Database: Ovid MEDLINE(R) <1966 to January Week 3 2004>
Search Strategy:
-------------------------------------------------------------------------------1
barotrauma/ or decompression sickness/ (2783)
2
exp sports/ (47461)
3
1 and 2 (1067)
4
limit 3 to (human and english language) (714)
5
limit 4 to yr=1996-2004 (230)
6
(*barotrauma/ or *decompression sickness/) and 5 (192)
7
limit 6 to ovid full text available (20)
8
exp *sports/ and 6 (165)
9
limit 8 to review articles (26)
10
from 9 keep 2-4,6-7,9-12,14,16-18,21-22,26 (16)
11
7 or 10 (35)
12
limit 8 to yr=2002-2004 (37)
13
from 12 keep 1-3,5-7,9,11-12,15,19-20,25,29,31-33,35,37 (19)
14
11 or 13 (46)
15
from 14 keep 1-46 (46)
16
from 15 keep 1-46 (46)
***************************
<1>
Unique Identifier
8623700
Authors
Clenney TL. Lassen LF.
Institution
Naval School, Explosive Ordnance Disposal, Indian Head, Maryland, USA.
Title
Recreational scuba diving injuries. [Review] [17 refs]
Source
American Family Physician. 53(5):1761-74, 1996 Apr.
Abstract
Because of the increasing popularity of recreational scuba diving, primary
care physicians should be familiar with common diving injuries. One form of
barotrauma, middle ear squeeze, is the most common diving injury. Other
important diving injuries include inner ear barotrauma and pulmonary barotrauma.
Arterial gas embolism, a potentially life-threatening form of pulmonary
barotrauma, requires hyperbaric treatment. Decompression sickness is the result
of bubble formation in body tissue. Symptoms of decompression sickness range
from joint pain to neurologic or pulmonary problems. Recompression is the
mainstay of treatment. [References: 17]
<2>
Unique Identifier
11417773
Authors
Newton HB.
Institution
Department of Neurology, Ohio State University Hospitals, Columbus 43210, USA.
newton.12@osu.edu
Title
Neurologic complications of scuba diving. [Review] [18 refs]
Source
American Family Physician. 63(11):2211-8, 2001 Jun 1.
Abstract
Recreational scuba diving has become a popular sport in the United States,
with almost 9 million certified divers. When severe diving injury occurs, the
nervous system is frequently involved. In dive-related barotrauma, compressed or
expanding gas within the ears, sinuses and lungs causes various forms of
neurologic injury. Otic barotrauma often induces pain, vertigo and hearing loss.
In pulmonary barotrauma of ascent, lung damage can precipitate arterial gas
embolism, causing blockage of cerebral blood vessels and alterations of
consciousness, seizures and focal neurologic deficits. In patients with
decompression sickness, the vestibular system, spinal cord and brain are
affected by the formation of nitrogen bubbles. Common signs and symptoms include
vertigo, thoracic myelopathy with leg weakness, confusion, headache and
hemiparesis. Other diving-related neurologic complications include headache and
oxygen toxicity. [References: 18]
<3>
Unique Identifier
11326354
Authors
Strauss MB. Borer RC Jr.
Institution
Baromedical Department, Long Beach Memorial Medical Center, Long Beach, CA
90801-1428, USA.
Title
Diving medicine: contemporary topics and their controversies. [Review] [36
refs]
Source
American Journal of Emergency Medicine. 19(3):232-8, 2001 May.
Abstract
SCUBA diving is a popular recreational sport. Although serious injuries occur
infrequently, when they do knowledge of diving medicine and/or where to obtain
appropriate consultation is essential. The emergency physician is likely to be
the first physician contact the injured diver has. We discuss 8 subjects in
diving medicine which are contemporary, yet may have controversies associated
with them. From this information the physician dealing primarily with the
injured diver will have a basis for understanding and managing, as well as where
to find additional help, for his/her patients' diving injuries. [References: 36]
<4>
Unique Identifier
8915410
Authors
Harrill WC. Jenkins HA. Coker NJ.
Institution
Bobby R. Alford Department of Otorhinolaryngology and Communicative Sciences,
Baylor College of Medicine, Houston, TX 77030, USA.
Title
Barotrauma after stapes surgery: a survey of recommended restrictions and
clinical experiences.
Source
American Journal of Otology. 17(6):835-45; discussion 845-6, 1996 Nov.
Abstract
OBJECTIVE: To identify a consensus on the postoperative barorestrictions after
stapes surgery and to examine the clinical barotrauma experience within this
patient population encountered by the surveyed physicians. DATA SOURCE: A 34item survey was developed, allowing for detailed analysis of physician
demographic data, practice characteristics, surgical experience, and clinical
experience with barotrauma after stapes surgery. The postoperative restrictions
addressed by the survey included those for air travel, snorkeling, and scuba
diving. Recommendations for the use of ventilation tubes and hyperbaric oxygen
therapy were investigated as well. STUDY SELECTION: Surveys were mailed to 419
active members of the American Otological Society and the American Neurotology
Society as listed in the American Academy of Otolaryngology-Head and Neck
Surgery (AAO-HNS) 1994-1995 Conjoint Directory. A total of 284 (67.8%) surveys
were returned, of which 53 were not sufficiently completed and were excluded in
the statistical analysis. DATA EXTRACTION: The demographic data and clinical
experience were analyzed to determine statistical association with the
postoperative recommendations using chi 2 or Fisher's exact tests. The kappa
statistic was used as a measure of consistency between physicians' recommended
restriction for a specific activity after a stapedectomy or stapedotomy.
CONCLUSION: No consensus was demonstrated as to restrictions from activities
such as air travel, snorkeling, or scuba diving. Despite this lack of consensus,
no significant difference was demonstrated in the prevalence of barotrauma
reported within the responding physicians' practices based on their individual
recommendations for these activities.
<5>
Unique Identifier
11187416
Authors
Schwerzmann M. Seiler C. Lipp E. Guzman R. Lovblad KO. Kraus M. Kucher
N.
Institution
Swiss Cardiovascular Center Bern and University Hospital.
Title
Relation between directly detected patent foramen ovale and ischemic brain
lesions in sport divers.[see comment].
Comments
Comment in: Ann Intern Med. 2001 Nov 20;135(10):928-9; PMID: 11712889, Comment
in: Ann Intern Med. 2001 Nov 20;135(10):928; author reply 929; PMID: 11712888
Source
Annals of Internal Medicine. 134(1):21-4, 2001 Jan 2.
Abstract
BACKGROUND: In divers, the significance of a patent foramen ovale and its
potential relation to paradoxical gas emboli remain uncertain. OBJECTIVE: To
assess the prevalence of symptoms of decompression illness and ischemic brain
lesions in divers with regard to the presence of a patent foramen ovale. DESIGN:
Retrospective cohort study. SETTING: University hospital and three diving clubs
in Switzerland. PARTICIPANTS: 52 sport divers and 52 nondiving controls.
MEASUREMENTS: Prevalence of self-reported decompression events, patent foramen
ovale on contrast transesophageal echocardiography, and ischemic brain lesions
on magnetic resonance imaging. RESULTS: The risk for decompression illness
events was 4.5-fold greater in divers with patent foramen ovale than in divers
without patent foramen ovale (risk ratio, 4.5 [95% CI, 1.2 to 18.0]; P = 0.03).
