Database: Ovid MEDLINE(R) <1966 to January Week 3 2004>
Search Strategy:
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1 barotrauma/ or decompression sickness/ (2783)
2 exp sports/ (47461)
3 1 and 2 (1067)
4 limit 3 to (human and english language) (714)
5 limit 4 to yr=1996-2004 (230)
6 (*barotrauma/ or *decompression sickness/) and 5 (192)
7 limit 6 to ovid full text available (20)
8 exp *sports/ and 6 (165)
9 limit 8 to review articles (26)
10 from 9 keep 2-4,6-7,9-12,14,16-18,21-22,26 (16)
11 7 or 10 (35)
12 limit 8 to yr=2002-2004 (37)
13 from 12 keep 1-3,5-7,9,11-12,15,19-20,25,29,31-33,35,37 (19)
14 11 or 13 (46)
15 from 14 keep 1-46 (46)
16 from 15 keep 1-46 (46)
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<1>
Unique Identifier
8623700
Authors
Clenney TL. Lassen LF.
Institution
Naval School, Explosive Ordnance Disposal, Indian Head, Maryland, USA.
Title
Recreational scuba diving injuries. [Review] [17 refs]
Source
American Family Physician. 53(5):1761-74, 1996 Apr.
Abstract
Because of the increasing popularity of recreational scuba diving, primary care physicians should be familiar with common diving injuries. One form of barotrauma, middle ear squeeze, is the most common diving injury. Other important diving injuries include inner ear barotrauma and pulmonary barotrauma. Arterial gas embolism, a potentially life-threatening form of pulmonary barotrauma, requires hyperbaric treatment. Decompression sickness is the result of bubble formation in body tissue. Symptoms of decompression sickness range from joint pain to neurologic or pulmonary problems. Recompression is the mainstay of treatment. [References: 17]
<2>
Unique Identifier
11417773
Authors
Newton HB.
Institution
Department of Neurology, Ohio State University Hospitals, Columbus 43210, USA.
Title
Neurologic complications of scuba diving. [Review] [18 refs]
Source
American Family Physician. 63(11):2211-8, 2001 Jun 1.
Abstract
Recreational scuba diving has become a popular sport in the United States, with almost 9 million certified divers. When severe diving injury occurs, the nervous system is frequently involved. In dive-related barotrauma, compressed or expanding gas within the ears, sinuses and lungs causes various forms of neurologic injury. Otic barotrauma often induces pain, vertigo and hearing loss. In pulmonary barotrauma of ascent, lung damage can precipitate arterial gas embolism, causing blockage of cerebral blood vessels and alterations of consciousness, seizures and focal neurologic deficits. In patients with decompression sickness, the vestibular system, spinal cord and brain are affected by the formation of nitrogen bubbles. Common signs and symptoms include vertigo, thoracic myelopathy with leg weakness, confusion, headache and hemiparesis. Other diving-related neurologic complications include headache and oxygen toxicity. [References: 18]
<3>
Unique Identifier
11326354
Authors
Strauss MB. Borer RC Jr.
Institution
Baromedical Department, Long Beach Memorial Medical Center, Long Beach, CA 90801-1428, USA.
Title
Diving medicine: contemporary topics and their controversies. [Review] [36 refs]
Source
American Journal of Emergency Medicine. 19(3):232-8, 2001 May.
Abstract
SCUBA diving is a popular recreational sport. Although serious injuries occur infrequently, when they do knowledge of diving medicine and/or where to obtain appropriate consultation is essential. The emergency physician is likely to be the first physician contact the injured diver has. We discuss 8 subjects in diving medicine which are contemporary, yet may have controversies associated with them. From this information the physician dealing primarily with the injured diver will have a basis for understanding and managing, as well as where to find additional help, for his/her patients' diving injuries. [References: 36]
<4>
Unique Identifier
8915410
Authors
Harrill WC. Jenkins HA. Coker NJ.
