2021 December;51(4)

Diving Hyperb Med. 2021 December 20;51(4):322–327. doi: 10.28920/dhm51.4.322-327. PMID: 34897596.

Nutritional status of patients referred for hyperbaric oxygen treatment; a retrospective and descriptive cross-sectional study

Rutger C Lalieu1,2, Ida Akkerman3, Peter-Jan AM van Ooij4,5, Annieke A Boersma-Voogd4,6, Rob A van Hulst2,4

1 Hyperbaric Center Rijswijk, Rijswijk, the Netherlands
2 Hyperbaric and Diving Medicine, Anesthesiology, Amsterdam Medical Centre, Amsterdam, the Netherlands
3 Independent researcher, de nieuwe delta, Ede, the Netherlands
4 Antonius Hypercare, Sneek, the Netherlands
5 Diving Medical Center, Royal Netherlands Navy, Den Helder, the Netherlands
6 Independent researcher, Dieetstyle – Annieke Boersma, Sneek, the Netherlands

Corresponding author: Dr Rutger C Lalieu, Hyperbaric Center Rijswijk, Treubstraat 5A, 2288 EG Rijswijk, the Netherlands
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Key words
Hyperbaric medicine; Hyperbaric research; Irradiation; Nutrition; Obesity; Osteoradionecrosis; Wounds

Abstract
(Lalieu RC, Akkerman I, van Ooij PJAM, Boersma-Voogd AA, van Hulst RA. Nutritional status of patients referred for hyperbaric oxygen treatment; a retrospective and descriptive cross-sectional study. Diving and Hyperbaric Medicine. 2021 December 20;51(4):322–327. doi: 10.28920/dhm51.4.322-327. PMID: 34897596.)
Introduction: Due to the global rise of obesity, the role of nutrition has gathered more attention. Paradoxically, even overweight persons may be malnourished. This may delay wound healing or recovery of late radiation tissue injury (LRTI). Hyperbaric oxygen treatment (HBOT) is used to improve wound healing or LRTI complaints. The aim of this study was to assess the dietary intake levels of nutrients important for recovery in patients referred for HBOT.
Methods: This was a retrospective, cross-sectional study of patients referred for HBOT to a single centre between 2014 and 2019. Patients were offered a consultation with a dietitian as standard care. Information on nutrients was calculated from questionnaires, and compared to recommended daily allowances.
Results: One hundred and forty-six patients were included (80 female). Eighteen patients were treated for diabetic ulcers, 25 for non-diabetic ulcers and 103 for LRTI. Most were overweight or obese (64.4%), but did not consume the recommended quantities of calories, protein, or micronutrients. Vitamin C consumption was higher than recommended. Male patients had a higher intake of calories and protein than female patients but not other nutrients. No differences in intake existed between age or body mass index categories.
Conclusions: The nutritional status of patients referred for HBOT may be inadequate for healing wounds or LRTI, despite anthropomorphic data indicating a positive energy balance. Daily attendance for HBOT provides a unique opportunity to monitor and correct these deficiencies. Routine screening for malnutrition and supplement deficiencies is recommended for patients referred for HBOT.

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


2021 December;51(4)

Diving Hyperb Med. 2021 December 20;51(4):328–337. doi: 10.28920/dhm51.4.328-337. PMID: 34897597.

Inner ear barotrauma and inner ear decompression sickness: a systematic review on differential diagnostics

Oskari H Lindfors1, Anne K Räisänen-Sokolowski2,3, Timo P Hirvonen1, Saku T Sinkkonen1

1 Department of Otorhinolaryngology – Head and Neck Surgery, Head and Neck Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
2 Department of Pathology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
3 Centre for Military Medicine, Finnish Defence Forces, Helsinki, Finland

Corresponding author: Dr Oskari H Lindfors, Department of Otorhinolaryngology – Head and Neck Surgery, Head and Neck Centre, Helsinki University Hospital, PO Box 263, FI-00029 HUH, Helsinki, Finland
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Key words
Decompression; Diving; ENT; Epidemiology; Hearing; Labyrinth; Vertigo