Among divers, 1.23 +/- 2.0 and 0.64 +/- 1.22 ischemic brain lesions per person
(mean +/- SD) were detected in those with and those without patent foramen
ovale, respectively. Among controls, 0.22 +/- 0.44 and 0.12 +/- 0.63 lesion per
person were detected (P < 0.001 for all groups). CONCLUSIONS: Regardless of
whether a diver has a patent foramen ovale, diving is associated with ischemic
brain lesions.
<6>
Unique Identifier
14556567
Authors
Gerriets T. Tetzlaff K. Hutzelmann A. Liceni T. Kopiske G. Struck N.
Reuter M. Kaps M.
Institution
Department of Neurology, Justus-Liebig-University Giessen, Am Steg 20, 35390
Giessen, Germany. Tibo.Gerriets@neuro.med.uni-giessen.de
Title
Association between right-to-left shunts and brain lesions in sport divers.
Source
Aviation Space & Environmental Medicine. 74(10):1058-60, 2003 Oct.
Abstract
BACKGROUND: Recent studies suggest that healthy sport divers may develop
clinically silent brain damage, based on the association between a finding of
multiple brain lesions on MRI and the presence of right-to-left shunt, a pathway
for venous gas bubbles to enter the arterial system. METHODS: We performed
echocontrast transcranial Doppler sonography in 42 sport divers to determine the
presence of a right-to-left shunt. Cranial MRI was carried out using a 1.5 T
magnet. A lesion was counted if it was hyperintense on both T2-weighted and T2weighted fluid attenuated inversion recovery sequences. To test the hypothesis
that the occurrence of postdive arterial gas emboli is related to brain lesions
on MRI, we measured postdive intravascular bubbles in a subset of 15 divers 30
min after open water scuba dives. RESULTS: Echocontrast transcranial Doppler
sonography revealed a right-to-left shunt in 16 of the divers (38%). Only one
hyperintensive lesion of the central white matter was found and that was in a
diver with no evidence of a right-to-left shunt. Postdive arterial gas emboli
were detected in 3 out of 15 divers; they had a right-to-left shunt, but no
pathologic findings on cranial magnetic resonance imaging. CONCLUSIONS: Our data
support the theory that right-to-left shunts can serve as a pathway for venous
gas bubbles into the arterial circulation. However, we could not confirm an
association between brain lesions and the presence of a right-to-left shunt in
sport divers.
<7>
Unique Identifier
11846183
Authors
Clarke D. Gerard W. Norris T.
Institution
Department of Hyperbaric Medicine, Palmetto Richland Memorial Hospital,
University of South Carolina, Columbia 29203, USA.
dick.clarke@palmettohealth.org
Title
Pulmonary barotrauma-induced cerebral arterial gas embolism with spontaneous
recovery: commentary on the rationale for therapeutic compression. [Review] [86
refs]
Source
Aviation Space & Environmental Medicine. 73(2):139-46, 2002 Feb.
Abstract
Pulmonary barotrauma-induced cerebral arterial gas embolism (CAGE) continues
to complicate compressed gas diving activities. Inadequate lung ventilation
secondary to inadvertent breath holding or rapid buoyant ascent can quickly
generate a critical state of lung over-pressure. Pulmonary over-pressurization
may also occur as a consequence of acute and chronic pulmonary pathologies.
Resulting barotrauma frequently causes structural failure within the terminal
distal airway. Respiratory gases are then free to embolize the systemic
circulation via the pulmonary vasculature and the left heart. The brain is a
common target organ. Bubbles that enter the cerebral arteries coalesce to form
columns of gas as the vascular network narrows. Small amounts of gas frequently
pass directly through the cerebral circulation without occlusion. Larger columns
of gas occlude regional brain blood flow, either transiently or permanently,
producing a stroke-like clinical picture. In cases of spontaneous
redistribution, a period of apparent recovery is frequently followed by relapse.
The etiology of relapse appears to be multifactoral, and chiefly the consequence
of a failure of reperfusion. Prediction of who will relapse is not possible, and
any such relapse is of ominous prognostic significance. It is advisable,
therefore, that CAGE patients who undergo spontaneous recovery be promptly
recompressed while breathing oxygen. Therapeutic compression will serve to
antagonize leukocyte-mediated ischemia-reperfusion injury; limit potential reembolization of brain blood flow, secondary to further leakage from the original
pulmonary lesion or recirculation of gas from the initial occlusive event;
protect against embolic injury to other organs; aid in the resolution of
component cerebral edema; reduce the likelihood of late brain infarction
reported in patients who have undergone spontaneous clinical recovery; and
prophylax against decompression sickness in high gas loading dives that precede
accelerated ascents and omitted stage decompression. [References: 86]
<8>
Unique Identifier
12182213
Authors
St Leger Dowse M. Bryson P. Gunby A. Fife W.
Institution
Diving Diseases Research Centre, Plymouth, Devon, United Kingdom.
mstld@eurobell.co.uk
Title
Comparative data from 2250 male and female sports divers: diving patterns and
decompression sickness.
Source
Aviation Space & Environmental Medicine. 73(8):743-9, 2002 Aug.
Abstract
BACKGROUND: The aim of the study was to compare the diving habits and
histories of men and women in recreational scuba diving. METHODS: More than
10,000 questionnaires were circulated to recreational divers in the United
Kingdom. Retrospective, broad-based information was requested concerning general
health, smoking, alcohol, recreational drug use, diving habits and histories,
and physician-confirmed and self-diagnosed episodes of decompression sickness
(DCS). Data relating only to women were also gathered. Questionnaires were
anonymous. RESULTS: Over four years, 2250 divers responded, 47% of whom were
women. Of the 458,827 dives reported, 310% were by women. Differences in diving
habits were observed between men and women, which included number of dives per
annum, maximum depths dived, and dives with extra stops. When the level of
experience was taken into account in this study group, the estimated rate of DCS
in men was 2.60 times greater than for women. CONCLUSIONS: In this study,
comparison between men and women in recreational diving differed from the
initial evaluation when underlying factors were taken into account. Future
studies should attempt to control for underlying factors in the data gathering
and data analysis.
<9>
Unique Identifier
12398259
Authors
Freiberger JJ. Denoble PJ. Pieper CF. Uguccioni DM. Pollock NW. Vann RD.
Institution
Diver's Alert Network, and Duke University Medical Center, Center for
Hyperbaric Medicine and Environmental Physiology, Department of Anesthesiology,
Durham, NC 27710, USA. jfreiberger@dan.duke.edu
Title
The relative risk of decompression sickness during and after air travel
following diving.
Source
Aviation Space & Environmental Medicine. 73(10):980-4, 2002 Oct.
