Biomedical subjects
Publications and source records attributed to V M Voge.
Freons are generally considered to be minimally toxic. There are no reports in the literature of Freons causing secondary arterial hypertension. We report two cases of acute, massive Freon exposure that preceded secondary arterial hypertension. We hypothesize that the arterial hypertension was precipitated by renal proximal tubular damage, although several other mechanisms are possible.
A comprehensive anonymous questionnaire survey of all U.S. Army and U.S. Air Force rated female aircrew, with age- and duty-matched males, was conducted. This report addresses the menstrual concerns part of the questionnaire, which sought information from women on discomfort problems during the menstrual cycle and methods used for combating this discomfort. Five hundred sixty-seven women were surveyed. Only 9% of respondents admitted to having any menstrual complaints and, of these, only 17% attempted to take themselves off the flight schedule during the problem days. Even so, 41% of all women aircrew admitted to taking some form of medication for menstrual discomfort while on flight status. Most respondents to this section of the questionnaire were openly hostile, seemingly sensitive to sex-specific questions. This could be a safety-of-flight issue, in that menstrual symptoms could be a serious in-flight distraction to the female aircrew member.
This is the second of two studies done to determine whether moderate Gz exposure facilitates back disability. Cumulative trauma (repeated moderate to high G) exposures could be a precipitant of back pain in the military population. There is at present no reliable method of predicting who will suffer from back pain. We looked at officer back disability rates at separation from the Air Force (1972-1993). We compared non-rated Air Force officers to pilots and navigators exposed to low G and moderate to high G. We found no significant differences between aircrew and non-aircrew individuals until 1985, when the rates for aircrew fell below those of non-rated officers. Moderate G exposure does not seem to be a predictor of subsequent back disability. We recommend a larger prospective study of all rated and non-rated officers. We recommend that each separating officer undergo a detailed physical examination and answer a detailed back questionnaire.
Syncope in the aviation environment can be a very difficult problem to assess. Even more difficult is the differential diagnosis between convulsive syncope and epilepsy after the first event. This paper discusses syncope in general and the differential diagnosis between vasovagal syncope and other forms of syncope. About 50% of all syncopal episodes cannot be identified as to etiology. However, a benign outcome for a single syncopal episode, non-cardiac in origin, is the norm. The diagnosis of syncope is discussed, emphasizing that a meticulous history from an observer or the patient, a good physical examination, and an ECG are the cornerstones of diagnosis. Other diagnostic venues are discussed. Convulsive syncope occurs in only about 12% of syncopal episodes, 65% of these being vasovagal in origin. The other 35% are due to a variety of causes. We found no good algorithm to differentiate convulsive syncope from epilepsy. We reviewed the literature to develop a differential diagnostic table, focusing on: age, awake status, position, emotional/physiologic stressors, onset, aura, appearance, injury on falling, seizure characteristics, automatism, length of unconsciousness and subsequent confusion, pulse characteristics, blood pressure, urinary incontinence, seizure duration, recovery time post-event, post-seizure sequelae, amnesia, posture vs. recovery, EEG characteristics, and the value of sophisticated diagnostic procedures.
We evaluated 10 years of reported hazardous cargo incident information from the U.S. Air Force and Naval Safety Centers. In this first of two papers describing the hazardous cargo problems reported by the two services, we describe types of aircraft and types of hazardous cargo involved in incidents not causing aircraft mishaps. Normally, hazardous cargo must be manifested as such and no passengers are allowed on such flights. Unauthorized hazardous cargo was found on military aircraft carrying passengers. The most common problem was fuel spills or fumes. The most frequent cause of a hazardous cargo incident was improper manifest of same. Improvements are recommended for the incompatible or inconsistent hazardous cargo incident reporting systems, in order to improve prevention of hazardous cargo incidents.
This is the second of two articles describing reported incidents involving hazardous cargo on U.S. military aircraft over a 10-year period. In this article, we describe the various physiological responses reported on the incident reports. These physiological incidents may have involved either the aircrew, the passengers, or both. We also list the substances that caused the problems. Physiological responses ranged from nausea and lightheadedness to loss of consciousness. We discuss why flights involving a physiological incident may not have been aborted. The present military hazardous cargo incident reporting system is deficient in that there appears to be no requirement for reporting whether passengers were on board the incident aircraft, or whether passengers or aircrew suffered physiological responses to various toxic substances.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The question of whether sickle cell trait (SCT) is potentially dangerous to military aircrew personnel who have it and, consequently, whether such individuals should be allowed to fly in military aircraft is a very emotional issue. This article traces the evolution of how the U.S. military has dealt with the problem, and the present status of individuals with SCT in the U.S. military aviation community. Extensive studies and means for subjectively evaluating the problem were instituted by the Department of Defense in 1981, after making the decision not to restrict aircrew with the trait from aviation duties. All research projects and educational programs were abruptly stopped in 1985. Today, there are no actual restrictions on individuals with SCT for duty in the aviation and diving communities.
