Axillary vein thrombosis and congenital dysfibrinogenemia in a commercial pilot: a case report

A 34-yr-old male commercial pilot developed a painful swollen right upper arm following an episode of trauma. Venography confirmed the clinical diagnosis of a right axillary deep venous thrombosis. Magnetic resonance imaging suggested the presence of a fibrous tissue band overlying the junction of the right subclavian and innominate veins, potentially creating a thoracic outlet syndrome. A thrombophilia screen revealed an abnormal fibrinogen variant consistent with a diagnosis of congenital dysfibrinogenemia. The pilot was treated with anticoagulant therapy for 4 mo. There were diagnostic difficulties in determining the definitive etiology of the axillary vein thrombosis. Congenital dysfibrinogenemia is a rare condition, which is asymptomatic in the majority, but may manifest with hemorrhage or thrombosis in up to 45% of cases. The clinical management of the pilot and the aeromedical implications of the diagnosis are discussed.     

Central serous retinopathy (choroidopathy) in pilots

The clinical charts of pilots in the Israeli Airforce were reviewed retrospectively for evidence of central serous retinopathy (CSR). There were 14 pilots with documented CSR identified, with an incidence of 1.3 per 1000 per year. Of 6 pilots who had recurrent attacks, 5 had a decrease of visual acuity during the initial attack to at least 20/30 in the affected eye. On the other hand, in those with visual acuity no worse than 20/25, only 1 of 7 had recurrent attacks (p less than 0.05). We conclude that CSR is a common condition in pilots, and that visual acuity during the initial attack can predict those who will have recurrent disease.     

Blood-injection-injury phobia in a commercial aviator: a case report.

A small percentage of the population suffers from blood-injection-injury phobia. These individuals can have vasodepressor syncope related to episodes when their phobia is triggered by a stimulus such as the sight of blood or receiving an injection. A case is presented in which a commercial aviator had a vasodepressor syncopal event during flight. She is referred for evaluation. A discussion of the diagnosis, disease, treatment, and follow-up recommendations are included.     

Central neurocytoma: case report

The authors report a case of intraventricular tumor. The tumor was initially misdiagnosed as an oligodendroglioma but later proved to be a central neurocytoma. The imaging and histopathological features are reviewed. The immunopositivity allows a diagnosis of neurocytoma. Prognosis is favorable following total surgical resection, with low recurrence rate.     

Navy helicopter pilot with a juxtasellar mass: case report with aeromedical considerations

A Navy helicopter pilot was found to have a suprasellar mass during evaluation for primary infertility and mildly elevated prolactin level. Extensive evaluation revealed no other abnormalities. After 1 year of followup without radiographic tumor enlargement, he was returned to flying duties with continuing medical monitoring. Aeromedical considerations for tumors in the juxtasellar region are reviewed, including neuroendocrine disorders, neuro-ophthalmologic defects, and neurological impairment. The impact of improved diagnostic capabilities on aeromedical disposition is discussed.     

Central neurogenic hyperventilation with primary cerebral lymphoma: a case report

We report a case of a bright, alert patient with central neurogenic hyperventilation (CNH) associated with cerebral malignant lymphoma. CNH is a syndrome comprising normal or elevated arterial oxygen tension, decreased arterial carbon dioxide tension, and respiratory alkalosis in the absence of cardiac or pulmonary disease that stimulates a compensatory hyperpnea. A-72-year-old man with recurrent central nervous system lymphoma presented with hyperpnea. showing a respiratory rate over 30 per minute. He was fully awake and conscious. Routine laboratory studies and chest X-ray were normal, but arterial blood gas examination on room air showed respiratory alkalosis, regardless of wakefulness or sleep. Pulmonary infarction was denied by pulmonary flow scintigram. Rebreathing from a paper bag, intravenous administration of diazepam, and oxygen inhalation failed to alter the respiratory pattern. Brain MRI demonstrated two mildly enhanced lesions within the left side of the medulla oblongata and right side of the pons. CNH is rare in patients with normal consciousness. It seems to be caused by brainstem injury that includes the respiratory center.     

Functional MR to localize sustained visual attention activation in patients with attention deficit hyperactivity disorder: a pilot study.

PURPOSETo evaluate brain control activation in patients with attention deficit hyperactivity disorder (ADHD) and to provide an initial comparison between activated regions in ADHD subjects and those previously localized in an unaffected population.METHODSTen patients with ADHD underwent imaging with a functional blood oxygen level-dependent MR technique during sustained visual vigilance. Pixel activation was inspected visually and statistical group analysis was performed.RESULTSActivation was seen over the bilateral middle frontal gyri, the superior parietal lobules, and the inferior parietal lobules. The predominant activity occurred in the right middle frontal gyrus. Application of an additional statistical constraint revealed significant activity in the right inferior and left superior parietal lobules.CONCLUSIONADHD patients effectively tolerated the necessary MR imaging constraints despite their difficulty with confinement and immobility. Single-section functional MR imaging revealed activation in brain regions known to be involved in the maintenance of the attention in healthy subjects responding to auditory, tactile, or visual stimulation; additional areas of activity that were identified may represent true abnormal regions in the affected population or artifacts.     

Paratracheal air collection in a trauma patient: a case report

The presence of a paratracheal air collection in the setting of acute trauma may indicate a wide array of etiologies. When a paratracheal air collection is found in a trauma patient, the possibility of tracheal or esophageal rupture must be considered. Tracheal diverticulae are most frequently found incidentally during autopsy, with an incidence of approximately 1%. We present a case of an incidental tracheal diverticulum in a patient with a recent history of motor vehicle accident with chest and neck trauma.     

