Cases reported "Decompression Sickness"

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1/11. The monoplace hyperbaric chamber and management of decompression illness.

    Three cases of decompression illness are reported. Two patients presented with joint pain and skin signs, while one patient presented with joint pain and neurological signs and symptoms. The patients received emergency recompression therapy in a hong kong clinic, using a monoplace hyperbaric chamber. All three patients were treated successfully and no residual signs or symptoms were evident on review at 90 days' post-treatment. Issues concerning the use of monoplace and multiplace hyperbaric chambers are also discussed, along with additional clinical applications of the monoplace hyperbaric chamber.
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2/11. High-altitude decompression illness: case report and discussion.

    Decompression illness (DCI) can occur in a variety of contexts, including scuba diving and flight in nonpressurized aircraft. It is characterized by joint pain, neurologic injury, and respiratory or constitutional symptoms. To prepare flight crews for accidental decompression events, the Canadian Armed Forces regularly conducts controlled and supervised depressurization exercises in specialized chambers. We present the cases of 3 Canadian Armed Forces personnel who successfully completed such decompression exercises but experienced DCI after they took a 3-hour commercial flight 6 hours after the completion of training. All 3 patients were treated in a hyperbaric oxygen chamber. The pathophysiology, diagnosis and management of DCI and the travel implications for military personnel who have undergone such training exercises are discussed. Although DCI is relatively uncommon, physicians may see it and should be aware of its presentation and treatment.
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3/11. retinal artery occlusion in a diver.

    The clinical manifestation of decompression disorders is highly variable, ranging from mild rashes or joint pains to central nervous system symptoms like scotomata, paralysis and death. The diagnosis is easily overlooked, especially if an occupational history is not obtained. Recompression treatment with hyperbaric oxygen is the specific treatment for decompression sickness and air embolism. Prompt recognition and treatment are vital to recovery. However, there is a place for treatment of decompression disorders and embolism even when significant delay of up to 14 days has occurred. This case report discusses decompression disorders in relation to an unskilled fisherman diver who present with retinal artery occlusion. Decompression disorder leading to retinal artery occlusion is a very rare presentation. The difficulty of diagnosis is discussed as well as the result of delayed hyperbaric treatment.
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4/11. decompression sickness presenting as a viral syndrome.

    decompression sickness (DCS) is a well-known hazard of exposure to significant variations in ambient pressure. The diagnosis and management of DCS is frequently a source of confusion. Although the majority of cases are manifested by joint or limb pains (Type I DCS), patients may present with a wide array of symptoms, such as neurologic deficits, headache, fatigue, nausea, and respiratory difficulty. A thorough knowledge of the differential diagnosis and a strong index of suspicion are crucial to the proper management of DCS. Presented herein are two cases of altitude-related DCS which were confused initially with a viral syndrome. A discussion of the symptoms of DCS is included.
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5/11. Combined arterial gas embolism and decompression sickness following no-stop dives.

    decompression sickness (DCS) has been clinically classified as Type I (predominantly joint pain) or Type II (predominantly spinal cord lesions). We present 3 cases that are all characterized by severe (Type II) DCS with signs and symptoms of spinal cord injury occurring in conjunction with arterial gas embolism (AGE). We consider the AGE "minor" because only 2 of the 3 subjects initially lost consciousness, and in all cases the signs and symptoms of the AGE had essentially resolved within 1 h or by the time recompression therapy began. DCS was resistant to recompression therapy, even though treatment began promptly after the accident in 2 of the 3 cases. None of the cases had a good neurologic outcome and there has been one death. None of the divers exceeded the U.S. Navy "no-stop" limits for the depths at which they were diving. We have observed a previously unreported clinical syndrome characterized by severe Type II DCS subsequent to AGE following pressure-time exposures that would normally not be expected to produce DCS. We postulate that AGE may have precipitated or predisposed to this form of DCS.
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6/11. A case of decompression sickness at 2,437 meters (8,000 feet).

    Among aviators, decompression sickness is a condition that occurs almost exclusively at altitudes above 6,098 m (20,000 ft). Several reports have been published describing the development of decompression sickness after altitude exposures of 3,049 to 4,878 m (10,000-16,000 ft). In most of these cases, the affected individual had a previous history of pain in the involved area due to prior trauma or surgery, or had other risk factors for decompression sickness, such as obesity. Few of these reports have confirmed the presence of decompression sickness by a test of pressure. A case is reported here of multiple joint pains developing after a rapid decompression at 2,439 m (8,000 ft), which improved during descent and rapidly resolved with recompression therapy. There was no prior history of joint pain, trauma, or diving. A brief discussion of decompression sickness is included.
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7/11. decompression sickness affecting the temporomandibular joint.

    Two cases of pain-only decompression sickness of the temporomandibular joint following altitude chamber exposure are presented. A detailed interview of both individuals revealed no other joint involvement or other complaints. A careful neurologic examination failed to disclose abnormalities. In both cases, the pain resolved completely with compression therapy, supporting the diagnosis of decompression sickness. decompression sickness limited to this small joint is extremely rare, and may be easily confused with other causes of joint pain.
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8/11. Type II altitude decompression sickness (DCS): U.S. Air Force experience with 133 cases.

    Type II altitude-related decompression sickness (DCS), due to its wide spectrum of symptoms, is often difficult to diagnose. This difficulty sometimes leads unnecessarily to the permanent grounding of an experienced aviator. So that this condition could be better understood, a total of 133 cases of Type II altitude DCS (on file at the united states Air Force Hyperbaric Medicine Division, School of aerospace medicine, Brooks AFB, TX) were reviewed. Most cases (94.7%) followed altitude chamber training. The most common manifestation was joint pain (43.6%), associated with headache (42.1%), visual disturbances (30.1%), and limb paresthesia (27.8%). The next most common symptoms were, in order of decreasing frequency: mental confusion (24.8%), limb numbness (16.5%), and extreme fatigue (10.5%). spinal cord involvement, chokes, and unconsciousness were rare (6.9%, 6%, and 1.5%, respectively). Hyperbaric oxygen treatment produced fully successful results in 97.7% of the cases. Only 2.3% of the cases resulted in residual deficit; no deaths occurred. A thorough knowledge of the differential diagnosis and predisposing factors is essential to narrow the margins of error in the diagnosis and prevention of decompression sickness in the operational or training environment. A recommendation for favorable consideration of waiver action for those aviators who suffered Type II DCS is presented. These recommendations are based on a unique classification of the severity of symptoms.
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9/11. Intramuscular diclofenac sodium as adjuvant therapy for type I decompression sickness: a case report.

    The residual pain of type I decompression sickness (limb bends) occurring despite recompression therapy is due to an acute inflammatory reaction in the soft tissue around the joint. This case history reports an excellent response in resolving residual pain by the use of an intramuscular injection of the nonsteroidal anti-inflammatory drug, diclofenac sodium. The theoretical reasons for this are discussed.
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10/11. Compression pain in a diver with intraosseous pneumatocysts.

    A 30-yr-old diver experienced pain in the area of the sacroiliac joint during the descent phase of air diving to less than 10 ATA. Computed tomography of the pelvis demonstrated two gas-filled cysts within the ilium. The mechanism by which this lesion causes pain is discussed and reports of gas within bone are reviewed.
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