Abstract
(Lindfors OH, Räisänen-Sokolowski AK, Hirvonen TP, Sinkkonen ST. Inner ear barotrauma and inner ear decompression sickness: a systematic review on differential diagnostics. Diving and Hyperbaric Medicine. 2021 December 20;51(4):328–337. doi: 10.28920/dhm51.4.328-337. PMID: 34897597.)
Introduction: Inner ear barotrauma (IEBt) and inner ear decompression sickness (IEDCS) are the two dysbaric inner ear injuries associated with diving. Both conditions manifest as cochleovestibular symptoms, causing difficulties in differential diagnosis and possibly delaying (or leading to inappropriate) treatment.
Methods: This was a systematic review of IEBt and IEDCS cases aiming to define diving and clinical variables that help differentiate these conditions. The search strategy consisted of a preliminary search, followed by a systematic search covering three databases (PubMed, Medline, Scopus). Studies were included when published in English and adequately reporting one or more IEBt or IEDCS patients in diving. Concerns regarding missing and duplicate data were minimised by contacting original authors when necessary.
Results: In total, 25 studies with IEBt patients (n = 183) and 18 studies with IEDCS patients (n = 397) were included. Variables most useful in differentiating between IEBt and IEDCS were dive type (free diving versus scuba diving), dive gas (compressed air versus mixed gas), dive profile (mean depth 13 versus 43 metres of seawater), symptom onset (when descending versus when ascending or surfacing), distribution of cochleovestibular symptoms (vestibular versus cochlear) and absence or presence of other DCS symptoms. Symptoms of difficult middle ear equalisation or findings consistent with middle ear barotrauma could not be reliably assessed in this context, being insufficiently reported in the IEDCS literature.
Conclusions: There are multiple useful variables to help distinguish IEBt from IEDCS. Symptoms of difficult middle ear equalisation or findings consistent with middle ear barotrauma require further study as means of distinguishing IEBt and IEDCS.

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


2021 December;51(4)

Diving Hyperb Med. 2021 December 20;51(4):338–344. doi: 10.28920/dhm51.4.338-344. PMID: 34897598.

Microcirculation and tissue oxygenation in the head and limbs during hyperbaric oxygen treatment

Naoki Yamamoto1,2, Ryohei Takada1, Takuma Maeda2, Toshitaka Yoshii1, Atsushi Okawa1, Kazuyoshi Yagishita1,2

1 Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital, Tokyo, Japan
2 Hyperbaric Medical Centre, Tokyo Medical and Dental University Hospital, Tokyo, Japan

Corresponding author: Dr Ryohei Takada, Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital, Tokyo, Japan
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Key words
Cardiovascular; Laser Doppler; Hyperoxia; Patient monitoring; Peripheral blood flow; Transcutaneous oximetry

Abstract
Yamamoto N, Takada R, Maeda T, Yoshii T, Okawa A, Yagishita K. Microcirculation and tissue oxygenation in the head and limbs during hyperbaric oxygen treatment. Diving and Hyperbaric Medicine. 2021 December 20;51(4):338–344. doi: 10.28920/dhm51.4.338-344. PMID: 34897598.)
Introduction: Hyperbaric oxygen (HBO) exposure for 10−15 min has been shown to reduce peripheral blood flow due to vasoconstriction. However, the relationship between decreased peripheral blood flow and the therapeutic effects of HBO treatment on peripheral circulatory disorders remain unknown. Longer exposures have been reported to have vasodilatory effects and increase peripheral blood flow. This study investigated the effect of HBO treatment on blood flow and transcutaneous oxygen pressure (TcPO2).
Methods: Twenty healthy volunteers aged 20–65 years (nine males) participated in this study. All participants breathed oxygen for 60 min at 253.3 kPa. Peripheral blood flow using laser Doppler flowmetry and TcPO2 on the ear, hand, and foot were continuously measured from pre-HBO exposure to 10 min post-exposure.
Results: Peripheral blood flow in each body part decreased by 7–23% at the beginning of the HBO exposure, followed by a slow increase. Post-exposure, peripheral blood flow increased 4–76% in each body part. TcPO2 increased by 840–1,513% during the exposure period, and remained elevated for at least 10 min after the exposure.
Conclusions: The findings of the current study suggest vasoconstriction during HBO treatment is transient, and even when present does not inhibit the development of increased tissue oxygen partial pressure. These findings are relevant to studies investigating changes in peripheral blood flow during HBO treatment in patients with circulatory disorders.

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


2021 December;51(4)

Diving Hyperb Med. 2021 December 20;51(4):345–354. doi: 10.28920/dhm51.4.345-354. PMID: 34897599.

