Health experience of compressed air workers during construction of the Mass Transit Railway in Hong Kong.
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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.
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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.
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Cerebral perfusion deficits detected by injection of 99Tcm-hexamethylpropyleneamine oxime (HMPAO) and single photon emission tomography is said to correlate well with clinical findings in divers with neurological decompression illness. We studied 12 divers. Six had residual cerebral signs (group 1) and six had no residual cerebral symptoms or signs (group 2). Perfusion deficits were as common in group 2 as in group 1. The site of the deficit did not correlate well with either the neurological findings at presentation or the residual clinical signs after treatment. The data suggest that claims that HMPAO scanning correlates with clinical findings and can be used for patients management were incorrect.
AIM: The aim of this study was to use statistical parametric mapping (SPM) to investigate differences in the regional cerebral blood flow (rCBF) of decompression illness (DCI) and non-diving control subjects. METHODS: Twenty DCI subjects were imaged using 99Tcm hexamethylproplylene amine oxime (HMPAO) single photon emission tomography (SPET) within days of their incident of DCI, and on a second occasion between 2 and 27 months after their DCI event. SPM was used to make a comparison between decompression illness studies and a second group of non-diving control studies for both early and late imaging of DCI. A paired comparison of early and late imaging was also performed testing for correlation between time of imaging and changes in the rCBF pattern. RESULTS: The comparison between control subjects and early imaging of decompression illness showed a large, significant (P = 0.002), irregularly shaped, multi-focal area of reduced uptake in the left occipito-parieto-temporal region of the brain. Comparisons between control and repeat decompression illness imaging studies showed two areas of reduced uptake. The first was similar to that found in the initial comparison although it was less significant (P = 0.035). The second region was similar but contra-lateral to the first region with significance P < 0.001. An attempt to correlate any changes in rCBF with the time that elapsed between each set of imaging found no areas of significant correlation. CONCLUSION: 99Tcm HMPAO SPET images of decompression illness display areas of reduced perfusion, which persist in the majority of cases.
Decompression disorders can occur after a reduction in environmental pressure due to dissolved gases forming bubbles in affected tissues. The objective of this study was to evaluate the use of tear film bubble formation as an indicator of decompression. Eleven subjects were exposed to a simulated dive to 30.48 m (100 ft) (in sea water) for 15 min. There was a significant (p < 0.001) increase in tear film bubble formation post-dive. This noninvasive technique may be of value in both research and clinical environments for monitoring decompression.