Abstract
BACKGROUND: Decompression sickness (DCS) can be provoked by post-dive flying
but few data exist to quantify the risk of different post-dive, preflight
surface intervals (PFSI). METHODS: We conducted a case-control study using field
data from the Divers Alert Network to evaluate the relative risk of DCS from
flying after diving. The PFSI and the maximum depths on the last day of diving
(MDLD) were analyzed from 627 recreational dive profiles. The data were divided
into quartiles based on surface interval and depth. Injured divers (cases) and
uninjured divers (controls) were compared using logistic regression to determine
the association of DCS with time and depth while controlling for diver and dive
profiles characteristics. These included PFSI, MDLD, gender, height, weight,
age, and days of diving. RESULTS: The means (+/-SD) for cases and controls were
as follows: PFSI, 20.7 +/- 9.6 h vs. 27.1 +/- 6.7 h; MDLD, 22.5 +/- 14 meters
sea water (msw) vs. 19 +/- 11.3 msw; male gender, 60% vs. 70%; weight, 75.8 +/18 kg vs. 77.6 +/- 16 kg; height, 173 +/- 16 cm vs. 177 +/- 9 cm; age, 36.8 +/10 yr vs. 42.9 +/- 11 yr; diving > or = 3 d, 58% vs. 97%. Relative to flying >
28 h after diving, the odds of DCS (95% CI) were: 1.02 (0.61, 1.7) 24-28 h; 1.84
(1.0, 3.3) 20-24 h; and 8.5 (3.85, 18.9) < 20 h. Relative to a depth of < 14.7
msw, the odds of DCS (95% CI) were: 1.2 (0.6, 1.7) 14.7-18.5 msw; 2.9 (1.65,
5.3) 18.5-26 msw; and 5.5 (2.96, 1 0.0) > 26 msw. CONCLUSIONS: Odds ratios
approximate relative risk in rare diseases such as DCS. This study demonstrated
an increase in relative risk from flying after diving following shorter PFSIs
and/or greater dive depths on the last day. The relative risk increases
geometrically as the PFSI becomes smaller.
<10>
Unique Identifier
14556574
Authors
Benton PJ. Anthony G.
Institution
Institute of Naval Medicine, Alverstoke, Gosport, Hampshire, UK.
Title
Hand discomfort following heliox chamber dives.
Source
Aviation Space & Environmental Medicine. 74(10):1101-4, 2003 Oct.
Abstract
During a series of dry chamber dives using compressed heliox, five attendants
and one wet diver experienced eight episodes of hand discomfort, the character
of which was atypical of limb pain during decompression sickness. Although
immersed for most of the dive, during the compression and decompression phases,
the wet diver's hands were out of the water and hence exposed to the heliumcontaining chamber atmosphere. In all cases, symptoms resolved within a maximum
of 48 h. There was no response to hyperbaric oxygen therapy in the three cases
that presented before spontaneous resolution. While the attendants wore dry
suits to minimize skin absorption of helium, their hands, were exposed to the
heliox atmosphere. After the first six cases of hand symptoms, a dry glove
assembly was added to prevent helium absorption through the exposed hand. Two
cases of hand discomfort occurred following the addition of the dry glove
assembly to the dry suit. In both cases, the symptoms were less severe and
resolved over a significantly shorter time period. Adoption of the dry gloves
resulted in the incidence of hand discomfort among attendants falling from 25%
(5/20) to 2.4% (2/84) (p = 0.005). Possible mechanisms of causation of this hand
discomfort, thought to be the result of local tissue absorption of helium, are
discussed.
<11>
Unique Identifier
9056035
Authors
Moon RE. Sheffield PJ.
Institution
Duke Hyperbaric Center, Duke University Medical Center, Medical Durham, NC
27710, USA.
Title
Guidelines for treatment of decompression illness. [Review] [88 refs]
Source
Aviation Space & Environmental Medicine. 68(3):234-43, 1997 Mar.
<12>
Unique Identifier
12650269
Authors
Egi SM. Gurmen NM. Aydin S.
Institution
Biomedical Engineering Institute, Bogazici University, Istanbul, Turkey.
smegi@superonline.com
Title
Field trials of no-decompression stop limits for diving at 3500 m.
Source
Aviation Space & Environmental Medicine. 74(3):228-35, 2003 Mar.
Abstract
INTRODUCTION: In 1990, Bogazici University (Istanbul, Turkey) launched an
altitude diving program to develop techniques and safe decompression profiles
for diving at high terrestrial altitudes. Following pioneering diving
expeditions to lakes at high elevations in 1990-1992, it was deemed necessary to
calculate new tables. METHODS: Bottom time limits for dives requiring no
decompression stops (no-d) were calculated for 3500 m using linear extrapolation
of U.S. Navy M-values decreased by 4 ft of sea water (M4 limits). These limits
were tested for 15, 18, 21, 24, 27, and 30 m of depth by diving in the Great Sea
Lake at Mt Kackar (3412 m) with 10 dives per profile. RESULTS: The mean
decompression sickness (DCS) risk estimated from precordial bubble scores
(Spencer Scale) ranged from 0.3% to 2.8% per profile. After three expeditions,
165 dives had been achieved with a cumulative bottom time of 3199 min. No DCS
occurred in dives that adhered to the M4 no-d limits. However, two cases of Type
I and one case of Type II DCS were encountered where the divers accidentally
exceeded those limits. DISCUSSION: Considering the estimated risk of DCS and the
relatively small number of trials, a more conservative approach was used to
develop a final set of high altitude dive tables. This conclusive approach used
continuous compartment half-lives. It is based on fitting a surface of allowable
supersaturation limits using the empirical M-values from existing tables as well
as our altitude diving data, together with an added constraint that forces
calculated M-values to stay below the available M-value data.
<13>
Unique Identifier
12796196
Authors
Yanir Y. Abramovich A. Beck-Razi N. Shupak A.
Institution
Israel Naval Medical Institute, Israel Defense Forces Medical Corps, Haifa,
Israel.
Title
Telephone diagnosis of a strange voice.
Source
Chest. 123(6):2112-4, 2003 Jun.
<14>
Unique Identifier
11290892
Authors
Radaideh MM. Lamki LM.
Institution
Barron BJ.
Elshazly SM.
Department of Radiology, Memorial Hermann Hospital, University of TexasHouston Medical School, 77030, USA. Majdi.M.Radaideh@uth.tmc.edu
Title
Radionuclide lung imaging in respiratory decompression sickness: potential
role in the diagnosis and evaluation of hyperbaric therapy.
Source
Clinical Nuclear Medicine. 26(4):320-4, 2001 Apr.
Abstract
Of the more than 3.5 million trained divers in the United States, many will
experience various illnesses specific to divers. Most of these illnesses are
related to the changes in absolute pressure that divers experience while diving.
During and after ascent, a diver is at risk for decompression sickness and
pulmonary barotrauma. A very rare casualty is pulmonary decompression sickness
from immersion. This is a literature review and case report of a young woman
with acute respiratory decompression sickness who had defects on perfusion lung
imaging after a diving accident and after hyperbaric oxygen therapy. However,
the perfusion defects reverted to normal in less than 24 hours. Possible
explanations for the changes in the appearances of the scans are offered and
discussed. This case report shows the potential utility of lung scanning in the
diagnostic examination of these patients and the evaluation of the adequacy of
treatment with hyperbaric oxygen therapy. A greater use of ventilation-perfusion
lung scans in the treatment of such patients may establish its role more
definitely.
<15>
Unique Identifier
12074688
Authors
Ball R. Schwartz SL.
Institution
Decompression Program, Diving and Environmental Physiology Department, Naval
Medical Research Institute, Bethesda, Maryland, USA. BallR@cber.fda.gov
Title
Kinetic and dynamic models of diving gases in decompression sickness
prevention. [Review] [76 refs]
Source
Clinical Pharmacokinetics. 41(6):389-402, 2002.
