2018 September;48(3)

Diving Hyperb Med. 2018 September;48(3):132−140. doi: 10.28920/dhm48.3.132-140. PMID: 30199887.

Reliability of venous gas embolism detection in the subclavian area for decompression stress assessment following scuba diving

Julien Hugon1, Asya Metelkina1, Axel Barbaud1, Ron Nishi2, Fethi Bouak3, Jean-Eric Blatteau4, Emmanuel Gempp5

1 Azothe Systems – Technopôle de la Mer, Ollioules, France
2 Defence Research and Development Canada, Toronto Research Centre (retired), Toronto, ON, Canada
3 Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, Canada
4 Institut de Recherche Biomédicale des Armées, Équipe de Recherche Subaquatique Opérationnelle, Toulon, France
5 French Navy Diving School, Toulon, France
Corresponding author: Julien Hugon, Azoth Systems – Technopôle de la Mer, 93 Forum de la Méditerranée, 83190 Ollioules, France
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Key words
Bubbles; Cardiovascular; Doppler; Air; Statistics; Decompression sickness; Risk

Abstract
(Hugon J, Metelkina A, Barbaud A, Nishi R, Bouak F, Blatteau J-E, Gempp E. Reliability of venous gas embolism detection in the subclavian area for decompression stress assessment following scuba diving. Diving and Hyperbaric Medicine. 2018 September;48(3):132−140. doi: 10.28920/dhm48.3.132-140. PMID: 30199887.)
Introduction: Ultrasonic detection of venous gas emboli (VGE) in the precordial (PRE) region is commonly used in evaluation of decompression stress. While subclavian (SC) VGE detection can also be used to augment and improve the evaluation, no study has rigorously compared VGE grades from both sites as decompression stress indicators.
Methods: This retrospective study examined 1,016 man-dives breathing air extracted from the Defence Research and Development Canada dataset. Data for each man-dive included dive parameters (depth, bottom time, total ascent time), PRE and SC VGE grades (Kisman-Masurel) and post-dive decompression sickness (DCS) status. Correlation between SC and PRE grades was analyzed and the association of the probability of DCS (pDCS) with dive parameters and high bubble grades (HBG III- to IV) was modelled by logistic regression for SC and PRE separately for DCS risk ratio comparisons.
Results: PRE and SC VGE grades were substantially correlated (R = 0.66) and were not statistically different
(P = 0.61). For both sites, pDCS increased with increasing VGE grade. When adjusted for dive parameters, the DCS risk was significantly associated with HBG for both PRE (P = 0.03) and SC (P < 0.001) but the DCS risk ratio for SC HBG (RR = 6.0,
95% CI [2.7–12.3]) was significantly higher than for PRE HBG (RR = 2.6, 95% CI [1.1–6.0]).
Conclusions: The association of bubble grades with DCS occurrence is stronger for SC than PRE when exposure severity is taken into account. The usefulness of SC VGE in decompression stress evaluation has been underestimated in the past.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Original article


2018 September;48(3)

Diving Hyperb Med. 2018 September;48(3):141–167. doi: 10.28920/dhm48.3.141-167. PMID: 30199888.

Provisional report on diving-related fatalities in Australian waters in 2012

John Lippmann1,2, Chris Lawrence3, Andrew Fock4, Scott Jamieson1

1 Divers Alert Network Asia-Pacific, Ashburton, Victoria, Australia
2 School of Health and Social Development, Deakin University, Victoria, Australia
3 Statewide Forensic Medical Services, Royal Hobart Hospital, Tasmania, Australia
4 Departments of Hyperbaric Medicine and Intensive Care Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
Corresponding author: John Lippmann, DAN Asia Pacific, P O Box 384, Ashburton, Victoria 3147, Australia
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Key words
Diving deaths; Scuba; Breath-hold diving; Surface-supply breathing apparatus (SSBA); Diving incidents; Case reports