Scuba diving-related fatalities in New Zealand, 2007 to 2016

John Lippmann1,2,3, Christopher Lawrence4,5, Michael Davis6

1 Department of Public Health and Preventive Medicine, Monash University, Victoria, Australia
2 Australasian Diving Safety Foundation, Canterbury, Victoria, Australia
3 Royal Life Saving Society Australia, Sydney, Australia
4 Department of Pathology, Christchurch Hospital, Christchurch, New Zealand
5 Statewide Forensic Medical Services, Royal Hobart Hospital, Tasmania, Australia
6 Department of Anaesthesiology, School of Medicine, The University of Auckland, Auckland, New Zealand

Corresponding author: Dr John Lippmann, Australasian Diving Safety Foundation, PO Box 478, Canterbury, VIC 3126, Australia
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Key words
Cardiovascular; Coroner’s findings; Diving deaths; Diving incidents; Drowning; Epidemiology; Obesity

Abstract
(Lippmann J, Lawrence C, Davis M. Scuba diving-related fatalities in New Zealand, 2007 to 2016. Diving and Hyperbaric Medicine. 2021 December 20;51(4):345–354. doi: 10.28920/dhm51.4.345-354. PMID: 34897599.)
Introduction: New Zealand (NZ) diving-related fatalities have been reported since the 1960s. The aim is to identify contributing risk factors, including medical, and to inform appropriate preventative strategies.
Methods: NZ scuba diving fatalities from 2007 to 2016 were searched from multiple sources – the National Coronial Information System (NCIS); the NZ Chief Coroner’s office; Water Safety NZ Drownbase™ and the NZ Police National Dive Squad records. For inclusion, a victim must have been wearing a scuba set (which may include a rebreather). A key word search of the NCIS was made and the results matched to the other databases. An Excel® database was created and a chain of events analysis (CEA) conducted.
Results: Forty-eight scuba diving fatalities were identified, 40 men and eight women, average age 47 years (range 17−68), 20 of Māori ethnicity. Thirty-five were classified as overweight (14) or obese (21). Pre-existing medical risk factors were identified, either pre dive or at autopsy, in 37 divers, the commonest being ischaemic heart disease (IHD, 20), left ventricular hypertrophy (LVH, 18) and hypertension (seven). IHD, LVH and obesity were variously associated with each other. The likely commonest disabling conditions, identified in 32 cases, were asphyxia (15), cardiac (nine) and pulmonary barotrauma/cerebral arterial gas embolism (five). Multiple environmental and diving practice breaches and poor planning were identified in the CEA, similar to those seen in other studies. Thirty-eight divers had not released their weight belt. Information on resuscitation was limited.
Conclusions: Obesity and cardiovascular disease were common and Māori appear to be over-represented, both as previously reported.

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


2021 December;51(4)

Diving Hyperb Med. 2021 December 20;51(4):355–360. doi: 10.28920/dhm51.4.355-360. PMID: 34897600.

What are the effects of scuba diving-based interventions for clients with neurological disability, autism or intellectual disability? A systematic review

Karlee Naumann1, Jocelyn Kernot2, Gaynor Parfitt1, Bethany Gower1, Adrian Winsor3, Kade Davison1

1 Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, School of Allied Health and Human Performance, Adelaide, SA, Australia
2 University of South Australia, School of Allied Health and Human Performance, Adelaide, SA, Australia
3 Department of Hyperbaric Medicine, Royal Adelaide Hospital, Central Adelaide Local Health Network, SA Health, Adelaide, SA, Australia

Corresponding author: Karlee Nauman, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia, ORCID: 0000-0003-1887-2336.
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Key words
Adapted physical activity; Disabled diver; Evidence; Physiology; Psychology; Review article

