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Dysbaric osteonecrosis associated with decompression sickness in a fishing diver

Diving as a method of fishing is used worldwide in small-scale fisheries. However, one of the main causes of morbidity and mortality among fishermen is decompression sickness (DCS). We report the case of a 46-year-old male fisherman diver who presented with chronic inguinal pain that radiated to the lower left limb. Living and working in a fishing port in Yucatan, he had a prior history of DCS. A diagnosis of avascular necrosis in the left femoral head secondary to DCS was made via analysis of clinical and radiological findings. The necrosis was surgically resolved by a total hip arthroplasty. ..

  05-09-2019

Abdominal decompression illness following repetitive diving: a case report and review of the literature

The complete pathophysiology of decompression illness is not yet fully understood. What is known is that the longer a diver breathes pressurized air at depth, the more likely nitrogen bubbles are to form once the diver returns to surface [1]. These bubbles have varying mechanical, embolic and biochemical effects on the body. The symptoms produced can be as mild as joint pain or as significant as severe neurologic dysfunction, cardiopulmonary collapse or death. Once clinically diagnosed, decompression illness must be treated rapidly with recompression therapy in a hyperbaric chamber. This case report involves a middle-aged male foreign national who ..

  05-09-2019

Hyperbaric oxygen therapy for dermal ischemia after dermal filler injection with calcium hydroxylapatite: a case report

Dermal injection of fillers is a popular and relatively safe aesthetic procedure. Severe complications are rare, but they do occur. One of the most threatening complications after dermal filler injection is skin necrosis due to vascular occlusion. Different treatment options are available, including the use of hyperbaric oxygen (HBO2) therapy. A 46-year-old female received facial dermal filler injections with calcium hydroxylapatite at an aesthetic clinic. A few days after injection she developed a burning pain, numbness of the skin and white discoloration in the injected area. Two days after injection treatment was started with hyaluronidase and warm compresses. In ..

  05-09-2019

Atrial fibrillation associated with carbon monoxide poisoning

Carbon monoxide intoxication occurs usually via inhalation of carbon monoxide that is emitted as a result of a fire, furnace, space heater, generator, motor vehicle. A 37-year-old male patient was admitted to the emergency department at about 5:00 a.m., with complaints of nausea, vomiting and headache. He was accompanied by his wife and children. His venous blood gas measures were: pH was 7.29, partial pressure of carbon dioxide (pCO2) was 42 mmHg, partial pressure of oxygen (pO2) was 28 mmHg, carboxyhemoglobin (COHb) was 12.7% (reference interval: 0.5%-2.5%) and oxygen saturation was 52.4%. Electrocardiogram (ECG) examination showed that the patient ..

  05-09-2019

Delayed hyperbaric oxygen therapy for severe arterial gas embolism following scuba diving: a case report

We present the case of a 42-year-old female who was critically ill due to an arterial gas embolism (AGE) she experienced while diving in Maui, Hawaii. She presented with shortness of breath and dizziness shortly after surfacing from a scuba dive and then rapidly lost consciousness. The diver then had a complicated hospital course: persistent hypoxemia (likely secondary to aspiration) requiring intubation; markedly elevated creatine kinase; atrial fibrillation requiring cardioversion; and slow neurologic improvement. She had encountered significant delay in treatment due to lack of availability of local hyperbaric oxygen (HBO2) therapy. Our case illustrates many of the complications ..

  05-09-2019

Pulmonary barotrauma: assessment and investigation in divers

Decompression illness (DCI) is an uncommon problem but can be significant in terms of morbidity and, very rarely, mortality. The mechanisms of DCI are pulmonary barotrauma and decompression sickness due to inert gas supersaturation. After the initial management phase, identification of predisposing factors is important to help advise divers regarding future risk and avoidance. Here we present four cases of DCI where pulmonary barotrauma was the likely causative mechanism. We highlight the important features in assessment for pulmonary barotrauma and advising divers on the risk of a recurrence. DOI: 10.22462/04.06.2019.12

  05-09-2019

Dehydration of a diver during a hyperbaric chamber exposure with oxygen decompression

Objective: An analysis of factors that may indicate both the type and degree of dehydration of a diver’s body following a dry chamber hyperbaric exposure. Methods: The study was participated by 63 men – professional divers, with extensive diving experience, aged 24-51 years (average age 32.6). The subjects underwent two hyperbaric exposures, one to a pressure of 0.3 MPa and one to a pressure of 0.6 MPa, with oxygen decompression. The exposures were carried out in a hyperbaric chamber pursuant to the decompression tables of the Polish Navy, with the observance of a 24-hour interval between exposures. Blood samples were ..

  05-09-2019

Clustering of recreational divers by their health conditions in a database of a citizen science project

Divers Alert Network Europe has created a database with a large amount of dive-related data that has been collected since 1993 within the scope of the Diving Safety Laboratory citizen science project. The main objectives of this study are the grouping divers by their health information and revealing significant differences in diving parameters using data mining techniques. Due to the methodology of the project, data cleaning was performed before applying clustering methods in order to eliminate potential mistakes resulting from inaccuracies and missing information. Despite the fact that 63% of the data were lost during the cleaning phase, the ..

  05-09-2019

Decrease of tetrahydrobiopterin and NO generation in endothelial cells exposed to simulated diving

Purpose: Nitric oxide (NO) has been shown to protect against bubble formation and the risk of decompression sickness. We hypothesize that oxidation of tetrahydrobiopterin (BH4) leads to a decreased production of NO during simulated diving. Methods: Human umbilical vein endothelial cells (HUVEC) were exposed to hyperoxia or simulated diving for 24 hours. The levels of biopterins (BH4, BH2 and B) were determined by LC-MS/MS, and the production of NO by monitoring the conversion of L-arginine to L-citrulline. Results: Exposure to hyperoxia decreased BH4 in a dose-dependent manner; by 48 ± 15% following exposure to 40 kPa O2 (P < 0.001 vs. ..

