Diving Hyperb Med
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Case Reports
Decompression sickness after a highly conservative dive in a diver with known persistent foramen ovale: Case report.
A diver returned to diving, 15 months after an episode of neuro-spinal decompression sickness (DCS) with relapse, after which she had been found to have a moderate to large provoked shunt across a persistent (patent) foramen ovale (PFO), which was not closed. She performed a single highly conservative dive in line with the recommendations contained in the 2015 position statement on PFO and diving published jointly by the South Pacific Underwater Medicine Society and the United Kingdom Sports Diving Medical Committee. ⋯ Her symptoms and signs were milder but closely mirrored her previous episode of DCS and she required multiple hyperbaric oxygen treatments over several days, with residua on discharge. Although guidance in the joint statement was mostly followed, the outcome from this case indicates that there may be a subgroup of divers with an unclosed PFO, who have had a previous episode of serious DCS, who may not be safe to dive, even within conservative limits.
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Late radiation tissue injury (LRTI) after breast cancer may benefit from hyperbaric oxygen treatment (HBOT). This study aimed to report the LRTI symptom scores up to 12 months after HBOT and identify risk factors for poor scores. ⋯ In this case-series, patients who underwent HBOT for LRTI after breast cancer reported significant improvement in pain, fibrosis, oedema, and shoulder movement. The improvement persisted up to 12 months after HBOT. A poor score at the start of HBOT was predictive for a poor score 12 months after HBOT.
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Scrubbers in closed-circuit rebreather systems remove carbon dioxide (CO2) from the exhaled gas. In an attempt to be more user-friendly and efficient, the ExtendAir® non-granular, pre-formed scrubber cartridge has been developed. The cartridge manufacturer claims twice the absorptive capacity of granular CO2 absorbent, with less variability, lower work of breathing, and reduced exposure to caustic chemicals after a flood. To our knowledge there are no published data that support these claims. ⋯ Cartridge and granular scrubbers were very similar in duration, variability, ventilation pressures, and causticity after a flood. Our findings were not consistent with claims of substantial superiority for the ExtendAir® cartridge.
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Mesenteric ischaemia results from a lack of adequate blood flow to and oxygenation of the mesentery and intestines. The aim of the present study was to evaluate the effect of hyperbaric oxygen treatment (HBOT) on the healing process in intestinal mucosa of rats undergoing mesenteric ischaemia and reperfusion. ⋯ A beneficial effect of HBOT was observed on oxidative stress and inflammation in acute mesenteric ischaemia-reperfusion.
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Editorial Comment
Risk mitigation in divers with persistent (patent) foramen ovale.
In this issue, Anderson and colleagues report follow-up of divers who were found to have a persistent (patent) foramen ovale (PFO) or, in eleven cases, an atrial septal defect (ASD). In most divers diagnosis followed an episode of decompression illness (DCI). The efficacy of closure of the PFO/ASD in preventing future DCI was compared with conservative diving. They reported that in the closure group the occurrence of confirmed DCI decreased significantly compared with pre-closure, but in the conservative group this reduction was not significant.