Abstract
(Naumann K, Kernot J, Parfitt G, Gower B, Winsor A, Davison K. What are the effects of scuba diving-based interventions for clients with neurological disability, autism or intellectual disability? A systematic review. Diving and Hyperbaric Medicine. 2021 December 20;51(4):355–360. doi: 10.28920/dhm51.4.355-360. PMID: 34897600.)
Introduction: Recreational scuba diving has existed for over 70 years with organisations emerging that teach individuals with disabilities to dive. It is unclear what the physical and psychosocial effects of scuba interventions might be. This systematic review explores evidence for the effects of scuba diving in individuals with neurological disability, intellectual disability and autism.
Methods: The databases Medline, EMBASE, Ovid Emcare, and SportDiscus were searched. Included papers described a scuba-based intervention for clients with a neurological disability, intellectual disability and autism, with physical or psychosocial outcomes explored in the paper. Quality of the included papers was assessed using the McMaster Appraisal Tools, with descriptive data synthesis completed to explore the physical and psychosocial effects of the interventions.
Results: Four papers met the inclusion criteria: a cross-sectional investigation, a phenomenological study, a case-control study and a multiple case study. The quality of the papers was low to moderate. Papers addressed the psychosocial effects of scuba diving, including motivation to participate, participant experiences, the effect on cognition and physical self-concept. One study reported an increase in self-concept for the majority of participants. An increase in understanding instructions and in visual attention was reported in another. Enjoyment of the activity was reported and motivators to be involved in scuba diving for people with disabilities included fun and excitement. No papers addressed functional outcomes.
Conclusions: Whilst scuba diving interventions appear to enhance physical self-concept and are enjoyable, conclusive evidence regarding effectiveness could not be determined. Research in this area is extremely limited.

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


2021 December;51(4)

Diving Hyperb Med. 2021 December 20;51(4):361–367. doi: 10.28920/dhm51.4.361-367. PMID: 34897601.

Flying after diving: a questionnaire-based evaluation of pre-flight diving behaviour in a recreational diving cohort

Marguerite St Leger Dowse1, Sophie Howell2, Gary R Smerdon1

1 DDRC Healthcare, Plymouth, UK
2 Whangarei Hospital, Whangarei, Northland, New Zealand

Corresponding author: Marguerite St Leger Dowse, DDRC Healthcare, Hyperbaric Medical Centre, Plymouth Science Park, Research Way, Plymouth PL6 8BU, Devon, United Kingdom
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Key words
Altitude; Decompression sickness; Guidelines; Health surveys; Surface interval; Vacation

Abstract
(St Leger Dowse M, Howell S, Smerdon GR. Flying after diving: a questionnaire-based evaluation of pre-flight diving behaviour in a recreational diving cohort. Diving and Hyperbaric Medicine. 2021 December 20;51(4):361–367. doi: 10.28920/dhm51.4.361-367. PMID: 34897601.)
Introduction: Divers are recommended to observe a pre-flight surface interval (PFSI) ≥ 24 hours before boarding a plane following a diving vacation. Decompression sickness (DCS) symptoms may occur during or post-flight. This study aimed to examine the adherence of PFSI ≥ 24 in vacationing divers, and if any perceived signs and symptoms of DCS during or after flight were experienced.
Methods: An anonymous online survey was publicised through diving exhibitions and social media. Data included diver/diving demographics, PFSI before flight, flight details, and perceived signs and symptoms of DCS during or after flight.
Results: Data from 316 divers were examined (31% female) with the age range 17–75 years (median 49). Divers recorded 4,356 dives in the week preceding the flight, range 1–36 (median 14). Overall, 251/316 (79%) respondents reported a PFSI of ≥ 24 hours. PFSIs of < 12 hours were reported by 6 respondents. Diagnosed and treated DCS developing during, and post flight was reported by 4 divers with PFSIs ≥ 24 hours and by 2 divers with PFSIs < 24 hours. Fifteen divers boarded a plane with perceived symptoms of DCS.
Conclusions: These data suggest that most divers in this study observed the recommendations of a ≥ 24 hour PFSI with safe outcomes.

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


2021 December;51(4)

Diving Hyperb Med. 2021 December 20;51(4):368–372. doi: 10.28920/dhm51.4.368-372. PMID: 34897602.

The lower limit for FEV1/FVC in dive medical assessments: a retrospective study

Thijs T Wingelaar1,2, Peter-Jan AM van Ooij1,3, Edwin L Endert1

1 Diving and Submarine Medical Centre, Royal Netherlands Navy, the Netherlands
2 Department of Anaesthesiology, Amsterdam University Medical Centres, Amsterdam Medical Centre, the Netherlands
3 Department of Respiratory Medicine, Amsterdam University Medical Centres, Amsterdam Medical Centre, the Netherlands

Corresponding author: Dr Thijs Wingelaar, Royal Netherlands Navy Diving Medical Centre, Rijkszee en marinehaven, 1780 CA, Den Helder, the Netherlands
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Key words
Fitness to dive; Health surveillance; Lung function; Military diving