  05-09-2019

Rescue of a submerged convulsing diver

In 2018, the Medical Panel of the NATO Underwater Diving Working Group (UDWG) discussed the question of the rescue and management of a submerged unresponsive compressed-gas diver. The Panel reviewed the 2012 recommendation by the UHMS Diving Committee with respect to the specific recommendation in a convulsing diver using a half-face mask and separate mouthpiece, to delay surfacing until the clonic phase had subsided if the mouthpiece was in place. There is a paucity of scientific, epidemiological, experimental and observational human studies to substantiate this guidance. Experimental animal studies suggest that the likelihood of a complete airway obstruction during ..

  05-09-2019

Hyperbaric oxygen may improve vascular endothelial function in patients undergoing coronary stent implantation

Background: Hyperbaric oxygen (HBO2) therapy improves myocardial function and reduces clinical restenosis in coronary arteries. This study aims to evaluate whether the HBO2 therapy can improve vascular endothelial dysfunction in patients undergoing coronary stent implantation. Methods: The retrospective study included 115 patients undergoing coronary stent implantation. Patients receiving HBO2 therapy were included in the HBO2 group (n=55) and those without HBO2 therapy were included as controls (n=60). The levels of brachial artery endothelial-dependent flow-mediated dilation (FMD), endothelial-independent nitrate-mediated dilatation (NMD), nitric oxide (NO), endothelin-1(ET-1), calcitonin gene-related peptide (CGRP) and high-sensitivity C-reactive protein (hs-CRP) were used to evaluate vascular endothelial function. Results: ..

  05-09-2019

Operation of a hyperbaric oxygen therapy center in Korea: Report of our experience from a setting in its nascent stages

Purpose: Hyperbaric medicine is nascent in Korea when compared to other developed countries, such as the United States and Japan. Our facility has been managed by physicians with certifications from the Undersea and Hyperbaric Medical Society (UHMS) and National Oceanic and Atmospheric Administration in diving and clinical diseases since October 2016. This study was conducted to share similar issues that are encountered during the establishment of a program in a new area through our experiences in the operation of a hyperbaric oxygen (HBO2) therapy center.  Methods: In this retrospective observational study we collected data on HBO2 patients treated at our ..

  05-09-2019

Hyperbaric oxygen treatment ameliorates gentamicin-induced nephrotoxicity and expression of kidney injury molecule 1 in the rat model

In recent years, hyperbaric oxygen (HBO2) therapy has been considered as an effective method for the treatment of gentamicin (GM)-induced renal toxicity. However, the findings related to the use of HBO2 for GM toxicity are limited and contradictory. The aim of this study is to investigate the protective role of HBO2 on GM-induced nephrotoxicity. For this purpose, Wistar albino rats (n=28) were randomly divided into four equal groups: C, HBO2, GM and GM+HBO2. GM (100 mg/kg, ip) and HBO2 were applied over seven days. On the eighth day blood and kidney tissue samples were harvested. The albumin, creatinine, and ..

  05-09-2019

Effects of sprint interval training on cardiorespiratory fitness while in a hyperbaric oxygen environment

Objectives: Hyperbaric oxygen (HBO2) exposure may enhance cardiorespiratory fitness. Exercise training and HBO2 exposure stimulate mitochondrial biogenesis, increase capillary density, and induce adaptive antioxidant mechanisms. We hypothesized that an exercise regimen of sprint interval training (SIT) while breathing HBO2 would lead to a greater improvement in exercise performance compared to the same training breathing ambient air. Methods: Healthy long-term intermediate-altitude residents, ages 20-39 years, with normal spirometry and cardiorespiratory fitness were randomized to two groups: one performing six sessions of an SIT regimen over two weeks in a hyperbaric chamber (1.4 ATA [141.9 kPa], FiO2=1.0); the other performing under ambient ..

  05-09-2019

Methods for preventing middle ear barotrauma in computer-controlled pressurization of monoplace hyperbaric chambers

Middle ear barotrauma (MEB), one of the side effects of hyperbaric oxygen (HBO2) therapy, sometimes cannot be directly diagnosed during the therapy itself. Instead, its incidence and degree are judged based on subjective statements made by patients when in conversation with medical staff regarding how they feel. To prevent MEB in practice it is proposed that the tympanic membrane evaluation system and automatic control chamber developed in a previous study be applied as part of a prevention algorithm [16]. The proposed algorithm, which determines and equalizes the unbalanced pressure of a subject based on their tympanic admittance, was evaluated ..

  05-09-2019

Middle ear barotrauma during hyperbaric oxygen therapy; a review of occurrences in 5,962 patients

Hyperbaric-associated middle ear barotrauma (MEB) is one of the most common side effects of the exposure to hyperbaric oxygen (HBO2) therapy. This retrospective observational study of 5,962 patients undergoing long-termtherapy for chronic conditions took place at the local Diving & Hyperbaric Medicine Unit (DHMU) in Villafranca- Verona (Italy), a DHMU that administers, in multiplace chambers, more than 20,000 HBO2 treatments per year. The study was designed to weight and analyze both the incidence and severity of MEBs at the facility. Thanks to a systematic recording method over eight years, 2003-2010, we observed 549 MEBs (9.2% of all HBO2 treatments). ..

  05-09-2019


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