Abstract
Decompression sickness is a complex phenomenon involving gas exchange, bubble
dynamics and tissue response. Relatively simple deterministic compartmental
models using empirically derived parameters have been the mainstay of the
practice for preventing decompression sickness since the early 1900s. Decades of
research have improved our understanding of decompression physiology, and the
insights incorporated in decompression models have allowed people to dive deeper
into the ocean. However, these efforts have not yet, and are unlikely in the
near future, to result in a 'universal' deterministic model that can predict
when decompression sickness will occur. Divers using current recreational dive
computers need to be aware of their limitations. Probabilistic models based on
the estimation of parameters using modern statistical methods from large
databases of dives offer a new approach and can provide a means of
standardisation of deterministic models. Future improvements in decompression
practice will depend on continued improvement in understanding the kinetics and
dynamics of gas exchange, bubble evolution and tissue response, and the
incorporation of this knowledge in risk models whose parameters can be estimated
from large databases of human and animal data. [References: 76]
<16>
Unique Identifier
10331136
Authors
Moon RE.
Institution
Department of Anesthesiology, Duke University Medical Center, Durham, North
Carolina, USA. MOON0002@mc.duke.edu
Title
Treatment of diving emergencies. [Review] [167 refs]
Source
Critical Care Clinics. 15(2):429-56, 1999 Apr.
Abstract
Recognition of condition attributable to the environmental changes experienced
by divers will facilitate appropriate treatment. The diagnosis of these
conditions rarely requires sophisticated imaging or electrophysiologic testing.
Divers who have suspected DCI, in addition to general supportive measures,
should be administered fluids and oxygen and transported to a recompression
chamber. For diving-related conditions, on-line consultation is available from
the Divers Alert Network, Durham, NC (919-684-8111). [References: 167]
<17>
Unique Identifier
12544998
Authors
Cantais E. Louge P. Suppini A. Foster PP. Palmier B.
Institution
Military Teaching Hospital, Service de Reanimation, Toulon-Naval, France.
Title
Right-to-left shunt and risk of decompression illness with cochleovestibular
and cerebral symptoms in divers: case control study in 101 consecutive dive
accidents.[see comment].
Comments
Comment in: Crit Care Med. 2003 Jul;31(7):2083; PMID: 12847414
Source
Critical Care Medicine. 31(1):84-8, 2003 Jan.
Abstract
OBJECTIVE: We investigated the role of right-to-left shunt with standardized
transcranial Doppler ultrasonography in a large population of divers referred
for symptoms of decompression illness. DESIGN: Case series compared with a
control group. SETTING: Military teaching hospital, hyperbaric unit. PATIENTS:
Patients were 101 consecutive divers with clinical evidence of decompression
illness and a control group of 101 healthy divers. INTERVENTION: Specification
of the type of decompression illness involved and detection/evaluation of rightto-left shunt by standardized transcranial Doppler. The degree of right-to-left
shunt was defined as major if the number of high-intensity transient signals in
the middle cerebral artery was >20. MEASUREMENTS AND MAIN RESULTS: We evaluated
the odds ratios by logistic regression analysis with vs. without right-to-left
shunt for subjects with cochleovestibular symptoms, cerebral decompression
illness, spinal decompression illness, and Caisson sickness. Of the 101 divers
presenting with decompression illness, transcranial Doppler detected a right-toleft shunt in 59 (58.4%), whereas control subjects demonstrated a right-to-left
shunt in 25 cases (24.8%; odds ratio, 4.3; 95% confidence interval, 2.3-7.8;
p=.09). When a right-to-left shunt was detected, the right-to-left shunt was
major in 12 of 25 patients in the control group and in 49 of 59 patients in the
decompression illness group (odds ratio, 8.7; 95% confidence interval, 4.2-18.0;
p<.001). Within the decompression illness group, the proportion of major rightto-left shunt was 24 of 34 (odds ratio, 29.7; 95% confidence interval, 10.087.2; p<.0001) in the cochleovestibular subgroup, 13 of 21 (odds ratio, 24.1,
95% confidence interval, 6.8-86.0, p< 0.0001) in the cerebral decompression
illness subgroup, ten of 31 (odds ratio, 3.9; 95% confidence interval, 1.5-10.3;
p<.01) in the spinal decompression illness subgroup, and two of two (odds ratio,
1.1; 95% confidence interval, 0.2-5.7; p=.9) in the subgroup of divers with
Caisson sickness. CONCLUSION: Based on our results, we conclude that major
right-to-left shunt was associated with an increased incidence of
cochleovestibular and cerebral decompression illness, suggesting paradoxical
embolism as a potential mechanism.
<18>
Unique Identifier
12847414
Authors
Tetzlaff K. Muth CM.
Title
Right-to-left shunts and risk of decompression illness.[comment].
Comments
Comment on: Crit Care Med. 2003 Jan;31(1):84-8; PMID: 12544998
Source
Critical Care Medicine. 31(7):2083, 2003 Jul.
<19>
Unique Identifier
11140404
Authors
Krieger BP.
Institution
University of Miami at Mount Sinai Medical Center, Miami Beach, Florida 33140,
USA. bronchobruce@pol.net
Title
Diving: what to tell the patient with asthma and why?. [Review] [31 refs]
Source
Current Opinion in Pulmonary Medicine. 7(1):32-8, 2001 Jan.
Abstract
Until a decade ago, divers with asthma were uniformly barred from diving with
compressed air. This prohibition was based more on theoretical concerns for
barotrauma than on actual data. Follow-up studies, although retrospective, do
not support a ban on recreational or commercial diving for divers with stable
asthma. These studies have noted that, despite the prohibition on diving, many
divers with asthma have logged multiple dives without negative consequences.
When those who have suffered diving-related barotrauma have undergone
physiologic testing, measurements of small airways dysfunction (maximal midexpiratory flow rates) have been lower than measurements for comparable divers
who have never suffered diving accidents. Follow-up studies with long-term
commercial divers have shown that a small percentage of individuals who have
sufferred diving-related barotrauma also develop abnormal maximal mid-expiratory
flow rates and even some airway hyperreactivity. These latter findings correlate
with the changes that occur in chronic asthmatic patients, especially those who
are not well treated. The decision as to whether an asthmatic patient should be
allowed to dive rests on the individual's physiologic function, maturity, and
insight into the consequences of poorly managed airway inflammation and
bronchospasm. [References: 31]
<20>
Unique Identifier
11887277
Authors
Pelletier JP.
Institution
Naval School, Explosive Ordnance Disposal, Indian Head, Md., USA.
Title
Recognizing sport diving injuries.
Source
DCCN - Dimensions of Critical Care Nursing. 21(1):26-7, 2002 Jan-Feb.
Abstract
Even if scuba diving is not a local enthusiasm, someone with life-threatening
dive-related problems could turn up in the emergency department at any time.
This article describes how to respond.
<21>
Unique Identifier
12534478
Authors
Gorman D.
Institution
University of Auckland, Private Bag 92019, Auckland, New Zealand.
d.gorman@auckland.ac.nz
Title
Accidental arterial gas embolism.[see comment]. [Review] [41 refs]
Comments
Comment in: Emerg Med (Fremantle). 2002 Dec;14(4):354-5; PMID: 12534475
Source
Emergency Medicine (Fremantle, W.A.). 14(4):364-70, 2002 Dec.
<22>
Unique Identifier
12534479
Authors
Emerson GM.
