Naval Medical Center San Diego

San Diego, CA, United States

Naval Medical Center San Diego

San Diego, CA, United States
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Loeffler G.,Naval Medical Center San Diego | Delaney E.,Clinical Research Psychologist | Hann M.,Naval Medical Center San Diego
Brain Research Bulletin | Year: 2016

Synthetic cannabinoids (SC), commonly known as Spice, are a class of compounds that share affinity for the cannabinoid receptors. Recreational use of SCs has grown in recent years. A literature search was conducted of national and international organizations as well as peer-reviewed publications describing SC use in non-clinical populations. Our primary goal was summarizing SC use prevalence within the general population from representative surveys. Our secondary goals included describing SC use frequency, motivation for use, the relationship between SC use and use of other substances, and perception of SC use including beliefs about safety and use by peers. Nationally and regionally representative surveys describe lifetime prevalence of SC use in the general population as between 0.2% and 4%. Longitudinal data, though limited, shows decline in SC use with peak use occurring in the late teens and early twenties. Users tend to be males. The majority of SC users report using only a small number of times and use tends to not be sustained. The most common motive for SC use is curiosity. SC users generally report a history of extensive use of other substances. Perception of SC use by others tends to be significantly greater than actual SC use. © 2016

The International Association of HealthCare Professionals is pleased to welcome Robert J. Schmall, MD, Diagnostic Radiologist to their prestigious organization with his upcoming publication in The Leading Physicians of the World. Dr. Robert J. Schmall is a highly trained and qualified physician with an extensive expertise in all facets of his work, especially vascular and interventional radiology. Dr. Schmall has been in practice for 19 years and is currently serving patients within Radiology Consultants of Iowa in Cedar Rapids, Iowa. Dr. Schmall attended the University of Iowa College of Medicine in Iowa City, where he graduated with his Medical Degree in 1991. He subsequently undertook his residency training in Radiology at the Naval Medical Center San Diego. Then he completed his fellowship training in Vascular and Interventional Radiology at the University of Michigan. Dr. Schmall is board certified in Diagnostic Radiology by the American Board of Radiology. He also has his Certificate of Additional Qualification in Vascular and Interventional Radiology. To keep up to date with the latest advances and developments in his field, he maintains professional memberships with the Radiology Society of North America, the American College of Radiology, and the Society of Interventional Radiology. He attributes his success to his hard work, and when he is not assisting his patients, Dr. Schmall likes to relax by reading and spending time with his family. Learn more about Dr. Schmall here: and be sure to read his upcoming publication in The Leading Physicians of the World. is a hub for all things medicine, featuring detailed descriptions of medical professionals across all areas of expertise, and information on thousands of healthcare topics.  Each month, millions of patients use FindaTopDoc to find a doctor nearby and instantly book an appointment online or create a review. features each doctor’s full professional biography highlighting their achievements, experience, patient reviews and areas of expertise.  A leading provider of valuable health information that helps empower patient and doctor alike, FindaTopDoc enables readers to live a happier and healthier life.  For more information about FindaTopDoc, visit

