emergencies include acute appendicitis, abscesses, incarcerated hernias, and trauma. Acute appendicitis is of particular interest because it provides a clear example of a common surgical emergency that has been approached in various ways over the past decades in an effort to avoid the necessity of an untrained person performing an appendectomy in a remote environment. In 1979, studies in Antarctica documented an increased incidence of acute appendicitis (Lugg, 1979) and led to the recommendation that the team physician undergo prophylactic appendectomy. The spectrum of measures available to avoid performance of an appendectomy in a remote environment ranges from prophylactic appendectomy before the mission to treatment of appendicitis with antibiotics with later (interval) appendectomy and to the use of antibiotics supplemented by percutaneous drainage of any abscess that might form.

Management of Abscesses and Soft-Tissue Infections

Abscesses and other soft-tissue infections are treated with antibiotics and by drainage or debridement, as needed. Image-guided (probably ultrasound-guided) percutaneous drainage (Nakamoto and Haaga, 1995; Montgomery and Wilson, 1996; Shuler et al., 1996; Miller et al., 1997; Scott et al., 1997; Wroblicka and Kuligowska, 1998; D’Agostino, 1999) would seem to be an ideal method for the management of deep-seated abscesses (as well as some less common conditions such as acute cholecystitis refractory to antibiotics). This technology is well proven as a safe and effective alternative to surgical drainage under the proper conditions and with concurrent antibiotic therapy.

REHABILITATION FOR ASTRONAUTS ON LONGDURATION MISSIONS

Few controlled studies have assessed the contributions that rehabilitation interventions make to the prevention of the loss of lean mass in prolonged microgravity. The information learned from existing studies with both humans and animals is inadequate (NASA, 1997). This is true for existing studies of both of preflight ground-based training and in-flight exercise. Similarly, little is known about whether preflight training or onboard exercise has a mitigating effect on the loss of bone mineral density or muscle mass. Exercise strategies and techniques have not been selected on the basis



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement