Squamous Cell Papilloma in a Student Aviator.

BACKGROUND: Although oropharyngeal squamous cell papilloma (OSCP) is not uncommon in the general population, reports of OSCP in aviators are rare. This case report serves as a call for flight surgeons to consider all oropharyngeal pathology as a potential source of airway compromise during flight, and highlights regional risk factors for developing malignancies of the oropharynx.CASE REPORT: A 24-yr-old male foreign national student aviator from a central Asian country was at Fort Rucker for flight training. He presented to the clinic with a chief complaint of sore throat and cough for 2 d. He was afebrile but reported a history of a "throat" mass which was previously evaluated by a U.S. military otolaryngologist. Said mass was approximately 0.5 cm × 0.5 cm, irregular appearing, inflamed, and protruding from the inferior aspect of the right tonsil. Previous biopsy report revealed a squamous cell papilloma and, after consideration of the pilot's training program, active surveillance of the lesion was mutually agreed upon until the student's training had concluded and definitive excision was performed.DISCUSSION: A robust history and physical exam including an occupational, social, and environmental exposure history is crucial to diagnosis. Foreign national patients often have unique backgrounds that merit consideration when developing a differential diagnosis, assessment, and plan. In the field of Flight Medicine, a patient's occupational demands are essential to his or her care. In particular, any potential obstruction of the airway during flight must be considered, even if a pathology does not represent an immediate threat to the pilot's health.Swinson K, Burlile J, Pavelites J. Squamous cell papilloma in a student aviator. Aerosp Med Hum Perform. 2019; 90(11):978-981.

U.S. Army Parachute Mishap Fatalities: 2010-2015.

INTRODUCTION: Despite the large number of U.S. military members who conduct parachuting operations, its inherent safety risks, and the introduction of a new military parachute in 2010, little has been published in the last decade on U.S. military parachute fatalities.METHODS: Parachute fatality investigative records maintained by the U.S. Army Combat Readiness Center were reviewed for U.S. Army fatalities resulting from military parachuting operations from January 1, 2010, through December 31, 2015. De-identified data on cases were collected, including causes, lethal injuries, and demographic, environmental, and missional factors. A descriptive analysis was performed.RESULTS: There were 13 cases which met study inclusion criteria. Most occurred during static-line operations and were jumps from a C-17 aircraft using a T-11 parachute. The two most common assigned accident codes were "improper or abnormal exit" and "unstable or improper body position," which combined accounted for 33% of cases. Also noteworthy at 11% each were "entanglement," "parachute malfunction," and "dragged on the drop zone," and at 6% each were "static line injury," "lost or stolen air," and "drop zone hazard." In 69% of cases blunt force trauma was the cause of death.DISCUSSION: Incident factors included human actions, equipment failure, and the environment. Death from blunt force trauma upon impact with the ground as the most frequent lethal injury was expected for parachute operations. This descriptive study provides awareness to military leaders of circumstances in which fatalities occur. Future investigations should include data on the total number of jumps to provide a more comprehensive analysis of risk.Johnson ES, Gaydos SJ, Pavelites JJ, Kotwal RS, Houk JE. U.S. Army parachute mishap fatalities: 2010-2015. Aerosp Med Hum Perform. 2019; 90(7):637-642.

Deaths related to chemical burns.

The authors present a series of 6 deaths due to the uncommon cause of chemical burns. Of the 6 deaths due to chemical burns, 4 deaths were due to ingestion of a chemical, 1 death was caused by chemical burns of the skin, and 1 death resulted from rectal insufflation of a chemical. Seven additional cases where chemical burns may have been a contributing factor to the death or an incidental finding are also presented. Four cases are related to an incident involving chemical exposure during an industrial explosion. Three cases involve motor fuel burns of the skin. Two cases concern a plane crash incident, and 1 case involved a vehicular collision. Cases are derived from the records of the Dallas County Medical Examiner's Office and those of the authors' consultation practices. Each of the cases is presented, followed by a discussion of the various mechanisms of chemical injury.

An unusual case of lead snowstorm caused by fragmentation of buckshot.

This article reports the unusual radiographic findings of 2 cases of a shotgun shooting incident involving the homicide of a plant manager and the subsequent suicide of the assailant. Radiologic examination of wounds produced by the no. 00 copper-plated buckshot used in the incident revealed images with striking similarity to the lead snowstorm appearance generally associated with high-velocity, soft-point rifle bullets.

Fatal human monocytic ehrlichiosis: a case study.

Human ehrlichiosis is the term for a collection of tick-borne diseases caused primarily by obligate intracellular bacteria of the Ehrlichia species. Ehrlichiosis is characterized by a mild to severe illness, with approximately 3-5% of cases proving fatal despite receiving appropriate care. This report presents the case of a 60 year-old woman who was found collapsed and unresponsive in her home after an indeterminate time; possibly for up to 48 h. Despite rigorous resuscitative care and antibiotic treatment, the patient lapsed into multi-organ failure and died. Subsequent analysis by microscopic examination, PCR and immunohistochemistry revealed the patient died from an infection of Ehrlichia chaffeensis. Clinicians and pathologists must be aware of this emergent disease in order to make a timely and appropriate diagnosis. Discussion of the patient's clinical, laboratory and autopsy findings as well as treatment of Ehrlichia chaffeensis infections is presented.

Death by black powder revolver: a case report.

Deaths resulting from the use of black powder handguns are relatively uncommon compared to other firearms. We report the case of a 48 year-old woman who sustained a lethal gunshot wound to the face from a black powder revolver. Autopsy revealed extensive soot and powder deposition around the entrance wound between the right eye and nose with perforation of the skull and brain. The exit wound also contained evidence of soot. Discussion of this characteristic pattern of discharge deposition from black powder weapons is presented.