SCUBA Diving Fatality by Overweighted Belt: An Autopsy Case / 대한법의학회지

Scuba diving is a popular sports activity, even though it is associated with potential hazards. When a diver enters the water for an underwater expedition, he/she needs a series of diving gear, including a regulator, buoyancy compensator, diving suit, and weight belt, among others. Here, the author encountered a fatal diving accident wherein autopsy showed the evidence of death by drowning. The witness stated that the diver requested more weight to descend into the water, and the diver wore one more weight belt, totalling 26 kg. After a second trial of diving, he did not grab the regulator and disappeared into the water suddenly, and bubbles did not appear at the surface. Based on the witness statement and autopsy findings, the original cause of accident was concluded as an overweighted belt for descent into the water.

06-3Rehabilitation to residual functional disorders in spinal decompression sickness resulting from recreational scuba diving / 日本温泉気候物理医学会雑誌

  Spinal decompression sickness including spinal cord damage is indeed a rare sickness, and in particular, there have been few reports on residual functional disorder. This case was a 39-year-old male who had been a recreational scuba diver for 13 years. While scuba diving overseas, he had suffered from decompression sickness with spinal cord involvement. As a result, imcomplete paraplegia with spasticity, sensory disturbance, neurogenic bladder and bowel disturbance occurred. Inclusive rehabilitation containing physical therapy, was provided to control the spasticity, the pain, and the improvement of the activities of daily living was thereby achieved. However, the changes of the muscle hardness, paresthesia, and hyperalgesia, and the disturbance of position and vibration sense remained. The cause of spinal decompression sickness is not clear, but a venous embolism in the spinal veins has been reported. Further observation is considered necessary.

Technical Approach for the Postmortem Examination of SCUBA Diving Fatality / 대한법의학회지

Recreational diving is an exciting and adventurous sport, but is also potentially hazardous. Despite its inherent hazards, an increasing number of people enjoy SCUBA (self-contained underwater breathing apparatus) diving; the number of diving-related accidents is therefore also likely to increase. Divers might face physical or psychological stresses from the unfamiliar or hostile underwater environment, which can lead to fatal accidents. To investigate deaths related to SCUBA diving, a forensic pathologist should understand the types and mechanisms of injuries and illnesses unique to SCUBA diving. Postmortem examination of diving fatalities is therefore a formidable task for most forensic pathologists because cases are sparse and the process requires an understanding of diving physiology, diving equipment, and the underwater environment. The primary aim of autopsies in SCUBA diving fatalities is to detect evidence of pulmonary barotrauma, intravascular gas, or pre-existing illnesses. Standard autopsy protocol for SCUBA diving-related deaths should include methods to detect intravascular gas and gas accumulation in the tissue or body cavity through plain radiographs or Computerized Tomography (CT) scans. Analysis of the gas components is also helpful for determining the origin of the gas. Here, the author proposes a practical method for performing an autopsy on a person who died while SCUBA diving.

06-3 Rehabilitation to residual functional disorders in spinal decompression sickness resulting from recreational scuba diving / 日本温泉気候物理医学会雑誌

  Spinal decompression sickness including spinal cord damage is indeed a rare sickness, and in particular, there have been few reports on residual functional disorder. This case was a 39-year-old male who had been a recreational scuba diver for 13 years. While scuba diving overseas, he had suffered from decompression sickness with spinal cord involvement. As a result, imcomplete paraplegia with spasticity, sensory disturbance, neurogenic bladder and bowel disturbance occurred. Inclusive rehabilitation containing physical therapy, was provided to control the spasticity, the pain, and the improvement of the activities of daily living was thereby achieved. However, the changes of the muscle hardness, paresthesia, and hyperalgesia, and the disturbance of position and vibration sense remained. The cause of spinal decompression sickness is not clear, but a venous embolism in the spinal veins has been reported. Further observation is considered necessary.

The Changes of Intraocular Pressure, Optic Nerve and Visual Field in SCUBA Diving

PURPOSE: To examine how SCUBA diving activities in high-pressure underwater environment affect their intraocular pressure (IOP), visual field (VF), retinal nerve fiber layer (RNFL), and the shape of optic disc. METHODS: We performed visual acuity and refractory test, IOP test, VF test, RNFL photography, optical coherent tomography, and 3D optic disc photography for a group of 32 people and a control group of 32 non-divers, and analyzed the differences between the two groups. For the diver group, we conducted a questionnaire survey on the patterns of diving and diving experience, and analyzed their correlation with results of test. RESULTS: Compared to the Control, the diver group showed significant difference in the mean IOP (diver group: 15.71 +/- 2.54 mmHg, control group: 14.23 +/-2.15 mmHg, p = 0.019), and abnormal visual field (diver group: 7 eyes (11.3%), control group: 0 eye (0%), p = 0.006). 85.7% of abnormal visual field belonged to early defect. The diver group did not showed significant difference in the shape of optic disc (p = 0.546), but the optic nerve atrophy in shape of optic disc test field (diver group: 8 eyes (12.9%), control group: 2 eyes (3.1%), p = 0.042) was significantly different. CONCLUSIONS: Divers who did SCUBA diving activities need to have a glaucoma test regularly. Additional research and large cross or longitudinal study are needed to evaluate causes that scuba diving activities affect.

Checklist for Forensic Investigation on Fatal SCUBA Diving Accidents / 대한법의학회지

SCUBA diving is becoming one of popular sport around the world even though it has serious accident potentials. The most common cause of death in underwater diving fatality is drowning, but in many cases it could be just a terminal event. The eventual target of forensic investigation in underwater diving accidents is to examine the underlying cause of death or accident, and therefore forensic pathologists should get an information about diving equipments which were used by the victim and about environmental factors. The author think a uniformed check list of underwater diving accidents should be available for postmortem investigation, and here propose it.

Barotrauma of the Middle Ear in Guinea Pigs after Simulated Diving / 대한이비인후과학회지

To confirm the possibility of middle ear barotrauma in Guinea Pigs even to safe, recomm-endable diving profiles to sports SCUBA divers and to study operating microscopic findings and progress of middle ear barotrauma, 16 Guinea Pigs were exposed to hyperbaric chamber for simulated diving. Simulated diving profiles were 20 meter sea water of maximum depth, 18 meter per minute of ascent, descent rates, 20 minutes of bottom time, 60 minutes of surface interval time and 2 repetitive dives in a day for 2 consecutive days. Then, tympanic membrane, middle ear and round membrane window were examined by operating microscope on 1 day, 7 days after simulated diving respectively. The experimental results showed that 26 of 32 ears(81.2%) disclosed findings of barotrauma in total, 23 ears(71.9%) in tympanic membrane, 25(78.1%) in middle ear, 7 ears(21.9%) in round window membrane respectively. The main operating microscopic findings of barotrauma were hyperemia of tympanic membrane in 23 ears(71.9%), hyperemia in 25 ears(78.1%), bleeding in 22 ears(68.8%) of middle ear, followed by bleeding, perforation of tympanic membrane, edema, effusion in middle ear, bleeding and rupture of round window membrane in order. Hyperemia of tympanic membrane and bleeding of middle ear in day 7 group showed significantly lower rate of barotrauma than those of day 1 group, that suggest spontaneous improvement in mild case of experimental middle ear barotrauma.