The Walter Reed Army Medical Center (WRAMC)—known as Walter Reed General Hospital (WRGH) until 1951—was the U.S. Army's flagship medical center from 1909 to 2011. Located on 113 acres (46 ha) in the District of Columbia, it served more than 150,000 active and retired personnel from all branches of the military. The center was named after Major Walter Reed (1851–1902), an Army physician who led the team that confirmed that yellow fever is transmitted by mosquitoes rather than direct contact. Since its origins, the WRAMC medical care facility grew from a bed capacity of 80 patients to approximately 5,500 rooms covering more than 28 acres (11 ha) of floor space. WRAMC combined with the National Naval Medical Center at Bethesda, Maryland in 2011 to form the tri-service Walter Reed National Military Medical Center (WRNMMC). The grounds and historic buildings of the old campus are being redeveloped as the Parks at Walter Reed.
Background: Pediatric osteoid osteomas of the cervical spine are rare, representing a unique diagnostic and therapeutic challenge due to their proximity to critical neurovascular structures. Although benign, these bone-forming tumors can cause significant pain and functional limitation, often necessitating intervention. Lesions involving the axis, particularly at the base of the dens, require careful management given their relationship to the spinal cord and stabilizing elements of the craniovertebral junction. Case Description: We present a 9-year-old female with a 1-year history of progressive upper cervical pain refractory to medical therapy. Imaging demonstrated an osteoid osteoma of the axis at the base of the dens, with interval growth on surveillance studies. Given the lesion’s location and concern for preserving atlantoaxial stability, the patient underwent transoral resection, allowing direct midline access while minimizing disruption of posterior stabilizing structures. Gross total resection was achieved without complication. The accompanying surgical video demonstrates key steps of the transoral approach, including exposure, identification of midline landmarks, and lesion excision. Informed consent was obtained, and IRB approval was not required for this single-patient case report. To the best of our knowledge, a surgical video of this approach for dens-based osteoid osteoma has not been previously described and provides a focused illustration of relevant anatomy and technique. Conclusion: Osteoid osteomas of the dens in pediatric patients are rare and require a tailored approach that balances complete resection with preservation of stability. The transoral approach remains a valuable corridor for select midline craniovertebral lesions. This video contributes a practical technical reference to the limited literature on this approach.
This clinical practice guideline from the American Society for Gastrointestinal Endoscopy provides evidence-based recommendations regarding the role of endoscopy in the diagnosis and management of acute lower GI bleeding (LGIB). This document was developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. In the broad context of acute LGIB, this guideline addresses the use of colonoscopy versus CT +/- angiography as the first modality, urgent versus nonurgent colonoscopy, and prepped versus unprepped colonoscopy. For diverticular bleeding in particular, this guideline assesses endoscopic band ligation versus clipping and direct clipping of the bleeding site or vessel versus indirect clip closure of the diverticulum. All of these clinical questions were answered using the GRADE framework. The guideline also discusses the roles of upper endoscopy and surgery in the setting of acute LGIB and outlines the absolute and relative contraindications of colonoscopy. Finally, the guideline provides an overview of available endoscopic modalities to treat LGIB, with special attention to the evidence supporting the use of specific modalities according to lesion type. A summary of recommendations is provided in Table 1.
