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PubMed2005

Diving medicine.

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Barotrauma↗
PubMed1994

Neurophysiological assessment of divers with medical histories of neurological decompression illness.

OBJECTIVE: To examine the possibility that subclinical damage may persist after clinical recovery from neurological decompression illness. METHODS: The neuraxes of 71 divers with medical histories of neurological decompression illness and 37 non-diver controls were examined by recording the somatosensory evoked potentials produced on stimulation of the posterior tibial and median nerves. RESULTS: Although the tests gave some objective support for the presence of "soft" residual neurological symptoms and signs, no evidence was given for the presence of subclinical damage. CONCLUSIONS: The contention that neurological damage persists after full clinical recovery from the neurological decompression illness was not supported.

Adult↗
PubMed1995

Electroencephalographic study of divers with histories of neurological decompression illness.

OBJECTIVE: To determine whether divers with histories of neurological decompression illness are electroencephalographically distinguishable from non-divers. METHODS: The electroencephalograms (EEGs) from 68 divers with histories of neurological decompression illness and 45 non-diver controls were examined independently by two clinical neurophysiologists. RESULTS: The diver and non-diver groups were electroencephalographically indistinguishable. CONCLUSION: There is no electroencephalographic evidence for the existence of cerebral dysfunction in divers with histories of decompression illness.

Adult↗
PubMed1997

Correlation between 99Tcm-HMPAO-SPECT brain image and a history of decompression illness or extent of diving experience in commercial divers.

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.

Adult↗
PubMed2001

Positive reform of tuna farm diving in South Australia in response to government intervention.

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.

Adult↗
PubMed2003

Should computed chest tomography be recommended in the medical certification of professional divers? A report of three cases with pulmonary air cysts.

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.

Adult↗
PubMed2004

The powerful microbubble: from bench to bedside, from intravascular indicator to therapeutic delivery system, and beyond.

This review discusses the development, current applications, and therapeutic potential of ultrasound contrast agents. Microbubbles containing gases act as true, intravascular indicators, permitting a noninvasive, quantitative analysis of the spatial and temporal heterogeneity of blood flow and volumes within the microvasculature. These shelled microbubbles are near-perfect reflectors of acoustic ultrasound energy and, when injected intravenously into the bloodstream, reflect ultrasound waves within the capillaries without disrupting the local environment. Accordingly, microbubble ultrasound contrast agents are clinically useful in enhancing ultrasound images and improving the accuracy of diagnoses. More recently, ultrasound contrast agents have been used to directly visualize the vasa vasorum and neovascularization of atherosclerotic carotid artery plaques, thus suggesting a new paradigm for diagnosis and treatment of atherosclerosis. Future applications of these microscopic agents include the deliver of site-specific therapy to targeted organs in the body. Medical therapies may use these microbubbles as carriers for newer therapeutic options.

Animals↗
PubMed2000

Predicting time to decompression illness during exercise at altitude, based on formation and growth of bubbles.

For altitude decompressions, we hypothesized that reported onset times of limb decompression illness (DCI) pain symptoms follow a probability distribution related to total bubble volume [V(b.)(t)] as a function of time. Furthermore, we hypothesized that the probability of ever experiencing DCI during a decompression is associated with the cumulative volume of bubbles formed. To test these hypotheses, we first used our previously developed formation-and-growth model (Am J Physiol Regulatory Integrative Comp Physiol 279: R2304-R2316, 2000) to simulate Vb.(t) for 20 decompression profiles in which 334 human subjects performed moderate repetitive skeletal muscle exercise (827 kJ/h) in an altitude chamber. Using survival analysis, we determined that, for a controlled condition of exercise, the fraction of the subject population susceptible to DCI can be approximately expressed as a power function of the formation-and-growth model-predicted cumulative volume of bubbles throughout the altitude exposure. Furthermore, for this fraction, the probability density distribution of DCI onset times is approximately equal to the ratio of the time course of formation-and growth-modeled total bubble volume to the predicted cumulative volume.

Altitude↗