Tuberculosis on the flight deck.

Tuberculosis in commercial aircraft has been a concern since a 1995 incident of possible transmission from an active case of tuberculosis to passengers in the cabin of a 747. Subsequently, commercial air carriers have been vigilant in cooperating with public health authorities in tracking all known exposures to tuberculosis. In 1998, a pilot of a commercial airliner was diagnosed with active tuberculosis. Company records demonstrated that in the previous 6 mo, the pilot had flown with 48 other pilots. Every exposed pilot was contacted and evaluated by skin testing (IPPD) or chest x-ray if previously positive. There were no skin test conversions and no changes on x-rays. This study demonstrates that transmission of tuberculosis in the aircraft cabin environment, even under close and continuous exposure to an active case, is a rare event.

Cases from the aerospace medicine residents' teaching file. Case #62. Hypoxia.

Three aviators experience hypoxic symptoms in flight that persist on landing. These prove to be the initial presentations of anemia, leukemia and cardiac disease.

Cases from the aerospace medicine residents' teaching file. Case #62. Lead poisoning.

An aviator with occupationally-caused lead poisoning and entrapment neuropathies. Presentation, diagnosis and treatment are discussed.

Cases from the aerospace medicine residents' teaching file. Case #60. A Gulf War veteran and aviator with an occupational dermatitis.

A Gulf War veteran and aviator with an occupational dermatitis is evaluated as to cause and ability to work in his normal occupation as well as flying duty. The effects of the Americans With Disabilities Act upon disabled workers, pilots and collective bargaining agreements is discussed.

Body volume changes during simulated microgravity: auditory changes, segmental fluid redistribution, and regional hemodynamics.

Space adaptation syndrome (SAS), manifested by cephalad fluid shifts, spacial disorientation, nausea, and vomiting, is of varied expression and uncertain etiology. One theory is that fluid shift to the upper body alters the function of the vestibular apparatus to create an entity similar to Meniere's disease. Since clinical vestibular dysfunction syndromes are mirrored by altered cochlear function, this experiment was undertaken to study the relation between fluid redistribution and the auditory effects of initial antiorthostatic bed rest. Manual and bone audiometry, impedance tympanometry, and brain-stem evoked potentials were used to monitor auditory changes prior to, during, and following short term exposure to -6 degrees head down tilt. Impedance plethysmography was performed to assess the segmental and intracranial fluid redistribution and hemodynamic changes during short-term head down tilt simulated microgravity. Even though significant cephalad fluid shift produced marked intracranial congestion and the subjects exhibited SAS symptoms, no clinically significant changes in the auditory system could be detected.

Cases from the aerospace medicine residents' teaching file. Case #45. An aviator with a pigmented skin lesion.

The initial presentation and diagnosis of an aviator with a pigmented skin lesion. The epidemiology of the skin cancer epidemic, including melanoma is discussed. Prognostic implications of melanoma and the U.S. Air Force experience with melanoma in aircrew are also depicted.

Reported in-flight incapacitation: the early birds of 1911.

Numerous fatal accidents marred the early years of aviation, but not until 1911 was the first accident attributed to inflight incapacitation of the pilot. Two such accidents occurred in 1911 and were reported due to medical causes. Our review of the circumstances surrounding these two accidents lead to different conclusions. We believe them to have been caused by pilot error, and not by medical causes. So the first accident due to inflight incapacitation of the aircrew for medical reasons still remains unknown.

Cases from the aerospace medicine residents' teaching file. Case #15. An aviator with chronic lymphocytic leukemia.

A clinical presentation, evaluation and diagnosis of an aviator with stage 0 chronic lymphocytic leukemia discovered while being evaluated for asymptomatic mitral valve prolapse are discussed. The aeromedical disposition of this patient is also presented.

An aviator with idiopathic dilated cardiomyopathy.

The clinical presentation, evaluation and diagnosis of an aviator with dilated cardiomyopathy of determined etiology are discussed. The aeromedical disposition and prognosis of this patient are also presented.

Cases from the aerospace medicine residents' teaching file. Case #2. An aviator with acoustic neuroma.

From the Aerospace medicine residents' teaching file: on aviator with acoustic neuroma. The clinical presentation, evaluation and disposition of a patient with an acoustic neuroma are discussed.

Cases from the Aerospace Medicine Residents' Teaching File.

"From the aerospace medicine residents' teaching file: toxic peripheral neuropathy, sacroiliitis, and mitral valve prolapse." The clinical presentation, evaluation and diagnosis of an aviator exposed to N-Hexane and Butanone are discussed. The aeromedical disposition of this patient, who also had mitral valve prolapse and subclinical sacroiliitis, is also presented.