1/9. Type II altitude decompression sickness (DCS): U.S. air Force experience with 133 cases.Type II altitude-related decompression sickness (DCS), due to its wide spectrum of symptoms, is often difficult to diagnose. This difficulty sometimes leads unnecessarily to the permanent grounding of an experienced aviator. So that this condition could be better understood, a total of 133 cases of Type II altitude DCS (on file at the united states air Force Hyperbaric Medicine Division, School of aerospace medicine, Brooks AFB, TX) were reviewed. Most cases (94.7%) followed altitude chamber training. The most common manifestation was joint pain (43.6%), associated with headache (42.1%), visual disturbances (30.1%), and limb paresthesia (27.8%). The next most common symptoms were, in order of decreasing frequency: mental confusion (24.8%), limb numbness (16.5%), and extreme fatigue (10.5%). spinal cord involvement, chokes, and unconsciousness were rare (6.9%, 6%, and 1.5%, respectively). Hyperbaric oxygen treatment produced fully successful results in 97.7% of the cases. Only 2.3% of the cases resulted in residual deficit; no deaths occurred. A thorough knowledge of the differential diagnosis and predisposing factors is essential to narrow the margins of error in the diagnosis and prevention of decompression sickness in the operational or training environment. A recommendation for favorable consideration of waiver action for those aviators who suffered Type II DCS is presented. These recommendations are based on a unique classification of the severity of symptoms.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/9. Psychosocial issues in chronic obstructive pulmonary disease.Chronic illnesses such as COPD require both comprehensive evaluations and multisystem treatment approaches with integration of biological, behavioral, psychological, and social systems. People function as biopsychosocial units, with complex interplay between themselves and their environments determining the degree of their illness. Illness, as distinct from disease, is a person's subjective response to the state of disease or organ pathology. Recognition and identification of the psychosocial components of a person's illness allows for far more effective therapeutic intervention. Treatment objectives include better acceptance of life changes and the development of new attitudes and goals through an increase in self-confidence and control over emotional, physical, and respiratory functioning. These rehabilitation goals can be fulfilled by the use of supportive therapies (individual, family, or marital and group) and educational behavioral techniques based upon a solid working alliance with the patient.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
3/9. The confined space-hypoxia syndrome.Two meter readers of a local water company were found dead in an underground water meter pit. Studies revealed a decrease in oxygen and an increase in carbon dioxide in the pit as a result of aerobic microorganisms present in the pit. Such an atmosphere may be rapidly fatal to the unwary worker who frequents such an environment. It is of paramount importance that this occupational hazard be recognized so that preventative measures may be established. We propose that the term "Confined Space-Hypoxia syndrome" be adopted to all such confined space accidents occurring in water meter pits, tanks, holds of ships, mines, underground storage bins, and so forth, resulting from oxygen-deficient atmospheres. A series of recommended preventative procedures is included.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
4/9. Transient ischemic attacks at high altitude.The precise etiology of transient neurologic deficits at high altitude is unclear, particularly since the subjects are not investigated as they would be had the events occurred in an urban environment. This report describes two subjects who experienced transient ischemic attacks (TIAs) while ascending the northeast ridge route of Mt. Everest during the Ultima Thule Everest Expedition, and a third subject with TIAs during three separate high-altitude climbs. Possible etiologies and treatment for TIAs at high altitude are suggested.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
5/9. hyperventilation in aircrew: a review.The causes and effects of hyperventilation, relevant to the flight environment, have been reviewed and one case history is presented. methods of investigating in-flight hyperventilation are discussed.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
6/9. The sickle cell trait in relation to the training and assignment of duties in the armed forces: II. Aseptic splenic necrosis.Well-documented information gleaned from the world's literature reveals that in vivo sickling of erythrocytes and vascular occlusive lesions involving the spleen have occurred in individuals with the sickle cell trait (SCT) while flying in unpressurized airplanes or when exposed to hypoxic environments in mountains at intermediate altitudes. The clinical and anatomical manifestations of splenic infarcts are described. Individuals without the trait do not develop splenic infarcts during or following exposure to ambient hypoxia.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
7/9. The pathophysiology of acute high-altitude illness.Complex physiologic responses occur as nonacclimatized lowland dwellers ascend above 10,000 feet, with a resulting partial pressure of arterial oxygen of less than 60 mm Hg. There are marked hemodynamic changes and shifts in body fluids that may result in organ dysfunction. The suspected pathogenesis of these acute hypobaric hypoxic-induced illnesses is discussed. Cerebral dysfunction may present as acute mountain sickness or high-altitude cerebral edema. Usually asymptomatic high-altitude retinal hemorrhage and noncardiogenic high-altitude pulmonary edema also are described. All of these illnesses apparently represent a spectrum of pathologic states initiated by an exaggerated vascular response to hypoxia. With the exception of retinopathy, high-altitude illness can be prevented by slow ascent. Early recognition of cerebral or pulmonary edema and immediate descent will prevent serious consequences of nonacclimatized persons who are acutely exposed to hypobaric environments.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
8/9. Effects of long term extended wear of PMMA lenses on corneal function: a case report.BACKGROUND: Recent studies have shown that some long-term PMMA contact lens wearers who are presumably exposed to hypoxia can develop modest but permanent changes in corneal structure and function. What is not known is the corneal effects that may result from severe and long-term exposure to an hypoxic environment. This case report is presented to illustrate an extreme example of the effects of the cornea from prolonged exposure to hypoxia. methods: A 37-year-old male who had worn PMMA lenses on a 2-week extended wear basis for 20 years was examined in the laboratory to assess changes in corneal structure and function. Function was determined by monitoring the rate at which the cornea recovered from induced edema and is expressed as a percent recovery per hour (PRPH). Morphology was studied via specular microscopy. RESULTS: For this subject, the PRPH was 39.6 percent/hr and 40.5 percent/hr for right and left eyes respectively; these values are substantially reduced compared to the reported 55.3 percent/hr for an age-matched, non-contact lens wearing population. Specular microscopy demonstrated reduced cell counts of 1,052 cells/mm2 OD and 1,741 cells/mm2 OS compared to an age adjusted normal population with 2,853 /- 320 cells/mm2. CONCLUSIONS: This case example appears to represent an extreme case of contact lens abuse and the effects of long-term hypoxic contact lens wear on corneal function.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
9/9. suicide by environmental hypoxia (forced depletion of oxygen).Suicidal suffocation by forced oxygen depletion (environmental hypoxia) with carbon dioxide (CO2) and with propane is discussed in two cases. No toxicologic proof was available with the former and circumstantial evidence weighed heavily. The latter case demonstrated inhaled propane by an on-scene transthoracic aspirate; all other toxicology specimens, including brain, liver, blood, kidney, fat, and vitreous, did not contain hydrocarbons. This second fatality was complicated by multi-agent overdose, including diphenhydramine, fluoxetine (Prozac), and nordiazepam. The designation of these deaths as due to oxygen depletion involved careful scrutiny of the autopsy, toxicologic, and scene findings. Complete analysis of all factors surrounding these rarely encountered suffocation deaths is stressed.- - - - - - - - - - ranking = 5keywords = environment (Clic here for more details about this article) |