Institution
Bobby R. Alford Department of Otorhinolaryngology and Communicative Sciences, Baylor College of Medicine, Houston, TX 77030, USA.
Title
Barotrauma after stapes surgery: a survey of recommended restrictions and clinical experiences.
Source
American Journal of Otology. 17(6):835-45; discussion 845-6, 1996 Nov.
Abstract
OBJECTIVE: To identify a consensus on the postoperative barorestrictions after stapes surgery and to examine the clinical barotrauma experience within this patient population encountered by the surveyed physicians. DATA SOURCE: A 34-item survey was developed, allowing for detailed analysis of physician demographic data, practice characteristics, surgical experience, and clinical experience with barotrauma after stapes surgery. The postoperative restrictions addressed by the survey included those for air travel, snorkeling, and scuba diving. Recommendations for the use of ventilation tubes and hyperbaric oxygen therapy were investigated as well. STUDY SELECTION: Surveys were mailed to 419 active members of the American Otological Society and the American Neurotology Society as listed in the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) 1994-1995 Conjoint Directory. A total of 284 (67.8%) surveys were returned, of which 53 were not sufficiently completed and were excluded in the statistical analysis. DATA EXTRACTION: The demographic data and clinical experience were analyzed to determine statistical association with the postoperative recommendations using chi 2 or Fisher's exact tests. The kappa statistic was used as a measure of consistency between physicians' recommended restriction for a specific activity after a stapedectomy or stapedotomy. CONCLUSION: No consensus was demonstrated as to restrictions from activities such as air travel, snorkeling, or scuba diving. Despite this lack of consensus, no significant difference was demonstrated in the prevalence of barotrauma reported within the responding physicians' practices based on their individual recommendations for these activities.
<5>
Unique Identifier
11187416
Authors
Schwerzmann M. Seiler C. Lipp E. Guzman R. Lovblad KO. Kraus M. Kucher N.
Institution
Swiss Cardiovascular Center Bern and University Hospital.
Title
Relation between directly detected patent foramen ovale and ischemic brain lesions in sport divers.[see comment].
Comments
Comment in: Ann Intern Med. 2001 Nov 20;135(10):928-9; PMID: 11712889, Comment in: Ann Intern Med. 2001 Nov 20;135(10):928; author reply 929; PMID: 11712888
Source
Annals of Internal Medicine. 134(1):21-4, 2001 Jan 2.
Abstract
BACKGROUND: In divers, the significance of a patent foramen ovale and its potential relation to paradoxical gas emboli remain uncertain. OBJECTIVE: To assess the prevalence of symptoms of decompression illness and ischemic brain lesions in divers with regard to the presence of a patent foramen ovale. DESIGN: Retrospective cohort study. SETTING: University hospital and three diving clubs in Switzerland. PARTICIPANTS: 52 sport divers and 52 nondiving controls. MEASUREMENTS: Prevalence of self-reported decompression events, patent foramen ovale on contrast transesophageal echocardiography, and ischemic brain lesions on magnetic resonance imaging. RESULTS: The risk for decompression illness events was 4.5-fold greater in divers with patent foramen ovale than in divers without patent foramen ovale (risk ratio, 4.5 [95% CI, 1.2 to 18.0]; P = 0.03). Among divers, 1.23 +/- 2.0 and 0.64 +/- 1.22 ischemic brain lesions per person (mean +/- SD) were detected in those with and those without patent foramen ovale, respectively. Among controls, 0.22 +/- 0.44 and 0.12 +/- 0.63 lesion per person were detected (P < 0.001 for all groups). CONCLUSIONS: Regardless of whether a diver has a patent foramen ovale, diving is associated with ischemic brain lesions.
<6>
Unique Identifier
14556567
Authors
Gerriets T. Tetzlaff K. Hutzelmann A. Liceni T. Kopiske G. Struck N. Reuter M. Kaps M.