Abstract
(Lippmann J, Lawrence CL, Fock A, Jamieson S. Provisional report on diving-related fatalities in Australian waters 2012. Diving and Hyperbaric Medicine. 2018 September;48(3):141–167. doi: 10.28920/dhm48.3.141-167. PMID: 30199888.)
Introduction: An individual case review of known diving-related deaths that occurred in Australia in 2012 was conducted.
Method: The case studies were compiled using statements from witnesses and reports of the police and coroners. In each case, the particular circumstances of the accident and details from the post-mortem examination, where available, are provided.
Results: There were 26 reported fatalities (four less than the previous year). Only two of the victims were female
(one snorkeller and one scuba diver). Fourteen deaths occurred while snorkelling and/or breath-hold diving, 11 while scuba diving and one diver died while using surface supplied breathing apparatus in a commercial pearl diving setting. Two breath-hold divers likely drowned as a result of apnoeic hypoxia. Cardiac-related issues were thought to have contributed to the deaths of at least three and possibly seven snorkellers and four scuba divers.
Conclusions: Pre-existing medical conditions; poor organisation, planning and supervision; equipment-related problems; snorkelling or diving alone or with loose buddy oversight and apnoeic hypoxia were features in several deaths in this series.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Original article


2018 September;48(3)

Diving Hyperb Med. 2018 September;48(3):168–172. doi: 10.28920/dhm48.3.168-172. PMID: 30199889.

Impact of various pressures on fracture resistance and microleakage of amalgam and composite restorations

Elnaz Shafigh1, Reza Fekrazad2,3, Amirreza Beglou1

1 Operative Dentistry Department, Faculty of Dentistry, AJA University of Medical Sciences, Tehran, Iran
2 Department of Periodontology, Dental Faculty – Laser Research Centre in Medical Sciences, AJA University of Medical Sciences
3 International Network for Photo Medicine and Photo Dynamic Therapy (INPMPDT), Universal Scientific Education and Research Network (USERN), Tehran, Iran
Corresponding author: Amirreza Beglou, Department of Operative Dentistry, AJA University of Medical Science, Daneshjou Boulevard, Evin, Tehran, Iran, PO 19839
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Key words
Diving; Aviation; Dental; Barotrauma

Abstract
(Shafigh E, Fekrazad R, Beglou A. Impact of various pressures on fracture resistance and microleakage of amalgam and composite restorations. Diving and Hyperbaric Medicine. 2018 September;48(3):168–172. doi: 10.28920/dhm48.3.168-172. PMID: 30199889.)
Background: Pressure changes can influence dental restorations especially among divers. The aim of the current study was to evaluate the fracture resistance and microleakage of mesio-occluso-distal (MOD) amalgam and composite restorations undergoing pressure changes via diving and aviation simulation.
Methods: For the fracture resistance test, 60 sound maxillary premolar teeth were randomly allocated to two groups. Each group was then divided into three subgroups (n = 10) for simulating scuba-diving (pressure cycle to 203 kPa, 2 bar), flight (50.6 kPa, 0.5 bar), and control (atmospheric pressure). The teeth underwent pressure cycles for one month and then the fracture resistance test was conducted on them using the Instron testing machine. Microleakage scores were afterwards recorded by using a 2% methylene blue dye for 24 hours.
Results: Composite restorations showed significantly higher fracture resistance values compared to the amalgam group
(P < 0.05). The control group had significantly higher fracture resistance values compared to the dive group, whereas there was no significant difference between the control group and the flight group (P = 0.083). No significant difference in the level of microleakage was observed between restoration materials or pressure cycles (P > 0.05).
Conclusions: Composite restorations showed promising fracture resistance compared to the amalgam group. Diving pressure cycles demonstrated adverse effects on the fracture resistance values of the two restorative materials.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Original article


2018 September;48(3)

Diving Hyperb Med. 2018 September;48(3):173–185. doi: 10.28920/dhm48.3.173-185. PMID: 30199890.

Meta-analysis on the effect of hyperbaric oxygen as adjunctive therapy in the outcome of anastomotic healing of experimental colorectal resections in rats

Robin J Brouwer1, Alexander C Engberts1, Boudewijn LS Borger van der Burg1, Thijs TCF van Dongen1,2, Rob A van Hulst3,4, Rigo Hoencamp1,2,5

1 Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands
2 Defense Healthcare Organization, Ministry of Defense, Utrecht, The Netherlands
3 Department of Anesthesiology, Amsterdam Medical Center, Amsterdam, The Netherlands
4 Maritime Medical Expertise Center, Diving Medical Center, Royal Netherlands Navy, Den Helder, The Netherlands
5 Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
Corresponding author: RJ Brouwer, Department of Surgery, Alrijne Hospital, Simon Smitweg 1, 2353 GA Leiderdorp, The Netherlands
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Key words
Surgery; Gastrointentestinal tract; Animal model; Hyperbaric research; Systematic review