第四脑室中枢神经细胞瘤一例

患者男,27岁,于5个月前无明显诱因出现呕吐,3～4次/日,呕吐物为胃内容物,非喷射性,伴有头晕,时有轻微头胀痛感,按胃炎治疗无明显改善.1个月前出现行走不稳,足间距增宽,并渐出现记忆力下降、健忘,无肢体麻木、无力及口角歪斜等症状.体检:神志清楚,双眼视乳头水肿,站立不稳,闭目难立征阳性,余神经体征检查均阴性.     

Diffuse pulmonary ossification and spontaneous pneumothorax in a pilot: a case report

A 51-year-old pilot with spontaneous pneumothorax, emphysema, and multiple horny ossification in the lung is reported. The literature concerning diffuse pulmonary ossification is reviewed and aeromedical implications are discussed.     

颈髓中枢神经细胞瘤一例

患者男,27岁.因右侧上肢乏力、右侧上下肢体感觉异常2年于2009年7月29日就诊.体检:一般情况良好.神经系统检查示右上肢肌力Ⅳ级,肌肉轻度萎缩,右上肢及右小腿痛觉过敏,右侧霍夫曼征阳性,右侧腱反射亢进. MRI表现:颈髓明显增粗,T1WT以等信号为主,夹杂小片状低信号,境界模糊,蛛网膜下腔明显变窄,局部闭塞;T2WI呈混杂信号影,内见多发片状及结节样高信号,注射Gd-DTPA后病灶明显不均匀强化.     

子宫内膜浆液性癌前病变及宫外病变1例

1 病例报告 患者女,64岁,孕2产2。因全子宫、双附件切除术后10个月余,腹胀痛4个月,发现腹水1个月,于2006年9月27日入院。患者绝经11年,绝经后无阴道流液。2005年8月因无明显诱因阴道少量出血1次,于外院行诊刮术,病理结果见腺癌细胞。2005年10月20日我院病理科会诊结果为（刮宫）涂片见一些明显退变的上皮性细胞,考虑可能为退变的腺癌细胞。于我院再次行分段诊刮术,病理结果为（官腔）少许子宫内膜组织,腺体稀少。     

Enamel pearls in permanent dentition: case report and micro-CT evaluation

Objectives:

To investigate the frequency, position, number and morphology of enamel pearls (EPs) using micro-CT (µCT) and to report a case of an EP mimicking an endodontic–periodontic lesion.

Methods:

Cone beam CT (CBCT) was performed in a patient to evaluate a radio-opaque nodule observed on the left maxillary first molar during the radiographic examination. Additionally, 23 EPs were evaluated regarding frequency, position, number and morphology by means of µCT. The results were statistically compared using the Student’s t-test for independent samples.

Results:

1 pearl was presented in 13 specimens, while 5 specimens presented 2 pearls. The most frequent location of the EPs was the furcation between the disto-buccal and the palatal roots of the maxillary molars. Overall, the mean major diameter, volume and surface area were 1.98 ± 0.85 mm, 1.76 ± 1.36 mm³ and 11.40 ± 7.59 mm², respectively, with no statistical difference between maxillary second and third molars (p > 0.05). In the case report, CBCT revealed an EP between the disto-buccal and the palatal roots of the maxillary first left molar associated with advanced localized periodontitis. The tooth was referred for extraction.

Conclusions:

EPs, located generally in the furcation area, were observed in 0.74% of the sample. The majority was an enamel–dentin pearl type and no difference was found in maxillary second and third molars regarding diameter, volume and surface area of the pearls. In this report, the EP mimicked an endodontic–periodontic lesion and was a secondary aetiological factor in the periodontal breakdown.     

Atlas occipitalization in a supersonic fighter pilot involved in a midair collision: a case report

We report a case of a midair collision between two F16 fighter aircraft, in which one pilot survived and the other was ejected upon impact and his remains recovered from sea. In autopsy, no patholgy was detected, other than the expected evidence of mechanical trauma. No defects in the aircraft or faults in the parachute or ejection mechanism were found. Reconstruction of the shattered skull base and the cervical vertebrae revealed fusion of the atlanto-occipital joint (occipitalization) and a left paracondylar process. The effective diameter of the spinal canal was decreased by the abnormal articulation. Such malformations can cause a wide range of neurologic deficits. Considering the skill and alertness needed to operate a supersonic fighter aircraft, with the pressure applied by the heavy protective head gear and various G forces endured by the spinal column during flight, we postulate that the collision was related to the pilot's sudden incapacitation.     

Isolated dextrocardia in a commercial pilot candidate

Positional anomalies of the heart are rare and are seldom found during routine physical examinations. We describe the case of a 25-yr-old Swiss airline pilot candidate whose aeromedical examination was normal except that an unusual ECG raised suspicion, leading to a diagnosis of dextrocardia with a normal arrangement of atria and abdominal viscera. This diagnosis in a pilot candidate should raise concern because a high percentage of such individuals have congenital heart defects. Further tests were conducted to rule out associated cardiac malformations, conduction anomalies, or rhythm disturbances. Testing also excluded other associated diseases such as primary ciliary dyskinesia and Kartagener's syndrome. Dextrocardia is not listed as a disqualifying condition in the applicable aeromedical regulations (Joint Aviation Authorities Medical Manual, Joint Aviation Requirements-Flight Crew Licensing guidelines). Therefore, after demonstrating that there were no physical, hemodynamic, or electrophysiological abnormalities, the candidate was allowed to enroll in civilian pilot training without restrictions.     

Fatal air pressure injuries of the intestine: a case report

This is a case report of a worker in a big industrial company. He was injured by air, which forcefully entered into his body through his anus while he and his three co-workers were having fun with an air tube. He succumbed to his injuries. Details of the case are described. It is presented due to its rarity.