News Article | February 16, 2017

Orthopedic knee surgeon and shoulder specialist at The Steadman Clinic in Vail, Colorado Matthew Provencher, MD CAPT MC USNR has launched a new patient education website MATTHEWPROVENCHERMD.COM developed by eMedical Media. As one of the nation's leading orthopedic shoulder and knee surgeons, Dr. Provencher created this website to help patients advocate for their own best care and to provide medical professionals worldwide with access to his research and innovative treatment techniques. Before joining The Steadman Clinic, Dr. Provencher served as the Chief of Sports Medicine at Massachusetts General Hospital, Visiting Professor at Harvard Medical School and the Head Team Physician and Medical Director for the New England Patriots. He has published over 200 peer-reviewed publications and articles, 148 chapters, and has authored 5 textbooks. Through his dedication to orthopedic research and innovation, Dr. Provencher has pioneered a number of orthopedic procedures to help improve patient outcomes. Patients searching online for insight and practical knowledge on problems associated with shoulder and knee injuries will find information on conditions such as: Cartilage Injuries Labral & SLAP Tears Meniscus Deficiency Rotator Cuff Tears Ligament Injuries Bony injuries of the shoulder ACL Tears LCL, Posterolateral and Multiligamentous Knee Injuries Meniscal Injuries and Deficiency Cartilage Injury and Deficiency Shoulder Arthritis Shoulder Dislocations Treatment options addressed on the website are both non-surgical and surgical. A patient’s history, symptoms and activity level will help determine the right course of treatment. Patients seeking an accurate diagnosis and treatment must visit a qualified medical professional in person. Patients searching online for knowledge on treatment options will find information on: Biologic Shoulder Replacement Osteoarthritis Knee Treatment Capsulolabral Reconstruction Meniscal Transplantation Rotator Cuff Repair Surgery – early and late chronic tears Knee Osteotomy Shoulder Replacement Bony Reconstruction of the shoulder – glenoid and humerus Meniscal repair and transplantation Cartilage repair and transplantation Dr. Provencher and his team are dedicated to keeping patients of all ages active by providing the most progressive treatment for sports injuries and orthopedic disorders. For those who are seeking diagnosis or second opinion, Dr. Provencher offers film reviews and consultations. Dr. Provencher is a knee surgeon and shoulder specialist at The Steadman Clinic in Vail, Colorado. Dr. Provencher completed his orthopedic surgery residency at the Naval Medical Center San Diego and his orthopedic shoulder, knee and sports surgery fellowship at Rush University in Chicago. Dr. Provencher has returned many patients of all levels - Olympic, professional, collegiate and weekend warriors alike - back to full participation.

Baxter M.C.,Naval Medical Center San Diego
Otology and Neurotology | Year: 2017

OBJECTIVE:: To describe the presentation and management of surgical emphysema involving the temporomandibular joint and deep neck following exostoses removal. PATIENT:: A 60-year-old male surfer presented with hearing loss and recurrent infections in the right ear. An examination revealed obstructing bony exostoses in the right external auditory canal. He underwent right canalplasty using a postauricular approach. At 5 weeks after surgery, he presented with right otalgia, swelling of the right face and neck, and complaints of a squeaking noise in the right ear with mandibular excursions. An otomicroscopic examination demonstrated a focal area of prolapsing soft tissue along the anterior bony external auditory canal with mandibular movement. The examination also revealed palpable crepitus of the right face and neck. Computed tomography was obtained of the temporal bones and neck confirming a focal anterior canal wall defect allowing communication between the glenoid fossa and external auditory canal with subcutaneous emphysema tracking around the temporomandibular joint into the masticator, parotid, and parapharyngeal spaces. INTERVENTION:: Maxillomandibular fixation for 2 weeks with revision canalplasty using a split tragal cartilage graft. RESULTS:: At 6 weeks after revision surgery, the patient reported complete resolution of all symptoms. Repeat imaging demonstrated complete resolution of subcutaneous and deep neck emphysema, and the otomicroscopic examination revealed a fully epithelialized external auditory canal with no further evidence of soft tissue prolapse. CONCLUSION:: Maxillomandibular fixation with autologous cartilage graft is an effective management strategy for complications of canalplasty resulting in exposure of the temporomandibular joint capsule and surgical emphysema. Copyright © 2017 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