Institution
Department of Neurology, Justus-Liebig-University Giessen, Am Steg 20, 35390 Giessen, Germany.
Title
Association between right-to-left shunts and brain lesions in sport divers.
Source
Aviation Space & Environmental Medicine. 74(10):1058-60, 2003 Oct.
Abstract
BACKGROUND: Recent studies suggest that healthy sport divers may develop clinically silent brain damage, based on the association between a finding of multiple brain lesions on MRI and the presence of right-to-left shunt, a pathway for venous gas bubbles to enter the arterial system. METHODS: We performed echocontrast transcranial Doppler sonography in 42 sport divers to determine the presence of a right-to-left shunt. Cranial MRI was carried out using a 1.5 T magnet. A lesion was counted if it was hyperintense on both T2-weighted and T2-weighted fluid attenuated inversion recovery sequences. To test the hypothesis that the occurrence of postdive arterial gas emboli is related to brain lesions on MRI, we measured postdive intravascular bubbles in a subset of 15 divers 30 min after open water scuba dives. RESULTS: Echocontrast transcranial Doppler sonography revealed a right-to-left shunt in 16 of the divers (38%). Only one hyperintensive lesion of the central white matter was found and that was in a diver with no evidence of a right-to-left shunt. Postdive arterial gas emboli were detected in 3 out of 15 divers; they had a right-to-left shunt, but no pathologic findings on cranial magnetic resonance imaging. CONCLUSIONS: Our data support the theory that right-to-left shunts can serve as a pathway for venous gas bubbles into the arterial circulation. However, we could not confirm an association between brain lesions and the presence of a right-to-left shunt in sport divers.
<7>
Unique Identifier
11846183
Authors
Clarke D. Gerard W. Norris T.
Institution
Department of Hyperbaric Medicine, Palmetto Richland Memorial Hospital, University of South Carolina, Columbia 29203, USA.
Title
Pulmonary barotrauma-induced cerebral arterial gas embolism with spontaneous recovery: commentary on the rationale for therapeutic compression. [Review] [86 refs]
Source
Aviation Space & Environmental Medicine. 73(2):139-46, 2002 Feb.
Abstract
Pulmonary barotrauma-induced cerebral arterial gas embolism (CAGE) continues to complicate compressed gas diving activities. Inadequate lung ventilation secondary to inadvertent breath holding or rapid buoyant ascent can quickly generate a critical state of lung over-pressure. Pulmonary over-pressurization may also occur as a consequence of acute and chronic pulmonary pathologies. Resulting barotrauma frequently causes structural failure within the terminal distal airway. Respiratory gases are then free to embolize the systemic circulation via the pulmonary vasculature and the left heart. The brain is a common target organ. Bubbles that enter the cerebral arteries coalesce to form columns of gas as the vascular network narrows. Small amounts of gas frequently pass directly through the cerebral circulation without occlusion. Larger columns of gas occlude regional brain blood flow, either transiently or permanently, producing a stroke-like clinical picture. In cases of spontaneous redistribution, a period of apparent recovery is frequently followed by relapse. The etiology of relapse appears to be multifactoral, and chiefly the consequence of a failure of reperfusion. Prediction of who will relapse is not possible, and any such relapse is of ominous prognostic significance. It is advisable, therefore, that CAGE patients who undergo spontaneous recovery be promptly recompressed while breathing oxygen. Therapeutic compression will serve to antagonize leukocyte-mediated ischemia-reperfusion injury; limit potential re-embolization of brain blood flow, secondary to further leakage from the original pulmonary lesion or recirculation of gas from the initial occlusive event; protect against embolic injury to other organs; aid in the resolution of component cerebral edema; reduce the likelihood of late brain infarction reported in patients who have undergone spontaneous clinical recovery; and prophylax against decompression sickness in high gas loading dives that precede accelerated ascents and omitted stage decompression. [References: 86]
<8>
Unique Identifier
12182213
Authors
St Leger Dowse M. Bryson P. Gunby A. Fife W.
