Airline Health Restrictions

(Great Britain—The Practitioner, May 1998, p. 384.) Each airline has its own guidelines and regulations concerning patients with health conditions. Many of these regulations are designed to avoid medical problems that are due to low humidity and changes in air pressure that allow body gases to expand during flight. Because of the effects of flight on pressure in the ear, most carriers restrict passengers with active sinusitis, otitis media, recent ear, nose and throat surgery and conditions that require the jaws to be wired. Recent penetrating eye injuries or surgery are also contraindications to flying, as is any condition that could result in gas in the globe. Scuba divers who have had symptoms of decompression conditions are not accepted on flights within 10 days of illness. Patients who have had recent gastrointestinal surgery, including laparoscopy, and those with colostomies are at risk of gas expansion, and any recent gastrointestinal bleeding or acute episode of diverticulitis, ulcerative colitis or similar diseases is usually a contraindication to air travel. Cardiovascular conditions that may preclude flying include recent cardiac surgery or myocardial infarction, uncontrolled heart failure, certain congenital conditions and transplants, thrombophlebitis, bleeding disorders, recent sickle-cell crisis and any condition in which the person's hemoglobin measurement is below 0.75 g per dL (7.5 g per L). Passengers with recent fractures are only accepted if casts can be easily removed should swelling occur. Individuals with significant neuropsychiatric illnesses may be accepted if they are accompanied by a trained escort. Those with infectious disease are generally refused permission to fly, but patients with stable serious conditions such as paraplegia may be accommodated through individual arrangement with the airline.

Malaria Prophylaxis in Travelers

(Great Britain—The Practitioner, May 1998, p. 349.) All travelers to areas where malaria is endemic should take precautions against mosquito bites. The most effective repellent is diethyltoluamide (deet), and concerns about its possible toxicity, even in infants, have recently been allayed. The risk of infection with malaria and the most appropriate prophylactic agent vary according to destination. The highest risk of infection (approximately 2 percent) is in travelers to West Africa. Multiresistant strains of malaria are common in parts of Asia, particularly along the Thailand-Cambodia border and in South America in the Amazon region. The risk of infection and recommended prophylactic agent(s) change continuously. Physicians and patients should consult the Web page of the Centers for Disease Control and Prevention (http://www.cdc.gov/travel/yellowbk [ corrected]) for current recommendations. Even in countries with high rates of malarial infection, tourist areas may pose very little risk of infection, but visitors to rural areas and those spending prolonged periods in endemic areas may be at substantial risk.

Simple Treatment for Paraphimosis

(Canada—Canadian Family Physician, June 1998, p. 1253.) Several techniques have been described to reduce paraphimosis in boys, but many of these methods are traumatic or require considerable time. A method based on the “turban” technique combines simplicity and analgesia. The penis is wrapped from the tip proximally using gauze bandages liberally coated with 5 percent lidocaine ointment. The total amount of ointment should not exceed 1.25 g (approximately 6 cm [2.3 in] squeezed from the tube). The gauze is wrapped firmly, with the maximum pressure applied distally and gradually reduced toward the base of the penis. After five to 10 minutes, the bandaging is removed and the foreskin can usually be returned to the normal position. Good care is required after reduction to prevent recurrence.

Ocular Floaters and Flashes

(Great Britain—The Practitioner, April 1998, p. 302.) Although many cases of ocular floaters and flashes are benign, it is important to recognize and refer potentially serious conditions to an ophthalmologist. The key factors in distinguishing benign from serious conditions are the duration of symptoms and the presence of vision loss. Small round floaters suggest posterior vitreous detachment. Large multiple floaters are associated with vitreous hemorrhage. Diabetes and uveitis also produce opacities in the vitreous humor that present as multiple floaters. When floaters occur in conjunction with vision field loss, retinal detachment is likely. Flashes indicate stimulation of the retina or disturbance of its blood supply. When floaters and flashes occur together, posterior vitreous detachment or a retinal tear is likely. Flashes alone may be caused by posterior vitreous detachment, retinal or cerebral emboli, or migraine.