News Article | November 1, 2016

NEW ORLEANS — Despite being young and healthy, several U.S. military trainees have developed a rare bacterial infection that usually does not affect healthy people, a new study shows. The cases highlight the unique stresses this group of trainees, called Naval Special Warfare trainees, face that may put them at risk for infection with this bacterium, called Shewanella algae. Naval Special Warfare trainees include Navy SEALS, Navy divers and other specialists. The bacterium is common in seawater, but most healthy people don't get sick from it even if they come into contact with the microbe. Rather, people with compromised immune systems are more likely to get sick from this bacterium. [7 Devastating Infectious Diseases] But during training, these trainees are placed in an uncommon situation, particularly during the five-day stretch called "Hell Week," and this increases their vulnerability to infection, said Dr. Kristi Stone-Garza, a staff physician at the Naval Medical Center San Diego and the lead author of the study. During Hell Week, the trainees spend five days on land and sea — including a lot of time in the ocean — with minimal sleep, working under "arduous conditions," according to the study. When a person is in an extremely stressful situation like that, it's possible to induce an "immunocompromised state" in an otherwise healthy person, Stone-Garza told Live Science. In the study, presented Friday (Oct. 28) at IDWeek 2016 here, a meeting of several organizations focused on infectious diseases, Stone-Garza and her colleagues reviewed all of the cases of S. algae infections in Naval Special Warfare trainees between 2012 and 2015. Over the study period, five men got S. algae infections, the researchers found. Four of the men had recently completed Hell Week — and all had to be hospitalized due to serious skin infections, according to the study. The fifth man was infected not during Hell Week, but after completing an 18-foot dive during another part of his training, and rupturing his eardrum, Stone-Garza said. In all of the cases, S. algae wasn't the only bacterium implicated in the men's infections. They all had "polymicrobial" infections, Stone-Garza said, meaning that several types of bacteria were found, including Staphylococcus aureus and Vibrio harveyi. The symptoms of S. algae infection depend on where the bacteria get into the body, Stone-Garza said. In most cases, the bacteria get in through a break in the skin and cause abscesses or necrotizing fasciitis, she said. In the case of the man with the ruptured eardrum, a middle-ear infection developed, Stone-Garza said. The four hospitalized men were treated with IV antibiotics, Stone-Garza said. Some required surgery to clean their wounds, she added. The man with the ear infection was treated with oral antibiotics, she said. All of the men who got sick were young and healthy, Stone-Garza said. But during Hell Week, they're placed under constant physiological stress: they're in an exposed environment, they may get cuts or other skin breakdowns, they don't eat well and they're not clean, she said. "It's sort of a perfect storm" for getting sick, she added. A healthy person who wasn't involved in this type of intense training, on the other hand, could still get an S. algae infection, but he or she probably wouldn't get as sick as the Navy trainees did, or need to be hospitalized, Stone-Garza said. Preventing infections in future trainees may be difficult, Stone-Garza said. The main way to prevent this sort of infection is to keep the men from swimming around in a contaminated environment for five days, she said. Interestingly, S. algae infections appear to be unique to Naval Special Warfare trainees, compared with men in other similarly grueling military training programs, such as the Green Berets or Army Rangers, said Dr. Ryan Maves, the interim chairman of internal medicine at the Naval Medical Center San Diego and the senior author of the study. In other words, there's a cluster of this type of infection among these trainees, Maves told Live Science The findings have not yet been published in a peer-reviewed journal.

Mikals S.J.,U.S. National Institutes of Health | Brigger M.T.,Naval Medical Center San Diego
JAMA Otolaryngology - Head and Neck Surgery | Year: 2014

IMPORTANCE: Adenoidectomy at initial tympanostomy tube placement (TT) may reduce the rate of repeated surgery for otitis media. OBJECTIVE: To assess the effectiveness of primary adenoidectomy as an adjuvant to TT (Ad + TT) compared with TT alone. DATA SOURCES: PubMed and EMBASE electronic databases were searched with no publication year restrictions beyond those of the individual databases. STUDY SELECTION: Articles that compared outcomes of children having undergone primary Ad + TT with children having undergone TT alone for middle ear disease. DATA EXTRACTION: Medical literature addressing Ad + TT was systematically reviewed. Data extracted included study design, age of children, and follow-up time frame. Level of evidence was assessed, and data were pooled where possible. MAIN OUTCOMES AND MEASURES: Proportion of children requiring repeated TT (r-TT). Secondary outcomes included proportion of children with recurrent acute otitis media (RAOM), otitis media with effusion (OME), otorrhea, or any combination of the 3. RESULTS: Fifteen articlesmet inclusion criteria. Ten studies (n = 71 353) reported that primary Ad + TT decreased the risk of r-TT or risk of RAOM, OME, or otorrhea compared with TT alone. Four studies (n = 538) reported no difference between Ad + TT groups compared with TT-only groups in the prevention of r-TT or of RAOM, OME, or otorrhea. Despite significant heterogeneity, limited meta-analysis and pooling of data revealed that the estimated rate of r-TT for children undergoing primary adenoidectomy was 17.2%(95%CI, 12.2%-22.2%) vs 31.8%(95%CI, 23.9%-39.8%) for children undergoing primary TT only. When stratified by age younger than 4 years, the protective effects of adenoidectomy were diminished. CONCLUSIONS AND RELEVANCE: The current evidence suggests that primary Ad + TTmay be superior to TT only in decreasing the risk of r-TT and the risk of RAOM, OME, or otorrhea. Limitations include heterogeneity of the source data, with the predominance of retrospective data as well as studies with older children supporting the superiority of adjuvant adenoidectomy. The practice of Ad + TTmay decrease the risk of repeated surgery in children older than 4 years. Copyright 2014 American Medical Association. All rights reserved.