Simulator sickness is now a well-recognized entity. It is recognized as a form of motion sickness, having a higher incidence in the more sophisticated simulators. Human centrifuges (dynamic simulators) are the newest innovation in aircrew training devices. Simulator sickness has never been reported in human centrifuges. We are reporting on a case of delayed simulator sickness in a pilot-subject after a centrifuge experience. A review of the "psycho-physiological" problems routinely experienced by subjects on human centrifuges indicates such problems are due to simulator sickness, although they are not reported as such. In this paper, we give a brief overview of simulator sickness and briefly discuss simulator sickness, as related to the human centrifuge experience.
The "human factor" has long been recognized as the cause, or the contributing cause, of most aircraft mishaps. Frequently, the mishap aviator may be overstressed emotionally to the point that he makes errors of judgment, either by omission or commission. Occasionally, an educated observer can recognize this "failing aviator" before the mishap. This paper discusses the characteristics of the failing aviator syndrome and presents the case history of one who should have been recognized before the mishap.
Freon 113 is not usually considered a toxic chemical and is not generally included in toxicology text lists of dangerous chemicals. However, during one 7-year period, the U.S. Navy recorded 38 freon-related mishaps, including 16 chemical burns and 22 inhalation injuries. Several deaths were also recorded. Part of the problem seems to be that freon compounds are excellent degreasing and cleaning agents. Consequently, they are widely and inappropriately used by aviation ground crews for this purpose. Such use usually presents no problem, except when the agent is used in small, closed, unventilated areas. This paper outlines the properties of freon that make it dangerous in the aviation community, some case histories of freon-related mishaps, what the Navy has done to control or prevent the problem from recurring, and the Navy's relative success with its prevention policies.
Decompression sickness has not previously been reported at altitudes below 16,000 ft (4,878m), unless the patient had been previously exposed to hyperbaric conditions (SCUBA). There are some underdocumented reports at lower altitudes. We are reporting a suspected case of bends appearing at 14,000 ft (4,268m) in a young student Naval aviator. The patient's only predisposing factors were an old athletic injury repaired with a permanently retained screw (foreign body) and a regular exercise program. A short discussion of bends is included.
Microscopic hematuria is not infrequently seen in the aviator population. After appropriate evaluation, excluding renal biopsy, such a finding is commonly diagnosed as "benign microscopic hematuria," and no further action is taken. The clinical case presented here involves a student naval aviator whose only findings were microscopic hematuria and a unilateral high-frequency hearing loss. A renal biopsy was performed to rule out another diagnosis and IgA nephropathy was found incidentally. He was subsequently denied clearance to fly because of the uncertain outcome of the disease. Berger's disease is discussed fully as to its clinical picture, diagnosis, treatment, and prognosis.
This is a case report of a male naval aviator suffering from bulimia. Bulimia is an eating disorder normally associated with young affluent females. A review of bulimia as to etiology, characteristics, prevalence, diagnosis, treatment, and prognosis is presented to familiarize the reader with the disease. About 1% of the U.S. male population is afflicted with this disorder, while it has been estimated that up to 22% of females are afflicted. The only documented case of bulimia in a male aircrewman is presented. He was misdiagnosed on several occasions. When diagnosed, his symptomatology was severe. He was offered psychotherapy and close medical supervision and allowed to return to flight duty. His disease was chronic and recurrent. He was eventually grounded again. It is felt that bulimics are a very poor risk for return to flight duty due to the recurrent nature of the disease, the manipulative characteristics of those afflicted and the extreme difficulty of following patients suffering from this illness.
Spontaneous pneumothorax (SP) is infrequently diagnosed in aircrew personnel. However, once it is diagnosed, aircrew disposition becomes a serious concern. To evaluate this problem, a literature review was conducted to put the disease into proper perspective. A questionnaire was then sent to all aircrew in the United States Air Force waiver file who had suffered SP in order to gain a retrospective view of problems and situations encountered. The following areas were investigated: recurrences, height, weight, age, smoking history, initial medical management, symptomatology, activity at time of occurrence, relationship to flight duties, treatment given and personal/family history of lung disease. A review of FAA, military, and NASA guidelines regarding personnel with a history of SP was also done. It is concluded that SP is an unrecognized hazard to aircrew personnel. Once an SP has been diagnosed in an individual, he/she should be grounded from further flight duties until either 9 years have elapsed without a recurrence or there has been a bilateral parietal pleurectomy.