INTRODUCTION:During interwar transition periods, military medical volume, particularly surgical volume, declines dramatically. The Knowledge, Skills, and Abilities (KSA) metric was developed to assess "readiness" and the ability of the Military Treatment Facilities (MTFs) to prepare active duty (AD) surgeons for deployment. The KSA metric, or threshold for readiness, has not been validated externally. We seek to provide that validation by comparing KSA statistics of the military neurosurgery community to those of civilian neurosurgeons at level 1 civilian trauma centers. MATERIALS AND METHODS:The Carepoint Health Data base compiles KSA totals for each surgeon over a 12-month period for their current stationed MTF. Forty-six AD attending neurosurgeons were included for the 2022 calendar year. To determine reliability of the Carepoint database, we secondarily analyzed the 2023-2024 academic year case logs of every AD neurosurgeon at 2 individual MTFs (N = 11). Civilian neurosurgeon KSA data was compiled by evaluating the case logs of neurosurgeons from 4 level 1 trauma centers (N = 29). We additionally utilized the database to analyze local Purchased Care Markets for each of the neurosurgery supported MTFs during that year to explain the historically low case volumes at the MTFs. RESULTS:In 2022, the average KSA per AD neurosurgeon per month was 393, extrapolated to 4,725 annually. Two of the 46 surgeons reached the KSA threshold. For the 2023-2024 academic year, the average AD military annual KSA was 3,192 (N = 9) and the average civilian KSA was 11,272 (N = 29) (P < .0001). Twenty-four of the 29 civilian surgeons met KSA goal 8,000; none of the AD surgeons met goal. Total neurosurgical KSA in Purchased Care was 3,01,535 compared to 1,39,005 for all MTFs. Operative cases were 7,324 deferred to the civilian sector compared to 2,286 performed at MTFs. CONCLUSIONS:The KSA Metric is a reasonable and attainable readiness standard based on civilian level 1 trauma center statistics but does have its limitations. The current MTF neurosurgery case volume does not support wartime readiness as described by the KSA Metric.
OBJECTIVE:To compare the efficacy of incobotulinumtoxinA to onabotulinumtoxinA for the treatment of idiopathic overactive bladder syndrome. METHODS:This study is a single-blinded, randomized, non-inferiority trial. Participants received intradetrusor injections of either 100 units of incobotulinumtoxinA or 100 units of onabotulinumtoxinA. The primary outcome was measured as a change in the mean number of urgency urinary incontinence episodes from baseline to 2-6 weeks post-procedure. RESULTS:Data from 59 participants were analyzed (29 incobotulinumtoxinA, 30 onabotulinumtoxinA). Most participants were between 40 and 59 years of age and postmenopausal. There were significantly more postmenopausal participants in the onabotulinumtoxinA group (51.72% incobotulinumtoxinA, 80% onabotulinumtoxinA, P<.05). Comparing incobotulinumtoxinA to onabotulinumtoxinA, the difference in mean reduction of urgency urinary incontinence episodes from baseline to 2-6 weeks post-treatment was 0.41 (90% confidence interval -0.88 to 1.71), meeting the predetermined non-inferiority margin of -1. The mean daytime voids decreased by 0.97 ± 2.54 from baseline of 7.28 ± 2.77 in the incobotulinumtoxinA group, and by 2.97 ± 4.74 from baseline of 9.57 ± 5.61 in the onabotulinumtoxinA group (P<.05). The Patient Global Impression of Improvement scores were significantly different between the 2 groups (2.57 ± 1.34 IncobotulinumtoxinA, 1.93 ± 0.83 OnabotulinumtoxinA [P<.05]). However, the number of participants answering "very much better" and "much better" was similar between the groups (64% IncobotulinumtoxinA, 71% OnabotulinumtoxinA). There was no statistically significant difference in other secondary outcomes or with adverse events between the 2 groups. CONCLUSION:Intradetrusor incobotulinumtoxinA was found to be non-inferior to onabotulinumtoxinA in the treatment of idiopathic overactive bladder syndrome and offers a more pure, cost-effective, and logistically convenient alternative.
Syphilis is known to mimic other disease presentations, but is seldom documented as mimicking autoimmune hepatitis with positive autoantibodies. We present a case of a 34-year-old male on pre-exposure prophylaxis (PrEP) for HIV with prior negative syphilis screening presenting with epigastric pain and constitutional symptoms. He endorsed anal sex practices with a monogamous male partner. Laboratory testing revealed elevated aminotransferases, alkaline phosphatase, and bilirubin, along with positive smooth muscle antibodies. A rapid plasma reagin and treponemal antibodies were reactive. He was treated with benzathine penicillin G with resolution of liver function derangements and autoimmune titer elevations.
