed in UPNM to assist dentist to manage the high level of periodontal problems encountered.