Institution
Department of Emergency Medicine, Royal Brisbane Hospital, Herston Road,
Herston, Qld 4029, Australia. Greg_Emerson@health.qld.gov.au
Title
What you need to know about diving medicine but won't find in a textbook.[see
comment]. [Review] [7 refs]
Comments
Comment in: Emerg Med (Fremantle). 2002 Dec;14(4):354-5; PMID: 12534475
Source
Emergency Medicine (Fremantle, W.A.). 14(4):371-6, 2002 Dec.
Abstract
The old adage that 'if a patient in your emergency department (ED) is wearing
a wetsuit, fins and a mask, then he/she probably has a diving related illness'
is one that should be remembered. This is an obvious statement that should not
need stating; however, simple clues can be missed or disregarded. This article
will address issues that may confront emergency physicians and for which there
are few resources to find the answers. It aims to explain the reasons behind
some of the advice given during consultation with a hyperbaric physician. The
second aim is to bring emergency physicians up to date with new diving practices
and how these may impact upon traditional diving injuries. To achieve these
aims, this article is a compilation of answers to frequently asked or pertinent
questions related to diving medicine. [References: 7]
<23>
Unique Identifier
12534477
Authors
Francis J.
Institution
2 Merton Cottages, Tregatta, Tintagel, Cornwall PL34 0DY, UK.
tjrf@btinternet.com
Title
Decompression sickness.[see comment]. [Review] [34 refs]
Comments
Comment in: Emerg Med (Fremantle). 2002 Dec;14(4):354-5; PMID: 12534475
Source
Emergency Medicine (Fremantle, W.A.). 14(4):358-63, 2002 Dec.
<24>
Unique Identifier
9056577
Authors
Hardy KR.
Institution
Department of Emergency Medicine, University of Pennsylvania, Institute for
Environmental Medicine, Philadelphia, USA.
Title
Diving-related emergencies. [Review] [76 refs]
Source
Emergency Medicine Clinics of North America. 15(1):223-40, 1997 Feb.
Abstract
The proliferation of sport or recreational divers over the last several
decades has resulted in significant increases in the number of patients treated
for diving-related emergencies. The treatment of these individuals is no longer
confined to a small group of physicians with special training or experience.
Rather, community emergency physicians and physicians engaged in the practice of
travel medicine are increasingly called on to treat such patients. This article
discusses general physical principles relating to diving medicine and common
presentations and treatment of diving-related emergencies. [References: 76]
<25>
Unique Identifier
11264683
Authors
Cheshire WP Jr. Ott MC.
Institution
Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA.
Title
Headache in divers. [Review] [77 refs]
Source
Headache. 41(3):235-47, 2001 Mar.
Abstract
The increasing popularity of scuba diving has added a new category to the
differential diagnosis of headache. Headache in divers, while uncommon and
generally benign, can occasionally signify serious consequences of hyperbaric
exposure such as arterial gas embolism, decompression sickness, and otic or
paranasal sinus barotrauma. Inadequate ventilation of compressed gases can lead
to carbon dioxide accumulation, cerebral vasodilatation, and headache. Other
types of headache encountered in divers include exertional headache, cold
stimulus headache, migraine, tension-type headache, acute traumatic headache,
cervicogenic headache, carbon monoxide poisoning headache, and headache
associated with envenomation. Correct diagnosis and appropriate treatment
require a careful history and neurologic examination as well as an understanding
of the unique physiologic stresses of the subaquatic environment. [References:
77]
<26>
Unique Identifier
10047764
Authors
Lincoln EA.
Institution
Department of Family Medicine, Michigan State University College of Human
Medicine and Saginaw Cooperative Hospitals, USA.
Title
Management of dive-related trauma. [Review] [0 refs]
Source
Hospital Practice (Office Edition). 34(2):120-2, 1999 Feb 15.
<27>
Unique Identifier
12070208
Authors
Lillo RS. Himm JF. Weathersby PK. Temple DJ. Gault KA. Dromsky DM.
Institution
Biomedical Research Department, Navy Experimental Diving Unit, Panama City,
Florida 32407-7015, USA. lillors@nedu.navsea.navy.mil
Title
Using animal data to improve prediction of human decompression risk following
air-saturation dives.
Source
Journal of Applied Physiology. 93(1):216-26, 2002 Jul.
Abstract
To plan for any future rescue of personnel in a disabled and pressurized
submarine, the US Navy needs a method for predicting risk of decompression
sickness under possible scenarios for crew recovery. Such scenarios include
direct ascent from compressed air exposures with risks too high for ethical
human experiments. Animal data, however, with their extensive range of exposure
pressures and incidence of decompression sickness, could improve prediction of
high-risk human exposures. Hill equation dose-response models were fit, by using
maximum likelihood, to 898 air-saturation, direct-ascent dives from humans,
pigs, and rats, both individually and combined. Combining the species allowed
estimation of one, more precise Hill equation exponent (steepness parameter),
thus increasing the precision associated with human risk predictions. These
predictions agreed more closely with the observed data at 2 ATA, compared with a
current, more general, US Navy model, although the confidence limits of both
models overlapped those of the data. However, the greatest benefit of adding
animal data was observed after removal of the highest risk human exposures,
requiring the models to extrapolate.
<28>
Unique Identifier
12546369
Authors
Reichardt KA. Nabavi A. Barth H. Mehdorn HM. Blomer U.
Institution
Department of Neurosurgery, University Hospital Kiel, Germany.
Title
Barotrauma as a possible cause of aneurysmal subarachnoid hemorrhage. Case
report.
Source
Journal of Neurosurgery. 98(1):180-2, 2003 Jan.
Abstract
The authors report the case of a 47-year-old man who suffered a diving
accident. After regaining consciousness he experienced severe headache. He was
initially treated for barotrauma, but the persistent headache led to diagnostic
imaging that revealed an aneurysmal subarachnoid hemorrhage. To the authors'
knowledge, this is the first report of a ruptured brain aneurysm associated with
barotrauma.
<29>
Unique Identifier
10942141
Authors
Parell GJ. Becker GD.
Institution
University of Florida, Department of Otolaryngology, Head and Neck Surgery,
Gainesville, USA.
Title
Neurological consequences of scuba diving with chronic sinusitis.
Source
Laryngoscope. 110(8):1358-60, 2000 Aug.
Abstract
Sinus barotrauma from scuba diving is relatively common, usually selflimiting, and often the result of transient nasal pathology. We describe serious
neurological sequelae occurring in two scuba divers who had chronic sinusitis We
suggest guidelines for evaluating and treating divers who have chronic
sinusitis. Divers with nasal or sinus pathology should be aware of the
potentially serious consequences associated with scuba diving even after
endoscopic sinus surgery to correct this condition.
<30>
Unique Identifier
14660917
Authors
Shupak A. Gil A. Nachum Z. Miller S. Gordon CR. Tal D.
Institution
Israel Naval Medical Institute, Israel Defense Forces Medical Corps, PO Box
8040, Haifa 31080, Israel. shupak@internet-zahav.net
Title
Inner ear decompression sickness and inner ear barotrauma in recreational
divers: a long-term follow-up.
Source
Laryngoscope. 113(12):2141-7, 2003 Dec.
