Cutaneous sarcoma: a review and practical approach to management.

Sarcomas arising in the skin are rare but potentially fatal. These tumours originate from mesenchymal cells and can be divided between those that arise in soft tissue and those arising from bone. General guidelines exist for the management of soft-tissue sarcomas; however, there are no specific guidelines for cutaneous sarcomas. Current literature was reviewed for management of seven cutaneous sarcomas including atypical fibroxanthoma, pleomorphic dermal sarcoma, dermal and subcutaneous leiomyosarcoma, dermatofibroma sarcoma protuberans, Kaposi sarcoma, cutaneous angiosarcoma and malignant peripheral nerve sheath tumour. All suspected sarcomas should be discussed in a sarcoma multidisciplinary team meeting. This article is not a clinical guideline but should serve as a practical summary of how these tumours present, how they are recognized histologically, and how best to manage and follow-up patients. The aim is to support clinicians and facilitate the best and most evidence-based standard of care available.

Phantom menace: novel psychoactive substances and the UK Armed Forces.

Novel psychoactive substances (NPS) encompass a large group of synthesised compounds specifically designed to mimic traditional recreational drugs. Current UK Armed Forces compulsory drug testing does not screen for these substances, making them tempting to the small proportion of UK Armed Forces personnel who indulge in recreational drug use. The acute and chronic sequelae of NPS misuse are widely variable and associated with high morbidity. In this paper, we discuss NPS pharmacology and clinical presentation. We describe toxidromes and management of patients who have misused NPS.Finally, we reflect on the legal, ethical and military consequences of NPS misuse for both the service person misusing NPS and the Military Physician providing their care.

Hypertension in the military patient.

Hypertension and hypertension-related diseases are a leading cause of morbidity and mortality worldwide. A diagnosis of hypertension can have serious occupational implications for military personnel. This article examines the diagnosis and management of hypertension in military personnel, in the context of current international standards. We consider the consequences of hypertension in the military environment and potential military-specific issues relating to hypertension.

Atrial fibrillation in the military patient: a review.

Atrial fibrillation (AF) is the most common sustained atrial arrhythmia, and increases an individual's risk of morbidity and mortality from cardiovascular and thromboembolic events. In this article, we review the pathophysiology and clinical presentations of AF and describe appropriate investigations and management likely to be appropriate for a military population, in line with current National Institute for Health and Care Excellence and European Society of Cardiology guidelines. The implications for the individual's Medical Employment Standard in the UK Armed Forces, with specific reference to specific military occupational activities such as aviation, diving and driving occupationally, are also reviewed.

A 5-year review of atrial fibrillation in military aircrew.

INTRODUCTION: Atrial fibrillation (AF) is a common cause of disqualification from flying in both civilian and military aircrew. We reviewed 5 yr of atrial fibrillation management in the Royal Air Force (RAF) from both a clinical and occupational perspective. METHODS: Patients were identified from the RAF Medical Boards (RAFMB) electronic database using search terms "atrial," "fibrillation," and "arrhythmia." Management was compared to current RAF and national clinical guidelines and current civilian and military aviation medicine policy. RESULTS: Over the 5-yr period assessed, 23 aircrew were identified with AF. Paroxysmal AF (PAF) was the most common diagnosis. Five aircrew remained fit to fly with no limitations, 12 fit to fly with restrictions, and 6 were graded permanently unfit for flying, with one of these being medically discharged. DISCUSSION: The incidence and demographics of aircrew identified with AF in this paper is comparable to previous studies. All aircrew in our study were treated in accordance with current RAF/national guidelines. Emerging treatments such as radiofrequency ablation and the new anticoagulants remain to be assessed for suitability in a military context. CONCLUSION: Management of AF in RAF aircrew requires a holistic approach, with an awareness of the arrhythmogenic aviation environment in which RAF aircrew operate. Most RAF aircrew with AF will retain a restricted flying status, but this should be considered on a case-by-case basis.