Abstract
(Wingelaar TT, van Ooij PJAM, Endert EL. The lower limit for FEV1/FVC in dive medical assessments: a retrospective study. Diving and Hyperbaric Medicine. 2021 December 20;51(4):368–372. doi: 10.28920/dhm51.4.368-372. PMID: 34897602)
Introduction: Interpreting pulmonary function test (PFT) results requires a valid reference set and a cut-off differentiating pathological from physiological pulmonary function; the lower limit of normal (LLN). However, in diving medicine it is unclear whether an LLN of 2.5% (LLN-2.5) or 5% (LLN-5) in healthy subjects constitutes an appropriate cut-off.
Methods: All PFTs performed at the Royal Netherlands Navy Diving Medical Centre between 1 January 2015 and 1 January 2021 resulting in a forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and/or FEV1/FVC with a Z-score between -1.64 (LLN-5) and -1.96 (LLN-2.5) were included. Records were screened for additional tests, referral to a pulmonary specialist, results of radiological imaging, and fitness to dive.
Results: Analysis of 2,108 assessments in 814 subjects showed that 83 subjects, 74 men and nine women, mean age 32.4 (SD 8.2) years and height 182 (7.0) cm, had an FVC, FEV1 and/or FEV1/FVC with Z-scores between -1.64 and -1.96. Of these 83 subjects, 35 (42%) underwent additional tests, 77 (93%) were referred to a pulmonary specialist and 31 (37%) underwent high-resolution CT-imaging. Ten subjects (12%) were declared ‘unfit to dive’ for various reasons. Information from their medical history could have identified these individuals.
Conclusions: Use of LLN-2.5 rather than LLN-5 for FEV1/FVC in asymptomatic individuals reduces additional investigations and referrals to a pulmonary specialist without missing important diagnoses, provided a thorough medical history is taken. Adoption of LLN-2.5 could save resources spent on diving medical assessments and protect subjects from harmful side effects associated with additional investigations, while maintaining an equal level of safety.

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


2021 December;51(4)

Diving Hyperb Med. 2021 December 20;51(4):373–375. doi: 10.28920/dhm51.4.373-375. PMID: 34897603.

Adjuvant hyperbaric oxygen treatment of acute brain herniation after microsurgical clipping of a recurring cerebral aneurysm: a case report

Yaling Liu1

1 Department of Hyperbaric Oxygenation, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

Corresponding author: Dr Yaling Liu, Department of Hyperbaric Oxygenation, Beijing Tiantan Hospital, Capital Medical University, No.119 Nansihuanxilu Road, Fengtai District, Beijing, China, 100070
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Key words
Brain injury; Cerebral ischaemia; Hyperbaric medicine; Intracranial haemorrhage; Surgery

Abstract
(Liu Y. Adjuvant hyperbaric oxygen treatment of acute brain herniation after microsurgical clipping of a recurring cerebral aneurysm: a case report. Diving and Hyperbaric Medicine. 2021 December 20;51(4):373–375. doi: 10.28920/dhm51.4.373-375. PMID: 34897603.)
Introduction: Acute brain herniation is a life-threatening neurological condition that occasionally develops due to severe complications following cerebral aneurysm clipping. Strategies for managing acute brain herniation have not improved substantially during the past decade. Hyperbaric oxygen treatment (HBOT) may alleviate harmful effects of cerebral hypoxia, which is one of the most important pathophysiological features of acute brain herniation and, therefore, may be useful as an adjuvant therapy for acute brain herniation. A case treated with adjuvant HBOT is reported.
Case report: A 60-year-old asymptomatic man presented with a recurring left middle cerebral artery bifurcation aneurysm with previous stent-assisted embolisation. After craniotomy for surgical clipping of the aneurysm, disturbance of consciousness and right hemiplegia occurred. Computed tomography (CT) images suggested simultaneous cerebral ischaemia and intracranial haemorrhage. Pharmacologic treatment resulted in no improvement. A CT scan acquired five days after surgery showed uncal and falcine herniation. HBOT was administered five days after surgery, and the patient’s condition dramatically improved. He became conscious, and his hemiplegia improved following seven sessions of HBOT. Simultaneously, CT images showed regression of the acute brain herniation.
Conclusions: The patient had recovered completely at one year post-treatment. HBOT may be effective in the treatment of acute brain herniation following cerebral aneurysm clipping.