Abstract
(Brouwer RJ, Engberts AC, Borger van der Burg BLS, van Dongen TTCF, van Hulst RA, Hoencamp R. Meta-analysis on the effect of hyperbaric oxygen as adjunctive therapy in the outcome of anastomotic healing of experimental colorectal resections in rats. Diving and Hyperbaric Medicine. 2018 September;48(3):173–185. doi: 10.28920/dhm48.3.173-185.
PMID: 30199890.)
Background: Colorectal cancer is the third most common form of cancer and colorectal surgery is the treatment of choice in local disease. Anastomotic leakage following colorectal surgery is a major complication with a high incidence and mortality. Adjuvant hyperbaric oxygen treatment (HBOT) may be associated with reduction of anastomotic leakage. A systematic review was conducted regarding HBOT as an adjunctive therapy to colorectal surgery.
Methods: Systematic review (1900–2017) using PubMed, Cochrane, EMBASE, Web of Science and EMCARE. All original published studies on the effect of HBOT as an adjunctive therapy for colorectal surgery with the creation of an anastomosis were considered.
Results: Thirteen small animal trials were included for qualitative synthesis. We found no human trials. Eleven trials used bursting pressure whilst eight used hydroxyproline levels as a marker for collagen synthesis as primary outcome to assess the strength of the anastomosis. A meta-analysis performed for normal and ischaemic anastomoses showed that postoperative HBOT improves bursting pressure and hydroxyproline levels significantly in both normal (P ≤ 0.001 and
P = 0.02 respectively) and ischaemic anastomoses (P ≤ 0.001 and P = 0.04 respectively).
Conclusion: Postoperative HBOT has a positive effect on colorectal anastomoses in rats. Further research should focus on a larger systematic animal study.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Original article


2018 September;48(3)

Diving Hyperb Med. 2018 September;48(3):186–193. doi: 10.28920/dhm48.3.186–193. PMID: 30199891.

Inner ear barotrauma in divers: an evidence-based tool for evaluation and treatment

Stefan W Rozycki1, Matthew J Brown1, Macario Camacho2

1 NSSC Pearl Harbor 822 Clark St Suite 400 Joint Base Pearl Harbor Hickam, Hawaii, USA
2 Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, Hawaii
Corresponding author: Macario Camacho, Otolaryngology-Head and Neck Surgery, 1 Jarrett White Road, Tripler Army Medical Center, Hawaii, USA
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Key words
Hearing loss, sudden; ENT; Decompression sickness; Systematic review

Abstract
(Rozycki SW, Brown MJ, Camacho M. Inner ear barotrauma in divers: an evidence-based tool for evaluation and treatment. Diving and Hyperbaric Medicine. 2018 September;48(3):186–193. doi: 10.28920/dhm48.3.186-193. PMID: 30199891.)
Objective: To systematically search the literature for studies evaluating the typical presentation and testing that is performed for divers with inner ear symptoms and then to create a tool for clinicians when evaluating a diver with inner ear symptoms.
Methods: Nine databases, including PubMed/MEDLINE were systematically searched through 31 January 2018. The PRISMA statement was followed.
Results: Three-hundred and two manuscripts were screened, 69 were downloaded and 21 met criteria to be included in this review. The articles were evaluated for symptomatic trends and initial evaluation work-up primarily focusing on inner-ear barotrauma (IEBt) and inner ear decompression sickness (inner ear DCS). The trends for IEBt were compared to typical inner ear DCS presentation based on large study inner ear DCS results consistent with the plethora of research available. Finally, the HOOYAH Tool was developed to assist the receiving provider to better determine the most likely diagnosis and thus initiate appropriate treatment. The HOOYAH Tool is comprised of the following: 1) H: hard to clear; 2) O: onset of symptoms; 3) O: otoscopic exam; 4) Y: your dive profile; 5) A: additional symptoms and 6) H: hearing. For each of these components, the typical presentation is described allowing the provider better to discern the correct diagnosis.
Conclusion: The diagnosis of IEBt remains difficult to define short of visualization through surgical exploration. Early treatment is defined by conservative management with a subsequent observational period to determine symptomatic resolution and need for surgery. However, a similar differential diagnosis is inner ear DCS which requires early recompression. The HOOYAH tool provides a method for assisting the provider in forming a more confident decision regarding the underlying pathology and facilitation of the appropriate treatment.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Review article


2018 September;48(3)

Diving Hyperb Med. 2018 September;48(3):194−196. doi: 10.28920/dhm48.3.194-196. PMID: 30199892.

