Diving and hyperbaric medicine最新文献

Scuba diving requires situational awareness, cognitive flexibility, and the ability to adapt to changing conditions. For individuals with autism spectrum disorder (ASD), these demands may pose unique challenges due to differences in executive functioning, sensory processing, and social cognition. This article explores the key considerations in assessing fitness to dive in individuals with ASD, including the impact of comorbidities, medication use, and cognitive abilities on diving safety. To provide a broader perspective, we examine research on ASD and high-risk activities such as driving, where similar cognitive and decision-making challenges exist. Additionally, we discuss the role of neuropsychological assessments in evaluating a diver's cognitive fitness and the limited but emerging evidence on scuba diving interventions for individuals with ASD. While ASD is not an absolute contraindication to diving, a careful, individualised assessment is essential to determine suitability. This review aims to provide guidance for diving professionals and medical examiners in making informed decisions regarding ASD and scuba diving.

We report a case of a patient developing extensive periorbital, facial, and neck emphysema during hyperbaric oxygen treatment for his facial osteoradionecrosis after sequestrectomy. Hyperbaric physicians should be alert for the potential development of this complication during the treatment and have a contingency plan.

Freedivers can suffer respiratory symptoms indicative of freediving induced pulmonary syndrome (FIPS). Aetiology includes immersion pulmonary oedema and barotrauma of descent in the tracheobronchial or pulmonary parenchyma, also colloquially called 'squeeze'. The pathophysiology and natural history are still largely unknown. This case report describes a freediver who developed haemoptysis following a 49 m personal best constant weight bi-fin dive, presenting with two episodes of haemoptysis within 24 hours post-dive. This style of diving entails finning down to the desired depth, turning with a single pull on the rope, and then finning up to the surface without use of the arms. The diver exhibited no other symptoms and remained haemodynamically stable. Computed tomography (CT) imaging performed two days post-dive showed ground-glass opacities in the right upper and middle lobes. Treatment involved hospitalisation, high-dose corticosteroids, and antibiotics. Follow-up CT scans post-dive revealed almost complete resolution (six days) followed by complete resolution of pulmonary abnormalities (21 days). This case is unique for its documentation of changes in lung findings over three sequential CT scans, providing a timeline of anatomical recovery. Serial CT scanning would not be routinely recommended from a radiation safety perspective but yielded interesting data into the time course of this trauma. The findings raise questions about the underdiagnosis of squeeze injuries, as this diver displayed minimal symptoms despite radiographic evidence of ground-glass opacities. This case highlights the need for standardised imaging and management protocols, as well as further research into the natural history and clinical significance of FIPS.

The authors present the first documented case of the apparent effective use of hyperbaric oxygen therapy (HBOT) for the treatment of radiation-induced dropped head syndrome (DHS). DHS is a condition associated with progressive and often severe weakness of cervical paraspinal muscles, especially the neck extensors. This results in loss of horizontal gaze and in advanced cases causes a chin-on-chest deformity. Radiation-induced DHS is a rare, primarily late-term complication first described in patients treated with mantle field radiotherapy for Hodgkin lymphoma, though there is an increasing body of literature demonstrating a wide range of presentations. A 59-year-old man with a history of stage 2A Hodgkin lymphoma 34 years prior had been treated with extended field radiotherapy, including mantle radiotherapy, totalling 40 Gy in 19 fractions. He presented with three years of progressive neck extension weakness with associated stiffness and intermittent dysphagia. The patient underwent 60 sessions of HBOT, in conjunction with physiotherapy and thiamine replacement and demonstrated improvement of his postural maintenance and dysphagia. His improved function was maintained at three years follow-up. We discuss the literature on the management of this rare condition, including the rationale for using HBOT which is well documented for the treatment of other late-term radiotherapy side effects. This case adds to the increasing literature on the management of DHS and describes a novel approach to the management of this often-debilitating condition.

Introduction: The mechanism of injury and recovery of divers with inner ear decompression sickness (IEDCS) is not well understood and there is no consensus regarding management following recompression treatment. Given the rare occurrence, divers are not routinely offered the standard therapies that patients with other acute vestibular disorders may be offered such as vestibular rehabilitation.

Methods: This is an observational case series of 13 divers presenting acutely with IEDCS to DDRC Healthcare in Plymouth, UK between July 2021 and January 2024. Vestibular and balance tests were undertaken to aid the treating dive physician in the diagnosis and management of the divers with both hyperbaric oxygen therapy and customised vestibular rehabilitation.

