1/10. The role of computed tomography in the diagnosis of arterial gas embolism in fatal diving accidents in tasmania.Four cases of fatal diving accidents in tasmania are presented, highlighting the role of CT in the investigation of diving fatalities. The CT technique allows rapid diagnosis when arterial gas embolism (AGE) is suspected. The traditional method of investigation, underwater autopsy, is a difficult procedure that requires specialized training in which the subtle diagnosis of AGE may be completely missed. Facilities for performing underwater autopsies are normally available only in tertiary referral centres, and therefore the diagnosis of AGE may be missed due to lack of facilities. The use of CT in the diagnosis of AGE in divers was first utilized in the early 1980s but has still not become widely adopted in forensic practice. This radiological technique has the advantage of being sensitive, quick, reliable, readily available and provides a permanent record. For hospitals that do not have a resident forensic pathologist, a CT scan can be easily performed and interpreted to eliminate the possibility of AGE. There are a number of pitfalls in the diagnosis of AGE with CT, particularly intravascular gas production following postmortem fermentation and off-gassing. awareness of these pitfalls will help the radiologist in making a correct diagnosis of AGE.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
2/10. Delayed onset pulmonary barotrauma or decompression sickness? A case report of decompression-related disorder.A-24-yr-old male professional diver began to complain of substernal pain 3 h after a controlled ascent from a dive of less than 40 ft of sea water (fsw). The diving master who supervised his dive and the physicians who examined him on presentation suspected pulmonary barotrauma rather than decompression sickness (DCS) because he had only descended to a depth of 32 fsw. Hyperbaric oxygen therapy (HBO) by U.S. Navy treatment Table VI was implemented because of his progressively worsening pain. HBO was apparently effective and a relapse was not seen. The author cannot label his condition based on the conventional classification categories, such as decompression sickness (DCS), barotrauma or even decompression illness. This case report is offered as a topic for consideration in the controversy over decompression-related disorders.- - - - - - - - - - ranking = 0.5keywords = water (Clic here for more details about this article) |
3/10. Gastro-esophageal barotrauma in diving: similarities with mallory-weiss syndrome.mallory-weiss syndrome (MWS) is a well-defined entity in clinical medicine. However, the development of such a syndrome as a result of overpressure barotrauma of the stomach after repeated shallow-water scuba dives is rare. Also rare is the delayed onset of the MWS, approximately 20 hours after the dives. The causes of development of MWS in connection with scuba diving are discussed. The main causes seem to be the repeated changes of gas volume in the stomach with subsequent pressure forces toward the cardia in the course of repeated dives. The possibility of serious diving accident due to overpressure barotrauma of gastro-intestinal system is also pointed out.- - - - - - - - - - ranking = 0.5keywords = water (Clic here for more details about this article) |
4/10. Sensorineural hearing loss as the result of cliff jumping.A case of unilateral, sudden sensorineural hearing loss and possible perilymphatic fistula as the result of cliff jumping into water is presented. The physiological mechanisms contributing to such a barotraumatic auditory injury are described. A conservative treatment protocol is reviewed as well as documented hearing recovery.- - - - - - - - - - ranking = 0.5keywords = water (Clic here for more details about this article) |
5/10. Pneumoparotitis associated with the use of an air-powder prophylaxis unit.A case reporting barotrauma to the parotid gland secondarily to the use of an air-powder prophylaxis unit is presented. air pressure associated with these units usually exceeds that for air/driven turbines or air/water dental syringes, yet the reported incidence of iatrogenic trauma is very low. Improper angulation in the use of these instruments may result in serious sequellae. Differential diagnosis and physical examination following trauma to the parotid is discussed.- - - - - - - - - - ranking = 0.5keywords = water (Clic here for more details about this article) |
6/10. facial nerve palsy associated with underwater barotrauma.This report describes a case of facial nerve palsy following barotitis media sustained at shallow depth. The neuropraxia is likely to have been due to the direct effect of pressure, facilitated by a congenital hiatus in the bony canal protecting the facial nerve in the middle ear.- - - - - - - - - - ranking = 2keywords = water (Clic here for more details about this article) |
7/10. Pulmonary barotrauma and arterial gas embolism caused by an emphysematous bulla in a SCUBA diver.A 23-year-old female self-contained underwater breathing apparatus (SCUBA) diver developed central nervous symptoms and signs of arterial gas embolism when surfacing after 15 min at a depth of 18 m. The dive had been performed according to normal procedure. In the hospital, chest X-ray and computer tomography of the chest showed a large emphysematous bulla in the left hemithorax. Recompression treatment was not performed. Reexamination of old x-rays showed an emphysematous bulla on the left side which had been present before the dive. She made a complete recovery. Emphysematous bullae may be a more common cause of pulmonary barotrauma than is realised. Bullae visible on computer tomograms or magnetic resonance imaging may not be visible on conventional x-rays. The case reported illustrates the need for a consensus on the procedures necessary for the medical screening of diving candidates.- - - - - - - - - - ranking = 0.5keywords = water (Clic here for more details about this article) |
8/10. High-pressure water injury: case report.High-pressure water jets are commonly used for complex industrial cleaning jobs, yet we found few reports of injuries attributed to these potentially dangerous devices. We present a case of severe laceration to the lower extremity caused by a high-pressure water jet with concomitant major vascular injury, apparently the first reported. Principles of evaluation and treatment are reviewed and documented.- - - - - - - - - - ranking = 3keywords = water (Clic here for more details about this article) |
9/10. stomach rupture as a result of gastrointestinal barotrauma in a SCUBA diver.A single case of operatively proven spontaneous rupture of a normal stomach secondary to diving barotrauma is reported. The rupture was linear and located along the lesser curvature, as described most commonly in adults. Possible mechanisms to explain the closed loop obstruction required to produce this phenomenon are the swallowing of water and filling of the stomach with air, while trapped under water, at a depth of 27 meters. To the best of the authors' knowledge this case represents the first report of gastric rupture secondary to SCUBA (self-contained underwater breathing apparatus) diving. The presence of a normal abdominal examination by an experienced observed while compressed in the chamber does not preclude the diagnosis of a perforated viscus.- - - - - - - - - - ranking = 1.5keywords = water (Clic here for more details about this article) |
10/10. The pathophysiologic role of fat in dysbaric osteonecrosis.Dysbaric osteonecrosis (DON) can occur in humans and sheep after a single hyperbaric air exposure with inadequate decompression. The authors hypothesize that DON does not result from primary embolic or compressive effects of nitrogen bubbles on the osseous vasculature, but by secondary injury to the marrow adipose tissue by rapidly expanding nitrogen gas that triggers local, and possibly systemic, intravascular coagulation. A 28-year-old scallop diver remained at a depth of 92 feet in sea water for 4.5 hours on surface-supplied compressed air. decompression sickness occurred after a no-stop ascent to the surface, and he died 70 minutes later. autopsy showed multiple gas bubbles, not only within the great vessels, but in the fatty marrow of his femoral and humeral heads. Lipid and platelet aggregates were found on the surface of marrow bubbles. fibrin-platelet thrombi were detected within dilated venous sinusoids adjacent to bubbles, and in veins, capillaries, and arterioles. Since pulmonary, renal, and intraosseous (subchondral) fat embolism and fibrin thromboses were observed, it is suggested that injured marrow adipocytes can release liquid fat, thromboplastin, and other vasoactive substances, which conceivably can also play a systemic procoagulant role in triggering disseminated intravascular coagulation and additional DON.- - - - - - - - - - ranking = 0.5keywords = water (Clic here for more details about this article) |
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