A recurrent, ischaemic ileocolonic anastomosis ulcer refractory to surgery treated with hyperbaric oxygen

Puraskar Pateria, Andre Chong

Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia 6150
Corresponding author: Puraskar Pateria, Work Address: Department of Gastroenterology and Hepatology, Service 4, CD09, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia 6150
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Key words
Gastrointestinal tract; Chronic wounds; Case reports

Abstract
(Pateria P, Chong A. A recurrent, ischaemic ileocolonic anastomosis ulcer refractory to surgery treated with hyperbaric oxygen. Diving and Hyperbaric Medicine. 2018 September;48(3):194−196. doi: 10.28920/dhm48.3.194-196. PMID: 30199892.)
A 54-year-old male had undergone right hemicolectomy and ileo-colonic anastomosis for carcinoma-in-situ found at colonoscopy. Eighteen months later, he presented with a lower gastrointestinal bleed from an anastomotic ulcer, treated with resection of the anastomotic site and ileo-sigmoid anastomosis. In the ensuing 12 months, he had three episodes of haematochezia. Colonoscopy revealed a 12 mm anastomotic ulcer necessitating a further colonic resection and re-anastomosis. Two-years later, he presented with iron deficiency anaemia. He preferred expectant management and received ten iron-infusions over the subsequent four years. Thereafter, he developed painless haematochezia. Colonoscopy showed a 15 mm linear ulcer with mild ooze at the anastomosis. Histology was consistent with an ischaemic ulcer; there was no evidence of recurrence of carcinoma-in-situ. The ulcer remained refractory to endoscopic and medical treatment, as seen at three follow-up colonoscopies. Hyperbaric oxygen treatment (HBOT) was offered and he received 30 sessions over six weeks. Colonoscopy at HBOT completion revealed healing of the ulcer. The patient had no further overt bleeding and serum ferritin has continued to rise spontaneously over 12 months follow-up.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Case report


2018 September;48(3)

Diving Hyperb Med. 2018 September;48(3):194−196. doi: 10.28920/dhm48.3.194-196. PMID: 30199892.

A recurrent, ischaemic ileocolonic anastomosis ulcer refractory to surgery treated with hyperbaric oxygen

Puraskar Pateria, Andre Chong

Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia 6150
Corresponding author: Puraskar Pateria, Work Address: Department of Gastroenterology and Hepatology, Service 4, CD09, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia 6150
This email address is being protected from spambots. You need JavaScript enabled to view it.

Key words
Gastrointestinal tract; Chronic wounds; Case reports

Abstract
(Pateria P, Chong A. A recurrent, ischaemic ileocolonic anastomosis ulcer refractory to surgery treated with hyperbaric oxygen. Diving and Hyperbaric Medicine. 2018 September;48(3):194−196. doi: 10.28920/dhm48.3.194-196. PMID: 30199892.)
A 54-year-old male had undergone right hemicolectomy and ileo-colonic anastomosis for carcinoma-in-situ found at colonoscopy. Eighteen months later, he presented with a lower gastrointestinal bleed from an anastomotic ulcer, treated with resection of the anastomotic site and ileo-sigmoid anastomosis. In the ensuing 12 months, he had three episodes of haematochezia. Colonoscopy revealed a 12 mm anastomotic ulcer necessitating a further colonic resection and re-anastomosis. Two-years later, he presented with iron deficiency anaemia. He preferred expectant management and received ten iron-infusions over the subsequent four years. Thereafter, he developed painless haematochezia. Colonoscopy showed a 15 mm linear ulcer with mild ooze at the anastomosis. Histology was consistent with an ischaemic ulcer; there was no evidence of recurrence of carcinoma-in-situ. The ulcer remained refractory to endoscopic and medical treatment, as seen at three follow-up colonoscopies. Hyperbaric oxygen treatment (HBOT) was offered and he received 30 sessions over six weeks. Colonoscopy at HBOT completion revealed healing of the ulcer. The patient had no further overt bleeding and serum ferritin has continued to rise spontaneously over 12 months follow-up.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Case report


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Articles from 2017 are deposited in PubMed Central

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