Results: Average values for vertical perception, posturography, dynamic gait index and patient-reported outcomes measures improved by discharge and at the three month follow up despite 67% showing an ongoing positive head impulse test or nystagmus in the dark on videonystagmography at follow up.

Conclusions: Divers should be warned that despite symptom resolution or minimal residual symptoms post-IEDCS there is a high rate of deficit evident on vestibular testing, and this, alongside investigation for a right to left cardiac shunt, should be a major consideration when considering returning to diving. For the clinician, a stopwatch timed Sharpened Romberg's test appears to be a reasonable method for monitoring progress of balance stabilisation during the treatment period. Early initiation of vestibular rehabilitation exercises should be considered for all divers with IEDCS.

Technical and scientific divers breathing gases delivering hyperbaric pressures of inspired oxygen may be at risk of developing cerebral oxygen toxicity which can manifest as a seizure with little or no warning. The principle preventative strategy is adherence to time limits based on inspired PO₂ levels promulgated in 1991. These limits had their origins in US Navy studies of exposures to higher inspired PO₂s than are typically utilised by modern divers. Indeed, the duration limits for inspired PO₂s in the range typically utilised by technical divers (≤ 1.3-1.4 atm) have relatively little experimental provenance. Contemporary technical dives often involve decompression durations that result in breaches of these limits, and anecdotally, this common occurrence seems associated with a low risk of cerebral oxygen toxicity. A committee of experts recently sought experimental evidence that might support an adjustment to the recommended duration limits for typical technical dives. Such evidence exists only for an inspired PO₂ of 1.3 atm, which is a common default in use of constant PO₂ rebreather devices. The (1991) limit for a single exposure to an inspire PO₂ of 1.3 atm is 180 min with a 24-hour maximum of 210 min. Recent studies provide reassurance that dives with an inspired PO₂ of 1.3 atm consisting of up to 240 min of working dive activity followed by up to 240 min of resting decompression are associated with an acceptably low risk of cerebral oxygen toxicity. This recommendation was promulgated and endorsed at a recent workshop convened by the National Oceanographic and Atmospheric Administration (NOAA) involving technical and scientific divers.

Hyperbaric oxygen therapy (HBOT) administers oxygen under high pressure, mainly for decompression illness, carbon monoxide intoxication, wound healing, infections, and acute peripheral arterial ischaemia. There has been limited use in newborn infants. This case series aims to highlight the potential role of HBOT in management of rare and challenging conditions encountered in the neonatal period. Although HBOT is widely available, its application in newborns remains limited and not well established. We present three neonatal cases: acute peripheral ischaemia; vascular compromise due to thrombosis and compartment syndrome; and a non-healing surgical wound following omphalocele repair. We aim to emphasise the potential clinical benefit and discuss the safety profile of HBOT in select life or limb threatening neonatal pathologies. These cases demonstrate that HBOT, when use as an adjunctive therapy, may contribute to tissue salvage and overall improved outcomes in critically ill neonates. Our intention is to raise awareness and contribute to the limited literature regarding neonatal HBOT, particularly in contexts where usual treatment options are insufficient.

Psychotic disorders, characterised by impaired reality testing and a spectrum of symptoms, present significant challenges in assessing fitness for diving. While diving can be a safe and rewarding activity, the unique physiological and environmental stresses of hyperbaric conditions can exacerbate psychotic vulnerability or mimic psychotic symptoms. This article reviews the literature on psychosis and diving, exploring the implications of psychotic disorders, psychotropic medications, and hyperbaric effects. It highlights the critical importance of illness insight, the absence of comorbid conditions, and complete remission in determining diving fitness. Key recommendations include avoiding deep dives, careful evaluation of medication use, and a nuanced differentiation between chronic and transient psychoses. By synthesizing existing evidence, this article aims to guide diving medicine professionals in making informed decisions about psychosis and diving suitability.

Vibrio alginolyticus is a facultatively anaerobic, Gram-negative bacillus that is a common component of marine flora. Infections caused by Vibrio alginolyticus are rare and typically occur following exposure to seawater or marine animals. This report details the clinical presentation and follow-up of a 65-year-old immunocompetent male who developed a wound infection due to Vibrio alginolyticus. Advanced diagnostic tools, such as MALDI-TOF mass spectrometry, can enhance the identification of these bacteria. Sport clinicians need to recognise Vibrio infections in seawater-contaminated wounds, as infections may be serious and the therapeutic approach may differ from conventional treatments.