Abstract
OBJECTIVES/HYPOTHESIS: The objectives were to report the authors' experience
with the long-term follow-up of patients with diving-related inner ear
decompression sickness and inner ear barotrauma and to discuss residual cochlear
and vestibular damage in relation to the question of fitness to dive. STUDY
DESIGN: Retrospective consecutive case series. METHODS: Eleven recreational
divers with inner ear decompression sickness and nine with inner ear barotrauma
(IEB) were followed. A complete otoneurological physical examination and
laboratory evaluation were carried out. The latter included audiometry,
electronystagmography, a rotatory chair test using the sinusoidal harmonic
acceleration protocol, and computerized dynamic posturography. RESULTS: Residual
cochleovestibular deficits were found in 10 (91%) of the patients with inner ear
decompression sickness and 3 (33%) of those with IEB (P <.02, Fisher's Exact
test; odds ratio, 20). A significantly shorter follow-up period was required for
the inner ear barotrauma group (P <.05, simple t test) because three patients
(33%) recovered completely within 1 month of the diving accident. Eight patients
had residual vestibular deficits on follow-up, but only one (12.5%) was
symptomatic. However, five (56%) of the nine patients who had a cochlear insult,
as documented by follow-up audiometry, complained of significant hearing loss
and tinnitus. CONCLUSION: Inner ear decompression sickness carries a high risk
for residual inner ear damage despite hyperbaric oxygen recompression therapy. A
favorable prognosis might be anticipated for inner ear barotrauma. The finding
that most patients with residual vestibular deficits were asymptomatic at the
time of follow-up emphasizes the need for a complete vestibular evaluation,
including specific bedside testing and laboratory examinations, before a return
to diving activity may be considered.
<31>
Unique Identifier
12897559
Authors
Klingmann C. Benton PJ. Ringleb PA. Knauth M.
Institution
Department of Otolarynology-Head and Neck Surgery, University of Heidelberg,
Germany. christpoh_klingmann@med.uni-heidekberg.de
Title
Embolic inner ear decompression illness: correlation with a right-to-left
shunt.
Source
Laryngoscope. 113(8):1356-61, 2003 Aug.
Abstract
OBJECTIVES/HYPOTHESIS: Inner ear decompression illness is thought to be a rare
phenomenon in recreational divers, isolated signs and symptoms of inner ear
dysfunction usually being attributed to inner ear barotrauma. STUDY DESIGN: We
present 11 cases of inner ear dysfunction in nine divers with inner ear
decompression illness. RESULTS: All nine divers had significant right-to-left
shunt as diagnosed by transcranial Doppler sonography. CONCLUSIONS: The authors
thought that mechanism of causation in these cases may have been intravascular
bubble emboli and that inner ear decompression illness may be more common among
recreational divers than currently recognized. Failure to treat inner ear
decompression illness with recompression therapy can result in permanent
disability. Because the differential diagnosis between inner ear barotrauma and
inner ear decompression illness can be impossible, the authors suggested that
divers who present with inner ear symptoms following a dive should have
recompression immediately after having undergone bilateral paracentesis.
<32>
Unique Identifier
11889385
Authors
Uzun C. Adali MK. Koten M. Yagiz R. Aydin S. Cakir B. Karasalihoglu AR.
Institution
Department of Otolaryngology, Trakya University Faculty of Medicine, Edirne,
Turkey. cemuzun@yahoo.com
Title
Relationship between mastoid pneumatization and middle ear barotrauma in
divers.
Source
Laryngoscope. 112(2):287-91, 2002 Feb.
Abstract
OBJECTIVES/HYPOTHESIS: Previous studies have shown a relationship between
eustachian tube function and size of mastoid pneumatization, as well as
eustachian tube function and middle ear (ME) barotrauma. The purpose of this
study is to investigate a possible relationship between size of mastoid
pneumatization and ME barotrauma in sports scuba (self-contained underwater
breathing apparatus) divers. STUDY DESIGN: Prospective, blinded. MATERIAL AND
METHODS: Twenty-four sports scuba divers (48 ears), who were fit to dive in the
predive and otolaryngologic examination, were included in the study. Size of
mastoid pneumatization was measured by simplified rectangular dimension method
on a mastoid x-ray taken at Schuller's view. Divers were counseled to refer to
the investigators if any symptoms occurred during and/or after diving. All
symptomatic ears were examined within 24 hours of diving by the same
investigator, who was blinded to the degree of pneumatization. RESULTS: ME
barotrauma occurred in 15 ears (31%) of 11 divers (46%) at one time or another.
The median degree of pneumatization in ears with barotrauma (22.9 cm2) was
significantly smaller than that in unaffected ears (34.1 cm2; (P <.001).
Furthermore, findings showed that with increasing degree of pneumatization,
there was a decreasing risk of symptomatic barotrauma (P <.001). No barotrauma
occurred in ears with a pneumatization greater than 34.7 cm2. However,
barotrauma occurred in all 3 ears with a pneumatization degree smaller than 13.6
cm2. CONCLUSION: Our findings indicate an inverse relationship between size of
pneumatization and risk of symptomatic ME barotrauma in sport scuba divers.
<33>
Unique Identifier
11359165
Authors
Nachum Z. Shupak A. Spitzer O. Sharoni Z. Doweck I. Gordon CR.
Institution
Israel Naval Medical Institute, IDF Medical Corps, PO Box 8040, 31 080 Haifa,
Israel.
Title
Inner ear decompression sickness in sport compressed-air diving.
Source
Laryngoscope. 111(5):851-6, 2001 May.
Abstract
OBJECTIVE: We report our experience over the past 12 years with recreational
diving-related inner ear decompression sickness (IEDCS). STUDY DESIGN:
Retrospective, consecutive case series. METHODS: Twenty-four divers,
representing 29 cases of IEDCS, are presented with regard to evaluation,
treatment, and follow-up. RESULTS: These 29 cases represent 26% of the severe
decompression sickness (DCS) cases treated in that period. The patient group
includes 22 divers who had a single event of IEDCS, one diver who had two
events, and one with five repeated episodes. The cause of injury in 23 cases
(79%) was violation of the decompression schedule. The mean time from surfacing
to appearance of symptoms was 47 +/- 65 minutes. In 83%, symptoms appeared
within 1 hour of ascent, in 97% within 2 hours, and in only one diver after 5.5
hours. Ten divers (34%) had pure vestibular involvement, 4 (14%) had cochlear
insult alone, and 15 (52%) had combined vestibulo-cochlear injury. Except for
one patient who had central as well as peripheral vestibulo-cochlear DCS, all
the remaining patients had end organ involvement only, as demonstrated by
physical examination and laboratory test results. Fifteen (52%) had isolated
IEDCS, whereas 14 had additional symptoms of DCS. Twenty-six cases were treated
by hyperbaric oxygenation with supplementary daily hyperbaric sessions. Of the
25 cases with vestibular injury and the 19 with cochlear damage, only 7 (28%)
and 6 (32%), respectively, made a full recovery, whereas the others remained
with residual damage. Of the 17 treated within 6 hours of symptom appearance, 9
(53%) were cured, compared with one of the 9 treated later (P <.05).
CONCLUSIONS: IEDCS related to compressed-air recreational diving is more common
than previously thought, and might occur even when no decompression schedule
violation took place. Prompt diagnosis leading to the early commencement of
hyperbaric oxygen recompression therapy is the key to complete recovery of
cochlear and vestibular function.
<34>
Unique Identifier
9148088
Authors
Smith DJ.
Institution
Safety and Health Department, Armed Forces Radiobiology Research Institute,
Bethesda, MD 20889-5603, USA.
Title
Diagnosis and management of diving accidents.
Source
Medicine & Science in Sports & Exercise. 28(5):587-90, 1996 May.