Egan C.,Naval Medical Center San Diego
Clinical nuclear medicine | Year: 2013

This is a 66-year-old female patient being treated for diffuse large B-cell lymphoma. She reported to her physician in late January 2012 with a left flank pruritic painful rash. She was diagnosed with herpes zoster and treated with antiviral medication. Her chemotherapy regimen was delayed due to the zoster infection. In March 2012, the patient underwent a PET/CT as a lymphoma surveillance scan prior to reinstituting the chemotherapy treatment. As an incidental finding, the PET showed increased metabolic activity in a dermatomal distribution along the left flank, which corresponded to the patient's zoster infection.

Bavaro M.F.,Naval Medical Center San Diego
Current Gastroenterology Reports | Year: 2012

It is estimated that there are approximately 76 million illnesses, 325,000 hospitalizations, and 5,200 deaths in the US each year attributed to foodborne outbreaks with a total cost of 10-83 billion US dollars a year. While the rates of foodborne disease have remained relatively constant over the last few years, there have been large outbreaks associated with either a component of commercially prepared food or outbreaks that span between states or even countries. With the world population expecting fresh produce year round, organic produce, and exotic foods, these global outbreaks have the potential to increase in number and severity. There needs to be a means to both rapidly identify these outbreaks, screen our food supply, as well as prevent these outbreaks. This article will discuss the global nature of this problem associated with our food and water supply as well as explain potential ways to solve this international problem. © Springer Science+Business Media, LLC (outside the USA) 2012.

Kon A.A.,Naval Medical Center San Diego
Hormone and Metabolic Research | Year: 2015

Medical decisions for infants and children should generally be based on the best interests of the child. When there is legitimate controversy over the child's best interests, the right of the child to an open future should generally determine the course of treatment. In the case of infants born with disorders of sex development (DSD), early cosmetic genitoplasty was long believed to be in the child's best interest and was therefore the standard of care. New data suggest that early genitoplasty may be more harmful than helpful, therefore the best interest standard is no longer determinative in such cases. Because children born with DSD have a right to an open future, and because the openness of their future is clearly enhanced by delaying cosmetic genitoplasty until they themselves can participate meaningfully in decision-making, early genitoplasty is ethically supportable only when medically indicated (e. g., when the child is unable to urinate without surgical intervention). Further research is needed to clarify the benefits and burdens of early and delayed genitoplasty. In parallel with further research, efforts should focus on educating society broadly to decrease stigmatization of persons with DSD.

Kroonen L.T.,Naval Medical Center San Diego
Orthopedic Clinics of North America | Year: 2012

Compression of the ulnar nerve at the elbow, or cubital tunnel syndrome, is the second most common peripheral nerve compression syndrome in the upper extremity. Diagnosis is made through a good history and physical examination. Electrodiagnostic testing can confirm the diagnosis and severity of injury to the nerve. Surgical intervention is indicated when nonoperative treatment does not relieve the symptoms. There is currently no consensus on the best surgical treatment of cubital tunnel syndrome. However, the only randomized prospective studies to compare treatment options to date indicate that simple decompression and anterior transposition yield comparable results. © 2012.

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