Institution
Diving Diseases Research Centre, Plymouth, Devon, United Kingdom.
Title
Comparative data from 2250 male and female sports divers: diving patterns and decompression sickness.
Source
Aviation Space & Environmental Medicine. 73(8):743-9, 2002 Aug.
Abstract
BACKGROUND: The aim of the study was to compare the diving habits and histories of men and women in recreational scuba diving. METHODS: More than 10,000 questionnaires were circulated to recreational divers in the United Kingdom. Retrospective, broad-based information was requested concerning general health, smoking, alcohol, recreational drug use, diving habits and histories, and physician-confirmed and self-diagnosed episodes of decompression sickness (DCS). Data relating only to women were also gathered. Questionnaires were anonymous. RESULTS: Over four years, 2250 divers responded, 47% of whom were women. Of the 458,827 dives reported, 310% were by women. Differences in diving habits were observed between men and women, which included number of dives per annum, maximum depths dived, and dives with extra stops. When the level of experience was taken into account in this study group, the estimated rate of DCS in men was 2.60 times greater than for women. CONCLUSIONS: In this study, comparison between men and women in recreational diving differed from the initial evaluation when underlying factors were taken into account. Future studies should attempt to control for underlying factors in the data gathering and data analysis.
<9>
Unique Identifier
12398259
Authors
Freiberger JJ. Denoble PJ. Pieper CF. Uguccioni DM. Pollock NW. Vann RD.
Institution
Diver's Alert Network, and Duke University Medical Center, Center for Hyperbaric Medicine and Environmental Physiology, Department of Anesthesiology, Durham, NC 27710, USA.
Title
The relative risk of decompression sickness during and after air travel following diving.
Source
Aviation Space & Environmental Medicine. 73(10):980-4, 2002 Oct.
Abstract
BACKGROUND: Decompression sickness (DCS) can be provoked by post-dive flying but few data exist to quantify the risk of different post-dive, preflight surface intervals (PFSI). METHODS: We conducted a case-control study using field data from the Divers Alert Network to evaluate the relative risk of DCS from flying after diving. The PFSI and the maximum depths on the last day of diving (MDLD) were analyzed from 627 recreational dive profiles. The data were divided into quartiles based on surface interval and depth. Injured divers (cases) and uninjured divers (controls) were compared using logistic regression to determine the association of DCS with time and depth while controlling for diver and dive profiles characteristics. These included PFSI, MDLD, gender, height, weight, age, and days of diving. RESULTS: The means (+/-SD) for cases and controls were as follows: PFSI, 20.7 +/- 9.6 h vs. 27.1 +/- 6.7 h; MDLD, 22.5 +/- 14 meters sea water (msw) vs. 19 +/- 11.3 msw; male gender, 60% vs. 70%; weight, 75.8 +/- 18 kg vs. 77.6 +/- 16 kg; height, 173 +/- 16 cm vs. 177 +/- 9 cm; age, 36.8 +/- 10 yr vs. 42.9 +/- 11 yr; diving > or = 3 d, 58% vs. 97%. Relative to flying > 28 h after diving, the odds of DCS (95% CI) were: 1.02 (0.61, 1.7) 24-28 h; 1.84 (1.0, 3.3) 20-24 h; and 8.5 (3.85, 18.9) < 20 h. Relative to a depth of < 14.7 msw, the odds of DCS (95% CI) were: 1.2 (0.6, 1.7) 14.7-18.5 msw; 2.9 (1.65, 5.3) 18.5-26 msw; and 5.5 (2.96, 1 0.0) > 26 msw. CONCLUSIONS: Odds ratios approximate relative risk in rare diseases such as DCS. This study demonstrated an increase in relative risk from flying after diving following shorter PFSIs and/or greater dive depths on the last day. The relative risk increases geometrically as the PFSI becomes smaller.