Abstract
Humans experience significant physiological stresses while diving, which can
result in disease on occasion. With the increasing popularity of sports diving,
it is critical that both physicians and divers be aware of the spectrum of
illness associated with diving. An overview of common diving-related disorders
is presented. After a brief discussion of relevant physics principles, the
clinical presentation of ear and sinus squeeze is covered along with preventive
strategies and treatment. This is followed by a discussion of the
pathophysiology, clinical settings, and manifestations of pulmonary barotrauma
along with a review of the pathophysiology and presentation of decompression
illness. Initial emergency measures and referral procedures for decompression
related disorders are addressed. A brief discussion of recompression therapy is
included.
<35>
Unique Identifier
9153492
Authors
Kimbro T. Tom T. Neuman T.
Institution
School of Medicine, University of California, San Diego, La Jolla, USA.
Title
A case of spinal cord decompression sickness presenting as partial BrownSequard syndrome.
Source
Neurology. 48(5):1454-6, 1997 May.
Abstract
Type II decompression sickness (DCS) usually manifests as myelopathy; however,
there are no reports of Brown-Sequard syndrome in association with diving
accidents. We report a 35-year-old man who developed type II DCS presenting as
partial Brown-Sequard syndrome. MRI of the thoracic spine revealed two punctate
foci of increased signal intensity in the right T6 spinal cord.
<36>
Unique Identifier
9932967
Authors
Ries S. Knauth M. Kern R. Klingmann C. Daffertshofer M. Sartor K.
Hennerici M.
Institution
Department of Neurology, University of Heidelberg, Klinikum Mannheim, Germany.
ries@neuro.ma.uni-heidelberg.de
Title
Arterial gas embolism after decompression: correlation with right-to-left
shunting.
Source
Neurology. 52(2):401-4, 1999 Jan 15.
Abstract
Paradoxical gas embolism is a possible cause of neurologic sequelae after
decompression in divers. The authors detected arterial bubbles after
decompression from chamber dives in two of six divers using transcranial Doppler
sonography (TCD). Arterial bubbles correlated with the size of right-to-left
shunting as diagnosed by contrast TCD. The pathway of spontaneous paradoxical
embolism was tracked for the first time, supporting the concept of paradoxical
gas embolism as a cause of early neurologic sequelae after decompression in atrisk divers.
<37>
Unique Identifier
11113236
Authors
Gerriets T. Tetzlaff K. Liceni T. Schafer C. Rosengarten B. Kopiske G.
Algermissen C. Struck N. Kaps M.
Institution
Department of Neurology, Justus-Liebig-University, Giessen, Germany.
Title
Arteriovenous bubbles following cold water sport dives: relation to right-toleft shunting.
Source
Neurology. 55(11):1741-3, 2000 Dec 12.
Abstract
Neurologic injury subsequent to decompression from diving may be due to
paradoxical arterialization of venous gas emboli. Of 40 divers who performed 53
open water dives after being tested for a patent foramen ovale (PFO), arterial
gas emboli were detected in 7 of 13 dives, which resulted in venous bubbles. In
five of these seven dives, there was evidence of a PFO by contrast transcranial
Doppler sonography, indicating an increased risk of arterializing venous bubbles
in divers with a PFO.
<38>
Unique Identifier
11113237
Authors
Cordes P. Keil R. Bartsch T. Tetzlaff K. Reuter M. Hutzelmann A. Friege
L. Meyer T. Bettinghausen E. Deuschl G.
Institution
Department of Neurology, Christian-Albrechts University of Kiel, Germany.
Title
Neurologic outcome of controlled compressed-air diving.
Source
Neurology. 55(11):1743-5, 2000 Dec 12.
Abstract
The authors compared the neurologic, neuropsychological, and neuroradiologic
status of military compressed-air divers without a history of neurologic
decompression illness and controls. No gross differences in the
neuropsychometric test results or abnormal neurologic findings were found. There
was no correlation between test results, diving experience, and number and size
of cerebral MRI lesions. Prevalence of cerebral lesions was not increased in
divers. These results suggest that there are no long-term CNS sequelae in
military divers if diving is performed under controlled conditions.
<39>
Unique Identifier
12771393
Authors
Doolette DJ. Gorman DF.
Institution
Anaesthesia & Intensive Care, The University of Adelaide, Australia.
David.Doolette@adelaide.edu.au
Title
Evaluation of decompression safety in an occupational diving group using self
reported diving exposure and health status.
Source
Occupational & Environmental Medicine. 60(6):418-22, 2003 Jun.
Abstract
BACKGROUND: Many occupational diving groups have substantially different
diving patterns to those for which decompression schedules are validated. AIMS:
To evaluate tuna farm occupational diving practice against existing
decompression models and describe a method for collecting and modelling self
reported field decompression data. METHODS: Machine readable objective
depth/time profiles were obtained from depth/time recorders worn by tuna farm
occupational divers. Divers' health status was measured at the end of each
working day using a self administered health survey that produces an interval
diver health score (DHS) with possible values ranging from 0 to 30. Depth/time
profiles were analysed according to existing decompression models. The
contribution of diving exposure and between diver variability to DHS was
evaluated using linear regression. RESULTS: The mean risk of decompression
sickness was calculated as 0.005 (SD 0.003, n = 383). The mean DHS following
diving was 3 (SD 2, n = 383) and following non-diving activities was 1 (SD 1, n
= 41). After accounting for between diver variability in intercept, DHS was
found to increase one unit for every 1% increase in the risk of decompression
sickness. CONCLUSIONS: A method has been established for the collection and
analysis of self reported objective decompression data from occupational diving
groups that can potentially be used as the basis for development of purpose
designed occupational diving decompression schedules.
<40>
Unique Identifier
9166130
Authors
Shields TG. Duff PM. Evans SA. Gemmell HG. Sharp PF. Smith FW. Staff RT.
Wilcock SE.
Institution
Hyperbaric Research Unit, Robert Gordon University, Aberdeen.
Title
Correlation between 99Tcm-HMPAO-SPECT brain image and a history of
decompression illness or extent of diving experience in commercial
divers.[erratum appears in Occup Environ Med 1997 Jul;54(7):527].
Source
Occupational & Environmental Medicine. 54(4):247-53, 1997 Apr.
Abstract
OBJECTIVES: To explore the use of 99technetiumm-hexamethyl propylene amine
oxime single photon computed tomography (HMPAO-SPECT) of the brain as a means of
detecting nervous tissue damage in divers and to determine if there is any
correlation between brain image and a diver's history of diving or decompression
illness (DCI). METHODS: 28 commercial divers with a history of DCI, 26 divers
with no history of DCI, and 19 non-diving controls were examined with brain
HMPAO-SPECT. Results were classified by observer assessment as normal (I) or as
a pattern variants (II-V). The brain images of a subgroup of these divers (n =
44) and the controls (n = 17) were further analysed with a first order texture
analysis technique based on a grey level histogram. RESULTS: 15 of 54 commercial
divers (28%) were visually assessed as having HMPAO-SPECT images outside normal
limits compared with 15.8% in appropriately identified non-diver control
subjects. 18% of divers with a history of DCI were classified as having a
pattern different from the normal image compared with 38% with no history of
DCI. No association was established between the presence of a pattern variant
from the normal image and history of DCI, diving, or other previous possible
neurological insult. On texture analysis of the brain images, divers had a
significantly lower mean grey level (MGL) than non-divers. Divers with a history
of DCI (n = 22) had a significantly lower MGL when compared with divers with no
history of DCI (n = 22). Divers with > 14 years professional diving or > 100
decompression days a year had a significantly lower MGL value. CONCLUSIONS:
Observer assessment of HMPAO-SPECT brain images can lead to disparity in
results. Texture analysis of the brain images supplies both an objective and
consistent method of measurement. A significant correlation was found between a
low measure of MGL and a history of DCI. There was also an indication that
diving itself had an effect on texture measurement, implying that it had caused
subclinical nervous tissue damage.
