Navy Asbestos Medical Surveillance Program, 1995-1999: demographic characteristics and smoking status.

A descriptive study of the Navy Asbestos Medical Surveillance Program is presented from data provided by the Navy Environmental Health Center in Norfolk, Virginia, with an emphasis on demographic characteristics and smoking. Analysis of 79,598 physical examinations for the period 1995 to 1999 revealed that Navy and Marine Corps civil service employees constituted 90% and Navy active duty personnel constituted 9%. Most personnel reported "no current exposure, have prior exposure" to asbestos (Navy active duty, 77%; civil service employees, 61%). Current smoking rates per year decreased for Navy active duty (from 34.6% to 28.7%) and civil service workers (from 26.0% to 21.6%), both reductions being significant for trend. Logistic regression for current smoking showed higher rates for Navy active duty and those with "direct" asbestos exposure, whereas those 50 years or older and of Asian ethnicity had lower smoking rates. These findings provide programmatic insights for the Asbestos Medical Surveillance Program and suggest areas for further study.

"Abdominal crunch"-induced rhabdomyolysis presenting as right upper quadrant pain.

A young, active duty sailor presented with right upper quadrant abdominal pain. History, physical, and laboratory findings initially suggested cholecystitis or related disease. Further evaluation found myoglobinuria and a recently increased exercise program, leading to the diagnosis of exercise-induced right upper abdominal wall rhabdomyolysis. Although not a common cause of abdominal pain, this diagnosis should be considered in the patient with abdominal pain and a recently increased exercise program, particularly exercises of the abdominal wall such as "abdominal crunches."

Inpatient care for the aircraft carrier battle group.

A case series of 417 consecutive ward admissions onboard the USS Forrestal (CV59) is presented. During the 1-year study period, the inpatient ward was open for 260 days while the ship was underway, including workups and extended Mediterranean deployment. The case series displays the variety of clinical inpatient care provided in the shipboard environment. The 10 most clinically challenging patients demonstrate the complexity of care provided. Implication for inpatient care capability afloat are discussed.

Tobacco use and smoking policy perceptions onboard an aircraft carrier.

Prior to implementing a shipwide no-smoking policy, the crew of U.S.S. Theodore Roosevelt (CVN 71) participated in a voluntary survey on tobacco-related matters. The survey queried participants on their tobacco-use history, subjective exposure to environmental tobacco smoke (ETS), and attitudes related to smoking policy prior to the cessation of all smoking activities aboard ship. Of the 2,221 crewmembers who participated (74% response rate), 36% classified themselves as current cigarette smokers. Nonsmokers estimated their general exposure to ETS between "low" to "moderate." Of all participants, 57% were in favor of the current restricted smoking policy, including 18% of currently smoking personnel. Follow-up research is being conducted to assess the long-term impact of the no-smoking policy on changes in attitudes regarding policy, tobacco-use rates, and ETS exposure.

Catapult launch-associated cardioversion of atrial fibrillation.

A patient is presented with new-onset atrial fibrillation. While being air-evacuated, he cardioverted during the acceleration associated with aircraft carrier catapult launch. This case suggests a possible myocardial response to the kinetic energy produced by the acceleration force, similar to the electrical energy commonly used for cardioversion. Cardioversion using acceleration forces is probably not a clinically useful modality; however, this case demonstrates the importance of acceleration forces on patients during medical evacuation from aircraft carriers.

Performance evaluation impairment prior to HIV seropositive diagnosis: a preliminary Navy population-based study.

Significant work problems were noted in two U.S. Navy personnel immediately prior to being found Human Immunodeficiency Virus (HIV) seropositive. This finding suggested a preliminary study on performance evaluation impairment prior to HIV seropositive diagnosis. Cases studied were 75 (of a possible 82 available) HIV seropositive male sailors in the E-6 paygrade identified in 1987. One-sided analysis was conducted on categories from Navy performance evaluation reports prior to diagnosis, with controls' frequency matched for Rate, Rank, Date of Rank, Race, and Male sex (N = 71). The cases were significantly lower for Personal Behavior (OR = 2.04, p = 0.038 one-sided) and Overall (OR = 1.80, p = 0.048 one-sided). After adjustment by logistic regression for sea-shore duty, significant impairment was demonstrated for Personal Behavior (OR = 5.76, p = 0.002 one sided, with significant interaction p = 0.014), Reliability (OR = 2.89, p = 0.024 one-sided), and Overall (OR = 2.47 p = 0.036 one-sided). These findings suggest further studies on performance evaluation impairment prior to HIV seropositive diagnosis.

Brief reactive psychosis in naval aviation.

Five naval aviation personnel diagnosed with brief reactive psychosis (BRP) have appeared before the Special Board of Flight Surgeons (SBFS) at the Naval Aerospace Medical Institute (NAMI). These cases demonstrate the challenges in diagnosis and disposition that face the clinical aeromedical specialist in evaluating the aviator who develops psychiatric symptoms. We discuss the aeromedical factors that must be considered when contemplating returning aviators with psychiatric diagnoses to flying duties. Sudden behavioral changes in aviation personnel require a systematic assessment, thorough documentation, and continuing reevaluation. The differentiation between organic and functional etiologies may be difficult. Final disposition may require consultation with experienced physicians skilled in both aviation psychiatry and neurology.

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.

From the Aerospace Medicine Residents' Teaching File. Case #36.

A designated naval aviator was evaluated after several episodes of vertigo related to a zoom climb flight profile. Workup led to the diagnosis of alternobaric vertigo. Contributing factors were concurrent upper respiratory infection and functioning left pressure equilibration (PE) tube for chronic otitis media.

HLA B27 positive helicopter pilot with reactive arthritis responsive to sulfasalazine.

An aviator with prolonged right sided low back pain is described. The diagnostic workup is presented leading to diagnosis of HLA B27 positive reactive sacroiliitis. Trial of sulfasalazine lead to resolution of his pain. The spondylarthropathies are briefly reviewed. Implications on his aeromedical status are discussed.

Intranasal retraction of nasogastric feeding tube: case report and suggestion for design modification.

A 61-year-old black woman was admitted with intermittent small bowel obstruction following multiple therapies for recurrent ovarian carcinoma. Conservative enteric therapy with central hyperalimentation was begun prior to surgical intervention. After approximately 3 wk without resolution, surgical bypass of the obstructed area was performed for palliation. With the return of bowel function, continuous enteral feeding was utilized. During placement of enteral feeding tube, the proximal end spontaneously retracted into the patient's nasal cavity with associated patient distress. After some difficulty, the feeding tube was removed. Simple design modification of the proximal portion of the nasogastric feeding tube should prevent such complication. The addition of "wings" to the proximal end should be considered as a modification to prevent similar occurrences.