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

Publication Type: Case report


2021 December;51(4)

Diving Hyperb Med. 2021 December 20;51(4):376–381. doi: 10.28920/dhm51.4.376-381. PMID: 34897604.

A neoprene vest hastens dyspnoea and leg fatigue during exercise testing: entangled breathing and cardiac hindrance?

Jacques Regnard1, Mathieu Veil-Picard2, Malika Bouhaddi1, Olivier Castagna3

1 University Hospitals Dept of Physiology, EA3920 University of Bourgogne Franche Comté, Besançon, France
2 Department of Respiratory Diseases, University Hospital, Besançon, France
3 Underwater Research Team (ERRSO), Military Biomedical Research Institute, Toulon, France

Corresponding author: Dr Jacques Regnard, University Hospitals Dept of Physiology, EA3920 University of Bourgogne Franche Comté, Besançon, 25000, France
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Key words
Cardiac function; Cardiopulmonary testing; Dyspnea; Immersion pulmonary oedema; Snorkelling; Wetsuit; Work of breathing

Abstract

(Regnard J, Veil-Picard M, Bouhaddi M, Castagna O. A neoprene vest hastens dyspnoea and leg fatigue during exercise testing: entangled breathing and cardiac hindrance? Diving and Hyperbaric Medicine. 2021 December 20;51(4):376–381. doi: 10.28920/dhm51.4.376-381. PMID: 34897604.)
Symptoms and contributing factors of immersion pulmonary oedema (IPO) are not observed during non-immersed heart and lung function assessments. We report a case in which intense snorkelling led to IPO, which was subsequently investigated by duplicating cardiopulmonary exercise testing with (neoprene vest test – NVT) and without (standard test – ST) the wearing of a neoprene vest. The two trials utilised the same incremental cycling exercise protocol. The vest hastened the occurrence and intensity of dyspnoea and leg fatigue (Borg scales) and led to an earlier interruption of effort. Minute ventilation and breathing frequency rose faster in the NVT, while systolic blood pressure and pulse pressure were lower than in the ST. These observations suggest that restrictive loading of inspiratory work caused a faster rise of intensity and unpleasant sensations while possibly promoting pulmonary congestion, heart filling impairment and lowering blood flow to the exercising muscles. The subject reported sensations close to those of the immersed event in the NVT. These observations may indicate that increased external inspiratory loading imposed by a tight vest during immersion could contribute to pathophysiological events.

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


2021 December;51(4)

Diving Hyperb Med. 2021 December 20;51(4):382-383. doi: 10.28920/dhm51.4.382-383. PMID: 34897605.

Diving-related disorders in breath-hold divers could be explained with the distal arterial bubble hypothesis

Ran Arieli

The Israel Naval Medical Institut, Haifa, Israel; Eliachar Research Laboratory, Western Galilee Medical Centre, Nahariya, Israel

Address for correspondence: Dr Ran Arieli, 12 Klil-Hakhoresh, Rakefet, D.N. Misgav 2017500, Israel
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Key words
Ama diver; Decompression sickness; Gas micronuclei; Letters (to the Editor); Nanobubbles; Taravana

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

Publication Type: Letter


2021 December;51(4)

Diving Hyperb Med. 2021 December 20;51(4):383-384. doi: 10.28920/dhm51.4.383-384. PMID: 34897606.

Reply: Diving-related disorders in breath-hold divers could be explained with the distal arterial bubble hypothesis

Kiyotaka Kohshi

Division of Neurosurgery, Nishinihon Hospital, Kumamoto, Japan

Address for correspondence: Dr Kiyotaka Kohshi, 3-20-1, Hattanda, Kumamoto-higashi, Kumamoto 861-8034, Japan
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Key words
Ama diver; Cerebral embolism; Cerebral infarction; Decompression sickness; Letters (to the Editor); Magnetic resonance imaging

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

Publication Type: Letter


2021 December;51(4)

Diving Hyperb Med. 2021 December 20;51(4):384-385. doi: 10.28920/dhm51.4.384-385. PMID: 34897607.

Pulmonary barotrauma after helicopter underwater escape training

Jan Risberg

NUI as, Gravdalsveien 245, 5165 Laksevag, Norway

Address for correspondence: Dr Jan Risberg, NUI as, Gravdalsveien 245, 5165 Laksevag, Norway
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Key words
Case reports; Cerebral arterial gas embolism; Diving; Injuries; Letters (to the Editor)

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

Publication Type: Letter


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