<41>
Unique Identifier
12883024
Authors
Toklu AS. Kiyan E. Aktas S. Cimsit M.
Institution
Istanbul University, Istanbul Faculty of Medicine, Department of Underwater
and Hyperbaric Medicine, Istanbul, Turkey. akin@toklu.net
Title
Should computed chest tomography be recommended in the medical certification
of professional divers? A report of three cases with pulmonary air cysts.
Source
Occupational & Environmental Medicine. 60(8):606-8, 2003 Aug.
Abstract
Pulmonary barotrauma (PBT) is a recognised risk of compressed gas diving. Any
reason that causes air trapping in the lung during ascent may cause PBT by
increasing intrapulmonary pressure. Chest x ray examination is mandatory for
medical certification of the professional divers in many countries, but
pulmonary air trapping lesions such as an air cyst in the lungs cannot always be
detected by plain chest x ray examination. Computed tomography (CT) is a
reliable, but expensive measure for detecting pulmonary abnormalities in divers.
Three cases with pulmonary air cysts are reported in which air cysts were
invisible on the x ray pictures, but well defined by CT. It is impractical and
not cost effective to perform CT for medical certification of all divers, but it
can be an option to recommend CT once during the initial examination of the
candidates for professional diving, especially if there is a history of
predisposing factors, such as smoking or pulmonary infections.
<42>
Unique Identifier
11160991
Authors
Whyte P. Doolette DJ. Gorman DF. Craig DS.
Institution
Department of Anaesthesia and Intensive Care, Royal Adelaide Hospital,
Adelaide, Australia.
Title
Positive reform of tuna farm diving in South Australia in response to
government intervention.
Source
Occupational & Environmental Medicine. 58(2):124-8, 2001 Feb.
Abstract
OBJECTIVES: Much of the tuna harvested in South Australia since 1990 has
involved "farming" techniques requiring the use of divers. From 1993 to 1995, 17
divers from this industry were treated for decompression illness (DCI). In
response, the State Government introduced corrective strategies. A decrease in
the number of divers presenting for treatment was subsequently recorded.
Consequently, the hypothesis was tested that the government intervention
resulted in a decrease in the incidence of DCI in the industry and an improved
clinical outcome of divers with DCI. METHODS: The incidence of treated DCI in
tuna farm divers was estimated from the number of divers with DCI treated and
the number of dives undertaken extrapolated from a survey of the industry in
1997-8. General health was measured in the tuna farm diving population by a
valid and reliable self assessment questionnaire. The outcome of the divers
treated for DCI was analysed with a modified clinical severity scoring system.
RESULTS: The apparent incidence of treated DCI has decreased in tuna farm divers
since the government intervention. The evidence supports a truly decreased
incidence rather than underreporting. The general health of the tuna farm divers
was skewed towards the asymptomatic end of the range, although health scores
indicative of DCI were reported after 1.7% of the dives that did not result in
recognised DCI. The clinical outcome of the divers treated since the
intervention has improved, possibly because of earlier recognition of the
disease and hence less time spent diving while having DCI. CONCLUSIONS: The
government intervention in the tuna industry in South Australia has resulted in
a reduced incidence of DCI in the industry.
<43>
Unique Identifier
12621358
Authors
Uzun C.
Title
Cartilage palisade tympanoplasty, diving and eustachian tube
function.[comment].
Comments
Comment on: Otol Neurotol. 2001 Jul;22(4):430-2; PMID: 11449094
Source
Otology & Neurotology. 24(2):350; author reply 351, 2003 Mar.
<44>
Unique Identifier
10892042
Authors
Newbegin C. Ell S.
Institution
Huddersfield Royal Infirmary.
Title
Ear barotrauma after flying and diving. [Review] [3 refs]
Source
Practitioner. 244(1607):96-9, 101-2, 105, 2000 Feb.
<45>
Unique Identifier
10193343
Authors
Russi EW.
Institution
Department of Internal Medicine, University Hospital Zurich, Switzerland.
Title
Diving and the risk of barotrauma. [Review] [31 refs]
Source
Thorax. 53 Suppl 2:S20-4, 1998 Aug.
Abstract
STUDY OBJECTIVES: Pulmonary barotrauma (PBT) of ascent is a feared
complication in compressed air diving. Although certain respiratory conditions
are thought to increase the risk of suffering PBT and thus should preclude
diving, in most cases of PBT, risk factors are described as not being present.
The purpose of our study was to evaluate factors that possibly cause PBT.
DESIGN: We analyzed 15 consecutive cases of PBT with respect to dive factors,
clinical and radiologic features, and lung function. They were compared with 15
cases of decompression sickness without PBT, which appeared in the same period.
RESULTS: Clinical features of PBT were arterial gas embolism (n = 13),
mediastinal emphysema (n = 1), and pneumothorax (n = 1). CT of the chest
(performed in 12 cases) revealed subpleural emphysematous blebs in 5 cases that
were not detected in preinjury and postinjury chest radiographs. A comparison of
predive lung function between groups showed significantly lower midexpiratory
flow rates at 50% and 25% of vital capacity in PBT patients (p < 0.05 and p <
0.02, respectively). CONCLUSIONS: These results indicate that divers with
preexisting small lung cysts and/or end-expiratory flow limitation may be at
risk of PBT. [References: 31]
<46>
Unique Identifier
12964853
Authors
Hagberg M. Ornhagen H.
Institution
Department of Occupational and Environmental Medicine, Sahlgrenska Academy and
University Hospital, Goteborg University, St Sigfridsgatan 85, SE 412 66
Goteborg, Sweden.
Title
Incidence and risk factors for symptoms of decompression sickness among male
and female dive masters and instructors--a retrospective cohort study.
Source
Undersea & Hyperbaric Medicine. 30(2):93-102, 2003 Summer.
Abstract
The aim was to determine the incidence of symptoms of decompression sickness
(DCS) in dive masters and instructors in relation to number of dives and
possible risk factors. STUDY DESIGN: Retrospective cohort study of dive masters
and instructors in Sweden. STUDY BASE: All dive masters and instructors listed
with PADI, NAUI and CMAS in Sweden as of January 1st 1999 (2380 divers).
METHODS: The dive masters and instructors received a validated questionnaire on
diving activities and symptoms of DCS in 1999. 1516 men and 226 women answered,
i.e. 73% of the initial study base. RESULTS: DCS symptoms were reported by 190
divers. The incidence of DCS symptoms was 1.52 for males and 1.27 for females
per 1000 dives. Dive masters, divers not performing decompression-stop dives,
divers not practicing advanced diving and divers with a low number of total
lifetime dives had a higher proportion (p < 0.05) of DCS symptoms per 1000
dives. There were no major differences in DCS symptom incidence related to sex,
age, asthma, overweight or alcohol abuse in this study.